Meeting Archive Congratulations to the 2024 winners: ​​ First Place Oral Presentation: Asthma and Comorbid Obstructive Sleep Apnea: Outcomes after Hypoglossal Nerve Stimulation Surgery David Goldrich, MD Penn State Hershey ​ Second Place Oral Presentation: A Novel Proof-Of-Concept Study of Mixed Reality Technology for Ideal Placement of Bone-Anchored Hearing Devices for Application in Complex Patient Populations Kelly Daniels, MD UPMC First Place Poster: Response-Adaptive Surgical Timing in Neoadjuvant Immunotherapy Demonstrates Enhanced Pathologic Treatment Response in Head and Neck Squamous Cell Carcinoma Pablo Llerena, BS Thomas Jefferson University Hospital Second Place Poster: Free Flap Neurotization and Radial Forearm Free Flap Reconstruction Improves Functional Outcomes in Hemiglossectomy Defects Eric Wu, MD University of Pittsburgh Medical Center Resident Jeopardy Bowl Winner: Combined team from PCOM & Jefferson Congratulations to the 2023 winners: ​ First Place Oral Presentation: Effects of hypoglossal nerve stimulation surgery on rhinologic quality of life - A cohort study ​Glen D’Souza, Jefferson Second Place Oral Presentation: Cost Effectiveness of Non-echo Planar Diffusion Weighted MRI in the Surveillance of Cholesteatoma Terral Patel, UPMC First Place Poster: The Use of Actigraphy to Assess Sleep Improvement After Parathyroidectomy Christopher Tseng, PSU Second Place Poster: Efficacy of Fibrin Sealants in Reducing Postoperative Complications in Facial Plastic Surgery Hanel Eberly, PSU Resident Jeopardy Bowl Winner: Combined team from AHN, PCOM, & Jefferson Congratulations to the following winners: First Place Oral Presentation: Endoscopic Versus Microscopic Ear Surgery for Management of Cholesteatoma: A Cost Effectiveness Analysis Lauren Gardiner, MD University of Pittsburgh Medical Center Second Place Oral Presentation: The Effects of Adjuvant Radiotherapy on Survival in Elderly Patients with Advanced Head & Neck Squamous Cell Carcinoma Joann Butkus, MD Thomas Jefferson University Hospital First Place Poster: Acoustic Neuroma: A Surveillance, Epidemilogy, and End Results (SEER) Analysis Thomas Haupt, MD Howard University Second Place Poster: Viral Integration and Genomic Instability in HPV-Transformed Tonsillar Keratinocytes Emily Milarchi, MD Pennsylvania State University Resident ​Jeopardy Bowl Winner: ​Geisinger Medical Center Congratulations to the following winners: First Place Oral Presentation: Validity of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) in a Pediatric Population Kelly Daniels, MD UPMC Second Place Oral Presentation: Human Papilloma Virus Integration Strictly Correlates with Global Genome Instability in Head and Neck Cancer Max Hennessy, MD Penn State Health Third Place Oral Presentations: Survivorship, At What Cost? Understanding Financial Toxicity in Patients with Head and Neck Cancer: A Systematic Review Shivam Patel, MD Penn State Health Clinical and Immunological Profile of Patients with Immune-Related Adverse Effects Following Treatment with Immune Checkpoint Inhibitors Angela Alnemri, MD ​Thomas Jefferson University Hospital Resident Jeopardy Bowl Winner: UPMC Pittsburgh Congratulations to the following winners: ​First Place Poster: Implant Failure and Osteomyelitis in the Setting of Selective Serotonin Reuptake Inhibitor Usage: A Case Report & Review of the Literature Katie Melder, MD University of Pittsburgh Second Place Poster: Post treatment Surveillance in Sinonasal Malignancies Prachi Patel, MD Thomas Jefferson University Hospital First Place Oral Presentation: Multi-institutional study utilizing surgery + cesium-131 brachytherapy in recurrent head and neck cancer Adam Luginbuhl, MD Thomas Jefferson University Hospital Second Place Oral Presentation: Analysis of spatial relationships between CD8 and FoxP3 cells using digital imaging in head and neck squamous cell carcinoma Uche Nwagu, MD Thomas Jefferson University Hospital Second Place Oral Presentation: Clinical Implications of the Integration Status of HPV in Head and Neck Cancer Brandon LaBarge, MD Penn State Health Resident Quizzo winners: Will Kennedy, MD and Ravi Shah, MD from the University of Pennsylvania. Congratulations to the following winners: First Place Oral Presentation: A Computer-Learning Neural Network Algorithm for the Radiographic Assessment of Thyroid Nodules : A Pilot Study Kelly Daniels​ Sidney Kimmel Medical College at Thomas Jefferson University Second Place Oral Presentation: Assessment of cranial base repair techniques in a validated cadaveric CPAP model Chandala Chitguppi, MD Thomas Jefferson University Hospital ​First Place Poster: Innervation of the Cricothyroid Muscle by the Recurrent Laryngeal Nerve and Implications for Clinical Practice Thomas Kaffenberger, MD University of Pittsburgh Medical Center Second Place Poster: