Oto newsletter winter 2015

THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER

OTOLARYNGOLOGY REPORTWINTER 2015

Message from the Chair

THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER OSU DEPARTMENT OF OTOLARYNGOLOGY I WINTER 2015

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Greetings to our friends and colleagues from the beautiful campus of The Ohio State University Wexner Medical Center:

It is with bittersweet emotion that we begin a new era in the Department of Otolaryngology – Head and Neck Surgery here. We thank Dr. Welling for his 25 years of service and his nine years of exceptional leadership as chair. We also wish him well in his new position as professor and chair of the Harvard Otolaryngology Program. He left our department in excellent shape and we will miss him dearly, both personally and professionally.

Moving forward, I am committed to help propel our team to the next level of success. As you will read in the subsequent pages, we have had quite a year of accomplishments. The celebration of our department’s 100th anniversary set the stage; we are also welcoming in some exciting new recruits, and thus we are moving full steam ahead in pursuit of our mission.

Collectively, our department has set a goal of being recognized as a Top 5 Department of Otolaryngology within five years by excelling in five areas (Clinical Care, Fiscal Stability, Academic Productivity, Quality and Community). We have already achieved this distinction in clinical care as our department was ranked #1 for patient volume in the latest U.S.News & World Report (as determined by hospital discharges). These five areas are the pillars under which we organize our department activity. We look forward to new and exciting times in Columbus at THE Ohio State University.

Sincerely,

Theodoros Teknos, MD Professor and Chair, Department of Otolaryngology – Head and Neck Surgery The David E. Schuller, MD, and Carole Schuller Chair in Otolaryngology Medical Director of Development, The James Campaign The Ohio State University Wexner Medical Center The James Cancer Hospital and Solove Research Institute

OHIO STATE OPENS NATION’S THIRD LARGEST CANCER HOSPITALDepartment of Otolaryngology oncologists transition to new facility

With the opening of the new Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at Ohio State, oncologists in the Department of Otolaryngology – Head and Neck Surgery are transitioning to their new home.

The 21-story facility, which opened in December, is the third largest cancer hospital in the nation, featuring 306 inpatient beds, 14 operating rooms, six interventional radiology suites and seven linear accelerators for radiation therapy. The new 1.1-million-square-foot building replaces the former James Cancer Hospital and Solove Research Institute that opened in 1990.

David Schuller, MD, professor emeritus and former chair of the Department of Otolaryngology – Head and Neck Surgery, was one of the driving forces behind this new facility.

“Research-driven patient care is absolutely essential to making progress against this common, dreaded disease. The new James’s unique architectural design, which integrates translational research labs within the patient care area, creates an environment that will increase the clinician-researcher interactions so important to making progress toward a cancer-free world,” says Dr. Schuller.

The new facility brings cancer clinical care, research and education together in a highly subspecialized care model. Its innovative design aims to provide a unique, state-of-the-art healing environment.

Each inpatient unit of the new James focuses on a specific cancer type, such as the dedicated head and neck cancer unit, to facilitate care. Each inpatient floor also features translational research labs aimed at increasing collaboration between physicians and researchers.

The James houses a cancer emergency department integrated with the hospital’s main emergency department. It includes one of the largest cancer surgical facilities in the United States, and it is one of only two centers in the country to construct its radiation oncology center on the second floor (instead of the basement), providing patients and families sunlight and a view overlooking the park outside.

Oncologists in the Department of Otolaryngology – Head and Neck Surgery who are now seeing patients at the new facility include Amit Agrawal, MD; Ricardo Carrau, MD; Matthew Old, MD; Enver Ozer, MD; James Rocco, MD, PhD; and Theodoros Teknos, MD.

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Neurotologist Aaron Moberly, MD, an assistant professor in the Department of Otolaryngology – Head and Neck Surgery, is searching for answers to help adults with cochlear implants (CIs) attain a more robust understanding of spoken language.

To aid him in this endeavor, the Triological Society (the national clinical society for otolaryngology) has awarded Dr. Moberly a $40,000 grant for two years to study variables that may influence a person’s ability to understand language with a CI. He was one of only six physicians in the country to receive this prestigious annual ENT award for research.

For people with CIs, average word recognition in quiet settings remains at 60 percent, and an enormous individual variability has been unexplainable. Clinicians, therefore, do not have specific targets for intervention with poorly performing patients, nor can they counsel patients on how they might perform with the implant.

Dr. Moberly’s research study, “Personalizing Aural Rehabilitation for Adults with Cochlear Implants,” is enrolling 40 patients with implants and a similar number with normal hearing. Dr. Moberly aims to identify the predictors of speech understanding among four processing domains for adults with CIs.

Domains that govern robust speech understanding include:

• Auditory sensitivity to sounds delivered through implants

• Means by which sensory input is perceptually organized into wholes

• Linguistic skills that may contribute to understanding degraded speech signals

• Cognitive functions such as memory and attention

According to Dr. Moberly, “These implants are amazing devices, but a lot of patients are still limited in how they understand spoken language. The implants stimulate the hearing nerve, but it’s not a rich sound. The brain has to interpret the information it receives.”

“We want to determine which predictors are likely the best targets for clinical intervention,” he continues. “If we can figure out what factors allow some patients to have very good speech understanding while other patients continue to struggle, we can design personalized, tailored rehabilitation programs to maximize outcomes.”

Speech understanding and quality of life will be the outcome measures used in the study.

“Our findings will advance the long-term objective of developing personalized rehabilitation programs that target individual

NEW RESEARCH FOCUSES ON SPOKEN LANGUAGE UNDERSTANDING IN COCHLEAR IMPLANT RECIPIENTSAaron Moberly, MD, is one of six investigators selected nationally for research grants from Triological Society

“Our findings will advance the long-term objective

of developing personalized rehabilitation programs that

target individual patients’ weaknesses, particularly for

patients who would otherwise face unexplained poor outcomes,”

notes Dr. Moberly.

patients’ weaknesses, particularly for patients who would otherwise face unexplained poor outcomes,” notes Dr. Moberly. “Ultimately, we want to train the brain to use the signal that’s coming in more effectively.”

New interventions might include auditory training, computerized tasks, language rehabilitation or changes in the way CI devices are programmed.

