Department of Otolaryngology / Head and Neck Surgery

Department of Otolaryngology/Head and Neck Surgery of Otolaryngology/Head Department DEPARTMENT OF OTOLARYNGOLOGY / HEAD AND NECK SURGERY

CB 7070 | Chapel Hill, NC 27599 | med.unc.edu/ent

Annual Report

Annual Report 2013 Annual Report 2013

2013 Resident Graduates Jessica K. Smyth, MD, Yu-Tung Wong, MD Scott A. Shafar, MD Mihir R. Patel, MD About the Cover 2013 OHNS resident graduate, Yu-Tung Wong, honed his skills this year in the new Temporal Bone Lab and Boy Hears His Simulation Center in Thurston Bowles. Father’s Voice For The First Time

Grayson was born with no cochlear nerves Grayson is beginning to understand that sound and as a result could not hear. is meaningful. He is pairing sound with visual information and using it for communication. He is “I’ve never seen a look like that today,” said Grayson’s also beginning to understand phrases and words. father, Len Clamp, of the day that the implanted device was turned on for the first time. “I mean, Turn to page 8 for a message from the Clamps. he looked deep into my eyes. He was hearing my To see the CBS Evening News’ six-month voice for the first time. It was phenomenal.” update about Grayson, and the video that started it all, please visit go.unc.edu/Mz8i3 CONTENTS About the Cover ...... 2 Rhinology, Allergy & Endoscopic Skull Base Message from the Chair ...... 4 Surgery ...... 92 Message from the Dean ...... 5 Skull Base Center ...... 101 Mission of the Department ...... 6 Voice Center ...... 106 Mission of the School of Medicine ...... 7 Pediatric Otolaryngology ...... 110 Hello from the Clamp Family...... 8 NC Children’s Airway Center ...... 114 Faculty ...... 10 Department Research WakeMed ENT ...... 19 Carlton Zdanski ...... 118 Staﬀ ...... 20 Adam Kimple ...... 118 Graduating Chief Residents Reﬂect ...... 22 Douglas Fitzpatrick ...... 119 Junior Residents ...... 23 Hannah Eskridge ...... 120 Message from Residency Coordinator ...... 26 Paul Manis ...... 121 Residency Program ...... 27 Charles Ebert ...... 122 The Department ...... 29 Craig Buchman ...... 123 New Developments & Highlights ...... 30 Adam Zanation ...... 124 FY13 Statistics & Philanthropy ...... 34 Amelia Drake ...... 124 Distinguished Professorships ...... 37 Carol Shores ...... 125 Educational Programs Oliver Adunka ...... 125 Medical Students ...... 43 Austin Rose ...... 127 NIH Training Grant ...... 44 Robert Buckmire ...... 128 Visiting Professors ...... 48 Holly Teagle ...... 128 Newton D. Fischer Society...... 49 Shuman He ...... 129 Airway Course ...... 50 Emily Buss ...... 129 Fellowship Programs ...... 51 Julia Kimbell ...... 131 Outreach Programs ...... 53 Margaret Dillon ...... 132 Clinical Programs Heather Porter ...... 133 Ear and Hearing Center ...... 58 John Grose ...... 133 Adult Cochlear Implants...... 64 Joseph Hall ...... 134 Pediatric Audiology ...... 66 D. Neil Hayes ...... 135 Hearing and Speech ...... 69 Grace Kim Austin ...... 137 CCCDP ...... 71 Dennis Frank ...... 137 CASTLE ...... 74 Gi for the School of Medicine ...... 138 Facial Plastic & Reconstructive Surgery ...... 76 Presentations ...... 140 Head & Neck Oncology ...... 82 Publications ...... 147 Voice Restoration & Swallowing ...... 88 What Else Do We Do? ...... 154 Robotic Head & Neck Surgery ...... 90 Message from the Chair 4 Message fromthe Ihopeyou enjoy thisreport asmuchIhave. from thebenchtobedside. andNeckSurgery in Otolaryngology/Head push the envelope of advancing our specialty including the translational activities can accomplish as a specialty, a medical center, and a university. We continue to and operative genius. When all cylinders are firing in order, it is amazing what we excellence,clinical research, of coalescence the of example striking a is implant brainstem auditory an received who boy young a Clamp, Grayson of story The the fill to vacancies. Ourdedicationtoteachingthenextgeneration isasrobust asever. students outstanding equally recruited and residents outstanding We graduatedhavewitness. to me for gratifying been has Report Annual this in and the Affordable Health care Act. The wonderful commitmentmultidisciplinary TechnologyfromInformation challenges futureincluding facethe to aligned well if that commitment is held by all the parts of the organization. Our department is that Excellence will prevail and brilliant people will find ways to deliver Excellence we As embark upon the changing health care landscape, departments. I am struck Otolaryngology by the simple notion among significance national of level the Thomas J. Dark Distinguished Professor of Otolaryngology/Head andNeckSurgery Thomas J.DarkDistinguished Professor ofOtolaryngology/Head Department Chair In reviewing is possible. Our efforts in each of these areas reachareas these of each in efforts Our possible. is care, research expertise, and teaching excellence that a have levelsworkdeliverwho to clinicalconcert best in the We all at professionals the dedicated of group department. by tremendous struck our am of I cohesiveness Report, Annual year’s this Chair, andNeckSurgery Department ofOtolaryngology/Head Harold C. Pillsbury III,MD,FACSHarold C.Pillsbury

Message from the Message from the 5

Department Chair Medical School Dean Message from the Dean The Department of Otolaryngology/Head and Neck Surgery (OHNS) at the School of Medicine thrived during a year of unprecedented change in health care. As concerns rose around cost and improving patient experience, UNC’s OHNS faculty, residents and students addressed these issues through partnerships and innovation.

One of OHNS’s most impressive advancements is featured on the cover of this Annual Report. Department faculty, staff and researchers worked together last spring to give the gift of hearing to Grayson Clamp, a 3-year- old from Charlotte, NC. Grayson was the first child in the country to receive an auditory brain stem implant, and he received it right here at UNC Hospitals. The surgery was a partnership between OHNS and the Department of Neurosurgery, and was performed as part of an FDA clinical trial.

Cutting-edge care like the kind provided to Grayson help put UNC Health Care and the School of Medicine in a position to lead – not just our own colleagues and patients, but also people from across the country. By translating research and discovery into real results for our patients, we are living out our mission to improve the health of North Carolinians and others whom we serve.

This year, U.S. News & World Report, ranked OHNS 22 nationally. OHNS is consistently one of the highest-ranking specialties at UNC. Through superb care, ground breaking research and enhanced opportunities for medical residents, our OHNS Department is leading the charge for innovation in medicine and health care delivery.

The list of accomplishments and accolades for the OHNS Department is long. From expanding otolaryngology services to Chatham Hospital in Siler City, to success in the Malawi Surgical Initiative, to the countless awards for care, humanitarian efforts and research faculty have received, your unwavering commitment to patients and the practice of medicine is clear.

Thank you for your research pursuits, and for your service to our students and each patient who walks through our doors. Because of your efforts, the practice of medicine William L. Roper, MD, MPH and delivery of care are stronger. Dean, School of Medicine Vice Chancellor for Medical Affairs CEO, UNC Health Care System 6

he mission of the Department of Otolaryngology/Head and Neck Surgery is to improve T health care by enhancing the field of otolaryngology/head and neck surgery and by advancing its clinical application. To fulfill this mission, our objectives are the following:

1. To provide excellent otolaryngologic/head and neck surgical patient care that can serve as a national model.

2. To provide outstanding undergraduate and postgraduate education that disseminates otolaryngology/head and neck surgery knowledge and facilitates more contributions to the knowledge base.

3. To carry out basic science, clinical, and health services research that advance the field of otolaryngology/head and neck surgery. Mission of the Department of OHNS Mission of the Department 7 Vision Mission of the School Medicine To be the nation’s leading public school of medicine.

Mission of the Our mission is to improve the health of North Carolinians and others whom we serve. We will accomplish this by achieving excellence and providing leadership in the interrelated areas of patient School care, education, and research.

• Patient Care of Medicine As a key component of the UNC Health Care System, the School of Medicine will provide superb care to North Carolinians and others whom we serve. We will maintain our strong tradition of reaching underserved populations. Excellence in education and research will enhance our delivery of the very best medical care, which will be presented in an environment that is exceptionally welcoming, collegial, and supportive both for those receiving and those providing the care.

• Education We will achieve excellence in educating tomorrow’s health care professionals and biomedical researchers by providing exceptional support for outstanding teaching and research faculty. We will offer an innovative and integrated curriculum in state-of-the-art facilities. The School of Medicine will attract the very best students and trainees from highly diverse backgrounds. • Research

We will achieve excellence in research and in its translation to patient care by developing and supporting a rich array of outstanding research programs, centers, and resources. Proximity to the clinical programs of UNC Hospitals, to UNC-Chapel Hill’s other premier health affairs Schools (Dentistry, Nursing, Pharmacy, and Public Health) and the other departments, schools, and programs on the UNC-Chapel Hill campus affords an exceptional opportunity for innovative, world- class research collaborations.

In all of these missions, we will strive to meet the needs of our local, state, national, and global communities. 8 The Clamp Family L-R: Ethan, Nicole, Len and Grayson Grayson Clamp Hello from The Clamp Family! by Len & Nicole Clamp

We are and continue to be so blessed to have UNC as our that we were well informed and educated on all options/risks, medical partner and health care provider through what and able to make a decision together…as a unified team. has been an absolute miracle in the life of our 3-year-old, Grayson. Throughout the process, UNC has provided access to both state-of-the-art approaches and a world-class treatment We have had the great fortune of being able to work with facilities. Knowing that our goal for Grayson was for him UNC since 2010; through multiple surgeries on Grayson, time to learn and use spoken language, we elected to use Cued in the Pediatric Speech over American ICU, and Sign Language (which countless hours “His success is in large part due is a more common of therapy. We visual approach). now stand able to the team at UNC, and the UNC supported our to share a story decision, which we of victory as our confidence and care with which knew would provide son becomes important benefits one of the first they work to help children.” in developing speech children in the when paired with a world to gain hearing device such access to hearing through an Auditory Brainstem Implant as a cochlear implant or (for us) an ABI. Finally, the treatment (ABI), implanted at UNC Hospitals in April 2013. center at CASTLE where we go weekly for Audiology and Speech Therapy is a parent-centered, teaching environment Through North Carolina’s early intervention process and where we work directly and alongside Grayson’s specialists UNC’s phenomenal hearing program, our family was able to to become skilled “in home” therapists so we can keep the identify and diagnose Grayson’s unique hearing needs very progress moving at home in between visits. early on, and put a comprehensive plan together to address his challenges just after his 3rd birthday. At every step, both Grayson can now hear, has begun vocalizing vowels and groups created a very collaborative atmosphere, ensuring consonant sounds, and will one day be able to tell his own 9 story of perseverance and thanksgiving. His success is in

large part due to the team at Grayson Clamp UNC, and the confidence and care with which they work to help children. I wish all parents around the country had access to the network we have.

Grayson’s story is but a glimpse of the miracle work God can do through faithful parents Drs. Holly Teagle and Lisa Park with Grayson. (Sara Davis/Associated Press) and expert physicians and specialists. God Bless. on cochlear implants and a unique form of sign language More about Grayson’s Journey called Cued Speech. Cued Speech, unlike American Sign Language, signals every word that is spoken (through Grayson was born with a condition called CHARGE, a combination of hand shapes and lip reading), which leaving him with a heart defect, no hearing, and no when accompanied by a hearing aid stimulates speech sight in his left eye. We adopted Grayson through North and language development. They also connected us to Carolina’s Foster Care system in 2010. the audiology experts at UNC.

Upon finding out for sure that Grayson could not hear Grayson was implanted with a Cochlear implant at 18 (at about a year old), a blast email opened the door for months old. The device was a long-shot given his lack us to a wonderful family in Charlotte who educated us of hearing nerves in either ear, but we took the chance anyway, and in doing so, opened the door to develop a relationship with Dr. Craig Buchman and Dr. Holly Teagle. The cochlear implant did prove to be ineffective, so when Dr. Buchman offered us the chance to join the ABI trial, we jumped at the opportunity.

In April 2013, Grayson became the first child in the US to receive an ABI under the FDA approved trial through UNC’s protocol. Dr. Craig Buchman (ENT) and Dr. Matt Ewend (Neuro) performed the surgery. We spent nearly 4 weeks in the hospital – 2.5 in the pediatric ICU where Grayson had to literally lay in a bed without moving for 14 days to stabilize a post operation cranial fluid leak.

Grayson’s device was activated on May 21st…the most amazing day of our lives! Watch the videos online to see for yourself!

Our life verse throughout this journey has been 1 Corinthians 2:9, “No eye has seen, no ear has heard (until May 21st), no mind has conceived what God has prepared for those who love him.” N.C. Senator Kay Hagan visited CCCDP to observe Grayson. (Sara Davis/Associated Press) 10 Faculty Special Interests: Otology/neurotology andskullbasesurgery, lateral skull Research University ofPittsburghSchool of Fellowship (Otolaryngology): base surgery, acoustictumors,cochlearimplants, hearingpreservation. Chief, DivisionofOtology/Neurotology andSkullBaseSurgery Fellowship (Otology/Neurotology and Skull Base Surgery): Fellowship (Otology/Neurotology andSkullBaseSurgery): Residency: University ofPittsburghSchoolMedicine Craig A. Buchman, MD, FACS Harold C. Pillsbury DistinguishedProfessorHarold C.Pillsbury Medicine, Children’s HospitalofPittsburgh Medical Administrative Director, CCCDP House EarInstituteandClinic,Los Angeles Special Interests: Otolaryngology-head andnecksurgery,Special Interests: neurotology, Otolaryngology-head facial allergy, plasticsurgery, otolaryngic Vice ChairforClinicalAffairs Executive Director oftheW. MD,Carolina PaulBiggers, Children’s Communicative Disorders Program MD: University ofFlorida cochlear implantation,acoustictumors,skullbasesurgery, laserutilizationinheadandneckcancer. Professor Thomas J. Dark Distinguished Professor of Otolaryngology/Head andNeckSurgery Thomas J.DarkDistinguishedProfessor ofOtolaryngology/Head Residency: University ofNorthCarolina SchoolofMedicine Harold C. Pillsbury III, MD,Harold C. Pillsbury FACS MD: GeorgeWashington University Professor andChair Chief, DivisionofRhinology, Allergy, andEndoscopicSkull Fellowship (Rhinology and Sinus Surgery): University of University of Fellowship (RhinologyandSinusSurgery): of the anterior skull base; surgical management of sleep of theanteriorskull base;surgicalmanagement ofsleep management of sinusitis, CSF rhinorrhea, and tumors management ofsinusitis,CSFrhinorrhea, andtumors Residency: BostonUniversity andTufts University Brent A. Senior, MD, FACS, FARS Special Interests: Endoscopicminimallyinvasive Nathaniel T. and SheilaW. HarrisProfessor Vice ChairforAcademic Affairs Pennsylvania MedicalCenter MD: University ofMichigan apnea andsnoring; allergy. Base Surgery Professor

Faculty 11

Buss, PhD Buss, Professor Assistant Professor Emily Esa A. Bloedon, MD Bloedon, Esa A. University of North Carolina at Chapel Hill of North Carolina University Special Interests: Normative psychoacoustics, Normative Special Interests: development, speech perception, binaural hearing, binaural speech perception, development, Residency: Thomas Jefferson University Hospital Residency: Thomas Jefferson University MS, PhD (Psychology): University of Pennsylvania University MS, PhD (Psychology): auditory prostheses and sensori neural hearing loss. auditory and sensori neural prostheses Post-doctoral Research Fellowship (Psychoacoustics): Fellowship Research Post-doctoral sinus surgery, thyroid and parathyroid disease, rhinology. disease, and parathyroid thyroid sinus surgery, MD: Thomas Jefferson Medical College, Philadelphia, PA Philadelphia, MD: Thomas Jefferson Medical College, Otolaryngology/Head and Neck Surgery, Wake Medical Center Otolaryngology/Head Wake and Neck Surgery, Special Interests: General and pediatric otolaryngology, endoscopic and pediatric otolaryngology, General Special Interests:

Residency Program Associate Professor Director, UNC Voice Center UNC Voice Director, Director, Surgical Education Director, Robert A. Buckmire, MD Buckmire, A. Robert Director, Neurotology Fellowship Neurotology Director, micro-laryngeal, laser-control mechanisms. micro-laryngeal, laser-control Oliver F. Adunka, MD, FACS MD, Adunka, Oliver F. MD: University of Virginia School of Medicine MD: University MD: Medical University of Vienna, Austria MD: Medical University Chief, Division of Voice and Swallowing Disorders and Swallowing Division of Voice Chief, microsurgical treatment of laryngeal pathology, and of laryngeal treatment pathology, microsurgical Special Interests: Voice and swallowing disorders, and swallowing Voice Special Interests:

March Floyd Riddle Distinguished Research Professor Riddle Distinguished Research Floyd March diagnostic laryngeal surgery, EMG, laryngeal framework Director, UNC Otolaryngology/Head and Neck SurgeryDirector,

acoustic tumors, cochlear implants, hearing preservation.acoustic tumors, cochlear implants, hearing Residency: J. W. Goethe University, Frankfurt, Germany Frankfurt, Goethe University, Residency: J. W. Residency: University of North Carolina School of Medicine of North Carolina Residency: University Department of Otolaryngology/Head and Neck Surgery Fellowship (Laryngology): Vanderbilt University Voice Center Voice University (Laryngology):Fellowship Vanderbilt

Fellowship (Otology/Neurotology and Skull Base Surgery): and Skull (Otology/Neurotology UNCFellowship Special Interests: Otology, neurotology, lateral skull base surgery, skull base lateral neurotology, Otology, Special Interests: 12 Faculty Otolaryngology/Head and Otolaryngology/Head Neck Surgery, Wake Medical Center Special Interest: Otolaryngic allergies,providing Special Interest: Otolaryngic studentsand Residency: DukeUniversity MedicalCenter, General Surgery Residency: DukeUniversity MedicalCenter, Otolaryngology MD: University ofNorthCarolina SchoolofMedicine residents insightsonprivate practice ofmedicine. Residency: DukeUniversity MedicalSchool MD: Emory University SchoolofMedicine MD: Emory Special Interests: Rhinology, allergy, sinus Peter G. Chikes, MD, FACS surgery, care ofthe professional voice. Brett E. Dorfman, MD Brett E. Dorfman, Assistant Professor Assistant Professor Assistant Professor Fellowship (Pediatric Otolaryngology): CincinnatiChildren’sFellowship Hospital (PediatricOtolaryngology): Clinical Externship(Adult CochlearImplants):UNCHospitals Special Interests:- Cochlear implantation,hearingpreserva tion, middleearimplantation,signalprocessing outcomes. MD: University ofNorthCarolina SchoolofMedicine Special Interests: Pediatricotolaryngology, pediatric Associate Program Director, UNCOtolaryngology/ AuD: University ofNorthCarolina atChapelHill Margaret T. Dillon, AuD, CCC-A Newton D. Fischer Distinguished Professor of Newton D.FischerDistinguishedProfessor of Head and Neck Surgery ResidencyProgramHead andNeckSurgery Executive AssociateDeanforAcademic Amelia F. Drake, MD, FACS airway disorders,airway craniofacial anomalies. Otolaryngology/Head andNeckSurgery Otolaryngology/Head Residency: University ofMichigan Director, UNCCraniofacial Center Programs, UNCSchoolofMedicine Assistant Professor Faculty 13 Assistant Professor Associate Professor MSP: University of South Carolina MSP: University Through Listening Enrichment (CASTLE) Through implants, speech/language and audition development after cochlear implantation. development Douglas C. Fitzpatrick, PhD Fitzpatrick, Douglas C. Special Interests: Pediatric hearing loss, cochlearSpecial Interests: Hannah R. Eskridge, MSP, CCC-SLP MSP, Eskridge, Hannah R. Director, Center for the Acquisition of Spoken language Center for the Acquisition Director, system, binaural hearing, auditorysystem, binaural information processing. PhD (Anatomy): University of North Carolina at Chapel Hill of North Carolina PhD (Anatomy): University cochlear implants, electrical stimulation of the central auditorycochlear implants, electrical stimulation of the central Special Interests: Physiology and anatomy of the auditory Physiology and anatomy of the Special Interests: system, Associate Professor Assistant Professor and Neck and Facial Plastic Surgery and Neck Surgery Residency Program Michael O. Ferguson, MD Ferguson, Michael O. Head and Neck Surgery Residency Program Charles S. Ebert, Jr., MD, MPH MD, Jr., Ebert, Charles S. Associate Director, WakeMed Otolaryngology/ WakeMed Associate Director, Associate Director, UNC Otolaryngology/HeadAssociate Director, Director, WakeMed Faculty Physicians ENT-Head Faculty Physicians ENT-Head WakeMed Director, MD: University of North Carolina School of Medicine of North Carolina MD: University

rhinology, allergy, sinus surgery, head and neck oncology. sinus surgery, allergy, rhinology, MD: University of North Carolina School of Medicine School of of North Carolina MD: University Special Interests: General and pediatric otolaryngology, General Special Interests: Residency: University of North Carolina School of Medicine of North Carolina Residency: University Fellowship (Rhinology): Georgia Nasal and Sinus Institute Fellowship

MPH: University of North Carolina School of Public Health School of North Carolina MPH: University Residency: University of North Carolina School of Medicine School of North Carolina Residency: University and revision sinus surgery, sinonasal tumors, computer guided sinus surgery, and revision Otolaryngology/Head and Neck Surgery, Wake Medical Center Otolaryngology/Head Wake and Neck Surgery, surgery, allergic disease, and other nasal disorders; investigation other nasal disorders; and disease, allergic surgery, into the genetic alterations in chronic eosinophilic rhinosinusitis. in chronic into the genetic alterations Special Interests: Chronic sinusitis, allergic fungal sinusitis, primary sinusitis, allergic fungal sinusitis, Chronic Special Interests: Co-Director, UNC Advanced Rhinology and Skull Base Surgery UNC Advanced Fellowship Co-Director, 14 Faculty MS (Audiology):University ofNorthCarolina atChapelHill James S.andJuneM.FicklenDistinguishedProfessor MSc: University ofSouthampton,UnitedKingdom PhD (ExperimentalPsychology): University Special Interests: Clinicalpsychoacoustics, PhD (Audiology):Northwestern University Chief, Research DivisionofAuditory Special Interest: Psychoacoustics of NorthCarolina atGreensboro Joseph W. Hall, PhD John H. Grose, PhD cochlear implantation. Professor Residency (InternalMedicine): Boston University SchoolofMedicine Co-Director, UNCAdvanced HeadandNeckOncologyFellowship Special Interests: Headand necksurgicaloncology, endocrine surgery, parotid surgery, transoral lasermicrosurgery, openand endoscopic skullbasesurgery, headandneckreconstruction, minimally invasive headandnecksurgery, andsinussurgery. Post-Doctoral Fellowship: DanaFarberCancerInstitute MD: University ofNorthCarolina SchoolofMedicine Special Interests: Clinicalresearch inhead andneck testing; cancertherapeutics andchemotherapy. and lung cancer; clinical application of genomic and lungcancer;clinicalapplication ofgenomic Trevor G. Hackman, MD, FACS Fellowship (Head&Neck/Microvascular): Fellowship (Hematology/Oncology):Tufts MPH: Harvard SchoolofPublicHealth MPH: Harvard D. NeilHayes, MD, MPH Residency: University ofPittsburgh Washington University St. Louis MD: University ofPittsburgh New EnglandMedicalCenter Associate Professor Assistant Professor Faculty 15 Professor Assistant Professor Paul B. Manis, PhD Manis, B. Paul University School of Medicine University Thomas J. Dark Research Professor Thomas J. Dark Research PhD (Neuroscience): University of Florida University PhD (Neuroscience): Andrea Jarchow-Garcia, MD Andrea Jarchow-Garcia, processing; central nervous system plasticity. central processing; Tulane University/Hedgewood Surgical Center University/Hedgewood Tulane Postdoctoral Training (Neurobiology): Vanderbilt Vanderbilt (Neurobiology): Training Postdoctoral Special Interests: Surgery facial Special Interests: for the aging face, Chief, Division of Research Training and Education Training Division of Research Chief, rejuvenation with injectables & fillers, and rhinoplasty. with injectables & fillers, and rejuvenation Residency: University Hospitals, Case Medical Center Residency: University Fellowship: (Facial Plastic and Reconstructive Surgery) (Facial Plastic and Reconstructive Fellowship: Special Interests: Cellular basis of auditorySpecial Interests: information MD: Brody School of Medicine, East Carolina University School of Medicine, East Carolina MD: Brody Assistant Professor Associate Professor Auditory Electrophysiology. Julia S. Kimbell, PhD Kimbell, Julia S. of North Carolina at Chapel Hill of North Carolina Shuman He, MD, PhD MD, He, Shuman MD: Shandong Medical University PhD (Mathematics): Duke University electrophysiology): The University of Iowa The University electrophysiology): Special Interests: Cochlear Implantation,Special Interests: Auditory The University Electrophysiology): Post-Doctoral Training (Psychoacoustics and (Psychoacoustics Training Post-Doctoral in the nasal passages of rodents, primates, and humans. in the nasal passages of rodents, effects of nasal anatomy and respiratory airflow patternsrespiratory airflow effects of nasal anatomy and Post-Doctoral Training: CIIT Centers for Health Research Training: Post-Doctoral PhD (Speech and Hearing Sciences specilized in auditoryPhD (Speech and Hearing Sciences specilized on the uptake and deposition of inhaled gases and particles Residency (Otolaryngology): Shandong Provincial Hospital Residency (Otolaryngology): Shandong Provincial Special Interests: Research in biomathematical modeling; the Research Special Interests: 16 Faculty Special Interests: Roboticsurgery, headandneckcancer, diseases Otolaryngology/Head andNeckSurgery, WakeOtolaryngology/Head MedicalCenter Otolaryngology/Head andNeckSurgery, WakeOtolaryngology/Head Medical Center Special Interests: Adult andpediatricgeneral otolaryngology, Residency: University ofNorthCarolina SchoolofMedicine including rhinology, allergy, endoscopic sinussurgery, thyroid Residency: Wake Forest University BaptistMedicalCenter of thethyroid andparathyroid, laryngology, general and MD: University ofNorthCarolina SchoolofMedicine MD: TheUniversity ofAlabamaSchoolMedicine and salivary glandsurgery, eardisease,andhearing. and salivary James T. O'NeilJr, MD Allen F. Marshall, MD Assistant Professor Assistant Professor pediatric disorders. Chair, DepartmentofEpidemiology, UNCSchoolofPublicHealth Special Interests: Acute care, cardiology, oncology, critical MS, PhD(Epidemiology):University ofWashington Special Interests: Molecular epidemiology of Special Interests: Molecular epidemiologyof care, otolaryngology headandneckcancer. care, otolaryngology MSN: DukeUniversity SchoolofNursing Brien R. Pace, ACNP-BC head andneckchildhoodcancer. Andrew F. Olshan, PhD Nurse Practitioner Professor Faculty 17 Professor Associate Professor AuD: University of Florida AuD: University Director of Pediatric Audiology Director and surgical airway management. Patricia A. Roush, AuD Roush, A. Patricia MA (Audiology): University of Iowa MA (Audiology): University Special Interest: Pediatric Audiology Special Interest: including salivary surgery, malignancies, thyroid Carol G. Shores, MD, PhD, FACS PhD, MD, Shores, Carol G. Special Interests: Head and neck surgical oncology, Head and neck surgical oncology, Special Interests: MD: University of North Carolina School of Medicine of North Carolina MD: University Residency: University of North Carolina School of Medicine of North Carolina Residency: University PhD (Biochemistry): at Chapel Hill of North Carolina University Associate Professor Reconstructive SurgeryReconstructive Johns Hopkins University MD: Indiana University Austin S. Rose, MD Rose, Austin S. Residency: University of Cincinnati Residency: University Chief, Division of Facial Plastic and Chief, Special Interests: Facial plastic andSpecial Interests: reconstructive surgery, rhinoplasty, skin rhinoplasty, surgery, reconstructive Fellowship (Pediatric Otolaryngology):Fellowship Facial Plastic and Reconstructive SurgeryFacial Plastic and Reconstructive Methodist Hospital, Indianapolis, Indiana W. Paul Biggers Distinguished Professor W. cancer, salivary gland surgery. cancer, and thyroid Board Certified by the American Board ofby the American Board Certified Board Pediatric Rhinology, Allergy & Sinus Surgery. Pediatric Rhinology, Special Interests: Pediatric Otolaryngology;Special Interests: William W. Shockley, MD, FACS MD, Shockley, William W. Fellowship (Head and Neck Surgical Oncology):Fellowship MD: University of North Carolina School of Medicine School of North Carolina MD: University Co-Director, Newton D. Fischer Society Annual Meeting Co-Director, Director, UNC Pediatric Otolaryngology Program Fellowship Director, Residency: University of North Carolina School of Medicine School of North Carolina Residency: University 18 Faculty Co-Director, UNCAdvanced HeadandNeckOncologyFellowship Co-Director, Fellowship UNCRhinologyandSkullBaseSurgery Residency: University ofNorthCarolina SchoolofMedicine Special Interests: Cochlear implantsinchildren, childhood Fellowship (Skull Base Surgery and Oncology/Rhinology): andOncology/Rhinology): Fellowship (SkullBaseSurgery development after cochlear implantation, cochlear implant development aftercochlearimplantation,implant device efficacyandclinicalmanagementissues,audiology. Special Interests: Skull base tumors, sinonasal tumors, Special Interests: Skullbasetumors,sinonasal tumors, MD: University ofNorthCarolina SchoolofMedicine CSF rhinorrhea, robotic andminimallyinvasive head and necktumor surgery, parotid tumors, headand Program Director, W. MD,Carolina PaulBiggers, Director, UNC Otolaryngology/Head and Neck Director, andNeck UNCOtolaryngology/Head Adam M. Zanation, MD, FACS Children’s Communicative Disorders Program neck sarcomas, rhinology, sinussurgery. University ofPittsburghMedicalCenter MA (Audiology):University ofIowa Holly F.B. Teagle, AuD Surgery MedicalStudentAffairs Surgery AuD: University ofFlorida Associate Professor Associate Professor Fellowship (Head and Neck Oncologic Surgery): University ofCincinnati Fellowship (HeadandNeckOncologicSurgery): Surgical Director, NorthCarolina Children’s Center Airway Special Interests: Pediatricotolaryngology, reconstructive Special Interests: Headand neckcancer, thyroid cancer, MD: University ofNorthCarolina SchoolofMedicine Carlton J. Zdanski, MD, FACS, FAAP repair, cleft palate,pediatricheadand neckmasses. utilization inheadandnecksurgery, voice disorders, laryngeal/tracheal stenosis,headandnecktrauma.laryngeal/tracheal salivary gland neoplasms, skull base tumors, laser glandneoplasms,skullbasetumors,laser salivary airway surgery,airway cochlearimplantation, microtia Chief, DivisionofPediatricOtolaryngology Chief, DivisionofHeadandNeckOncology Mark C. Weissler, MD, FACS Joseph P. RiddleDistinguishedProfessor Fellowship (Pediatric Otolaryngology): Fellowship (PediatricOtolaryngology): Residency: University of North Residency: University ofNorth Children’s HospitalofPittsburgh Residency: Harvard UniversityResidency: Harvard Carolina SchoolofMedicine MD: BostonUniversity Associate Professor 19 WakeMed ENT

WakeMed ENT The WakeMed ENT Department is comprised of with the UNC residents. We are confident that five board-certified Otolaryngologists, and all we provide a unique training experience for hold adjunct faculty appointments in the UNC the residents that few programs can boast. Department of Otolaryngology/Head and Neck Given our relatively small group size and Surgery. The veteran members of the practice our persistent focus on clinical training, the are Dr. Michael Ferguson (Director and Chief), residents continue to thrive under the careful Dr. Brett Dorfman, Dr. Esa Bloedon and Dr. guidance of our physicians. The continuity Allen Marshall. Additionally, they are pleased to of care and the repetition that the residents introduce the newest member of their practice, receive working so closely with each individual Dr. James T. O’Neil. An Alabama native, Dr. attending makes for an ideal training ground for O’Neil trained at the Wake Forest Department the building blocks of our specialty. The six- of Otolaryngology. Like the other members month experience of the second year residents of the WakeMed practice, his skill set and has them arriving with almost no clinical clinical interests are diverse, but in particular, experience and leaving with confidence and he is excited about bringing his skills in Trans- clinical competence in a wide range of bread Oral Robotic Surgery to Wake County and the and butter surgical procedures. WakeMed system. The third year residents get their first real look The group is proud of our proficiency in at sinus and nasal surgery, middle ear surgery all subspecialties, whether it be acute and the management of thyroid disease. And pediatric care, complex facial trauma, airway as always, our fourth year residents leave with emergencies, head and neck oncology, a wealth of knowledge in the realm of head and endocrine disorders, complex sinus disease, neck surgical oncology. or just bread and butter ENT. WakeMed ENT welcomes the opportunity to provide WakeMed ENT has offices in Raleigh, North comprehensive care to the citizens of Wake Raleigh. Knightdale, and opened an additional County and beyond. The WakeMed group office in Garner in the Fall of 2013. continues to cherish our teaching relationship 20

Nursing Staff Associate Chair for Administration ENT Clinic Support Supervisor Staff Members Carolyn Hamby Anna Bradshaw Bj Squires, RN Joanne Griffin-McClain, LPN

Kathy Tommerdahl, RN Cathy Nakayama, RN, MSN Samylia Alston, CNA Sheila Ergle, RN, BSN Jo Ann Kelly, RN

Teresa McInerney, RN Kristen Jewell, RN Samantha Wilson, CNA Robin Gunter, RN Brittany Wardrick, CNA

Traci McKinney, RN Sharon Rubischko, RN Carla Toto, CNA Ashley Tenney, RN Gina Stoffel, RN

Elaine Hinkle, RN, BSN Soon Young Rondinelli RN Diane Burden, CNA Katie Sams, RN Michelle Solano, CNA Staff Members 21 Nakia Hackney Phyllis Dixon Sonia Meeks Katherine Eng Michelle Handy Patricia Longest Surgery Schedulers Ashley Myles Venice Benitez Venice Paige McDaniel Allison Turner Shanta Beard Tammy Moore-Andrews Moore-Andrews Tammy Angel Jeffries Wendy Boyd Wendy Earlene Howze Tery Armstrong Tery Patient Business Associates Business Patient Manager) and Nicolette DeGroot (Communications Director). Manager) and Nicolette DeGroot to Drs. Jarchow, Hackman, Shockley and Shores). Not pictured: Cheryl Not pictured: Goodrich (Personnel Hackman, Shockley and Shores). to Drs. Jarchow, and Senior), Kathy Harris (Executive Assistant to Dr. Pillsbury) Assistant to Dr. and Jonna Apple (Assistant and Senior), Kathy Harris (Executive (Assistant to Drs. Zdanski, Zanation and Rose), Kathy Bogie (Assistant to Drs. Buckmire Drs. Buckmire (Assistant to Drs. Zdanski, Zanation and Rose), Kathy Bogie (Assistant to (Residency Program Coordinator and Assitant to Drs. Drake and Ebert), Dawn Wilson and Ebert), Dawn and Assitant to Drs. Drake Coordinator (Residency Program L-R: Donna Woodard (Assistant to Drs. Weissler, Buchman and Adunka), Ellen Doutt Buchman and Adunka), (Assistant to Drs. Weissler, L-R: Donna Woodard Administrative Academic Affairs Academic Administrative 22 Residents L-R: Drs.Shadfar andYin,&Drs.HarmonWong. Chief give backafter somuchhasbeengiven tome. UNC. Itistrulymyhopethat Iwillbeableto the excellentpatientcare I’ve cometoknow at foundation I’ve developed forward here andcarry military, Iintendtocontinuebuildonthe AsItransitionhas beenamazing. backtothe deployments andourgeographic separation family.” Your supportduringmyhusband’s Finally, Iwanttothankyou forbeingmy“military also individualsthroughout theworld. not onlytheresidents of NorthCarolina, but Malawi. Thework doneatUNCisbenefiting with herandshare inthework sheisdoingin like tothankDr. Shores forallowing metotravel mentored andeducatedme.Iwould especially incredible. Allofthefaculty have, insomeway, afforded meduringmytraining have been haven’t beendisappointed. Theopportunities I wantedtotrain atUNC.Afterfive years, I campus andmetthestaff, faculty, andresidents, me. From themomentIfirstdrove through start by thankingDr.forselecting Pillsbury depart ChapelHill.Iwould beremiss ifIdidn’t it iswithaheartfilledgratitude thatI to sopublicallyproclaim ourgratefulness, but Jessica Smyth,MDNotoftenare we privileged Residents bittersweet. Ianxiouslybeganroaming the Scott Shadfar, MDFarewells are often pride togrow asadaddyhere inChapelHill. store, andScroggsFrogs. Ithasbeenadistinct theBLTforget volleyball camp,Lego Engineering, them torun,play, ride,learn.Giannawillnever found theperfectneighborhoodinChapelHillfor happy, healthy, andsafe.Iamsohappy tohave Carolina. Mytwo “Carolina Girls”are wonderful, Most notablymyfamily grew here inNorth a distinctpridetowork withDr. Buckmire. new arenas over thelastfive years. Ithasbeen I unexpectedlylearnednewtechnicalskillsin mix technicalthinkingwithmedicalpractice. who knewmybackground encouraged meto as aresearcher. person Withoutexception,every mentality alsocontributedtomyfuture growth My opportunitytomaintainanengineering It hasbeenadistinctpridetotrain atUNC. directly tothefaculty’s intensityforexcellence. were notatmyforefront before. Iattributethis opened myeyes tosubspecialtyfieldsthat Ifeelfortunatetohavemy scopeofthinking. programexpansive otolaryngology hasgrown me growth way. inevery Inparticularthis Yu-Tung Wong, MDNorthCarolina hasgiven R EFl E CT

Residents 23 (PGY-3, Research(PGY-3, 2016) Track, National Cancer Institute, NIH, Post-Bac Research Fellow, 2005 SUNY Binghamton at University, Biomedical Sciences, 2009 MD, SUNY Buffalo at Schoolof Medicine & BS Psychology/Computer Science, 2002 . . feel free to call me insane. feel free . . Baishakhi Choudhury, MD Baishakhi Choudhury,

making me the best physician I could be. As I embark physician I could be. As I embark making me the best a being I will honor and embrace endeavors on future I will miss everyone of UNC. begin my as I graduate surgery plastic and reconstructive in facial fellowship all the best. in Indianapolis, Indiana. I wish you Mihir Patel, MD Einstein defines Insanity: again and over doing the same thing over results. different and expecting forging of mentorship, years seven Wife and an Ariya later my friendships, (PGY-3, 2016) Vanderbilt University, University Florence, of Italian Language & History, 2004 BS Communication Studies, 2006 UNC School Medicine, of 2011 MD, Adam P. Campbell, MD Campbell, Adam P.

(PGY-2, 2017) (PGY-2,

Boston University

MA Medical Sciences, 2007

School Medicine, of 2012 MD,

Junior Residents Junior L-R: Drs. Shores, Charles and Smyth, & Drs. Senior and Patel Charles and L-R: Drs. Shores, Boston University School Medicine, of Navigating life through residency has not been has not been residency life through Navigating after finding myself nor should it. However, easy, such gifted, industrious, courageous by surrounded persevered. have we humans beings, I can safely say and room to all my friends, operating I am grateful and mentors who clinic teams, colleagues, faculty, time, life, and energy in any of their invested have halls of UNC hospital in 2008. This was the start in 2008. This was the start halls of UNC hospital my home in Oklahoma. from far of my intern year, be demanding,I knew the path would but to The relationships what extent was unpredictable. during my and solidified developed I have drove been invaluable, and at UNC have training in North Carolina. here my ability to thrive

UNC School Medicine, of BS Biology, 2003 Nathan H. Calloway, MD Calloway, Nathan H. 24 Residents The Pennsylvania State University, MBA, 2000 MBA, State University, Pennsylvania The John P. Dahl, MD, PhD, MBA The College of Wooster, BA Chemistry, 2004 of Wooster, Chemistry, BA College The lxne .Frg D arnW eoe D AnnaX. Hang, MD Lauren W. Fedore, MD Alexander A. Farag, MD Villanova University, BS Biology, 1997 Biology, BS University, Villanova Jefferson Medical College, MD, 2009 College, Medical Jefferson Carengie Mellon University, BS Biology, 2003 Biology, BS University, Mellon Carengie The Pennsylvania State University, State University, Pennsylvania The University of Pennsylvania, Post-BS, 2006 Post-BS, of Pennsylvania, University College of Medicine, MD, 2009 of Medicine, College University of Medicine and Dentistry of Dentistry and of Medicine University Grace K. Austin, MD The University of Toldedo of Toldedo University The New Jersey, Robert Wood Johnson Johnson Wood Robert Jersey, New PhD Pharmacology, 2001 Pharmacology, PhD (PGY-4, Research Track, 2017) Research (PGY-4, Medical School, MD, 2010 School, Medical (PGY-5, 2014)(PGY-5, 2014)(PGY-5, The Pennsylvania State University, BS Science, 1999 Science, BS State University, Pennsylvania The Tufts University School of Medicine, MD, 2012 Medicine, of School TuftsUniversity Tufts University, BS Biological Sciences, 2008 Sciences, Biological BS Tufts University, Adam J. Kimple, MD, PhD Penn Hospital, Residency, Internal Med, 2005 Med, Internal Residency, Hospital, Penn UNC School of Medicine, MD/PhD, 2012 of Medicine, School UNC University of Pittsburgh Medical Center, Medical of Pittsburgh University Jefferson Medical College, MD, 2004 College, Medical Jefferson Anand R. Dugar, MD MS Computational Chemistry and and Chemistry MS Computational Anesthesiology Residency, 2008 Residency, Anesthesiology Michigan State University, State University, Michigan BS Chemistry, 2003 Chemistry, BS (PGY-2, 2016) (PGY-2, (PGY-3, 2016) (PGY-3, (PGY-2, 2015) (PGY-2, Cristine N. Klatt-Cromwell, MD Uniformed Services University of the Health Health of the University Services Uniformed University of Illinois at Urbana-Champaign, at ofUrbana-Champaign, Illinois University BA Biology/MD Seven-Year Program, 2010 Program, Seven-Year Biology/MD BA University of Oklahoma, BS Biochemistry/ BS of Oklahoma, University Deepak R. Dugar, MD Spanish, Medical Humanities, 2007 Humanities, Medical Spanish, George Washington University, University, Washington George College of Medicine, MD, 2011 of Medicine, College University of Oklahoma of Oklahoma University BS Chemistry, 2006 Chemistry, BS Sciences, MD, 2010 Sciences, (PGY-4, 2015) (PGY-4, (PGY-4, 2015) (PGY-4, (PGY-3, 2016) (PGY-3, Residents 25 (PGY-4, 2015) (PGY-2, 2018) (PGY-2, Carolina, 2013 MD, University Georgia, of Surgery Residency, 2011 BS Biology/Pre-Med, 2004 Medical University South of UNC-Chapel BS Hill, Biology, 2009 Lewis J. Overton, MD Overton, J. Lewis Duke UniversityMedical General Center, Keimun A. Slaughter, MD Slaughter, A. Keimun Morehouse School Medicine, of 2009 MD, (PGY-1, 2018) (PGY-1, BS Biology, 2002 and Chemistry, 2004 (PGY-7, Research 2014) Track, (PGY-7, (PGY-6, Research 2016) Track, UNC-Chapel 2013 MD/PhD, Hill, Joseph P. Roche, MD Roche, Joseph P. St. Mary’sSt. University Minnesota, of University Pennsylvania, of 2008 MD, Medical College Wisconsin, of 2007 MD, UNC-Chapel PhD Hill, Pharmacology, 2011 Clemson University, BS Biological Sciences Stanford University, BA Human Biology/Spanish, 2001 Christopher M. Welch, MD, PhD MD, Welch, Christopher M. (PGY-2, 2018) (PGY-2, (PGY-5, 2014) UNC-Chapel 2012 Hill, Georgetown University, (PGY-3, Research(PGY-3, 2018) Track, Brian D. Thorp, MD Thorp, Brian D. MSc Physiology/Biophysics, 2006 UNC School Medicine, of 2011 MD, Rounak B. Rawal, MD Rawal, B. Rounak Gita M. Fleischman, MD Fleischman, Gita M. MD McKinney, A. Kibwei Boston University, BA/MD Program, 2009 UNC-Chapel BS Hill, Biology/English, 2004 Eastern Virginia Medical School, 2009 MD, James Madison University, BS Biology 2005 Doris Duke Clinical Research Fellow OHNS, in Boston University School Medicine, of 2013 MD, 26 Residents Message fromthe Ellen Doutt American Board of Otolaryngology (ABOto)American Board ofOtolaryngology as well aschangesininstitutionalpolicies, resident concernsandapproaching deadlines, the mostglobalviewofprogram, including Program Coordinator isoftenthepersonwith to increase fortheProgram Director, the and documentation.Asclinicaldutiescontinue scope andcomplexityofprogram requirements a challengingoccupationduetotheincreasing Working asaResidencyTraining Coordinator is a 23%increase inthepastyear alone). 334 in2011/2012to4102012/2013(nearly number ofapplicantstoourProgram, i.e.from We have seenasteadyincrease eachyear inthe consideration tofillthree residency positions. department receives hundreds ofapplicationsfor programs inthecountry. Eachyear, our Residency T sought aftertraining of themosthighly Chapel Hillisone North Carolina at at theUniversity of Training Program Residency Surgery Head &Neck he Otolaryngology/ academic medicine and research inthespecialty. of the head and neck, whileremaining dedicatedto compassionate medicalcare topatientswithdiseases careers toprovide innovative, comprehensive, and for young physicianswhohave dedicatedtheir provide anextremely uniquetraining opportunity As ourdepartmentgrows, ourfaculty continuesto seven years oftheircareer here withusatUNC! part oftheirlives andtraining astheyspendfive to group ofyoung doctors andIamhonored tobea with ourresident physicians.Theyare awonderful over theyears. I truly enjoy whatIdo andlove working many great andpositive changesinthedepartment andhave &NeckSurgery seen Otolaryngology/Head Residency Training Coordinator inthedepartmentof sheet. Ijustcelebrated mythirteenthyear asthe completes theprogram andturnsintheirclearance usually thelastpersontosay goodbye astheresident when requesting informationabouttheprogram and prospective residency applicantcommunicateswith and professionally.a Iamusuallythefirstperson and strive torepresent theprogram effectively I amthefront linerepresentative oftheprogram As theResidencyTraining Coordinator forOtolaryngology, and theNextAccreditation System(NAS). requirements, ResidencyReviewCommittee(RRC), Coordinator 27 Message from the Residency Coordinator Residents

2013 Intern Residents: Residency Program Drs. Welch, Rawal and Overton

Dr. Robert A. Buckmire serves as the Director each at Wake Medical Center in Raleigh, as well of the Residency Program and Drs. Charles S. as participate in the services of Head and Neck Ebert and Amelia F. Drake serve as the Associate Oncology/Facial Plastics, Pediatric Otolaryngology/ Program Directors at UNC Hospitals. Dr. Michael Otology, and Rhinology/Laryngology. O. Ferguson serves as the Director at Wake Medical Center. Responsibilities include implementing the The clinical program consists of graduated six clinical competencies, as per ACGME guidelines, responsibilities for residents at each level. Senior as well as ensuring the smooth transition of the residents attend either the Annual Meeting of the residents through their specialty training. American Academy of Otolaryngology/Head and Neck Surgery or the Combined Otolaryngology Spring Meeting. Many OHNS residents attend at RESPOnSiBiLitiES least one other meeting during the year as scientific The residency program in Otolaryngology/ presenters. Upper level residents learn to balance Head and Neck Surgery is structured to have clinical and administrative responsibilities with four residents for five years of Otolaryngology/ on-call duties and academic pursuits, such as Head and Neck Surgery. The first year, the intern completing publications from their basic research year, includes five months of assorted General experiences or conducting clinical research projects. Surgery rotations, Neurosurgery, Emergency Medicine, Anesthesiology, Intensive Care, and Chief resident responsibilities include: supervising three months of OHNS. Second-year residents the specific OHNS clinical service, organizing and participate in six months at Wake Medical Center distributing the educational conference schedule, in Raleigh and six months of research in the and assigning residents to specific clinics, call OHNS laboratories. A rotation in Audiology is duties, consult responsibilities, and operative cases. incorporated into the research block. The third and fourth-year house officers spend three months 28 RESIDENT EDuCATION and Cell Biology. The quality of resident research has been consistently high, tends to be collaborative and A curriculum of didactic lectures spans the academic has resulted in numerous awards and publications. year. During the summer months, our residents design and coordinate a head and neck anatomy dissection The Department of Otolaryngology/Head and Neck course. This entails preparation and pro-section of Surgery has a number of laboratories engaged in common procedures performed in OHNS. Attending both auditory and head and neck oncology research. Residents physicians “take the residents through” the technical Auditory research currently has separate laboratories aspects of the procedure, and the discussion engaged in human psychoacoustics, cochlear covers the indications, surgical options, technical implant performance and modeling, information highlights and pitfalls, as well as complications processing and plasticity in the auditory brainstem associated with the procedure performed. and midbrain, the neural basis of sound localization, and inflammatory mechanisms in viral otitis media. A Temporal Bone Course and Competition is scheduled in the spring. In addition, there are weekly With the addition of Dr. Julia Kimbell, PhD. to the conferences that include Journal Club, Head and research faculty, a novel focus in Computational Neck Conference, Radiology, Pathology, Patient of Fluid Dynamics has been added to the departmental the Month Program, Morbidity and Mortality, Speech research efforts with a primary focus and Pathology, Audiology, and Research Conferences. collaboration within the Rhinology division.

