Events Read the Meeting Wrap-Up ​ View the Photo Gallery ​ June 14-15, 2024 ​ Annual Scientific Meeting ​ ​ 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. Learn More Soundings Read the PAO-HNS Newsletter ​

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Annual Awards This award honors a member otolaryngologist who has done extraordinary work for the Academy or who has made an extraordinary contribution to his/her specialty. In 2012, the award was named to honor the memory of Helen Krause, MD, FACS, FACO-HNS, FAAOA. Dr. Krause was a pioneer in the specialty who served the Academy in many capacities during her 46 years of membership. She was the consummate example of a strong, female physician leader and the PAO-HNS commemorates her legacy by dedicating this award in her name. Recipients 1961 James E. Landis, MD, Reading 1964 Matthew S. Ersner, MD, Philadelphia 1973 Daniel S. DeStio, MD, Pittsburgh 1975 John T. Dickinson, MD, Pittsburgh 1977 David Myers, MD, Philadelphia 1979 James M. Cole, MD, Danville 1980 Silvio H. DeBlasio, MD, Pittsburgh 1983 Bernard J. Ronis, MD, Philadelphia 1985 Eugene G. Rex, MD, Philadelphia 1986 Donald B. Kamerer, MD, Pittsburgh 1988 Stewart R. Rood, PhD, Pittsburgh 1990 G. William Jaquiss, MD, Pittsburgh 1991 Clyde B. Lamp, Jr., MD, Pittsburgh 1992 Donald P. Vrabec, MD, Danville 1993 Helen F. Krause, MD, Pittsburgh 1994 George H. Conner, MD, Hershey 1994 Louis D. Lowry, MD, Philadelphia 1995 Thomas L. Kennedy, MD, Danville 1996 Alfred K. Walter, Reading 1997 Webb Hersperger, MD, Carlisle ​1998 John Milliron, Harrisburg ​ 1999 James B. Snow, Jr., MD, Easton, MD 2003 Phillip K. Pellitteri, DO, FACS, Danville 2004 Karen A. Rizzo, MD, FACS, Lancaster 2005 Barry E. Hirsch, MD, Pittsburgh 2006 Edmund A. Pribitkin, MD, Philadelphia 2007 Scott M. Gayner, MD, Mechanicsburg 2008 Robert T. Sataloff, MD, DMA, FACS, Philadelphia 2009 Robert L. Ferris, MD, PhD, FACS, Pittsburgh 2012 Eugene N. Myers, MD, FACS, Pittsburgh 2013 David W. Kennedy, MD, Philadelphia 2014 Jason G. Newman, MD, FACS, Philadelphia 2015 Berrylin J. Ferguson, MD, FAAOA, FACS, PIttsburgh 2016 David Goldenberg, MD, FACS, Hershey 2017 Jeffrey Simons, MD, FACS, FAAP, Pittsburgh 2018 Jonas T. Johnson, MD 2019 James C. Denneny, III, MD, Alexandria, VA 2020 ​Bert W. O'Malley, Jr., MD ​2021 Johnathan D. McGinn, MD, Hershey 2022 David M. Cognetti, MD, FACS, Philadelphia 2023 Ahmed M.S. Soliman, MD Presented to a non-physician who has done unusual work for the deaf, hearing deaf, hearing, voice, or speech impaired. Recipients ​1991 James C. Roddey, Pittsburgh 1993 David P. Augustine, RN, Clinician I, Mt. Carmel 1994 Carol Finkle, M Ed, MA, Philadelphia 1995 Rachel D. Dubin, Baltimore 1996 Patricia Exley Ambler & Ann Friedlander, Wynnewood 1997 Christina Seaborg, MA, Wilkes-Barre 1998 Pamela Dickinson, MS, CCC-A, Pittsburgh 1999 Virginia Ehr, North Myrtle Beach, SC2001 Mark Y. Harlor, M Ed, Danville 2002 Laura R. Sabol, M. Ed, CCC/SLP, Lancaster 2003 Hearing Center of Children’s Hosp of Pitts Community Advisory Board ​2005 Kathleen J. Gilmartin, Au.D., University of Pittsburgh Ear & Eye Inst. 2006 Catherine V. Palmer, Ph.D., University of Pittsburgh Medical Center 2007 George Nofer, JD, Philadelphia, PA 2008 Roberta Aungst, MS, CCC-A 2009 Deborrah Johnston, Au.D., DePaul School for Hearing and Speech 2010 John Nicotra 2012 Donald E. Rhoten, M.Ed., M.S., Pittsburgh 2014 Anne Gaspich, Harrisburg 2016 Mary