Ohio State’s Department of Otolaryngology – Head and Neck Surgery has three surgeons who implant CIs and four audiologists who are quite experienced in programming the devices.

“Ohio State is in a great position to do this work. We have strong Speech and Hearing and Psychology departments, and I collaborate closely with Dr. Susan Nittrouer, an expert in the language development of children with hearing loss,” concludes Dr. Moberly. “I hope to extend some of her methods to adults with implants.”

For more information on the study, contact 614-293-6926.

Predicting cancer patient outcomes and matching the right therapies to the right patients are at the heart of research work by James Rocco, MD, PhD, FACS, newly appointed professor and director of the Division of Head and Neck Oncology in the Department of Otolaryngology – Head and Neck Surgery. Dr. Rocco is also the holder of the Mary E. and John W. Alford Research Chair in Head and Neck Cancer.

“Dr. Rocco’s research in genomic heterogeneity of tumors is setting the standard for predicting the course of head and neck cancers using genomic data. He is a gifted surgeon and scientist who will augment our existing knowledge in genomics in head and neck cancer. We are fortunate to have recruited him,” says Ted Teknos, MD, professor and chair, Department of Otolaryngology – Head and Neck Surgery, and holder of the David E. Schuller, MD, and Carole Schuller Chair in Otolaryngology.

For the bulk of his career, Dr. Rocco has been a researcher and otolaryngology surgeon with Massachusetts Eye and Ear Infirmary and Massachusetts General Hospital. He also served as an associate professor at Harvard Medical School.

Following an MD/PhD program at Mount Sinai School of Medicine in New York City, Dr. Rocco completed a head and neck surgery residency and cancer genetics post-doctoral program at Johns Hopkins Hospital in Baltimore. He received robotic surgical training at the University of Pennsylvania in Philadelphia.

Dr. Rocco brings two National Institutes of Health grants and members of his research team with him to Ohio State. Dr. Rocco’s wife, a former neurobiologist and patent attorney, will join him in Columbus. They have four children, ages 13 to 19.

He explains his desire to blend his clinical specialization in ablative head and neck surgery with research, saying, “I saw mentors at Johns Hopkins who were successful in seeing patients and being active in the lab. Clinicians can make contributions with so many unique insights.”

“I want to build on the resources at Ohio State, its great collaborative faculty and high surgical volume. I’m excited about the opportunity to think about the origins of tumor heterogeneity and whether we can target therapies and improve cancer cure rates,” Dr. Rocco adds.

PHYSICIAN FROM HARVARD LEADS HEAD AND NECK CLINICAL TEAM AND RESEARCH STUDIESJames Rocco, MD, PhD, FACS, brings thriving cancer research program to Ohio State


OHIO STATE OFFERS NEWLY APPROVED SLEEP APNEA TREATMENT Inspire® therapy introduces first neuromodulation technology for sleep apnea

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Procedure Screening and Implantation

About 12 million American males and six million females (particularly those who are postmenopausal) experience sleep apnea.

Those who qualify for Inspire® therapy include people with moderate to severe apnea and a body mass index less than 32. They also must be a candidate for surgery and must undergo a drug-induced sleep endoscopy to determine if their anatomy would benefit from the Inspire® system.

During a surgical procedure—often outpatient—a surgeon implants the three components of the system:

1) Through an incision under the chin, the surgeon connects a stimulation lead to the hypoglossal nerve in the tongue, which signals the tongue to maintain its muscle tone at the back of the throat.

2) A “pacemaker,” or generator, is placed in the right upper chest to provide signals through the lead to the tongue.

3) A sensing lead is inserted between the ribs underneath the armpit to sense respiratory effort and activate the generator signal to create tone in the throat and prevent tissue from collapsing during breathing.

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About a month after surgery, the patient undergoes a postoperative sleep study so a sleep pulmonologist can program the system and provide follow-up adjustments. Every 10 years, the generator requires a new battery that can be installed in the surgeon’s office under local anesthetic.

During use at home, the patient places an external controller over the chest to turn the system on at bedtime and off upon waking.

Dr. Chio is enthusiastic about the device’s possibilities.

“There’s a huge potential here, especially for patients who are unhappy with or don’t tolerate CPAP, and who are not interested in surgical procedures that change the anatomy. We can help a lot of people.”

For more information about Inspire® therapy at Ohio State, contact 614-366-5837.

For more on the device, visit inspiresleep.com.

“This is the first neuromodulation technology for sleep apnea.

It’s the first dynamic solution that stimulates nerve activity

and muscle tone to prevent the collapse of soft tissue in the

throat that blocks the airway and causes sleep apnea,”

shares Dr. Chio.

A new treatment for obstructive sleep apnea approved by the Food and Drug Administration in 2014 is now available at The Ohio State University Wexner Medical Center.

Inspire® is an upper airway stimulation device for people with moderate to severe obstructive sleep apnea who cannot be helped with a continuous positive airway pressure (CPAP) breathing mask or oral appliances during sleep.

Ohio State is one of about 30 medical centers—and the only one in central Ohio—selected by Inspire Medical Systems Inc. to implant the system.

“It’s like a pacemaker you turn on when you go to sleep at night. It sends signals to stimulate the hypoglossal nerve in your tongue to keep your airway open,” explains Eugene Chio, MD, director of the Division of Sleep Surgery in the Department of Otolaryngology – Head and Neck Surgery.

“This is the first neuromodulation technology for sleep apnea. It’s the first dynamic solution that stimulates nerve activity and muscle tone to prevent the collapse of soft tissue in the throat that blocks the airway and causes sleep apnea,” he adds.

Clinical Trial Reports Success

The Stimulation Therapy for Apnea Reduction (STAR) multi-center, national trial of Inspire®, published in January 2014, reported a 70-percent reduction in the number of times patients stopped breathing in an hour. Patient questionnaires indicated that quality of life rose and daytime sleepiness decreased.

During a second phase of the trial, participants who were withdrawn from the treatment saw their symptoms worsen.

Dr. Chio believes Inspire® therapy is a promising alternative to surgeries aimed at removing or repositioning tissue in the throat. It also is an alternative option to less invasive treatments for obstructive sleep apnea that are unsuccessful.