Finally, most residents participate in outside Head and neck oncology research includes clinical educational meetings. Second year residents attend research in the form of trials involving management the American Academy of Otolaryngologic Allergy. of patients with squamous cell carcinoma, The third year residents attend the North Carolina/ investigation of the mechanisms and treatment of South Carolina Otolaryngology meeting as well cancer cachexia, analysis of genetic mechanisms as the Carolinas Airway Course, the fourth year of head and neck cancer, and studies in the residents attend an off-site didactic temporal bone pathogenesis, diagnosis, treatment, and epidemiology course, and fifth year residents attend the annual of head and neck squamous cell carcinoma. In meeting of the American Academy of Otolaryngology- addition to auditory and head and neck cancer Head & Neck Surgery. Many residents attend and studies, research is also currently being carried present research at the Triological meetings, or out in the area of dysphagia, robotics, allergies, other subspecialty meetings throughout the year. and sinonasal disorders. The options for research by residents are limited only by imagination. RESEARCH OPPORTuNITIES Each resident in the Department is required to design and carry out a research project during the PGY-2 year. Many have chosen to undertake projects within the established laboratories in the Department, while others have chosen to work in related disciplines such as microbiology, molecular biology, tumor biology, audiology, or cochlear physiology. The Department also has affiliations with the Dental Research Center and the Department of Anatomy The Department 30 in North #1 Carolina, #7 among public institutions, and #22 in the nation in US News & World Report in NIH 2012 rankings Carolina Crossing Speech #10 grant & Audiology made it in the funding for all U.S. otolaryngology New location Top 5 UNC Clinics departments 1added to our for Patient Satisfaction services in Siler City, Commitment to Care Initiative North Carolina:

New Developments & Highlights New Developments New surgical skills lab: Chatham Hospital Pg138 A state- of-the-art practice space Practice location update: offering real hands-on Carolina Pointe became simulations for otolaryngology, Carolina Crossing, ophthalmology & neurosurgery including a new address

Out of 18 residents passing the oral Membership of Installation of a College of Surgeons exams, localization 6 are from the UNC array in the Malawi Surgical clinical research lab Initiative at Carolina Crossing.

Dr. Hackman Best Doctors for completed his 20th 82012-2013: Drs. Trans Oral Robotic Zdanski, Senior, Pillsbury, Surgery on the da Vinci Shockley, Weissler, Adunka, surgical robot in 2012 Buchman, & Drake Dr. Eskridge was awarded the 2013 CARE Project Humanitarian Award 31

Dr. He New Developments & Highlights was awarded the NIH R03 grant of Dr. $456,000 Campbell won a first place poster award at the 116th Annual Triological Society Dr. Kim Austin was awarded the UNC Dr. Lineberger Comprehensive Pillsbury was awarded a 2013 Cancer Center 2012 Clinical/ Order of the Golden Translational Developmental Fleece, UNC’s oldest Research Award of $40,000 and most prestigious honor society

Dr. Fitzpatrick was awarded the NIH R01 Dr. grant of $250,000 Zdanski recieved the 2012 AAO- HNS Foundation Award.

Dr. Zanation Drs. Zanation & was awarded the Harris won P. Mosher Award & was Klatt-Cromwell a first place poster award at the inducted as a fellow into 116th Annual Triological Society the Triological Society

Dr. Pillsbury Dr. Ebert became was awarded the Triological a Member in the Academy Society Gold Medal of Educators

34 t otal FY13 Grants $3.3 Million

tRENDS iN GRaNt FuNDiNG, 2003-2013 in NIH $3.5M grant $3.0M #10

$2.5M funding of all U.S. $2.0M otolaryngology $1.5M departments 2003 2004 2005 2006 2007 2009 2010 2011 2012 2013

FY13 Statistics & Philanthropy FuNDiNG BY Pi, FY13 (lighter shade denotes indirect costs) FY13 StatiSticS

OR cases 3,938

inpatient Beds 830

inpatient admissions 630

inpatient Discharges 630

Outpatient Visits 40,969

Emergency Department 64,322 Visits

Faculty 36

Staff 76

Grant Funding $3.3 million

tOP FiVE SuRGERiES

Nasal/Sinus Endoscopy

Laryngoscopy

tympanostomy

cochlear implant

cervical Lymphadenectomy 35 Total FY13 Gifts $625,927

FY13 Statistics & Philanthropy FY13 Giving by Donor Type FY13 Giving by Gi Type

15%

30% 7% 48% 61%

9% 30%

$92,686 Research $186,889 Foundations

$43,640 Education & Outreach $58,510 Corporations

$190,776 Clinical Initiatives $380,528 Individuals

$298,825 Faculty Recruitment & Development DONORS, 2013

Mr. and Mrs. Omir Ahdieh Ms. Mary C. Cooper Ms. Bettie K. Formyduval Mr. Wayne Ayers Dr. Benjamin J. Copeland Mr. Tristan Fretwell Mr. William Ayers Dr. Adam C. Creech Mr. and Mrs. Brandon P. Gall Mr. Stan Bailey Ms. Nicolette D. DeGroot Dr. C. Gaelyn Garrett Mr. and Mrs. Robert A. Baillie Ms. Janice DeRosa Mr. and Mrs. Gordon K. Gold Mr. Sam Baker Mr. Burke H. Dickens Ms. Margo L. Grant Mr. and Mrs. Lewis B. Barnhardt Ms. Wendelyn V. Dickson Mr. and Mrs. Kyle H. Gray Mr. and Mrs. Thomas M. Barnhardt Dr. Stacy L. and Mr. Michael S. Dinges Mr. and Mrs. James C. Gray, Jr. Mr. Martin E. Birnbaum and Mr. and Mrs. Stephen P. Dorer Ms. Anne E. Hager-Blunk Ms. Roslyn G. Greenspon Dr. and Mrs. Brian W. Downs Ms. Marsha A. Hale Dr. Laura P. Boschini Dr. Amelia F. and Mr. Craig L. Drake Mr. and Mrs. Jack R. Haley Ms. Rachelle Boudreau Mr. and Mrs. Monty S. Edge Ms. Alison L. Halpern Ms. Mary A. Boudreau Dr. Samer Elbabaa Mr. and Mrs. Robert E. Hamby Mr. Charles Burleson Mr. Jason Elmore Ms. Shirley D. Harder Dr. and Mrs. Jeffrey P. Campbell Dr. and Mrs. John P. Evans Mr. Holt Hathaway Mr. John R. Carlson and Ms. Caitlin Ms. Maegan K. Evans Ms. Yvonne C. Hauser Fenhagle Mrs. Ruth A. Everett Ms. Kristina I. Helms Ms. Cynthia Carmola Drs. William and Gloria Fan Mr. James S. Henderson Ms. Denise F. Carter Dr. Joel F. Farley Dr. and Mrs. John T. Henley Mr. Charles B. Carver Ms. Margot H. Filippini Mr. and Mrs. Perry C. Hinkle Mr. Zhao Cheng Ms. Ruth Flowers Mr. Curtis Holmes 36 DONORS, 2013

Mr. W. H. Holsenbeck Mr. tracy G. Peck Mr. an Mrs. Robert B. Ward Mr. Brian t. Honeycutt Ms. Barbara Perry Mr. Don P. Warren Ms. Peggy Honeycutt Dr. and Mrs. Harold c. Pillsbury iii Dr. and Mrs. Mark c. Weissler Mr. and Mrs. James a. Horn Mr. Jeffrey S. Plentl Mr. Gary P. Welchman Mr. Henry c. House Mr. Will Plentl Ms. tammy L. Wells-angerer Ms. adrienna Hunt Dr. ivy P. and Mr. William J. Pointer Mr. and Mrs. Steven H. White Ms. Linda Hutchinson Mr. and Mrs. David L. Pruitt Mr. consuelo R. Wild Mr. tom Jackson Mr. Jerry Ramsey Ms. Natasha Wiles Ms. Donna F. Johnson Ms. Miryam E. Rendon Dr. and Mrs. aaron Wilharm Mr. Robert E. Jones Mr. Morris c. Resnik Ms. Kathryn Wilson Ms. Lindsey E. Kanes Mr. turner Revels Dr. and Mrs. Jeffrey L. Wilson Dr. Mia Kang Ms. Kathy S. Rhoades Mr. thomas R. Winton Mr. Lawrence F. Katzin Ms. March F. Riddle and Family Dr. David L. Witsell Mr. and Mrs. David B. Keim Mr. and Mrs. Johnny E. Ross Ms. Michelle Yelton Dr. Dan P. Kelaher Mr. Rob Ruark Dr. Maher N. Younes FY13 Statistics & Philanthropy Ms. Jamie D. Kerzner Mr. and Mrs. Louis F. Santospago Ms. Earline M. Young Mr. Ross c. Kirkman Mr. and Mrs. William c. Scheppegrell tarheel Housestaff council Ms. Sue Koenigshofer Ms. alishea P. Scroggs advanced Bionics corporation Ms. Landon B. Lacey Ms. Susan t. Sehgal Bull city Running company Dr. Keith M. Ladner Dr. and Mrs. Brent a. Senior community Nutrition Partnership Dr. and Mrs. andrew P. Lane Mr. Michael Sessoms Endurance Magazine, LLc Mr. Gregory J. Lee Dr. John E. Sexton Rise Biscuits & Donuts Ms. Barbara B. Lee Ms. Denise B. Sherril Nickolas B. Boddie Sr. & Lucy M. Boddie Mr. Richard M. Lever Dr. carol G. Shores Foundation Dr. and Mrs. thomas B. Logan Mr. and Mrs. Michael Shoun uNc Gamma chapter of alpha Omega Mr. and Mrs. Matthew L. Maciejewski Ms. colleen M. Siadak alpha Ms. Elizabeth R. Martinez Ms. Georganna G. Simpson North Mecklenburg Woman’s club Mr. Brock Matthews Ms. Natalie N. Skergan Ms. Patricia charlene Pell Mr. Rich Mccloskey Ms. amanda Smith top of the Hill Mr. William H. Mcculloch Ms. M. L. Smith DuBose National Energy Services Mr. Blake McMurray Ms. allison S. Smull J & S Runners LLc Ms. ashley Meagher Ms. Marianne Snyder Peacock Haven Farm Ms. Jessica c. Meyers Dr. and Mrs. Brian Stabler united american Pharmaceuticals, inc. Dr. John Migaly Dr. and Mrs. J. Gregory Staffel the Soo Foundation, inc. Ms. Valerie S. Miller Ms. Mary Jo B. Stone Physicians for Peace Ms. Virgi Mills Dr. Jennifer tang triangle community Foundation, inc. Ms. Rhonda Mills Ms. Holly teagle carolina Ear Nose and throat Mr. Raphael Mouawad Ms. Sherry H. thomas anonymous Ms. Judith E. Naugle Mr. andrew tignanelli Reminger co. LPa Ms. Jane c. Mac Neela Dr. christopher J. tignanelli Mark Moldenhauer Landscaping inc. Mrs. Leslie H. Nelson Ms. caroline upchurch WWGP Broadcasting corporation Dr. Meredith c. Northam Ms. christina J. Van Donk the care Project, inc. Ms. Libby E. Norvell Dr. courtney H. and Mr. George Van Wells Fargo Foundation Mr. and Mrs. J. Delos O’Daniel Houtven addison’s aid, inc. Ms. Yuko Oikawa Ms. Sherri D. Vernelson the center For Facial Restoration, inc. Ms. Nancy K. Ott Mr. Donald G. Wallace Phonak LLc Ms. Kim Patrey Dr. and Mrs. Peter a. Wallenborn Oberkotter Foundation Distinguished Professorships 37 in 2011 through a bequest from Mr. Dark. Dark. Mr. from a bequest in 2011 through of family in North Carolina, he divided his time he divided his time in North Carolina, of family with visits to and Siler City, Ft. Lauderdale between he sports fan, his alma mater in Chapel Hill. An avid game in the last two missed a home football rarely City in 1987 at decades of his life. He died in Siler age 93. Professorship, In addition to establishing the Dark including other gifts to the University, he provided Medicine, a scholarship fund in the School of a gift to a challenge gift to his classmates and of the Bell Tower establish an office for the Order He Hill Alumni Center. in the new George Watts to endow his friend, Eunice Bernhard, also inspired of Medicine. In in the School a professorship and generosity, loyalty of his continuing recognition him with its the School of Medicine presented in 1982. Distinguished Service Award of MD was the first recipient Newton D. Fischer, the Thomas J. Dark Distinguished Professorship C. Pillsbury Harold 1977-1991. which he held from holds this professorship. III, MD currently Thomas J. Dark Research The inaugural to Paul B. Manis, was awarded Professorship PhD cells in the studying how Manis is currently Dr. studying sound information, by process brain

Soon after his retirement, he bought a home in he bought a home in Soon after his retirement, bees and raised roses He grew Ft. Lauderdale. sailing trips. Because recreational in between In 1940, he invested in a small manufacturing in a small manufacturing In 1940, he invested the Buchmann Spark-Wheel Corp where company, He also purchased he later became president. Athens, Georgia, and of land near 3,000 acres cotton plantation into a a rundown converted Black Angus beef for raising highly prized farm until cattle. He continued both of these vocations in 1958. his retirement Upon graduation, he returned to Siler City where to Siler City where he returned Upon graduation, department fire he organized the community’s first briefly for a chair He worked and became its chief. company company in High Point and an automobile on to a sales job with moving before in Greensboro and New York. Collins & Aikman Corp. of Roxboro The Thomas J. Dark Professorship in in The Thomas J. Dark Professorship Otolaryngology was established in the University’s Thomas Jefferson School of Medicine in 1976 by Florida. Dark Dark of Siler City and Ft. Lauderdale, and studied in was a member of the class of 1925 the — now School of Commerce the University’s Business School. Kenan-Flagler The Thomas J. Dark Distinguished Dark Distinguished J. The Thomas Professorships

Joseph W. Hall III, PhD (2011-present) Joseph W. Distinguished Research Professor Paul B. Manis, PhD (2011-present); James S. and June M. Ficklen Distinguished Professor M. Ficklen Distinguished Professor James S. and June Paul B. Manis, PhD (2011-present); Professor Distinguished Research Harold C. Pillsbury Distinguished Professor Craig A. Buchman, MD, FACS (2012-present); Thomas J. Dark Thomas J. Dark (2012-present); Buchman, MD, FACS A. C. Pillsbury Craig (Left to right) Harold Professor Distinguished 38 Distinguished Professorships that benefited education,medicineand quality Mr. Riddlecontributedsubstantiallytoprojects beginning inthe1960s. the growth explosionofFayetteville’s west side t building effortsontheboundariesofFortBragg. March Development c construction anddevelopment company, the growthrespond tothemilitary inthearea. His building homesinc Robeson c Navy. a foratimeintheu Riddle went ontoserve future wife,March Floyd ofFairmont,N.c at theshipyard inWilmington, where hemethis opportunities forhisfuture. Hebeganworking motivated theyoung Riddletolookother t store.age athisfamily’s gasstationandcountry railroad conductor, hewent towork atanearly in 1921Fayetteville, Nc a giftfrom Joseph“J.P.” Riddle.Riddlewas born in theu wasestablishedProfessorship inOtolaryngology t Professorship The JosephPalmer Riddle Distinguished a and astheEditor-in-c u education, andisoneofonlyaboutadozeninthe grant supportsmedicalstudentandresident Department’s Ni successfully submittedandhasmaintainedour N His research hasbeencontinuouslyfundedby the organizationofneural cellassemblies. chemical communicationbetween cellsand the electricalactivityofsinglecells, he companyiscredited withcontributingto he longhoursandminimallivingconditions he JosephPalmerRiddleDistinguished ssociation forResearch inOtolaryngology. S. He also serves ontheNi S. Healsoserves i H grants fornearly25years. additionally, he fterwards, thenewlywedsfterwards, returned to niversity’s SchoolofMedicinein1977by ounty andin1952,Riddlebegan H research training grant. t umberland c hief oftheJournal orp., concentrated its . a s theeldestsonofa D c dvisory c D advisory ounty to . .S. his ouncil was thefirst c year before comingtoc u Fischer completedhisresidency atJohnsHopkins a B.S.in1942,B. earned three degrees from theu Fischer wasborninSana contribution toacademicotolaryngology. Society, whofundedit,envisioninganongoing by themembersofNewtonD.Fischer in1952. i Head andNeckSurgery who establishedtheDivisionofOtolaryngology/ Dr. Fischer, alongtime medicalschoolprofessor Professorship wasestablishedin1993honorof t Professorship The NewtonD. Fischer, MDDistinguished c Sharlene (B.a Riddle andhiswife,March, have three children: a Service and support,hewaspresented theDistinguished that bearshisname.i laboratory andmicrosurgery an otolaryngology allergyandtheestablishmentof otolaryngologic Department ledtoadvancesinthestudyof c c Riddle contributedfundstotheDivisionof i athletic programs oftheu gifts have gonetosupportboththeacademicand was oneofagrowing numberofindividualswhose supports theu Directors oftheEducationalFoundation,which of Directors. on theBoard Healsoserved of untiring force ontheMedicalFoundationBoard a of lifeinFayetteville andattheu n additiontoestablishingthisprofessorship, he NewtonD.FischerDistinguished lthough notanalumnus,hewasavigorous and arolyn. Riddlediedin1995attheageof73. ancer c ardiology andLinebergerc niversity, where hewasaninstructorfor one enter. HissupportoftheOtolaryngology ward by theSchoolof Medicinein1980. .’84), Josephiii(B.S.’77)and hief ofOtolaryngology, aposthe niversity’s athleticprograms. He . in1943,andanM.D.1945. n recognition ofhisinterest hapel Hillin1952. Fischer ntonio in1921.He niversity. omprehensive niversity oft t wascreated niversity. exas: Distinguished Professorships 39 Greenville, NC in honor of Dr. Harold C. Pillsbury Harold NC in honor of Dr. Greenville, attended native, NC, Ficklen, a Greenville, III. Mr. in School in Virginia, graduating Forest Woodberry The University he entered fall 1942. The following he joined at Chapel Hill where of North Carolina ROTC. in Naval Sigma Alpha Epsilon and enrolled he enlisted in the Naval of study, years After two in Cambridge, Massachusetts School Training service by USS as a Lieutenant on the followed Ficklen, a Communications Officer, Cleveland. to General witnessed the Japanese surrender the USS Missouri. After the MacArthur on board and studies completed his undergraduate he war, he joined E. B. Ficklen where to Greenville returned NC as treasurer. in Greenville, Company Tobacco in the for his interest Ficklen was known Mr. life in his throughout community and was active He served affairs. civic and financial Greenville’s including Home of directors on various boards Bank. He and Loan and Wachovia Savings Federal with a number of charitable organizations worked Salvation United Way, including the Red Cross, Home in Greensboro. Army and The Children’s June Montague Ficklen is the spouse of the is a Ms. Ficklen late James Skinner Ficklen, Jr. a special for Women, founding member of Women Community Greenville fund of the Greater interest

This professorship was established in 2008 in 2008 was established This professorship the late James Ficklen and June Ficklen of by The James S. and June M. Ficklen Ficklen M. and June The James S. Distinguished Professorship Fischer is credited with helping the Division of with helping the Division of Fischer is credited Otolaryngology/Head and Neck Surgery achieve as one widely recognized national prominence, for residents programs of the top 10 in training awards Fischer’s numerous in otolaryngology. in 1977 and The Award include “The Professor” in Teaching Bank Excellence Carolina Central in 1988. In 1984, he and his wife, Janet, a Award in the School of Professor Kenan Graham Sarah which the Thomas Jefferson Award, Medicine, won member annually to the UNC-CH faculty is given of who best exemplifies the ideals and objectives influence, teaching, personal Jefferson through writing and scholarship. Newton and Janet Fischer twins Jeannette (M.D. ’81) and children: five have Amelia (M.D. ’81), and Duncan, Anne (B.A. ’83) and Helen (B.A. ’81, M.A. ’86), and eight grandchildren: and Duncan Jake, and Eva Stein; Luke, Kent, Sarah, Fischer; and Connor and Cliff Drake. held for more than 30 years. He was among the He was among the than 30 years. held for more an otolaryngology training first doctors to receive Institutes of Health. the National from grant

(1998-present) Professor Mark C. Weissler, MD, FACS (2000-present); Newton D. Fischer Distinguished Professor Amelia F. Drake, MD, FACS MD, FACS Drake, Amelia F. Professor Newton D. Fischer Distinguished (2000-present); MD, FACS Mark C. Weissler, Professor Thomas J. Dark Distinguished Professor Harold C. Pillsbury (1991-present); Joseph Palmer Riddle Distinguished C. Pillsbury Riddle Distinguished Joseph Palmer Harold (1991-present); Professor (Left to right) Thomas J. Dark Distinguished 40 Distinguished Professorships member ofthe u c of Northc the Board ofDirectors oftheMedicalFoundation additionally, Mr. withdistinctionon Harrisserved c c 1989), anEndowment t asPresident in1988andFoundation (serving atc service Scott&Millerin1981.Mr.Long, Harris’previous & a sales leader. i later joinedMassachusettsMutualasanational u Miller inWhitsett,Nc Senior PartnerofHarris,c Burlington, Northc t physician, Dr. Harold c c by NatandSheilaHarrisofBurlington,North t Distinguished Professorship The NathanielT. andSheilaW. Harris Ear, Noseandt member oftheFD Society ofa a the Ni of thec of continuousfundingby theNi excellent research hasresulted inover 25years Joseph W. HallIII,PhDin2011.Dr. Hall’s professorship wasawarded toitsfirstrecipient, East c North c is amemberandpastBoard ofadvisorsforthe money tostartthisfundin2005.Ms.Ficklen Foundation. Ms.Ficklenprovided theseed homas “Nat”Harris,Jr. wasbornandraised in his professorship wasestablishedin2006 ssociate EditoroftheJournalacoustical ancer c ampaign andtheNationalDevelopment c lub, RegionalVolunteer fortheBicentennial arolina inhonoroftheirgoodfriendand niversity ofNorthc ssociates whichlaterbecameHarris,c H Deafnessi arolina u arolina Outward BoundSchoolandthe laude Peppera enter Board ofVisitorsandisapast arolina, theLinebergerc arolina includestheEducational merica andcurrentlyasa serves n 1967,Mr. Harrisfounded niversity Board ofVisitors.t hroat DevicesPanel. N a c nstitute. He has served asnstitute. Hehasserved DivisionofOphthalmicand arolina. HeisPresident and Board ofVisitors. arolina atc . Mr. Harrisattended t ward ofExcellencefrom . Pillsbury iii.Nathaniel . Pillsbury rustee fortheRams rouch, Scott& Long, H andthereceipt hapel Hilland omprehensive rouch, ouncil. his he he served ontheBoardserved ofExaminersforSpeech and lifelong interest inspeechandlanguage Beyond thesecontributions, Dr. hada Biggers to medicalteachingofstudents andresidents. the School of Medicine evidenced his contribution numerous teachingawards bestowed uponhimby care, andteachingthat is beyond compare. t scholarly devotion, commitmenttopatient Dr. offered Biggers anexampleofcompassion, atu Surgery andNeckthe faculty inOtolaryngology/Head and residency atu at c and hisM.D.attheu North c wasbornin1937c in 1959.Biggers North c had beenanintegral partoftheu was establishedin2000tohonorDr. who Biggers t Professorship The W. Paul Biggers, MDDistinguished academic andVicec Endoscopic SkullBaseSurgery is c Senior hasbeenatu recipient, Brent A.Senior, MD,FACS, FARS. Dr. t and SciencesFoundationProfessorship Program. Board of Visitors and actively supports on theLinebergerc on thecoastofNorthc grandchildren. Shealsoenjoys timeattheirhome (B.a enjoys spendingtimewithherdaughters,Kim herfamily.has dedicatedherlifetoserving She and raised inBurlington,Northc Sheila EileenWestbrook Harriswasalsoborn he W. DistinguishedProfessorship PaulBiggers his professorship wasawarded in2011toitsfirst hief oftheDivisionRhinology, a hapel Hill.Healsocompletedhisinternship . ’89)andLawson (B.a arolina, earnedaB.S.atDavidson c arolina sincebecomingamedicalstudent ffairs fortheDepartment N c . N omprehensive c c N niversity ofNorthc . i c arolina. Shehasserved n 1968Dr. joined Biggers forthelast12years. He .’93), andherfour arolina. She niversity of ancer c harlotte, llergy, and u N arolina hair for c enter ollege ’s he he a rts Distinguished Professorships 41 The Harold C. Pillsbury III MD Professorship in C. Pillsbury in The Harold III MD Professorship Otolaryngology/Head and Neck Surgery was Pillsbury and his established in honor of Dr. commitment to our Department, unwavering of native the School of Medicine and UNC. A Maryland, Pillsbury Baltimore, Dr. earned his George Washington from B.A. and M.D. degrees 1970 and 1972, DC in in Washington, University training He completed his residency respectively. Otolaryngology/Headin Neck Surgery and at the School of Medicine of North Carolina University in 1976. School University at the Yale years five Following in 1982 of Medicine, he joined the UNC faculty He served as Chief of as an Associate Professor. the Division of Otolaryngology/Head and Neck Surgery 1983 to 2001. Since 2001, he has from served as the Chairman of the Department of OHNS. Pillsbury Dr. served term on an eighteen year of Otolaryngologythe American Board where He is also he was Exam Chair and President. of Academy of the American past President Otolaryngology-Head The and Neck Surgery, American Laryngological The Association, The Harold C. Pillsbury III, MD Pillsbury MD The Harold C. III, Distinguished Professorship

In recognition of Dr. Biggers’ many contributions, Biggers’ many contributions, of Dr. In recognition Paul Biggers Distinguished Professorship the W. died in April of 2000 he was established before Biggers asked that this at the age of 62. Dr. to a physician who be awarded Professorship teaching. In his passion for innovative shares MD was Shockley, July 2005, William W. Paul Biggers Distinguished named as the first W. of Otolaryngology/Head Professor and Neck of Shockley continues the tradition Dr. Surgery. compassion, teaching, excellence in patient care, Biggersand service exemplified. that Dr. Outside of our Department, Dr. Biggers was very Outside of our Department, Dr. He helped coach within the University. active the football team and served on the Executive for the of Directors Committee of the Board Educational Foundation. Language Pathologists and Audiology. Through Through Language Pathologists and Audiology. that the state efforts, he ensured his tireless establish and continue a program legislature with speech and hearing designed to aid children Communicative Children’s The Carolina disorders. of (CCCDP) was the result Program Disorders served thousands these efforts and has already of hearing. or hard deaf who are of children

William W. Shockley, MD, FACS (2005-present) MD, FACS Shockley, William W. Floyd Riddle Distinguished Research Professor Robert A. Buckmire, MD (2013-present); W. Paul Biggers Distinguished Professor Paul Biggers Professor Distinguished W. MD (2013-present); Robert A. Buckmire, Professor Riddle Distinguished Research Floyd Nathaniel T. and Sheila W. Harris Distinguished Professor Brent A. Senior, MD, FACS, FARS (2011-present); March March (2011-present); FARS MD, FACS, A. Senior, Brent Professor Harris Distinguished and Sheila W. (Left to right) Nathaniel T. 42 Distinguished Professorships in somanyways andpassingthevalues of but always contributingtothecommunity family over theyears. Oftenbehindthescenes supportsystem forher has beentheprimary Mrs. Riddle,matriarch oftheRiddleFamily, research professorship in2012. Floyd RiddleofFayetteville, Nc appreciation oftheDepartment, Mrs.March a Research Professorship The MarchFloyd RiddleDistinguished also beloved by hispatientsandtheirfamilies. is anexceptionalteacherandresearcher who is c of theu andDirectorNeurotology andSkullBaseSurgery c theDepartmentasVicec serving been atu Buchman, MD,FACS in2012.Dr. Buchman has Professorship wasawarded toCraig A. t Otolaryngology. integrity andexcellenceinlifethefieldof nameissynonymouswithhonesty,Pillsbury’s most especially, cochlearimplantation.Dr. His specialfieldofinterest isneurotology and, investigator orco-investigator onover 21grants. and internationally. Hehasbeentheprimary has alsogiven over 412presentations nationally over 270publicationsandover 45textbooks.He Dr. haswrittenand/orcontributedto Pillsbury a astheimmediatePastPresident oftheserving Section t coordinator andVice-President oftheSouthern the t Society ofu he inaugural Harold c s testamenttotheRiddleFamily’scontinued a merican academyofOtolaryngic ommunicative Disorders Program (cccDP).He linical a riological Society. Heisalsopastc N riological Society. Heiscurrently ffairs, c N c W. c PaulBiggers c niversity Otolaryngologists, andniversity Otolaryngologists, forover 12years andiscurrently hief oftheDivisionOtology/ . Pillsbury iii,MD . Pillsbury arolina c establishedthis hairman for llergy. hildren’s ME ME u to completehisinternshipandresidency at Virginia SchoolofMedicine.Hewent on He received hisM.D.from theu Residency Program Director forourDepartment. Director oftheu Division ofVoice andSwallowing Disorders, Dr. Buckmire currentlyasc serves was awarded toRobertA.Buckmire, MD. t t also helpedstarttheRoseGarden atFayetteville shop. a flower arrangements thatwere soldatthegift at HighsmithRaineyHospitalwhere shemade Mrs. Riddleenjoyed volunteering asaPinkLady u the Y.M.c u as a member of the MethodistMrs. Riddle served many localandregional colleges. husband have alsoestablishedscholarshipsat Schools andFayetteville academy. Sheandher c c has ledhertosupportorganizationssuchasthe especially underprivilegedchildren. t a softspotforprojects thatbenefitchildren, Like herhusband,Mrs.Riddlehasalways had grandchildren andsixgreat-grandchildren. a children, JosephP. Riddleiii,c charity, humanity, love andfriendshiptoher patients. garnered highpraise forhisexpertcare toour teacher andmentortoour studentsandhas from Vanderbilt u fellowship inVoice andSwallowing Disorders echnical c he firstMarch Floyd RiddleProfessorship rmstrong andSharleneRiddleWilliams,herten hildren’s Home,c umberland c N nited Methodistc niversity Board oft c inourDepartment.Healsocompleteda memberofherlocalgarden club,she . a ommunity c andanactive memberofHaymount ounty Boys andGirlsc N niversity. Heis anoutstanding c umberland c hurch. Formanyyears, Voice c rustees, aboard memberat ollege. enter andasthe arolyn Riddle ounty Public niversity of hief ofthe lub, Falcon his love Educational Programs 43

Principles and Techniques of Wound of Wound Principles and Techniques and The OHNS residents Closure. serve faculty as instructors as the techniques fundamentals of suture the students. to introduced are of medical During the fourth year 15-20 acting school, approximately students rotate interns and 4th year the OHNS service through throughout the year. This constitutes a high a high This constitutes the year. level of activity and responsibility to simulate the to simulate the of activity and responsibility level rigors of internship within our department. positions Many of these students apply for residency The Department the country. in OHNS throughout research. for medical student resources offers many years first and second During the summer between students spend 6-8 of medical school, numerous throughout projects in short-term research weeks 2-5 medical students also the department. Usually, and fourth year third between decide to take a year of medical school to perform dedicated research within the departments. These students and their the funding through mentors garner competitive the UNC School of Medicine NIH T32 programs, and the Doris Duke Medical Programs, Research the students During this year Program. Research of an and the inner workings both research explore academic Otolaryngology/Head and Neck Surgery these department. When they apply for residency, and most competitive some of the students are sought-after applicants due to this experience. approximately over 50 medical students rotating on on rotating 50 medical students over approximately During this servicethe OHNS the year. throughout and faculty clinics with OHNS time, students attend Students make procedures. to operative gain exposure for keeping responsible morning and are each rounds At the beginning of the up with assigned patients. in students participate year all third surgical rotation, entitled Soft Tissue Laboratory: a soft tissue course Medical Students Medical

serves as Director of of serves Zanation as Director Adam r. Department within the Affairs Medical Student

In the third year of medical school, there are are of medical school, there year In the third During the second year of medical school, the Special of medical school, the Special During the second year to medical students Senses Courses is offered semester. period during the fall a ten week over emphasized, covering Mechanisms of disease are and problems a spectrum of diseases, disorders, in Otolaryngology/Headencountered and Neck curriculum is presented This section of the Surgery. and of Neurology with the curriculum in coordination sessions focus on case Small group Ophthalmology. options. and treatment diagnosis, studies, differential First-year medical students are medical students are First-year course in head and intensive a two-week provided a series of one-hour This involves neck anatomy. four-hour afternoon and includes three, lectures dimensional dissections sessions, including three as multiple radiologic of the head and neck, as well around members from Clinical faculty demonstrations. the state also participate in these demonstrations, out This rounds their practice. donating time from the students’ experience in head and neck anatomy the years. over and has been very received well of Otolaryngology/Head This and Neck Surgery. Internship and Acting year includes being fourth Dr. coordinator. rotation Selective Critical Care students with all 4th year Zanation also meets in Otolaryngology/Headinterested and Neck Surgery application the residency to mentor them through Austin Rose serves as Dr. process. for the Otolaryngology coordinator Surgery Dr. rotations. Year Third the Charles Ebert, coordinates Head and Neck Surgery Specialty Oliver and Dr. Selective 4th Year serves as the second year Adunka Otolaryngology/Head and Neck Surgery course coordinator. D 44 Educational Programs NIH Training Grant he Department has held a training grant from neurons in the cochlear nucleus. Kola worked with Tthe National Institutes on Deafness and Other Dr. Serody on characterization of myeloid-derived Communication Disorders (NIDCD) for research tumor suppressor cells. training in Otolaryngology/Head and Neck Surgery since 2001, when the Department joined an elite Mr. Matthew Woffard (MS3) worked with Dr. Julia group of about a dozen institutions that offer Kimbell. Mr. Wofford’s work was in two areas using 2-year research training positions during residency. computational fluid dynamic (CFD) simulations The grant also guarantees the Department’s to model sinonasal particle deposition. The first continued support and promotion of medical area was a mesh refinement study. A “mesh” is student research experiences at UNC. The training a three-dimensional (3D) grid that approximates grant provides stipends for medical students (2 for an air space like the nasal passages with a large the summer and 1 for a whole year, each year of the number of small, 3D elements that are used to grant) and one resident for two years of research solve the equations of airflow numerically. The training each year. We are currently completing main finding was that tetrahedral meshes without our second 5-year cycle of this grant, and Dr. Paul additional thin layers of prism elements near Manis is the PI. The training grant is undergoing airway walls significantly over-predict deposition, review for renewal so that we can continue to especially at the lower end of the particle sizes provide these training opportunities. that we investigated. The second broad area of work centered on studying topical drug delivery to This past year, we supported two medical students the maxillary sinus (MS) pre- and post-functional in the summer training program, Andrew Barber endoscopic sinus surgery (FESS). Although (MS1) and Kola Agboola (MS1). Andrew worked topical medications are commonly used both pre- with Dr. Manis and Dr. Xie on identification of and post-FESS, there is little existing evidence glycine receptor subtypes in different classes of describing how much delivery is actually achieved, and how physical properties of the particles research track with Dr. John Serody (Dept. of 45 (namely size and velocity) affect that delivery. Medicine and Immunology) and is internally 3D reconstructions of the nasal passages were mentored by Dr. Adam Zanation. Educational Programs made using CT scans from four patients obtained before and 12-weeks post-FESS. An additional Dr. Austin completed several projects. Myeloid- 4 virtual surgery models were also created from derived suppressor cells (MDSCs) in squamous each post-FESS model to represent a range of cell cancer: The goal of this research project is to clinically relevant maxillary antrostomy sizes. better characterize myeloid-derived suppressor Both nebulized and sprayed particle delivery were cells (MDSCs) in squamous cell cancer of simulated, and the fraction of released particles the head and neck (SCCHN), especially in depositing in the maxillary sinus were analyzed relation to cancer associated with HPV. When by particle size. There were four main results. completed, the project will reveal whether HPV First, following FESS, airflow into the maxillary viral oncoproteins mediate a vigorous immune sinus may correlate with antrostomy size and response in the tumor microenvironment that may represent a substantial portion of total nasal augments tumor progression or recurrence and airflow when antrostomy size is standard or if there is preferential accumulation of MDSCs larger. Second, the results support the idea that (i.e., peripheral blood versus primary tumor site) NIH Training Grant medical therapy via spray or nebulizer devices to in patients with HPV-associated SCCHN. The the maxillary sinus is more feasible post-surgery research project will also improve knowledge on than pre-surgery. We expanded on this finding effector mechanisms by which MDSCs directly by observing that larger antrostomies generally and indirectly suppress T cell responses in increase drug delivery, although the effects of patients with head and neck cancer. The project increased antrostomy size are not simple. Third, has 3 aims. Aim I: To measure and compare delivery to the maxillary sinus is highly sensitive the accumulation of MDSCs in previously to particle size, so that maximal deposition in untreated patients with SCCHN between the post-surgical sinus requires optimally-sized those who are HPV-positive and HPV-negative. particles. Fourth, there was considerable inter- This is being accomplished by isolating and individual variability in post-FESS delivery, immunophenotyping MDSCs by flow cytometry and variability within an individual based on from peripheral blood and primary tumor tissue antrostomy size. By predicting the degree of specimens, and the results will be stratified by drug delivery that can be anticipated for a given tumor subsite and size. The hypothesis is that combination of individual sinonasal anatomy, MDSCs present at the site of tumor inhibit this antrostomy size, and particle size, use of CFD immune response and promote tumor progression, analysis based on individual pre-surgical CT scans allowing for a new target for head and neck may significantly guide clinical decision making cancer therapy. An additional hypothesis is that about the use of topical medication post-FESS. chemoradiotherapy is more effective in HPV- associated SCCHN due to the ability to deplete The crown jewel of the training grant is the 2-year MDSCs in the tumor environment. Aim II: The research program for selected residents. goal of this aim is to measure and compare the accumulation of MDSCs in previously untreated Grace K. Austin, MD just completed her 3nd patients with SCCHN to normal controls. residency year, and the second year of her 2-year This will be accomplished by isolating and 46

immunophenotyping MDSCs by flow cytometry In addition to the Aims originally described, Dr. Kim from blood and tissue specimens. The result of added experiments using in vitro hybridization to this experiment will reveal whether the number of detect MDSCs in paraffin-embedded tissues. At Educational Programs MDSCs are different in patients with SCCHN relative this time, the majority of tissue has been stained to normal controls. In addition, this aim will further and analyzed. She is drafting a manuscript for explore whether suppressive functions of MDSCs submission and had a poster presentation at the on effector immune cells in patients with SCC of the American Society of Clinical Oncology meeting in oropharynx are reduced by prior chemoradiation June 2013. therapy. This is accomplished by isolating MDSCs from prospectively collected fresh blood and tissue In addition to this primary project, Dr. Kim has specimens, then performing effector functional participated in several clinical research projects. studies including the lymphocyte response test. One set of projects focused on the usage of Comparisons are made between previously untreated different flaps for reconstruction of the head and patients and patients with prior chemoradiation neck, including analysis of the complication rates, therapy who will be stratified by dose, type, and case studies of specific flaps, and evaluation of frequency of therapy. The result of this experiment treatment outcomes of patients with head and neck will tell us how effectively MDSCs effector functions cancer. She also is evaluating an evolving pediatric are suppressed by chemoradiation treatment. tracheostomy protocol using polysomnography as an objective measure. Finally, she is studying Over one hundred subjects were enrolled in the longitudinal assessment of vocal outcomes of study, with half of these having squamous cell patients who underwent surgery for voice therapy. cancer of the head and neck, approximately 10% with other diagnoses (e.g., melanoma, keratosis, Gita Fleischman, MD is currently in her 3rd mucoepidermoid), and 12% normal healthy residency year, and in the second year of her 2-year subjects. Flow cytometry was used to evaluate the research track with Dr. Julia Kimbell (Dept. of MDSC status for these subjects. Different gating Otolaryngology-Head and Neck Surgery). strategies were evaluated to analyze the data by flow cytometry and to help in interpreting results. Dr. Fleischman’s primary project uses Computational Preliminary results were presented at the Triological Fluid Dynamics (CFD) to determine whether virtual Combined Sections meeting in January 2013. functional endoscopic sinus surgery (FESS) can Effector function assays were also run on peripheral be used to predict post-FESS surgical airflow blood of a subset of patients and normal controls. patterns. CRS represents a heterogeneous group She also examined autologous T cells, which were of disorders resulting from chronic sinonasal found in variable amounts in the patients' tissues. inflammation. While FESS has been shown to 47 Educational Programs

successfully eliminate obstructions and facilitate completed modeling and simulation on four patients, sinonasal ventilation and drainage, post-operative and Dr. Fleischman has focused on one patient medical management is essential, as most patients as the subject for the virtual surgical simulations. continue to have persistent disease. The objective These simulations revealed a number of interesting of this project is to use CFD to simulate the delivery results regarding particle deposition and FESS of topical medication in the sinonasal cavities, to that were not necessarily intuitive, suggesting that eventually optimize drug delivery after FESS. CFD deposition is a more complex process than might be techniques are used to conduct a systematic study expected. Additional drug-deposition simulations are of the physical effects of CRS, FESS, and patient- also being run. use factors on the deposition of sprayed nasal medications in the pre- and post-FESS paranasal In addition to her primary project, Dr. Madan has sinuses. The specific hypotheses are: 1) Paranasal two other CFD-related basic research projects. The sinus deposition of nasal spray medication is first is Predictive Modeling for Treatment of Upper lower in pre-FESS patients and higher in post-FESS Airway Obstruction in Young Children. The goal patients than in normal nasal airways. 2) FESS of this project is to determine how CFD analysis increases paranasal sinus deposition of nasal spray might help in assessing post-surgical outcomes in particles. 3) Virtual Surgery may be used to predict children with subglottic stenosis (SGS) who undergo deposition patterns and airflow patterns prior to laryngotracheal reconstruction (LTR). The immediate actual surgery. objectives being to visualize and quantify airflow through the respiratory tracts of children before and These are tested in the following two specific aims: after LTR, utilizing CFD modeling derived from pre- Aim 1: To create patient-specific CFD models based and post-operative CT scans. The preliminary results on pre- and post-FESS CT scans and compare from this project were presented at the Combined paranasal sinus deposition of sprayed particles Otolaryngological Spring Meetings (COSM) meeting predicted in CRS patients with deposition predicted in January 2013. A second objective of this study is in normal nasal passages. Furthermore, pre- and to illustrate the effects of LTR in a child with SGS by post-FESS predictions of deposition in the same comparing airflow in pre- and post-LTR airways with patient will be compared, which will provide a age/weight-matched normal airways using CFD. This quantitative comparison of deposition improvement research will be presented at the American Thoracic after FESS. Aim 2: To determine if virtual functional Surgery Meeting in 2013. endoscopic sinus surgery (FESS) can be used to predict post-FESS surgical airflow patterns and drug- The second project is entitled “Characterization of deposition using CFD. Eight subjects were consented Post-Surgical Changes in Nasal Airflow in Functional and 5 were enrolled in the study. Of these, we have Nasal Surgery Through A Computational Fluid 48 Dynamics Model." post-processing has been completed, and the CFD data are currently being analyzed. The goal of this project is to create anatomically correct computational models of the nasal passages The trainees have been actively submitting papers for of cadaveric heads which have received several both their basic research and in the clinical arena, as functional nasal surgery (FNS) interventions, well as attending a variety of conferences to present including septoplasty, rhinoplasty, turbinate or nasal their work. Additional success in the program is valve surgery. These models will be used to evaluate evident in the number of applicants we have had from CFD response, including nasal airflow, resistance, wall institutions outside UNC Chapel Hill, attesting to the pressure, wall shear, air conditioning, and particle national stature of the program and the strength of penetration, to surgical intervention for nasal valve the research opportunities.

