(page 12) uncover anew potentialcause cochlear synaptopathy, scientists A decadeafterthediscovery of A 10-Year Journey HIDDEN HEARINGLOSS: HARVARD Otolaryngology Department of Otolaryngology–Head andNeckSurgery Otolaryngology–Head of Department FROM THE NEWS Depart Head and NeckSurgery ment of HARVARD SCHOOL MEDICAL

Otola ry ngolog y

FALL 2019 VOL. 16, NO. 2 HARVARD Otolaryngology Contents

News from the Harvard Medical School Department of Otolaryngology–Head and Neck Surgery

Fall 2019 Vol. 16, No. 2 1 Letter from the Chair Published twice per year. D. Bradley Welling, MD, PhD, FACS

Please send comments, requests for additional 2 P01 Grant Awarded for copies, and other inquiries regarding this issue to: Head and Neck Cancer Mary Yaeger Massachusetts General Hospital and Massachusetts Communications Manager Eye and Ear receive a P01 grant from the NIH/NCI Department of Otolaryngology–Head and Neck Surgery for head and neck cancer translational research Massachusetts Eye and Ear 243 Charles Street, Boston, MA 02114 4 Saving Voices with Silk 617-573-3656 | [email protected] A new FDA-approved silk-based product may offer hope for long-term voice restoration

8 Is Tongue-Tie Surgery Always Necessary? Contributors New research questions whether too many infants are receiving tongue-tie surgery to improve Editor-in-Chief breastfeeding D. Bradley Welling, MD, PhD, FACS

Walter Augustus Lecompte Professor and Chair Department of Otolaryngology–Head and Neck Surgery 12 Hidden Hearing Loss: A 10-Year Journey A decade after the discovery of cochlear Harvard Medical School synaptopathy, scientists uncover a new Chief of Otolaryngology–Head and Neck Surgery potential cause Massachusetts Eye and Ear Massachusetts General Hospital 16 Graduation and Annual Meeting Managing Editor/Writer Mary Yaeger 19 New Trainees Design/Layout/Photography 20 Alumni Profiles Garyfallia Pagonis Paul E. Hammerschlag, MD, FACS, Class of 1977 Cover design by Garyfallia Pagonis Lara A. Thompson, PhD, Class of 2013

22 Alumni Giving Society

23 Highlights Department of Otolaryngology Head and Neck Surgery 26 Research Advances Massachusetts Eye and Ear Beth Israel Deaconess Medical Center Boston Children’s Hospital Brigham and Women’s Hospital Massachusetts General Hospital

©2019, Massachusetts Eye and Ear Dear colleagues and friends, Letter from the Chair from the Letter his year marks my five-year anniversary as Chief of Otolaryngology–Head and Neck Surgery at Harvard Medical School. As I reflect on the past five years, I am grateful for Tthe opportunities we have been given and for the progress we’ve seen. Building upon our foundation in medical education, research, and clinical care, our faculty base and residency program have grown, new fellowship programs have been introduced, many high-level National Institutes of Health (NIH) grants have been awarded, new research endeavors have begun, and our affiliate hospitals have continued to be recognized by U.S. News & World Report as leaders. It’s been a wonderful five years, and I am looking forward to what the next five will bring.

Also celebrating a milestone year is the discovery of cochlear synaptopathy. It’s been 10 years since M. Charles Liberman, PhD, and Sharon G. Kujawa, PhD, of the Eaton-Peabody Laboratories at Massachusetts Eye and Ear/Harvard Medical School, described this phenomenon, which is commonly known as “hidden hearing loss.” In our cover story starting on page 12, we discuss the progress that has been made in understanding this condition, including a recent study that reveals that conductive hearing loss may be a potential cause of cochlear synaptopathy.

In this issue, we also highlight an NIH P01 grant awarded to our head and neck team to explore immunotherapy as it relates to head and neck cancer, a new silk-based product for voice restoration, and a study questioning if tongue-tie surgery is always the best option for improving breastfeeding.

We’re excited to share with you more about our research advances and current progress across the field. Thank you for your interest in and support of the department’s activities.

Sincerely,

D. Bradley Welling, MD, PhD, FACS

Walter Augustus Lecompte Professor and Chair Department of Otolaryngology–Head and Neck Surgery Harvard Medical School

Chief of Otolaryngology–Head and Neck Surgery Massachusetts Eye and Ear Massachusetts General Hospital