“About half of patients don’t tolerate CPAP well,” notes Dr. Chio, “whether it makes them claustrophobic, prevents comfortable sleep because of the mask strapped on their face or causes hassles if they travel frequently.”

He says oral appliances can cause bite problems or aggravate temporomandibular joint (TMJ) and muscle disorders, and they can have large out-of-pocket costs because they often are not covered by insurance.


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Lauren Bakaletz, PhD 09/30/99-11/30/14 NIH/NIDCD R01DC003915 Determinants of H.influenzae Virulence in Otitis Media

Lauren Bakaletz, PhD 09/20/02-08/31/14 NIH/NIDCD R01DC005847 Antimicrobial Peptides & Innate Immunity in Otitis Media

Lauren Bakaletz, PhD 07/20/11-06/30/16 NIH/NIDCD R01DC11818

Novel Immunotherapeutics for the Management of Otitis Media Due to H.influenzae

Pawan Kumar, MS, PhD 07/02/14-06/30/16 NIH/NCI R21CA178649Role of Tumor-Associated Enothelial Cells in Chaperoning Tumor Cells

Jas Lang, PhD 03/26/13-Present NIH/NCI SAICFrederick Cancer Genome Atlas Project (TCGA) BOA 13XS121

Susan Nittrouer, PhD 07/01/94-02/29/16 NIH/NIDCD R01DC000633Ontogeny of Segmental Speech Organization

Susan Nittrouer, PhD 09/01/03-02/28/15 NIH/NIDCD RO1DC00623709Early Development of Children with Hearing Loss

Quintin Pan, PhDCo-PI: Theodoros Teknos, MD 08/01/08-05/31/14 NIH RO1 R01CA135096Role of PKCepsilon in Oral Cancer

PI: Anna Map, PhDCo-Inv: Qunitin Pan, PhD 05/20/09-02/28/14 NIH/NCI R01 CA140667Complement in S. Pneumoniae Otitis Media

Gregory Wiet, MDBrad Welling, MD, PhD 08/05/11-07/31/16 NIH RO1 R01DC011321Virtual Temporal Bone Surgery: Defining and Translating Standardized Metrics

OTHER ACTIVE RESEARCH FUNDINGLauren Bakaletz, PhD 01/01/12-12/31/14 Australian Government National Health and Medical Research CouncilImpact of Phasevarions of Nontypeable Haemophilus Influenzae on Otitis Media Pathobiology and Vaccine Development

Aaron Moberly, MD 08/01/14-07/31/16 Triological Society Career Development AwardPersonalizing Aural Rehabilitation for Adults with Cochlear Implants

Matthew Old, MD 01/13-Present OSUCCC Viral Oncology Program Research AwardEnhancement of Oncolytic Herpes Virus (34.5ENVE) Activity in Head and Neck Squamous Cell Carcinoma with Bortezomib

Enver Ozer, MD 01/01/12-03/12/14 Intuitive Surgical Clinical Robotics Research GrantComparison of Quality of Life Outcomes of TORS with Non-Surgical Treatment Regimens for Oropharynx Cancer

Theodoros Teknos, MDEnver Ozer, MD 2010-2014 National Comprehensive Cancer NetworkUse of Vorinostat for Definitive Treatment of Advanced Stage Oropharyngeal Squamous Cell Carcinoma

NIH FUNDING

Amit Agrawal, MD Head and Neck Oncology A Phase 3, Prospective, Open-Label, Multicenter Study of Lymphoseek® as Lymphoid Tissue-Targeting Agent in Patients With Known Cutaneous or Mucosal Head and Neck Squamous Cell Carcinoma Who Are Undergoing Lymphadenectomy

Brad deSilva, MD Laryngology Voice Outcomes Following Transcutaneous Steroid Injection for Vocal Fold Nodules Combined with Voice Therapy Compared to Voice Therapy Alone

Laura Matrka, MD Laryngology Treatment of Vocal Cord Granulomas with KTP Laser vs. Traditional PPI Therapy Improving Patient Care Via Proteomics-Based, Microbe-Specific Detection of Chronic Rhinosinusitis

Aaron Moberly, MD Neurotology Evaluation of the Nucleus® Hybrid™ L24 Cochlear Implant System

Matthew Old, MD Head and Neck Oncology A Prospective, Single-Arm Clinical Trial Evaluating Hyperbaric Oxygen Therapy (HBOT) for the Prevention of Post-Operative Complications in Patients Undergoing Salvage or Reconstructive Head and Neck Surgery Following Radiation or Chemoradiation

Enver Ozer, MD Head and Neck Oncology Randomized Phase II Trial of Transoral Endoscopic Head and Neck Surgery Followed by Risk-Based IMRT and Weekly Cisplatin Versus IMRT and Weekly Cisplatin for HPV-Negative Oropharynx Cancer

HIGHLIGHTED CLINICAL TRIALS 2014OSU Department of Otolaryngology – Head and Neck Surgery


Surgeons at The Ohio State University Wexner Medical Center recently became the first in the United States to insert a neurostimulator in a patient to provide relief from cluster headaches.

The outpatient surgery was performed as part of a national, multi-center, clinical trial for an investigational device developed by Autonomic Technologies, Inc.

Inserted through a small incision in the patient’s gum on the side of the face affected by headaches, the device stimulates the nerve bundle behind the nose known to play a role in severe headaches—the sphenopalatine ganglion.

“This nerve control center sits behind the cheek sinus and is involved in the transmission pathway of cluster headaches,” says Bradley Otto, MD, director of Rhinology in the Department of Otolaryngology – Head and Neck Surgery, who performed the groundbreaking surgery with Ohio State oral surgeon Peter Larsen, DDS. “By blocking or short-circuiting that involvement, we think it will help treat cluster headaches.”

Once implanted with the device, a patient can activate the stimulator to block pain signals at the onset of a

headache by holding up a remote control to his or her cheek.

“The beauty of the device is that there are no internal batteries or other structures that need to be routinely removed. Once we make the incision in the mouth and place this device back behind the cheek sinus, it can be left forever,” says Dr. Otto.

Ali Rezai, MD, Ohio State’s director of Neuroscience is one of the scientific developers of this technology.

“Cluster headaches are one of the most severe and disabling chronic pain conditions known to humankind. That’s why it’s important to look at options to help these patients,” Dr. Rezai says.