Educational Programs obstruction (NAO). All modeling, simulation, and Visiting Professors LaNNy CLose, MD Jeffery Myers, MD Columbia University Medical Center MD Anderson Cancer Center July 10-11, 2012 November 13-14, 2012 • History of Head and Neck Surgery in New York: A • Personalizing Head and Neck Cancer Therapy Columbia Perspective • Management of the N(+) Neck in Oral Cavity Cancer • Endoscopic Approaches for Orbital Decompression & Resection of Orbital Tumors MarouN seMaaN, MD University Hospital Case Western Medical Center BraDLey Kesser, MD November 20-21,2012 University of Virginia • A Mouse Model of Endolymphatic Hydrops: Where August 21-22, 2012 are we now? • An In-Vitro Model System to Study Gene Transfer • Otologic Innovations at Case Western Reserve in the Human Inner Ear Approach to the Tinnitus University Patient • Why Do We Need Two Ears? Studies in Congenital fraNK LIN, MD, PHD Aural Atresia Johns Hopkins School of Medicine November 27-28, 2012 roBerT LaBaDIe, MD • Hearing Loss and Healthy Aging Vanderbilt University Medical Center • Outcome After Cochlear Implantation in Older Adults: September 25-26, 2012 Moving Beyond Speech • Use of Robotics in Otologic Surgery • Navigating Academic Otolaryngology WILLIaM KeaNe, MD Thomas Jefferson University earL HarLey, MD June 25-26, 2013 Georgetown University • Microvascular Reconstruction of the Orbital Area October 23-24, 2012 • Management of Sinonasal Malignancy • Pediatric Thyroid Disease • Panday Syndrome

CHrIs MeLroy, MD Georgia Sinus & Nasal Institute October 30-31, 2012 • Management of Nasal Disorders: The Forgotten Aspect of Rhinology • Tips for a Successful Career Start in the Practice of Otorhinolaryngology 49 Educational Programs Newton Fischer 2013 he great tradition of the Department’s Newton D. Fischer Society Meeting continued this year RobeRT A. buckMIRe, MD T Laryngology Update 2013 on Saturday, June 1st at the Paul J. Rizzo Conference

Center here in Chapel Hill. For many years, this annual ANDReA JARcHow-GARcIA, MD meeting has served as a forum for both practical clinical The Science of Beauty updates and the presentation of newly discovered research findings, as well as a terrific opportunity cRAIG A. bucHMAN, MD for alumni of the residency program to reconnect. What’s New in Implantable Auditory Devices

In recent years, under the leadership of Course Co- AuSTIN S. RoSe, MD Directors Drs. Austin S. Rose and Charles S. Ebert, Jr., Evolution in the Management of Chronic the meeting has grown into a fully CME accredited and Sialorrhea

sponsored annual meeting. This year’s accompanying cHARleS S. ebeRT, JR., MD, MPH exhibit, the NC ENT EXPO featured representatives Management of Complications of Endoscopic from Acclarent, Alcon, Brainlab, Entellus, Gyrus/ Sinus Surgery Olympus, Meda Pharmaceuticals, Medtronic, Karl Storz, Stryker, and the The Medical Foundation of North keNNeTH D. RoDRIGuez, MD Carolina. The Department greatly appreciates the Update on Allergic Fungal Sinusitis continued support of all the sponsors of this annual and growing meeting. This year, EXPO participants MATTHew woFFoRD, bS, MS4 were eligible for several prize drawings including a new Functional Endoscopic Sinus Surgery & Apple iPad mini – and the lucky grand prize winner Nebulized Particle Delivery to the Maxillary Sinus was one of our chief residents, Dr. Yu-Tung Wong, who ADAM M. zANATIoN, MD has since completed his training at UNC and begun Skull Base Surgery Update 2013 his neurotology fellowship in San Diego, California. PeTeR D. coSTANTINo, MD, FAcS The 2013 program included a number of excellent Keynote Speaker Lecture: New Paradigms In presentations, including a keynote lecture from Dr. Peter Health care – Crossing the Chasm D. Costantino of the New York Head & Neck Institute on the New Paradigms in Health care: Crossing the Chasm. bRIAN D. THoRP, MD, cHARleS S. ebeRT, Dr. Costantino also participated, along with Drs. Brent JR., MD, MPH, ADAM M. zANATIoN, MD, Senior, Charles Ebert, Adam Zanation, and Brian bReNT A. SeNIoR, MD, AND PeTeR D. Thorp, in a well-received Skull-Base Surgery Panel. coSTANTINo, MD, FAcS Skull-Base Surgery Panel The annual Newton D. Fischer Society Meeting, along with the accompanying NC ENT EXPO has now grown TRevoR G. HAckMAN, MD into the largest annual ENT meeting and forum for Accuracy of Ultrasound Guided FNA in the Post- Radiated Neck exhibitors here in the state of North Carolina – an achievement we hope will continue in the coming cARol G. SHoReS, MD, PHD years. In fact, Drs. Ebert & Rose have already begun Head and Neck Squamous Cell Carcinoma in planning next year’s meeting, which will be held, once Sub-Saharan Africa again at the Rizzo Conference Center here in Chapel Hill, on Saturday, June 7th, 2014 – so save the date! 50

airway Course 2012

Educational Programs he 4 Annual Carolina’s Pediatric Airway Course the University of North Carolina, Medical University T took place on December 13-14, 2012 at the of South Carolina, Duke University Medical Center, University of North Carolina at Chapel Hill. This Eastern Virginia Medical School, Georgia Health two-day course is hosted by The University of North Sciences University, Vanderbilt University Medical Carolina and the Medical University of South Carolina, Center, and Wake Forest University School of alternating locations yearly. Co-Course Directors, Medicine. All of these participants participated in Carlton J. Zdanski, MD and David R. White, MD lectures on the first day from our Visiting Professor, have received high praise from its attendees for such Michael J. Rutter from the University of Cincinnati a successful course and implementing the following College of Medicine in Cincinnati, OH who gave a objectives: Demonstrate proper management of lecture on Endoscopic Treatment of Pediatric Airway the normal and abnormal pediatric airway during Problems. Other lectures were given by Dr. Amelia laryngoscopy and bronchoscopy; provide hands- Drake on Airway Endoscopy and Foreign Body on experience with open and endoscopic airway Management; Dr. David White, Open Techniques for procedures in a living animal model, simulated Airway Reconstruction; and Dr. Robert Buckmire, human model, and microlaryngeal laboratory; expose Pediatric Laryngeal Microsurgery. The second day participants to a variety of surgical techniques for all participants were involved in the Simulation management of pediatric airway problems; and Laboratory and the Endoscopic Techniques Laboratory develop and improve skills of airway management where they could develop and improve on their skills. and bronchoscopic technique by managing emergent scenarios in a simulation laboratory. The Carolina’s Pediatric Airway Course has proven to be a viable and important course for all physicians With these objectives in mind the course reaches involved and will only grow with each coming year. out to attendings, fellows and 3 rd year residents from Fellowship Programs 51 Fellowship Programs Pediatric rotations in pediatric anesthesia, pediatric pulmonary medicine, and pediatric genetics. With three full-time OtOlaryngOlOgy faculty and approximately 3000 cases per year in the Children’s Hospital OR and Ambulatory Surgical FellOwshiP Center outpatient operating rooms, the position offers As the Division of Pediatric Otolaryngology a great deal of clinical and operative experience. grows, there has clearly developed an excellent opportunity for training at the fellow level. Dr. OtOlOgy/ Carlton Zdanski serves as Director of the Pediatric Otolaryngology Fellowship Program. neurOtOlOgy/ Dr. Lorien Paulson completed the fellowship lateral skull base program in 2012. She joined us after her residency at Oregon Health & Science University in Portland, surgery FellOwshiP Oregon. She did rotations in Pediatric Plastic & The Division of Otology/Neurotology continues to offer a Reconstructive Surgery for cleft lip and palate fellowship in advanced otology/neurotology and lateral patients. Upon graduation, Dr. Paulson joined skull base surgery. Dr. Oliver Adunka has been serving Children's Mercy Hospital in Kansas City, Missouri. as the fellowship director. Previously, Dr. Benjamin Wei completed his fellowship in Our 2013 Pediatric Fellow 2012 and is currently practicing is Dr. Jason Roberts, who in Melbourne, Australia. completed his residency at Subsequently, the Division Albany Medical College. UNC- was able to attract another OHNS played a formative role fellow from Down Under. Dr. in his otolaryngology career: Claire Iseli, born and raised while in medical school, he in Melbourne, Australia, has received a NIH T32 Grant for joined UNC in January 2013 for auditory electrophysiology study with Dr. Fitzpatrick, a two-year fellowship. Dr. Iseli is a well-accomplished and worked with Drs. Shores, Rose, and Weissler. otolaryngologist with broad experience in auditory As the only Pediatric Otolaryngology Fellowship electrophysiology. Besides her busy clinical and surgical in the state, the program helps to establish the schedule, Dr. Iseli will help with various translational Division’s position as the premier group for Pediatric projects both in the lab as well as in a clinical setting. Otolaryngology care and training in North Carolina. UNC is home to a freestanding Children’s Hospital, advanced surgical Pediatric Airway Center, Craniofacial Center, and Pediatric Cochlear Implant Program, offering pediatric head and neck otolaryngologists entering the field many ways OncOlOgy FellOwshiP to get involved and expand upon their residency The Department of Otolaryngology/Head and Neck training. In addition to clinical responsibilities, Surgery continued its Advanced Head and Neck there are also opportunities for research, as well as Oncology Fellowship on July 1, 2013, with David Ludlow, 52 MD as fellow. Co-directors of skull base surgery practice. the fellowship, Drs. Trevor Dr. Mitchell Gore completed Hackman and Adam Zanation, his fellowship in June are pleased to offer this unique 2012 and Dr. Kenneth one-year opportunity, which Rodriguez completed his

rograms will provide the highest quality fellowship in June of 2013. training in the medical and Dr. Stanley McClurg, who surgical management within the completed his residency at field of Head and Neck Oncology. This includes ablative The Ohio State University, aerodigestive tract surgery, transoral laser microsurgery began his fellowship in July of 2013. Fellowship P Fellowship (TLM), transoral robotic surgery (TORS), endocrine surgery, skull base oncology, facial plastics and reconstructive surgery, including microvascular surgery. Judith gRAvel pediAtRic Jeremiah Traci, MD will begin his fellowship in July 2014. Audiology Fellowship In 2010 the UNC Pediatric Audiology program Rhinology, AlleRgy was invited by Hear the World Foundation to host & endoscopic an annual fellowship named for the late Judith Gravel who died in 2009. Dr. Gravel was recognized skull BAse suRgeRy internationally for her expertise in pediatric audiology and her commitment to the advancement of Fellowship educational opportunities for clinicians and students. The highly sought after Rhinology and Skull Base The Gravel Fellowship is awarded each year to a Surgery Fellowship began in 2011 and is co-directed by 4th year AuD student whose externship is at UNC Drs. Adam Zanation and Charles Ebert. Drs. Brent Hospitals, focusing on the needs of infants and young Senior, American Rhinologic Society past-President, children with hearing loss and their families. The Austin Rose, and Julie Kimbell comprise the remaining Judith Gravel Fellow for the faculty. In just three short years, the fellowship has 2013-14 academic year is gained a place in the top tier of fellowship. Out Bernadette Rakszawski, a of a total of 48 applicants our program received 4th year AuD student from 36 applications, 75% of which were from UNC. Washington University in The fellowship is a one-year fellowship program that St. Louis. Judith Gravel provides comprehensive training in the medical and Fellows from previous years surgical management of sinonasal inflammatory are: Mallory Baker, a former disease, anterior and central skull base lesions UNC student currently (endoscopic and/or open management), allergic working as a pediatric audiologist at Children’s disease, and orbital pathology. The fellow also performs Hospital in Philadelphia, Ashley Timboe from the high quality and thoughtful research that ranges from University of Washington, now working as a pediatric basic science translational work to clinical trials. Our audiologist at Seattle Children’s Hospital and Nicole fellowship provides the highest-quality, broad-based Duncan now working in Bangor, Maine as a pediatric training that imparts fellows with the knowledge and audiologist with Penobscot Community Health Care expertise to develop a successful tertiary rhinology/ (PCHC). Applications are being reviewed for 2013-2014. 53 Outrech Programs outreach Programs ent surgeOns in vietnamese exchange By Lily Lauer with Jeff Stebbins It was a busy week in early April for the team of seven residents, Dr. Eugene Son and Dr. Viet Pham, who otorhinolaryngologists who served in Vietnam—and has traveled with Dr. Pine on two previous trips. Dr. an adventure for Jeff Stebbins, who facilitated the Lorien Paulson, a Pediatric Otolaryngology Fellow, trip. Jeff has a “Dr.” before his name, but he has a and Dr. Alex Farag, both from UNC Chapel Hill, PhD in linguistics, not medicine. This was his first rounded out the team. Because of a blizzard on the medical trip, so—besides offering his valuable skills east coast, Dr. Farag didn’t arrive in Ho Chi Minh City in language, culture, logistical coordination, and until hours before the team began their first day of ordering noodles—he was able to observe our very work. Nevertheless, he dove into a full schedule of talented team of ENTs as they performed patient patient consultations. consultations, lectures, and surgeries. Upon arriving, most of the doctors had two days to Jeff met Dr. Brent Senior, ENT team leader from recover from jet lag and explore nearby shopping. UNC, Chapel Hill (in North Carolina) in Hanoi a few Over the weekend, Drs. Pine, Pham and Young, days before the rest of the team arrived. Dr. Senior and Dr. Young’s brother, Aaron (in Vietnam after flew into Vietnam from Indonesia where he had been a business trip in Korea), went on a bike and boat working with a humanitarian mission. Dr. Senior has expedition in the delta south of Ho Chi Minh City. Dr. taken a whopping sixteen trips to Vietnam since 1998. Young was surprised to see many children run outside During this trip he divided his time in Hanoi between their home to shout “hello” as they rode by on their National ENT Hospital and Bach Mai Hospital, where bicycles. Arriving at the different hospitals, Drs. Pine he performed three surgeries and lectured on the and Senior were welcomed by old friends. They were development of sinuses from embryo to adulthood. able to reconnect with numerous REI-Vietnam Fellows Brent operated on one of our friends, Dr. Dinh, an including Drs. Ðinh, Luong, Ha, Huong, and Huy, and REI-Vietnam Fellow and head of the ENT Department they met a new Fellow, Dr. Tran (who is currently in at Bach Mai Hospital. Dr. Dinh’s wife was moved by the United States on a REI Fellowship). Dr. Senior’s expert care for her husband, and her Drs. Harold Pine and Lorien Paulson worked at farewell to Brent was very touching. Number One Children’s Hospital throughout the week. Jeff and Brent met the rest of the ENT team in Ho The other doctors divided time between Number One Chi Minh City. Dr. Harold Pine, pediatric ENT from Children’s Hospital, Gia Ðinh Hospital, HCMC’s ENT the University of Texas Medical Branch (UTMB) in Hospital, and Nguyen Tri Phuong Hospital. Most of Galveston, is also a veteran traveler, with ten trips the doctors spent the first part of the day in patient under his belt. He brought his colleague, Dr. Dayton consultations, often with cases specially chosen by Young, an Assistant Professor at UTMB, and two our Vietnamese colleagues for their difficulty. The 54

doctors performed surgery in the afternoon on The ENT team was very appreciative of a generous selected patients. Dr. Dayton Young, in particular, donation of equipment from Karl Storz, Ltd. Tino Outrech Programs was given some challenging surgeries. He specializes Demmler and Philippe Lux, Product Specialists for in repairing large perforations of the ear drum. He Karl Storz, provided the team with equipment for often receives referrals of cases where previous navigation and endoscopy, both in Hanoi and in Ho surgery, sometimes multiple surgeries, have been Chi Minh City. Surgeries were much easier and more unsuccessful. In Vietnam, he demonstrated a lateral effective with this generous gift of equipment. graft technique to successfully close these large During their downtime, the team was able to enjoy holes. There were roughly fifteen doctors observing delicious food at banquets provided by our friends at in the operating room and up to sixty additional Gia Ðinh Hospital and Nguyen Tri Phuong Hospital. doctors watching in another room via live video They enjoyed rich fellowship with their Vietnamese stream. After surgery, he lectured on the technique counterparts from each of the hospitals during other to the doctors who had watched the surgery earlier. meals as well. A highlight was the team’s enjoyment Dr. Senior performed sinus surgery on a very special of the Rooftop Garden Restaurant at the Rex Hotel, patient who is so dear to us: Mrs. Lien, REI-VN’s where international correspondents dined during the Representative for Vietnamese Relations. war in the 1960s. Just before leaving, Dr. Paulson proudly noted that she had managed to avoid eating She had been suffering for months and had been any western food during the entire trip. hospitalized several times. Her husband, Dr. Long, traveled to Ho Chi Minh City to support her. The Dr. Young related that he especially appreciated the surgery was obviously successful as Mrs. Lien was friendliness and welcoming disposition of the people back to work within 24 hours. of Vietnam. He found them to be “gracious, bright, and hard-working.” He appreciated the time the Several members of the ENT team were also able to Vietnamese doctors would take to get to know the observe a former REI-VN Fellow, Dr. Son of Number team over a cup of tea before the busyness of the One Children’s Hospital, perform an otoplasty day began, as well as their enthusiasm and eagerness on a child born with all the requisite parts of the to learn. Team members had fun socializing with inner ear, but missing the external cartilage of the colleagues outside of the hospital after work. They visible parts of the ear itself. He removed a piece cultivated delightful relationships within the team of cartilage from the patient’s ribcage, traced the and with Vietnamese doctors, and they look forward shape of the child’s good ear onto the cartilage, and to future trips when they can reconnect with their then inserted it under the skin where the child’s ear new friends. should be. It will take several surgeries to achieve ‘the final product.’ 55 Outrech Programs

MAlAwI SuRGIcAl INITIATIve

In August 2009, the Kamuzu Central Hospital accepted (COSECSA) Membership exams. Charles Mabedi the first class of general surgery residents. The is looking forward to taking these exams this program was the culmination of years of effort by Dr. coming year. Vanessa Msosa, Keller Kumwenda, Arturo Muyco, the chief emeritus of General Surgery and Michael Phiri are finishing their intern year. at KCH, and is a collaborative effort with the Malawi Two new residents will start Ministry of Health, the UNC the program in August 2013, Departments of Surgery and Ms. Natasha Ngwira and Mr. Otolaryngology/Head & Neck Frank Mponya. Drs. Munthali Surgery and the Haukland and Manda are training in University Hospital (Bergen, orthopeadic surgery, and all Norway) Departments of other residents are general Surgery and Orthopeadic surgery. In August 2013, all 5 Surgery. Dr. Carlos Varela, a years of the general surgery Malawian surgeon trained in residency will be full, and we South Africa is the current anticipate Gift Mulima and Chairman of KCH Department L-R: UNC Surgery Residents Anna Tyson and Melanie Sion, President Bill Clinton, UNC Trauma Tiyamike Chilunjike finishing of Surgery and our residency Surgeon Anthony Charles next July, qualifying for the director is Dr. Leonard Banza. COSECSA Fellowship exams. Six KCH residents, Gift Mulima, Chifundo Kajombo, Drs. Carol Shores and Anthony Charles attended Enock Ludzu, Judith Mkwaila, Boston Munthali, the COSECSA annual meeting in Addis Ababa, and Kumbukani Manda passed their written Ethiopia in December 2012. Dr. Shores was (September 2012) and oral (December 2012) College inducted as a COSECSA Fellow at this meeting. of Surgeons of East, Central and Southern Africa For more information, please visit med.unc.edu/msi.

L-R: Class of 2016 resident Dr. Charles Mabedi, and Class of 2017 residents Drs. Vanessa Msosa, Michael Phiri and Keller Kumwenda. 56

free oraL, HeaD & NeCK CaNCer sCreeNING

The Department held its annual Head and Neck a delicate balance of “not too much” treatment and

Outrech Programs Cancer Screening Day on April 25, 2013: a free event “not too little” treatment. We quickly learned that the that allows attendings and residents the opportunity side effects of the treatment felt ten times worse than to participate in community cancer outreach, and is the cancer itself. Overcoming the occasional nausea, open to the public. Rich Rivera, a volunteer for the frequent digestive issues, excruciatingly persistent event graciously offered to share the story of his pain in the mouth and throat became a daily battle. partner, Bart Queen. For more information about Bart’s recovery, please visit go.unc.edu/a8MFd A few months following the completion of treatments, the nausea and digestive problems slowly began am often asked what were my initial reactions and to subside. The pain became tolerable and the I thoughts when my partner and I learned that he feeding tube inserted into his stomach and used for had stage four throat cancer. Our first reaction, like intake of water and liquid nutritional supplements many who have unexpectedly been diagnosed with a was removed almost six months to the day of life threatening illness or ailment, was simply, disbelief. his first chemotherapy/radiation treatment. Bart, who was in his early 50s at the time had never In November, Bart and I waited anxiously, yet smoked or used tobacco products. Anyone who has hopefully, for the results of the first post treatment met Bart knows of his extraordinary active lifestyle, full body PET scan and were absolutely joyful and combining his busy professional life as a speaker and thankful that all traces of cancer were gone. He communications trainer with a disciplined exercise and I had much to share and be grateful for during regimen at the gym and strenuous chores on the farm. the Thanksgiving Holiday with our families. Nine The idea of Bart having throat cancer was something months have passed since that first post-treatment he and I never anticipated. After our initial period of PET scan and Bart is healthy and free of cancer. disbelief, we agreed that only through our combined We celebrated the One Year Anniversary of the acceptance, perseverance, and faith would we completion of his treatments in May and remind succeed in the many battles during the next several ourselves often of our blessings of his good health. months to win the war over cancer! The oncologists Bart is gradually gaining back much of the strength and along with the patient team at the Cancer Clinic stamina lost during the treatment and post-treatment were methodical and precise in the treatment plan recovery period. We know that our acceptance of the that included radiation and chemotherapy. situation, perseverance to complete the painful and The medical team at the Cancer Clinic agreed upon discomforting treatment plan and our belief in our faith a treatment plan that would provide the greatest got us through this difficult time. Bart has been and assurance of eliminating the cancer cells while striving continues to be an inspiration to many. His triumph to preserve and protect Bart’s ability to speak. It was over cancer has renewed his strength and faith. clinical Programs pediatric cochlear implants • speech-language pathologists • audiologists • mentorship • fundraising • Auditory Brainstem Implant • intervention • education • collaboration • auditory neuropathy spectrum disorder • cochlear malformation • Investigational Device Exemption • psychological and academic development • pediatric cochlear implants • speech-languageThe UniversiTy of nor Thpathologists Carolina aT Chapel • audiologistshill • mentorship • fundraising • Auditory Brainstem Implant • intervention • educationEar and • collaborationHearing Center • auditory neuropathy spectrum disorder • cochlear malformation • Investigational Device Exemption • psychological and academic development The UNC Ear and Hearing Center, directed by Dr. Craig Buchman, is • an pediatric organization with cochlear a shared mission: implants • speech-language pathologists • audiologists • mentorship • fundraising • AuditoryTo preserve Brainstem and/or restore Implant the hearing • intervention of all • education • collaborationindividuals through • auditory high-quality neuropathy patient care, research, spectrum disorder • teaching, and service. cochlear malformation • Investigational Device Exemption • psychologicalMoreover, the organization and is academic intended to be developmenta fully-integrated • pediatric cochlearcenter that implantsprovides an interactive • speech-language and comprehensive scope pathologists of • effort across all domains of the academic health center mission. audiologists • mentorship • fundraising • Auditory Brainstem Implant • intervention • education • collaboration • auditory neuropathy spectrum disorder • cochlear malformation • Investigational Device Exemption • psychological and academic development • pediatric cochlear implants • speech-languagemed.unc.edu/earandhearing | med.unc.edu/ent/for-patients/clinical-services/unc-adult-cochlear-implant-program pathologists • audiologists • mentorship | • fundraisingmed.unc.edu/earandhearing/pediatric-services/pedsaud • Auditory Brainstem | med.unc.edu/earandhearing/pediatric-services/castle Implant • intervention | • pediatric cochlear implants • speech-language pathologists • audiologists • mentorship • fundraising • Auditoryfa CUBrainstemlTy Implant • intervention • education • collaboration • auditory neuropathy linical services include consultation, C diagnosis, disease treatment, medical/surgical spectrum disorder • cochlear malformation • Investigational intervention, rehabilitation and follow-up for patients with the entire range of diseases of the ear Device Exemption • psychological and academic development and related structures. These services transcend all ages, technologies, and interventions with the • pediatric cochlear implants • speech-language pathologists • intent of providing one-stop care for all patients. Necessarily, the Center represents a comprehensive audiologists • mentorship • fundraising • Auditory Brainstem Implant multidisciplinary effort to service delivery and Craig A. Buchman, MD, FACS Harold C. Pillsbury, MD, FACS Professor and Center Director Professor and Chair patient care. We are fortunate to have world-class • intervention • education • collaboration • auditory neuropathy professionals trained in all aspects of hearing spectrum disorder • cochlear malformation • Investigational disorders staff the Center including pediatric and adult audiologists and otolaryngologists, Device Exemption • psychological and academic development neurosurgeons, geneticists, auditory/verbal therapists, speech pathologists, teachers of the • pediatric cochlear implants • speech-language pathologists • hearing-impaired, and a designated Ear & Hearing Center nurse. Theses individuals are widely audiologists • mentorship • fundraising • Auditory Brainstem Implant recognized as leaders in the field, placing us on firm • intervention • education • collaboration • auditory neuropathy ground at the cutting edge for both service delivery Oliver F. Adunka, MD, FACS Carlton J. Zdanski, MD, FACS, FAAP and investigative pursuit. This effort requires Associate Professor Associate Professor spectrum disorder • cochlear malformation • Investigational participation from a variety of departments within UNC’s School of Medicine, UNC Hospitals, as well Device Exemption • psychological and academic development as professionals from the State of North Carolina’s Departments of Health and Human Services (DHHS) • pediatric cochlear implants • speech-language pathologists • and Public Instruction (DPI) and Beginnings. audiologists • mentorship • fundraising • Auditory Brainstem Implant Over the last decade, this group has worked together to eliminate redundant evaluations by • intervention • education • collaboration • auditory neuropathy related providers. We have created one-stop visits spectrum disorder • cochlear malformation • Investigational Device for very complex interdisciplinary visits. In addition Hannah R. Eskridge, MSP, CCC-SLP to creating convenience, this organization has Holly F.B. Teagle, AuD, CCC-A Director of Center for the Acquisition of Spoken Director of Carolina Children’s Language Through Listening Enrichment reduced the time needed for information transfer, Exemption • psychological and academicCommunicative development Disorders Program Assistant • pediatric Professor Associate Professor intervention provision, as well as the number of cochlear implants • speech-language pathologists • audiologists • anesthetics a child requires for evaluation (e.g. radiographic and electrophysiological hearing mentorship • fundraising • Auditory Brainstem Implant • intervention studies carried out in the same setting). These • pediatric cochlear implants • speech-language pathologists • changes have improved patient safety, efficiency, and effectiveness while reducing costs. Significant audiologists • mentorship • fundraising • Auditory Brainstem Implant research benefits have also been realized from analysis of the multi-dimensional data sets that are • intervention • education • collaboration • auditory neuropathy generated through this alliance. Meg Dillon, AuD, CCC-A Claire E. Iseli, MBBS, MS, FRACS Clinical Research Audiologist, Fellow 2013-2014 spectrum disorder • cochlear malformationAssistant Professor • Investigational Device Exemption • psychological and academic development 61 Extensive audiology E

services, in r a conjunc- d n a tion with H Otolaryn- E gology/ g n i r a Head & C Neck phy- E sicians, are t n E an integral r part of the Ear & Hear- L-R: Matt Ewend (Chair Neurosurgery), Craig Buchman, Kay Hagan (US Senator), Nicole, Ethan, ing Center. Len and ABI recipient Grayson Clamp. Newborn to geriatric Central to the mission of the Ear & Hearing Center hearing screening; comprehensive audiological is the provision of research to help solve the assessment, hearing aid evaluation, fitting, and problems of the patients we serve. A vision that dispensing; and cochlear implantation evaluation all patients can teach us something about hearing and mapping are offered. American Sign Language loss is a cornerstone. Our scope of research interpreter service is also readily available through includes both clinical and basic science efforts “Deaf Talk,” a video interpreting system. Diagnostic that span the entire auditory system (from pinna exams available include behavioral, evoked re- to cortex). Like the clinical domain, Ear & Hearing sponse, and vestibular testing. Patient education, Center research is an integrated, multidisciplinary on a wide variety of hearing related conditions, effort across departments within the School of has been developed for patients and families. Medicine. A clear focus on translational projects Comprehensive medical and surgical care for helps to bridge the gap between the research a variety ear, hearing, balance, facial nerve bench and the patient. Another key aspect to disorders, and skull base tumors located from improving patient care is the routine collection the outer ear to the brainstem are treated of a variety of outcome measures during routine commonly. Surgeries include tympanostomy visits. Development of this research infrastructure tubes, tympanoplasty, mastoidectomy, ossicular makes it possible to capture data to identify reconstruction, stapedectomy, cochlear therapeutic efficacy and improve patient care implantation, osseointegrated implants, active through quality improvement initiatives. middle ear implants, acoustic neuroma and lateral For the purposes of education and awareness, skull base surgeries, and auditory brainstem Center staff participate in 1) community-based implants (ABI) among others. In addition to efforts in the promotion of hearing wellness rehabilitative audiology, speech and language for schools and other groups, 2) professional therapy, educational services, and vestibular organizations focused on the hearing impaired therapy are readily available from highly and related disorders, 3) development and experienced individuals. 62 involvement in local, national and international • Vibrant Soundbridge (VSB) trial recruitment events promoting the goals of the Center and • Sound Localization booth at Carolina Crossing academic interests of the University and the hearing- • New clinical trials established for residual r

E impaired community at large. We also participate hearing

n t extensively in the education of professionals at all • Cognitive test battery as a part of the adult E

C levels and disciplines including audiology, speech cochlear implant process pathology, teachers of the hearing impaired, as well Leadership and advocacy continue to be important a r i n g as physicians and physicians in training. E to the Center’s mission. Many of us serve in a variety H The following pages give a peak in to some of the of leadership positions in related organizations. a n d

accomplishments at the Ear & Hearing Center last We were also very fortunate to have United States

a r year. Some clinical highlights include: Senator Kay Hagan visit our program to showcase E the work we are doing to enhance hearing loss Pediatric Hearing Program rehabilitation in children. • Our first Auditory Brainstem Implantations in Children On the research and education front, our group con- • 1000th Cochlear implant surgery in a child tinues to be prolific: writing numerous manuscripts • >400 annual pediatric hearing evaluations and giving lectures around the world that are fur- • >100 annual pediatric hearing aid fittings thering our understanding in the field. We have also • >400 Auditory Brainstem Response testing in proudly launched the new multidisciplinary surgical children lab that provides the needed environment for train- • New findings regarding cortical auditory ing the next generation of doctors. evoked responses While these accomplishments make us all exceeding- Adult Hearing Programs ly proud, the people that make these things happen • More than 30 electroacoustic (EAS) stimulation are truly the foundation for our success! surgeries

HEARIng PRESERvATIOn COCHLEAR IMPLAnTATIOn AT UnC. Left: The EAS Investigative Team - English King, AuD, Meg Dillon, AuD, Oliver Adunka, MD, Joseph Templeton, PhD (EAS Recipient and former UNC faculty chair), Craig Buchman, MD and Harold Pillsbury, MD. Not pictured, Marcia Clark Adunka, AuD and Ellen Pearce, AuD. Right: Schematic of the EAS device implanted in Dr. Joe Templeton by Dr Buchman in May of 2008.. 63 E r a

d n a H E g n i r a C E t n E r

AuditoRy BRAinstem impLAntAtion (ABi) in ChiLdRen At unC. LeFt to RiGht: Grayson Clamp after his surgery, and an illustration of the ABI implantation. B ottom LeFt to Right: The team with Grayson and his family: Drs. Jennifer Woodard, Holly Teagle and Craig Buchman. R iGht: Example of the electrical responses elicited by stimulating Grayson’s brain in the operating room.

ViBRAnt medeL impLAntAtion FoR ConduCtiVe And mixed heARinG Loss. Former US Marine Dac Carpenter celebrates his restored hearing beside Dr. Oliver Adunka. Dr. Adunka implanted Dac’s left ear in August 2011. 64

ensures development of novel approaches for UNC Hospitals Adult everyday patient care.

Cochlear Implant The adult cochlear implant program also has a long-

r o g r a m standing commitment to the training and mentoring p Program of doctorate of audiology students. The final year he Adult Cochlear Implant Program at the of the doctorate of audiology program consists University of North Carolina at Chapel Hill in

m p l a n t of a clinical work in the student’s area of interest

i T collaboration with UNC Health Care represents the under the mentorship of seasoned clinicians. This a r

E largest cochlear implant center in North Carolina and l year’s audiology externs are Abby Bennett of the

CH is among the nation’s busiest and most progressive. University of North Carolina at Chapel Hill and o The program has been in existence since the late

C Theresa Bartoldus of City University of New York 1970s and has grown significantly in terms of both Graduate Center. Both students will spend the year

d u lt patient care numbers and clinical staff under the

a furthering their knowledge on diagnostic assessment,

: leadership of Dr. Harold C. Pillsbury, Chairman of r adult hearing aids and cochlear implants under the E the Department of Otolaryngology/Head and Neck

n t direction of Drs. Clark Adunka, King, and Pearce. E Surgery. Additional cochlear implant team members Two additional UNC doctorate of audiology students, C include, Craig A. Buchman, MD, Oliver F. Adunka, Andrea Bucker (3rd year) and Sarah Obarowski (2 nd MD, Marcia Clark Adunka, AuD, English King, year), will spend the year conducting clinical research a r i n g

E AuD, Ellen Pearce, AuD, and a valuable team of with our team on implantable technologies. H researchers, including Joseph Hall, PhD, John grose,

a n d PhD, Emily Buss, PhD, and Margaret Dillon, AuD. The number of adult cochlear implant patients

a r Active collaboration between all team members

E evaluated and treated at UNC Health care continues to increase with each passing year, and we as clinicians are proud of the growth we are experiencing and the level of care and services we can deliver. Cochlear implants represent a dynamic field in the realm of hearing health care, and we are routinely offering this technology to patients with more

Marcia Clark Adunka, AuD, CCC-A, English King, AuD, CCC-A, Ellen Pearce, AuD, CCC-A, and Meg Dillon, AuD, CCC-A 65 E r a

d n a H E g n i r a C E significant residual hearing. Candidacy criteria management via hearing evaluations, speech t n E was once isolated to patients with only severe perception assessment and mapping of external r : : and profound degrees of hearing loss. The hardware are routinely performed at this a lt u d picture of a current candidate now includes satellite location. Candidacy evaluations and patients with moderate to severe and profound intraoperative monitoring of cochlear implant C o

sensorineural hearing loss. Not only have the surgeries are still completed at the main hospital H C

audiometric requirements changed to reflect a campus location. The growth and development l E new type of candidate, but the speech perception of our satellite location for cochlear implant r a

i test battery for determining candidacy has treatment has not only provided our adult t n a l p m evolved to include more challenging, real-world patients with comprehensive clinical care

listening tasks. With all of these changes in options, but also served to reduce commute p testing materials, we can better examine and times for our patrons. Carolina Crossing is m a r g o r classify the limitations of those with hearing loss located at 2226 Nelson Highway in Chapel Hill. and simultaneously determine true candidacy for cochlear implantation. Both unilateral and As a research hospital, we not only aim to bilateral applications of cochlear implantation provide quality clinical services but also to are possible with the help of insurance support conduct cutting-edge research. Since 2007, and recognition of this valuable procedure. UNC investigators initiated enrollment in the With the continued growth of the Audiology Electric-Acoustic Stimulation (EAS) clinical and Otolaryngology/Head and Neck Surgery trial sponsored by MED-EL Corporation. This departments, the program moved in fall 2012 to technology incorporates a hybrid cochlear a larger treatment facility at Carolina Crossing. implant system with a hearing aid to present The expanded space includes five sound suites acoustic stimulation to the low-frequency region for comprehensive audiometric testing, facilities of the cochlea and cochlear implant inserted for hearing aid dispensing, using state of the art partially into the cochlea to electrically stimulate fitting tools, three independent cochlear implant the high-frequency region. Potential candidates programming stations, and patient resources have normal to moderate low-frequency for aural rehabilitation training as well as a hearing out to 1500 Hz, sloping to severe to patient workstation for demoing patient driven profound sensorineural hearing loss in the high rehabilitation tools. The traditional patient care frequencies. The UNC Adult Cochlear implant associated with cochlear implants, including program continues to lead the U.S. commitment candidacy evaluations and postoperative to this clinical trial via subject enrollment and 66 r o g r a m p

m p l a n t i

a r

E monitoring of outcomes as defined by the study hearing and soft surgery techniques, unilateral l

CH protocol. Currently, over 30 patients have been hearing loss, electric acoustic stimulation, bimodal o implanted and are participating in the clinical and bilateral cochlear implantation, optimized C trial. The outcomes have been robust for all study programming of electric stimulation, and subjective

d u lt participants, demonstrating improved hearing in benefits of cochlear implant recipients as measured a

: both quiet and noise. By pursuing such research by patient satisfaction questionnaires. The r E avenues and being dedicated to new advances in satellite office at Carolina Crossing also includes n t E science, we are better able to serve our patients a research sound suite with an 11-speaker arc. C and their families. If you would like to receive This technology allows for the assessment of information regarding our EAS investigational trial localization abilities and speech perception a r i n g

E or other research associated with hearing, please in spatially-separated noise. These topics are H contact the clinic at 919-966-5251 or 919-490-3716. currently under investigation via our skilled team

a n d of otologists, audiologists, and hearing research

a r UNC research in the adult cochlear implant scientists. Please contact us if you are interested E population continues to focus on the benefits in learning more about our clinical and scientific of cochlear implants in patients with residual research.

this year after serving for several years as the Pediatric Audiology audiologist in charge of newborn hearing screening During the past year, the UNC Pediatric Audiology in the UNC newborn intensive care nursery. We team, under the direction of Patricia Roush, welcomed Dr. Shana Jacobs, a graduate of the and in collaboration with otologists and AuD UNC Division of Speech and Hearing Sciences otolaryngologists from the UNC Department of Audiology program to our pediatric team this year. Otolaryngology and audiologists on the UNC pediatric cochlear team, has continued to provide After graduation from UNC, Dr. Jacobs worked for timely diagnostic and habilitative care for infants five years in the UNC Department of Otolaryngology and children with hearing loss within and outside as an audiology research assistant on the of North Carolina. Dr. Roush is joined by a “Moderators of Functional Outcomes in Children team of pediatric audiologists at UNC Hospitals with Mild to Severe Hearing Loss” (OCHL) project. that includes , nissele Franco, AuD Corinne In addition to diagnostic and habilitative work with , , and Macpherson, AuD Sarah Martinho, AuD pediatric patients with hearing loss, Dr. Jacobs will . Patricia Reitz, M.S. retired Jill Ritch, AuD work together with Dr. Nissele Franco to provide 67

newborn hearing screening and follow-up for babies addition to children with ‘typical’ sensorineural in the UNC pediatric intensive care nursery. The UNC hearing loss, the UNC pediatric audiology team, E

Pediatric Audiology team is also fortunate to have working in collaboration with the UNC pediatric r a

three talented 4th year AuD students working in our cochlear implant team, is following over 300 d n a

program this year: Ms. Bernadette Rakszawski, a children diagnosed with “auditory neuropathy H

student from Washington University in St. Louis, the spectrum disorder” (ANSD), a condition that affects E g n i r a current Judith Gravel Fellow, Ms. Beth Van Hollebeke approximately 10% of children with permanent

and Ms. Danielle Verrilli both graduate students in hearing loss. ANSD is a hearing impairment in C

UNC’s Audiology program. which outer hair cell function is spared but neural E t n

transmission in the auditory pathway is disordered. E r The number of children with hearing loss followed While not a new problem, newer test techniques P : E

by the UNC team continues to grow with over in recent years have made diagnosis of ANSD i r at i d 1000 children who wear hearing aids receiving possible. This disorder presents new challenges

care by the pediatric audiology team, and several in management for pediatric audiologists. The C

hundred children with cochlear implants followed UNC pediatric team, in conjunction with UNC a ogy g lo o i d u by the UNC pediatric cochlear implant team. In otolaryngologists, has developed an evidence-

Sarah Martinho, Bernadette Rakszawski, Danielle Verrilli, Pat Roush, Corinne Macpherson and Beth Van Hollebeke Not pictured: Shana Jacobs, Jill Ritch and Nissele Franco 68 u d i o lo g y a

C d i at r i E based protocol for evaluation and management amplification in infants and children up to nine : P r

E so that infants diagnosed with this disorder will years of age, whose hearing losses range from mild n t

E have early and effective treatment. In addition to to severe. By the conclusion of the five-year project

C providing direct service to patients with ANSD, the that ended in July 2013, 300 children across the UNC program is contributing to the education of three sites with mild to severe hearing loss and

a r i n g other professionals. In September of 2012, Dr. Roush 100 children with normal hearing were enrolled. E

H along with Dr. Holly Teagle, Director of the UNC The study was funded by an $8.9 million grant pediatric cochlear program, gave a presentation from the National Institute on Deafness and Other a n d on ANSD to early intervention specialists at the Communication Disorders, NIH, and differed from a r

E Language and Literacy Workshop in Greensboro, NC. most other research on childhood hearing loss by In October, Dr. Roush gave an invited presentation focusing on children with milder degrees of hearing to audiologists, otolaryngologists, and early loss who use amplification. intervention specialists at the Third Latin American Pediatric Audiology Conference in Buenos Aires, This spring, we were pleased to celebrate the Argentina. In November of 2012, Dr. Roush and opening of the new Pediatric Audiology program at Hannah Eskridge, MSP, director of the UNC CASTLE Mission Children’s Hospital in Asheville. This is an Program gave an invited presentation entitled important partnership between Mission Hospital Collaborative Management of Auditory Neuropathy and the UNC pediatric audiology program that Spectrum Disorder at the American Speech- has as its goal to provide comprehensive pediatric Language-Hearing Association Annual Convention in audiology services in Western NC using an approach Atlanta. to management of pediatric hearing loss similar to that provided at UNC. After an extensive search The UNC pediatric audiology program together with for a pediatric audiologist for the Mission Hospital the University of Iowa and Boys Town National program, we were pleased to hear that Mission Research Hospital in Nebraska just concluded the Hospital hired Dr. Melissa Aldana, a graduate of the five-year research project entitled “Moderators UNC Doctor of Audiology program who completed of Functional Outcomes in Children with Mild to her 4th year externship here at UNC with the pediatric Severe Hearing Loss” (OCHL). The primary aim of the audiology team. UNC has agreed to provide ongoing study was to investigate how hearing loss affects training and technical support to the Mission Hospital communication, educational performance, social program. Our team is looking forward to working with skills, and psychological development. Results Dr. Aldana and the Mission Hospital staff to serve from the study are providing important information children with hearing loss and reduce travel time for regarding the effects of early intervention and children and families living in western NC. 69 E r a

d n a H E g n i r a C E Members of the team are also engaged in a number frequency sounds not available using conventional t n E of other research projects. Work continues on a amplification. Dr. Roush is collaborating on this r : U : clinical research project involving a new hearing aid work with Department of Otolaryngology faculty n technology called ‘frequency compression,’ a hearing member Dr. Emily Buss and Dr. Lori Leibold from H CH aid processing strategy that allows access to higher the Division of Speech and Hearing Sciences. E g n i r a & S & The UNC Hospitals Hearing Center at Carolina

UNC Hospitals p Crossing provides specialty voice evaluation H C E E and treatment services. The Speech team at this Hearing & Speech location is comprised of two full time speech C E pathologists, ellen markus and elizabeth t n

Center at Carolina E Ramsey. Dr. Markus is dedicated to the diagnosis r

and treatment of patients with voice disorders at C Crossing with a special emphasis on the vocal development The UNC Hospitals Hearing and Speech Center at a n i l o r a of both the professional and amateur singer. Ms. Carolina Crossing is a community-based Audiology Ramsey joined the UNC Speech department in and Speech Pathology clinic. In October 2012, May 2012 and also specializes in voice disorders. C

we moved to our new building, which is located o r In addition, both of these professionals have at 2226 Nelson Highway in Chapel Hill, NC. Our S S taken on an active role in providing Aural satellite clinic location is one of true convenience g n i Rehabilitation (AR) to UNC’s adult cochlear implant as we are located just south of the intersection recipients. They help this patient population of Highway 54 and Interstate 40 (Exit 273). to learn how to listen and understand the new This Audiology and Speech Pathology satellite sounds that come from their cochlear implant. clinic is staffed by an interdisciplinary team The Audiology clinic space at Carolina of seven audiologists and two speech- Crossing includes five sound booths for language pathologists who work collaboratively comprehensive audiometric testing, facilities with the physicians from the UNC Ear and and state of the art fitting tools for hearing aid Hearing Center. Many of the services and dispensing, three independent cochlear implant appointments that are available at our UNC programming stations, and a patient resource Hospitals Neurosciences location are also center for aural rehabilitation training. available at our Carolina Crossing location. 70

The Audiology team at the UNC Hospitals Hearing in the forms of new services as well as with the and Speech Center provides comprehensive addition of clinical staff. As of July 2013, the diagnostic and rehabilitative audiology services team of participating audiologists at our Carolina i n g

SS for both pediatric and adult populations. The Crossing location includes Drs. Marcia Clark

r o Audiology team provides auditory intervention and Adunka, Angela Byrd, Mark Haythorn, English

C support to patients with traditional amplification King, Sarah Martinho, Ellen Pearce, and Jill Ritch. or hearing aids, Bone Anchored Hearing Aids Dr. Martinho and Dr. Ritch are pediatric (BAHAs), Vibrant Soundbridge (VSB) middle ear a r o l i n a audiologists, who offer clinical support in the implants, and cochlear implants. The Audiology C area of pediatric diagnosis and management of

at team collaborated with the department of ENT

r children with hearing loss. They specialize in

E in a new implant endeavor for UNC this year. the fitting and application of hearing aids and n t E assistive listening devices for pediatric patients. C Similarly, Drs. Clark Adunka, King, and Pearce

EECH specialize in the evaluation of adults with severe p and profound sensorineural hearing loss, who

& S qualify for cochlear implantation. The adult cochlear implant program at UNC is amongst the largest a r i n g

E of its kind in the world and provides some of the most innovative and cutting edge approaches to

CH H hearing loss rehabilitation. Drs. Byrd, Haythorn,

n and Pearce contribute clinical skills in the fitting : U

r of state of the art hearing aid technology for the E adult patient population. They have and continue n t E to commit to the growth and development of C the adult hearing aid dispensing program. Five adult patients were successfully implanted a r i n g

E with the Sophono, an implantable, abutment- The UNC Hospitals Hearing and Voice Center

H free bone conduction hearing device. The fitting is open Monday through Friday, from 8:00 and programming of the external Alpha sound

a n d AM to 5:00 PM. For more information

processors was successfully achieved at UNC regarding available services, appointments a r E Hospitals Hearing and Voice Center. The Audiology or referrals, please call (919) 490-3716. team is dedicated in learning and providing the The UNC Hospitals Hearing and Speech Center latest, state of the art technology to their patients has been consistently voted as a Top Five with hearing loss. A new option to patients with Clinic of UNC Health Care by its patients in conductive hearing loss or single sided deafness is the surrounding community, and we would the SoundBite. It is a non-surgical option that uses be pleased to offer our services to you. bone conduction to transmit sound via the teeth.

Over the years, the Audiology program at the UNC Hospitals Hearing and Voice Center has experienced consistent growth and development 71 which has been recognized nationally for providing W. Paul Biggers quality care to families of children with hearing loss. E r a

Carolina Children’s The program is also unique in its ability to d n a provide financial assistance to families in North Communicative Carolina and for its ongoing professional learning H E

programs to mentor and train educators and g n i r a Disorders speech and hearing specialists from around he W. Paul Biggers Carolina Children’s North Carolina and surrounding states. C E T Communicative Disorders Program (CCCDP), t n E

The CCCDP Financial Grant Program, The Carolyn The North Carolina General Assembly has provided r : CCC : J. Brown Center for the Acquisition of Spoken for the core budget of the CCCDP with a recurring language Through Listening Enrichment (CASTLE) grant this year totaling $519,919. With separate are all part of the UNC Ear and Hearing Center. funding and a distinct budget, CASTLE is a public- d P/C Located at a satellite clinic in Durham, the CCCDP private partnership. State funding for CASTLE and CASTLE are unique programs of the Department has been provided since 2004, with $550,000 a S

allocated in 2012-2013. Other in-house funding t of Otolaryngology. dr. harold pillsbury serves LE as Executive Director of the CCCDP, d r. Craig and awareness raising efforts include staff and Buchman is the Medical Director, dr. holly teagle patient family participation in the Great Human is the CCCDP Program Director and m s. hannah Race 5k in March, and the second annual CASTLE eskridge is the CASTLE Director. They are joined Breakfast in April. Hosted at the Rizzo Center, by drs. Carlton Zdanski and oliver Adunka, invitations to the CASTLE breakfast were extended surgeons, and a staff of talented and dedicated through CASTLE board members and friends of the speech-language pathologists, audiologists, and program and over $23,000 in support was generated support staff. Together they form a dynamic team towards a matching grant from the Oberkotter

Lillian Henderson, Chrissy Kramer, Shuman He, Hannah Eskridge, Erin Thompson, Velma Grose, Jennifer Woodard, Maegan Evans, Robert Humphreys, Deb Hatch, Holly Teagle, Lori Parker, and Lisa Park 72 LE t S a P/C d : CCC r

E Foundation. The 2012 CCCDP/CASTLE Summer Fun Early identification of hearing loss, a thorough n t

E and Fundraiser held in October due to an earlier medical work up followed by intensive audiological

C rain out, was a great success raising just over management, and appropriate intervention are $10,000. In 2013 this ever-popular and growing all critical aspects of patient care that make a r i n g

E event is planned for September and will mark its eventual success with a cochlear implant possible.

H 5th anniversary featuring the Nomads Band, led The pediatric audiologists at UNCH provide the

a n d by staff member Robert Humphreys. CCCDP and important groundwork in diagnosis and hearing aid

CASTLE staff and patients always contribute their management for the child. When a child is referred a r E musical talents as well. And finally new this year, as a potential candidate for cochlear implantation, the First Annual CASTLE Golf Tournament was held the Team strives to identify the unique strengths in May in Greensboro at the Sedgefield Country and needs of the patient during the evaluation Club-The Dye Course. This was an event conceived process. Counseling and plans for subsequent and executed by one of CCCDP/CASTLE’s families intervention are aimed at enabling each child the and Board Members. A great first year effort opportunity to reach his or her full potential to generated over $16,000 and a great time was had communicate. Excellent clinical care begins with by all. Golfers from all over the state participated communication and collaboration among team and encouraged all to make it an annual event. members. The relationship between the patient and the program is long-term, usually lasting throughout The UNC Pediatric Cochlear Implant Team childhood, so the collaborative approach must be The UNC pediatric cochlear implant program at maintained at a high level. The Team is committed UNC continues to experience tremendous growth, to monitoring each patient’s performance with making it one of the largest centers in the county. care, as well as to staying abreast of technological UNC surgeons and staff at the CCCDP care for changes and state-of-the-art methods to ensure over 1000 children. Between July 1, 2012 and June the best possible result for each child. 30, 2013, 126 surgeries were performed. These Holly F.B. Teagle, AuD, CCC-A, Associate Professor, included children receiving their first or second and the other CCCDP audiologists, who include Lisa side devices, 13 revision surgeries and the first Park, AuD, CCC-A, Debora Hatch, AuD, CCC-A, and pediatric Auditory Brainstem Implant, which received Jennifer Woodard, AuD, CCC-A provide audiological global attention. As in previous years, many other management for the children, ensuring their children transferred into the program that were implant devices are carefully programmed and well- implanted elsewhere. The program is providing maintained to obtain the maximal benefit. Lillian ongoing support for children who live in North Henderson, MSP, CCC-SLP, LSLS Cert AvT and Carolina as well as several surrounding states. Maegan Evans, Ph.D, CCC-SLP, LSLS Cert AvEd 73 provide speech/language evaluations for children children who use a hearing aid in addition to a before and after receiving cochlear implants. cochlear implant. dr. shuman he collaborates

with the team on various research projects that E r a The commitment to following patients with implants, include electrophysiological measures, comparing to supporting a team approach, and to assuring objective measures to the behavioral data being d n a that the technology is used to its full potential are collected in the clinic. These endeavors combine H E all critical aspects of the CCCDP mandate. It was basic science with clinical care and, at some point, g n i r a for this reason that The Carolyn J. Brown Center for could shed light on patient management decisions.

