Voice and Throat Disorders In This Section: Airway Stenosis Chronic Cough Dysphagia (difficulty swallowing) Spasmodic Dysphonia Zenker’s Diverticulum Airway Stenosis Author: Ahmed M.S. Soliman, MD Overview: The term stenosis refers to the abnormal narrowing of a tube-shaped organ. In the human airway, the three main areas where this can occur are in the larynx (voice box), subglottis (just below the vocal folds), and trachea (windpipe). The main cause of laryngeal narrowing is having had a breathing tube in place. Other causes include certain autoimmune/rheumatological conditions (Wegener’s granulomatosis, Sarcoidosis Relapsing polychondritis, Amyloidosis), trauma to the neck or voice box, and surgery, or radiation to the larynx. Symptoms: Symptoms include noisy breathing, coughing, and shortness of breath. It is frequently misdiagnosed as asthma. The symptoms may become quite severe and life threatening. What to Expect at Your Otolaryngologist Office Visit: Evaluation will start with a complete examination of the head and neck. It will also include examination of the nose, voice box and the throat using a laryngoscope. Your doctor may order a chest X-ray, CT or other tests as appropriate. If you have had any of these already done, please bring them with you to the visit. Treatment: Treatment usually starts with evaluation of the larynx, subglottis, and trachea in the operating room. Endoscopic treatment with the laser and dilation is usually successful although sometimes, surgical reconstruction through the neck is necessary. Chronic Cough Author: Ahmed M.S. Soliman, MD Overview: A chronic cough is a cough that persists for eight or more weeks. Chronic cough can lead to exhaustion, rib fractures, vomiting, hoarseness and lightheadedness. Symptoms: Chronic cough is a symptom and not a diagnosis. It is typically the result of an underlying condition or health factor. The most common of these include tobacco use, certain blood pressure medications, asthma, chronic rhinosinusitis, and acid reflux. Other causes of chronic cough include respiratory infections, and chronic bronchitis. What to Expect at Your Otolaryngologist Office Visit: Evaluation will start with a complete examination of the head and neck. It will also include examination of the nose, voice box and the throat using a laryngoscope. You may be given some food to eat while the doctor examines your throat (called flexible evaluation of swallowing or FEES). Your doctor may order a chest X-ray, modified barium swallow, esophagram, sinus CT or other tests as appropriate. If you have had any of these already done, please bring them with you to the visit. Treatment: Treatment will depend upon what the underlying cause or causes. This may include dietary and behavioral modifications, antibiotics, antireflux medications, inhalers, etc. Dysphagia (difficulty swallowing) Authors: Nausheen Jamal, MD – Department of Otolaryngology-Head & Neck Surgery, Lewis Katz School of Medicine, Temple University Overview: Dysphagia refers to any difficulty swallowing that a person may have. This difficulty may occur in many different forms and will affect a person’s ability to eat or drink in the upper digestive tract – in other words, anywhere from the lips down to the stomach. Causes of dysphagia vary as well. These include weakness of throat muscles, “pouches” within the throat or food pipe, narrowing of the throat or food pipe, muscle spasms, trouble with coordination within the throat or food pipe, or even issues with the teeth or dentures. Sometimes other medical conditions can lead to dysphagia. These include medications, prior stroke, any tumors, and prior surgeries. Trouble with swallowing can cause drastic quality of life issues. In addition, it can lead to serious medical complications, such as pneumonia, malnutrition, and undesired weight loss. Symptoms: Coughing and choking during eating Extra time needed to eat meals Avoiding or having difficulty with certain food consistencies because of swallowing difficulty Drooling Difficulty chewing Difficulty starting a swallow Waking up at night choking or drooling Food coming back up into the throat or nose during eating Feeling food stick in the throat or chest History of pneumonia Weight loss and malnutrition What to Expect at Your Otolaryngologist Office Visit: A careful examination of your mouth and throat will provide your doctor with a lot of information. Your otolaryngologist may perform specialized tests, including a laryngoscopy (“scope” procedure through your nose and into your throat), a swallow evaluation, and possibly even a procedure to look in your food pipe. It is possible that your otolaryngologist will order specialized testing, including x-ray swallow tests (such as a barium swallow or modified barium swallow). You may be given a referral to see a speech pathologist who is also trained in swallow disorders. Treatment: Because the causes of swallow