Hawkshaw, RN, BSN, CORLN, Drexel University College of Medicine ​ 2017 Katherine T. Verdolini Abbott, PhD, M.Div ​2018 Margaret McCall Baroody, MM 2019 Linda M. Carroll, PhD 2020 Ruth G. Auld, EdD 2021 Tamara L. Wasserman-Wincko, M.S. 2022 Paula B. Marcinkevich, AuD, CCC-A 2023 Adeline R. Schultz, M.Ed. Presented to a lay person in Pennsylvania (frequently a legislator) who has rendered outstanding service to community in support of quality health care. Recipients ​1991 State Senator J. Doyle Corman, Bellefonte 1992 State Representative Edwin G. Johnson, Hollidaysburg 1993 State Representative Elaine F. Farmer, McCandless 1994 U. S. Senator Arlen Specter 1995 State Representative Matthew J. Ryan, Delaware County 1996 Hon. Merle Phillips, Sunbury 1997 Gov. Thomas Ridge, Harrisburg 1998 Hon. J. Scot Chadwick, Harrisburg 1999 None Presented 2000 None Presented 2001 Hon. Charles T. McIlhinney, Jr., Harrisburg 2002 Hon. Curt Schroder, Harrisburg 2003 Hon. Jane C. Orie, Pittsburgh ​2004 Hon. Rick Santorum ​2005 Hon. Jake Corman 2006 Hon. Charles D. Lemmond 2007 Hon. Jim Gerlach 2008 Hon. Mike Turzai, Allegheny County 2009 Hon. P. Michael Sturla, Lancaster County 2010 Hon. Susan Helm, Dauphin County 2012 Hon. Ronald S. Marsico, Dauphin County 2013 Hon. Joseph B. Scarnati, III 2014 Hon. Jay Costa, Pittsburgh 2015 Hon. Mark Mustio 2017 Madame Justice Sandra Schultz Newman ​2018 Hon. Harry Readshaw 2019 Hon. Bryan D. Cutler, JD, BS RTR, Lancaster County 2020 Hon. David S. Hickernell 2021 Hon. Kerry A. Benninghoff 2022 Hon. Marty Flynn 2023 Hon. Ryan P. Aument The Ellie Goldenberg Award is presented in loving memory of Ellie Goldenberg (z"l), by her parents Drs. Renee and David Goldenberg’s . In establishing this award, the Goldenberg Family wants Ellie’s legacy of hard work, dedication, and kindness to be commemorated and perpetuated for generations. Recipients ​2023 Kasra Ziai , MD and Nicole Molin, MD

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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.

Annual Scientific Meeting Venue Information The Hotel Hershey ​100 Hotel Road, Hershey, PA 17033 NOTE: The room block at The Hotel Hershey has now been filled or there may be very limited availability for the dates of the PAO-HNS 2024 Annual Scientific Meeting. The cut-off date of May 15 has passed, and rooms and/or group rate may no longer be available. Cancellations must be made 72 hours prior to the day of arrival. No changes or cancellations are permitted within 72 hours of arrival. To inquire about possible rooms, please call the hotel at 855-729-3108 and ask for the room block for PAO-HNS 2024 Annual Scientific Meeting. ​ Nearby hotel options include: The Hershey Lodge (adjacent to Hotel Hershey): rooms available as of May 8 Contact information: 844-330-1802 . PAOHNS does NOT have a room block here. https://www.hersheylodge.com/accommodations/ ​ Hilton Garden Inn (3 miles from Hotel Hershey): Room block available for PAO-HNS. When online or in app use code: Use Group Code PAOHNS under Special Rates Rates information here: https://www.otopa.org/asm-2024---hotel.html Reservations: https://www.hilton.com/en/hotels/mdthegi-hilton-garden-inn-hershey/ ​ Register for the Annual Scientific Meeting Questions? For questions about the Annual Scientific Meeting, please contact the PAO-HNS Meeting Manager, ​ Jessica Winger: jwinger@pamedsoc.org or (717) 909-2693 .

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.