Acquisition of Spoken Language Through Listening C E

Enrichment (CASTLE) was created in 2001. h annah Funded research includes a multi-centered NIH- t n

, Assistant sponsored project, Childhood Development E eskridge, msp, CCC-sLp LsLs Cert AVt r Professor and CASTLE Director, is supported by a after Cochlear Implantation, which is in its tenth CCC : staff of experienced speech-language pathologists year. This landmark study continues to generate and listening and spoken language specialists: interesting findings. Thirty children and their parents d P/C maegan evans, ph.d, CCC-sLp, LsLs Cert AVed., were initially enrolled in this study at the UNC sandra hancock, ms, CCC-sLp, LsLs Cert AVt, site; most have been followed to document spoken a S

Lillian henderson, msp, CCC-sLp, LsLs Cert AVt, language as well as psychosocial and academic t LE Chrissy Kramer, ms, CCC-sLp, LsLs Cert. AVt, development. With continued funding, we hope erin thompson, mA, CCC-sLp, LsLs Cert AVt. to follow this cohort of children into adulthood. After years of planning and preliminary work, Other staff critical to the daily function of the an Investigational Device Exemption (IDE) was CCCDP and CASTLE are Robert humphreys, obtained from the FDA to pursue a feasibility study Financial Officer, Lori parker, Receptionist and of Auditory Brainstem Implants (ABI) in children Scheduling Assistant, and Velma Grose, Assistant to with severe cochlear malformations or absent the Directors. Robert, Velma, and Lori go above and cochlear nerves who do not benefit from cochlear beyond to help families and support the programs. implantation. The Pediatric cochlear implant team, Collaborative Research headed by dr. Craig Buchman, collaborates with The diverse characteristics of the large clinical Dr. Matt Ewend of the Division of Neurosurgery population of cochlear implant candidates seen and dr. John Grose and dr. shuman he for this by the Pediatric Cochlear Implant Program have study. The first child enrolled underwent surgery been the impetus for the research projects in April and his device was activated in May. We the CCCDP team has undertaken or plans to did not anticipate the magnitude of response pursue. Study of special populations of children when the video of his initial stimulation went contributes to our overall understanding of the viral and was covered in depth by all of the major many variables affecting outcomes. Currently, news outlets in the US and around the world. projects underway include studies of children with We continue to monitor his progress and plan to a common etiology or characteristic of hearing eventually include 9 more children in this important loss, such as auditory neuropathy spectrum project. This is an exciting opportunity to extend disorder (ANSD), cochlear malformation, or a the benefits of technology to a patient population specific genetic marker. Management issues also that has had limited remedial options in the past. provide questions for study, including outcomes A study of outcomes for children who have received for children with bilateral cochlear implants, or CASTLE services over the years is now underway. 74 CASTLE’s newest venture, REACH, is also being tremendously as distance or lack of resources is no funded for two research projects. REACH is our longer a barrier for accessing appropriate services. tele-therapy and tele-training program described

LE below. In collaboration with the University of Akron Facets of CASTLE include the following: t

S we will be studying the particular skills needed by • Speech/language diagnostic evaluations a therapists to conduct Listening and Spoken Language determine need and eligibility for a variety

P/C Therapy for children with hearing loss and their of available programs, as well as assess d outcomes for children with hearing loss. families using telemedicine. We are also analyzing parent skill development and the outcomes of children • Individual therapy is provided for infants and

: CCC toddlers with hearing loss, as well as older children,

r receiving therapy through REACH in comparison to E including both auditory-verbal therapy and

n t children receiving face to face services in our clinic.

E preschool speech/language therapy, to facilitate

C language and speech development at home. CASTLE • A model toddler class is focused primarily

a r i n g The mission of CASTLE is to provide a quality on listening and talking – the development E of spoken language. Language groups for H listening and spoken language program for children with hearing loss; to empower parents as primary preschool children are also offered. a n d teachers and advocates; and to train and mentor • Tele-therapy and training program, UNC a r

E specialists in listening and spoken language. REACH, launched in summer 2012.

CASTLE is dedicated to providing quality Listening CASTLE offers training and hands-on experience and Spoken Language intervention services to the for professionals and graduate students in teaching families of children who are deaf or hard of hearing children who are deaf or hard of hearing how to throughout North Carolina, especially those who listen and talk. This includes practical experience reside in the rural areas and/or have limited financial with supervision in a listening and spoken language resources. The program focuses on educating, approach for teachers and therapists working in the encouraging, and empowering parents as the primary field. The program is focusing particular effort on teachers of their children, in order to promote healthy supporting school professionals in rural areas where parent-child bonding and to maximize the amount of training opportunities are limited. In this way, CASTLE time a child spends in a language-rich environment. is building the capacity of early intervention and public school programs to fully support the ability of Last summer, CASTLE launched the UNC REACH children who are deaf to develop spoken language program which provides tele-therapy and tele-training while living at home and attending local schools. throughout the state. CASTLE therapists are currently Currently in North Carolina there are approximately able to provide speech-language services to children 2000 children with hearing loss in the public school with hearing loss throughout North Carolina and system. However, most professionals working with Virginia. We are looking to expand this program to children who are deaf have been and are still being other states this coming year. With a pilot grant from trained to teach children through sign language. the Kids ‘N Community Foundation, we focused our Teaching listening and speech to children with hearing tele-therapy for children ages birth to three. We are loss requires an entirely different set of skills. Our also able to work with teachers, speech pathologists ability to improve services in the public schools & early interventionists throughout the state to implies massive cost-savings to the public sector. provide distance training and coaching. This will allow the impact of the CASTLE mission to grow 75 E r a

d n a H E g n i r a C E

Our training program consists of many different The program funds hearing technology and UNC- t n E elements that include workshop presentations, provided diagnostic and therapy services for children r : CCC : internships on-site at CASTLE, school observations from birth to age 21 whose families need financial and attendance at IEP (individual education support to meet their children’s special needs. planning) meetings. Our most intensive Qualifying children are accepted into the CCCDP d P/C training takes place when we are mentoring/ financial assistance program based on such criteria coaching a professional in their own setting. as family size, income, other medical expenses, and a S t

the limitations of insurance and other resources LE Other Training and Therapy Services such as Medicaid. Since its inception, the program Other projects in recent years: has provided financial assistance to 1,549 children • The CCCDP and CASTLE are proud to be part of a from 92 North Carolina counties. From June 1, 2012 NC Consortium working to provide free training to to May 31, 2013, 42 children were enrolled for the NC professionals. This consortium sponsored 14 first time: seven were previous cochlear implant one- and two-day workshops this past year. recipients and five of the new children received • The 16th annual Carolina Summer Institute cochlear implants. A total of 313 children were was a resounding success. With special served by the program at some point during the year. fundraising, CASTLE was able to provide $11,300 in scholarship aid. Twenty-four participants The UNC Pediatric Cochlear Implant Program came this year from North Carolina, Florida, and the CCCDP and CASTLE programs are truly South Carolina, Texas, and Virginia. unique: No other state offers this level of support • The 2012 annual CCCDP Fall Conference, for children and families and for students and co-sponsored by the North Carolina A.G. Bell Association, featured Dr. Susan Wiley professionals who work with children with hearing presenting on the Medically Complex Child. The loss. The collaboration between UNC Health Conference was attended by 144 professionals Care, the University, the North Carolina General and parents from across the state. Assembly, and a number of private individuals and The Financial Assistance Program organizations have directly benefitted children and The CCCDP Financial Assistance Program, which is families in the State by providing excellent clinical funded by the North Carolina General Assembly, care, expert educational and therapeutic services, continues to provide supplies and clinical support a venue for conducting important research, and to families who have children with hearing loss. The the financial assistance needed by many families. CCCDP was first proposed to the North Carolina General Assembly by W. Paul Biggers, MD, in the spring of 1992, and was funded later that year. cosmetic surgery • microtia repair • rhinoplasty • scar revision • facial defects • facial trauma • facelifts • browlifts • blepharoplasty • surgery of the aging face • resident education • aesthetic track • non-surgical track • practice management track • reconstructive track • cosmetic surgery • microtia repair • rhinoplasty • scar revision • facial defects • facial trauma • facelifts • browlifts • blepharoplasty • surgery of the aging face • resident education • aesthetic track • non- surgicalFacial track Plastic • practice & Reconstructive management track Surgery • reconstructive track • cosmetic surgery • microtia repair • rhinoplasty • scar revision • facial defects • facial trauma • facelifts • browlifts The Division of Facial Plastic and Reconstructive Surgery continues • blepharoplastyto provide patients with • reconstructive surgery of and the cosmetic aging surgical face • resident educationexcellence under • aesthetic the leadership track of Dr. • William non-surgical Shockley . Dr. track • practice managementShockley dedicates track his time• reconstructive to a variety of difficult track reconstructive • cosmetic surgery • microtiaproblems repairincluding • revision rhinoplasty cosmetic •and scar functional revision rhinoplasty, • facial defects • microtia repair, scar revision, and complex facial defects. Dr. facialAndrea trauma Jarchow • facelifts devotes her • timebrowlifts to primary • blepharoplasty cosmetic and • surgery of the functionalaging facerhinoplasty, • resident surgery ofeducation the aging face, • and aesthetic facial trauma. track • non- surgicalShe has track a special • interestpractice in performing management facelifts, browlifts, track •and reconstructive blepharoplasty. track • cosmetic surgery • microtia repair • rhinoplasty • scar revisionThe Division • facial continues defects to expand • facial with a newtrauma location • atfacelifts the • browlifts • blepharoplastyCarolina Crossing • office. surgery A state of theof the aging art photography face • resident room, education • aestheticformal consultation track • office, non-surgical a new procedure track room, • practice and comfortable management trackexam • reconstructive rooms were added fortrack an ideal • cosmetic patient experience. surgery • microtia repair • rhinoplasty • scar revision • facial defects • facial trauma med.unc.edu/ent/for-patients/clinical-services/facial-plastic-and-reconstructive-surgery • facelifts • browlifts • blepharoplasty • surgery of the aging cosmetic surgery • microtia repair • rhinoplasty • scar revision • facial defects •F facialaculty trauma • facelifts • browlifts • blepharoplasty • surgery of the aging face • residenthe education building is easily spotted • aesthetic from Highway 54 withtrack the Facial • non-surgical Plastic Surgery Tsign highlighting the building. We are also hard at work on a website for our track • practice managementpractice. Look track for us in • the reconstructive future at med.unc.edu/uncfacialdocs track • cosmetic surgery • microtia repair •Dr. rhinoplastyShockley has been particularly • scar busy thisrevision year, serving • as facialCo-Chair of thedefects Fall Meeting of the American Academy of Facial Plastic and Reconstructive Surgery • facial trauma • facelifts(AAFPRS) • browlifts in New Orleans on • October blepharoplasty 19-21, 2013. The meeting introduces • surgery a of brand new format with four educational tracks: Non-Surgical Track, Aesthetic William W. Shockley, MD, FACS the agingChief offace Facial Plastics • residentTrack, education Practice Management • Track,aesthetic and a Reconstructive track Track. • non-surgical W. Paul Biggers Distinguished Professor track • practice managementResident trackExperience • reconstructive track • cosmetic surgery • microtia repair •We rhinoplastyare very proud of our resident• scar graduates revision and thrilled •that facial they matched defects at AAFPRS accredited fellowships. Dr. Scott Shadfar started July 1st with Dr. Steve • facial trauma • faceliftsPerkins • in browlifts Indianapolis for •a one blepharoplasty year fellowship. Dr. Joshua Surowitz • surgery and Dr. of Maher Younes both completed their fellowships in June 2012. We look forward the aging face • residentto educationinviting them back to share• aesthetic their experiences andtrack teach our • residentsnon-surgical new track • practice managementand exciting track techniques. • reconstructive track • cosmetic surgery • microtia repair •Resident rhinoplasty education and enthusiasm • scar for Facialrevision Plastic Surgery • facial continues todefects be Andrea Jarchow-Garcia, MD one of the primary goals of the division. Residents have the opportunity with Assistant Professor • facial trauma • faceliftsour new • browliftsskills lab to discover • firsthand blepharoplasty the complexity of the facial • anatomy surgery of the aging face • resident education • aesthetic track • non-surgical track • practice management track • reconstructive track • cosmetic surgery • microtia repair • rhinoplasty • scar revision • facial defects • facial trauma • facelifts • browlifts • blepharoplasty • surgery of the aging face • resident education • aesthetic track • non-surgical track • practice management track • reconstructive track • cosmetic surgery • microtia repair • rhinoplasty • scar revision • facial defects • facial trauma • facelifts • browlifts • blepharoplasty • surgery of the agingcrotia repair • rhinoplasty • scar revision • facial defects • facial trauma • facelifts • browlifts • blepharoplasty • surgery of the aging face • resident education • aesthetic track • non-surgical track • practiceAshley management Tenney, RN, Anna Bradshaw (Patienttrack Care • Coordinator), reconstructive Drs. Jarchow and Shockley, track & Elaine • Hinkle, cosmetic RN surgery • microtia repair • rhinoplasty • scar revision • facial defects • facial 79 Facial Plastic & Reconstructive Surgery

as well as to practice and perform many of our able to visualize objectively their concerns. The procedures in dedicated facial plastics labs. goal of each consultation is to give the patient Our curriculum continues to be augmented by an individualized analysis while adequately excellent guest lecturers including Dr. Madison Clark (Alamance Facial Plastic Surgery), Dr. George Blakey (UNC OMFS), Dr. Cynthia Gregg (Facial Plastic Surgery Cary, NC), Dr. Bradley Merritt (UNC Dermatology), and Dr. Amy Fowler (UNC Oculoplastic Surgery).

Cosmetic Consultation Dr. Andrea Jarchow offers comprehensive facial aesthetic care. Consultations place emphasis on rejuvenating facial aging according to the patient’s concerns. We strive to restore a natural facial appearance offering a range of surgical procedures including open and endoscopic browplasty, upper and lower blepharoplasty, rhytidectomy, neck lifts, otoplasty, and chin implantation. Clinic services include placement of facial fillers, injection of neurotoxins, and counseling on optimal skin care regimens. By using digital photographs as well as facial mirror examinations, the patients are better 80

communicating surgical goals and post-operative stage procedures, such as forehead flaps, cartilage expectations. graft reconstruction, and repair of internal nasal lining defects. Even patients with major rhinectomy Reconstructive Consultation defects following resections for life threatening Through this clinic we manage patients with post- and advanced cancers have been successfully traumatic facial deformities, facial scars, skin cancer reconstructed using multi-staged procedures to and Mohs defects, long standing facial paralysis, rebuild the surrounding cheek and lip, along with and those that have had reconstructive or cosmetic their nasal defects. surgeries elsewhere with unsatisfactory results.

Facial Plastic & Reconstructive Surgery Plastic & Reconstructive Facial With the increased incidence of skin cancer and UNC Hospitals Level 1 Trauma status facilitates an the improved access to Mohs surgery a number active facial trauma practice. We treat everything of patients are seen with facial and nasal defects. from simple zygomatic arch fractures, malar Those with nasal, lip, and ear defects present fractures, frontal sinus fracture, mandible fractures special anatomical problems, given the unique to complex LeFort fractures and nasoorbitoethmoid configuration of these specialized structures. (NOE) fractures. Patients with major nasal defects may require multi-

Left: Eight year old girl with a congenital malformation of the external ear (microtia). Right: Final result after staged reconstruction of the ear using her own rib cartilage. 81 Facial Plastic & Reconstructive Surgery

Rhinoplasty Consultation patient has been fully evaluated, the family can In recent years we established a Rhinoplasty be counseled about the multiple options that Clinic devoted to patients with post-traumatic exist with respect to aural rehabilitation. Luckily, nasal deformities, congenital nasal anomalies, many patients have a normal ear on the opposite patients with nasal valve problems, and patients side with normal hearing on that side. Once who have nasal obstruction and/or cosmetic the patient is deemed a candidate for microtia deformities. The clinic offers a wide range of repair the optimal age and timing of the repair is reconstructive procedures including rhinoplasty, outlined for the family. In most patients this is at septorhinoplasty, nasal valve repair, and 6-8 years old. correction of other deformities such as saddle nose deformities and soft tissue injuries. The For Grade III microtias we are using the most significant change that we have seen in the traditional four stage technique popularized by past couple of years is a significant increase in Dr. Burt Brent. We have several children in the the number of revision cases that are referrals to program at various stages of their reconstructive UNC, especially with respect to septorhinoplasty procedure. We have found many advantages and nasal valve repair to the two-team approach including saving operating time by being able to operate on two Microtia Program sites simultaneously. This allows harvesting Our Microtia Program has been remarkably the rib graft while removing the cartilaginous successful. Dr. Shockley and Dr. Carlton remnant and creating an appropriate recipient Zdanski offer a multidisciplinary approach pocket for the auricular framework. to the treatment of these complex congenital anomalies. Patients are seen initially by both In addition we offer two aesthetic perspectives Dr. Zdanski and Dr. Shockley. Management with respect to the shape and size of the final decisions are made as to whether further reconstructed cartilaginous framework. We anatomical imaging will be required with have been very pleased with the success of respect to their atresia abnormalities. Those this program and are grateful to our referring with multiple anomalies and clinical syndromes physicians. are managed through the Craniofacial Clinic. Hearing evaluation by Audiology is critical in these young children and our Otology colleagues play a crucial role in this process. Once the tumor treatment • temporal bone • head and neck cancer • speech • swallowing • minimally invasive endoscopic skull base surgery • transoral laser resection • transoral robotic surgery • microvascular free flap reconstruction • surgeons • oncologists • nutritionists • radiologists • dentists • epidemiologists • prosthetic specialists • clinical trials • tumorThe UNCtreatment MUlTidisC •ipli temporalNary bone • head and neck cancer • speech • swallowing • minimally invasive endoscopic skullHead base & surgery Neck •Oncology transoral laser Program resection • transoral robotic surgery • microvascular free flap reconstruction • surgeons • oncologists • nutritionists • radiologists • dentists The Multidisciplinary Head & Neck Oncology Program offers the full • epidemiologistsrange of cutting-edge diagnostic• prosthetic and therapeutic specialists techniques • clinicalfor the trials • tumortreatment treatment of all benign • temporal and malignant bone tumors • ofhead the Head and & Neck neck cancer • speechincluding, but • not swallowing limited to, tumors • minimally of the oral cavity, invasive pharynx, endoscopic and skulllarynx; base soft surgerytissues; thyroid; • transoral nose and sinuses; laser ear resectionand temporal • transoral bone; skull base; salivary glands; and the cerebello-pontine angle. roboticThe Program’s surgery main •goal microvascular is to cure head and free neck cancerflap whilereconstruction • surgeonsmaintaining • oncologists optimal speech and • nutritionists swallowing function • radiologists and achieving • dentists • epidemiologiststhe best possible cosmetic • prosthetic result. We have specialists extensive experience • clinical trials • in minimally invasive endoscopic skull base surgery, transoral tumorlaser treatment resection, transoral • temporal robotic surgery bone and • microvascular head and free neck cancer • speechflap reconstruction. • swallowing A Minimally • Invasive minimally Head and invasive Neck Surgery endoscopic skullCenter base has been surgery formed •and transoral is starting to lasersupport resectionquality of life • transoral roboticand functional surgery outcomes • microvascular research. free flap reconstruction • surgeons • oncologists • nutritionists • radiologists • dentists • epidemiologists • prosthetic specialists • clinical trials • med.unc.edu/ent/for-patients/clinical-services/head-and-neck | med.unc.edu/ent/for-patients/clinical-services/adult-speech-pathology | tumormed.unc.edu/ent/for-patients/clinical-services/robotic-head-neck-surgery-program treatment • temporal bone • head and neck cancer tumor treatment • temporal bone • head and neck cancer • speech • swallowing • T minimallyeaM invasive endoscopic skull base surgery • transoral laser he team consists of surgeons, medical resection • transoral robotic surgery • microvascular Toncologists, radiation oncologists, pathologists, diagnostic and interventional free flap reconstruction • surgeons • oncologists • radiologists, dentists, epidemiologists, prosthetic specialists, nutritionists, speech and swallowing nutritionists • radiologists • dentists • epidemiologists • specialists, nurses, and social workers. The Mark C. Weissler, MD, FACS exchange of knowledge and opinions among Professor and Chief prosthetic specialists • clinical trials • tumor treatment team members ensures that the best possible • temporal bone • head and neck cancer • speech • treatment plan is developed for each patient. Each week, the Program holds an interactive swallowing • minimally invasive endoscopic skull base conference attended by Program members from each discipline. Mark C. Weissler, MD, surgery • transoral laser resection • transoral robotic William W. Shockley, MD, Carol Shores, MD, PhD, Adam M. Zanation, MD, and Trevor G. surgery • microvascularD. Neil free Hayes, MD, MPH flap reconstructionTrevor G. Hackman, MD, FACS • Hackman, MD serve as the Program’s Head & Associate Professor Assistant Professor surgeons • oncologists • nutritionists • radiologists • Neck oncologic surgeons. Dr. Bhishamjit Chera is the H&N radiation oncologist and Drs. David dentists • epidemiologists • prosthetic specialists • Neil Hayes, MPH, MD, Juneko Grilley-Olson, MD and Jared Weiss, MD serve as the H&N clinical trials • tumor treatment • temporal bone • medical oncologists. Robert P. Hollowell, Jr., DDS, MS and Lauren Patton, DDS serve as the head and neck cancer • speech • swallowing • programs dental experts.. This conference has the ability to be webcast around the state so minimally invasive endoscopicWilliam W. Shockley, MD, FACS skull baseBrian Kanapkey, surgery MA, CCC-SLP • Professor Speech Pathologist that outside providers elsewhere can participate transoral laser resection • transoral robotic surgery directly and discuss their patients. Patients from WakeMed in Raleigh are also regularly presented • microvascular free flap reconstruction • surgeons at this conference. Our weekly tumor board now routinely discusses over 35 patients per week, • oncologists • nutritionists • radiologists • dentists • actively undergoing multidisciplinary cancer therapy at UNC. In 2009, 675 new patients epidemiologists • prosthetic specialists • clinical trials came through the Multidisciplinary Head & Neck Cancer Program at UNC Hospitals. • tumor treatment • temporalAndrew F. Olshan, bone PhD • headBrien R. Pace, and ACNP-BC neck Professor, Nurse Practitioner cancer • speech • swallowingUNC SPH Epidemiology Chair • minimally invasive The program now performs many ultrasound examinations in the ENT clinic for the evaluation endoscopic skull base surgery • transoral laser and ultrasound guided needle biopsy of thyroid and other neck masses. Trans-nasal resection • transoral robotic surgery • microvascular esophagoscopy and laryngeal video stroboscopy are also available for the evaluation of Head and free flap reconstruction • surgeons • oncologists • Neck patients with special problems. Mr. Brian nutritionists • radiologists • dentists • epidemiologists Kanapkey from speech pathology works hand in Carol G. Shores, MD, PhD, FACS Adam M. Zanation, MD hand with the surgeons in the management of • prosthetic specialists Associate • Professor clinical trialsAssistant Professor • tumor treatment • temporal bone • head and neck cancer 85 Head & Neck Oncology Program

Front Row: Shannon Aumer, Mary Fleming, Lauren Fedore, MD, Ben Huang, Adam Zanation, MD, Ashley Tenney RN, Hazel Hampton RN, BSN, Bridgett Wesley MD, DDS, David Ludlow, MD, Gita Fleischman, Back Row: Jared Weiss, MD, Mark Weissler, MD, Laura Miller, William Shockley, MD, Bishamjit Chera, MD, D. Neil Hayes, MD, Dale Flowers, Glenda Blackwood, Daniel Duncan, Nathan Calloway, MD, Sharon Rubischko, RN, Trevor Hackman, MD, and Traci McKinney, RN

post-treatment speech and swallowing dysfunction. Ms. Laura Lyndon Miller and Glenda Blackwood are Dr. Glen Minsley from dental prosthetics assists our our program coordinators. They arrange for initial patients with prosthetic management of head and consultations at UNC from referring physicians, neck defects. Dr. Bill Shockley has a special interest in the rehabilitation of facial palsy resulting from cancer therapy, and the reconstruction of complex facial wounds resulting from Moh’s chemosurgery.

Hazel Hampton RN, BSN and Nancy Jensen, RN serve as our nurse navigators for head and neck cancer patients. They assist patients as they navigate through their complex treatment protocols. They work closely with the patients and their families to insure that they are well informed about the multiple treatment modalities utilized in modern cancer Hazel Hampton, RN, BSN, Glenda Blackwood, Laura Miller and volunteer at the Free Head and Neck Cancer Screening Day 2013, Rich Rivera treatment. 86

gathering all the outside medical information on underserved populations. Her clinical interests these often complex patients. include the role of stress management and disease response. Elizabeth Sherwood, RN, MS, ANP-C, assists

Head & Neck Oncology Program with psychological support through the trying Xiaoying Yin, MD, MS is a full time basic science period of treatment and follow-up. She is the researcher in the Head and Neck laboratory Coordinator of Survivorship Programs and helps within the Lineberger Cancer Center. Dr. our patients by providing support during and David Neil Hayes along with Dr. Yin received a after treatment as they transition from active University Cancer Research Fund competitive treatment to surveillance. We offer a Symptom grant in 2009 which continues to study Genomic Management Clinic, which assists with follow- Classification of Head and Neck Cancer in up of medications (i.e., anti-depressant, anti- Paraffin Samples. The purpose of this research anxiety) and emotional/mental health issues, is to identify molecular fingerprints of clinically as well as the whole range of side effects folks apparent subtypes of squamous cell cancer of deal with related to surgery, chemotherapy, and the head and neck. radiation. Each year we run a very successful oral cancer Dale Flowers, RN, OCN serves as the Clinical screening day. Under the auspices of the Trials Nurse and works with Dr. Neil Hayes and Head and Neck Cancer Alliance, formerly the others in medical oncology to assist patients to Yul Brynner Foundation, physicians spend an navigate through the complexities of treatment afternoon in the Oto-HNS clinic screening the on the wide variety of experimental protocols public for oral cancer and other diseases of the available. head and neck. The oncology nurse navigators and program coordinators put on an exhibit Mary Fleming, MSN, ANP, is a nurse practitioner in the hospital lobby and provide information with the head and neck oncology program in about head & neck cancer and smoking the divisions of medical and radiation oncology. cessation. This was the busiest year ever, with She returns to UNC after serving 5 years in over 100 people from 12 counties in North the US Public Health Service providing care to Carolina taking advantage of this special event. 87 Head & Neck Oncology Program

Clinical Trials The Head and Neck Oncology Program continues to strive for a goal of having at least one clinical trial open for all of the clinical cancer scenarios seen frequently in our group. Present open (and pending) clinical trials are listed below.

LCCC 1120: Phase II Study of De-Intensification of Radiation and Chemotherapy for Low-Risk HPV-related Oropharyngeal Squamous Cell Cardinoma

LCCC1103: A Phase II study of carboplatin, nab-paclitaxel and cetuximab for induction chemotherapy for locally advanced squamous cell carcinoma of the head and neck

LCCC1125: Multimodality Risk Adapted Therapy including Carboplatin/Paclitaxel/Lapatinib as Induction for Squamous Cell Carcinoma of the Head and Neck Amenable to Transoral Surgical Approaches

RTOG 0920: A Phase III Study of Postoperative Radiation Therapy (IMRT) +/- Cetuximab for Locally Advanced Resected Head and Neck Cancer

RTOG1008: A Randomized Phase II Study of Adjuvant Concurrent Radiation and Chemotherapy versus Radiation Alone in Resected High-Risk Malignant Salivary Gland Tumors

CCCWFU-60107: Phase I/II Clinical Trial Of Combined Re-irradiation With Pemetrexed And Erlotinib Followed by Maintenance Erlotinib For Recurrent And Second Primary Squamous Cell Carcinoma of the Head and Neck

UPCC15309: A Phase II Study of Capecitabine and Lapatinib in Squamous Cell Carcinoma of the Head and Neck

09-266-B: Randomized Phase II Trial of Everolimus versus Placebo as Adjuvant Therapy in Patients with Locally Advanced Squamous Cell Cancer of the Head and Neck (SCCHN)

A041-03: Phase II An Open-label Phase 2 Study of ACE-041 in Patients with Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck

I4E-MC-JXBA:(IMCL-CP02-0861) Phase 2 Study to Evaluate the Pharmacokinetics and Drug-Drug Interaction of Cetuximab and Cisplatin in Patients with Recurrent or Metastatic Carcinoma of the Head and Neck

CEP-37250/KHK2804-001:Two-Part, Open-Label, Multi-Center Phase 1 Study of Monoclonal Antibody CEP-37250/ KHK2804 in Subjects with Advanced Solid Tumors

LCCC1037: Accuracy of ultrasound guided FNA in detecting persistent disease in lymph nodes of patients with head and neck squamous cell carcinoma after definitive chemoradiotherapy voice restoration • multidisciplinary team • head & neck cancer patients • evaluation • treatment • swallowing deficits 88 • radiation therapy • chemotherapy • clinical research trials Voice Restoration radiation oncologists, medical oncologists and ENT • barium swallow studies • fiberopticphysicians on multiple endoscopic clinical research trials. swallow Shannon uses modified barium swallow studies and Swallowing Clinic and fiberoptic endoscopic swallow evaluations evaluationsThe Voice • Restoration laryngectomy and Swallowing Clinic •consists tracheoesophageal puncture • to objectively assess head and neck cancer of a multidisciplinary team providing evaluations skull base tumors • nutrition • aspirationpatients risks prior to • and electromyography following completion or • and therapy for a wide variety of head and neck radiation therapy, chemotherapy and surgery. cancer patients. Speech pathology services in the biofeedback • VitalStim electrical stimulationPatients treated in the • speech voice pathology restoration clinic area of head and neck cancer are coordinated by include but are not limited to those patients with speech pathologist Brian Kanapkey with additional • multidisciplinary team • head partial & neckand total laryngectomy cancer with or without patients • coverage by Shannon Aumer and Leslie Johnson. evaluation • treatment • swallowingtracheoesophageal deficits puncture,• radiation oral cavity cancers, therapy neck cancers, skull base tumors, short and long term Shannon Aumer continues to expand speech • chemotherapy • clinical research trialstracheostomy, • barium and chemotherapy, swallow and radiation studies pathology services within the head and neck injury patients.The ENT surgeons within the oncology program. Working with Dr. Bhishamjit • fiberoptic endoscopic swallow evaluationsUNC ENT Clinic, along with • oncology laryngectomy physicians, Chera, she provides comprehensive continued evaluate cancers and provide proper surgical evaluation and treatment of speech and • tracheoesophageal puncture • skulland/or chemotherapybase tumors and radiation treatment• nutrition • swallowing deficits for head and neck cancer for these patients. The speech pathologist works aspirationpatients risks receiving • electromyography chemo and radiation therapy. • biofeedbavoice restoration on order from the ENT physician or oncologist • multidisciplinaryIn addition, she is a co-investigator team •with UNC head & neck cancer patients • evaluation • treatment • swallowing deficits • radiation therapy • chemotherapy • clinical research trials • barium swallow studies • fiberoptic endoscopic swallow evaluations • laryngectomy • tracheoesophageal puncture • skull base tumors • nutrition • aspiration risks • electromyography • biofeedback • VitalStim electrical stimulation • voice restoration • multidisciplinary team • Head & Neck Oncology Program: Voice Restoration and Swallowing Clinic Restoration Voice Head & Neck Oncology Program: head & neck cancer patients • evaluation • treatment • swallowing deficits • radiation therapy • chemotherapy • clinical research trials • barium skull base tumors • nutrition • aspiration risks • electromyography • biofeedback • VitalStim electrical stimulation • voice restoration • multidisciplinary team • head & neck cancer patients • evaluation • treatment • swallowing deficits • radiation therapy Leslie • Johnson, chemotherapy Brian Kanapey & Shannon Aumer • clinical research trials • barium voice restoration • multidisciplinary team • head & neck cancer patients • evaluation • treatment • swallowing deficits 89 • radiation therapy • chemotherapy • clinical research trials and provides evaluation and treatment for the • barium swallow studies • fiberoptic endoscopic swallow functional disorders that result from cancer treatment. Functional deficits affecting maintenance Head & Neck Oncology Program: Voice Restoration and Swallowing Clinic evaluations • laryngectomy • tracheoesophageal puncture • of proper nutrition by mouth and aspiration risks are treated by the speech pathologist. skull base tumors • nutrition • aspiration risks • electromyography • The latest in technology for swallowing therapy, such biofeedback • VitalStim electrical stimulation • voice restoration as surface electromyography for biofeedback and VitalStim electrical stimulation is used here at UNC. • multidisciplinary team • head & neck cancer patients • Both techniques allow for excellent data keeping for evaluation • treatment • swallowing deficits • radiation therapy research analysis. In this way, the physicians and speech pathology team in the UNC ENT Clinic help to • chemotherapy • clinical research trials • barium swallow studies contribute new information in the area of swallowing rehabilitation after treatment for head and neck • fiberoptic endoscopic swallow evaluations • laryngectomy cancer. regarding the device’s use and effectiveness have • tracheoesophageal puncture • skull base tumors • nutrition • Prevention and treatment of trismus remains a large shown significant success in alleviating trismus. aspiration risks • electromyography • biofeedbavoice restoration focus for Kanapkey, who is actively involved in training patients with devices and techniques to both Yet another role filled by the Head and Neck Clinic • multidisciplinary team • head & neck cancer patients • help prevent trismus due to radiation therapy and Speech Pathologist is teaching about tracheotomy treat trismus that has already become a problem. before and after surgery. Speech Pathology is evaluation • treatment • swallowing deficits • radiation therapy The training with various devices extend to ENT, part of the team seeing this population for the oncology as well as maxillofacial and dental services. purpose of providing educational information, thus • chemotherapy • clinical research trials • barium swallow studies The Dual Valve TEP prosthesis was pioneered helping patients make more informed decisions. • fiberoptic endoscopic swallow evaluations • laryngectomy here in UNC ENT. Product evolution and eventual manufacture was a result of collaboration The Head And Neck Clinic Speech Pathologist • tracheoesophageal puncture • skull base tumors • nutrition • between Kanapkey and Dr. Eric Blom of CENTA also provides therapy to help restore optimal in Indianapolis, Indiana. Dr. Blom is largely communication to the patient who has had aspiration risks • electromyography • biofeedback • VitalStim responsible for historical development as well laryngectomy and oral cavity resections and as the current state of the TEP prosthesis in the reconstruction. Additionally, Botox injection(s) electrical stimulation • voice restoration • multidisciplinary team • U.S. The professional collaboration between evaluations are available to those who fail head & neck cancer patients • evaluation • treatment • swallowing Blom and Kanapkey continues with hopes of to develop TEP speech post-operation. continued contributions to the advancement deficits • radiation therapy • chemotherapy • clinical research of TEP prostheses and related products. Finally, a program for remediation of oversized TEP continues. In this technique, Brian trials • barium skull base tumors • nutrition • aspiration risks • In yet another collaboration, Brian Kanapkey Kanapkey uses silicone for creation of extended and Byron Kubik, speech pathologist at CENTA tracheoesophageal flanges to stop around the electromyography • biofeedback • VitalStim electrical stimulation of Indianapolis, IN have developed a new device TEP prosthesis leakage. This process reduces for treating trismus that is in prototype phase pulmonary aspiration and risk of aspiration • voice restoration • multidisciplinary team • head & neck cancer by an international company. The company pneumonia due to around the prosthesis leaks. patients • evaluation • treatment • swallowing deficits • radiation plans to market the device internationally after appropriate trials take place. Thus far, patient data therapy • chemotherapy • clinical research trials • barium Transoral Robotic Head and Neck Surgery • tumor resections • obstructive sleep apnea surgery • pediatric airway reconstruction 90 is a three dimensional endoscope- • skull baseFa CU tumorlTy surgeryRobotic • robotic Head surgeriesbased robot with three • articulating pediatric instrument arms. As the surgeon otolaryngology • Transoral& Neck Robotic Surgery Head andoperates, state-of-the-art Neck Surgery robotic • tumor resections • obstructive sleep apneaand surgery computer technologies • pediatric scale, Program filter and seamlessly translate the In March 2010, Dr. Adam Zanation surgeon’s hand movements into airway reconstruction • skullperformed base North tumor Carolina’s firstsurgery • robotic surgeries precise micro-movements of the da Transoral Robotic Head and Neck • pediatric otolaryngology • Transoral RoboticVinci instruments. Head The and primary Neck Surgery (TORS) and since that time advantage of the system is high the OHNS Department has setup Surgery • tumor resections • obstructive sleepdefinition apnea 3D visualization, surgery flexibility • Adam M. Zanation, MD, FACS a Robotic Head and Neck Surgery Associate Professor with complex instrument movements pediatricDirector, airway Head & Neck Robotics reconstruction Program Program. Currently• skull Dr. baseTrevor tumor surgery • robotic in tight spaces, and the ability to Hackman and Dr. Carlton Zdanski access areas of aerodigestive tract surgeries • pediatric otolaryngologyare credentialed in TORS, • Transoral giving the Robotic Head and without incisions or splitting the UNC Department of Otolaryngology/ Neck Surgery • tumor resections • obstructive mandible.sleep This apnea has the potential surgery Head and Neck Surgery three active to reduce surgical morbidity and TORS surgeons. Currently, UNC • pediatric airway reconstruction • skull base tumorprovide better surgery patient functional • robotic has performed robotic surgeries for outcomes. surgeries • pediatric otolaryngologytransoral tumor resections, • Transoral complex Robotic Head and obstructive sleep apnea surgery, Dr. Carlton Zdanski (Pediatric Neck Surgery • tumor resectionspediatric airway • obstructive reconstruction and sleep apnea surgery Carlton J. Zdanski, MD, FACS, FAAP Otolaryngology) and Dr. Zanation Associate Professor even skull base tumor surgery.

• pediatric Program Robotics Head & Neck Oncology Program: airway reconstruction • skull base tumorhave been surgery working together • robotic on pediatric Transoral Robotic The da Vinci robotic surgery system surgeries • pediatric otolaryngology • TransoralSurgeries. Robotic They performed Head the first and Neck Surgery • tumor resections • obstructive sleep apnea surgery • pediatric airway reconstruction • skull base Surgery • tumor resections • obstructive sleep apnea surgery • pediatric airway reconstruction • skull base tumor surgery • robotic surgeries • pediatric otolaryngology Trevor G. Hackman, MD, FACS • Transoral RoboticAssistant Professor Head and Neck Surgery • tumor resections • obstructive sleep apnea surgery • pediatric airway reconstruction • skull base Surgery • tumor resections • obstructive sleep apnea surgery • pediatric airway reconstruction • skull base tumor surgery • robotic surgeries • pediatric otolaryngology • Transoral Robotic Head and Neck Surgery • tumor resections • obstructive sleep Dr. Hackman apnea surgery • pediatric airway reconstruction • skull base 91 reported Pediatric TOR surgery for a tumor in the nation and performed Head & Neck Oncology Program: Robotics Program TORS on the smallest known child (8 pounds). The two of them have now successfully performed multiple pediatric TORS procedures without a complication. By combining the expertise in pediatric otolaryngology and TORS/head and neck surgery, Drs. Zanation and Zdanski are hoping to advance the care of children that need minimally invasive surgery. Drs. Zanation and Zdanski

The UNC Robotics Program is currently seeing patients for involve expanding robotic indications for skull base selected head and neck cancers, tongue base related surgery and merging other technologies with the obstructive sleep apnea, complex pediatric airway robotic interface. For patient referrals call Laura lesions, and skull base tumors. Future research plans Miller at the Head and Neck Oncology Program at 919-966-9717.

da Vinci Robot sinusitis • allergy • rhinology • endoscopic skull base surgery • medical & surgical management • tumor management • minimally invasive • Functional Endoscopic Sinus Surgery • paranasal sinuses • Allergic Fungal Sinusitis • computer image guidance • balloon sinus dilation • intraoperative CT imaging • immunotherapy • sinusitis • allergy • rhinology • endoscopic skull base surgery • medical & surgical management • tumor managementRhinology, • Allergy minimally & invasive • Functional Endoscopic SinusEndoscopic Surgery • paranasal Skull Base sinuses Surgery • Allergic Fungal Sinusitis • computer image guidance • balloon sinus dilation • intraoperative CT imaging • immunotherapy • sinusitis • allergy Sinusitis and allergy are two of the most common diseases oc- • rhinologycurring in the • United endoscopic States with millions skull of base new cases surgery be- • medical & surgicaling diagnosed management every year. With• tumor a tradition management dating back to • minimally invasive • Functional1979 with W. PaulEndoscopic Biggers, MD, andSinus Libby Surgery Drake, RN, • theparanasal Di- sinuses • Allergicvision ofFungal Rhinology, Sinusitis Allergy, •and computer Endoscopic image Skull Base guidance Sur- • balloon gery provides a complete range of services for medical and sinussurgical dilation management • intraoperative of sinusitis and allergy,CT imaging in addition • toimmunotherapy • sinusitiscutting • edgeallergy management • rhinology of tumors • andendoscopic other complex proskull- base surgery • medicalcesses and &diseases surgical affecting management the sinuses and skull • tumor base. management • minimallyThe Division invasive is led by Brent • Functional A. Senior, MD Endoscopic, Past President of Sinus Surgery • paranasalthe American Rhinologic sinuses Society, • Allergic with other Fungal members Sinusitis includ- • computer imageing Adam guidance M. Zanation, • balloonMD; Charles sinus S. Ebert, dilation MD; Peter • intraoperative Chikes, MD; and Harold C. Pillsbury, MD, Immediate Past CT President imaging of the • immunotherapyAmerican Academy of •Otolaryngic sinusitis Allergy. • allergy • rhinology • endoscopic skull base surgery • medical & surgical management • tumor management • minimally invasive • med.unc.edu/ent/research/division-of-rhinology-allergy-and-endoscopic-skull-base-surgery | Functionalmed.unc.edu/ent/for-patients/clinical-services/skull-base-center Endoscopic Sinus Surgery • paranasal sinuses • sinusitis • allergy • rhinology • endoscopic skull base surgery • medical & surgical managementFacuty • tumor management • minimally invasive • Functional Endoscopic ogether, they perform the full range of Sinus Surgery • paranasal sinuses • Allergic Fungal Sinusitis Tallergy, medical, as well as minimally invasive endoscopic surgical management • computer image guidance • balloon sinus dilation • of diseases of the nose and paranasal sinuses, including Functional Endoscopic intraoperative CT imaging • immunotherapy • sinusitis Sinus Surgery (FESS), a minimally invasive technique used to restore normal sinus • allergy • rhinology • endoscopic skull base surgery • ventilation and function in the setting of Brent A. Senior, MD, FACS, FARS, FAAOA chronic inflammation and infection. Recent medical & surgical managementNathaniel T. and • Sheila tumor W. Harris Distinguished management Professor Chief of Rhinology, Allergy & Endoscopic Skull Base Surgery advances in these minimally invasive • minimally invasive • Functional Endoscopic Sinus techniques developed by UNC surgeons now allow for performance of endoscopic surgery Surgery • paranasal sinuses • Allergic Fungal Sinusitis for cancerous and non-cancerous tumors of the nose and sinuses and skull base, • computer image guidance • balloon sinus dilation • including tumors extending into the eye and brain. Technological innovations, including intraoperative CT imaging • immunotherapy • sinusitis the latest in powered instrumentation • allergy • rhinology • endoscopic skull base surgery • and drills, computer image guidance, and balloon sinus dilation, aid in these advanced medical & surgical managementHarold C. Pillsbury III, MD, FACS,• FAAOAtumor Charles managementS. Ebert, Jr., MD, MPH, FAAOA techniques and provide significant advantages Thomas J. Dark Distinguished Professor Assistant Professor of Otolaryngology/Head & Neck Surgery Co-Director, Rhinology & Endoscopic over traditional approaches. In addition, • minimally invasive • Functional EndoscopicSkull Base Surgery Fellowship Sinus the division was among the first in the world to obtain and utilize intraoperative Surgery • paranasal sinuses • Allergic Fungal Sinusitis CT imaging for real-time surgical use. • computer image guidance • balloon sinus dilation • As a leader in the field, the Division is proud intraoperative CT imaging • immunotherapy • sinusitis to treat extremely complicated sinonasal inflammatory disorders such as allergic • allergy • rhinology • endoscopic skull base surgery • fungal rhinosinusitis. Allergic Fungal Sinusitis (AFS) is a refractory subtype of chronic Austin S. Rose, MD Peter G. Chikes, MD, FACS, FAAOA medical & surgical managementAssociate Professor • tumor managementAssistant Professor • rhinosinusitis and is noted for its difficulty Co-Director, Rhinology & Endoscopic Skull Generalist Base Surgery Fellowship to manage through typical medical regimens. minimally invasive • Functional Endoscopic Sinus Surgery Almost universally, a diagnosis of AFS requires • paranasal sinuses • Allergic Fungal Sinusitis • computer operative intervention, with the goals of removing anatomic obstruction, clearing image guidance • balloon sinus dilation • intraoperative infection and inflammatory debris from the sinus cavities, creating patent sinus outflow CT imaging • immunotherapy • sinusitis • allergy • rhinology tracts, and preserving the mucociliary function of healthy sinonasal mucosa. Our Division has • endoscopic skull base surgery • medical & surgical become a leading innovator of postoperative Adam M. Zanation, MD, FACS Stanley W. McClurg, MD adjuvant medical therapy for AFS. This management • tumor managementAssociate Professor • minimallyRhinology, Allergy invasive & Endoscopic • Co-Director, Rhinology & Endoscopic Skull Base Fellow 2013-2014 Functional Endoscopic SinusSkull Base Surgery Surgery Fellowship • paranasal sinuses 95 treatment may include the use of systemic and may allow some to avoid general anesthesia topical corticosteroids in irrigation solution or gels, while experiencing quicker recovery times. Rhinology, Allergy & Endoscopic Skull Base Surgery immunotherapy directed at fungal-specific antigens, and/or systemic and topical antibiotics. The efficacy A major activity of the Division is co-sponsorship of these regimens is variable and the goal is to of educational programs in rhinology, sinus and lengthen the time to recurrence rather than to cure endoscopic skull base surgery. One such effort, the underlying disease. Therefore, long-term follow- now in its tenth year is the Southern States up with serial physical and endoscopic examination Rhinology Course held each spring on Kiawah is necessary to monitor for disease progression. Island, South Carolina. Jointly sponsored by the Medical University of South Carolina, Georgia Gina Stoffel, RN and Robin Gunter, RN at our Health Sciences University, Emory University, and new Carolina Crossing facility provide full allergy the Georgia Nasal and Sinus Institute, the course service including allergy shots to over 400 patients attracts annually over 80 participants from around a month. The Carolina Crossing satellite clinic provides unparalleled walk-up convenience and free parking right at the front door. New testing methods including immunocap blood testing as well as the multi-test 11skin test screen, have opened doors for diagnosis in younger children, while the imminent initiation of sublingual immunotherapy (SLIT), allowing shots to be given as drops under the tongue, will allow for painless treatment of children and adults who are apprehensive about Robin Gunter, RN and Gina Stoffel, RN traditional allergy injection therapy. UNC physicians in the Division of Rhinology, Allergy, and Endoscopic Skull Base Surgery are pioneers in the use of in- the world in addition to over 30 residents. It office minimally invasive surgical treatments for provides an opportunity to participate in laboratory sinusitis. One such technology is balloon catheter dissections while hearing renowned rhinologists dilation of the sinus openings. This technology over the course of this three-day meeting. The next allows for a thin balloon catheter (similar to an course will take place May 8-10, 2014; for more info: angioplasty catheter for the heart) to be placed into southernstatesrhinology.org. the opening of a sinus and inflated. When the sinus balloon catheter is inflated, it gently restructures The Division also sponsors the 360 Degree UNC and dilates the opening of the passageway while Skull Base Surgery Course. This course brings maintaining the integrity of the sinus mucosal together senior otolaryngology and neurosurgery lining. In selected patients, this technology residents and fellows from all over the nation, 96

pairing them in a novel team approach to learning training in all aspects of sinus, skull base, and and dissections. The course encompasses both temporal bone surgery. As a joint facility with endoscopic and transcranial approaches. colleagues in the departments of ophthalmology, neurosurgery, and thoracic surgery, the lab also The new home of this course is the Harold C. offers the latest in surgical simulation technology Pillsbury Sinus and Temporal Bone Training as well as several full size operating room tables facility, highlight for the division in 2012. for more extensive dissection training. Starting Offering the latest in endoscopic technology in 2013, this lab will be the new home of the and videoconferencing technology, this 1300 360 Degree UNC Skull Base Surgery Course. square foot, 16 station facility allows for full Rhinology, Allergy & Endoscopic Skull Base Surgery Rhinology,

Drs. Senior, Ebert, Zanation, and Rose with 2013-2014 Rhinology Fellow, Dr. Stanley McClurg 97 Rhinology, Allergy & Endoscopic Skull Base Surgery

Research remains a major focus for the Division. work with the Division of Pulmonary Medicine This year, numerous residents and medical yielding new insights into the molecular basis of students participated in Division research inflammatory diseases of the nose and paranasal activities resulting in several presentations at sinuses, and the Division of Nephrology examining major national and international otolaryngology involvement of the upper airway in vasculitis. meetings including the Annual Meeting of the Outside the UNC School of Medicine, the Division AAO/HNS, the Annual Meeting of the American has an ongoing collaborative project with the UNC Rhinologic Society, the Annual Meeting of the Gillings School of Public Health, Department of North American Skull Base Society, as well as the Biostatistics to specifically characterize the genetic Combined Otolaryngology Section Meeting. A expression profiles of patients with Allergic Fungal highlight of this year’s research activity is the Rhinosinusitis through a comparative analysis completion of a very important, high impact of healthy and diseased specimens of sinonasal study on the use of topical steroid rinses in mucosa. Through both of these collaborations, we treatment of polyp disease, currently in press in have received funding through the North Carolina the International Forum of Allergy and Rhinology. Translational and Clinical Sciences Institute funded through Clinical and Translational Science Awards. Julie Kimbell, PhD who joined the Division in 2010 as a basic science researcher with a background Other recent topics of division research have in mathematics, has developed several cutting included investigations in the use of image edge projects in the realm of computer modeling guidance during endoscopic sinus and skull base of airflow through the nasal cavity and paranasal surgery, cost effective analyses of endonasal, sinuses in healthy noses and in the presence of endoscopic surgical approaches to the skull sinus and nasal disease. This cutting edge work base versus traditional open approaches, and has helped us to understand how medications are quantification of the impact of Functional distributed in the nose and sinuses as well as the Endoscopic Sinus Surgery, and endoscopic potential impact of airflow on disease development skull base surgery via patient-rated quality or progression of sinusitis. Ongoing work in this of life (QOL) measures. All of these efforts area is also leading to new understanding of have led to numerous grants, presentations, the impact of different aspects of sinus surgery and publications in peer-reviewed journals. on the progression or resolution of sinusitis. As a result of the Division of Rhinology, Allergy, The Division collaborates with several departments and Endsocopic Skull Base Surgery’s leadership in in the UNC School of Medicine including exciting the realm of nasal, sinus, and skull base disease, 98