disorders vary, so do the treatments. Generally speaking, swallow disorders that are caused by issues of weakness or lack of muscle coordination are treated with swallow therapy, which is like physical therapy for the swallowing muscles of the throat. This therapy is performed by a speech pathologist. Swallow disorders that are caused by areas of narrowing, “pouches,” certain types of muscle spasms, voice box movement disorders, or tumors are typically treated with surgery. Most of these surgeries are performed endoscopically, meaning that they are performed through the mouth without a need for incisions in the neck. Sometimes, however, a surgery that requires an incision in the neck is needed. Most surgeries require staying in the hospital for at least one night following the operation. A few minimally invasive surgeries may allow discharge on the same day as the operation. Your doctor will discuss if surgery is the right option for you, and what an operation might involve. Spasmodic Dysphonia Author: Ahmed M.S. Soliman, MD Overview: Spasmodic dysphonia (SD) is a rare neurologic disorder in which the larynx experiences involuntary spasms. There are three forms of the condition, adductor SD, Abductor SD, and Mixed SD, each with distinct vocal symptoms. It is estimated that roughly 50,000 people in North America have some form of SD. The condition usually sets in gradually during middle age, and is more likely to affect woman than men. Symptoms: Adductor SD, the most common form, causes the vocal folds to involuntarily close while speaking. The speech of someone with adductor SD sounds choppy, strained or strangled. Abductor SD is much less common and causes the vocal folds to involuntarily open with speaking that they do not vibrate properly. As a result, the voice may sound soft, weak or breathy. Mixed SD has features of both types and is rare. What to Expect at Your Otolaryngologist Office Visit: Evaluation will start with a complete examination of the head and neck. It will also include examination of the larynx or voice box using a laryngoscope. The examination is often videotaped and played back. Your doctor may order an MRI of your brain, and evaluation by Neurology and Speech Pathology. Treatment: Treatment usually involves weakening of the overactive muscle group with botulinum toxin. This treatment is usually done in the office and is highly successful. Voice therapy is often used as an adjunct to treatment. Rarely surgical procedures of the larynx are performed for this. Zenker’s Diverticulum Author: Ahmed M.S. Soliman, MD Overview: Zenker's diverticulum is a pouch that forms in the throat, where the esophagus meets the uppr part of the throat called the pharynx. The pouch forms by pushing through a weakened portion of the pharynx and balloons outward. The condition tends to occur in patients over 60 years but may occur in younger patients. It does not appear to be hereditary. Symptoms: The main symptom of Zenker's diverticulum is dysphagia, or difficulty swallowing. Undigested food or liquid can rise back into the throat and mouth even hours after swallowing. Other symptoms include choking, a buildup of mucous in the throat, bad breath, hoarseness, and recurrent pneumonias. What to Expect at Your Otolaryngologist Office Visit: Evaluation will start with a complete examination of the head and neck. It will also include examination of the voice box and the pharynx using a flexible laryngoscope. You may be given some food to eat while the doctor examines your throat (called flexible evaluation of swallowing or FEES). If you have had a swallowing test, please bring it with you. Otherwise, your doctor will likely order one. Treatment: In cases of mild dysphagia, Zenker's diverticulum can be treated with lifestyle changes. These include: Avoiding fatty, spicy and acidic foods, thoroughly chewing foods before swallowing, drinking lots of water after eating. If the dysphagia is severe, there are a variety of surgical options. The exact procedure our surgeons use will depends on the size and location of the diverticulum and include: Cricopharyngeal myotomy: This procedure is ideal for removing small diverticula. It can be performed directly through the mouth with the laser or through a small incision in the neck. Endoscopic diverticulotomy: This option involves dividing the wall between the esophagus and the diverticulum using the laser or a special staper/cut device. Once the wall is divided, food particles stuck inside the pouch are free to drain into the esophagus. The vast majority of Zenker’s diverticula are treated successfully in this minimally invasive manner. Diverticulectomy and cricopharyngeal myotomy: This procedure is the complete removal of the pouch along with a cricopharyngeal myotomy and is used for a small percentage of patients where the sac is very large or cannot be accessed through the mouth. It is done through a small neck incision.