Impact of gender on upper airway stimulation outcomes Kelly Daniels Sidney Kimmel Medical College at Thomas Jefferson University​ Resident Jeopardy Bowl Winners: B. Swendseid, MD, M. Chaskes, MD and J. Goldfarb, MD from Thomas Jefferson University Hospital Congratulations to the following winners: First Place Oral Presentation: Defining the role of CD169 macrophages in lymph node metastasis Michael Topf, MD Lewis Katz School of Medicine at Temple University ​Second Place Oral Presentation: High-Level Disinfection of Otorhinolaryngology Clinical Instruments: An Evaluation of the Efficacy and Cost-effectiveness of Instrument Storage Jason Yu, MD University of Pennsylvania ​Second Place Oral Presentation: Identification of Causative Mutations in Two Unrelated Kindreds with Familial Nonmedullary Thyroid Cancer Using Next-Generation Sequencing Darrin Bann Penn State Health Milton S. Hershey Medical Center ​​First Place Poster: Quality of Life Comparison of exenterated versus non-exenterated patients with sinonasal and craniofacial malignancies Alexander Graf, MD Thomas Jefferson University Hospital ​ Second Place Poster: Perfusion Dynamics in Pedicled and Free Tissue Reconstruction: Infrared Thermography and Laser Fluorescence Video Angiography Tom Shokri, MD Penn State Health Milton S. Hershey Medical Center Resident Jeopardy Bowl Winners: UMPC & PCOM

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Events Read the 2024 Meeting Wrap-Up ​ View the 2024 Photo Gallery ​ ​ ​ ​ ​ PAO-HNS PAO-HNS is a not-for-profit membership organization which represents and serves Otolaryngologists, Head and Neck Surgeons in Pennsylvania and the region. ​ PAO-HNS is dedicated to the professional interests of otolaryngologists and their patients, promoting the highest professional and ethical standards of practice through education and advocacy. We're planning for 2025! Soundings Read the PAO-HNS Newsletter ​

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Thyroid and Other Head and Neck Conditions In This Section: Obstructive Salivary Gland Disease Parathyroid Adenoma Parotid Gland (Salivary Glad) Tumors​ Obstructive Salivary Gland Disease ​Author(s): Nikolaus Hjelm, MD; David Cognetti, MD. ​ Overview: Obstructive salivary gland disease occurs when there is an blockage in the outflow duct from the salivary gland that prevents saliva from traveling out of the gland and into a patient’s mouth. The backflow of saliva behind the blockage results in enlargement of the obstructed salivary gland. This is similar to a clogged sink drain. When a sink drain (the salivary duct) is clogged, the water backs up into the sink (the salivary gland) and overflows the sink (resulting in a swollen salivary gland). The most common cause of a salivary gland obstruction is a sialolith, also known as a salivary duct stone. Other frequent etiologies include mucus plugging and narrowing of the duct from scarring. The best way to treat obstructive salivary gland disease is to remove the blockage. In the past, treatment was limited to surgically removing the entire salivary gland. However, in the mid 1990s, sialendoscopy emerged in Europe as a gland preserving management option for diagnosing and removing salivary stones. Fortunately, there are several otolaryngologists in Pennsylvania who are experienced with sialendoscopy. Sialendoscopy is a minimally-invasive procedure in which your physician uses a very small camera scope to evaluate the ducts of the salivary glands. The scope passes through your mouth and into the natural entrance of the salivary duct and therefore does not require an incision or result in a scar. The camera ranges from 0.8 mm to 1.6 mm in size, and allows for visualization of the inside of the small salivary ducts. A working channel in the larger endoscopes allows for treatment of salivary stones and scarring with baskets, burrs, balloons, and lasers. The endoscope can also be used to irrigate the duct with saline or steroids to clear mucus plugs and alleviate inflammation. Symptoms: Most frequently include but are not limited to: Salivary gland swelling with eating Discomfort or pain in the salivary glands with eating Dry mouth Feeling of a hard and possibly tender mass in the mouth, on the face, or under the jaw What to Expect at Your Otolaryngologist Office Visit: Your otolaryngologist will ask you about your symptoms including but not limited to when you first noticed them, when they typically occur, how frequently they occur, and any exacerbating or alleviating factors. Careful examination by your physician will include a full head and neck examination to rule out other causes of your symptoms. The exam will include but is not limited to palpation of the affected area as well as palpation inside your mouth to localize the origin of your discomfort. Additional tests may include