UNC Otolaryngology/Head and Neck Surgery was ability of the angled endoscopes to see behind named the first recipient of a National Center and under otherwise obstructing structures. of ENT Excellence Award in 2004 by BrainLAB, AG, of Munich, Germany, one of the world’s “Hydroscopy,” a technique developed by leading image guidance technology companies. Drs. Senior and Ewend, is then performed in order to assess for residual tumor. Members Pioneering Minimally Invasive of the Division along with collaborators in Skull Base Tumor Treatments: Neurosurgery have become recognized experts Minimally Invasive Pituitary Surgery in this exciting area, lecturing nationally and and Expanded Endoscopic internationally on the topic, in addition to Approaches to the Skull Base authoring publications in several books and journals. They have performed over 600 of Endoscopic Skull Base Surgery these procedures, placing the University of In March 2000, Brent Senior, MD along with North Carolina at the forefront of minimally

Rhinology, Allergy & Endoscopic Skull Base Surgery Rhinology, Matthew Ewend, MD of the Department of invasive approaches to skull base tumors. Neurosurgery, became the first team in North Carolina to perform Minimally Invasive Pituitary In 2008, Dr. Adam Zanation joined Dr. Surgery (MIPS) using an endoscopic approach Senior in the Division of Rhinology following entirely through the nose to treat pituitary his fellowship in Minimally Invasive Skull adenomas. In contrast to traditional open Base Surgery at the University of Pittsburgh. approaches, in this procedure the nose is used Teaming up with Dr. Deanna Sasaki-Adams as a corridor to the tumor, so no facial or oral in the Department of Neurosurgery, they are incisions are involved, dramatically reducing advancing minimally invasive skull base surgery the overall morbidity of the procedure. Sinus to new and exciting levels for patients with endoscopes are used to directly access and a variety of skull base, brain, spine, orbital open the sphenoid sinus. The scope is held in tumors, and even certain brain anuerysms. position and the sella is then accessed using a typical two-handed technique. The tumor is With the role of expanded endonasal skull removed using only the endoscopes, allowing base surgery continuously growing, ever more for visualization at angles deep in the sella for advanced benign and cancerous skull base removal of residual tumor that may otherwise be tumors are being successfully managed with missed using microscopic approaches. Recovery these techniques. Some of these tumors is rapid and no packing is typically used. Tumor include sinonasal cancers, meningiomas, removal is potentially more complete given the 99 Rhinology, Allergy & Endoscopic Skull Base Surgery

craniopharyngiomas, optic nerve and orbital patient care. Drs. Rose and Carlton Zdanski tumors, and petrous apex lesions. Indeed, in the and the UNC Skull Base Surgery Program are all last year, UNC performed over 100 expanded currently working together to provide the most endoscopic tumor surgeries. In a very special case advanced pediatric tumor care and advance the in 2008, Drs. Zanation and Germanwala performed research in pediatric skull base tumor surgery. one of the first endoscopic endonasal clippings of a ruptured aneurysm in the world. The one Treatment of Snoring and Obstructive year follow up of this patient revealed complete Sleep Apnea obliteration of the aneurysm and the manuscript Snoring is a ubiquitous problem in the United describing this novel approach has been published States, affecting more than 50% of middle aged in the prestigious journal Neurosurgery in the last men and 40% of middle aged women. Obtrusive year. This case illustrates the potential of the snoring can be associated with more severe medical minimally invasive endoscopic approach and shows conditions, including obstructive sleep apnea, or how UNC is expanding the limits in this new field. upper airway resistance syndrome (UARS), and treatments for these disorders of sleep are needed As techniques and experience lead us to utilize to prevent long-term problems with heart and lung the endoscopic corridor for more complex skull disease. base lesions, the natural progression is to utilize this approach for pediatric skull base tumors. For simple snoring, not associated with OSA or Drs. Zanation and Senior along with our Pediatric UARS, the division offers radiofrequency treatment Otolaryngology Attendings (Drs. Austin Rose and of the palate as our procedure of choice. Now Carlton Zdanski) have successfully performed available in the United States for over 10 years, it numerous pediatric skull base surgeries together. is a time tested office-based procedure that is fast, Dr. Zanation’s lab has recently published one of with little pain and rapid recovery. The procedure the first papers on endoscopic pediatric skull involves the placement of a tiny needle electrode base surgery and reconstruction in Laryngoscope into the palate, delivering radiofrequency energy in 2009, which illustrates the hurdles and offers the form of heat energy to the surrounding tissue. solutions that these pediatric cases present. Two Research performed in the Department has resulted additional follow-up manuscripts in pediatric in an alteration of the technique yielding fewer endonasal and skull base surgery have been treatment sessions and improved outcomes. Indeed accepted for publication this past year. What is 70% of patients will be significantly improved after clear is that all pieces of this multidisciplinary two treatment sessions using our technique, while puzzle are integral and needed to optimize the side effects of this procedure are minimal. 100 The relatively minor amount of post-procedure bone and cartilage of the center wall of the pain is the major advantage of this technique nose, allowing for the repair of deviations over other snoring therapies. And as opposed to causing nasal obstruction. Avoiding the need other minimally invasive treatments, no implants for packing of the nose or placement of splints are required with no risk of implant extrusion. makes this outpatient operation a remarkably painless procedure with rapid recovery. In some Obstructive Sleep Apnea Treatments cases the procedure may be combined with Nearly one-fourth of middle-aged men and turbinate reduction allowing for the reduction one-tenth of middle-aged women have of the bulky tissues on the side wall of the more severe problems with sleep disordered nose contributing to nasal blockage, performed breathing including obstructive sleep apnea. either in the office or in the operating room. Uvulopalatopharyngoplasty In addition to excessive daytime sleepiness, For over thirty years, this procedure has been obstructive sleep apnea has been associated widely applied to individuals with OSA. It with increased risk of several serious medical involves removing the uvula and portions of problems including hypertension, heart attack, the palate and is frequently combined with stroke, and even premature death, mandating tonsillectomy. This surgical procedure is diagnosis and treatment. For diagnosis, surgeons usually performed with an overnight hospital in the Department of Otolaryngology/Head and stay and results in significant improvement in Neck Surgery perform a careful upper airway obstructive sleep apnea (OSA) in about half evaluation, including an upper airway endoscopic of all individuals undergoing the surgery. exam, while working with a multi-disciplinary team Rhinology, Allergy & Endoscopic Skull Base Surgery Rhinology, of sleep medicine specialists in the Departments Radiofrequency Tongue Base Reduction of Neurology and the Division of Pulmonary Radiofrequency tongue base reduction is Medicine, as well as dentists from the University a minimally invasive procedure utilizing of North Carolina School of Dentistry, and radiofrequency energy to heat tissue surrounding surgical colleagues in the Department of Oral a small needle which is inserted into the tongue and Maxillofacial Surgery, work to develop a base. The heated tissue is resorbed by the body, personalized treatment plan for patients with sleep creating a small area of scar, thereby reducing the apnea, as there is not one simple treatment for size of the tongue base. This procedure has proven all patients. Options for treatment and services safe with few complications, as well as effective by provided include the full range of “multi-level” several studies, in properly selected individuals. surgery. This treatment philosophy recognizes that Genioglossus Advancement the obstruction occurring in OSA occurs at several and Hyoid Repositioning levels in the upper airway, requiring a variety Working with colleagues in the Department of of procedures to treat, including manipulation Oral and Maxillofacial Surgery, genioglossus of soft tissues from the nose to the back of the advancement is a procedure frequently performed throat, in addition to bony facial surgery involving for obstructive sleep apnea in the presence primarily the jaw. Some of these options include: of blockage in the upper airway caused by Septoplasty the position of the back of the tongue. The Septoplasty consists of manipulation of the procedure requires making an incision between 101 Rhinology, Allergy & Endoscopic Skull Base Surgery

the lower lip and the gum in the mouth. A for the treatment of sleep apnea as well for small window of bone in the jaw is then cut patients that have an enlarged tongue base and advanced slightly, thereby pulling the as a suspected cause. To date, robotic base of tongue forward and increasing the space tongue reduction has proven very efficacious in the breathing passage in the back of the for treatment of OSA in properly selected throat. Repositioning of the hyoid bone patients. As a primary (done with UPPP) and over the front of the neck is frequently secondary (after prior UPPP) surgery, TORS performed at the same time as genioglossus for OSA has been shown to markedly reduce advancement in order to augment its effect. a patient’s apnea hypopnea index, resulting in a greater than 50% reduction in nearly all Transoral Robotic Surgery cases and cure (AHI <10) in a large portion of of the Tongue Base patients. Even for those patients who do not Transoral robotic surgery (TORS) is exciting receive full cure, TORS base of tongue reduction new technology that has gained acceptance has been shown to result in significant benefit in the treatment of oropharynx cancer. with a reduction in Epworth Sleepiness Score and pressure settings required for CPAP, This success with TORS has lead UNC surgeons markedly improving their CPAP tolerance/usage. as well as others to explore the utility of Dr. Trevor Hackman and Dr. Adam Zanation robotic assisted base of tongue reduction offer this unique service at UNC Hospital.

patients throughout the region. The team Skull Base Center remains strongly committed to the concept The UNC Skull Base Center continues to of offering patients a balanced and unbiased provide multidisciplinary care for complex opinion with all avenues being explored. The pathologies found in both the anterior and scope and experience of this group is vast, lateral skull base regions. As such, the Skull Base thereby providing patients the opportunity Center provides a matrix network comprised for a truly comprehensive evaluation. of a variety of disciplines involved. This organizational structure allows the institution In order to coordinate efforts, members of to leverage the considerable collective talents the Skull Base Team meet routinely. These of the group for the benefit of individual meetings focus on multiple aspects including multidisciplinary care • anterior skull base • lateral skull base • patient care • treatment modalities • surgical 102 team management concepts • cranial nervethe complicated monitoring workflow of patient • care, endoscopic visualization • intraoperativeliterature updates, imaging and improvements to the complex organizational process. & navigation • neuroendovascularA special emphasis techniques of the UNC Skull Base Team is to implement new • stereotactic radiation • Radiationtreatment modalities Oncology as well as updated management concepts and technologies • NeurointerventionalOliver F. Adunka, MD, FACS Craig A. Radiology Buchman, MD, FACS •to ensure rhinologists contemporary patient care. • Director of Skull Base Center Harold C. Pillsbury Distinguished Professor neurotologists • neurosurgeons • multidisciplinary Background and Philosophy care • anterior skull base • lateralHistorically, skull the complex base anatomical • relationships of many important structures patient care • treatment modalitieswithin the skull • base surgical have made surgical management concepts • cranial nervemanagement monitoring particularly difficult. • Recent advances in surgical approaches, cranial endoscopicCarlos S. Ebert, Jr., MD, visualization MPH Trevor G. Hackman, • MD, intraoperative FACS nerve monitoring, imagingendoscopic visualization, Assistant Professor Assistant Professor intraoperative imaging and navigation, & navigation • neuroendovascularneuroendovascular techniques techniques, as well as intraoperative and stereotactic radiation • stereotactic radiation • Radiationhave allowed Oncology dramatic improvements • Neurointerventional Radiology •in patient rhinologists outcomes and quality of • life. Many of these improvements have been neurotologists • neurosurgeons • directly multidisciplinary attributable to close collaborations between a variety of medical disciplines Harold C. Pillsbury III, MD, FACS Brent A. Senior, MD, FACS, FARS care Thomas • J. Dark anterior Distinguished Professor skull Nathaniel base T. and Sheila W. • Harris lateralincluding skull Neurosurgery, base Otolaryngology- • Distinguished Professor Head & Neck Surgery, Radiation Oncology, patient care • treatment modalitiesNeurointerventional • surgical Radiology, and rehabilitative disciplines. For example,

management Allergy & Endoscopic Skull Base Surgery: Skull Base Center Rhinology, concepts • cranial nerve monitoring • surgical approaches developed by endoscopic visualization • intraoperativerhinologists and neurotologists imaging have allowed neurosurgeons access to tumors & navigation • neuroendovascularand other lesions techniques involving the skull base without the need for traumatic brain William W. Shockley, MD, FACS Adam M. Zanation, MD, FACS • stereotacticW. Paul Biggers Distinguished Professor radiation Associate Professor • Radiationretraction, resection, Oncology or in some instances, • Neurointerventional Radiology •skin incisions. rhinologists Moreover, working • together, surgeons and radiation therapists have been neurotologists • neurosurgeons • able multidisciplinary to apply precise anatomic knowledge to the delivery of highly focused radiation in care • anterior skull base • lateralan effort skull to avoid collateral base tissue • damage. Skull base lesions are uncommon and patient care • treatment modalitiesclinical trials • for treating surgical many of these

Matthew G. Ewend, MD, FACS Deanna M. Sasaki-Adams, MD managementChair of Neurosurgery conceptsAssistant Professor• cranial of Neurosurgery nerve monitoring • endoscopic visualization • intraoperative imaging & 103 lesions are lacking. Patients are frequently Department of Ophthalmology, Drs. Mauricio left to seek opinions from a variety of clinical Castillo, Benjamin Huang, Valerie Jewells, Keith

specialists including medical and radiation Smit, and Sten Solander from the Department Rhinology, Skull Base Center Allergy & Endoscopic Skull Base Surgery: oncologists as well as surgeons in an attempt of Radiology, Dr. Robert Greenwood from to find a consensus regarding optimal therapy. Neurology, and Drs. Neil Hayes and Jing However, opinions are frequently divergent and Wu from Medical Oncology. Sharon Cush, dictated by the practitioner’s area of expertise RN and Pasha Lemnah, RN help coordinate rather than by patient factors. This creates patient care and Diane Meyer, PT serves as significant uncertainty among both patients the center’s primary physical therapist. as well as referring physicians during difficult times.

Both Neurosurgery and Otolaryngology/Head and Neck Surgery have added faculty members with special interests and training in this area. For several years, The Department of Radiation Oncology has been able to treat patients via the Vestibular schwannomas (Acoustic tumors) are by far the most common lesion in the cerebellopontine angle. A multidisciplinary approach Cyberknife Radiosurgical System. ensures proper management, which can include watchful waiting, This system has a number of stereotactic radiation, or surgical excision via various approaches. distinct advantages over its competition in that it allows for precise frameless delivery of either single Lateral Skull Base dose or fractionated dose radiation to tumors UNC has emerged a leader in the comprehensive throughout the body including the skull base. management of acoustic neuromas (vestibular schwannomas) other intracranial neoplasms Dr. Oliver Adunka serves as Director of the UNC of the middle and posterior cranial fossae. Skull Base Center. Others from the Department While most tumors in this area are benign, they of Otolaryngology/Head and Neck Surgery can pose a variety of clinical challenges and a who are directly involved include Drs. Craig highly individualized management scheme is Buchman, Charles Ebert, Trevor Hackman, typically required. Over the past decade, UNC Harold Pillsbury, Brent Senior, William has been able to build a substantial caseload Shockley, and Adam Zanation as well as nurses with more than 75 evaluations per year. The B.J. Squires, RN and Kristen Jewell, RN. Skull Base Team has continued to collect and Other UNC disciplines involved in the Skull evaluate patient outcomes using all three base center include Drs. Matthew Ewend and main surgical access routes. Overall, hearing Deanna Sasaki-Adams from the Department preservation rates have remained around 75% of Neurosurgery, Dr. Julie Sharpless from in patients undergoing tumor removal via Endocrinology, Dr. Jonathan Dutton from the the middle fossa approach. Also, UNC offers 104 the CyberKnife as an option for stereotactic mainly causing pulsatile tinnitus (pulsations that can radiation for small and medium size tumors. be perceived in the affected ear) and hearing loss. A main emphasis of the UNC Skull Base Center Also, these tumors carry the potential to harm lower is to offer hearing restoration via both cochlear cranial nerves. In fact, their intimate involvement and brainstem implantation in selected patients. with certain nerves responsible for swallowing and Specifically, we have developed an FDA approved voice production makes them difficult surgical cases. clinical protocol that will allow us to pursue Radiation, on the other hand, often does not treat auditory brainstem implantation (ABI) in children the patient’s symptoms of hearing loss and pulsatile with cochlear nerve deficiency (CND) as part tinnitus. Also, radiation treatment alone can damage of a clinical trial. Typically, the ABI is a device the inner ear irreversibly and can thus affect the that allows auditory stimulation in patients with patient’s hearing and balance functionality. A new Neurofibromatosis Type II (NFII), where both approach, which has been propagated by clinicians cochlear nerves are dysfunctional due to bilateral at Case Western University, has been to manage vestibular schwannomas. As such, the current jugular foramen tumors via a planned subtotal efforts focus to potentially expand the indication resection and subsequent stereotactic radiation criteria for this device beyond this group. (CyberKnife). This treatment algorithm has been For patients with Neurofibromatosis Type II, shown to resolve the patient’s symptoms while we have begun to offer adjuvant systemic moving the radiation field away from the inner treatments. Specifically, Avastin® (Bevacizumab), ear. Therefore, the patient typically undergoes a an angiogenesis inhibitor, has been used in the relatively small outpatient procedure followed by management of several patients with NFII to outpatient stereotactic radiation treatment that will facilitate tumor control and hearing outcomes. most likely not compromise inner ear function. Preliminary results are certainly encouraging and correlate with previous data from the literature. These latter examples demonstrate our dedication to a true multidisciplinary approach to managing Other pathologies of the lateral skull base include skull base disease. In fact, members of the UNC Skull temporal bone paragangliomas, and specifically Base Team are proud to provide this type of clinical jugular foramen tumors (glomus jugulare tumors). algorithm, which clearly benefits patient outcomes.

Rhinology, Allergy & Endoscopic Skull Base Surgery: Skull Base Center Rhinology, These tumors are slow growing vascular neoplasms It appears that most other centers use either a “surgery-centric” or “radiosurgery-centric” model depending on the institution’s expertise and interest. However, this institutional bias might not serve the patient’s best interests. At UNC, we are fortunate to have a unique skull base program that combines professional experience and skills, cutting edge technologies and facilities, and a burning desire to provide a balanced and unbiased MRI of a glomus jugulare paraganglioma originating from the opinion of the treatment options. jugular foramen and extending into the middle ear. A multi-modal Cooperation through mutual respect for management approach using planned subtotal resection of the middle ear content with subsequent sterotactic radiation has been chosen. 105 one another’s skills and opinions forms the backbone for this Rhinology, Skull Base Center Allergy & Endoscopic Skull Base Surgery: eclectic treatment philosophy. Anterior Skull Base Over the last 15 years UNC has developed into a world leader in expanded endonasal skull base surgery generally and minimally Pre and 2 year post operative MRIs on a JNA with extensive skull invasive pituitary surgery (MIPS) base involvement with a complete resection via a single stage specifically, with over 130 of endoscopic endonasal approach (Drs. Zanation and Rose) these surgeries performed in the last year. Past UNC research has shown that MIPS results in shorter hospital stays, UNC surgeons have developed novel techniques more rapid recovery, and less overall complications of reconstruction of the skull base, including the compared to traditional open approaches. More development of the endoscopic pericranial flap recent work in a study of 50 patients undergoing for skull base cancer reconstruction. Additionally, MIPS at an average of two years follow-up showed UNC has the world’s largest prospective series of no significant detrimental impact of the surgery nasoseptal flap skull base reconstructions (over on a patient’s sinonasal quality of life. Additional 300). Also, UNC has the largest known prospective recent UNC research has shown a similar benefit cohort of vascularized endoscopic skull base with regards to the economics of this surgery, reconstructions. The primary goal of endoscopic with a marked reduction in total health care skull base reconstruction is to prevent post- costs related to MIPS compared to traditional operative CSF leaks. With adequate reconstructive techniques. With decreased length of stay and measures in place, the overall post-operative CSF lower nursing costs, savings were found to average leak rate is 2.3% with an overall meningitis rate nearly 24%, over $3,000 less for each procedure. of 0.33%. Both of these results are significantly In the field of expanded endonasal skull better than outcomes associated with traditional base surgery tumors such as meningiomas, transcranial skull base reconstructions. craniopharyngiomas, and sinonasal/skull base cancers have all been successfully managed with Also, it was noted that there is likely a long- an endoscopic minimally invasive approach. UNC’s term learning curve associated with endoscopic Skull Base Center is one of only a few in the skull base reconstructions. If one compares the country that offers expertise in both endoscopic first 25 nasoseptal flaps ever published upon and traditional transfacial or transcranial skull and the first 150 patients and the most recent base surgery. This ability to offer all surgical 150 patients from our institution, there is a options at the highest level allows for the best- significant improvement in outcomes with more individualized care. With this in mind, surgeons experience. As such, outcomes for the last 150 in the UNC Skull Base Center have been among patients show a CSF leak rate of only 0.67%. the first in the world to perform an endoscopic endonasal clipping of a cerebral aneurysm. therapeutic services • laryngeal pathologies • vocal cord paralysis • paresis • airway problems • Vocal Cord Dysfunction • behavioral assessment • videolaryngostroboscopy • acoustic measurements • vocal ergonomics • spirometric evaluation • voice rehabilitation • laryngeal dystonia • voice therapy • therapeutic services • laryngeal pathologies • vocal cord paralysisThe Universi • paresisTy of nor • Tairwayh Carolina problems • Vocal Cord Dysfunction • behavioral assessment • videolaryngostroboscopy • acoustic measurementsVoice Center • vocal ergonomics • spirometric evaluation • voice rehabilitation • laryngeal dystonia • voice therapy • therapeuticThe UNC Voice services Center is comprised • laryngeal of a multidisciplinary pathologies team •of vocal cord highly-experienced physicians and speech pathologists providing paralysisspecialized • paresis diagnostic • airwayand therapeutic problems services • Vocalto dysphonic Cord patients Dysfunction • behavioralwith all descriptions assessment of voice • disorders videolaryngostroboscopy and laryngeal pathologies, • acoustic measurementsincluding laryngeal • vocal dystonia, ergonomics vocal cord paralysis • spirometric and paresis, cysts, evaluation • voicepolyps, rehabilitation nodules, and other • pathologieslaryngeal of thedystonia larynx in both• voice casual andtherapy • professional voice users. Evaluation and management of airway problems therapeuticincluding Vocal services Cord Dysfunction • laryngeal and laryngeal pathologies and tracheal stenosis • vocal is cord paralysisalso available. • paresis Available • airway voice and problems speech services • Vocal include Cord behavioral Dysfunction • behavioralassessment, assessment videolaryngostroboscopy, • videolaryngostroboscopy acoustic and aerodynamic • acoustic measurements, assessment of vocal ergonomics, spirometric measurementsevaluation and assessment• vocal forergonomics voice rehabilitation • spirometric candidacy. evaluation • voice rehabilitation • laryngeal dystonia • voice therapy • therapeutic services • laryngeal pathologies • vocal cord paralysis • paresis • airway problems • Vocal Cord Dysfunction • behavioral assessment • videolaryngostroboscopy • acoustic measurements • vocal ergonomics • spirometric evaluation • med.unc.edu/ent/for-patients/clinical-services/voice-center voice rehabilitation • laryngeal dystonia • voice therapy • therapeutic services • laryngeal pathologies • vocal cord paralysis

• paresisfa CU• airwaylTy problems • Vocal Cord Dysfuncion • behavioral assessment • videolaryngostroboscopyeyond the treatment of voice • acousticdiagnostic voice measurementsevaluations one • Bdisorders, the Voice Center and one-half days each week, as vocal ergonomics • spirometricalso acts as an informationevaluation well• voice as all voice therapyrehabilitation services. • resource to the referring medical (The Voice Center continues to laryngeal dystonia • voicecommunity therapy along with • providingtherapeutic provide oneservices half day service • atlaryngeal UNC educational materials, seminars, in the Neuroscience Hospital for pathologies • vocal cordand paralysis outreach programs • paresis on voice • airwayappropriate patient problems evaluations). • Vocal Cord Dysfuncion • behavioralscience, assessmentcare of the voice, and • videolaryngostroboscopyThe Voice Center sponsored an state of the art diagnosis and Open House on May 14th, 2010, • acousticRobert A. Buckmire, measurements MD treatment• vocal of voice ergonomics disorders. which• spirometric highlighted the art workevaluation of Director of Voice Center Chief of Voice & Swallowing Disorders Marjorie Labadie. Ms. Labadie March Floyd Riddle Distinguished Professor • voice rehabilitation •Diagnostic laryngeal voice evaluations dystonia are is a former • voice voice patient who therapy • performed at The UNC Hearing and developed a series of art pieces therapeutic services • laryngealVoice Center at Carolinapathologies Crossing, about • vocalher experience cord with an paralysis • paresis • airway problemsthe new • home Vocal as of October Cord 2012. Dysfuncioninitially devastating voice • behavioraldisorder, The clinic is conveniently located entitled Finding My Voice. The assessment • videolaryngostroboscopyat 2226 Nelson Highway, close to• acousticUNC Voice Center measurements Team presented • the intersection of Highway 54 and a case study with guest speaker, vocal ergonomics • spirometricInterstate 40. Theevaluation Voice Center Ms.• voiceLabadie at the rehabilitation state Speech & • expanded its presence in the fall Hearing convention in April, 2011. Mark C. Weissler, MD, FACS laryngealJoseph P. Riddle Distinguished dystonia Professor • voiceof 2009 therapy and is now providing• therapeutic services • laryngeal pathologiesChief of Head & Neck •Oncology vocal cord paralysis • paresis • airway problems • Vocal Cord Dysfuncion • behavioral assessment • videolaryngostroboscopy • acoustic measurements • vocal ergonomics • spirometric evaluation • voice rehabilitation • laryngeal dystonia • voice therapy • therapeutic services • laryngeal pathologies • vocal cord paralysis • paresis • airway problems • Vocal Cord Dysfuncion • behavioral assessment • videolaryngostroboscopy • acoustic measurements • vocal ergonomics • spirometric evaluation • voice rehabilitation • laryngeal dystonia • voice therapy • therapeutic services • laryngeal pathologies • vocal cord paralysis • paresis • airway problems • Vocal Cord Dysfuncion • behavioral assessment • videolaryngostroboscopy • acoustic measurements • vocal ergonomics • spirometric evaluation Elizabeth Ramsey, Dr. Ellen Markus, Dr. Robert Buckmire, and Joanne McClaine-Griffin, LPN • voice rehabilitation • laryngeal dystonia • voice therapy • 109 The Voice Center Team

The Voice Center Director, Voice Center Dr. Robert Buckmire joined the faculty in September of 2004 after completing a post-graduate fellowship in Laryngology and Care of the Professional Voice, and a subsequent faculty position at the University of Pittsburgh. His special clinical and research interests include care of the professional voice, the application of “I want you to use those belly muscles; the belly is supporting all of this,” says Dr. Ellen Markus, speech language pathologist, while teaching robotics to microlaryngeal speaking techniques to 85-year-old Voice Center patient, Ray Carpenter. surgery, diagnostic SHNS photo courtesy Raleigh News & Observer laryngeal electromyography, laryngeal framework surgery and the diagnosis has lectured regionally and nationally on the and treatment of swallowing disorders. care and prevention of voice disorders.

Dr. Mark Weissler has maintained an active Elizabeth Ramsey joined the Voice Center team practice in laryngology since 1986 with special in May 2012. She holds a Master’s Degree in emphasis on the treatment of laryngeal dystonias, Speech Pathology, and has a background in voice benign and malignant laryngeal neoplasms, vocal disorders, swallowing disorders, and head & neck fold paralysis, and laryngeal and tracheal stenosis. cancer. She specializesin voice disorders of various natures and also working with the pediatric Dr. Ellen Markus is the Voice Center voice population. She has expertise in performing Coordinator. She has a Master’s Degree in laryngovideostroboscopic evaluation of the vocal Speech Pathology and a Doctorate in Vocal folds and also in treating Vocal Cord Dysfunction, Music Performance and specializes in working particularly in the population of athletes. with singers, from amateur to professional.

She has taught singing for over 38 years and cofounded the UNC Voice Wellness Clinic in 1991 with Dr. Mark Weissler. She specializes in rehabilitating singers who have experienced vocal injury, as well as working with all other types of voice disorders. She pediatric pulmonary medicine • pediatric anesthesia • pediatric gastrointestinal medicine • pediatric hematology/oncology • pediatric speech & language pathology • audiology • physicians assistants • cleft lip • cleft palate • pediatric pulmonary medicine • pediatric anesthesia • pediatric gastrointestinal medicine • pediatric hematology/oncology • pediatric speech & language pathology • audiology • physicians assistants • cleft lip • cleft palate • pediatric pulmonary medicinePediatric • pediatric Otolaryngology anesthesia • pediatric gastrointestinal medicine • pediatric hematology/oncology • pediatric speech & language pathology • audiology • physicians assistants Drs. Amelia F. Drake, Carlton J. Zdanski, and Austin S. Rose, • clefttogether, lip care • cleft for infants palate and children • pediatric with problems pulmonary relating to medicine • pediatricthe ears, nose, anesthesia and throat. •They pediatric see patients gastrointestinalin the NC Children’s medicine • pediatricHospital, the UNC hematology/oncology ENT Clinic in the North Carolina • Neurosciences pediatric speech & languageHospital, and pathology the UNC Ear, Nose • audiology & Throat Clinic •at Carolina physicians assistants Crossing. • cleft lip • cleft palate • pediatric pulmonary medicine • pediatricAs children anesthesia presenting to UNC • pediatrichave complicated gastrointestinal medical problems medicine • pediatricand multi-system hematology/oncology diseases,work in Pediatric Otolaryngology • pediatric is speech & often carried out in conjunction with other providers in the fields languageof Pediatric pathology Pulmonary Medicine, • audiology Pediatric •Anesthesia, physicians Pediatric assistants • cleft lip •Gastrointestinal cleft palate Medicine • pediatric and Pediatric pulmonary Hematology/Oncology, medicine as • pediatric anesthesiawell as Pediatric • pediatric Speech & Language gastrointestinal Pathology and medicineAudiology. • pediatric hematology/oncology • pediatric speech & language pathology • audiology • physicians assistants • cleft lip • cleft palate • pediatric pulmonary medicine • pediatric anesthesia med.unc.edu/ent/for-patients/clinical-services/pediatric-otolaryngology | • pediatricmed.unc.edu/ent/for-patients/clinical-services/nc-childrens-airway-center gastrointestinal medicine • pediatric hematology/ pediatric pulmonary medicine • pediatric anesthesia • pediatric gastrointestinal medicine • pediatric hematology/oncology • Faculty pediatric speech & language pathology • audiology • physicians ver the last few years, the North Carolina Children’s Airway Center, assistants • cleft lip • cleft palate • pediatric pulmonary medicine • Odirected by Dr. Zdanski, has helped to better organize and facilitate this coordination of care. In a similar manner, the UNC Craniofacial Clinic, led by pediatric anesthesia • pediatric gastrointestinal medicine • pediatric Dr. Drake and housed in the UNC School of Dentistry, has helped to coordinate the care of patients with cleft lip and palate and other craniofacial disorders hematology/oncology • pediatric speech & language pathology • from the entire Southeast United States, and as far away as Switzerland, since 1963. In addition to their clinical work, the faculty of the Division of Pediatric audiology • physicians assistants • cleft lip • cleft palate • pediatric Otolaryngology dedicates significant time to both teaching and research responsibilities. Drs. Rose and Zdanski formerly served on the American Board pulmonary medicine • pediatric anesthesia • pediatricCarlton gastrointestinal J. Zdanski, MD, FACS, FAAP Associate Professor of Otolaryngology’s Task Force for New Materials. Dr. Zdanski currently Chief of Pediatric Otolaryngology medicine • pediatric hematology/oncology • pediatricDirector, NC Children’s speech Airways Center & serves on the AAO-HNSF’s Pediatric Otolarynology Education Committee, as a guest examiner for the American Board language pathology • audiology • physicians assistants • cleft lip • of Otolaryngology, President of the Newton D. Fischer Society, Secretary/Treasurer of the North cleft palate • pediatric pulmonary medicine • pediatric anesthesia • Carolina Society of Otolaryngology/Head and Neck Surgery, and is the Co-Director of the pediatric gastrointestinal medicine • pediatric hematology/oncology Annual Carolina’s Pediatric Airway Course. • pediatric speech & language pathology • audiology • physicians Dr. Rose is a current Course Co-Director of the annual assistants • cleft lip • cleft palate • pediatric pulmonaryAmelia F. medicineDrake, MD, FACS • Newton Newton D. Fischer Distinguished Professor D. Fischer pediatric anesthesia • pediatric gastrointestinal medicine • pediatric Society meeting. Dr. hematology/oncology • pediatric speech & language pathology • Drake now audiology • physicians assistants • cleft lip • cleft palate • pediatric serves as the Executive Associate pulmonary medicine • pediatric anesthesia • pediatric gastrointestinal Dean of Academic Programs, and works in this capacity for the medicine • pediatric hematology/oncology • pediatric speech & School of Medicine, helping to start a graduate program for Physicians Assistants, Austin S. Rose, MD language pathology • audiology • physicians assistantsAssociate • Professorcleft lip • among other roles. cleft palate • pediatric pulmonary medicine • pediatric anesthesia Recent publications have included research • pediatric gastrointestinal medicine • pediatric hematology/ in the areas of computational fluid dynamic modeling of the pediatric airway, pediatric, oncology • pediatric speech & language pathology • audiology • cochlear implantation, management of caustic ingestion, management of hemangiomas in pediatric patients, and physicians assistants • cleft lip • cleft palate • pediatric pulmonary management of tracheal tumors in children. The Division is the recipient of NIH R01 HL105241-01, “Predictive Modeling for Treatment of Upper Airway medicine • pediatric anesthesia • pediatric gastrointestinal medicine Obstruction in Young Children.” Jason Roberts, MD • pediatric hematology/oncology • pediatric speechPediatric & Otolaryngology language Fellow 2013-2014 pathology • audiology • physicians assistants • cleft lip • cleft palate • 113 Pediatric Otolaryngology

In addition to work recognized both locally and nationally, the Division has been well represented internationally, with presentations to audiences overseas, such as at the International Cleft Congress and the European Society of Pediatric Otolaryngology. They participate in medical mission trips to Malawi, the West Bank, and Vietnam. The faculty has also worked to strengthen its ties with international colleagues in Pediatric Otolaryngology by hosting a number of visiting physicians from around the world, including the United Kingdom, Israel, and Thailand. As in the past year, the future should prove exciting for the Division of Pediatric Otolaryngology as it continues to provide state of the art care, expand its services, and renew its commitment to research and education in the field. 114 The Center is a unique endeavor, supported by the North Carolina Department of Otolaryngology/Head and Neck Surgery, the Department of Pediatrics’ Division of Children’s Airway Pulmonology, and includes members from across multiple divisions and departments within the Center UNC Health Care system. The Center provides The North Carolina Children’s Airway Center again comprehensive cutting edge care for children with helped The North Carolina Children’s Hospital these unique airway problems in an efficient and achieve a ranking of 11th in the nation among timely manner. Additionally, the Center instructs children’s hospitals caring for children with families, medical students, clinicians and health respiratory disorders by US News & World Report care providers, and supports research in pediatric in their 2013 issue of America’s Best Children’s airway disorders including providing the supporting Hospitals, and to help the Department of OHNS to infrastructure for the National Institutes of Health its 22nd ranking in the US in Ear, Nose, and Throat R01 grant “Predictive Modeling for Treatment of Disorders. The Center was awarded a generous grant Upper Airway Obstruction in Young Children.” from The Duke Endowment from 2007 to 2010 for the creation of a center to care for children with The North Carolina Children’s Airway Center officially complex congenital or acquired airway problems opened its doors in September 10, 2007. Since then, and it continues to grow in clinical, educational, and thousands of children have been evaluated and research endeavors. treated by the multi-disciplinary team. Multiple,

streamlined protocols have been implemented for the Pediatric Otolaryngology:Pediatric Airway North Carolina Children’s Center 115 Pediatric Otolaryngology: North Carolina Children’s Airway Center North Carolina Children’s Airway Pediatric Otolaryngology:

evaluation of children with airway problems, and and Program Coordinator Kathy Abode, RN. several collaborative research projects have been Multidisciplinary involvement from Anesthesia, established and grants awarded with multiple Neurology/Sleep Medicine, NICU, PICU, Pediatric presentations offered at the international, Surgery, Maternal-Fetal Medicine, Cardiothoracic national, state, and local level. In addition, the Surgery, Genetics, Hematology/Oncology and Carolina’s Pediatric Airway Course has been more are integral to coordinating care for these established in collaboration with the Medical medically complex children. University of South Carolina, teaching residents The North Carolina Children’s Airway Center and practicing surgeons within the Southeastern provides an individualized, coordinated approach United States. to each patient. The entire spectrum of Outreach efforts extend to Africa where Dr. pediatric medical and surgical services, including Zdanski is visiting faculty, Department of Surgery, otolaryngology, pulmonology, anesthesia, Kamuzu Central Hospital, Lilongwe, Malawi and radiology, ICU care, feeding and swallowing, involved in teaching of airway endoscopy and nutrition, tracheostomy care, social work, head and neck surgery to surgical residents and respiratory therapy, speech and communication, clinical officers. are available to patients of the Airway Center. The clinicians at the Center have an interest The Center’s core organizational structure in caring for all children with airway problems, includes Surgical Director Carlton J. Zdanski, including those with existing tracheotomies or MD; Medical Director George Retsch-Bogart, with new airway problems. If you have a patient MD; Respiratory Therapist Mark Hall, RT (back you would like to refer to the North Carolina from performing military service in Iraq); Children’s Airway Center, please feel free to Tracheostomy Nurse Cynthia Reilly, PNP; Speech contact the OHNS Clinic at 919-966-6485 or call Pathologists Leah Thompson, SLP, and Krisi the Consultation Center at 800-862-6264, and Brackett, SLP; Administrative Coordinator Amanda request Dr. Zdanski. Gee; Administrative Assistant Dawn Wilson; Airways Course 2012 Participants in the course experienced hands-on simulations of children with obstructed airways. Pictured here, a medical student quickly tries to remove a penny from the the airway of a simulation doll, which is hooked up to a beeping monitor, and makes breathing sounds. Department Research 118 Carlton J. Zdanski, MD, FACS tools such as the Virtual Pediatric Airway Workbench, Through the concerted efforts of many individuals the Pediatric Airway Atlas, quantitative bronchoscopy, within the Department of Otolaryngology/Head and anatomic optical coherence tomography. and Neck Surgery, The Department of Pediatrics, and multiple individuals within the UNC Hospitals Additional selected invited publications include Section Editor for Pediatric Otolaryngology/ Research system, we continue to build the North Carolina Children’s Airway Center. Initially formed with Head and Neck Surgery Clinical Reference Guide, the assistance of a generous grant from The Duke Airway for A Color Handbook of Otolaryngology, Endowment, the Airway Center specializes in The Sisson Conference, Conversations in the coordinated delivery of cutting edge, multi- Pediatric Otolaryngology, and The Caribbean disciplinary, specialized care for children with Pediatric Otolaryngology Conference. airway disorders. The Center also seeks to educate The Department co-sponsored the Carolina’s patients and their families, as well as clinicians, Pediatric Airway Course with the Department of regarding airway disorders and to perform research. Otolaryngology at the Medical University of South Carolina. Dr. Zdanski and former UNC OHNS resident and Pediatric otolaryngologist Dr. David White co-directed the two day course. This past year the course was hosted at the University of North Carolina and included faculty, fellow, and resident participants from the Medical University of South Carolina, Duke University, Wake Forest/Bowman Gray School of Medicine, Eastern Virginia Medical School, and Vanderbilt University. The course continues to grow in content and scale and will be hosted by the Medical University of South Carolina in 2013.

Clinical research has primarily revolved around our excellent Pediatric Cochlear Implant Program at UNC. This is one of the most active pediatric cochlear implant programs in the country. Our Internal Review The Airway Center’s multi-disciplinary clinics Board approved protocol for the study to determine began formally seeing patients in September of the optimal protocol for the auditory rehabilitation 2007. Multiple areas of research are currently of children with Auditory Neuropathy/Dys-synchrony being explored and protocols for efficient and safe continues and data collection continues. Interest evaluation and management of more common airway has been intense on an international level and problems are being developed and finely tuned. across disciplines. We plan to continue to collect, Work continues with the National Institutes of present, and publish our data on as it matures. Health R01 grant “Predictive Modeling for Treatment Adam J. Kimple, MD, PHD of Upper Airway Obstruction in Young Children,” Dr. Kimple completed his PhD in the laboratory with multiple manuscripts and presentations being of Dr. David Siderovski studying RGS21, a protein produced. Enrollment of patients is at pace as is the which turns off bitter taste (highlighted in J. development of new computational fluid dynamic Biol Chem 2012 Dec 7;287(50)). He gave a take modeling techniques and new research and clinical 119 about the potential role of RGS21 in mucociliary an RO1 to study auditory processing in pathways clearance at the Triological Society meeting in between the midbrain and cortex. As always,

Orlando, FL in April 2013. His current research medical students and residents have contributed Research interests are aimed at understanding how greatly to progress over the past year. mucociliary clearance is affected by other Regulators of G-proteins Signaling proteins (RGS). In the human cochlear implant subjects, we are testing the hypothesis that the outcomes with Dr. Kimple was awarded a resident research cochlear implants depend at least in part on the award from the American Rhinologic Society degree of cochlear function at the time of surgery. (ARS) for his proposal entitled “Regulator of The degree of cochlear function is measured in the G-Protein Signaling-22: a Putative Regulator of form of the ECoG responses to acoustic stimuli Motile Cilia.” He is currently collaborating with measured at the round window just prior to implant insertion. It has long been expected that the cochlear implant outcomes should depend in part on how many healthy neural elements exist to be stimulated through the implant. Our expectation is that the ECoG can indicate the neural survival in most subjects. Preliminary measurements that should be published next year indicate that there is indeed a high correlation between ECoG magnitudes and speech outcomes measured as word scores in adults. We expect to extend this analysis to pediatric patients in the next year. Current results show that the ECoG recordings are nearly identical between the adult and pediatric implant population. the Tarran laboratory in the UNC Cystic Fibrosis / Pulmonary Research and Treatment Center An additional focus in the human ECoG studies and the Roth Laboratory in the Pharmacology is whether we can detect trauma to the cochlear Department to understand how mucociliary that occurs during implant insertion or determine clearance is affected by regulators of G-proteins electrode position in near real-time. If so, this signaling. He hopes his research will identify information could be used to avoid further new pharmaceuticals targets that could help trauma or to determine when the electrode was treat disease conditions such as cystic fibrosis, in an optimal position. This project has advance chronic sinusitis, and otitis media with effusion. in the last year through collaboration with Douglas C. Fitzpatrick, PhD cochlear implant companies (MED-EL, Advanced Bionics, and the Cochlear Corporation). Dr. Fitzpatrick and his colleagues study the physiology and anatomy of hearing using animal A major advance in the gerbil studies this year was models and human subjects. A project that has to apply kainic acid to the cochlea to eliminate nerve continued this year is to obtain intraoperative responses. Kainic acid is a glutamate analogue that electrocochleography (ECoG) recordings from disrupts neural transmission due to excitotoxicity patients receiving cochlear implants. This at the post-synaptic site where glutamate receptors project is advanced and informed by parallel are located. Using kainic acid we were able to study experiments in an animal (gerbil) model. Dr. the contributions of hair cell and neural potentials Fitzpatrick also has an NIH grant in the form of to the ECoG across frequencies and intensities. 120

This work will allow for a more sensitive evaluation do to the electrocautery used during tumor removal. of cochlear potentials recorded from humans. This possibility is being addressed in the gerbil model. In both human OR recordings and in animal studies we have continued to implement Hannah Eskridge, MSP, CCC- recordings through the implants themselves SLP, LSLS Cert AVT Hannah Eskridge is the NCFI/Barnhardt Director Research using hardware and software provided by cochlear implant manufacturers (Cochlear Corp, of the Carolyn J. Brown Center for the Acquisition Advanced Bionics, Inc, and MED-EL Corp). of Spoken language Through Listening Enrichment (CASTLE). She has been working with children who are deaf or hard of hearing and their families for over 10 years. She directs the Professional Training Program, coordinates staff and various other programs at CASTLE as well as raises private funds to support the program. Hannah also conducts Listening and Spoken Language sessions with children and their families. She currently serves on the AG Bell Academy Certification Committee and is the chair of the OPTION SCHOOLS Strategic Planning Committee. We have an ongoing study in collaboration with Dr. She has coordinated the implementation of REACH, Nell Cant at Duke University to study the pathways a program using video-conferencing technology and physiology from the inferior colliculus to auditory to conduct tele-therapy and tele-training. Current thalamus, and then from the thalamus to auditory research being conducted with the REACH program cortex. There is a distinct transformation in the includes a study to compare child outcomes in representation of auditory information that occur addition to parent skill development using tele- between the inferior colliculus, where information therapy with those obtained with direct services in is arrayed according to frequency, and auditory the CASTLE clinic. In collaboration with the University cortex, where information is arrayed according to of Akron, a study to assess therapist qualifications function. Our hypothesis is that this transformation and skills that produce the best outcomes for first occurs in the auditory thalamus due to complex children with hearing loss learning spoken language outputs from the inferior colliculus to the thalamus. in a tele-therapy approach has just begun.

We also began a new study under the guidance or Dr. Buchman, to determine if electrocautery is contraindicated in tumor-removal surgeries where an auditory brainstem implant (ABI) is to be provided. Patients who are candidates for an ABI are those with no functional auditory nerve so that cochlear implants cannot be used. It has been found that patients with NF2 who lose their auditory nerve during surgery have poorer outcomes with the ABI than patients who have compromised nerves for other reasons. The hypothesis is that the relatively poor Research measuring outcomes of children having outcomes are due to damage to the cochlear nucleus graduated or received services from CASTLE since 121 its inception in 2001 is underway. This data will types, the bushy and stellate cells. We created two help to demonstrate the effectiveness of CASTLE detailed computational models based on these services, the impact of variables such as multiple physiological studies that have helped to reveal the Research disabilities on a child’s future outcomes and school functional significance of the different time courses services as well as anticipated cost of special of inhibition. The first is that the slow inhibition onto education for children receiving appropriate listening bushy cells improves their ability to precisely respond and spoken language services prior to age five. to auditory nerve inputs. The second is that the fast inhibition onto the stellate cells seems essential She traveled to Vietnam this year with the for them to detect modulated signals in noise; slow Global Foundation for Hearing Loss to train inhibition does not work to improve this detection. professionals in Hanoi and Ho Chi Minh City on the development of listening and spoken language for children with hearing loss.