Nose, Sinus, and Allergy In This Section: Allergic Rhinitis Aspirin Exacerbated Respiratory Disease (AERD) Chronic Rhinosinusitis (CRS) Deviated Nasal Septum Allergic Rhinitis Authors: Heather N. Ungerer, BA (University of Pennsylvania Hospital), Nithin D. Adappa, MD (University of Pennsylvania Hospital) Overview: Allergic Rhinitis is an inflammatory condition characterized by hypersensitive and overreactive immune system responses to allergens (otherwise harmless substances that do not cause symptoms for other individuals). Common allergens include pollen, airborne mold spores, animal dander, cockroach particles and dust mites. In patients with allergic rhinitis, the immune system responds to allergens by releasing histamine, a chemical that causes a variety of symptoms in the nose, throat, eyes, ears, and skin.[1] Allergic rhinitis can be either seasonal or perennial (year-around). Patients with seasonal allergic rhinitis will notice flare-ups in symptoms around the changing of the seasons or during certain times of the year. Allergic rhinitis is a common condition that impacts over 24 million people in the United States and between 10-30% of the worldwide population[2] [3] . A common variant of allergic rhinitis is nonallergic rhinitis with eosinophilia syndrome (NARES). NARES is a condition of unknown cause but presents with symptoms similar to that of allergic rhinitis. The primary difference between allergic rhinitis and NARES is that patients with NARES will test negative to allergens in skin tests or blood tests. Additionally, a key component of NARES is the presence of eosinophils (a type of white blood cell) in nasal secretions. While the cause remains unknown, treatment for NARES generally consists of steroid nasal sprays which can be combined with antihistamines. Symptoms: Patients with Allergic rhinitis may experience a combination of any of the following symptoms: Rhinorrhea (runny nose) or nasal obstruction Itchy or watery eyes Itchy skin or mouth Sneezing Sore or irritated throat accompanied by a cough Fatigue Headaches What to expect at your office visit: Your office visit will begin with your allergist or otolaryngologist asking you detailed questions about the onset and nature of your symptoms in addition to questions about your lifestyle in order to identify the cause of your symptoms. Important considerations include your work conditions, home conditions, exposure to household pets, geographical factors, and family medical history. A clinical diagnosis can be made based on the characteristics of the symptoms, however, in most cases your physician will recommend allergy testing in order to determine specific allergies and the severity of each. If you are experiencing severe nasal symptoms, your physician may also perform a nasal endoscopy during which a nasal endoscope, a long, thin device with a camera and light at the end, is used to access and view your sinuses. Treatment: Treatment of allergic rhinitis depends on symptoms and severity. Luckily, there are a variety of options available. Lifestyle changes (replacing carpet, air filters, using humidifiers, protective bedding) Patients benefit from small lifestyle changes that reduce their exposure to certain allergens. Airborne particulate matter can be controlled by regularly replacing air filters or using a stand-alone air filter. Dusting hardwood surfaces, vacuuming carpeted floors, and using protective bedding to control exposure to dust mites has also proved beneficial to patients with specific dust mite allergies. Antihistamines Antihistamines act by limiting the amount of histamine produced by the immune system when exposed to an irritating allergen. This mediates the body’s response to the allergen. Many over the counter options are available as either oral tablets, nasal sprays, or eye drops. Some common antihistamines include Loratadine, Ceterizine, and Fexofenadine. Please consult your doctor before beginning a new medication. Decongestants Decongestants are often confused with antihistamines. While antihistamines can help with itching and sneezing, decongestants target the inflammation inside your nose that makes you feel congested or experience sinus pressure. Decongestants are readily available over the counter but can also be prescribed in more severe cases. Decongestants should only be used for a few days at a time, otherwise side effects may occur and result in a worsening of symptoms. Immunotherapy (allergy shots) Immunotherapy, or allergy shots, is an effective way to manage allergic rhinitis that has otherwise failed to respond to medication. Immunotherapy is a long-term treatment option that can last anywhere from 3-5 years. Patients undergoing immunotherapy are incrementally exposed to the allergen(s) that cause their symptomatic response, thereby actually training the immune system to become less sensitive to the allergen. Initially, shots