but are not limited to a CT scan or ultrasound of your head and neck. Treatment: If it is determined that sialendoscopy is indicated for assessment and treatment of your salivary problem, your otolaryngologist will schedule you for the procedure. This typically takes place in the operating room. The risks for this minimally invasive procedure are low as it simply involves looking within the duct. In patients with scarring or blockages in the duct, there is a small risk of damage to the duct. Most patients experience swelling of the salivary gland after the procedure. This is expected and subsides within the first few days. Massage of the gland helps with this, and it is important to stay well hydrated. In patients with a large salivary stone, your physician may need to make a small incision within the mouth to remove the stone. This heals very quickly and without scar (if you ever accidentally bit the inside of your cheek you know how quickly the mouth heals). In some rare cases when the stone is in the parotid gland (salivary gland on side of face) and is unable to be reached with the endoscope or an intraoral incision, a small skin incision in front of your ear may be required. After the procedure, you can resume a normal diet. If an incision was made, you should be careful brushing your teeth in that area. You doctor will likely recommend an oral rinse during the recovery period. Rarely, patients experience numbness along the side of their tongue, which typically improves with time. Occasionally, a stent is placed in the salivary duct at the time of the procedure. This stent is then removed at your postoperative visit after the duct is well healed. Parathyroid Adenoma Authors: Robert Saadi M.D., Elizabeth Cottrill M.D. Overview: The parathyroid glands are part of the body’s endocrine system and are located in the neck close to the thyroid gland. Most people have four glands, each roughly the size of a pea. These glands are responsible for making parathyroid hormone (PTH), a chemical which controls calcium levels in the blood by altering how it is absorbed in the gut, excreted in the kidney, and deposited in or released from the bones. Calcium is vital to the function of many different types of cells in the body, especially muscle and nerve cells. A parathyroid adenoma is a benign growth of one or more of the parathyroid glands which results in over production of PTH. Parathyroid adenomas account for the vast majority of what is called “primary hyperparathyroidism”. Primary hyperparathyroidism is about 3 times more common in women than in men and usually occurs in people in their 50’s and 60’s, but can occur at any age. While some genetic mutations are known, and tend to run in families (Multiple Endocrine Neoplasia or “MEN”), the majority of primary hyperparathyroidism is caused by sporadic mutations. There is no known cause, although radiation exposure to the neck may increase the risk. Most cases of primary hyperparathyroidism are due to over-growth of a single gland (about 80%). Less commonly, there is growth of multiple glands at once, termed parathyroid hyperplasia (about 20%). Less than 1% of cases are caused by a cancer (malignancy) of a parathyroid gland. In all of these cases, too much PTH causes the levels of calcium to rise in the blood. This results from more absorption of calcium from the gut, less excretion of calcium by the kidneys, and more calcium release from the bones. Symptoms: Many patients with primary hyperparathyroidism do not have any symptoms and, very often, it is diagnosed by routine blood work that incidentally finds a high calcium level. Symptoms that may be caused by elevated calcium in the blood include kidney stones, bone pain and weak bones, abdominal cramping, irritability or depression. When a cancer of the parathyroid gland is present, patients are more likely to have severe symptoms due to very high levels of hormone and, although rare, may also note hoarseness or a neck mass. What to Expect at Your Otolaryngologist Office Visit: Prior to seeing your otolaryngologist, you may have already been evaluated by your primary care doctor or an endocrinologist to rule out other diagnoses that are associated with high calcium levels. When the diagnosis of primary hyperparathyroidism is confirmed, additional tests may be necessary. Because parathyroid hormone causes calcium to be absorbed into the blood from bones, you may develop weak bones or osteoporosis which can be determined with a bone density test. If you have symptoms of kidney stones, radiographic imaging of your abdomen may sometimes be necessary. Depending on your medical and family history, your doctor may recommend genetic testing for MEN 1 or MEN2. Your Otolaryngologist will perform a head and neck examination at your visit. Parathyroid adenomas are generally not able