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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.

Executive Council and Committees Executive Council President Colin T. Huntley, MD Jefferson University - Otolaryngology - Head & Neck Surgery President Elect Pamela C. Roehm, MD, PhD Temple Otorhinology Associates Secretary/Treasurer Neerav Goyal, MD, MPH Penn State Health Milton S. Hershey Medical Center - Otolaryngology - Head & Neck Surgery Immediate Past President Jessyka G. Lighthall, MD, FACS Penn State Health Milton S. Hershey Medical Center Otolaryngology - Head & Neck Surgery Nithin Dev Adappa, MD University of Pennsylvania, Department of Otorhinolaryngology Robert Brody, MD Hospital of the University of Pennsylvania and the Veteran's Administration Medical Center David M. Cognetti, MD, FACS J efferson University - Otolaryngology - Head & Neck Surger y Richard E. Ferraro, MD Carlisle Ear Nose & Throat Assoc. David Goldenberg, MD, FACS Penn State Health Milton S. Hershey Medical Center Otolaryngology - Head & Neck Surger y Thomas Kaffenberger, MD UPMC – Otolaryngology Kevin Kovatch, MD Geisinger Health, Danville Phillip K. Pellitteri, DO, FACS Guthrie Clinic Nicholas Purdy, DO Geisinger Health, Danville Karen A. Rizzo, MD, FACS Lancaster Ear Nose and Throa t Justin C. Ross, DO Philadelphia College of Osteopathic Medicine – Otolaryngology Robert T. Sataloff, MD, DMA, FACS Drexel University - Philadelphia ENT Associates Cecelia Schmalbach, MD, MSc, FACS Temple University Department of Otolaryngology – Head & Neck Surgery, Temple Head & Neck Institut e Jeffrey P. Simons, MD, FACS Children's Hospital of Pittsburgh of UPMC Ahmed M.S. Soliman, MD Temple University Department of Otolaryngology – Head & Neck Surgery, Temple Head and Neck Institut e Kevin Stavrides, MD Geisinger Wyoming Valley Medical Center Sandra Stinnett, MD University of Pittsburgh School of Medicine Department of Otolaryngology Paul B. Swanson, MD ENT and Allergy Specialists Scott Walen, MD Penn State Health Milton S. Hershey Medical Center - Otolaryngology - Head & Neck Surgery Christina M. Yver, MD, MBA University of Pittsburgh School of Medicine, Facial Plastic & Reconstructive Surgery Resident Liasons Jeffrey Lorenz, MD Penn State Health William "Jack" Palmer, MD Jefferson University - Otolaryngology - Head & Neck Surgery Committees Allergy & Rhinology Chair: Nithin Adappa, MD Awards Chair: Robert Thayer Sataloff, MD, DMA, FACS David M. Cognetti, MD, FACS Karen A. Rizzo, MD Jeffrey P. Simons, MD, MMM, FAAP, FACS Bylaws Chair: Philip Pellitteri, DO Facial Plastic & Reconstructive Surgery Chairs : Scott Walen, MD,; Christina M. Yver, MD, MBA Head and Neck Surgery Chair: Neerav Goyal, MD Legislative Chair: Richard Ferraro, MD Membership Chair: Pamela Roehm, MD, PhD Nominating Chair: Jessyka Lighthall, MD, FACS Ototology Chair/term 2024-2026: Pamela Roehm, MD, PhD Patient Safety Chair: Neerav Goyal, MD Pediatrics Chair: Jeffrey Simons, MD Scientific Program 2026 Co-Chair: Sandra Stinnett, MD; Co-Chair: Arielle Thal, MD Sleep Medicine Chair: Vacant Voice, Speech, Swallowing Co-Chair: Ahmed Soliman, MD; Co-Chair: Aaron Jaworek, MD

Annual Scientific Meeting Registration is OPEN! Register Now NEW Location! Lancaster Marriott at Penn Square, Lancaster, PA View Agenda Join the Pennsylvania Academy of Otolaryngology – Head and Neck Surgery (PAO-HNS) Annual Scientific Meeting for a high-impact experience bringing together top physicians, residents, and innovators in the field. This educational event showcases the latest advances in ENT care, cutting-edge research, and expert-led sessions—all designed to inspire, connect, and elevate patient care. Click to Reserve a Room Lancaster Marriott Rooms are being held at the Lancaster Marriott for the PAO-HNS 2026 Annual Scientific Meeting attendees at a reduced rate of $229 for a king and $249 for two queens per room night, plus taxes. Discounted rooms will be offered until Monday, May 11, 2026 - OR UNTIL THE BLOCK IS FULL. A limited number of rooms are being offered; early reservations are strongly encouraged. After the cut-off date, rooms and/or group rate may no longer be available. Cancellations must be made 48 hours prior to the day of arrival. To book your room, please call the hotel at 717-239-1600 and ask for the room block for the Pennsylvania Academy of Otolaryngology Head and Neck Surgery. Past Meeting Highlights To play, press and hold the enter key. To stop, release the enter key. Questions? For questions about the Annual Scientific Meeting, please contact the PAO-HNS Meeting Manager, Jessica Winger: jwinger@pamedsoc.org or (717) 909-2693 .