Often called “suicide headaches,” cluster headaches are estimated to affect 400,000 people in the U.S. The headaches typically happen many times each day, lasting from 15 minutes to three hours each time. There is currently no cure.

Over the next few years, up to 120 patients with cluster headaches will receive the experimental device as part of the clinical trial.

OHIO STATE SURGEONS IMPLANT FIRST NEUROSTIMULATOR TO TREAT CLUSTER HEADACHES

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Durmus K, Patwa HS, Gokozan HN, Kucur C, Teknos TN, Agrawal A, Old MO, Ozer E. (2014). Functional and quality-of-life outcomes of transoral robotic surgery for carcinoma of unknown primary. Laryngoscope. Vol. 124. Issue 9: 2089-95.

Agrawal A, Civantos FJ , Brumund KT, Chepeha DB, Hall NC, Carroll WR, Smith RB, Zitsch RP, Lee WT, Shnayder Y, Cognetti DM, King DW, Christman LA, Lai SY. [99mTc] (2014).Tilmanocept Accurately Detects Sentinel Lymph Nodes and Predicts Pathologic Nodal Status in Patients with Squamous Cell Carcinoma of the Head and Neck: Results of a Phase 3 Multi-Institutional Trial. Submitted to Lancet Oncology.

Calhoun KH. (2014). The role of fractional exhaled nitric oxide in asthma management. Otolaryngol Clin North Am. Vol. 47. Issue 1:87-96.

Kerr EE, Prevedello DM, Jamshidi A, Ditzel Filho LF, Otto BA, Carrau RL. (2014). Immediate complications associated with high-flow cerebrospinal fluid egress during endoscopic endonasal skull base surgery. Neurosurg Focus. Vol. 37. Issue 4:E3.

McClurg SW, Carrau R. (2014). Endoscopic management of posterior epistaxis: a review. Acta Otorhinolaryngol Ital. Vol. 34, Issue 1:1-8.

Marcinow AM, Thompson J, Chiang T, Forrest LA, deSilva BW. (2014). Paradoxical vocal fold motion disorder in the elite athlete: experience at a large division I university. Laryngoscope. Vol. 124. Issue 6:1425-30.

Kim L, Wisely CE, Dodson EE. (2014). Transmastoid approach to spontaneous temporal bone cerebrospinal fluid leaks: hearing improvement and success of repair. Otolaryngol Head Neck Surg. Vol.150. Issue 3:472-8.

Walz PC, Hubbell MP, Elmaraghy CA. (2014). Voice related quality of life in pediatric patients with a history of prematurity. Int J Pediatr Otorhinolaryngol. Vol. 78. Issue 7:1010-4.

Raman VT, Jatana KR, Elmaraghy CA, Tobias JD. (2014). Guidelines to decrease unanticipated hospital admission following adenotonsillectomy in the pediatric population. Int J Pediatr Otorhinolaryngol. Vol. 78. Issue 1:19-22.

Kako H, Krishna SG, Ramesh AS, Merz MN, Elmaraghy C, Grischkan J, Jatana KR, Ruda J, Tobias JD. (2014). The relationship between head and neck position and endotracheal tube intracuff pressure in the pediatric population. Paediatr Anaesth. Vol. 24. Issue 3:316-21.

Kumar B, Yadav A, Hideg K, Kuppusamy P, Teknos TN, Kumar P. (2014). A novel curcumin analog (H-4073) enhances the therapeutic efficacy of cisplatin treatment in head and neck cancer. PLoS ONE. Vol. 9, Issue 3: e93208. doi:10.1371/journal.pone.0093208

Matrka L. (2014). Paradoxic vocal fold movement disorder. Otolaryngol Clin North Am. Vol. 47. Issue 1:135-46.

Nittrouer S, Caldwell-Tarr A, Moberly AC, Lowenstein JH. (2014). Perceptual weighting strategies of children with cochlear implants and normal hearing. J Commun Disord. [Epub ahead of print]

Moberly AC, Tweel B, Welling DB. (2014). Wound breakdown after middle cranial fossa craniotomy: An unusual complication after rhytidectomy. Larygoscope. Vol. 124, Issue 2:270-84.

Moberly AC, Lowenstein JH, Tarr E, Caldwell A, Welling DB, Shahin AJ, Nittrouer S. (2014). Do adults with cochlear implants rely on different acoustic cues for phoneme perception than adults with normal hearing? Journal of Speech, Language, and Hearing Research. Vol. 57, Issue 2:566-82.

Robinett ZN, Walz PC, Miles-Markley B, Moberly AC, Welling DB. (2014). Comparison of Long-term Quality-of-Life Outcomes in Vestibular Schwannoma Patients. Otolaryngology Head

Nittrouer S, Sansom E, Low K, Rice C, Caldwell-Tarr A. (2014). Language structures used by kindergartners with cochlear implants: relationship to phonological awareness, lexical knowledge and hearing loss. Ear Hear. Vol. 35. Issue 5:506-18.

Santaliz-Ruiz L, Xie X, Old M, Teknos TN and Pan Q. (2014) Emerging role of Nanog in tumorigenesis and cancer stem cells. Int. J. Cancer. doi: 10.1002/ijc.28690. [Epub ahead of print] PMID:24375318.

Kucur C, Durmus K, Teknos TN, Ozer E. (2014). How often parapharyngeal space is encountered in TORS oropharynx cancer resection. Eur Arch Otorhinolaryngol. [Epub ahead of print]

Xie X, Teknos TN, Pan Q (2014). Are all cancer stem cells created equal? Stem Cells Transl. Med. Submitted.

Islam, M, Sharma S, Teknos TN. (2014). RhoC Regulates Cancer Stem Cells in Head and Neck Squamous Cell Carcinoma by Overexpressing IL-6 and Phosphorylation of STAT3. PLoS One. [In press].

Scholes MA, McEvoy T, Mousa H, Wiet GJ. (2014). Cricopharyngeal achalasia in children: Botulinum toxin injection as a tool for diagnosis and treatment. Laryngocsope. Vol. 124, Issue 6: 1475-80.

HIGHLIGHTED PUBLICATIONS

Oliver Adunka, MDWill serve a 4-year term beginning July 1, 2015, as the CORE Study Section Chair-elect for the Otology Sub-Committee for AAO-HNSF.