to be felt in the neck, therefore, for surgical planning, your Otolaryngologist will often order certain imaging studies and may perform a bed-side ultrasound in clinic. An ultrasound of the neck, which may also be done by a radiologist, is an inexpensive and radiation-free method for looking for an enlarged gland. Sometimes, a Tc-sestimibi scan, which uses a drug that is taken up by a parathyroid adenoma and is then shown on imaging, will be required to locate the enlarged gland. A specialized CT or MRI scan may be necessary in some cases. Treatment: Treatment for primary hyperparathyroidism is often coordinated by a team of doctors including both an Endocrinologist and also an Otolaryngologist. The most common and effective treatment is to remove the enlarged gland or glands, with surgery. For patients who are not having obvious symptoms, there are criteria that help guide when to undergo surgery and when to observe. For patients who are not good candidates for surgery or who have severe kidney failure, a prescription medication may be given to lower the PTH levels. Surgery can be done with a minimally invasive approach through a very small incision in the neck when a parathyroid adenoma is clearly seen on imaging. Additional imaging may be performed the day of surgery to assist with this. If imaging does not localize the adenoma, a slightly larger incision is planned and all four glands are found and evaluated (“parathyroid exploration”). Removal of multiple over-active glands may be necessary to drop the parathyroid hormone to normal levels. Parathyroid hormone levels drop dramatically after removal of the adenoma and this is can be measured during the operation to confirm that all hyper-secreting glands have been removed. In some cases, the surgeon may have to switch from a minimally invasive approach to look at all four glands if levels do not drop appropriately or if visualization is difficult. Rarely, the location of the parathyroid glands will be abnormal and parathyroid glands may be found inside the thyroid gland, in the chest, or higher in the neck. The main risks of surgery include hoarseness, bleeding, and long-term low calcium levels. Hoarseness may result from stretch or damage to the nerve that controls the vocal cords. The risk of damage to this nerve is less than 4% for experiences surgeons. If bleeding occurs following surgery, it can result in a collection of blood in the neck, called a hematoma. Often these are small and resolve on their own over time, or they may require a procedure to drain the blood. Low calcium levels are actually expected for a short period after surgery since function of the normal glands is suppressed by the over-functioning gland, however long term low calcium is rare. Calcium and Vitamin D supplements may be needed after surgery for several weeks. Signs of low calcium include numbness and tingling around your lips and fingertips and in extreme cases muscular contractions called tetany. References 1. Cole DE, Webb S, Chan PC. Update on parathyroid hormone: new tests and new challenges for external quality assessment. Clin Biochem. 2007;40(9-10):585-90. 2. Mourad M, Buemi A, Darius T, Maiter D. Surgical options for primary hyperparathyroidism. Ann Endocrinol (Paris). 2015;76(5):638-42. Parotid Gland (Salivary Gland) Tumors Authors: Christopher Pool, MD (Penn State Hershey Medical Center) and Neerav Goyal, MD MPH (Penn State Hershey Medical Center) Overview: The parotid gland is a salivary gland located in front of the lower border of the ear. The nerve responsible for facial expression and movement, called the facial nerve, courses through the parotid gland. Tumors (or masses) of salivary glands occur most commonly in the parotid gland although they can occur less frequently in the sublingual (below the tongue) or submandibular gland (below the jaw).1, 2 The majority (75%) of parotid masses are benign (not cancerous) and a visit to your otolaryngologist-head and neck surgeon (ENT) will help determine the nature of the mass.3 Salivary gland tumors are rare, representing six to eight percent (6-8%) of head and neck tumors.1, 2 In the United States, there are approximately 2500 cases per year.1, 2 Although there are no predominant risk factors for salivary gland cancer, smoking has been associated with Warthin’s tumor, a type of non-cancerous salivary gland tumor.4, 5 Possible reasons for a parotid mass include: benign (non-cancerous) or malignant (cancerous) tumors, salivary cysts, salivary gland stones, sarcoid, autoimmune conditions, infections or other inflammatory processes. Many of these reasons present with a single-sided mass, but some conditions can be associated with a mass in both glands. Symptoms: Most patients with salivary gland tumors present with painless swelling of the parotid, submandibular (below the