1 NEWS P01 Grant Awarded for Head and Neck Cancer

Massachusetts General Hospital and Massachusetts Eye and Ear receive a P01 grant from the NIH/NCI for head and neck cancer translational research

he head and neck cancer program at Massachusetts For decades, clinicians have sought ways to improve survival rates General Hospital and Massachusetts Eye and Ear has and have recently found promise in immunotherapy, a treatment T received its first Program Project (P01) grant from the that uses the body’s natural defenses to fight off diseased cells. National Institutes of Health (NIH) and National Cancer Institute (NCI). This $10.9M grant aims to better understand how cancer “Your immune system is the first line of defense that protects cells in the head and neck evade recognition by the immune you from harmful infections and the growth of abnormal system and, in turn, use that knowledge to develop novel therapies cells,” said Sara I. Pai, MD, PhD, FACS, Associate Professor of that reactivate an immune response against cancer cells. Surgical Oncology at Harvard Medical School and Director of Translational Research in Head and Neck Cancer at Mass General. Head and neck squamous cell carcinomas (HNSCCs) are a “Immunotherapy harnesses the body’s natural cells to eradicate worldwide public health problem—they’re the sixth most cancer. It’s one of the most personalized forms of cancer care common malignancy in the world. The standard treatment is a available.” combination of surgery, radiation, and/or chemotherapy. While these can be successful, current survival rates range anywhere As a result of new immunotherapy drugs, the overall survival from 30 to 70 percent. When primary therapies fail and disease rate of HNSCC has recently been impacted for the first time in 50 recurs, HNSCC patients then have limited effective treatment years. On June 10, 2019, the U.S. Food and Drug Administration options. (FDA) approved immunotherapy as a first-line treatment for

2 HARVARD Otolaryngology recurrent and/or metastatic head and neck cancer based on the define the relevant crosstalk needed between macrophages and P01 Grant Awarded for promising results of the phase III KEYNOTE-048 clinical trial. T cells, which translates into improved clinical responses. “Immunotherapy is one of the biggest breakthroughs in head Two cores, led by Dr. Lin, Peter M. Sadow, MD, PhD, and William and neck cancer,” said Derrick T. Lin, MD, FACS, Daniel Miller C. Faquin, MD, PhD, of Mass General, and Maureen A. Sartor, Head and Neck Cancer Associate Professor of Otolaryngology–Head and Neck Surgery at PhD, of the University of Michigan Medical School, will support Harvard Medical School and Director of Head and Neck Surgical these three projects. Oncology at Mass. Eye and Ear. These projects will leverage Mass General and Mass. Eye and Although the approval of this treatment is an exciting step forward, Ear expertise in head and neck oncology, cancer immunology, just a small subset of HNSCC patients benefit from it at this time. genomics, epigenomics, and bioinformatics. This knowledge, Today’s success rate with immunotherapy is only 15 to 20 percent in combination with the high patient volumes and innovative because some patients develop resistance to the therapy while technology at both institutions, uniquely positions the team to others have no response at all. find ways to better utilize immunotherapy in patients with head and neck cancer. Bringing together a multidisciplinary team of experts, Paul M. Busse, MD, PhD, and Lori J. Wirth, MD, of Mass General, “We are so grateful for this opportunity,” said Dr. Lin. “With are leading a group alongside Dr. Lin and Dr. Pai with plans to our systematic approach, we strongly believe our team will tackle the two main barriers to achieving clinical response with be able to increase survival rates for head and neck cancer immunotherapy: (1) the tumor’s overall poor antigenicity, which patients. Immunotherapy may only work for one in five limits the generation of antitumor immunity, and (2) innate HNSCC patients now, but we don’t intend to stop until all and adaptive immune suppressive mechanisms that can lead to patients derive benefit.” l immune tolerance. “By gaining further insight into both of these mechanisms of immune resistance, we have the potential to overcome them The generosity of patients, the Mike Toth Head and Neck Cancer Research Center at Mass. Eye and Ear, and other grateful donors helped support the infrastructure for through the rational design of novel combinatorial strategies, the tissue collection and subsequent translational investigation and discovery that which can ultimately increase the number of head and neck competitively positioned this group to apply for and secure such a prestigious grant. cancer patients who respond to immunotherapy,” said Dr. Pai. The team will address these barriers through three interrelated projects. The first project, led by Dr. Pai, will investigate epigeneti- cally reprogramming head and neck cancers to improve their recognition by the immune system. The second project will focus on redirecting pre-existing viral-specific T cells to tumors through antibody-peptide epitope conjugate (APEC) molecules, co-led by Robert M. Anthony, PhD, and Thorsten R. Mempel, MD, PhD, of the Mass General Cancer Center. Lastly, a project led by Mikael J. Pittet, PhD, of the Mass General Center for Systems Biology, will From left to right: Drs. Paul Busse, Lori Wirth, Derrick Lin, Sara Pai, and Peter Sadow.