Ricardo Carrau, MDCo-lead one of 4 projects awarded an $11.3 million Special-ized Program of Research Excellence (SPORE) grant by the National Cancer Institute to study and treat thyroid cancer.

Receives Latino of the Year Award from Ohio State’s Hispanic/Latino Network. The HLN will in turn sponsor a scholarship in Dr. Carrau’s name to the College of Medicine MD Camp which is geared toward high school students interested in a career in medicine.

In 2006, was a contributor in the article “A novel recon-structive technique after endoscopic expanded approaches: vascular pedicle nasoseptal flap” published in The Laryngo-scope. As of January 2014, the article had become one of the most highly cited in the journal.

Leslie Kim, MDThe 5th year resident is awarded the AAFPRS Leslie Bern-stein Resident Research Grant.

Pawan Kumar, MS, PhDAwarded an R21 grant by the National Institutes of Health for research focusing on how cancer cells metastasize.

Aaron Moberly, MDReceived a Triological Society Career Development Award and a 2014 Speech Science Research Grant from the Amer-ican Speech-Language-Hearing Foundation for his research in “Personalizing Aural Rehabilitation for Adults with Cochlear Implants.”

Susan Nittrouer, PhDSelected for the 2013 Editor’s Award in the Hearing section of the Journal of Speech, Language, and Hearing Research for article “Speech Perception in Noise in Children with Co-chlear Implants.” This award is given by the Editor and Asso-ciate Editors to those that meet the highest quality standards in research design, presentation and impact for a given year.

OSU Skull Base Team Presented the largest number of papers at The 2014 North American Skull Base Society’s 24th Annual Meeting – over 30 papers and presentations.

OSU Head and Neck TeamPresented the most of any group at the IFHNOS/ANS Meeting in NYC with 3 panels/invited presentations, 17 oral presentations, 10 poster presentations – also won the AHNS Institutional Challenge for the Centurion Club.

Quintin Pan, PhDR01 grant submission, “Role of p300 in HPV-positive Head and Neck Cancer” was scored in the 15th percentile.

Quintin Pan, PhD, and Ted Teknos, MDCollaborative research with OSU radiology in a study to de-velop a hybrid imaging agent that has the ability to “light up” cancer cells during surgery giving surgeons a better success rate of removing all cancerous cells.

David Schuller, MDAwarded the 2013 HCD10 “Owner” category by Healthcare Design Magazine for his role in the creation of the new Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

AWARDS AND RECOGNITION


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NEW HOUSE STAFF: FELLOWS

Otolaryngology PGY-1 Residents

Corey Cheresnick, MD

Hometown: Charlotte, NC

Undergrad: University of Florida, B.S. (Accounting)

Medical School: Jefferson Medical College of Thomas Jefferson University

Hobbies/Interests: Family, golf, crossfit, fantasy baseball, reading, traveling, cooking

Maria Koenigs, MD

Hometown: Springfield, MA Undergrad: Bowdoin College, BA (Biochemistry, Spanish) Medical School: Yale University School of Medicine

Hobbies/Interests: University of Kansas (Jayhawk) basketball, singing, skiing, baking

Scott Kramer, MD

Hometown: Midland, MI Undergrad: Northwestern University, BS (Communication Sciences and Disorders)

Medical School: Ohio State University College of Medicine

Hobbies/Interests: Music - singing, playing guitar and piano / Athletics - soccer, rock climbing, running, basketball, golf / Religious - Christian church membership, small groups

Pediatric Otolaryngology Fellow

Phillip Chaffin, MD

Hometown: Salt Lake City

Undergrad: BS in Biology - University of Utah

Medical School: University of Pittsburgh

Residency: Otolaryngology – Head and Neck Surgery - University of Minnesota

Hobbies/Personal Interests: Camping, hiking, traveling, reading

Head and Neck Surgery Fellow

Stephen Kang, MD

Hometown: West Plains, MO

Undergrad: BA in Music - Eckerd College

Medical School: University of Michigan Medical School

Residency: Otolaryngology – Head and Neck Surgery - University of Michigan Hospitals

Hobbies/Personal Interests: Piano, fishing, college football

Facial Plastic and Reconstructive Surgery Fellow

Chaz Stucken, MD

Hometown: Long Beach, CA

Undergrad: BA in Medical Sciences and Psychology - Boston University

Medical School: Boston University School of Medicine

Residency: Otolaryngology – Head and Neck Surgery – Ichan School of Medicine at Mount Sinai

Fellowship: Head & Neck Oncology and Microvascular Surgery - University of Michigan

Hobbies/Personal Interests: Family, travel, eating, triathlons, surfing

NEW HOUSE STAFF: RESIDENTS

Jigar Sitapara, MD

Hometown: Gaithersburg, MD

Undergrad: University of Pennsylvania, BA (Biological Basis of Behavior, Health Care Management)

Medical School: Ohio State University College of Medicine Hobbies/Interests: Playing guitar, snowboarding

New PGY-2 Resident

Yin Yiu, MD

Hometown: Houston

Undergrad: Duke University - BS Biology

Medical School: Baylor College of Medicine

Hobbies/Interests: Traveling, scuba diving, hiking, yoga, cooking, trying new restaurants, hanging out with dog Abby, supporting Duke basketball

Rhinology Fellow

Christie Barnes, MD

Hometown: Durango, CO

Undergrad: BS in Biology - Creighton University

Masters: Biology - Georgetown University

Medical School: Creighton University School of Medicine

Residency: Otolaryngology – Head and Neck Surgery - Fletcher Allen Healthcare

Hobbies/Personal Interests: Soccer, fishing, boxing, biking, hiking, weight lifting, marksmanship

Skull Base Fellow

Raewyn Campbell, MD

Hometown: Sydney, Australia

Undergrad: BAS in Physiotherapy - University of Sydney

Grad Dip: Exercise and Sports Science - University of Sydney

Medical School: BMed (Hons & faculty medal) - University of Newcastle

Residency: Otorhinolaryngology – Head and Neck Surgery – FRACS Fellowship of the Royal Australasian College of Surgeons

Hobbies/Personal Interests: Running after my 9-month-old son Jonah, long distance running, swimming, rock climbing, French


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Early results of a clinical trial at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) show a dramatic percentage of patients who receive breathing therapy for paradoxical vocal fold movement disorder (PVFMD) are able to decrease their medication use.