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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Officers President Colin T. Huntley, MD A ssociate Professor, Jefferso n University, Otolaryngology - Head & Neck Surgery President-Elect Pamela C. Roehm, MD, PhD St. Luke’s University Health Network, Lehigh Valley, PA Secretary/Treasurer Neerav Goyal, MD, MPH Penn State Health Milton S. Hershey Medical Center - Otolaryngology - Head & Neck Surgery Immediate Past 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 Past Presidents The Pennsylvania Academy of Otolaryngology - Head & Neck Surgery 2023-2025 Jessyka Lighthall, MD, FACS 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) 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.

Scenes from the 2024 Annual Scientific Meeting

Advocacy Update What We're Watching.... Noncompete Clauses/Restrictive Covenants On July 17, 2024 Governor Shapiro signed HB1633 into law. The measure, known as Act 74 of 2024 places, for the first time in PA statutory restrictions on noncompete agreements in physician employment contracts. Act 74 will limit noncompete agreements in physician contracts to maximum duration of one year. In a related matter, on August 20, 2024, a Federal District Court judge in Texas struck down the Federal noncompete rule. Senate Bill 25 A scope of practice measure that continues to be of interest to the physician community is SB25. This legislation is known as the Rural Certified Registered Nurse Practitioner Health Care Access Program. If passed into law, this program could be implemented in the 49 (our of 66) counties of the Commonwealth that are deemed rural. This bill will allow an eligible rural Certified Registered Nurse Practitioner to practice as an independent primary healthcare practitioner without a written or collaborative agreement with a physician. The bill requires a CRNP to comply with the requirements of law and standard of advanced nursing care and recognize limitations in knowledge and experience. A CRNP must wear a name identification badge showing the professional title and must inform patients of the title before or during the initial patient encounter. Any signage or advertisements must contain a CRNP’s professional title. A CRNP is required to plan for the management of situations beyond a CRNP’s expertise and consult with and refer patients to other health care providers as appropriate. Senate Bill 25 excludes a collaborating physician from having any legal responsibility for acts or omissions of a CRNP while practicing under the program when there is a written or collaborative agreement with the physician outside of the program. The bill specifically prohibits a CRNP from practicing under the Medical Practice Act of 1985 or the Osteopathic Medical Practice Act through the program. No physician-patient relationship is established when a CRNP consults with a physician or seeks clinical information or guidance. SB25 has been reported out of the Senate Consumer Protection and Professional Licensure Committee as well as the Senate Appropriations Committee. It currently is on the legislative calendar for full Senate consideration this fall. House Bill 1235 SB 1235, if passed, would authorize PA to join the Audiology and Speech Language Pathology Interstate Compact. Although 33 states have passed legislation to join the Compact as of this writing, PAO has taken the position of opposing the legislation as currently written. Reasons for opposing the legislation are as follows; Despite assurances to the contrary, the proposed Interstate Compact for Audiology and Speech-language Pathology attempts to overtake the established licensure process and create a compact that puts the protection of the public in their own hands by creating a Commission that can override state laws, “Unlike the medical licensure compact where a physician must already be licensed to practice in a state (voluntary expedited licensure), this compact attempts to create and dictate initial universal licensure for two very different professions without adequate quality standards. For example, an ASLP licensed in a state with lower standards of practice would be allowed to practice in a state with stronger practice standards. Telehealth: The current compact proposal would allow any compact member to practice telehealth in any other member’s state without documenting appropriate standards of care are being met. Exclusion of physician members: Physician members are appointed to the state ASLP licensing boards, but this is excluded in the Compact. This compact calls for an audiology or speech language pathology service provider to be in compliance with state practice laws outside of their home state yet, the compact negates states’ jurisdictional testing requirements. Oversight is missing from the compact including continuing education. On August 29, 2024 members of the PAO had a meeting with the prime sponsor of the bill to relay their concerns with the legislation. From this discussion we found out that the legislation would most likely not advance this fall and will be reintroduced next year when the new legislative session begins. During the next 3 months, PAO will work with House staff to see if common ground can be found resulting in possible amendments to the measure. 2025 General Assembly Session Dates STATE HOUSE OF REPRESENTATIVES tba STATE SENATE tba

Membership 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