jaw), or sublingual (below the tongue) glands. Occasionally, the mass may be associated with facial droop as the facial nerve runs through the gland. Facial weakness or droop is more commonly found in cancerous masses. This droop may sometimes be recognized as a “Bell’s palsy.” Some patients may present with a lump in their neck or cheek. What to Expect at Your Otolaryngologist Office Visit: Your doctor will ask you questions to better understand when the swelling began, where it is located, and if you are in pain or discomfort. The physical exam will include an assessment of the mass or salivary glands as well as an assessment of your facial movement and facial function. Several additional tests may be helpful. Tissue diagnosis remains the gold standard for determining the nature of the mass.6 An ultrasound will be used to identify the architecture of the mass and a fine needle (FNA) will be used to collect a sample for pathologic analysis.7 This maybe done in the office by the otolaryngologist or by a radiologist or ultrasonographer at a separate visit. Some practices have someone (a cytopathologist or pathologist) review the slide immediately to ensure there are enough cells to help make the diagnosis. Your surgeon will also likely get a CT (“CAT”) scan or MRI to assess the extent of the parotid mass.9 Treatment: Surgery is the cornerstone of treatment of this disease, with most benign and low-grade cancers treated with surgery alone.10 Tumors that are high-grade, are treated more aggressively with radiation therapy in addition to surgery.11 Every effort is made to remove the entire tumor while preserving the facial nerve. In experienced hands and in patients with no evidence of facial nerve weakness, the risk to this nerve is usually low. Patients who have tumors that are non-cancerous or benign, can elect to have the masses followed instead of having surgery. However, many of these masses do continue to grow and get larger in size. The surgeon may recommend repeat imaging if you choose to follow the mass instead of surgery. The surgery is usually an outpatient surgery or associated with a short hospital stay. The surgeon may use a drain, or a small plastic tube, connected to a suction bulb to help keep the wound fluid out. The surgeon may also suggest a compressive dressing over the surgical wound. Your surgeon will be able to provide the most relevant information regarding your parotid tumor and how to best address it as well as more details regarding the surgery and associated risks. Further reading: Fine Needle Aspiration Salivary Gland Cancer References 1. Barnes L EJ, Reichart P, Sidransky D. (Eds). Pathology and Genetics of Head and Neck Tumours: Tumours of the Salivary Glands. World Health Organization.2005: 209. 2. Guzzo M, Locati LD, Prott FJ, Gatta G, McGurk M, Licitra L. Major and minor salivary gland tumors. Critical Reviews in Oncology/Hematology. 2010;74: 134-148. 3. Spiro RH. Salivary neoplasms: overview of a 35-year experience with 2,807 patients. Head and Neck Surgery. 1986;8: 177-184. 4. de Ru JA, Plantinga RF, Majoor MH, et al. Warthin's tumour and smoking. B-ent. 2005;1: 63-66. 5. Pinkston JA, Cole P. Cigarette smoking and Warthin's tumor. American Journal of Epidemiology. 1996;144: 183-187. 6. Liu CC, Jethwa AR, Khariwala SS, Johnson J, Shin JJ. Sensitivity, Specificity, and Posttest Probability of Parotid Fine-Needle Aspiration: A Systematic Review and Meta-analysis. Otolaryngology and Head and Neck Surgery. 2016;154: 9-23. 7. Christensen RK, Bjorndal K, Godballe C, Krogdahl A. Value of fine-needle aspiration biopsy of salivary gland lesions. Head and Neck. 2010;32: 104-108. 8. Maiorano E, Lo Muzio L, Favia G, Piattelli A. Warthin's tumour: a study of 78 cases with emphasis on bilaterality, multifocality and association with other malignancies. Oral Oncology. 2002;38: 35-40. 9. Lee YY, Wong KT, King AD, Ahuja AT. Imaging of salivary gland tumours. European Journal of Radiology. 2008;66: 419-436. 10. Lim YC, Lee SY, Kim K, et al. Conservative parotidectomy for the treatment of parotid cancers. Oral Oncology. 2005;41: 1021-1027. 11. Mahmood U, Koshy M, Goloubeva O, Suntharalingam M. Adjuvant radiation therapy for high-grade and/or locally advanced major salivary gland tumors. Archives of Otolaryngology - Head and Neck Surgery. 2011;137: 1025-1030.