Paul B. Manis, PhD Dr. Manis and his colleagues are studying cellular mechanisms of information processing in the central auditory system. The research has two principal goals. The first goal is to understand the normal cellular mechanisms and the organization and function of neural networks that are responsible for the remarkable sensory abilities of the auditory system. The second goal is to understand how these mechanisms are affected by hearing loss, and how they may contribute to tinnitus. This work is currently supported by 2 NIH R01 grants to Dr. We are also evaluating how the function of these Manis, and a 3-year R03 grant to Dr. Ruili Xie. inhibitory circuits, as well as excitatory circuits, is affected by hearing loss and aging. In one study, we In the first research project, Dr. Manis, along with (Xie and Manis) found that the strength of inhibition Dr. Ruili Xie and Mr. Luke Campagnola (Neurobiology in one pathway decreases with age, even in relatively graduate student), are investigating the integrative young mice. Surprisingly, we also found that the mechanisms of anterior ventral cochlear nucleus time course of inhibition changed at the onset of (AVCN) bushy and stellate neurons in normal hearing loss in a genetic mouse model of hearing animals, and in animals experiencing acute and loss, but that this recovered with age, even though chronic hearing loss. These cells are part of a major the hearing sensitivity became much worse. We are set of pathways that are important in both speech also using optical methods of glutamate uncaging perception and for sound localization. Recent to map the organization of synaptic connections studies have shown that inhibition plays a much within the VCN and from the dorsal cochlear nucleus more important role in sculpting the responses to the VCN with unprecedented resolution. This has of ventral cochlear nucleus (VCN) neurons to the revealed the specific patterns of circuit organization temporal and spectral composition of sound than onto particular cell types in the cochlear nucleus. previously appreciated. Our studies have revealed We are also studying the effects of aging and noise- that the time course of inhibition, even from a induced hearing loss on synaptic transmission from single source, is different in the two principal cell the auditory nerve to the VCN. There are surprising 122 parallels between the effects of noise-induced hearing that the local circuits change both their spatial loss and aging on the function of the synapses arrangement and synaptic strength to compensate between the auditory nerve and the cochlear nucleus for the loss of input. The changes in these circuits neurons that suggest the involvement of molecular will affect how people with hearing loss process mechanisms of calcium homeostasis. This work will auditory information, and circuit remodeling at be continued by Dr. Xie with his new R03 grant. this level is likely to contribute to tinnitus. Research

The second project is supported by a research grant Lastly, a collaborative project between the lab from NIH to study the auditory cortex. A key aspect (Manis, Mancilla, Zhang) with Drs. Patricia Maness of this grant was to bring new optical techniques (Department of Biochemistry and Biophysics) is into the laboratory. While auditory information examining inhibitory circuits and their role in network processed by the brainstem and midbrain auditory activity in the auditory and prefrontal cortex in nuclei is ultimately analyzed in the auditory cortex, two mouse models of schizophrenia. The current which consists of a core or primary region and project, with postdoctoral associate Dr. Xuying several highly interconnected surrounding areas Zhang, uses an optogenetic approach (genetically defined by their tonotopic organization and acoustic controlled expression of light-activated ion channels responsiveness. Recent studies have shown that in very specific sets of neurons) to examine the the primary auditory cortex is highly plastic, and spatial and functional organization of inhibitory that the properties of the cells can be modified by networks using laser-guided photostimulation of a relevant interactions between the organism and its specific set of cells expressing channelrhodopsins. environment, and also in response to hearing loss. This work has revealed the specific pattern of an Furthermore, it has become evident that sensory increase in inhibitory connections in prefrontal cortex not only processes sensory information, cortex in a mouse model of schizophrenia in which but also plays an active role in the recall of prior neural cell adhesion molecules are manipulated. sensory experience. This grant focuses first on examining the organization of local cortical circuits Charles S. Ebert, Jr., MD, MPH in normal animals and in animals with hearing Dr. Ebert completed advanced Rhinology training at loss using laser guided photostimulation of neural the Georgia Sinus and Nasal Institute and returned circuits using caged glutamate, the main excitatory to UNC as an Assistant Professor in the Division of neurotransmitter in the brain. The organization of Rhinology, Allergy and Endoscopic Skull Base Surgery. circuits onto layer 4 neurons is being studied by As the first former resident to complete the T32 Ms. Megan Kratz, a Research Specialist. Ms Kratz NIH Training Program, he has remained active in his found a novel pattern of connections that may be research pursuits, providing mentorship to numerous related to certain patterns of auditory spectral current residents, including Drs. Kibwei McKinney, processing. Dr. Deepti Rao, a a recent graduate of Jessica Smyth, Alex Farag, Baishakhi Choudhury, the Department of Cell and Molecular Physiology, Deepak Dugar, Brian Thorp, Gita Fleischman, and also investigated spike timing dependent plasticity, numerous medical students. which is thought to be a learning rule that maximizes mutual information between inputs and outputs His basic science interests have been directed at of simple neural networks, and is thought to be investigating the molecular basis of inflammatory associated with learning and memory in the cortex. diseases of the nose and paranasal sinuses. In this The final aim of this grant is to examine how the research, he seeks to specifically characterize the functional neural circuits of the cortex are rewired genetic expression profiles of patients with Allergic following noise-induced hearing loss. We expect Fungal Rhinosinusitis through a comparative analysis of healthy and diseased specimens of sinonasal 123 mucosa. Through a collaborative effort with the combining electrical stimulation from a cochlear Department of Biostatistics in the UNC School of implant with the natural acoustic signal from

Public Health, he received a funding for this project patients with preserved residual hearing following Research through the North Carolina Translational and implant surgery in an attempt to improve hearing performance for patients. Newer areas of study include a clinical trial for auditory brainstem implants (ABI) in children and the use of the round window membrane for implantation of the Vibrant MedEl device for conductive and mixed hearing losses. We have recently implanted 2 children with deafness resulting from cochlear nerve deficiency with ABIs. We continue to be very interested in the field of ANSD in children. Here at UNC, we have a particularly robust clinical experience with this disorder as we are currently following more than 300 affected Clinical Sciences Institute funded through Clinical children. What is clear from our current research is and Translational Science Awards as well as from that the findings of ANSD on hearing testing can the Combined Otolaryngology Research Effort be associated with a variety of medical conditions. via the American Academy of Otolaryngic Allergy. We have learned that some children with ANSD Other research interests include: characterizing can occasionally have absent or severely deficient socioeconomic and demographic factors in patients cochlear nerves on MRI and that these children may with Allergic Fungal Rhinosinusitis, cost effective not benefit from cochlear implants and may be ABI analyses of endonasal, endoscopic surgical candidates. By contrast, most children with ANSD approaches to the skull base versus traditional open can benefit from either hearing aids or cochlear approaches, attempting to quantify the impact of implants depending on their native hearing abilities. Functional Endoscopic Sinus Surgery via patient- Identifying which children can benefit from the rated quality of life (QOL) measures and through various intervention strategies is a major area of objective correlates with Computational Fluid investigation. Dr Buchman, together with Drs Grose, Dynamics (CFD) models. Dr. Ebert is a fellow of the Roush and He have recently begun to use a variety American Academy of Otolaryngic Allergy, the co- of electrophysiological test together with imaging director for the Rhinology and Endoscopic Skull Base studies to try and better characterize which children surgery fellowship, and is the Associate Residency with ANSD can benefit from amplification and those Program Director. that require cochlear implantation or no intervention. Craig A. Buchman, MD, FACS We are particularly excited about recent finding in Dr. Buchman is actively involved in research in this population of children that show correlations between auditory cortical responses and performance a number of hearing-related topics. Together using either hearing aids or cochlear implants. These with a number of co-investigators from UNC and results hold great promise for helping to choose abroad, he continues to study cochlear nerve the most appropriate device for young children. deficiency, auditory neuropathy spectrum disorder Together with the Office of Technology Development (ANSD), inner ear malformations, and a number at UNC, Dr. Buchman and Dr. Adunka have applied of hearing restorative device-related topics. In the for a US and International Patent to provide field of cochlear implantation, Dr. Buchman and intracochlear measurements of acoustically evoked colleagues have been studying the effects of auditory potentials. This new technology should 124 Research

provide improved means to monitory hearing Career Development Grant to support a clinical trial during hearing preservation cochlear implantation. entitled “Phase II Quality of Life and Neurocognitive Also, this method might be helpful in the direct Outcomes Trial in Skull Base Tumor Surgery.” assessment of hair cell function rather than to gather in-direct data via conventional audiometric Dr. Zanation partners with Dr. Charles Ebert on evaluation. The patent application has recently been research in the areas of sinonasal quality of fife, cost published with the US Patent and Trademark Office. outcomes and genomics of sinusitis. Dr. Charles Ebert and Dr. Zanation, completed a CTSA grant Adam M. Zanation, MD, FACS on the Genomics of Allergic Fungal Sinusitis and Dr. Zanation continues to explore a research path were refunded to continue this program through the that encompasses both clinical and translational AAOA. Lastly with the addition of Dr. Julie Kimbell, science in Skull Base Surgery, Rhinology and Head the lab is now in the midst of multiple prospective and Neck Oncology. His passion for research began computation fluid dynamitic outcomes clinical trials in residency and continues to grow as he embarks his and hopes to fulfill the goal of obtaining NIH funding career in a new surgical specialty in Otolaryngology. in this area soon. Lastly, this past year Dr. Zanation Dr. Zanation has mentors several medical students, was awarded the 2013 Mosher Award from the residents and fellows per year. Dr. Zanation is an Triological Society for his Thesis on the Treatment active mentor in both the Holderness and Doris Impact of the Head and Neck Multidisciplinary Duke Medical Scholars Programs. As such, Dr. Tumor Board. Zanation was selected as a member of the Academy of Educators in 2013. Projects involved everything Amelia F. Drake, MD, FACS from the basic science of thyroid and skull base Dr. Drake serves as director of the UNC Craniofacial tumor molecular biology to radioanatomic studies Center in the School of Dentistry. Over the past in pediatric skull base surgery to clinical outcomes 2 years, she served as the PI of a subcontract on projects in head and neck oncology and endoscopic the study of phenotypic variations of patients skull base surgery. Dr. Zanation has 85 pubmed with craniofacial microsomia. The study provides indexed publications and over 150 presentations. a description of the condition and an enhanced The research team has presented over 20 abstracts understanding of the variation in this diagnosis. this past year and published over 15 papers in last Collaboration in the CFM Planning Grant (RC1 year. The lab has won multiple awards including the DE 020270) has enabled the development Harrell Resident Research Award from the Triological of the Facial Asymmetry Collaborative for Society, the North American Skull Base Society Interdisciplinary Assessment and Learning (FACIAL) Research Award, the Triological Society Head and network. As a sub-awardee of another NIH grant Neck Best Poster Award and many others. In May of (“CFM: Longitudinal Outcomes in Children pre- 2010, Dr. Zanation was awarded a Triological Society Kindergarten (CLOCK),” R01 DE 022438 (Heike/ 125 Speltz, PIs), which will be conducted through be controlled for and final electrode positions are the FACIAL network, the collaborators plan often times hard to predict. Also, intracochlear

to perform a longitudinal cohort study of 125 damage has been linked to hearing preservation and Research infants with craniofacial microsomia (CFM) and the successful implementation of electric acoustic controls to assess neurodevelopmental and social stimulation (EAS) of the auditory system. As such, communication outcomes over the next 5 years. damage appears to interfere with out ability to conserve hearing remnants and thus utilize them at a Carol G. Shores, MD, PhD, FACS later point in conjunction with the cochlear implant. Malawi update: Claire Kendig, UNC MS4 returned to Such a combined stimulation has been demonstrated Malawi with Dr. Charles Mabedi and they will work to result in superior speech perception outcomes. on a project to better characterize Head & Neck Cancer at Kamuzu Central Hospital. Surprisingly, Thus, the current clinical practice of blind electrode head and neck squamous cell carcinoma in Malawi implantations may not be contemporary. Instead, appears to have a low rate of HPV involvement, Dr. Adunka together with Drs. Fitzpatrick and as demonstrated by low levels of p16 expression. Buchman, has established an animal model Immunohistochemistry for this study was performed simulating the effects of electrode insertion on at the KCH Pathology lab. Claire and Charles have cochlear health. This effort was first taken on in submitted 6 papers involving studies at KCH, 2006 and has since developed into a larger project. including study of the HIV infection rate in surgical First, the feasibility of recording acoustically evoked patients, surgical cancer care, incidence of cervical early auditory potentials had to be confirmed adenopathy and a review of head and neck cancers via normal hearing gerbils. Then, the presence of in sub-Saharan Africa. Claire has returned to these potentials had to be confirmed in animals UNC and plans to pursue a career in OB/GYN. with severe-to-profound sensorineural hearing loss. These projects were completed in 2007 Dan Olson’s paper Phase I clinical trial of valacyclovir and 2008. Subsequent studies utilized various and standard of care cyclophosphamide in children electrodes and different insertion scenarios. These with endemic Burkitt lymphoma in Malawi. Was demonstrated the potential applicability of real- published in the Clinical Lymphoma Myeloma and time feedback during the insertion process. Also, Leukemia. This is the first phase I cancer trial a microendoscope was introducted to confirm to be completed in Malawi. Dan is currently a findings from the electrophysiologic recordings. pediatric infectious disease fellow in Colorado. Histology was used to further strengthen these results. Experiments performed in 2009 and 2010 Gift Mulima KCH PGY4 and Javeria Qureshi UNC utilized soft cochlear implant electrodes that PGY4 have collected prospective data on 300 closely mimic clinically utilized human devices. patients with upper GI bleeds who present to KCH. The results of these experiments were encouraging Data analysis in ongoing and should be ready for and suggested that acoustically evoked early submission for publication by the end of 2013. auditory potentials will likely be able to be used during human cochlear implantation. Oliver F. Adunka, MD, FACS Experimental/Translational Projects Therefore, current efforts focus on detailing our knowledge base via further experiments in the Currently, electrode insertions during cochlear animal. More importantly, however, we have been implantation are performed as a blind procedure able to port our findings to the operating room. without real-time feedback to the surgeon. Specifically, recordings during human cochlear Consequently, many insertion parameters cannot 126 implantation have been started in 2011 and are the safety and effectiveness of this stimulation ongoing. The results so far are very exciting and paradigm and the UNC has just received approval essentially confirm our findings obtained from our for another 10 subjects for Arm 2 of the protocol. animal experiments. First, we have been able to Subjects implanted with this new system typically obtain meaningful measurements during human demonstrate substantial benefits especially cochlear implantation. Thus, despite the severe- with background noise. The ongoing animal

Research to-profound sensorineural hearing loss typically projects and translational research efforts (see present in both adult and pediatric cochlear implant above) also aim to optimize hearing preservation candidates, acoustically evoked potentials remained and electrode placement critical for EAS. very strong in this setting using an electrode close to or within Other clinical the cochlea. research Furthermore, endeavors these include potentials did various topics not correlate in pediatric well with and adult the patient’s cochlear audiogram implantation but instead such as correlated ongoing strongly with research on postoperative cochlear nerve speech deficiency and perception performance using the implant. auditory neuropathy in collaboration with Dr. Craig Thus, it appears that a very good measure of Buchman. Of note, UNC has identified and enrolled cochlear health has been identified; one that more subjects with absent or small cochlear nerves may be superior to conventional audiometry and than any other center worldwide. Correspondingly, other biographical markers. Currently ongoing Dr. Buchman has initiated an FDA approved clinical projects further investigate this relationship trial on pediatric auditory brainstem implantation. and explore potential clinical applications. Dr. Adunka’s has helped to develop diagnostic algorithms incorporating CT and MRI imaging as well Clinical Trials/Projects as certain audiometric data. This algorithm is the Dr. Adunka has helped to establish cochlear basis for selecting candidates for the clinical trial. implantation with hearing preservation at UNC. He Further analyses are ongoing especially evaluating is the principal investigator of the electric-acoustic the role of unilateral cochlear nerve deficiency. stimulation (EAS) clinical trial; a multi-center North American trial in which UNC performed the Over the past 5 years, Dr. Adunka has developed first surgeries (in 2007) and is leading enrollment a multi-client relational pediatric hearing loss with over 30 subjects. In an ongoing collaboration database. Data have been collected from the CCCDP, with MED-EL North America, UNC has completed the CASTLE, and the pediatric hearing aid group the first arm of the study and has also completed at UNC Hospitals. Currently, more than 2,800 initial enrollment of the second arm, which includes pediatric patients with all types and severities subjects with greater levels of residual hearing. of hearing loss and assistive devices have been Preliminary results have been able to demonstrate entered. This includes more than 900 children 127 with cochlear implants. Also, this database has would benefit from simultaneous sinus mucosal been integrated into the clinical algorithm and transplantation, with decreased sinonasal symptoms

data entry and various analyses have become and disease postoperatively. It is our hope that Research part of the clinical routine and quality control. this model will help to demonstrate the feasibility of sinus mucosal transplantation as a potential During his research efforts, Dr. Adunka has treatment of chronic rhinosinusitis (CRS) in CF. mentored medical students including Mathieu Forgues MS IV, who has now completed a full Another new area of research in pediatric rhinology year of research and is currently applying for is our effort to decrease the amount of radiation otolaryngology residency. During this year, Matt exposure from repeated CT scans in children has been extremely productive helping mainly followed for chronic and recurrent sinonasal disease. with animal experiments detailed above. Current While CT-image guidance in the operating room is students in the lab are Eric Formeister MS III, Joe an important tool in the safe surgical treatment of Mcclellan MS III, and William Merwin MS III. such children, it may be that the number of such scans can be reduced in certain young patients Other Research requiring revision sinus procedures for conditions such as CRS, cystic fibrosis and allergic fungal Dr. Adunka has been named the director of the NC Eyebank Surgical Skills Laboratory. This new lab space is a collaborative effort between Ophthalmology, Neurosurgery, and Otolaryngology/ Head & Neck Surgery and features 16 surgical simulation stations to practice open, endoscopic, and microscopic procedures. This space also includes a histology lab to process various specimens including non-decalcified bones. Currently, the histology portion of the lab is being installed. Planned projects include the collaborative development of next generation cochlear implant electrodes and the assessment of various insertion parameters on cochlear morphology.

Austin S. Rose, MD sinusitis. Dr. Rose has partnered with the Brainlab corporation to study the accuracy of older scans in Dr. Rose has several ongoing clinical and basic children undergoing additional surgery, based on science research projects, primarily in the their age, size and time elapsed from the original CT areas of sinonasal disease in children and new scan. The hope is to produce data that might inform technologies in ENT. In the past year he, along future recommendations and guidelines in the area with Dr. Douglas Fitzpatrick, PhD and Andrew of CT imaging of the paranasal sinuses in children. Wyker from North Carolina State University, have collaborated to develop an animal model for Lastly, Dr. Rose and his colleagues in the Division sinus mucosal transplantation. In cases of severe of Rhinology, Allergy and Sinus Surgery continue pulmonary disease such as cystic fibrosis (CF), an ongoing effort to evaluate the potential benefits certain patients may undergo lung transplantation, of balloon catheter sinuplasty in children. Though though generally still suffer from significant controversy exists regarding its usefulness in CRS sinonasal disease. It may be that certain patients in general, and for pediatric patients in particular, 128 some initial studies have suggested the potential the core of Dr. Buckmire’s ongoing Triological thesis for symptomatic improvement both when used project. alone or in conjunction with adenoidectomy. Other current research studies are investigating Ostium of the maxillary sinus in a child relative swallowing outcomes of laser and following balloon catheter sinuplasty. stapler assisted diverticulotomy as well as open

Research diverticulectomy for the treatment of Zenkers Robert A. Buckmire, MD diverticulum. Other work investigates the medium Dr. Buckmire has several ongoing clinical and and long-term voice outcomes for patients research projects involving voice and swallowing. The undergoing goretex medialization thryroplasty for Voice center currently partners with both academic non-paralytic glottis incompetence. This work was departments and local industry on research projects. recently published in the July 2013 edition of the In a collaborative effort with the Department Laryngoscope entitled: “Multidimensional voice of Biomedical Engineering (UNC/NC State), Joe outcomes after type I gore-tex thyroplasty in patients Giallo II, was granted a Doctor of Philosophy with nonparalytic glottic incompetence: a subgroup degree in November 2008 for a project and thesis analysis.” entitled: “A Medical Robotic System for Laser Projects determining the role for quantitative Phonomicrosurgery.” The resultant novel laser control laryngeal electromyography (LEMG) and its role device became the subject of Dr. Yu-Tung Wong’s in laryngeal reinnervation patients continue being resident research. This work was published in the conducted by Dr. Robert Buckmire and Dr. James Laryngoscope journal in 2011, entitled: “Novel CO(2) Howard, who staffs the LEMG clinic, as a joint effort laser robotic controller outperforms experienced between the Department of Neurology and the laser operators in tasks of accuracy and performance Department of Otolaryngology. repeatability.” This project has established the superiority of the robotic controller in laser guidance Holly FB Teagle, AuD accuracy and repeatability over expert human As CCCDP Director, Holly FB Teagle, AuD collaborates with other faculty and staff on clinical research projects related to outcomes related to pediatric cochlear implantation. She is the primary investigator for an NIH-funded study called Childhood Development after Cochlear Implantation (CDaCI) and works closely with Jennifer Woodard, AuD and Hannah Eskridge, MSP, to collect data for this long term multi-center study. Cochlear implantation provides deaf children with access to sound, which is the first step in overcoming significant delays in receptive and expressive language development and the resultant cognitive laser operators. The operative accuracy and depth and academic deficits. Psycho-social aspects of child consistency of the device has now been rigorously development, including parent-child interactions and compared to the performance of the industry social development are also strongly influenced by standard micromanipulator in a simulated operative significant hearing loss. The effects of deafness and environment, guided by surgeons of varying the subsequent acquisition of sound through cochlear experience. These data are quite intriguing and form implantation on the whole child has been the focus 129 of this multicenter study in which has been renewed Shuman He, PhD for a third five year term. Drs. Pillsbury, Buchman, Dr. He is conducting several research projects

and Zdanski are the surgeons for the project. focusing on objective measures in hearing impaired Research children. The long-term goal of these projects is to Collaboration with Hannah Eskridge and other develop objective tools that can be used in clinical CASTLE staff to develop the Reaching Educators settings to select appropriate candidates, to assess to Access best practice for Children with Hearing the impact, and to assist with the programming loss (REACH) has been ongoing in the past year. process of cochlear implantation in patients who are Distance video-conferencing technology has been unable to reliably participate in behavioral tasks. purchased and is being used to connect with therapists who work with children with hearing In one program of research, Dr. He, together with loss around the state in a mentoring and training Dr. Buchman and Dr. Grose, are assessing the utility mission. Research to identify the effectiveness and of objective measures to select early – and optimal efficiency of this form of tele-practice could guide – intervention for individual patients with auditory future development and use of this technology. neuropathy spectrum disorder (ANSD). In one project, we are investigating the feasibility of using Other research projects underway at the CCCDP the cortical auditory evoked potential to estimate include ongoing study of the benefits of cochlear hearing thresholds in ANSD children. In the second implantation in special populations of children, project, we are evaluating the association between such as those with Auditory Neuropathy acoustically/electrically evoked cortical event-related Spectrum Disorder and children with Cochlear potentials and speech perception performance in Malformations. Collaboration with Dr. Buchman ANSD children who use hearing aids or cochlear and Dr. Shuman He to examine speech perception implants. In the third project, we are investigating and electrophysiological results in these special the possibility of using objective measures to assess populations has been very productive. A feasibility the degree to which neural synchronization can be study is currently underway with children who do restored by electrical stimulation in ANSD patients. not benefit from cochlear implantation and may In the fourth project, we are exploring the feasibility be candidates for Auditory Brainstem Implants of using the electrically evoked cortical event-related (ABI). This is an exciting opportunity to extend potentials to program and estimate benefits of the the benefits of technology to a patient population auditory brainstem implant in children with ANSD. that has had limited remedial options in the past. We also continue to collect clinical outcome Dr. He is also investigating the feasibility of using results for children who have undergone cochlear the binaural interaction component (BIC) of the implant revision surgery, children who are using electrically evoked cortical event-related potential bimodal technology: a hearing aid in one ear and to 1) assist in programming bilateral CIs; 2) evaluate a cochlear implant in the other, and children who the benefits of bilateral cochlear implantation; and have bilateral cochlear implants. New cochlear 3) assess effects of bilateral cochlear implantation implant technology becomes available on a regular on binaural hearing. Results of this project could basis from the 3 manufacturers. Because of our potentially improve the way candidates for large and diverse patient population and our bilateral implantation is selected in the future. depth of experience, the CCCDP is often asked to participate in clinical trials with all three cochlear Emily Buss, PhD implant manufacturers to evaluate new cochlear Dr. Buss is an auditory researcher involved in a implant system features, evaluation materials, wide range of projects investigating the perception or participate in post-market approval studies. of sound in human listeners. Many of these 130 projects are clinically focused, including adults and psychoacoustic methods are being constructed children with sensorineural hearing loss; some of for differentiating between the effects of hearing these listeners make use of hearing aids or cochlear impairment and more central auditory processing implants. Other projects focus on normal-hearing limitations, and for evaluating listening effort under adults and children, with the goal of constructing complex listening conditions. It is anticipated normative models of auditory processing and that the results of this work will advance our

Research development. Experimental methods used in basic understanding of the role of auditory cue these studies include traditional psychophysical redundancy in speech perception and guide the paradigms based on behavioral responses, such as development of clinical tools for better diagnosis the detection or discrimination of simple sounds, and treatment of hearing impairment. Recent as well as masked speech recognition. In many collaborations with Dr. Lauren Callandruccio, in the cases the resulting data can be incorporated into Division of Speech and Hearing, have expanded the computer-based models that formally characterize scope of this project to include adult non-native different stages of auditory processing. These models speakers of English. Understanding the perception address an important gap in the existing knowledge of English test materials in this group is of both base and could be used to improve the delivery basic science and clinical significance, as more of acoustic signals and/or electric stimulation. non-native speakers are projected to required audiological services in the coming decades. Dr. Buss is currently working on a research initiative sponsored by the National Institutes Dr. Buss has considerable expertise and a long- of Health aimed at understanding effects of standing interest in the normal development of level fluctuation on the encoding of spectral hearing. Recently this interest has focused on cues, such as the spectral cues underlying good establishing a model of the development of auditory speech perception. Level fluctuation can have a processing based on internal noise. A primary marked effect on auditory processing, degrading goal of this work is to provide a uniform metric sensitivity in some conditions and improving it for comparing performance across a wide range of in others. The overarching goal of this work is to auditory tasks in school-aged children. Another goal identify and characterize the auditory processes is to identify the mechanisms responsible for reduced that limit detection and spectral discrimination auditory sensitivity in these tasks. Collaboration of stimuli that vary in level for normal-hearing, with Dr. Lori Leibold, in the Division of Speech hearing-impaired, and cochlear-implanted listeners. and Hearing, focuses on better understanding Parallel experiments in psychoacoustics and speech susceptibility to and release from masking in infancy perception paradigms are expected to result in a and childhood as well as the consequences of greater understanding of basic auditory processes. sensorineural hearing loss on auditory development. Results of this work could have implications for the clinical evaluation of speech perception. In addition to this laboratory work, Dr. Buss maintains an ongoing involvement in a number Another project examines the importance of highly of clinically based cochlear implant and hearing redundant temporal cues in speech understanding, aid investigations, for which she provides support particularly when the signal is highly masked or in experimental design and analysis. One such degraded. This work is relevant to public health project evaluates performance of hearing-impaired in that it provides a theoretical framework for children fitted with frequency compression understanding how hearing loss and limited language hearing aids. This project relies on collaboration experience impact speech perception, particularly with colleagues in UNC’s Division of Speech and in complex background maskers. To that end, Hearing, the Department of Otolaryngology, and the 131 CCCDP. Another project, carried out in conjunction airflow, resistance, heat exchange, and spray with Dr. Craig Buchman and Dr. Margaret Dillon, particle deposition. They are currently using CFD

examines the ability of patients with conductive models to study objective ways to measure and Research or mixed hearing loss to benefit from a bone predict improvements in patients’ symptoms after conduction hearing aid. These clinically focused surgery to treat nasal airway obstruction, chronic projects represent an important step in applying rhinosinusitis, and craniofacial cancers, to gain a basic-science research to real-world problems. quantitative understanding of intervention effects on children being treated for airway collapse and Julia S. Kimbell, PhD cystic fibrosis, and to study the delivery of nebulized Dr. Kimbell is a Research Associate Professor. She and sprayed medication in the nasal passages of is an applied mathematician, currently conducting patients being treated for chronic rhinosinusitis. research on applications of computational fluid dynamics (CFD) to studies of nasal airflow, gas Dr. Kimbell is currently funded to conduct research uptake, and particle deposition. This research using nasal CFD models to (1) study possible focuses mainly associations of on medicine and patient-reported therapeutics symptoms with in which CFD specific variables models are used computed from to predict surgical three-dimensional effects on nasal CFD models of function as well the patients’ nasal as more effective passages based ways of delivering on CT scans taken topical nasal both before and medications. Dr. after surgery, Kimbell also uses and the effects CFD models of the nasal passages of laboratory of surgery on the distribution of nasal sprays inside animals to test hypotheses about the role of dose the nasal cavity (NIH/NIBIB via Medical College of in respiratory tract responses to inhaled materials, Wisconsin, PI: Dr. John Rhee), (2) gain a quantitative and to support risk assessments in which animal understanding of intervention effects on children responses are extrapolated to humans on the being treated for airway collapse (NIH/NHLBI, PIs: basis of dose predictions in the respiratory tract. Drs. Stephanie Davis, Rich Superfine, and Carlton Zdanski, and NIH/NHLBI via University of California In her research, Dr. Kimbell uses CT or MRI scans at Irvine, PI: Dr. Brian Wong), and (3) examine or cross-sectional images of tissue specimens to the role of viral infections in the pathogenesis build three-dimensional, anatomically-accurate of infant cystic fibrosis using information from CFD models of the nasal passages of laboratory bronchoalveolar lavage combined with computerized mice, rats, primates, and humans. Dr. Kimbell and x-ray tomographic (CT) imaging, infant pulmonary her collaborators have recently completed studies function measurements, and airway and vascular using these models on respiratory tract uptake of modeling techniques (NIH/NHLBI via Indiana several fragrance compounds in rats and humans University, PI: Dr. Stephanie Davis). Dr. Kimbell and ozone in infant primates. They also recently also collaborates with Dr. Brent Senior, Dr. Adam used human CFD models to predict how surgical Zanation, Dr. Charles Ebert, Dr. Kibwei McKinney, changes to address nasal obstruction affect nasal and Dr. Gita Madan on CFD modeling of sinus 132 surgery effects on nasal airflow and topical drug colored Carolina Blue. The design and installation delivery, Dr. Lauren Fedore and Dr. Zanation on CFD of the arc was led by Drs. Hall, Grose and Buss. modeling of airflow and heat and humiditiy exchange in craniofacial resection patients, and Dr. William The UNC cochlear implant research team is continuing Shockley, Dr. Scott Shadfar, and Dr. Anand Dugar to participate in two multi-center FDA controlled on CFD modeling of rhinoplasty effects on nasal clinical trials: Electric-Acoustic Stimulation (EAS) of

Research airflow. Dr. Kimbell also works with her postdoctoral the auditory system and utilization of the Vibrant fellow, Dr. Dennis Frank, PhD along with Dr. Rhee Soundbridge (VSB) for conductive and mixed hearing and other colleagues at Medical College of Wisconsin losses. UNC continues to lead the US in enrollment on the simulation of airflow, heat and water vapor for both clinical trials, and investigators have given transport, and nasal spray distribution in normal multiple presentations on our team’s findings at and diseased nasal passages. The department’s state, national and international meetings. Otolaryngology/Head and Neck Surgery Computing and Clinical Research Lab, run by Drs. Kimbell and This year UNC reached maximum enrollment for the Zanation, provides a resource for conducting this VSB clinical trial. The VSB converts the acoustic signal research as well as increasing departmental access into controlled, amplified oscillations which are then to high-performance computer workstations and software to create and run computer simulations in 3D models created from imaging data.

Margaret Dillon, AuD Dr. Dillon is a clinical research audiologist on the adult cochlear implant team. She conducts projects evaluating cochlear implant signal processing outcomes, middle ear implantation, hearing preservation, and the programming and associated outcomes of combined electric and acoustic stimulation.

This year a localization array was installed in the delivered to the cochlea. Currently, the device is clinical research lab at Carolina Crossing. This was approved in the US for patients with sensorineural made possible by the generous contributions from hearing loss. The VSB clinical trial investigates the HEARRING, an international network of hearing safety and efficacy of placement of the Floating centers that facilitates research. The 11-speaker arc Mass Transducer (FMT) on the round window in opens up a wide range of future research projects patients with conductive and mixed hearing loss who on speech perception in spatially separated noise are unsuccessful users of traditional amplification. and localization abilities of patients listening with We are continuing to evaluate postoperative various implantable hearing technologies. The objective and subjective benefits in this cohort. knowledge gained in the course of these experiments will provide researchers and clinicians with a EAS utilizes a relatively short, flexible electrode array greater understanding of the abilities of patients designed to preserve residual hearing during cochlear with hearing loss in realistic environments, and implantation in patients with substantial low-to- will give us powerful tools for evaluating patient mid-frequency hearing remnants. In an ipsilateral performance. Further, the arc itself is a re-purposed listening condition, the high-frequency information trampoline supporting a green initiative while still is presented via electrical stimulation, while the 133 low-frequency input is delivered by a hearing listeners with cochlear hearing loss and elderly aid. Since enrollment initiated in 2007, over 32 listeners with normal hearing. In addition, she has

subjects have participated in the clinical trial at been working with Drs. Joe Hall and Emily Buss Research our center. Drs. Pillsbury, Buchman, and Adunka on studies of auditory development in children. continue to receive referrals from centers in North Carolina and across the country. Additionally, our Recently, Dr. Porter was awarded a grant from the team is completing further testing in this patient National Organization for Hearing Research to population after 12 months of listening experience establish an objective technique to characterize with the external speech processor. The goal auditory temporal processing abilities in of this single-site test protocol is to document children. The goal of this project is to develop an the influence of preserved ipsilateral residual electrophysiological analog of the psychophysical hearing on speech perception and localization test known as the masking period pattern (MPP). abilities, with additional consideration of benefits This test assesses sensitivity to a signal as a conferred by the use of a contralateral hearing aid function of its temporal position within a fluctuating in patients with contralateral residual hearing. masker. Dr. Porter will measure cortical potentials evoked by the signal as a means of objectively Collaborations with the clinical audiology team gauging how robustly the signal is represented (Drs. Clark Adunka, King, and Pearce) include in the auditory neural pathway. The long-term studies investigating signal coding strategies, objective of this research is to identify factors programming of combined electric and acoustic responsible for apparent immaturities in the stimulation, and the influence of different speech auditory temporal behaviors of children, evidence processor configurations. The aims of these projects that is essential for differentiating between the are to gain a better understanding of speech sensory coding of auditory information vs. age- perception outcomes associated with specific dependent changes at higher levels of auditory signal coding strategies and mapping parameters, processing (e.g., signal detection strategies). and to determine the best programming methods in patients who make use of hearing aids. John H. Grose, PhD Dr. Grose continues his investigations into age- Ongoing collaborations with senior researchers (Drs. related changes in hearing. A highlight of this year Buss, Grose, and Hall) include speech perception has been the successful renewal of his NIH-funded in spatially separated noise and localization R01 award focused on this issue. The investigations abilities of subjects with various implantable will move into several new areas: (1) psychophysical technologies, the effect of providing fine-structure and electrophysiological studies designed to probe cues via a cochlear implant, and telephone use whether neural loss in the presence of a relatively of cochlear implant recipients. These projects will uncompromised cochlea accounts for some of the allow for a greater understanding of the abilities hearing difficulties experienced by older listeners of cochlear implant recipients beyond what is with ‘normal’ audiograms; (2) speech studies currently assessed with the clinical test battery. designed to determine how aging affects the ability of listeners to piece together snippets of speech Heather Porter, AuD, PhD that ‘pop out’ in a fluctuating noise background; Dr. Porter is the Research Audiologist in the Hearing and (3) studies of the auditory brainstem Research Lab, and she contributes a clinical response that are evoked by complex sounds. perspective to the on-going research projects. Her primary role has been to work with Dr. John Grose The past year has also seen the completion of on studies examining temporal processing in adult other on-going experiments. A study looking at the 134 association between two auditory processes that rely funded by the National Institute of Deafness on the comparison of stimulus envelopes distributed and other Communication Disorders. across frequency was recently published in the Development and Plasticity in Journal of the Acoustical Society of America. An Normal and Impaired Hearing extension of this work is now looking at how cochlear hearing loss affects this association. Dr. Heather NIH awarded a new five-year extension of this

Research Porter – a member of the lab team – presented the grant this past year. One of the sub-projects in this current findings at the Acoustical Society Meeting grant is investigating the ability of children to hear in Montreal in June, 2013. Dr. Sara Mamo, currently complex signals like speech in background noise. undertaking her Ph.D. work in the lab, has also The sub-project was developed, in part, to begin to been studying age-related effects on auditory better understand why hearing-impaired children processing using a combination of psychophysical have particular trouble understanding speech when and electrophysiological approaches. In addition to background noise is present. This sub-project will presenting her work at the Montreal meeting, she also provide us with a better idea of how normally- was the invited speaker at the Speech and Hearing hearing children piece together fragments of speech Colloquium series that arise above the at Dalhousie level of background University, Halifax. noise, and also how the normal Dr. Grose’s other auditory system line of funded develops over time. research involves a research A second sub- collaboration with project in this grant the Universidade will explore the Federal de development of Pernambuco hearing in children (UFPE: Federal who have unilateral University of conductive hearing Pernambuco) in Recife, Brazil. In May, he was loss. In this type of hearing loss, one ear has normal able to spend a week there setting up equipment hearing, but the other ear has significantly reduced and protocols to run experiments in parallel with hearing due to a failure of sound to be efficiently studies in his lab at UNC. Two doctoral students at transmitted from the air to the inner ear. This UFPE are involved in data collection, and a number sub-project will not only tell more about hearing of interesting findings related to the Brazilian loss, but will also provide new information about Portuguese version of the Hearing In Noise Test how the development of auditory perception is have emerged. One of the colleagues there, Dr. affected by the patterns of sound reaching the ear. Silvana Griz, spent a few months in Dr. Grose’s A third sub-project in this grant will further explore lab as a Fulbright Scholar. Plans are underway how hearing loss may affect the development of for the other colleague, Dr. Denise Menezes, to hearing. Part of the rationale for this sub-project spend her sabbatical at UNC in the coming year. is related to the idea that the brain may be able to Joseph W. Hall, PhD develop very efficient ways to process the reduced or partial information it receives from an impaired Dr. Hall is presently the principal investigator ear. Even though the auditory information received on two R01 NIH research grants, both 135 by the central auditory system is impoverished due to frequency selectivity might provide to a hearing- the hearing loss, the brain may be able to develop the impaired listener in simple temporal processing means to “get the most” out of the abnormal signal it paradigms may be matched by the advantage Research is presented with. If this is true, then normal-hearing available to a normal-hearing listener due to listeners presented with sounds that simulate the the combination of information across multiple, impoverished signal perceived by a hearing-impaired peripheral auditory filters. The hypothesis we are listener may actually perform more poorly than the investigating is that hearing-impaired listeners will hearing-impaired listener. This will be investigated in show temporal processing that is better than normal children with conductive hearing losses and in adults under conditions where it is more advantageous to and children with sensori-neural hearing losses. base performance on the output of a single, broad auditory filter than to combine information across Spectro-temporal Processing in multiple, narrow auditory filters. The information Normal and Impaired Ears obtained should result in a better understanding One of the subprojects in this NIH NIDCD grant of the factors that govern the perception of is examining the sensitivity of listeners to across- complex sounds in hearing-impaired patients. frequency coherence of temporal envelope. A novel feature of the study is that it uses noise bandwidths A third study in this project is investigating the that are considerably wider than the width of the ability of listeners to integrate speech information normal auditory filter. Therefore, in order to perform across frequency and time. Results indicate that well on the task, the listener would have to be able this ability can be quite robust in people with to “reconstruct” the stimulus temporal envelope by normal hearing. However, patients with hearing loss combining the outputs of multiple peripheral auditory may be relatively poor at this kind of integration, filters. A related possibility is that listeners perform perhaps limiting their ability to hearing well in noisy many narrowband analyses of the information and backgrounds. One thread of this research, led by then combine the cues extracted from the analysis. PhD student Erol Ozmeral, is investigating whether there may be ways of reducing the disadvantage A second study in this project is examining whether experienced by patients with hearing loss. sensorineural hearing loss can sometimes facilitate the encoding of some temporal auditory cues. A D. Neil Hayes, MD, MPH classic notion is that hearing-impaired listeners Dr. Hayes of the Division of Hematology and may be able to benefit from improved temporal Oncology, Department of Medicine, was given envelope detail at the outputs of relatively wide a joint appointment with the Department of auditory filters. However, most studies on temporal Otolaryngology/Head and Neck Surgery in 2009. processing have shown either similar performance He has been collaborating with our head and between normal and impaired ears, or slightly neck oncologists on projects for many years. poorer performance by hearing-impaired listeners. One important reason that could account for the The Hayes Lab endeavors to bring together a general failure to find better temporal processing collection of researchers with intersecting interests in impaired listeners with poor frequency in multidisciplinary clinical cancer care, clinical trials, selectivity than in normal-hearing listeners with translational cancer research, and model systems good frequency selectivity is that normal-hearing of cancer with a focus on aerodigestive tumors. listeners appear to be very adept at combining Clinical Practice and Clinical Trials information across multiple, relatively narrow In the clinic we provide multidisciplinary care across auditory filters. Thus any advantage that reduced a spectrum of aerodigestive tumors. Our primary 136 focus is on lung tumors and epithelial tumors of Our lab is intimately connected with the practice the head and neck (mouth, throat, larynx, sinuses, of clinical medicine, and as such, our interest is and salivary glands). All patient care is delivered not simply the detection of alterations such as by a full services tertiary and quaternary care those described above. All alterations are placed facility with rich compliment of oncology care. in their clinical context, including the frequency In this context, we have endeavored to develop of the event and any relevant association with

Research a palate of clinical trials serving the spectrum cancer outcome. To accomplish these goals, our of disease we treat, including focused trials lab works equally hard to capture both clinical and appropriate to every patient stage and function. molecular data for any samples we evaluate. The The breadth and depth of our practice leads us to hypothesis of our research is that tumor-specific an expertise in rare tumors of the head, neck, and predictors based on high throughput nucleic acid lung as well, and the treatment of these tumors. and protein assays will offer significant advances.

Translational cancer research Early work by Dr. Hayes, performed in collaboration and model systems with his mentor Dr. Matthew Meyerson, included Progress in two key areas of science has provided a meta-analysis of approximately 500 human the foundation for the work in our group. First, the lung adenocarcinoma expression arrays generated advent of personal computers along with associated by the National Cancer Institute’s Director’s progress in the field of statistical computing greatly Challenge Program. We successfully reconciled accelerated the development of data-rich models discordant previous reports by demonstrating of human disease behavior. Second, collaborative three reproducible molecular tumor subtypes efforts across the biomedical science have made of lung adenocarcinoma that are otherwise available the building blocks of normal (i. e. The indistinguishable by routine clinical evaluation. Human Genome Project) and adherent genomes The subtypes have statistically significant survival (i. e. The Cancer Genome Atlas). To leverage the differences, independent of disease stage and are power of computers to assess alterations in the comprised of tumors with differing underlying rates genome associated with cancer a host of molecular of mutations in key lung cancer genes including technologies has become commercially available in KRAS and EGFR. Similar reports for squamous recent years. The primary targets of these assays cell carcinoma of the lung are forthcoming, as are have been nucleic acids (DNA and RNA), although a reports of clinically applicable diagnostic tests. limited number of protein assays are also included. More recently, in collaboration with Kwok Wong and The technologies allow labs such as ours to make Ned Sharpless we have documented the frequent broad and inclusive measurements in samples of mutation of the gene STK11/LKB1 in human lung alterations in gene expression (RNA), gene dosage cancers, including squamous cell carcinoma. (DNA amplification and deletions), gene structure Numerous follow up reports of the clinical (normal population variants, mutations, alternate importance of these findings are forthcoming. splices, fusion genes, epigenetic modifications), Statistical Collaborations protein abundance and other events such as Data analysis of the type we routinely perform presence of a pathogen. Primary technologies in requires a strong set of statistical collaborators use in our lab include array based approaches (gene since standard methods are frequently lacking. In expression arrays, methylation profiling, SNP chips, this way, we have been fortunate to build ties with CGH, miRNA arrays), sequencing (targeted and deep numerous local and national statisticians, computer sequencing/NextGen), and immunohistochemistry scientists, biostatisticians, and epidemiologists. (including tissue microarrays). 137 Research

Grace Kim Austin, MD airflow patterns, resistance, air conditioning, Dr. Austin has been active in clinical and deposition of inhaled gases, and particle transport translational research projects in Otolaryngology/ (topical drug delivery) using computational fluid Head and Neck Surgery. Supported by the dynamics (CFD). In collaboration with some NIH T32 training research grant, NIH Loan of the clinical faculty (Drs. Senior, Ebert and Repayment Program, and the UNC Lineberger Zanation), medical residents (Drs. McKinney Comprehensive Cancer Center Clinical/Translational and Fleischman) and medical students in the Developmental Research Award, she has been department, and at Medical College of Wisconsin, able to study tumor biology and mechanisms Milwaukee, WI (Drs. Rhee, Garcia, Cannon and of tumor escape in head and neck cancer. Pawar), Dr. Frank has published a number of peer- reviewed papers in clinical (Rhinology) journals. Her main project, “The Role of Myeloid-Derived Suppressor Cells in Head and Neck Cancer,” is In a recently published study by our computational near completion with over 120 patients enrolled. and clinical research group, CFD was used to This research investigates the role of myeloid- quantify the effects of functional endoscopic derived suppressor cells in immune suppression sinus surgery on airflow entering the maxillary or tumor progression in the setting of squamous sinuses in patients with chronic rhinosinusitis as cell carcinoma of the head and neck. Preliminary well as compared flow into the maxillary sinuses findings have been presented at the 2013 American with patient-reported outcome measures. Other Society of Clinical Oncology conference. projects have focused on investigating the effects of nasal anatomic deformity, aerosolized particle In addition to translational research studies, Dr. size, and delivery device on topical medication; Austin remains active in clinical research projects modeling changes in nasal physiology due to ranging from transoral robotic surgery applications locations of septal perforation; evaluating whether in the skull base to different reconstructive computational models based on pre-operative options for head and neck defects. To date, she computed tomography scans are predictive of has published 10 refereed manuscripts and has post-surgery nasal physiology; identify CFD made numerous oral and poster presentations derived variables that have the ability to detect on local and national levels. Dr. Austin is surgical changes and predict patient-reported highly motivated to continue her research symptom relief for nasal airway obstruction projects and pursue an academic career. surgeries such as correction of septal deviation.

Dennis Frank, PhD Dr. Frank will continue his research in CFD modeling Dr. Frank was a postdoctoral fellow under the of the human airway as a research faculty in mentorship of Dr. Julia Kimbell. His translational the Division of Otolaryngology/Head and Neck research involved modeling the effects of nasal Surgery at Duke University Medical Center. He will anatomy and sinonasal conditions on respiratory continue to collaborate with Dr. Kimbell and the department’s Rhinology clinical faculty members. UNC School of Medicine By Stephanie Crayton, MS Media Relations/Broadcast Manager, UNC Health Care Receives Gift

The University of North Carolina School of Medi- laboratory is dedicated to the thousands of The lab also houses three full body surgical cine received a $1 million gift from The North Car- North Carolinians who unselfishly provided the stations and 16 cadaveric head or skull surgical olina Eye Bank (NCEB) to establish a unique and gift of sight that others may see again. We are stations that will allow didactic, simulation and innovative multidisciplinary surgical skills lab. proud to partner with The University of North cadaveric based surgical education in eye, ear

The gift to the Department of Ophthalmol- Carolina School of Medicine in this endeavor,” and neurosurgery. “This (gift) is a transforma- ogy will be shared among three neurosciences said Dean Vavra, MS, CEBT, Executive Direc- tive investment in the training of ophthalmolo- departments: Ophthalmology, Neurosurgery, and tor of The North Carolina Eye Bank, Inc. gists, neurosurgeons, and ENT surgeons,” said Otolaryngology/Head and Neck Surgery. The The multidisciplinary surgical skills and biomet- Matthew Ewend, MD, Van L. Weatherspoon, Jr. newly created laboratory, the only of its kind rics laboratory, located on the UNC campus, Eminent Distinguished Professor and Chair of in the region, provides state-of-the-art surgical occupies 3,500 square feet with 19 stations; a the UNC Department of Neurosurgery. “Pa- training opportunities to medical students, resi- 50-person conference room; and an 800-square tients can expect that the physicians of North dents, fellows and physicians across the state. foot simulation lab with access to high fidelity Carolina who take advantage of this training lab will be armed with the best and newest “Training future generations of eye surgeons simulators such as robotic stations and ana- techniques. Surgeons-in-training can expect to to serve the people of North Carolina is one tomic computer based simulators. The simula- practice and master their crafts in the lab prior of our top priorities at UNC Eye,” said Don- tors allow controlled proctoring and progres- to entering the operating room. This lab is the ald L. Budenz, MD, MPH, Professor and Chair sive educational scoring of surgical skills. future of ophthalmologic and surgical training.” of Ophthalmology. “The new surgical training “The extremely generous gift from the North center will greatly enhance our educational Carolina Eye Bank to fund the laboratory is a The entire facility is wired for telecommu- mission by providing our residents with a state huge shot in the arm for the UNC Health Care nications with both high definition video of the art facility where they can practice System,” said Harold C. Pillsbury III, MD, Thomas and audio, operative microscopes, powered and learn from our world-class surgeons.” J. Dark Distinguished Professor and Chair of the instrumentation, operating rooms and distance education and web-based sources. This On January 16, 2013, chairs of the departments Department of Otolaryngology/Head and Neck telecommunication will provide both distance officially opened The North Carolina Eye Bank Surgery. “The opportunity to educate residents, based and surgical simulation based learn- Multidisciplinary Surgical Skills Laboratory faculty, and community physicians in this facility ing to medical students, residents, fellows at UNC with a ribbon-cutting ceremony. “This will create a state of the art opportunity for all students and physicians in North Carolina.” and current physicians of North Carolina.