are administered once or twice weekly until a maintenance dose is reached. Once patients are in the maintenance phase, allergy shots are administered every two to four weeks. ​ [1] https://www.aaaai.org/conditions-and-treatments/allergies/rhinitis [2] http://www.aafa.org/allergy-facts/ [3] https://www.healthline.com/health/allergic-rhinitis Aspirin Exacerbated Respiratory Disease (AERD) Authors: Heather N. Ungerer, BA (University of Pennsylvania Hospital), Nithin D. Adappa, MD (University of Pennsylvania Hospital) Overview: Aspirin Exacerbated Respiratory Disease (AERD), formerly known as Samter’s Triad, is a chronic inflammatory condition and a difficult to treat variant of asthma, known for its triad of symptoms: nasal polyps, asthma, and hypersensitivity or allergy to non-steroid anti-inflammatory drugs (NSAIDs) including Aspirin. Patients with AERD experience acute reactions that mimic an asthma attack when exposed to NSAIDs. AERD is an acquired condition with no known cause and generally presents around age 30-40. Symptoms: Patients with AERD will find themselves suffering from all of the following symptoms: Sensitivity to non-steroid anti-inflammatory drugs (NSAIDs) including Aspirin Nasal Polyps Asthma These symptoms can present in any order and are often accompanied by chronic rhinosinusitis and anosmia (loss of the sense of smell). What to expect at your office visit: Your office visit will begin with your physician asking you questions about the onset and nature of your symptoms in order to gain an understanding of the duration and severity. In cases where a patient has a known history of NSAID sensitivity, asthma and nasal polyps, a diagnosis can be made with minimal further testing. Your doctor will use a nasal endoscope, which is a long, thin device with a camera and light at the end, to access and view your sinuses to determine the presence of nasal polyps. You may also be asked to obtain a CT of your sinuses which will allow your physician to visualize areas unable to be accessed with the endoscope. If NSAID sensitivity is unknown, your physician may also recommend an aspirin challenge during which you will be exposed to a small amount of aspirin to see if you have a respiratory response in a carefully monitored medical setting. Treatment: Treatment of AERD is a multifaceted process that almost always involves surgical intervention, aspirin desensitization and long-term aspirin therapy. Once a positive diagnosis of AERD has been made your physician will discuss sinus surgery in order to remove nasal polyps. You can expect approximately four to six weeks after surgery to undergo aspirin desensitization. Aspirin desensitization is a procedure in a closely monitored clinical setting where you are incrementally exposed to a higher dose of aspirin until you are able to tolerate the dosage with no adverse systemic reactions. After this, your physician will place you on a daily aspirin regimen. Over time, the dosage will be lowered until you are on a maintenance dose daily. AERD is one of the most difficult forms of chronic rhinosinusitis and nasal polyposis to manage. Data supports this multidisciplinary approach as patients who are not correctly treated have multiple surgeries and continue to be symptomatic. Chronic Rhinosinusitis (CRS) Authors: Heather N. Ungerer, BA (University of Pennsylvania Hospital), Nithin D. Adappa, MD (University of Pennsylvania Hospital) Overview: Sinuses are small, air filled cavities between the bones of the head and face. Healthy sinuses are lined with soft tissue called mucosa and a thin layer of mucus. This thin layer of mucus lubricates your nose and acts to drain out allergens and bacteria down the back of your throat. Chronic Rhinosinusitis is a condition in which the sinuses become inflamed for a period of twelve weeks or longer. This inflammation disrupts the normal drainage of mucus, causing it to accumulate within the sinuses. The causes of CRS are multifaceted and are most commonly a result of the body’s natural inflammatory response to allergens and other airborne particulates. Chronic rhinosinusitis can also be due in part to chronic infections which lead patients to become chronically inflamed and swollen. The physical structure of the sinuses, including a deviated nasal septum and/or nasal polyps, respiratory disorders such as cystic fibrosis, autoimmune disorders and immunosuppressant drugs are also related to chronic rhinosinusitis. Symptoms: Patients with CRS will find themselves suffering from two or more of the four following symptoms: Facial pain or pressure or headaches around and above the eyes Thick, discolored drainage running from the nose or down the throat Congestion and nasal obstruction and difficulty breathing through the nose Loss of sense of smell What to expect at your office visit: Your office visit will begin with your physician asking you questions