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OWNER MAKES NO EXPRESS OR IMPLIED WARRANTIES, REPRESENTATIONS OR ENDORSEMENTS WHATSOEVER WITH RESPECT TO THE SITE OR ANY GOODS OR SERVICES OFFERED ON OR THROUGH THE SITE. OWNER EXPRESSLY DISCLAIMS ALL WARRANTIES OF ANY KIND, (EXPRESS, IMPLIED, STATUTORY, OR OTHERWISE), INCLUDING, BUT NOT LIMITED TO, IMPLIED WARRANTIES OF MERCHANTABILITY, SECURITY, COMPLETENESS, TIMELINESS, APPROPRIATENESS, ACCURACY, FITNESS FOR A PARTICULAR PURPOSE, FREEDOM FROM COMPUTER VIRUSES, TITLE, AND NON-INFRINGEMENT. THE DISCLAIMER OF WARRANTIES APPLIES TO THE SITE, ITS CONTENT, AND ANY GOODS OR SERVICES OFFERED ON OR THROUGH THE SITE. OWNER DOES NOT WARRANT THAT THE SITE FUNCTIONS OR CONTENT WILL BE UNINTERRUPTED, TIMELY, OR SECURE. OWNER DOES NOT WARRANT THE ACCURACY OR COMPLETENESS OF THE SITE. OWNER DOES NOT WARRANT THAT THE SITE AND/OR CONTENT WILL BE ERROR-FREE, THAT ANY ERRORS ON THE SITE WILL BE CORRECTED, OR THAT THE SITE/SERVERS ARE FREE OF VIRUSES OR OTHER HARMFUL COMPONENTS. THE SITE AND RELATED CONTENT, INCLUDING ANY GOODS, SERVICES OR INFORMATION PROVIDED ON OR THROUGH THE SITE, ARE PROVIDED ON AN “AS IS” AND “AS AVAILABLE” BASIS WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED. YOU ASSUME THE ENTIRE COST OF ALL NECESSARY REPAIRS IN THE EVENT YOU EXPERIENCE ANY LOSS OR DAMAGE ARISING FROM THE USE OF THE SITE OR ANY SITE GOODS OR SERVICES. OWNER MAKES NO WARRANTIES THAT YOUR USE OF THE SITE WILL NOT INFRINGE THE RIGHTS OF OTHERS AND ASSUMES NO LIABILITY FOR SUCH INFRINGEMENT. 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In no event will the collective liability of Owner or its officers, directors, employees, affiliates, agents, licensors, representatives, attorneys, and business partners to any party, regardless of the type of action whether in contract, tort, or otherwise, exceed the greater of $100.00 or the amount you paid to Owner for the applicable good or service out of which the liability arose. IF YOU ARE DISSATISFIED WITH THESE TOU, THE SITE, OR ANY GOOD OR SERVICE OFFERED ON OR THROUGH THE SITE, YOUR SOLE AND EXCLUSIVE REMEDY IS TO DISCONTINUE USING THE SITE. GIVEN THAT SOME STATES DO NOT ALLOW FOR THE EXCLUSION OR LIMITATION OF LIABILITY FOR CONSEQUENTIAL OR INCIDENTAL DAMAGES, SOME OF THE ABOVE LIMITATIONS MAY NOT APPLY TO YOU. THE LIMITATION OF LIABILITY WILL APPLY TO THE GREATEST EXTENT ALLOWED UNDER THE LAW. Password/Username Protection The Site offers a “Members Only” section where Otolaryngologists can access additional information. In order to get access to the Members Only content, you will need to fill out the membership application[LINK TO APPLICATION PAGE HERE. IF THE MEMBERSHIP SELECTION HAS RULES/GUIDELINES YOU WANT KNOWN, THOSE SHOULD BE POSTED IN CLOSE PROXIMITY TO THE APPLICATION FORM]. If accepted as a member, you will be issued a user name and password in order to access content through the Members Only section of the Site. You are responsible for maintaining the confidentiality of your password and user name, and agree to notify Owner if your password is lost, stolen, disclosed to an unauthorized party, or otherwise may have been compromised. You are responsible for all activities that occur under your Site membership account. You may only set up one Site membership account, and must do so in your own name. You agree to immediately notify Owner at info@otopa.org of any unauthorized use of your Site membership account or any other breach of security in relation to the Site known to you. If Owner suspends or terminates your Site membership account under these TOU, you acknowledge that all information and content associated with such account will no longer be available to you. You may cancel your Site membership account at any time by contacting the Pennsylvania Academy of Otolaryngology – Head and Neck Surgery at info@otopa.org or by calling 717-558-7750 ext. 1519. Geographic Limitation Owner operates the Site from its headquarters in the United States, and the Site and TOU are intended only for users within the United States. If you use the Site outside the United States, you are responsible for following your applicable local laws and determining, among other things, whether your use of the Site violates any of those local laws. By using the Site, you agree and acknowledge that information about you, including personally identifiable information, may be transmitted to and stored in the United States. Site Privacy PolicyYour use of the Site is governed by the Site Privacy Policy located at __________________. The Site Privacy Policy is incorporated by reference into these TOU. Miscellaneous You acknowledge that the opinions and recommendations contained on the Site are not necessarily those of Owner nor endorsed by Owner. Any reliance on any opinions or recommendations offered on the Site is done at your risk. Owner does not guarantee or promise that any opinions and/or recommendations on the Site are accurate or will be helpful to any issue you may have. You agree that Owner is not liable to you or anyone else for any harm that might arise as a result of using and/or implementing in any manner any of the opinions or recommendations found on the Site. Please note that Owner does not accept unsolicited content or ideas you may attempt to transmit to Owner directly. As