NOW OPEN: UNC Health Care Dean, William Roper, MD; UNC Ophthalmology Chair, Donald Budenz, MD; UNC Neurosurgery Chair, Matthew Ewend, MD; UNC Otolaryngology Chair, Harold Pillsbury, MD; UNC Ophthalmology Associate Professor, Craig Fowler, MD; NC Eye Bank Board Chairman, Bailey Liipfert, JD; and NC Eye Bank Executive Director, Dean Vavra, MS, CEBT. Presentations & Publications 140

consequences of electrode insertion in to a Buchman CA. Comprehensive Assessment and Presentations gerbil model of cochlear implantation featuring Management of Congenital Hearing Loss: An noise induced hearing loss. 146th Annual Otologist’s Perspective. CCCDP & NC AG Bell Adunka OF. Active middle ear implants. South Meeting of the American Otological Society, Annual Fall Conference, Asheboro, NC, Nov 8, Carolina & North Carolina Otolaryngology, Head Orlando, FL, April 13, 2013. 2012. & Neck Surgery Assembly, Asheville, NC, August 3-5, 2012. Roche J, Adunka OA, Pillsbury HC, Buchman CA. Buchman CA, Dillon M, Clark-Adunka MS, King The cost of cholesteatoma care at a tertiary E, Pillsbury HC, Adunka OF. Electroacoustic Coehlo D (Moderator), Babu S, Buchman medical center. 146th Annual Meeting of the Stimulation: Results of the US Clinical Trial at CA, Kesser B, Papsin B, Roland JT. Hearing American Otological Society, Orlando, FL, April UNC. Hearing Preservation Workshop. Toronto, 2013: Expanded Technology, Expanded 13, 2013. CA October 20, 2012.

Presentations Criteria. Accepted for presentation at the Annual Meeting of the American Academy Beatty CW (Moderator), Balkany TJ, Buchman Adunka OF, Buchman CA, Fitzpatrick D. of Otolaryngology-Head and Neck Surgery, CA, Gantz B, Roland P. “Cochlear Implants--- Montioring electrode insertion properties during Vancouver, CA, Sept 2013. Which Device?Triological Society’s 116th Annual cochlear implantation. Hearing Preservation Meeting, Orlando, FL April 12, 2013. Workshop. Toronto, CA October 20, 2012. He S, Grose JH, Teagle HFB, Buchman CA. Temporal Response Properties of the Auditory Verrilli DM, He S, Teagle HFB, Roush P, Buchman CA. Kent Wilson Lecture: Failed Nerve in Children with Auditory Neuropathy Grose JH, Buchman CA. Objective Threshold newborn hearing screening: What’s Next. Spectrum Disorder. Conference on Implantable Determination in Children with Auditory Pediatric Grand Rounds: Children Hospital of Auditory Prostheses (CIAP) 2013, Lake Tahoe, Neuropathy Spectrum Disorder. 40th Annual Minnesota, St. Paul, MN, Oct 11, 2012. CA, July 14-19, 2013. AAS Scientific and Technology Conference of the American Auditory Society, Scottsdale, AZ, Buchman CA. Failed newborn hearing screening: March 7-9, 2013. What’s Next. Pediatric Grand Rounds: Presbyterian Hospital, Charlotte, NC, Sept 27, Buchman CA. 2012. Emerging trends in implantable auditory Driscoll CLW (moderator), Buchman CA, devices. Semana de Gifford R, Lustig LR. Panel: Preserving Residual Otologia, Bogota, Hearing with Conventional Cochlear Implants: Colombia, Mar 11, Technique and Implications. American 2013. Neurotology Society Fall Scientific Program. Washington DC, Sept 8, 2012. Buchman CA. Chronic Ear Surgery: Are we Hang AV, He S, Buchman CA. Extra-tympanic doing it all wrong? electrocochleography in auditory neuropathy Semana de Otologia, spectrum disorder. Poster presentation at the Bogota, Colombia, Annual Meeting of the American Academy of Mar 11, 2013. Otolarngology-Head and Neck Surgery, Sept 2012. Buchman CA, Lin J, Uhler K, Calandruccio, L, Gomez, B, Buss, E, and Leibold, Yoshinago-Itano C, LJ. Speech-on-speech masking for children Zeitler D. Cochlear and adults: Effects of target/masker language Implantation-Panel. Ultimate Colorado mismatch. ASHA Annual Convention, Chicago, He S, Grose JH, Teagle HFB, Buchman CA. Midwinter Meeting, University of Colorado, Vail, IL, November 2013. The binaural interaction component of the CO, Feb 5, 2013. cortical auditory evoked potential in children. Leibold, LJ, Taylor, CN, Hillock-Dunn, A, Conference on Implantable Auditory Prostheses Buchman CA. Decision making in auditory and Buss, E. Effect of talker sex on infants’ (CIAP) 2013, Lake Tahoe, CA, July 14-19, 2013. neuropathy spectrum disorder. Ultimate detection of spondee words in a two-talker Colorado Midwinter Meeting, University of or a speech-shaped noise masker. The 165th Buchman CA. Cochlear Implantation: Surgical Colorado, Vail, CO, Feb 5, 2013. Meeting of the Acoustical Society of America, Aspects. Department of Otolaryngology-Head Montreal, Quebec, Canada, June 2013. and Neck Surgery, Eastern Virginia Medical Buchman CA. Chronic Ear Surgery: Are we doing School, Norfolk VA, May 16, 2013. it all wrong? Ultimate Colorado Midwinter Porter, HL, Grose, JH, Hall, JW, and Buss, E. Meeting, University of Colorado, Vail, CO, Feb Comodulation masking release and monaural Buchman CA. Chronic Ear Surgery: Are we doing 5, 2013. envelope correlation perception in listeners it all wrong? Tidewater Otolaryngology Society, with cochlear hearing loss. The 165th Meeting Norfolk, VA, May 16, 2013. Buchman CA. Emerging trends in of the Acoustical Society of America, Montreal, implantable auditory devices. Department Quebec, Canada, June 2013. Buchman CA. Conductive Hearing Loss. of Otorhinolaryngology, University of Department of Otolaryngology-Head and Neck Pennsylvania, Philadelphia, PA Nov 29, 2012. Taylor, CN, Buss, E, and Leibold, LJ. Factors Surgery, University of North Carolina at Chapel affecting frequency discrimination in school- Hill, Chapel Hill, NC, May 29, 2013. Buchman CA. Chronic Ear Surgery: Are we doing aged children and adults. The 165th Meeting it all wrong? Department of Otolaryngology, of the Acoustical Society of America, Montreal, Buchman CA. Safety and Efficacy of the University of Virginia, Charlottesville, VA, Nov Quebec, Canada, June 2013. Cochlear Nucleus 422 Cochlear Implant in 16, 2012. Adults. Clinical trial session. Cochlear Corp. Calandruccio, L, Buss, E, and Leibold, LJ. Denver, CO May 3-4, 2013. Buchman CA. Auditory Neuropathy Spectrum Speech-on-speech masking for children: male Disorder. Department of Otolaryngology, vs. female talkers. American Auditory Society, Choudhury B, Awan O, Pike JM, Buchman University of Virginia, Charlottesville, VA, Nov Scottsdale, AZ, March 2013. CA, Fitzpatrick DC, Adunka OF. Physiologic 15, 2012. 141

Leibold, LJ, Bonino, AY, and Buss, E. Masked Buss, E, Hall, JW, and Grose, JH. Temporal Dillon MT, Buss E, Adunka MC, King ER, speech detection in infants, children and integration for detection of a tonal signal in a Pillsbury HC, Buchman CA, Adunka OF. Electric- adults. American Auditory Society, Scottsdale, comodulated masker: Effects related to signal- Acoustic Stimulation (EAS): Speech perception AZ, March 2013. to-noise ratio. The 36th Midwinter Research in fluctuating noise. American Academy of Presentations Meeting of the Association for Research in Audiology – North Carolina Fall Conference, Gomez, B, Calandruccio, L, Buss, E, and Leibold, Otolaryngology, Baltimore, MD, Feb 2013. Asheville, NC, September 21-22nd 2012. Poster LJ. Energetic and informational masking of presentation abstract page 16. speech for Spanish/English bilingual children. Dillon, MT, Adunka, MC, King, ER, Buss, E, American Auditory Society, Scottsdale, AZ, Pillsbury, HC, Buchman, CA, and Adunka, OF. Anderson M, Dillon MT. Long-term outcomes of March 2013. Electric-acoustic stimulation (EAS): Speech Electric-Acoustic Stimulation (EAS). American perception in fluctuating noise. American Academy of Audiology – North Carolina Fall Buss, E, Hall, JW, and Grose, JH. Temporal Academy of Audiology, NC Fall Conference, Conference, Asheville, NC, September 21-22nd integration for detection of a tonal signal in a Ashville, NC, September 2012. 2012. Poster presentation abstract page 15. comodulated masker: Effects related to signal- to-noise ratio. The 36th Midwinter Research Hall, JW, Buss, E, and Grose, JH. Wideband Dillon MT, Adunka MC, King ER, Adunka Meeting of the Association for Research in monaural envelope correlation perception. OF, Buchman CA. UNC Vibrant Soundbridge Otolaryngology, Baltimore, MD, Feb 2013. The 16th International Symposium on Hearing, experience: Round Window stimulation for Cambridge, UK, July 2012. conductive or mixed hearing loss using Vibrant Dillon, MT, Adunka, MC, King, ER, Buss, E, Soundbridge in adults. TUUCAN Vibratory Pillsbury, HC, Craig Buchman, CA, and Adunka, Ozmeral, EJ, Buss, E, and Hall, JW. Symposium, Halifax, Nova Scotia, July 12-14th OF. Electric-acoustic stimulation (EAS): Speech Asynchronous glimpsing of speech with real 2012. Keynote speech abstract page 42. perception in fluctuating noise. American and simulated hearing loss. Gordon Research Academy of Audiology, NC Fall Conference, Conference: Auditory System, Lewiston, ME, Dillon MT, Adunka MC, King ER, Adunka Ashville, NC, September 2012. July 2012. OF, Buchman CA. UNC Vibrant Soundbridge experience. TUUCAN Vibratory Symposium, Hall, JW, Buss, E, and Grose, JH. Wideband Dahl, JP. Sleep Medicine for the Halifax, Nova Scotia, July 12-14th 2012. Oral monaural envelope correlation perception. Otolaryngologist. Grand Rounds, Department presentation abstract page 15. The 16th International Symposium on Hearing, of Otolaryngology: Head and Neck Surgery, Cambridge, UK, July 2012. University of North Carolina at Chapel Hill. Drake AF. The Role of Polysomnography in Assessing Readiness for Decannulation in Ozmeral, EJ, Buss, E, and Hall, JW. Dillon MT, Adunka MC, King ER, Pillsbury HC, Patients with Craniofacial Anomalies With Asynchronous glimpsing of speech with real Adunka OF, Buchman CA. Apical versus non- Tracheotomies. 12th International Cleft and simulated hearing loss. Gordon Research apical electric stimulation of the cochlea. 2013 Congress, Orlando, May 2013. Conference: Auditory System, Lewiston, ME, Conference on Implantable Auditory Prosthesis, July 2012. Lake Tahoe, CA, July 14-19th 2013. Poster Miller JD, Fleischman GM, Austin GK, Zanation presentation abstract page 214. AM, Ebert CS Jr. “Hybrid Balloon Frontal Sinus Leibold, LJ, Taylor, CN, Hillock-Dunn, A, Surgery in the Endoscopic Treatment of CRS and Buss, E. Effect of talker sex on infants’ Dillon MT, Adunka MC. Implantable treatments with Variant Frontal Sinus Anatomy”. NC/ detection of spondee words in a two-talker for different types of hearing loss. Hearing SC Society of Otolaryngology- Head and Neck or a speech-shaped noise masker. The 165th Loss Association of America Convention 2013, Surgery Annual Meeting. Myrtle Beach, SC. Meeting of the Acoustical Society of America, Portland, Oregon, June27-30th 2013. Oral August 2, 2013. Montreal, Quebec, Canada, June 2013. presentation abstract page 48. Ebert CS Jr. “The Etiology of Pediatric Chronic Porter, HL, Grose, JH, Hall, JW, and Buss, E. Dillon MT, Adunka OF. Pediatric bilateral Rhinosinusitis.Invited Oral Presentation. Comodulation masking release and monaural atresia: audiologic outcomes with VSB. 11th American Rhinologic Society Summer Sinus envelope correlation perception in listeners European Symposium on Paediatric Cochlear Symposium. Chicago, IL. July 20, 2013 with cochlear hearing loss. The 165th Meeting Implantation, Istanbul, Turkey, May 23-26th of the Acoustical Society of America, Montreal, 2013. Oral presentation abstract page 69. Zanation AM, Wofford MR, Fleischman GM, Quebec, Canada, June 2013. Frank DO, Senior BA, Ebert CS, Kimbell JS. “Post Anderson MA, Dillon MT, Adunka MC, Pillsbury Operative Topical Medications for CRS: Current Taylor, CN, Buss, E, and Leibold, LJ. Factors HC, Buchman CA, Adunka OF. Single-site Knowledge and Future Exploration”. Invited affecting frequency discrimination in school- objective and subjective outcomes of Electric- Oral Presentation. American Rhinologic Society aged children and adults. The 165th Meeting Acoustic Stimulation (EAS). AudiologyNOW, Summer Sinus Symposium. Chicago, IL. July of the Acoustical Society of America, Montreal, Anaheim, CA, April 3-6th 2013. Poster 20, 2013. Quebec, Canada, June 2013. presentation abstract page 182. Ebert CS Jr. “Management and Prevention of Calandruccio, L, Buss, E, and Leibold, LJ. Dillon M. Music perception in cochlear Complications During Functional Endoscopic Speech-on-speech masking for children: male implantation. The realLIFE meeting: current Sinus Surgery”. Chapel Hill, NC. Newton D. vs female talkers. American Auditory Society, status and future options for providing best Fischer Society Meeting June, 2013. Scottsdale, AZ, March 2013. benefit with hearing implants, Rome, Italy, November 8-11th 2012. Oral presentation Ebert CS Jr. ENT Grand Rounds. “Otolaryngic Leibold, LJ, Bonino, AY, and Buss, E. Masked abstract page 12. Allergy and the Otolaryngologists’ Practice”. speech detection in infants, children and February, 2013. adults. American Auditory Society, Scottsdale, Buchman CA, Adunka OF, Dillon M, King E, AZ, March 2013. Adunka MC, Pillsbury HC. Electroacoustic Fleischman GM, Kim GG, Ebert CS Jr, Zanation stimulation (EAS) trial at UNC. 11th Hearing AM. “Hybrid Balloon Frontal Sinus Surgery in Gomez, B, Calandruccio, L, Buss, E, and Leibold, Preservation Workshop, Toronto, Canada, the Endoscopic Treatment of CRS with Variant LJ. Energetic and informational masking of October 18-21st 2012. Oral presentation Frontal Sinus Anatomy”. Triological Combined speech for Spanish/English bilingual children. abstract page 32. Sections Meeting. Phoenix, AZ. January 2013. American Auditory Society, Scottsdale, AZ, Poster Presentation. March 2013. 142 McKinney KA, Zanation AM, Thorp BD, Rose squamous cell carcinoma of the head and Medicine. Inhalation Toxicity: Pathways to AS, Rawal RB, Ebert CS Jr. “A Gene Pathway neck in the Cancer Genome Atlas. American Better Methods Workshop, Institute for In Analysis of Differential Expression in AFRS. Association for Cancer Research Annual Vitro Sciences, Gaithersburg, MD, May 1, American Rhinologic Society 2012 Annual Meeting. Washington, D.C. April 6-10, 2013. 2013; Department of Mathematics, Virginia Meeting, Washington, DC. September 2012. Commonwealth University, Richmond, VA, Oral Presentation. He, S, Grose, J H, Teagle, HF, Buchman, CAB. April 19, 2013; Biomathematics Program, Neural adaptation patterns of the auditory Department of Statistics, North Carolina State Rawal RB, Deal AM, Ebert CS Jr, Gore nerve in children with auditory neuropathy University, Raleigh, NC, March 21, 2013. MR, Senior BA, Zanation AM. “Evaluation spectrum disorder. 20th World Congress of of Post-operative Nasal Irrigations with the International Federation of Oto-Rhino- Ludlow, D. Predicting post-treatment feeding Budesonide for Patients with Polyposis: A Laryngological Societies, Seoul, Korea [Invited tube and tracheostomy dependence in blinded Randomized Controlled Trial.American Speaker]. chemoradiated laryngeal cancer patients. 16th

Presentations Rhinologic Society 2012 Annual Meeting, Annual Ray A. Barlow Symposium, January Washington, DC. September 2012. Oral He, S, Grose, JH, Teagle, HFB, Roush, P, 2012. Poster Presentation. Presentation. Buchman, CA. Acoustically-Evoked Auditory Change Complex in Children with Auditory Pillsbury HC. How Obamacare Will Affect Frank DO, Zanation AM, Dhandha VH, Ebert Neuropathy Spectrum Disorder: A Potential Your Practice: The Academic Health CS Jr, Senior BA, Kimbell JS. “Quantification of Objective Tool for Identifying Cochlear Implant care Perspective. Visiting Professor, Airflow into the Maxillary Sinuses Before and Candidates. The 36th Annual MidWinter Otolaryngology/Head and Neck Surgery, Yale After Functional Endoscopic Sinus Surgery. Meeting of Association of Research in University, New Haven, CT, May 31, 2013. American Rhinologic Society 2012 Annual Otolaryngology, Baltimore, MD. [Poster]. Meeting, Washington, DC. September 2012. Pillsbury HC. New Technologies in Otology. Oral Presentation. Kim GG, Zanation AM, Taylor N, Scanga Annual Education Meeting The Art of LR, Shores CG, McKinnon KP, Serody JS. Otolaryngology: How Images Enhance Choudhury B, Awan O, Pike JM, Zdanski C, Significance of myeloid-derived suppressor Education, Connecticut Ear, Nose, & Throat Prazma J, Ebert CS Jr. “Oral Probiotics in the cells in squamous cell carcinoma of the head Society, Plantsville, CT, May 30, 2013. Prevention and Treatment of Allergy Induced and neck. 2013 American Society of Clinical Eustachian Tube Dysfunction Model.American Oncology Annual Meeting. Chicago, IL. May Pillsbury HC. Tinnitus, Visiting Professorship, Academy of Otolaryngic Allergy Annual 31-June 4, 2013. Abst #6070. Department of Otolaryngology/Head and Neck Meeting. Washington, DC. September 2012. Surgery, Georgia Health Sciences University, Oral Presentation. Kim GG, Zdanski CJ, Cohn EE, Vaughn B, Drake Augusta, GA, December 5, 2012. AF. The evolving utility of polysomnography Ebert CS Jr. Clinical case conundrums: A plan in the management of tracheostomies Pillsbury HC. How Obamacare Will Affect for managing common and severe surgical for pediatric patients with craniofacial You, Visiting Professorship, Department of complications. The Open Forum. New York, anomalies. 116th Annual Meeting at Combined Otolaryngology/Head and Neck Surgery, New York. July 2012. Oral Presentation. Otolaryngological Spring Meetings, Orlando, Georgia Healthy Sciences University, Augusta, FL. April 11-14, 2013. Abst #274. GA, December 4, 2012. Ebert CS Jr. Panel: Care of Pediatric Patients after Endoscopic Sinus Surgery. American Kim GG, Klatt-Cromwell CN, Shah RN, Pillsbury HC, Semaan M, Megerian C, Carter Rhinologic Society Summer Sinus Symposium. Buckmire RA. Assessment of dysphagia J, Kinney S. Vertigo – Case Discussion, Chicago, Il. July 2012. Invited Panelist. after surgical treatment of Zenker’s 10th Annual Temporal Bone Surgical Course, diverticulum using the Eating Assessment University Hospitals Case Medical Center, Eskridge, H, Henderson, L. The Development of Tool. 116th Annual Meeting at Combined Cleveland, OH, October 20, 2012. Auditory Memory. Burlington, NC. Otolaryngological Spring Meetings, Orlando, FL. April 11-14, 2013. Abst #366. Pillsbury HC. Techniques of Hearing Eskridge, H, Henderson, L. Listening and Preservation in Cochlear Implant Surgery: Spoken Language for Children with Hearing Klatt-Cromwell CN, Kim GG, Shah RN, Role of Electric Acoustic Stimulation. 10th Loss, Ho Chi Minh City, VN. Buckmire RA. Longitudinal assessment of Annual Temporal Bone Surgical Course, voice outcome measures following Gore-Tex University Hospitals Case Medical Center, Eskridge, H. Workshop for Educating Hearing- medialization thyroplasty. 116th Annual Cleveland, OH, October 19, 2012. Impaired Children to Listen and Speak. Hanoi, Meeting at Combined Otolaryngological Spring VN. Meetings, Orlando, FL. April 11-14, 2013. Abst Pillsbury HC, Kaylie D, Oliver E, Buchman C, #239. McElveen Jr J. Adunka O, Moderator. Panel Eskridge, H, Roush, P. Collaborative Discussion: Otology/Neuro-Otology, NC/SC Management of Auditory Neuropathy Kim GG, Zanation AM, Shores CG, McKinnon OHNS 2012 Assembly, August 3, 2012. Spectrum Disorder. ASHA, Atlanta, GA. KP, Moore DT, Serody JS. Identification of myeloid-derived suppressor cells in squamous Rose AS. Mock oral boards: Pediatric Mamo, SK, Grose, JH. Detection of mistuning cell cancer of the head and neck. Triological congenital neck masses. University of Texas in a complex of unresolved harmonics: Effects Society Combined Sections Meeting, Medical Branch at Galveston – Galveston, TX, of age. Research poster presentation at the Scottsdale, AZ. January 24-26, 2013. Abst Apri 26, 2013. 165th Meeting of the Acoustical Society of #190. America, Montreal, QC, Canada. Rose AS and Ebert CS. Evolution in the Fleischman GM, Kim GG, Ebert C, Zanation management of chronic sialorrhea. University Mamo, SK, Grose, JH. Speech-evoked ABR: AM. Hybrid balloon frontal sinus surgery in of Texas Medical Branch at Galveston – Periodicity coding of a temporally jittered the endoscopic treatment of CRS with variant Galveston, TX, April 26, 2013. stimulus. Research poster presentation at frontal sinus anatomy. Triological Society the annual meeting of the American Auditory Combined Sections Meeting, Scottsdale, AZ. Rose AS. Pediatric sinonasal masses: a Society, Scottsdale, AZ. January 24-26, 2013. Abst #185. case-based approach. Department of Otolaryngology – Head & Neck Surgery – Hayes DN, Grandis J, El-Naggar AK. Kimbell JS. Uses of Upper Respiratory University of North Carolina, Chapel Hill, NC, Comprehensive genomic characterization of Tract Modeling in Risk Assessment and December 4, 2012. 143 Rose AS. Congenital pediatric neck masses: Wake Forest School of Medicine Division of Senior BA. Endoscopic Management of a case-based approach. Department of Surgery, Winston Salem, NC 11/2012 Pituitary Tumors, 2013 Lone Star Rhinology Otolaryngology – Head & Neck Surgery – Course, UT Southwestern Medical Center, University of North Carolina, Chapel Hill, NC, O’Neil, JT. Teaching Session Presenter, Dallas, TX, April 28, 2013 December 5, 2012. Simulation Potpourri from the Cutting Edge, Presentations AAO Annual Meeting, Washington DC, 9/2012 Senior BA. Management of FESS Rose AS. Inservice on image capture and use Complications, 2013 Lone Star Rhinology of the Brainlab Digital Lightbox. Department Senior BA. Functional Endoscopic Sinus Course, UT Southwestern Medical Center, of Otolaryngology – Head & Neck Surgery – Surgery (FESS) and Nebulized Particle Delivery Dallas, TX, April 28, 2013 University of North Carolina, Chapel Hill, NC, to the Maxillary Sinus: A Computational Fluid November 15, 2012. Dynamics Study, Newton Fischer Meeting, Senior BA. Instructor: Cadaver dissection Chapel Hill, NC, June 1, 2013 laboratory (fresh frozen cadavers with image- Rose AS. Challenging cases in pediatric guidance), 2013 Lone Star Rhinology Course, otolaryngology ( Panel presentation with Drs. Senior BA. Moderator – Panel: Stump the UT Southwestern Medical Center, Dallas, TX, Harold S. Pine and Arie Gordin ). Rambam experts – Bring your most challenging case, April 27, 2013 Health Care Campus, Haifa, Israel, November 2013 Southern States Rhinology Course 6, 2012. Program, Kiawah, SC, May 3, 2013 Senior BA. Dissector: Cadaver dissection demonstration: Complete FESS, balloon Rose AS. Current treatment for chronic Senior BA. ESS for Neoplasms, 2013 Southern dilatation, sphenopalatine artery ligation, sialorrhea. Slide presentation at the Annual States Rhinology Course Program, Kiawah, SC, orbital decompression, lateral canthotomy/ Newton D. Fischer Society Meeting, Chapel May 3, 2013 cantholysis, 2013 Lone Star Rhinology Course, Hill, NC, June 2013. UT Southwestern Medical Center, Dallas, TX, Senior BA. Moderator – Panel: Frontal Sinus April 27, 2013 Mckinney KA, Zanation AM, Thorp BD, Rose Cases, 2013 Southern AS, Rawal R, Ebert CS. Paired matched States Rhinology analysis of gene expression profiles in Course Program, unilateral allergic fungal rhinosinusitis. Kiawah, SC, May 3, Annual Meeting of the American Rhinologic 2013 Society, Washington, DC, September, 2012. Senior BA. Panelist Rose AS. Pediatric tracheotomy site – ESS failures and complications. Slide presentation at the NC/ how to salvage, 2013 SC Otolaryngology and Head & Neck Surgery Southern States Assembly, Asheville, NC, August 2012. Rhinology Course Program, Kiawah, SC, Roush, P and Teagle, HFB. Audiologic May 3, 2013 Management of Progressive Hearing Loss in Children. Invited presentation, Frontier’s in Senior BA. Coding Hearing Symposium, Vail Colorado, July 12, Update, 2013 Southern 2013. States Rhinology Course Program, Roush, P. Audiological Management of Kiawah, SC, May 2, Auditory Neuropathy Spectrum Disorder. 2013 Invited presentation, Frontier’s in Hearing Symposium, Vail Colorado, July 11, 2013. Senior BA. Panelist – Balloons, Stints & Emerging Technologies, 2013 Senior BA. Panelist - Case Studies in Fungal Roush, P and Eskridge, H. Collaborative Southern States Rhinology Course Program, Rhinosinusitis, 2013 Lone Star Rhinology Management of Auditory Neuropathy Kiawah, SC, May 2, 2013 Course, UT Southwestern Medical Center, Spectrum Disorder. Invited presentation, Dallas, TX, April 27, 2013 American Speech, Language and Hearing Senior BA. Panelist – Management of Nasal Association Annual Convention, Atlanta, GA, Obstruction, 2013 Southern States Rhinology Senior BA. Rhinogenic Headaches, 2013 Lone November 16, 2012. Course Program, Kiawah, SC, May 2, 2013 Star Rhinology Course, UT Southwestern Medical Center, Dallas, TX, April 26, 2013 Roush, P. Diagnosis and Management of Senior BA. Sinus Anatomy, 2013 Southern Auditory Neuropathy. Invited presentation, States Rhinology Course Program, Kiawah, SC, Senior BA. Panelist - Case Studies, 2013 Lone Third Latin American Pediatric Audiology May 2, 2013 Star Rhinology Course, UT Southwestern Conference, Buenos Aires, Argentina, October Medical Center, Dallas, TX, April 26, 2013 12-13, 2012. Senior BA. Medical Management of CRS: Pathophysiology of CRS, 2013 Southern States Senior BA. Endoscopic Frontal Sinusotomy, Roush, P, and Teagle, HFB. Auditory Rhinology Course Program, Kiawah, SC, May 2013 Lone Star Rhinology Course, UT Neuropathy Spectrum Disorder. Invited 2, 2013 Southwestern Medical Center, Dallas, TX, April presentation, Language and Literacy 26, 2013 Workshop, September 11, 2012. Senior BA. Panelist: Coding Controversies in Rhinology, 2013 Lone Star Rhinology Course, Senior BA. Mastering Safe Ethmoidectomy, O’Neil, JT. Grand Rounds, Over the Counter UT Southwestern Medical Center, Dallas, TX, 2013 Lone Star Rhinology Course, UT ENT and Alternative Otolaryngology. Wake April 28, 2013 Southwestern Medical Center, Dallas, TX, April Forest Department of Otolaryngology, 1/2013 26, 2013 Senior BA. Future Directions of the American O’Neil, JT. Resident Research Day, Pediatric Rhinologic Society, 2013 Lone Star Rhinology Senior BA. Moderator - Fundamental Concepts Pharyngeal Abscess Associated with Clival Course, UT Southwestern Medical Center, and Basic FESS Technique, 2013 Lone Star Defect: A Case Series, Poster Presentation, Dallas, TX, April 28, 2013 Rhinology Course, UT Southwestern Medical 144 Center, Dallas, TX, April 26, 2013 Senior BA. Head and Neck Manifestations of Diego, CA, April 18-22, 2012 Vasculitis, Genentech Educational Seminar, Senior BA. Extent of Sinus Surgery: Evidence UNC Chapel Hill, NC, October 17, 2012 Senior BA. Live Surgery, 7th Semarang Basic Review of How Much We Should Do, 2012 New FESS Workshop, Semarang, Indonesia, March York Advanced Rhinology and Sinus Surgery Senior BA. Expanding Into Skull Base Surgery, 7, 2012. Course, Weill Cornell Medical Center, New ARS Summer Sinus Symposium, Chicago, IL, York, NY, November 10, 2012. Guest of Honor July 14, 2012 Senior BA. Skull Base Reconstruction, 7th three consecutive times. Semarang Basic FESS Workshop, Semarang, Senior BA. Moderator - Management of Indonesia, March 7, 2012. Anand, Lebowitz, Schaberg, Senior, Jacobs. Benign Skull Base Tumors, ARS Summer Sinus Panelist - Management of CSF Leaks, 2012 Symposium, Chicago, IL, July 14, 2012 Senior BA. Lab Instructor and Prosector, 8th New York Advanced Rhinology and Sinus Jakarta International Functional Endoscopic

Presentations Surgery Course, Weill Cornell Medical Center, Senior BA. Management of Bleeding in Skull Sinus Surgery Course, Jakarta, Indonesia, New York, NY, November 10, 2012 Base Surgery, ARS Summer Sinus Symposium, March 3-5, 2012. Chicago, IL, July 14, 2012 Senior BA. Antibiotics in Chronic Rhinosinusitis Senior BA. Rhinogenic Headache, 8th Jakarta – What’s the Evidence? 2012 New York Senior BA. Evidence for Extent of Surgery, ARS International Functional Endoscopic Sinus Advanced Rhinology and Sinus Surgery Course, Summer Sinus Symposium, Chicago, IL, July Surgery Course, Jakarta, Indonesia, March 3-5, Weill Cornell Medical Center, New York, NY, 14, 2012 2012. November 9, 2012 Senior BA. Keynote Address - Rhinology Senior BA. Avoiding Complication in Frontal Anand, Fried, Setzen, Senior. Case through the Ages, ARS Summer Sinus Sinus Surgery, 8th Jakarta International Presentations: Expert Management, Simple to Symposium, Chicago, IL, July 13, 2012. Guest of Functional Endoscopic Sinus Surgery Course, Complex, 2012 New York Advanced Rhinology Honor and Keynote speaker. Jakarta, Indonesia, March 3-5, 2012. Guest of and Sinus Surgery Course, Weill Cornell Honor. Medical Center, New York, NY, November 9, Senior BA. Minimally Invasive Pituitary 2012 Surgery, ERS-ISIAN 2012, Toulouse, France, Senior BA. Life Experience as an Endoscopic June 17-21, 2012 Skull Base Surgeon, 8th Jakarta International Stewart, Jackman, Senior, Lebowitz. Panelist Functional Endoscopic Sinus Surgery Course, - Defining CRS in 2012, 2012 New York Kennedy DW, Stammberger H, Senior B, Jakarta, Indonesia, March 3-5, 2012. Advanced Rhinology and Sinus Surgery Course, Simmen D, Carrau R, Stamm A. Endoscopic Weill Cornell Medical Center, New York, NY, Skull Base and Intracranial Surgery: How Far Senior BA. Lab Instructor: Indications and November 9, 2012 We Should Go?, ERS-ISIAN 2012, Toulouse, Limitations of Endoscopic Skull Base Surgery, France, June 17-21, 2012 North American Skull Base Society Meeting, Senior BA. Future Directions of the American Las Vegas, NV, February 17, 2012. Rhinology Society, Advanced Techniques Setzen M, Jacobs J, Senior B, Kennedy DW, in Endoscopic Management of Sinonasal Kern R, Fried M. Palmer J. Controversies in Senior BA. Making Sense of Sinusitis: Evidence Disorders, Univ. of South Florida, St. Rhinology-Pearls We Have Learned, ERS-ISIAN for Extent of Surgery, Triologic Combined Petersburg, FL, November 3, 2012 2012, Toulouse, France, June 17-21, 2012 Sections Meeting, Miami, FL, January 27, 2012.

Senior BA. Moderator – Panel: Controversies Senior BA. Panel – Consult the Experts – Bring Senior BA. Quiz Bowl, Faculty Team, Triologic in Procedure Based Therapy of Headache Your Most Challenging Case, 2012 Southern Combined Sections Meeting, Miami, FL, Contact Points, Trigger Points, Migraine States Rhinology Program, Kiawah Island, SC, January 27, 2012. Surgery, Advanced Techniques in Endoscopic May 4, 2012 Management of Sinonasal Disorders, Univ. of Senior BA. Minimally Invasive Pituitary South Florida, St. Petersburg, FL, November 3, Senior BA. ESS for Neoplasms, 2012 Southern Surgery, Triologic Combined Sections Meeting, 2012 States Rhinology Program, Kiawah Island, SC, Miami, FL, January 26, 2012. May 4, 2012 Senior BA. CSF Leaks & Their Repair, Advanced Fleischman G, Kimbell J, Frank D, Wofford Techniques in Endoscopic Management of Senior BA. Panel – Primary ESS for CRS: M, Ebert C, Senior B, Zanation A. Poster – Sinonasal Disorders, Univ. of South Florida, St. When and How Much? 2012 Southern States Sinonasal Computational Fluid Dynamics Petersburg, FL, November 1, 2012 Rhinology Program, Kiawah Island, SC, May Airflow Patterns in Actual and Virtual Surgery 3, 2012 for Chronic Rhinosinusitis, COSM, Orlando, FL, Stammberger H, Senior B. Demonstration April 9-13 Dissection: Endoscopic Sinus Surgery – FESS Senior BA. Sinus Anatomy, 2012 Southern Technique 2012/CSF Leak Repair, Advanced States Rhinology Program, Kiawah Island, SC, Senior B. Panel Discussion – Evidence-Based Techniques in Endoscopic Management of May 3, 2012 Rhinology: How has the Evidence Changed Sinonasal Disorders, Univ. of South Florida, St. my Treatment of Sinonasal Disease? COSM, Petersburg, FL, November 2, 2012 Senior BA. Panel – Primary CRSsNP & CRSwNP American Rhinologic Society, Orlando, FL, April Workup and Medical Rx, 2012 Southern States 13, 2013 Senior BA. Pituitary Adenoma, Advanced Rhinology Program, Kiawah Island, SC, May Techniques in Endoscopic Management of 3, 2012 Senior B. Panel Discussion – Advances in in Sinonasal Disorders, Univ. of South Florida, St. Office-Based CT Scanning – Diagnostic and Petersburg, FL, November 1, 2012 Senior BA. Pathophysiology of CRSI, 2012 Therapeutic Procedures, COSM, Triological Southern States Rhinology Program, Kiawah Meeting, Orlando, FL, April 12, 2013 Senior BA. Endoscopic Balloon Dilation of Island, SC, May 3, 2012 the Frontal Recess, Advanced Techniques Senior B. Surgical Anatomy of the Paranasal in Endoscopic Management of Sinonasal Senior BA. Panel – Sleep and the Nose, ARS/ Sinuses, AAO-HNSF Annual Meeting, Disorders, Univ. of South Florida, St. COSM, San Diego, CA, April 18-22, 2012 Washington, DC, September 9-12, 2012 Petersburg, FL, November 1, 2012 Senior BA. Panel – Endoscopic Skull Base Senior B, Ewend M. Minimally Invasive Surgery: Where Do We Stand? ARS/COSM, San Pituitary Surgery, AAO-HNSF Annual Meeting, 145 Washington, DC, September 9-12, 2012 Farag AF, Rawal R, Senior BA, Zanation AM, Esophagological Association annual meeting. Ebert CS. Effect of Surfactant Irrigations April 2013. Orlando, FL. Rawal R, Deal A, Ebert C, Gore M, Senior B, versus Hypertonic Saline Irrigation on Olfaction Zanation A. Evaluation of Post-Operative Nasal following Endoscopic, Endonasal Surgery, Shah RN, Altman KW, Woo P. “Discrepancies Irrigations with Budesonide for Patients with Triologic Combined Sections Meeting, Miami, in laryngeal diagnoses between Presentations Polyposis: A Blinded Randomized Controlled FL, January 2012. otolaryngologists: a descriptive review. Trial, ARS Annual Meeting, Washington, DC, First Place Poster Presentation Laryngology/ September 8, 2012 Shockley WW. Moderator for Panel on Multi- Bronchoesophagology, Triological Society Disciplinary Management of Skin Cancer, Combined Sections meeting. January 2013. Frank D, Zanation A, Dhandha V, Ebert C, Senior American College of Surgeons. Chicago, IL Scottsdale, AZ. B, Kimbell J. Quantification of Airflow into the October 2, 2012. Maxillary Sinuses Before and After Functional Shah RN, Woo P. “Bilateral Vocal Fold Endoscopic Sinus Surgery, ARS Annual Meeting, Shockley WW. Nasal Reconstruction in Immobility…Don’t Hold Your Breath.Grand Washington, DC, September 8, 2012 2012; Where Do We Stand? Panel on Multi- Rounds, University of North Carolina Disciplinary Management of Skin Cancer, Department of Otolaryngology-Head & Neck Batra P, Lee J, Barnett S, Senior B, Setzen American College of Surgeons. Chicago, IL Surgery. December 12, 2012, Chapel Hill, NC. M, Kraus D. Poster – Endoscopic Skull Base October 2, 2012. Surgery Practice Patterns: Survey of the North Shah RN, Deal AM, Buckmire RA. “Multi- American Skull Base Society, ARS Annual Thorp BD, Deal AM, Shockley WW. Full dimensional Voice Outcomes after Type I Gore- Meeting, Washington, DC, September 8, 2012 Thickness Skin Grafts for Nasal Reconstruction: Tex Thyroplasty in Patients with Mobile Vocal Analysis of Aesthetic Results Folds: a Subgroup Analysis.Oral presentation, using a Novel Grading System. Fall Voice Conference. October 2012, New York, American Academy of Facial NY. Plastic and Reconstruction Surgery. Washington, DC, Shah RN, Buckmire RA. “Laryngology Update September 7, 2012. 2012.Oral presentation, Newton D. Fischer Society meeting. June 2012, Chapel Hill, NC. Shockley WW. Saddle Nose Deformity: Options in Surgical Teagle, HFB. Managing patients with ANSD Management. North Carolina/ and progressive hearing loss. Frontiers in South Carolina Otolaryngology Hearing, Symposium, Vail, CO. - Head and Neck Surgery Assembly. Asheville, NC, Teagle, HFB & Roush, PA. Auditory Neuropathy August 5, 2012. Spectrum Disorder. Language and Literacy Workshop, Greensboro, NC. Shockley WW. Perspectives in Nasal Reconstruction. Plastic Teagle, HFB. Grand Rounds: Cochlear Implants and Reconstructive Surgery for Children with ANSD: what are we learning? Grand Rounds. University of Audiology OnLine Webinar. October 16th 2012 North Carolina. Chapel Hill, NC, May 23, 2012. Thorp BD and Ebert CS Jr. Clinical Conundrums: Kimple AJ, Ebert CS, Senior BA, Zanation Rhinology Panel. Newton D. Fischer Society AM. Techniques and Limitations for Reducing Shockley WW. Reconstruction of Cutaneous Meeting. Chapel Hill, NC. June 2013. Nasoseptal Flap Donor Site Morbidity Following Nasal Defects With a Full Thickness Skin Thorp BD and Zanation AM. The Vidian Nerve: Endoscopic Skull Base Surgery, ARS/COSM, San Graft. Panel on Cutaneous Malignancies and nothing to sniffle about. Grand Rounds, Diego, CA, April 18-22, 2012 Local Flap Reconstruction. Combined Sections Meeting of the Triological Society. Miami, FL, Department of Otolaryngology/Head and Neck Dugar DR, Rawal R, Senior BA, Zanation AM, January 27, 2012. Surgery, University of North Carolina – Chapel Ebert CS. Pediatric Allergic Fungal Sinusitis Hill. January 2013. (AFS): Is It a More Severe Disease than Adult Eight others and Shores, C. Phase I clinical Mckinney KA, Zanation AM, Thorp BD, Rose AFS? Combined Otolaryngology Section trial of valacyclovir and standard of care AR, Rawal R, and Ebert CS Jr. Paired, matched Meeting, San Diego, CA, April 19, 2012. cyclophosphamide in children with endemic Burkitt lymphoma in Malawi. American Head analysis of gene expression profiles in Dugar DR, Rawal R, Senior BA, Ebert CS, and Neck Society International meeting, unilateral allergic fungal rhinosinusitis. Annual Zanation AM. Endoscopic Approach to Lateral Toronto, Canada July 2012 Meeting of the American Rhinologic Society. Encephaloceles Originating in Sternberg’s Washington, DC. September 8, 2012. Presented Canal, North American Skull Base Society Shah RN, Altman KW, Woo P. “The Answer to by Dr. Kibwei McKinney. Meeting, Las Vegas, NV, February 2012. Bilateral Vocal Fold Immobility…Don’t Hold Your Breath.Grand Rounds, Icahn School of Medicine Thorp BD, Deal AM, and Shockley WW. Full Mitchell C, Oosmanally N, Paul JE, Zanation at Mount Sinai Department of Otolaryngology. Thickness Skin Grafts for Nasal Reconstruction: AM, Ewend MG, Senior BA, Ebert CS. June 19, 2013, New York, NY. Analysis of Aesthetic Results Using a Novel Comparative Analysis of Cost of Minimally Grading System. Fall Meeting of the American Invasive and Sublabial-Transseptal Approaches Shah RN, Del Signore AG, Altman KW, Woo P. Academy of Facial Plastic and Reconstructive to the Pituitary, North American Skull Base “Laryngeal sarcoidosis: proposal for clinical Surgery. Washington, DC. September 5-8, 2012. Society Meeting, Las Vegas, NV. February 17, classification and treatment.Oral presentation, Thorp BD, Lam C, and Hackman TG. 2012. American Laryngological Association annual meeting. April 2013. Orlando, FL. Retrospective Review of Oropharynx Cancer: Rawal R, Suberman TA, Zanation AM, Ewend Prognostic Factors and Failure Patterns.8th MG, Senior BA, Ebert CS. Quality-of-Life before Del Signore AG, Shah RN, Gupta N, Altman KW, International Conference on Head and Neck and after Minimally Invasive Pituitary Surgery, Woo P. “Complications and failures of office Cancer. Toronto, Ontario. July 20 – 25, 2012. North American Skull Base Society Meeting, Las based endoscopic applications of angiolytic Klatt-Cromwell CN, Newberry T, Ewend M, Vegas, NV. February 17, 2012. lasers.Oral presentation, American Broncho- 146 Sasaki-Adams D, Ebert C, Senior B, Zanation Kim GG, McKinney KA, Ebert CS, Zanation AM. Zanation AM. Complex Frontal Sinus Disease: AM. Evaluation of Skull Base Reconstruction Computed Tomography Image-Guided Robotic Current Concepts. NC/SC Otolaryngology and Sinonasal Disease Following Surgery: A Preclinical Feasibility Study. North and Head and Neck Surgery Meeting, (Invited Endoscopic Surgery and Radiation Therapy. American Skull Base Society Annual Meeting, Faculty) August 3-5-2012, Asheville, NC. American Rhinologic Society at Combined February 15-17, 2013, Miami, FL. Otolaryngology Sections Meeting, April 2013, Zanation AM. Invited Faculty, Demonstration Orlando, FL. Fleischman GM, Zanation AM, Cohn EE, Ebert Prosector. North American Skull Base Surgery CS, Senior BA. Obstructive Sleep Apnea in Meeting, July 28, 2012, New Orleans, LA. Fleischman GM, Kimbell JS, Frank DO, Patients Undergoing Endoscopic Surgical Wofford M, Ebert CS, Senior BA, Zanation Repair of Cerebrospinal Fluid Rhinorrhea. Zanation AM. Invited Faculty, Extended Orbits AM. Sinonasal Computational Fluid Dynamics North American Skull Base Society Annual – Zygomatic Approach to Skull Base. North Airflow Patterns in Actual and Virtual Surgery Meeting, February 15-17, 2013, Miami, FL. American Skull Base Surgery Meeting, July 28,

Presentations for Chronic Rhinosinusitis. Combined 2012, New Orleans, LA. Otolarynogology Spring Meetings, April 10-14, Klatt-Cromwell CN, Ewend M, Sasaki-Adams D, 2013, Orlando, FL. Zanation AM. Magnetic Resonance Imaging Zanation AM. New York Open Forum Meeting Confirms Vascularity of Nasoseptal Flaps 2012, Office-Based Ultrasonography: Making Klatt-Cromwell CN, Ewent M, Sasaki-Adams in the Late Post-Operative Period. North Optimal Use of What is Known, July 27-28, D, Jewells V, Zanation AM. Post Operative American Skull Base Society Annual Meeting, 2012, New York, New York,. Magnetic Resonance Imaging Characteristics February 15-17, 2013, Miami, FL. of Vacularized Nasoseptal Flap Skull Base Zanation AM: Anterior Skull Base Surgery. Reconstructions. Triological Society Meeting at Fleischman GM, Kim GG, Ebert CS, Zanation Kansas University Medical Center Meeting, Combined Otolaryngology Sections Meeting. AM. Hybrid Balloon Frontal Sinus Surgery in (Invited Visiting Professor), July 16, 2012, April 12, 2013, Orlando, FL. the Endoscopic Treatment of CRS with Variant Kansas City, MO. Frontal Sinus Anatomy. Combined Sections Zanation AM. How Does Coordinated Meeting, January 24-26, 2013, Scottsdale, AZ. Fleischman GM, Kimbell JS, Davis S, Superfine Multidisciplinary Care Impact Head and R, Zdanski C. Effect of Laryngotracheal Neck Tumor Treatment Planning. Triological Kim GG, Zanation AM, Shores, CG, McKinnon Reconstruction on Airflow Patterns: A Pilot Society Annual Meeting, COSM, April 12, 2013, KP, Moore DT, Serody JS. Poster Presentation. Computational Fluid Dynamics Study in Orlando, FL. Winner of the 2013 Mosher Identification of Myeloid Derived Suppressor a Child with Subglottic Stenosis (Poster). Award. Cells in Squamous Cell Cancer of the Head and COSM/Triological Society, Orlando, FL, April Neck. Combined Sections Meeting, January 10 – 14, 2013. Rawal RB, Zanation AM. Otolaryngology 24-26, 2013, Scottsdale, AZ. Faculty and Residents’ Attitudes Towards the Kim GG, Zdanski CJ, Cohn E, Vaughn B, Drake Pharmaceutical Industry. Triological Combined Zanation, AM. Invited Speaker. How I Do It: AF. The Evolving Utility of Polysomnography Sections Meeting, April 12, 2013, Orlando, FL. Not When and Why, Just How – Nasoseptal in the Management of Tracheostomies for Flap for Endoscopic Skull Base Surgery. Pediatric Patients with Craniofacial Anomalies Zanation AM, Cohn E, Wheless S, McKinney Combined Sections Meeting, January 24-26, (Poster). COSM/Triological Society, Orlando, K, Deal A. Prospective Study of Head and 2013, Scottsdale, AZ. FL, April 10 – 14, 2013 Neck Quality of Life in a Comprehensive Skull Base Surgical Practice. American Head and Zanation, AM. Invited Panelist. Sinonasal Zdanski CJ. Innovations in Pediatric Neck Society Annual Meeting, April 11, 2013, Malignancies: State of the Art in Otolaryngology: A Video Forum Pediatric Orlando, FL. Management. Combined Sections Meeting, Otolaryngology. AAO-HNS Pediatric January 24-26, 2013, Scottsdale, AZ. Otolaryngology Committee and the American Patel MR, Taylor R, Hackman TG, Sasaki- Society of Pediatric Otolaryngology Meetings; Adams DM, Ewend MG, Zanation AM. Beyond Zanation, AM. Invited Faculty. UPMC Center Washington, DC, September 12, 2012. the Nasoseptal Flap: Outcomes and Pearls for Cranial Base Surgery, November 17, 2012, with Secondary Vascular Flaps in Skull Base Pittsburgh, PA. Zdanski CJ. Invited Speaker, Pediatric Voice Reconstruction. North American Skull Base Disorders: Medical/Surgical Management; Society Annual Meeting, February 15-17, 2013, Zanation AM. Skull Base Surgical Outcomes, Tools for Children’s Voice Disorders. Chapel Miami, FL. Anatomy and Diseases of the Infratemporal Hill, NC, August 24, 2012. Fossa and Academic Career Development. Cohn EE, Newberry TR, Rodriguez KD, Sasaki- NYU Department of Otolaryngology Grand Adams DM, Zanation AM. Management of Rounds and Resident Didactics, (Invited Invasive Fungal Sinusitis with Intracranial Visiting Professor) October 3, 2012, New York, Involvement. North American Skull Base NY. Society Annual Meeting, February 15-17, 2013, Miami, FL. McKinney KA, Zanation AM, Thorp BD, Rose AS, Rawal RB, Ebert CS. A Gene Pathway Dhandha VH, Zanation, AM. Time to Analysis of Differential Expression in AFRS. Esthesioneuroblastoma Recurrence: A Meta American Rhinologic Society Meeting, Analysis. North American Skull Base Society September 8, 2012, Washington, DC. Annual Meeting, February 15-17, 2013, Miami, FL. Rawal RB, Deal AM, Ebert CS, Gore MR, Senior BA, Zanation AM. Evaluation of Post- Zanation AM. Invited Panelist. Chordomas: Operative Nasal Irrigations with Budesonide Has Endoscopic Approaches for Patients for Patients with Polyposis: A Blinded with Chordoma Improved Outcomes? North Randomized Controlled Trial. American American Skull Base Society Annual Meeting, Rhinologic Society Meeting, September 8, February 15-17, 2013, Miami, FL. 2012, Washington, DC. 147 for Cancer: Analyzing High-Dimensional Data. Management. Oral and Maxillofacial Surgery Publications Weinheim, Germany: Wiley-Blackwell Press. Clinics of North America: Pediatric Maxillofacial 241-260. 2013. Surgery. Elselvier Publishers, Volume 24, Issue

3, August 2012, Pages 325-336. Publications Kim GG, Zdanski C. Neck Syndromes. Pediatric Books/Chapters Otolaryngology-Head and Neck Surgery Buchman CA.Implantable Devices – A Clinical Reference. Plural Publishing. in Otorhinolaryngology, In: Current [submitted February 28, 2013]. Refereed Journals Otorhinolaryngology Reports. Springer Ahmad FI, Demason CE, Teagle H, Henderson Health Care, PA, 2013. Kim GG, Hang AX, Mitchell CA, Zanation L, Adunka OF, Buchman CA. Cochlear AM. Pedicled Extranasal Flaps in Skull Base implantation in postlingually hearing Iseli C, Adunka OF, Buchman CA. Cochlear Reconstruction. Advances in Oto-Rhino- impaired children. Laryngoscope, accepted for implants in children with cochlear nerve Laryngology- Comprehensive Techniques in CSF publication. deficiency. In: Cochlear Implants in Children: Leak and Skull Base Reconstruction. (Bleier BS Learning and the Brain, Young N & Kirk K (ed), vol 74, page 71-80) Switzerland: S. Karger Ahmad FI, Demason CE, Choudhury B, Adunka (eds). Springer Publishing, Philadelphia, PA, (in AG- Medical and Scientific Publishers. OF, Finley CC, Fitzpatrick DC. Detection of preparation). intracochlear damage during cochlear implant Brownell, WE, Manis, PB. Structures, electrode insertion using extracochlear Adunka OF, Buchman CA. Cochlear implants Mechanisms, and Energetics in Temporal measurements in the gerbil. Laryngoscope and other auditory prostheses. In: Johnson’s Processing. In: SHAR Perspectives, Popper, 2012; 122:636-44. Head and Neck Surgery-Otolaryngology (5th A., and Fay, R. Eds., Springer Handbook of edition). Johnson JT (ed), Lippincott, Williams & Auditory Research, Vol. 50, 2013 (In Press). Dillon M, Adunka OF, Hillman T, Chen DA, Wilkins, Philadelphia, PA, (75 pages-in press). Buchman CA. Round window stimulation Rose AS. Nose and sinus. In: Color Handbook for conductive and mixed hearing loss. Otol Cullen RF, Buchman CA. Device reliability and of Otolaryngology. Devon, United Kingdom: Neurotol 2013 (in preparation). reimplantation. In: Cochlear Implants and Other Manson Publishing. In Implantable Hearing Devices. Ruckenstein M press, 2013. (ed). Plural Publishing, 2012, San Diego, CA, Chapter 17: pp: 303-16. Gore MR, Senior BA. Minimally Invasive Buss, E, Hall, JW, and Grose, JH. “Development Pituitary Surgery, in: of auditory coding as reflected in Online Encyclopedia psychophysical performance,in L. Werner, R.R. of Otolaryngology. Fay and A.N. Popper (Eds) Human Auditory Kountakis S et al (eds). Development, Springer. 2013 In Press.