about the onset and nature of your symptoms in order to gain an understanding of the duration, severity and potential causes of your condition. In order to make an accurate diagnosis of your condition your doctor will use a nasal endoscope, which is a long, thin device with a camera and light at the end, to access and view your sinuses. You may be asked to obtain a CT of your sinuses which will allow your physician to visualize areas unable to be accessed with the endoscope. Your physician may also take a culture of your sinuses to determine if a bacteria is present. Treatment: If you are actively infected at the time of your visit you can expect to be prescribed a course of antibiotics and/or a steroid taper. Additional therapies may include routine sinus rinses. This can be done with an OTC nasal irrigation squeeze bottle and either a plain saline solution or with steroids and/or antibiotics that can be added to the saline. In some cases, nasal sprays will also be prescribed. Patients with severe allergy induced inflammation can expect to be directed to their local allergist for evaluation and potential immunotherapy/allergy shots. For patients with a history of long-term sinus disease, lasting over 3 months, who have exhausted all medical management, surgery is an option. Sinus surgery is also commonly known as Functional Endoscopic Sinus Surgery or FESS. Patients undergoing functional endoscopic sinus surgery can expect their surgeon to open up their sinuses by removing small bony partitions and all purulent drainage. If you have a deviated nasal septum, your surgeon will also perform a septoplasty to straighten the septum. In the case of nasal polyps, your surgeon will also remove these during surgery. In general, the vast majority of patients do well with surgery but must continue long-term with nasal rinses and allergy management (if necessary). References: https://www.uptodate.com/contents/chronic-rhinosinusitis-beyond-the-basics http://www.entnorthtexas.com/Documents/Sinus%20Surgery%20Description.pdf https://www.americansinus.com/where-does-sinus-drainage-go/ Deviated Nasal Septum Authors: Heather N. Ungerer, BA (University of Pennsylvania Hospital), Nithin D. Adappa, MD (University of Pennsylvania Hospital) Overview: A nasal septum is the piece of cartilage and bone that separates the two sides of the nasal cavity. A deviated septum is a common condition that occurs when the septum is bent, or deviated, causing one side of the nasal cavity to be narrower than the other. While patients with severe deviations can present with a variety of symptoms, most patients with a deviated septum are asymptomatic and unaware that they have a deviation. A patient with a severely deviated septum often has difficulty breathing through one side of their nose and may notice an unusual amount of nasal obstruction from one or both sides of the nose. A deviated nasal septum can be present at birth or can result from trauma to the face and nose leading to misalignment of the septum. It is important to note that a deviated septum is often not visible from the outside of the nose and does not necessarily change the apparent structure of the nose itself. Symptoms: The most common symptom of a deviated nasal septum is nasal obstruction which leads to difficulty breathing and the feeling of congestion, predominately from one side of the nose. Other symptoms include: Nosebleeds Snoring or loud breathing during sleep Headaches or facial pain Frequent or seemingly constant sinus infections What to expect at your office visit: Your office visit will begin with your physician asking you questions about the onset and nature of your symptoms. In order to make an accurate diagnosis of your condition your doctor will use a nasal endoscope, which is a long, thin device with a camera and light at the end, to access and view your septum and your sinuses. You may also be asked to obtain a CT of your sinuses which will allow your physician to more clearly visualize the severity of your septal deviation. Treatment: Currently, the only treatment for a deviated nasal septum is a surgical procedure called a septoplasty. During a septoplasty, your surgeon will straighten your septum by removing parts of the septum, repositioning them and then reinserting them. The pieces are then held in place by dissolvable stiches. Patients can generally expect 1-2 follow up visits with their surgeon to make sure that the septum has healed properly and in the correct position. Rather than surgery, patients can also attempt to manage symptoms caused by their deviated septum. Initial treatment consists of nasal steroid sprays. While nasal steroid sprays will not help the deviated septum, they act to shrink the inferior turbinates which will allow more airflow through your nasal cavities decreasing the amount of nasal obstruction. If this is not successful, surgery is the next option.