PVFMD, an abnormal closure of the vocal cords during breathing, is often confused with asthma. Episodes of throat tightening or shortness of breath can be set off by physical activity, strong odors, anxiety, strong emotion or no trigger at all.

Six months after trial participants received an initial diagnosis of PVFMD at the JamesCare Voice and Swallowing Disorders Clinic, 76 percent of those who received breathing therapy were using

fewer asthma inhalers and had less shortness of breath. Sixty-four percent of them had complete resolution of breathing issues.

“After two or three sessions, many participants could stop using their inhalers completely,” says principal investigator Laura Matrka, MD, laryngologist and assistant professor with the Department of Otolaryngology – Head and Neck Surgery.

“A lot of patients were surprised that they could break the cycle themselves through this breathing technique. They are re-training their vocal cord muscles and physically opening their airways,” Dr. Matrka notes, adding that “It makes me happy to see noninvasive therapy working so well. We’re improving quality of life, and patients are having less exposure to asthma inhalers and steroids.”

She says the breathing exercises are performed both at rest and during physical exertion. Techniques can be as simple as creating muscle memory with exercises such as taking a deep breath through the nose and breathing out with lips pursed. Low abdominal breathing and avoidance of breath-holding also are important.

Although the study already has reached statistical significance, it will continue accepting patients into 2015.

For more information on this and other studies of vocal cord disorders, call the JamesCare Voice and Swallowing Disorders Clinic at 614-293-0363.

Diagnosing PVFMD

Distinguishing between asthma and PVFMD can be a gray area, says Dr. Matrka, because the tests for both disorders can be subjective and because both problems cause shortness of breath.

“You have to look at the vocal cords to make the diagnosis, but the patient’s history is really important, too,” says Dr. Matrka. Signs that point to PVFMD include:

• Rapid onset of shortness of breath

• Unresponsiveness to inhalers

• Tightness in the neck rather than the chest

• Intermittent episodes triggered by physical exertion, strong odors, stress, anxiety, reflux or sinus drainage

“We diagnose PVFMD with a flexible laryngoscope, passed through one nostril into the back of the throat. We look at the vocal cords from above and take a video of their function, which we can play back for the patient. We watch what the vocal cords do during breathing and after several other tasks, such as breath-holding and counting,” explains Dr. Matrka. “The vocal cords close when you hold your breath and

BREATHING THERAPY FOR VOCAL CORD DISORDER CAN REDUCE MEDICATION USEClinical trial proves vocal cord re-training decreases inhaler and steroid use for shortness of breath

“I like working on a sense that’s all about communication. To communicate and talk to other people is very important for our well-being. It’s a very rewarding practice to help people hear and communicate,” says Oliver Adunka, MD, newly appointed director of Neurotology at Ohio State’s Department of Otolaryngology – Head and Neck Surgery.

Dr. Adunka comes to Ohio State following nine years of clinical practice and research at University of North Carolina (UNC) Chapel Hill. He is a native of Vienna, Austria, and completed his medical degree and residency in Vienna and then Germany.

His desire to subspecialize in the neurological aspects of the ear brought Dr. Adunka to Chapel Hill, where he completed fellowship training in otology/neurotology, after which UNC asked him to stay on. Dr. Adunka met his wife, an

audiologist, at UNC, and they have two children ages three and four.

As director of Neurotology, Dr. Adunka plans to “help further develop and grow an already great hearing program. We especially hope to integrate adult and pediatric programs with Nationwide Children’s Hospital,” he notes.

“Dr. Adunka is a gifted surgeon and a highly talented scientist. His particular area of research expertise is in cochlear implants, and he will greatly expand our cochlear implant program and research opportunities. Partnering with Dr. Susan Nittrouer, he will create one of the country’s finest otologic research groups,” says Ted Teknos, MD, professor and chair, Department of Otolaryngology – Head and Neck Surgery and holder of the David E. Schuller, MD, and Carole Schuller Chair in Otolaryngology.

Dr. Teknos continues, “I’m thrilled to have him on our staff. He’s tremendously talented both in skull base surgery and cochlear implants. He has an international reputation and is ready to lead our program to even greater heights. We are pleased to have both him and his family join the department.”

DIRECTOR OF NEUROTOLOGY APPOINTEDOliver Adunka, MD, pursues passion for hearing work from Vienna to Chapel Hill to Columbus

generally open widely when you inhale. If they don’t open widely, it may be a sign of PVFMD.”

Doctors generally make a diagnosis of PVFMD when vocal cords narrow at least 50 percent twice for a given breathing test.

“PVFMD can occur in adults or children. The disorder is more common in females—85 percent of our study participants were female. We see lots of teenagers, mostly

athletes. Elite college athletes can develop the disorder and will sometimes require therapy sessions performed on the field or during a practice,” Dr. Matrka says.

“I worry about kids with undiagnosed PVFMD who are assumed to have poorly controlled asthma. They are sometimes treated for years on escalating doses of asthma medications, with poor response. I encourage all physicians to have the vocal

cords checked in patients not responding to asthma medications or who have symptoms that don’t look like typical asthma,” she concludes.

Once the diagnosis is made and there is good response to therapy, Dr. Matrka advises her patients to talk with their pulmonologists to see if it’s appropriate to discontinue use of their inhalers.

“After two or three sessions, many participants could stop using their inhalers completely,” says principal investigator Laura Matrka, MD

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A first-of-its-kind Columbus hearing conference hosted by Nationwide Children’s Hospital drew nearly 100 physicians and other health professionals from across Ohio this past summer to learn about:

• Early identification of hearing loss in children

• Evaluation and intervention options by pediatric hearing specialists

• Resources and methods to empower children who have hearing loss to achieve their highest potential

Conference director Prashant Malhotra, MD, director of the Hearing Program at Nationwide Children’s Hospital and assistant professor in the Department of Otolaryngology – Head and Neck Surgery at The Ohio State University Wexner Medical Center, coordinated a similar conference in Cleveland in 2012, when a survey showed that pediatricians had a lack of comfort and familiarity in dealing with hearing loss.