such, we take no responsibility for such transmitted content or ideas. If you do send Owner unsolicited content or ideas, you agree that Owner may use such content and ideas in any way Owner wishes without any compensation to you. Any and all disputes relating to these TOU, the Site, and/or any goods or services offered on or through the Site, are governed by, and will be interpreted in accordance with, the laws of the Commonwealth of Pennsylvania, without regard to any conflict of laws provisions. You hereby irrevocably and unconditionally consent to submit to the exclusive jurisdiction of the courts of the Commonwealth of Pennsylvania (USA)(specifically, Common Pleas Court of Dauphin County or the U.S. District Court for the Middle District of Pennsylvania) for any litigation arising out of or relating to the use of the Site, waive any objection to the venue of any such litigation in the Commonwealth of Pennsylvania courts, and agree not to plead or claim in any Commonwealth of Pennsylvania court that such litigation brought therein has been brought in an inconvenient forum. If any part of these TOU is determined by a court of competent jurisdiction to be invalid or unenforceable, it will not impact any other provision of these TOU, all of which will remain in full force and effect. These TOU constitute the entire agreement of the parties with respect to the Site and supersede all prior communications, promises and proposals, whether oral, written, or electronic, between you and Owner, with respect to the Site. If you violate any portion of these TOU, Owner reserves the right, without an obligation to do so, to deny you access to the Site and/or remove any UGC you may have posted/uploaded on the Site. If Owner terminates your access to the Site, Owner may also delete your Site membership account. Owner has the right to terminate any password-restricted account for any reason. Owner's failure to enforce any portion of these TOU is not a waiver of such portion. The proprietary rights, disclaimer of warranties, representations made by you, indemnities, and limitations of liability shall survive the termination of these TOU. Owner reserves the right, without notice and reason, to take down or terminate the Site or otherwise revoke any and all access granted to you related to the Site. You agree that Owner is not liable to you or any other third party for this action. Owner does not assume any liability or responsibility for your use of the Internet or the Site including, but not limited to, any change your computer or related systems may sustain as a result of accessing the Site. You are free to text link to the Site so long as there is nothing deceptive or infringing about the link. Owner may revoke this linking permission at any time and for any reason. Certain software elements of the Site and related Site services may be subject to U.S. export laws and controls. As such, no software may be downloaded or exported to any country or foreign citizen that is under a U.S. embargo or that would otherwise violate U.S. law or regulations. If you need to contact Owner for any reason not already specified in these TOU, please use the following contact information: Pennsylvania Academy of Otolaryngology – Head and Neck Surgery 400 Winding Creek Boulevard Mechanicsburg, PA 17050 Phone: 717-558-7750 ext. 1519 Fax: 717-558-7841 Email: info@otopa.org If you’re a business, talk about how you started and share your professional journey. Explain your core values, your commitment to customers and how you stand out from the crowd. Add a photo, gallery or video for even more engagement.

Advocacy Update Governor Shapiro unveiled his Fiscal Year 2024-2025 budget in February. This proposal represents an 8.4% increase ($3.7 billion) over the prior fiscal year. The Pennsylvania General Assembly will now grapple with the details with an eye towards final passage by the end of June. ​ The budget document shows an 8.5% increase in the Department of Health. Of note are three new initiatives: ​ 1. Ten million for the Long-Term Care Transformation Office 2. One million for Firearm Injury Prevention 3. Four million for Medical Debt Relief The entire budget tracking spreadsheet c an be accessed here: 2024-25 PA Budget ​ What we're watching... ​ Medical Licensure Compact Act Although Pennsylvania enacted a medical licensure compact act in 2016, it remains to be one of four states that continues to experience delays in implementation due to language concerns with the FBI over background checks. Once this obstacle is removed, final enactment will take place directly. We are tracking impact on otolaryngology. Septoplasty In December 2023, Highmark BC/BS issued a Policy Directive that stated that a twelve week course of either an intranasal antihistamine or intranasal steroid would be required prior