Membership Membership Application Join the Pennsylvania Academy of Otolaryngology - Head and Neck Surgery and become a part of the only statewide organization representing the interests of otolaryngologists and their patients. Physicians who holds a degree of Doctor of Medicine or Doctor of Osteopathy, have completed an approved residency training program or fellowship in otolaryngology or their equivalent, who are licensed to practice medicine in Pennsylvanian and whose practice is limited to otolaryngology/head and neck surgery are eligible to apply for membership.​ ​We have moved! Your member portal will look a little different when you log in now. To log in for the first time, select “Forgot your password?” and enter your email address. You will be emailed a password reset request that will allow you to log into your new member portal. Once you are logged in, take a look around! You will be able to update your information as needed, add a profile picture, and a biography if you so choose. Please reach out to info@otopa.org or call us at 833-770-1544 if you have any questions. View the Benefits of Membership

Acoustic Neuroma​ ​ Author: Andrew A. McCall, MD, University of Pittsburgh Medical Center Overview: Acoustic neuroma, otherwise known as vestibular schwannoma, is a benign intracranial tumor that develops in the space between the brainstem and inner ear (the cerebellopontine angle). Although the tumor is commonly referred to as acoustic neuroma, this term is a misnomer because these tumors usually arise from the vestibular (balance) nerve rather than the acoustic (hearing) nerve. Most often these tumors develop spontaneously, however in a small percentage of cases they develop as a result of an underlying genetic disorder (Neurofibromatosis type 2) where the tumors are present on both sides. Symptoms: Symptoms of acoustic neuroma include unilateral or asymmetric sensorineural hearing loss (hearing loss originating from the inner ear and/or hearing nerve), tinnitus (ringing or buzzing in the ear), and imbalance or dizziness. Less common symptoms include facial numbness and rarely facial weakness or paralysis. What to Expect at Your Otolaryngologist Office Visit: A complete history and physical examination of the head and neck will usually be obtained for patients who present with symptoms suggestive of an acoustic neuroma. An audiogram will often be obtained for hearing related complaints. Vestibular testing may be performed for balance related symptomatology. If an acoustic neuroma is suspected, a MRI scan will typically be obtained to evaluate for the presence of a tumor. Many other disease processes (e.g. Meniere’s disease, sudden sensorineural hearing loss, labyrinthitis, etc.) can mimic the symptoms of acoustic neuroma, but do not share the MRI findings of a tumor. Once the diagnosis of acoustic neuroma is established, consultation is typically sought with a specialized otolaryngologist known as an otologist/neurotologist. Treatment: While each patient and situation is unique, three main treatment options should be considered: observation, surgical resection, and radiosurgery. Observation of acoustic neuroma entails evaluating the tumor for growth with serial MRI scanning. Acoustic neuroma, on average, tends to be very slow growing – on the order of one or two millimeters per year. However, some tumors are dormant and do not grow and, occasionally, some tumors grow at a more rapid pace. If a tumor should grow during observation, more active intervention with surgery or radiosurgery would likely be recommended. There are three surgical approaches used to remove acoustic neuroma: translabyrinthine, retrosigmoid, and middle fossa. The decision upon which surgical approach is best for a particular patient and tumor is highly individualized and should be discussed in detail with the treating physician. Surgery for these tumors is often performed as a team approach incorporating the skills of an neurotologist and a neurosurgeon because these tumors reside at the junction between the inner ear and brainstem. Radiosurgery is used to arrest growth of acoustic neuroma. Radiosurgery involves steering beams of radiation from multiple angles to concentrate the radiation on the tumor and spare adjacent structures, such as the inner ear or brainstem. One of several different machines may be recommended for delivery of the radiation treatment (e.g. Gamma Knife and Cyber Knife).

COVID-19 Resources The Pennsylvania Academy of Otolaryngology - Head and Neck Surgery (PAO-HNS) is aware of our members concerns during this challenging time. Information on the coronavirus and COVID-19 continues to grow, which creates new recommendations that evolve and even change frequently. Many national organizations have created resources for physicians seeking guidance on the disease, its impact to our patients, the growing evidence of unique risks we face as surgeons, and the business challenges of practice operation during this time of limited patient visits and surgeries. ​In an effort to guide our colleagues in the state to helpful sources of information, we are providing these resources. The PAO-HNS hopes that as we remain dedicated to the care of our patients, we can likewise function in an educated and safe fashion to protect ourselves, our fellow healthcare workers, and our families. American Academy of Otolaryngology - Head and Neck Surgery Coronavirus 2019 Resources American College of Surgeons COVID-19 and Surgery Centers for Disease Control and Prevention Information for Healthcare Providers Pennsylvania Department of Health COVID-19 Information for Health Care Professionals ​ Sub-Specialty Societies ​ American Head and Neck Society COVID-19 Bulletin Board American Society of Pediatric Otolaryngology IPOD COVID-19 Survey Report American Rhinologic Society Coronavirus (COVID-19) Updates

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