The one-day Columbus conference, “What the Pediatric Provider Needs to Know about

Hearing Loss,” sought to address a knowledge gap among professionals who care for people with hearing loss.

Keynote speaker Susan Wiley, MD, from Cincinnati Children’s Hospital Medical Center, talked about the role of a medical home for people with hearing loss and emphasized the need for more diligent follow-up on universal hearing screenings.

Dr. Malhotra explains, “All children are supposed to be screened at birth, certainly by the age of one month. If they fail the screening test, they should be getting diagnostic testing by three months and in treatment by six months.

“We have a huge opportunity for improvement at each stage,” he says, citing factors such as unclear communication to families, poor prioritization by families and lack of awareness in physicians.

Permanent hearing loss occurs in two per 1,000 births; two to four per 1,000 children by age five; and four to nine per 1,000 adolescents.

“The conference gave an overall sense of the child’s experience of hearing loss from birth through childhood, not just how to refer children. We wanted to pull all parts of the puzzle together and round out the knowledge for all who attended,” Dr. Malhotra says.

Attendees included pediatricians, family physicians, audiologists,

speech therapists, social workers, local and state department workers and educators in local hearing-impaired schools.

Hearing Program

The Hearing Program at Nationwide Children’s Hospital in Columbus provides comprehensive care for children with hearing loss. Multidisciplinary hearing clinics offer services including:

• Initial evaluation

• Nonsurgical and surgical management of hearing loss

• Specialized pediatric audiologic services

• Hearing-impaired-specific speech and language services

• Multidisciplinary evaluation for hearing loss surgery, including cochlear implantation

• Family support and engagement programs

• Community education and resources

Nationwide Children’s Hospital and Ohio State’s Wexner Medical Center collaborate in serving the pediatric population with hearing loss.

“We are working toward building a more unified hearing program with our research collaboration and clinical programs,” Dr. Malhotra notes.

Visit the Nationwide Children’s Hearing Program web page for information on hearing resources for physicians and parents at nationwidechildrens.org/hearing.

IMPROVING TREATMENT OF HEARING LOSS IN CHILDRENNationwide Children’s hosts Columbus’s first hearing loss conference for primary care providers

A study that may shed new light on how cancer spreads from a primary tumor to other vital organs is underway at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James).

“Tumor metastasis to vital organs causes more than 90 percent of cancer deaths. For the tumor cells to successfully metastasize to a distal site, they have to survive the harsh conditions in the blood circulation. We are trying to show a novel biological phenomenon for how this survival of tumor cells occurs,” says principal investigator Pawan Kumar, PhD, assistant professor in the Department of Otolaryngology – Head and Neck Surgery and researcher at the OSUCCC – James.

A two-year National Institutes of Health grant is funding the study, titled “Role of Tumor-Associated Endothelial Cells in Chaperoning Tumor Cells.”

The research team’s hypothesis is that tumor cells latch onto endothelial cells that line the blood vessels, break free from the blood vessel wall and move through the bloodstream to lodge in a new organ.

Tumor cells left on their own quickly die in the bloodstream. With an endothelial cell to “chaperone” the tumor cell on its journey, however, the tumor cell has a much greater chance for survival, Dr. Kumar explains.

So far, there is no study that has demonstrated the role of tumor-associated endothelial cells or any other tumor-accessory cell to bind and chaperone tumor cells.

“Although our understanding of the biology of tumor cells has considerably improved in recent years, similar growth in the knowledge of the molecular events that promote tumor cell survival in circulation and metastasis to distal sites has not been achieved,” Dr. Kumar states.

This investigation focuses on factors that contribute to the binding of tumor cells with endothelial cells, and theorizes that endothelial cells provide a mechanism for prolonging tumor cell survival and transportation to other organs.

“If our hypothesis is proved, this study will bring a paradigm shift in our understanding of tumor cell survival in blood circulation. It also may help us identify new therapeutic targets to block tumor spread in cancer patients,” Dr. Kumar says. “To our knowledge, our group is the only one investigating the role of tumor-associated endothelial cells in chaperoning tumor cells to distal sites.”

Dr. Kumar and his research team are predominantly looking at head and neck squamous cell carcinomas, but they anticipate their findings will have far-reaching implications for all solid tumors.

Co-investigators for this research include Arti Yadav, MS, from the

OSUCCC – James, and Ted Teknos, MD, and Bhavna Kumar, MS, from Ohio State’s Department of Otolaryngology – Head and Neck Surgery. An additional research team member is Jeffrey Chalmers, PhD, professor of Chemical and Biomolecular Engineering at Ohio State.

“We are striving hard to perform cutting-edge research that will develop new therapeutic treatments for head and neck cancer patients. This study will contribute to the outstanding research that is going on in our department and, in the long run, we hope it will also contribute to better patient care,” concludes co-investigator Dr. Teknos.

NIH-FUNDED STUDY COULD PROVIDE BREAKTHROUGH ON HOW CANCERS METASTASIZEResearch focuses on role of endothelial cells in transporting tumor cells


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A recent $1 million gift from the Alford family, combined with the family’s previous gifts, is funding the newly created Mary E. and John W. Alford Research Chair in Head and Neck Cancer at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James).

“The chair will be critical in furthering our efforts in head and neck cancer research,” says Ted Teknos, MD, professor and chair, Department of Otolaryngology – Head and Neck Surgery and The David E. Schuller, MD, and Carole Schuller Chair of Otolaryngology.

“This chair generously donated by the Alfords was a main factor in recruiting Dr. James Rocco to Ohio State from Harvard. He was being recruited by multiple institutions,” Dr. Teknos continues. “The fact that we have a wonderful new cancer hospital, and the chair, clinched the deal for him.”

Dr. Rocco is bringing his entire lab with him, and the research chair will provide support for him and his research program.

“Everything we’re doing is a tribute to our parents,” says Ron Alford, who, with his sister Barb and her husband Mike Cantlin, has provided the necessary funds for the Alford Research Chair.

The family’s first major gift to cancer research at Ohio State was made by their father, John Alford, in memory of his wife, Mary, who died of stomach cancer in 1987. When John died of esophageal cancer in 1996, his children donated an additional $500,000 for a cancer research endowment fund in their parents’ names.

The latest contribution comes from personal donations from Ron, Barb and Mike, and the John and Mary Alford Foundation.