to procedure approval. In February, Highmark issued a Policy Update that reduced the treatment course from twelve weeks to four weeks before approval would be granted. This policy change is to become effective on May 27, 2024. PAO, with AAO, is working on letters to Highmark, the Pennsylvania Insurance Commission, and the Senate and House Insurance Committees to indicate opposition to this policy change. Another septoplasty issue has arisen lately, Highmark’s refusal to reimburse for debridements after sinus surgery. Highmark claims that this procedure is not just part of post-operative care. This issue will be further flushed out with PAO actively expressing concerns with this issue. ​ ​ ​2024 General Assembly Session Dates STATE HOUSE OF REPRESENTATIVES June 3, 4, 5, 10, 11, 12, 17, 18, 24, 25, 26, 27, 28 STATE SENATE June 3, 4, 5, 10, 11, 12, 24, 25, 26, 27, 28, 29, 30

Officers President Jessyka G. Lighthall, MD, FACS Chief, Division of Facial Plastic and Reconstructive Surgery Director, Facial Nerve Disorders Clinic Medical Director, Esteem Penn State Health Cosmetic Associates Fellowship Director, Facial Plastic and Reconstructive Surgery Associate Professor, Department of Otolaryngology-Head & Neck Surgery and Department of Surgery Penn State College of Medicine ​ President-Elect Colin T. Huntley, MD Associate Professor, Jefferso n University, Otolaryngology - Head & Neck Surgery ​ Secretary/Treasurer Andrew A. Mccall, MD, FACS Assistant Professor, Department of Otolaryngology, University of Pittsburgh University of Pittsburgh Hearing Research Center ​ Immediate Past President David M. Cognetti, MD, FACS ​Jefferson University - Otolar yngology - Head & Neck Surgery Past Presidents The Pennsylvania Academy of Otolaryngology - Head & Neck Surgery 2021-2023 David M. Cognetti, MD, FACS 2019-2021 Johnathan D McGinn, MD 2017-2019 Ahmed M.S. Soliman, MD 2015-20 17 Jeffrey P. Simons, MD, FACS 2013-2015 David Goldenberg, MD, FACS 2011-2013 Jason Newman, MD, FACS 2009-2011 Scott M. Gayner, MD 2007-2009 Robert L. Ferris, MD, PhD, FACS 2005-2007 Robert T. Sataloff, MD, FACS 2003-2005 Edmund A. Pribitkin, MD, FACS 2001-2003 Karen A. Rizzo, MD, FACS 1999-2000 J. David Cunningham, MD, FACS 1998-1999 Carl L. Reams, MD 1997-1998 Phillip K. Pellitteri, DO, FACS 1996-1997 Barry E. Hirsch, MD 1995-1996 Alan M. Miller, MD, FACS 1994-1995 Ernest L. McKenna, Jr., MD, FACS 1993-1994 Frank I. Marlowe, MD, FACS 1992-1993 Thomas L. Kennedy, MD, FACS 1991-1992 G. William Jaquiss, MD 1990-1991 Louis D. Lowry, MD, FACS Pennsylvania Academy of Ophthalmology and Otolaryngology (1943 – 1990) Pennsylvania Academy of Ophthalmology and Otolaryngology (1943 – 1990) 1989 Helen F. Krause, M.D. 1988 Dorothy C. Scott, M.D. 1987 Webb Hersperger, M.D. 1986 Edward A. Jaeger, M.D. 1985 Donald P. Vrabec, M.D. 1984 James L. Curtis, M.D. 1983 George H. Conner, M.D. 1982 George J. Gerneth, M.D. 1981 Donald B. Kamerer, M.D. 1980 Jerome Dersh, M.D. 1979 Eugene B. Rex, M.D. 1978 William C. Frayer, M.D. 1977 Silvio H. DeBlasio, M.D. 1976 Paul A. Cox, M.D. 1975 Louis E. Silcox, M.D. 1974 Robert D. Mulberger, M.D. 1973 James M. Cole, M.D. 1972 C. William Weisser, M.D. 1971 Joseph P. Atkins, M.D. 1970 Robert J. Beitel, Jr., M.D. 1969 H. Ford Clark, M.D. 1968 Harold G. Scheie, M.D. 1967 John T. Dickinson, M.D. 1966 Benjamin F. Souders, M.D. 1965 Merril B. Hayes, M.D. 1964 Glen G. Gibson, M.D. 1963 Raymond E. Jordan, M.D. 1962 Robert E. Shoemaker, M.D. 1961 Norbert E. Alberstadt, M.D. 1961 Benjamin H. Shuster, M.D. 1960 John Knox Covey, M.D. 1959 Paul C. Craig, M.D. 1958 Murray F. McCaslin, M.D. 1957 J. Floyd Buzzard, M.D. 1956 Chevalier L. Jackson, M.D. 1955 William T. Hunt, Jr., M.D. 1954 James H. Delaney, M.D. 1953 Paul McCloskey, M.D. 1952 Samuel T. Buckman, M.D. 1951 Matthew S. Ersner, M.D. 1950 Jay G. Linn, Sr., M.D. 1949 Daniel S. DeStio, M.D. 1948 James J. Monahan, M.D. 1947 Gilbert L. Daily, M.D. 1946 Thomas F. Furlong, Jr., M.D. 1945 Lewis T. Buckman, M.D. 1944 Lewis T. Buckman, M.D. 1943 James E. Landis, M.D.

Page Title This is a Paragraph. Click on "Edit Text" or double click on the text box to start editing the content and make sure to add any relevant details or information that you want to share with your visitors. Click Here Section Title Every website has a story, and your visitors want to hear yours. This space is a great opportunity to give a full background on who you are, what your team does and what your site has to offer. Double click on the text box to start editing your content and make sure to add all the relevant details you want site visitors to know. If you’re a business, talk about how you started and share your professional journey. Explain your core values, your commitment to customers and how you stand out from the crowd. Add a photo, gallery or video for even more engagement.