Dahl, JP and Zdanski CJ. Sialadenitis. Pediatric Senior BA. Image Otolaryngology – Head and Neck Surgery, A Guidance in Endoscopic Clinical Reference Guide. Sinus Surgery and Skull Base Surgery, Chin J. Dahl, JP and Zdanski CJ. Salivary Gland Clinicians (Electronic Tumors. Pediatric Otolaryngology – Head and Edition), June 15, 2012, Neck Surgery, A Clinical Reference Guide. vol 6, No 12, 3157-3164

Dahl, JP and Rose AS. Salivary Glands and Senior BA. Endoscopic Sialorrhea. Pediatric Otolaryngology – Head Resection of Pituitary Adenomas, Thieme, Forgues M , Koehn HA, Dunnon AK, Pulver and Neck Surgery, A Clinical Reference Guide. Kennedy DW & Hwang P (eds), 2012 SH, Buchman CA, Adunka OF, Fitzpatrick DC. Hair cell and neural potentials recorded at the Campbell A, Dillon MT, Buchman CA, Bednarski K, Senior BA. Advanced Frontal round window in gerbils. J Neurophysiol 2013 Adunka OF. Hearing preservation cochlear Surgery Techniques in Rhinology: Diseases (submitted). implantation. In CA Buchman (Ed.), Current of the Nose Sinuses, and Skull Base, Thieme, Otorhinolaryngol Rep, Implantable Devices in Kennedy DW & Hwang P (eds), 2012 He S, Grose JH, Teagle HFB, Buchman CA. Otorhinolaryngology (vol 1, issue 2, 69-79). New Objective measures of electrode discrimination York, NY: Springer. Shadfar S, Shockley WW. Management of with electrically-evoked auditory change Facial Soft Tissue Trauma in Head and Neck complex and speech perception abilities in Adunka OF, Dillon MT, Buchman CA. Auditory Surgery-Otolaryngology. 5th Ed. Lippincott, children with auditory neuropathy spectrum outcomes in the adult population. In Susan Williams and Wilkins (publication pending) disorder. Ear Hear 2013 (submitted). Waltzman, & J. Thomas Roland (Eds.), Cochlear Implants (3rd edition), New York, NY: Thieme. Thorp BD, Rodriguez KD, and Senior BA. The Hatch DR, Teagle HFB, Park L, Woodard J, Nose and Paranasal Sinuses: Benign Neoplasm Buchman CA. The impact of cochlear implant Rosenthal,LHS, Caballero,N, Drake, AF. (2014). In Sataloff R (Ed.), Sataloff’s Textbook revision surgery on speech perception Otolaryngologic Manifestations of Craniofacial of Otolaryngology. Philadelphia, PA: Jaypee performance in children. JAAA 2013 Syndromes. Otolaryngologic Clinics of North Brothers Medical Publishers (Anticipated (submitted). America, 45 (2012), 557-577. publication 2014). Park LR, Henderson L, Teagle HFB, He S, Evans Shadfar,S Drake AF Vaughn,BV, Zdanski, CJ. Zanation AM, Smyth J. K.J. Lee’s Essential M, Buchman CA. Language and audition Pediatric Airway Abnormalities, Oral and Otolaryngology Tenth Edition. Tumors of the outcomes in children with auditory neuropathy Maxillofacial Surgery Clinics,24(2012), 325-336. Paranasal Sinuses. McGraw Hill Medical 2012, spectrum disorder using cochlear implants. J Chapter 30:669-680. Speech Lang Res 2013 (submitted). Walter V, Nobel AB, Hayes DN, Wright FA. Identification of Recurrent DNA Copy Number Shadfar S, Drake A, Vaughn B, Zdanski C. Van de Heyning P, Adunka O, Buchman C, Aberrations in Tumors. Statistical Diagnostics Pediatric Airway Anomalies: Evaluation and Pillsbury H and many others.Standards of 148 practice in the field of hearing implants. Cochlear Dillon MT, Buss E, Adunka MC, King ER, Pillsbury implant users. Archives of Otolaryngology – Head Implants Int. 2013 Jun;14 Suppl 2:1-5. doi: HC 3rd, Adunka OF, Buchman CA. Long-term & Neck Surgery, 139, 279-283. 10.1179/1467010013Z.00000000093.PubMed speech perception in elderly cochlear implant PMID: 23764325. users. JAMA Otolaryngol Head Neck Surg. 2013 Leibold, LJ, Hillock-Dunn, A, Duncan, N, Roush, Mar;139(3):279-83. PubMed PMID: 23657352. PA, and Buss, E. Influence of hearing loss on Fitzpatrick, DC, Campbell AP, Choudhury B, children’s identification of spondee words in a Dillon MT, Forgues M, Buchman CA, Adunka OF. Buchman, CA and many others. Effects of speech-shaped noise or a two-talker masker. Ear Round window electrocochleography just prior maternal sensitivity and cognitive and linguistic and Hearing [Epub ahead of print]. to cochlear implantation: Relationship to word stimulation on cochlear implant users’ language recognition outcomes in adults. Otol Neurotol development over four years. J Pediatr 2013 Buss, E., He, S., Grose, J.H., and Hall, J.W. III 2013 (in press). Feb;162(2):343-8.e3. doi:10.1016/j.jpeds. (2013) “The monaural temporal window based

Publications 2012.08.003. Epub 2012 Sep 14. PubMed PMID: on masking period pattern data in school-aged He S, Grose JH, Teagle HF, Woodard J, Park LR, 22985723. children and adults,Journal of the Acoustical Hatch DR, Buchman CA. Gap detection measured Society of America, 133, 1586-1597. with electrically evoked auditory event-related He S, Grose JH, Buchman CA. Auditory potentials and speech-perception abilities in discrimination: The relationship between Buss, E., Grose, J.H., and Hall, J.W. III (2013) children with auditory neuropathy spectrum psychophysical and electrophysiological “Factors affecting the processing of intensity disorder. Ear Hear 2013 May 29. [Epub ahead of measures. Int J Audiol. 2012 Oct; 51(10):771-82. in school-aged children,Journal of Speech, print] PubMed PMID: 23722354. PubMed PMID: 22998415. Language and Hearing Research, 56, 71-80.

Choudhury B, , Adunka OF, Awan O, Pike JM, Adunka OF, Teagle HF, Zdanski CJ, Buchman CA. Buchman CA, Fitzpatrick DC. Electrophysiologic Influence of an intraoperative perilymph gusher consequences of flexible electrode insertions on cochlear implant performance in children in gerbils with noise induced hearing loss. Otol with labyrinthine malformations. Otol Neurotol. Neurotol (in press). 2012 Dec; 33(9):1489-96.

Roche JP, Adunka OF, Pillsbury HC, Buchman CA. He S, Grose J, Hang AX, Buchman CA. Cochlear Cost of cholesteatoma care at a tertiary medical implant-evoked cortical activation in children center. Otol Neurotol 2013 (in press). with cochlear nerve deficiency. Otol Neurotol. 2012 Sep;33(7):1188-96. CDaCI Investigative Team. Age-Dependent Cost- Utility of Pediatric Cochlear Implantation. Ear Mitchell CA, Ebert CS, Buchman CA, Zanation Hear. 2013 July/August;34(4):402-412. PubMed AM. Combined transnasal/transtemporal PMID: 23558665. management of the eustachian tube for middle ear inverted papilloma. Laryngoscope. 2012 He S, Teagle HF, Roush P, Grose JH, Buchman Aug;122(8):1674-8. CA. Objective hearing threshold estimation in children with auditory neuropathy spectrum Ahmad FI, Demason CE, Teagle HF, Henderson L, disorder. Laryngoscope 2013 Apr 25. doi: Adunka OF, Buchman CA. Cochlear implantation 10.1002/lary.24137. [Epub ahead of print] in children with postlingual hearing loss. PubMed PMID:23620187. Laryngoscope. 2012 Aug;122(8):1852-7.

Buchman, CA and many others. Identification Demason C, Choudhury B, Ahmad F, Fitzpatrick of effective strategies to promote language in DC, Wang J, Buchman CA, Adunka OF. deaf children with cochlear implants. Child Dev. Electrophysiological properties of cochlear 2013 Mar-Apr;84(2):543-59. doi: 10.1111/j.1467- implantation in the gerbil using a flexible array. 8624.2012.01863.x. Epub 2012 Sep 24. PubMed Ear Hear. 2012 Jul;33(4):534-42. Buss, E., Hall, J. W., and Grose, J. H. (2013) PMID: 23002910; PubMed Central PMCID: “Effects of masker envelope irregularities on PMC3530629. Buchman, CA and many others. Language tone detection in narrowband and broadband and behavioral outcomes in children with maskers,Hearing Research, 294, 73-81. Buchman, CA and many others. Supplement to developmental disabilitiesusing cochlear the JCIH 2007 Position Statement: Principles implants. Otol Neurotol. 2012 Jul;33(5):751-60. Bonino, AY, Leibold, L J, and Buss, E. Release and Guidelines for Early Intervention After from perceptual masking for children and adults: Confirmation That a Child Is Deaf or Hard of Park LR, Teagle HF, Buss E, Roush PA, Buchman Benefit of a carrier phrase. Ear and Hearing, 34, Hearing. Pediatrics. 2013 Apr;131(4):e1324-49. CA. Effects of frequency compression hearing 3-14. doi: 10.1542/peds.2013-0008. Epub 2013 Mar 25. AIDS for unilaterally implanted children PMID: 23530178 with acoustically amplified residual hearing Buss, E, Hall, JW, and Grose, JH. Monaural in the nonimplanted ear. Ear Hear. 2012 envelope correlation perception and stimulus Buchman, CA and many others. Influence Jul;33(4):e1-e12. bandwidth. Journal of the Acoustical Society of of implantation age on school-age America, 133, 405-416. languagecperformance in pediatric cochlear Buchman, CA and many others. Timing of implant users. Int J Audiol. 2013 Apr;52(4):219 cochlear implantation and parents’ global ratings Ozmeral, E, Buss, E, and Hall, JW. Asynchronous 29. doi:10.3109/14992027.2012.759666. Epub of children’s health and development. Otol glimpsing of speech: The roles of upward spread 2013 Feb 28. PubMed PMID: 23448124. Neurotol. 2012 Jun;33(4):545-52. of masking and task set-size,Journal of the Acoustical Society of America, 132, 1152-1164. Gifford RH, Dorman MF, Skarzynski H, Lorens Buchman, CA and many others. Pearls A, Polak M, Driscoll CL, Roland P, Buchman CA. and pitfalls in cochlear implantation. Int J Park, LR, Teagle, HFB, Buss, E, Roush, PA, and Cochlear implantation with hearing preservation Otolaryngol; 2012:438696. Buchman, CA. Effects of frequency compression yields significant benefit for speech recognition hearing aids for unilaterally implanted children in complex listening environments. Ear Hear 2013 Dillon, M, Buss, E, Adunka, MC, King, ER, with acoustically amplified residual hearing in Feb 26. [Epub ahead of print] PubMed PMID: Pillsbury, HC, Adunka, OF, and Buchman, C A. the non-implanted ear. Ear and Hearing, 33, 23446225. Long-term speech perception in elderly cochlear e1-e12. 149 Hall, JW III, Buss, E, Grose, JH, and Roush, PA. Grose, JH, Buss, E, Porter, HL, and Hall, malignancies with neuroendocrine Effects of age and hearing loss on the ability to JW. Across-frequency envelope correlation differentiation. Laryngoscope. 2012 benefit from temporal and spectral modulation. discrimination and masked signal detection. Oct;122(10):2210-5. Epub 2012 Aug 9. PubMed Ear and Hearing, 33, 340-348. Journal of the Acoustical Society of America, PMID: 22886723. Publications 134, 1205-1214. Buss, E, Grose, JH, and Hall, JW. Frequency Hayes DN and many others. Comprehensive discrimination under conditions of He, S, Grose, JH, Teagle, HFB, Woodard, J, Park, molecular portraits of human breast tumours. comodulation masking release. Journal of the LR, Hatch, DR, and Buchman, CA. Gap Detection Nature. 2012 Oct 4;490(7418):61-70. Epub 2012 Acoustical Society of America, 131, 2557-2560. Measured with Electrically-Evoked Auditory Sep 23. PubMed PMID: 23000897. Event-Related Potentials and Speech Perception Grose, JH, Buss, E, and Hall, JW. Binaural beat Abilities in Children with Auditory Neuropathy Hayes DN and many others. Comprehensive salience. Hearing Research, 285, 40-45. Spectrum Disorder. Ear & Hearing. genomic characterization of squamous cell lung cancers. Nature. 2012 Sep 27;489(7417):519-25. Pappa, AK, Caballero, M, Dennis, RG, Boehm, Grose, JH, and Mamo, SK. Frequency Epub 2012 Sep 9. PubMed PMID: 22960745. R, Dahl, JP, Narayan, RJ, Skancke, MD, and JA modulation detection as a measure of temporal van Aalst. Biochemical Properties of Tissue processing: Age-related monaural and binaural Hayes DN and many others. ReQON: a Engineered Cartilage. In Press, Journal of effects. Hearing Research, 294, 45-54. Bioconductor package for recalibrating quality Craniofacial Surgery, scores from next-generations sequencing data. Buss E, Hall JW, and Grose JH. Monaural BMC Bioinformatics. 2012 Sep 4;13(1):221. Pappa, AK, Caballero, M, Dennis, RG, Boehm, envelope correlation perception for bands PubMed PMID: 22946927. R, Dahl, JP, Narayan, RJ, Skancke, MD, and narrower or wider than a critical band. J. JA van Aalst. Biophysical Properties of Tissue Acoust. Soc. Am. 133, 405-416. PMID: 23297912 Hayes DN and many others. Multiclass Engineered Cartilage: Replicating Endogenous Distance Weighted Discrimination. Journal of Cartilage. Hayes DN and many others. Integrated genomic Computational and Graphical Statistics. 2012 characterization of endometrial carcinoma. July 29. No PMID available. Dillon, MT, Buss E, Pillsbury HC, Adunka OF, Nature. 2013 May 2;497(7447):67-73. PubMed Buchman CA, Adunka MC. Effects of hearing PMID: 23636398. Hayes DN and many others.Comprehensive aid settings for Electric-Acoustic Stimulation. molecular characterization of human [accepted, JAAA]. Fried D, Mullins B, Weissler M, Shores C, colon and rectal cancer. Nature. 2012 Jul Zanation A, Hackman T, Shockley W, Hayes 18;487(7407):330-7. PubMed PMID: 22810696. Adunka OF, Dillon MT, Adunka MC, King ER, N, Chera BS. Prognostic significance of Pillsbury HC, Buchman CA. Hearing preservation bone invasion for oral cavity squamous cell Yin XY, Patel MR, Hackman T, Zanation AM, and speech perception outcomes with electric- carcinoma considered T1/T2 by AJCC size Shockley WW, Weissler MC, Shores CG, Olshan acoustic stimulation after 12 months of listening criteria. Head Neck. 2013 Apr 25. [Epub ahead AF, Hayes DN and many others. Different experience. [accepted, Laryngoscope] of print]. cellular p16(INK4a) localisation may signal different survival outcomes in head and neck Dillon MT, Buss E, Adunka MC, King ER, Hayes DN and many others. Cisplatin and cancer. Br J Cancer 2012 Jul 24;107(3):482-90. Pillsbury HC, Adunka OF, Buchman CA. Long- Radiotherapy With or Without Erlotinib in Epub 2012 Jun 26. PubMed PMID: 22735904. term speech perception in elderly cochlear Locally Advanced Squamous Cell Carcinoma implant users. JAMA Otolaryngol Head Neck of the Head and Neck: A Randomized Phase II Kim GG, Halvorson EG, Hang AX, Pederson WC, Surg, 139(3):279-283. Trial. J Clin Oncol. 2013 Apr 10;31(11):1415-21. De Santis G, Hackman TG. Prelamination of Epub 2013 Mar 4. PubMed PMID: 23460709. Radial Forearm Free Flap with Buccal Mucosa. Choudhury B, Fitzpatrick DC, Buchman CA, Wei Otolaryngology-Head and Neck Surgery. 2013 BP, Dillon MT, He S, Adunka OF. Intraoperative Hayes DN and many others. Proteomic Analysis Feb 2;148(2): 10. round window recordings to acoustic stimuli of Ubiquitin Ligase KEAP1 Reveals Associated from cochlear implant patients. Otol Neurotol, Proteins That Inhibit NRF2 Ubiquitination. Kim GG, Hang AX, Mitchell CA, Zanation AM. 33(9):1507-15. Cancer Res. 2013 Apr 1;73(7):2199-2210. Epub (2013). “Pedicled Extranasal Flaps in Skull 2013 Feb 4. PubMed PMID: 23382044. Base Reconstruction.Advances in Oto-Rhino- Heike, CL, Stueckle, LP, Hing, Pimenta, LA, Laryngology- Comprehensive Techniques in CSF Drake, AF, Sie, KY, Luquetti, D. Advancement of Weissler MC, Shockley WW, Zanation AM, Leak and Skull Base Reconstruction. (Bleier BS clinical research and health care for children Hackman T, Olshan AF, Shores CG, Hayes DN (ed), vol 74, page 71-80) Switzerland: S. Karger with craniofacial microsomia, American Journal and many others. Molecular subtypes in head AG- Medical and Scientific Publishers. of Medical Genetics. Submitted, May 2013. and neck cancer exhibit distinct patterns of chromosomal gain and loss of canonical cancer Hang AX, Kim GG, Zdanski C. Cochlear Farag AA, Deal AM, McKinney KA, Thorp BD, genes. PLoS One. 2013;8(2):e56823. Epub 2013 implantation in unique pediatric patients. Senior BA, Ebert CS Jr, Zanation AM. “Single- Feb 22. PubMed PMID: 23451093. Current Opinion in Otolaryngology and Head & blind randomized controlled trial of surfactant Neck Surgery. 2012 Dec;20(6):507-17. versus hypertonic saline irrigation following Hayes DN, and many others. DiffSplice: the endoscopic endonasal surgery in the early genome-wide detection of differential splicing Kim GG, Zanation AM. Transoral robotic post-operative period”. Int Forum Allergy Rhinol. events with RNA-seq. Nucleic Acids Res. 2013 surgery to resect skull base tumors via 2013. Apr;3(4):276-280. Jan;41(2):e39. Epub 2012 Nov 15.PubMed PMID: transpalatal and lateral pharyngeal 23155066. approaches. Laryngoscope. 2012 Gore MR, Ebert CS Jr, Zanation AM, Senior Jul;122(7):1575-8. BA. “Beyond the “central sinus”.: radiographic Lee W, Du Y, Sun W, Hayes DN, Yufeng L. findings in patients undergoing revision Multiple Response Regression for Gaussian Kim GG and many others. Function but not functional endoscopic sinus surgery.Int Forum Mixture Models with Known Labels. Statistical phenotype of melanoma peptide-specific Allergy Rhinol. 2013. Feb;3(2):139-146. Analysis and Data Mining. 2012 Dec;5(6):493- CD8+ T cells correlate with survival in a multi- 508. No PMID available. epitope peptide vaccine Trial (ECOG 1696). Thorp BD, Mckinney KA, Rose AS, Ebert CS Jr. International Journal of Cancer. 2012 Aug Allergic fungal sinusitis in children. Otolaryngol Zanation AM, Hayes N, Weissler M 15;131(4):874-84. Clin North Am. 2012 Jun;45(3):632-642. and many others. Management of nonesthesioneuroblastoma sinonasal Kimbell, JS, Frank, DO, Laud, P, Garcia, GJM, 150 and Rhee, JS. Changes in nasal airflow rescue flap technique. Otolaryngology--head between genetic polymorphisms and smoking and heat transfer correlate with symptom and neck surgery : official journal of American among controls in two population-based improvement after surgery for nasal Academy of Otolaryngology-Head and Neck studies. Int J Mol Epidemiol Genet. 3:333-60, obstruction. Submitted, 6/6/2013. Surgery. 2012;147(3):434-7. PMID: 22492297 2012.

Wofford, MR, Kimbell, JS, Frank, DO, Kimple AJ and many others. Structural hao N, Ang MK, Yin XY, Patel MR, Hackman Dhanda, V, McKinney, KA, Fleishman, GM, Determinants of RGS-RhoGEF Signaling Critical T, Zanation AM, Shockley WW, Weissler Ebert, CS, Zanation, AM, and Senior, BA. A to Entamoeba histolytica Pathogenesis. MC, Shores CG, Olshan AF, Hayes DN and computational study of functional endoscopic Structure. 2013;21(1):65-75. PMID: 23260656 many others. Different Cellular p16INK4a sinus surgery and maxillary sinus drug Localization may Signal Different Survival delivery. Submitted, 5/13/2013. Kimple AJ, Torres AD, Yang RZ, Kimple RJ. HPV- Outcomes in Head and Neck Cancer. British J

Publications associated head and neck cancer: molecular Cancer, Jun 26. Epub ahead of print, 2012. Frank, D, Zanation, A, Dhanda, V, McKinney, and nano-scale markers for prognosis and K, Ebert, C, Senior, B, and Kimbell, J. therapeutic stratification. Sensors (Basel). Olshan AF and many others. the National Quantification of airflow into the maxillary 2012;12(4):5159-69. PMID: 22666080 Birth Defects Prevention Study: Maternal sinuses before and after functional endoscopic occupation and the risk of major birth defects: sinus surgery. In press, International Forum of Kimple AJ and many others. Comparative A follow-up analysis from the National Birth Allergy & Rhinology, 6/18/2013. Effectiveness of Treatments. Comparative Defects Prevention Study. Int J Hyg Environ Effectiveness Review No. 101. (Prepared by Health. 2012 Jun 11. [Epub ahead of print] Schroeter, JD, Kimbell, JS, Asgharian, B, the RTI-UNC Evidence-based Practice Center Tewksbury, EW, Sochaski, M, Foster, ML, under Contract No. 290-2007-10056-I.) AHRQ Stingone JA, Funkhouser WK, Weissler MC, Dorman, DC, Wong, BA, and Andersen, ME. Publication No. 13-EHC091-EF. Rockville, MD: Bell ME, Olshan AF. Racial differences in the Inhalation dosimetry of hexamethylene Agency for Health care Research and Quality; relationship between tobacco, alcohol, and diisocyanate vapor in the rat and human 2013. squamous cell carcinoma of the head and respiratory tracts. Inhal. Toxicol. 25(3):168-177. neck. Cancer Causes and Control. 2012 Jun 7. Kimple AJ, Ishman SL. Allergy and sleep- [Epub ahead of print] Cannon, DE, Frank, DO, Kimbell, JS, Poetker, disordered breathing. Current opinion in DM, and Rhee, JS. Modeling nasal physiology otolaryngology & head and neck surgery. 2013. Weissler MC, Olshan AF and many others. changes due to septal perforation. Otolaryngol PMID: 23619424 Health-related quality of life differences Head Neck Surg. 148(3):513-518. between African-Americans and non-Hispanic Kimple AJ, Ishman SL. Treacher Collins whites with head and neck cancer. Head Neck. Kimbell, JS and many others. Development Syndrome. 2013. In: Clinical Decision Support: Aug 21. doi: 10.1002/hed.23115. [Epub ahead of a rhesus monkey lung geometry model Pediatrics [Internet]. Wilmington, DE.: of print], 2012. and application to particle deposition in Decision Support in Medicine, LLC. comparison to humans. Inhal. Toxicol. Olshan AF and many others. Mammographic 24(1):869-899. Siderovski DP, Kimple AJ. Regulator of density and breast cancer risk in White and G-Protein Signaling (RGS) Protein Family. African American Women.Breast Cancer Res Kimple AJ and many others. Heterotrimeric In: Choi S, editor. Encyclopedia of signaling Treat. 2012 Aug 3. [Epub ahead of print] G-protein signaling is critical to pathogenic molecules. New York, New York: Springer; 2013 processes in Entamoeba histolytica. PLoS Olshan AF and many others. Diabetes and pathogens. 2012;8(11):e1003040. PMID: Manis PB and many others. Polysialylated Obesity-Related Genes and the Risk of Neural 23166501 NCAM and EphrinA/EphA Regulate Synaptic Tube Defects in the National Birth Defects Development of GABAergic Interneurons in Prevention Study. Am J Epidemiol. 2012 Nov 6. Kimple AJ and many others. A P-loop Prefrontal Cortex.. Cereb Cortex. Jan;23(1):162- [Epub ahead of print] mutation in Galpha subunits prevents 77. 2013 Epub 2012 Jan 23. PMID: 22275477 transition to the active state: implications for Olshan AF and many others. Polymorphisms in G-protein signaling in fungal pathogenesis. Xie, R, Manis, PB. Target-specific IPSC kinetics oxidative stress genes, physical activity, and PLoS pathogens. 2012;8(2):e1002553. PMID: promote temporal processing in auditory breast cancer risk. Cancer Causes Control. 22383884 parallel pathways. Journal of Neuroscience 23(12):1949-58, 2012. 2013 Jan 23;33(4):1598-614, 2013. [this paper Kimple AJ and many others. Regulator of was also highlighted in “This Week in the Olshan AF and many others. Genome-wide G-protein signaling-21 (RGS21) is an inhibitor Journal”] association study of periodontal pathogen of bitter gustatory signaling found in lingual colonization. J Dent Res. 91(7 Suppl):21S-28S, and airway epithelia. The Journal of biological Xie, R, Manis, PB. Glycinergic synaptic 2012. chemistry. 2012;287(50):41706-19. PMID: transmission in the cochlear nucleus of mice 23095746 with normal hearing and age-related hearing Olshan AF and many others. Children’s loss. Journal of Neurophysiology (in Press, 25 Oncology Group’s 2013 blueprint for research: Kimple AJ, Eliades S, Richmon J. Transoral July 2013). Epidemiology. Pediatr Blood Cancer. 2012 Dec robotic resection of a lingual thyroglossal 19. doi: 10.1002/pbc.24434. [Epub ahead of duct cyst. Journal of Robotic Surgery. Weissler MC, Olshan AF and many others. print] 2012;6(4):367-9. Associations Between Dietary Patterns and Head and Neck Cancer: The Carolina Head Funk WE, McGee JK, Olshan AF, Ghio AJ. Kimple AJ, Leight WD, Wheless SA, Zanation and Neck Cancer Epidemiology Study. Am J Quantification of arsenic, lead,mercury and AM. Reducing nasal morbidity after skull Epidemiol. 175:1225-33, 2012. cadmium in newborn dried blood spots. base reconstruction with the nasoseptal flap: Biomarkers. 18(2):174-7, 2013. free middle turbinate mucosal grafts. The Olshan AF and many others. Genome-wide Laryngoscope. 2012;122(9):1920-4. PMID: association study of periodontal pathogen Olshan AF and many others. Exploring the 22926937 colonization. J Dent Res. Jul;91(7 Suppl):S21-8, genetic basis of chronic periodontitis: a 2012. genome-wide association study. Hum Mol Rawal RB, Kimple AJ, Dugar DR, Zanation AM. Genetics. [IF: 7.636] In press Minimizing morbidity in endoscopic pituitary Olshan AF and many others. The case-only surgery: outcomes of the novel nasoseptal independence assumption: associations Yin X, Weissler MC, Shockley WW, Zanation 151 AM, Hackman T, Olshan AF, Shores CG, Hayes Chronic rhinosinusitis in children. Pediatric Clin to listen. submitted, 28 pages. DN and many others. Molecular subtypes in North Am. 60(4):979-991, 2013 Aug. head and neck cancer exhibit distinct patterns Buss, E, Hall, JW, Porter, HL, and Grose, JH. of chromosomal gain and loss of canonical McCreery, RW, Bentler, RA, Roush, PA. The Gap detection in school-aged children and cancer genes.PLoS One. 2013;8(2):e56823. doi: characteristics of hearing aid fittings in infants adults: Effects of inherent envelope modulation Publications 10.1371/journal.pone.0056823. Epub 2013 Feb and young children. Ear Hear. 2013 Apr 10. and the availability of cues across frequency. 22. [Epub ahead of print] Journal of Speech, Language and Hearing Research, submitted, 31 pages. Olshan AF and many others. Periconceptional Walker, EA, Spratford, M, Moeller, MP, Oleson, maternal alcohol consumption and neural tube J, Oua, H, Roush, P, Jacobs, S. Predictors of Buss, E, Taylor, C, and Leibold, LJ. Limits defects. Birth Defects Res A Clin Mol Teratol. Hearing Aid Use Time in Children with Mild- to frequency discrimination in school-aged 2013 Mar 4. doi: 10.1002/bdra.23122. [Epub Severe Hearing Loss. Lang Speech Hear Serv children.Journal of Speech, Language and ahead of print] Sch, 2013 Jan; 44(1): 73-88 Hearing Research, in preparation.

Olshan AFand many others. Maternal Holte, L, Walker, E, Oleson, J, Spratford, M, Calandruccio, L, Buss, E, and Hall, JW. Effects DietaryPatterns are Associated With Risk of Moeller, MP, Roush, P, Ou, Hua, Tomblin, J. of linguistic experience on the ability to benefit Neural Tube and Congenital Heart Defects. AmJ Factors Influencing Follow-up to Newborn from temporal and spectral modulation. Epidemiol. 2013 May 2. [Epub ahead of print] Hearing Screening for Infants who are Hard- Journal of the Acoustical Society of America, in of-Hearing. The American Journal of Audiology, preparation. Weissler MC, Olshan AF and many others. 2012 Dec; 21(2): 163-74 Effects of polymorphisms in alcoholmetabolism Hall, JW, Buss, E, and Grose, JH. Development and oxidative stress genes on survival from O’Neil JT, Mims JW. Allergic Rhinitis - Chapter of speech glimpsing in synchronously and head and neck cancer.Cancer Epidemiol. 29, Byron J. Bailey’s Otolaryngology – Head asynchronously modulated noise. Journal of the and Neck Surgery. 2013 Acoustical Society of America, in preparation.

Pike JM, Choudhury B, Awan O, Adunka OF, Buchman CA, and Fitzpatrick DC. Effects of In Press or Submitted Intracochlear Trauma on Hearing Outcomes in Papers/Articles Normal Hearing Gerbils and Gerbils with Noise Dillon, MT, Buss, E, Pillsbury, HC, Induced Hearing Loss. Submitted to Ear and Adunka, OF, Buchman, CA, and Hearing. Adunka, MC. Effects of hearing aid settings for electric-acoustic Weissler M, Shores C, Shockley W, Hackman stimulation. Journal of the American T, Zanation A, Hayes DN, Weiss J, and many Academy of Audiology, in press. others. Clinical Significance of Indeterminate Pulmonary Nodules in Patients with Locally Grose, JH, Buss, E, Porter, HL, and Advanced Head and Neck Squamous Cell Hall, JW. Across-frequency envelope Carcinoma. 2013. Head & Neck, accepted. correlation and masked signal detection. Journal of the Acoustical Street, SE, Montey, KL, Ryugo, DK, Manis, Society of America, in press. PB. Identification of transient potassium conductances regulating the discharge pattern 2013 Apr 27. doi:pii: S1877-7821(13)00043-X. Leibold, LJ, and Buss, E. Children’s of dorsal cochlear nucleus pyramidal cells. 10.1016/j.canep.2013.03.010. [Epub ahead of identification of consonants in a speech- Journal of Neurophysiology (in revision). print] shaped noise or a two-talker masker. Journal of Speech, Language and Hearing Research, Mancilla, JM, Manis, PB. Gain Control by a Choi J, Cai J, Zeng D, Olshan AF. Joint Analysis submitted, 27 pages. Sodium Activated Potassium Conductance. of Survival Time and Longitudinal Categorical Journal of Neurophysiology. In revision, Outcomes. Statistics in Biosciences, In Press. Baker, M, Buss, E, Jacks, A, Taylor, C, and Leibold, LJ. Children’s perception of speech Campagnola, L and Manis, PB. Patch Olshan A and many others. Incidence and produced in a two-talker background. Journal Clamp Recording in Brain Slices. In: Basic Timing of Cancer in HIV-Infected Individuals of Speech, Language and Hearing Research, Electrophysiological Methods”, Covey, E. Following Initiation of Combination submitted, 39 pages. and Carter, M. Eds. Oxford University Press. Antiretroviral Therapy. Clin Infect Dis. 2013 Jun (Submitted, 12/2012). 4. [Epub ahead of print] Bonino, AY, Leibold, LJ, and Buss, E. Effect of signal-temporal uncertainty during childhood: Farag AA, Deal AM, McKinney KA, Thorp BD, Weissler MC, Olshan AF and many others. Detection of a tonal signal in a random- Senior BA, Ebert CS, Zanation AM. Single Single Nucleotide Polymorphisms in Nucleotide frequency, two-tone masker. Journal of the blind randomized controlled trial of surfactant Excision Repair Genes, Cigarette Smoking, and Acoustical Society of America, submitted, 47 vs hypertonic saline irrigation following the Risk of Head and Neck Cancer. Cancer pages. endoscopic endonasal surgery. Int Forum Epidemiol Biomarkers Prev. 2013 May 29. [Epub Allergy Rhinol. 2012 Nov 20. Doi: 10.1002/ ahead of print] Hillock-Dunn, A, Buss, E, Duncan, N, Roush, alr.21116. [Epub ahead of print] P A, and Leibold, LJ. Effects of nonlinear Olshan AF and many others. Cigarette, frequency compression on speech identification Gore MR, Ebert CS, Zanation AM, Senior Cigar, and Pipe Smoking and the Risk of in children with hearing loss. Ear and Hearing, BA. Beyond the “central sinus”: radiographic Head and Neck Cancers: Pooled Analysis submitted, 42 pages. findings in patients undergoing revision in the International Head and Neck Cancer functional endoscopic sinus surgery. Int Forum Epidemiology Consortium. Am J Epidemiol. 2013 Bonino, AY, Leibold, LJ, and Buss, E. Benefit of Allergy Rhinol. 2012 Nov 5. Doi: 10.1002/ Jun 30. [Epub ahead of print] a carrier phrase for target word recognition in alr.21079. [Epub ahead of print] a two-talker masker: Contributions of auditory Rose AS, Thorp BD, Zanation AM, Ebert CS. stream segregation and knowing when in time Senior BA and many others. Evaluation of high resolution gel beta 2 transferrin for detection 152 of cerebrospinal fluid leak. Clin Chem Lab Med. cyclophosphamide in children with endemic ear inverted papilloma. Laryngoscope. 2012 2012 Sep 28;0(0):1-5. Doi: 10.1515/cclm-2012- Burkitt lymphoma in Malawi. Clinical Aug; 122 (8):1674-8. doi: 10.1002/lary.23333. 0408. [Epub ahead of print] Lymphoma, Myeloma & Leukemia 2012 Epub Epub 2012 May 7. No abstract available. ahead of print PMID:23260601 PMID: 22565660. Senior BA and many others. Classification of antineutrophil cytoplasmic autoantibody Shores CG and many others. Addressing Zdanski CJ and many others. Identification vasculitides: the role of antineutrophil Malawi’s surgical workforce crisis: A of Effective Strategies to Promote Language cytoplasmic autoantibody specificity for sustainable paradigm for training and in Deaf Children with Cochlear Implants. myeloperoxidase or proteinase 3 in disease collaboration in Africa. Surgery. 2012 Oct 11. Child Dev. 2013 Mar-Apr;84(2):543-59.doi: recognition and prognosis. Arthritis Rheum. pii: S0039-6060(12)00445-X [Epub ahead of 10.1111/j.1467-8624.2012.01863.x.Epub 2012 2012 Oct;64(10):3452-62 print] PMID:23063312 Sep 24. PMID:23002910 Publications Hua X, Naselsky WC, Bennett WD, Ledent Yirmibesoglu E, Fried D, Shores C, Rosenman Neubauer P, Swibel-Rosenthal LH, Wooten III C, Senior BA, Tilley SL. Adenosine increases J, Weissler M, Hackman T, Chera BS. Incidence WI, Zdanski CJ, Drake AF. The Role of Direct nasal mucociliary clearance rate in mice of Subclinical Nodal Disease at the Time of Laryngoscopy in the Diagnosis of Laryngeal through A(2A) and A(2B) adenosine receptors. Salvage Surgery for Locally Recurrent Head and Cleft. Open Journal of Pediatrics (OJPED). Laryngoscope. 2012 Sept 10. Doi: 10.1002/ Neck Cancer Initially Treated With Definitive 2013 March; ID: 1330196. lary.23586. [Epub ahead of print] Radiation Therapy. Am J Clin Oncol. 2012 Jul 9. [Epub ahead of print] PMID:22781386 Zdanski CJ and many others. Effects of Senior BA and many others. European position Maternal Sensitivity and Cognitive and paper on rhinosinusitis and nasal polyps 2012. Yin XY, Patel MR, Hackman T, Zanation AM, Linguistic Stimulation on Cochlear Implant Rhinol Suppl. 2012 Mar;(23): 3, 1-298 Shockley WW, Weissler MC, Shores CG, Olshan Users’ Language Development Over Four AF, Hayes DN and many others. Different Years. J Pediatr. 2013 Feb;162(2):343-8.e3. doi: Senior BA and many others. Antimicrobials cellular p16(INK4a) localisation may signal 10.1016/j.jpeds.2012.08.003. Epub 2012 Sep and chronic rhinosinusitis with or without different survival outcomes in head and neck 14. PMID:22985723. polyposis in adults: an evidence-based review cancer. Br J Cancer. 2012 Jul 24;107(3):482-90 with recommendations. Int Forum Allergy PMID:22735904 Hang AX, Kim GG, Zdanski CJ. Cochlear Rhinol.2012 Jun 26. Doi: 10.1002/alr.21064. Implantation in Unique Pediatric Populations. [Epub ahead of print] He,S, Grose, JH, Teagle, HFB, Buchman, CA. Current Opinion in Otolaryngology & Head Electrically evoked cortical responses in and Neck Surgery. 2012 Dec;20(6):507-17. Senior BA and many others. Interrater children with auditory neuropathy spectrum doi:10.1097/MOO.obo13e328359eea4. agreement of nasal endoscopy in patients with Disorder. Ear & Hearing, May 29 PMID:23128686. a prior history of endoscopic sinus surgery. Int Forum Allergy Rhinol. 2012 Jun 13. Doi: Ahmad, FI, DeMason, CE, Teagle, HFB, Zdanski CJ, White D. Child with Sudden Onset 10.1002/alr.21058. [Epub ahead of print]. Henderson, LH, Adunka, OF and Buchman, CA. of Drooling. AAO-HNSF Patient Management Cochlear Implantation in Children with Post- Perspectives in Otolaryngology (PMP). Shah RN, Deal AM, Buckmire RA. Multi- Lingual Hearing Loss. Laryngoscope, 122(8): Hamilton, Ontario: Decker Publishing. 2012 dimensional voice outcomes after Type I gore- 1852-7. Sep; 41:6. tex thyroplasty in patients with non-paralytic glottic incompetence: a subgroup analysis. Rawal RB, Gore MR, Harvey RJ, Zanation AM. Adunka OF, Teagle HF, Zdanski CJ, Buchman Laryngoscope. 2013 Jul; 123(7):1742-5. Evidence-based practice: endoscopic skull CA. Influence of an Intraoperative Perilymph base resection for malignancy. Otolaryngol Gusher on Cochlear Implant Performance in Rawal RB, Shah RN, Zanation AM. Endonasal Clin North Am. 2012 Oct;45(5):1127-42. doi: Children With Labyrinthine Malformations. Otol odontoidectomy for basilar impression and 10.1016/j.otc.2012.06.013. PubMed PMID: Neurotol. 2012 Sep 19. PMID: 22996156. brainstem compression due to radiation 22980689. fibrosis. Laryngoscope. 2013 Mar; 123(3):584-7. Shadfar S, Drake AF, Vaughn BV, Zdanski CJ. Kimple AJ, Leight WD, Wheless SA, Zanation Pediatric Airway Abnormalities: Evaluation and Weissler M, Shores C, Shockley W, Hackman T, AM. Reducing nasal morbidity after skull base Management. Oral Maxillofac Surg Clin North Zanation A, Hayes DN and many others. Clinical reconstruction with the nasoseptal flap: Free AM. 2012 Aug; 24(3):325-36. Epub 2012 Jun 1. Significance of Indeterminate Pulmonary middle turbinate mucosal grafts. Laryngoscope. PMID:22658604. Nodules in Patients with Locally Advanced 2012 Sep;122(9):1920-4. doi: 10.1002/ Head and Neck Squamous Cell Carcinoma 2013 lary.23325. Epub 2012 Aug 1. PubMed PMID: Zdanski CJ and many others. Language Head & Neck, accepted 22926937. and Behavioral Outcomes in Children with Developmental Disabilities Using Cochlear Weissler M, Shores C, Zanation A, Hackman Rawal RB, Kimple AJ, Dugar DR, Zanation AM. Implants. Otol Neurotol. 2012 Jul; 33 (5):751- T, Shockley W, Hayes N and many others. Minimizing Morbidity in Endoscopic Pituitary 60. PMID: 22699986. Prognostic significance of bone invasion for Surgery: Outcomes of the Novel Nasoseptal oral cavity squamous cell carcinoma considered Rescue Flap Technique. Otolaryngol Head Neck T1/T2 by AJCC size criteria. Head & Neck. 2013 Surg. 2012 Sept; 147 (3) 434-7. Epub 2012 Apr 6. Instructional Websites Apr 25 [Epub ahead of print] PMID:23616341 PMID: 22492297. Teagle, HFB. Cochlear Implantation for Children: Opening Doors to Opportunity. Xiaoying Yin, X, Weissler MC, Shockley WW, Zanation AM, Hayes N, Weissler M Journal of Child Neurology. 27(6), 824-826. Zanation AM, Hackman T, Olshan AF, Shores and many others. Management of CG, Hayes DN and many others. Molecular nonesthesioneuroblastoma sinonasal subtypes in head and neck cancer exhibit malignancies with neuroendocrine distinct patterns of chromosomal gain differentiation. Laryngoscope. 2012 Aug 9. doi: and loss of canonical cancer genes. PLoS 10.1002/lary.23463. PubMed PMID: 22886723. One 2013;8(2):e56823. Epub 2013 Feb 22 PMID:23451093 Mitchell CA, Ebert CS, Buchman CA, Zanation AM. Combined transnasal/transtemporal Shores CG and many others. Phase I clinical management of the eustachian tube for middle trial of valacyclovir and standard of care 2013 Annual Report Produced by UNC-CH Dept of OHNS

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About the Cover 2013 OHNS resident graduate, Yu-Tung Wong, honed his skills this year in the new Temporal Bone Lab and Boy Hears His Simulation Center in Thurston Bowles. Father’s Voice For The First Time

t was a story that captivated the I world and became a viral online Len and Grayson Clamp with Dr. Craig Buchman after his spring 2013 ABS surgery. sensation. It quickly became the most shared and viewed report ever The surgery, performed by Craig Buchman, MD, Professor produced by UNC Health Care: the story of Grayson Otolaryngology/Head and Neck Surgery, and Matthew Clamp, the 3-year-old boy from Charlotte, North Ewend, MD, Chair, Department of Neurosurgery, is Carolina, who heard his father’s voice for the first time. the first of its kind performed in the United States as In the Spring of 2013, Grayson was among the first to part of an FDA-approved investigational device. have an auditory brain stem implant done as part of an “Seeing him respond, that had a lot of feelings for me,” FDA-approved said Dr. Buchman. “I investigational “He looked deep into my eyes. He was hearing felt like there was a device surgery my voice for the first time. It was phenomenal.” potential that we were at UNC - Len Clamp, Grayson Clamp’s father effectively changing the Hospitals. world in some ways.” The video produced by UNC Health Care has garnered more The device than 1.3 million views, and Grayson has been featured Grayson received was originally used for patients on many major news programs such as CNN, Today with deafness due to auditory nerve tumors, Show, Anderson Cooper 360, and CBS Evening News. which impacts hearing. The device is now being considered to help restore hearing in children. Grayson was born with no cochlear nerves and as a result could not hear. Grayson is beginning to understand that sound is meaningful. He is pairing sound with visual “I’ve never seen a look like that today,” said Grayson’s information and using it for communication. He is father, Len Clamp, of the day that the implanted also beginning to understand phrases and words. device was turned on for the first time. “I mean, he looked deep into my eyes. He was hearing my Turn to page 8 for a message from the Clamps. voice for the first time. It was phenomenal.” To see the CBS Evening News’ six-month update about Grayson, and the video that started it all, please visit go.unc.edu/Mz8i3 Department of Otolaryngology/Head and Neck Surgery of Otolaryngology/Head Department DEPARTMENT OF OTOLARYNGOLOGY / HEAD AND NECK SURGERY

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Annual Report

Annual Report 2013 Annual Report 2013

2013 Resident Graduates Jessica K. Smyth, MD Yu-Tung Wong, MD Scott A. Shadfar, MD Mihir R. Patel, MD