“We saw the lab and the research team. The work they are doing is fabulous. We are really pleased to give a sustainable gift that goes on in perpetuity in the fight against cancer,” Ron says. Ron himself has been successfully treated at the OSUCCC – James for cancer of the larynx.

Alford adds, “We want to carry on our parents’ philanthropy. Our father, who was a banker, always felt the importance of leaving the world a better place than it was when you arrived.”

Notes Dr. Teknos, “The Alfords are great ambassadors for the entire mission of The James. They are constantly referring patients for second opinions. They tell people about our research, and they are omnipresent at philanthropic and scientific functions.”

He says funding for the chair comes at an opportune time, when governmental research dollars are shrinking, but the potential for cancer breakthroughs is great. The chair will provide Dr. Rocco and his research team the flexibility to pursue novel research topics.

“In the past decade, the genomics revolution has created an explosion of progress in head and neck cancer treatment. Dr. Rocco’s expertise in genomic heterogeneity of tumors will augment our existing knowledge about genomics in head and neck cancer,” Dr. Teknos states.

He concludes, “The Alford family’s philanthropic gesture allows us to move the field forward in a way that doesn’t depend on the NIH—or it can supplement what is shrinking at the NIH. Without these gifts, the field would stagnate. Philanthropy is what’s going to find the cure for cancer.”

ALFORD FAMILY FUNDS $2 MILLION RESEARCH CHAIR James Rocco, MD, PhD, recruited from Harvard to study head and neck cancer

Combining low doses of the drug bortezomib with a particular cancer-killing virus might significantly improve the ability of the virus to kill cancer cells, according to research findings at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James). A report on the work was published in Clinical Cancer Research in July 2014.

Titled “Low Dose of Targeted Drug Might Improve Cancer-Killing Virus Therapy,” the work showed great promise in a laboratory setting and will be continued in a phase I clinical trial.

“The combination of bortezomib and a cancer-killing oncolytic virus had a synergistic effect. Bortezomib allowed the virus to replicate more quickly and robustly,” says Matthew Old, MD, assistant professor in the Department of Otolaryngology – Head and Neck Surgery and head and neck surgical oncologist at OSUCCC – James. Dr. Old initiated the study with Balveen Kaur, PhD, professor and vice chair of research, departments of Neurological Surgery and Radiation Oncology and a member of the OSUCCC – James Translational Therapeutics Program.

In head and neck and glioma models, the combination treatment suppressed tumor growth by 92 percent relative to controls and significantly increased survival.

“Historically, the problem with oncolytic viruses has been that they’ve performed great in a lab but haven’t worked as well in humans. The new trend is to combine novel agents such as bortezomib to improve the viruses’ replication and tumor-killing in humans,” Dr. Old says.

He explains that bortezomib has been used previously in treating head and neck cancer, but in a different way. He and other researchers tested the groundbreaking combination of the drug and cancer-killing virus on solid tumors in the head and neck, glioblastomas, female reproductive cancers and peripheral nerve sheath tumors.

In a phase I clinical trial, which Dr. Old hopes will commence in 2015, the treatment will be tested initially in people with head and neck solid tumors for whom all other treatments have failed.

“Oncolytic viruses possess a strong potential for targeted cancer therapy compared to chemotherapeutics and other treatments that are extremely toxic to the body,” Dr. Old says, adding that, “Because they are modified to only kill cancer cells, oncolytic viruses are well-tolerated in humans.”

Bortezomib also has a mild effect on the body, making the combination with cancer-killing viruses highly attractive as a therapy.

Nationwide Children’s Hospital in Columbus and Cincinnati Children’s Hospital Medical Center also participated in the research, which received funding from the National Institutes of Health and the Pelotonia Fellowship Program, a grassroots bike tour originating in Columbus that donates funds with the goal of ending cancer.

For more information on research studies at the OSUCCC – James, call 614-685-6778. For patient referrals to the Head and Neck Oncology Program, call 614-293-8074.

LOW DOSE OF TARGETED DRUG MIGHT IMPROVE CANCER-KILLING VIRUS THERAPY New study published in Clinical Care Research journal


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The Ohio State University Wexner Medical CenterDepartment of Otolaryngology –Head and Neck Surgery

SPEECH PERCEPTION ARTICLE WINS NATIONAL AWARDJournal of Speech, Language, and Hearing Research presents Editor’s Award to Ohio State’s Susan Nittrouer, PhD

The work of Susan Nittrouer, PhD, establishing the importance of language skill in facilitating actual perception of speech, received the 2013 Editor’s Award of the Journal of Speech, Language, and Hearing Research at the recent American Speech-Language-Hearing Association in Orlando.

Dr. Nittrouer, who is director of research and a professor in the Department of Otolaryngology – Head and Neck Surgery, was the only recipient of the award for the Hearing category. Her paper on “Speech Perception in Noise in Children with Cochlear Implants” was selected by the journal for meeting the highest-quality standards in research design, presentation and impact.

“I feel great appreciation for this honor, which indicates that our colleagues in the profession view the work as both rigorous and meaningful,” Dr. Nittrouer says.

She notes the assistance of Amanda Caldwell, PhD, former program director for the research project, for organizing testing and helping with data management.

The longitudinal study focused on outcomes of children with hearing loss, including an investigation of speech perception in noisy environments involving children with hearing loss and a control group of children with normal hearing.

“From our data, we were able to conclude that a large part of the problem of recognizing speech in noisy environments for children with hearing loss comes from their not having and being able to apply knowledge about a level of language structure known as phonological structure; that is, the level of actual speech sounds,” explains Dr. Nittrouer.

“If we can improve our teaching of language to these children, it will help them at everyday chores, such as recognizing speech in noisy backgrounds. It places the locus of treatment squarely on behavioral interventions, rather than on ‘fixing’ the ear.”

Dr. Nittrouer says the ideas being tested for her paper were based on 20-plus years of research funded by the National Institute on Deafness and Other Communication Disorders.

She believes the results of the study could have far-reaching implications and “should be a call to educators and speech-language pathologists to enhance their intervention with this level of structure.“

“This is true for children with hearing loss—regardless of whether they use cochlear implants or hearing aids—as well as for children with normal hearing who are experiencing language and reading difficulties.”

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