HARVARD Otolaryngology 3 FEATURE

Saving Voices with

A new FDA-approved silk-based SILKproduct may offer hope for long-term voice restoration

The highly porous, sponge-like micro-particles are engineered for cellular integration, a process that is critical for Silk microparticles (red) long-term serve as scaffolding for new voice restora- collagen production (blue), tion and for providing the opportunity mitigation of for long-lasting remediation. product migration tendency. Artwork provided by Sofregen by provided Artwork

Engineered to reflect the unique biomechanics of vocal fold tissue, silk microparticles offer a novel approach to treating vocal cord insufficiency. 44 HARVARDHARVARD OtolaryngologyOtolaryngology atients who suffer from vocal fold insufficiency, proteins, the constituents to the natural silk fibers used or incomplete closure of the vocal folds during in textiles, as a possible material to restore lost volume P speech, currently have limited long-term treatment in the vocal fold. Working with Dr. Kaplan’s students, Dr. solutions. The only permanent options available to them Carroll has helped explore the properties and potentials involve invasive procedures in the operating room. of silk as a vocal fold augmentation scaffold. Other treatment options include temporary injec- tions into the vocal folds, usually performed in an “Silk proteins incorporated into a outpatient setting. Often using materials such as novel vocal fold injection augmen- carboxymethylcellulose, hyaluronic acid, or calcium tation material may provide the hydroxylapatite, these injections are successful at longevity and tissue integration restoring the voice, but in most cases, wear off in 18 that can afford permanent voice months or less. restoration through an ‘off-the- “Once the effect fades, patients must return to the shelf’ material.” doctor for more injections or opt for surgery,” said —Dr. Carroll Thomas L. Carroll, MD, Assistant Professor of Otolaryngology–Head and Neck Surgery at Harvard Medical School and Director of the Voice Program at Silk, which silkworms and spiders produce, is most Brigham and Women’s Hospital. “For some patients, commonly known for its use in clothing. In nature, this is a reasonable option. However, for most, a it begins as a liquid before turning into a thread to permanent option that does not require a trip to the make a protective cocoon. In this native form, the silk operating room is desired.” fibers demonstrate high tensile strength and ductility, Clinicians and scientists are seeking a more permitting fibers to stretch without breaking. As a result, permanent solution to treating vocal fold insufficiency, silk fibers have traditionally been used in medicine, but most biologically relevant materials present two types most commonly as a suture material due to their natural of challenges. Typically, they either do not stay in the toughness and biocompatibility. body long enough, or they cannot inherently promote Unlike other materials, silk can be manipulated tissue growth in or around the material—both key to change with applied outside stimuli such as heat, contributors to longer lasting effects. electricity, or, in cases involving the voice, vibration. Over the past decade, Dr. Carroll has collaborated It makes it an attractive material for many applications with David L. Kaplan, PhD, of the Kaplan Laboratory for the voice. Because silk proteins create an optimal at Tufts University School of Engineering, to test silk environment for the tissue support and regeneration required in patients with a loss of vocal fold tissue volume or movement, silk demonstrates promise. “The medical field is typically look- ing for longevity in treatments that previously were temporary and did not offer a cure,” said Dr. Carroll. “It’s the same desire for those of us treating vocal fold insufficiency. Silk proteins incorporated into a novel vocal fold injection augmentation material may continued on page 6

Dr. Thomas Carroll demonstrates what an injection will look like for a single surgeon operator.

HARVARD Otolaryngology 5 | Saving Voices with Silk | continued FEATURE

provide the longevity and tissue integration that can without migration at the site of the injection in the afford permanent voice restoration through an ‘off-the- vocal folds in a series of animal studies published in shelf’ material.” The Laryngoscope, which allowed local integration of regenerative cells and collagen within the silk matrix.1 Introducing Silk Voice To make Silk Voice, Sofregen takes traditional, Through his collaboration with Dr. Kaplan, Dr. medical grade silk and reverse engineers it into a liquid Carroll was introduced to Sofregen Medical, Inc., a bio- state. Once the thread is dissolved, it is turned into engineering startup based in Medford, Massachusetts. spherical, porous silk particles. These particles are then This firm is focused on leveraging the regenerative completely cleaned and purified to ensure they are not properties of silk protein to restore tissue volume. Their immunogenic. Finally, the particles are mixed with goal is to reintroduce lost tissue volume in minimally hyaluronic acid, a common substance used for vocal invasive ways. SILKfold and cosmetic facial injections. With similar goals in mind, Dr. Carroll, who is now “We designed the silk particles to be porous and have on the Scientific Advisory Board of Sofregen, combined optimal dimensions for cellular attachment,” said Anh his efforts with them. Together they have developed Hoang, PhD, Co-Founder and Chief Science Officer at Silk Voice, an injectable silk protein and hyaluronic acid Sofregen. “With other products, a significant portion mixture. Although this product has yet to be introduced of the solution moves away from the injection site. Our to humans, the team found that Silk Voice remained product doesn’t do that, which allows for tissue volume to grow.” As a result of this investigational work, the U.S. Food The innovation team behind Silk Voice (from left to right): and Drug Administration (FDA) cleared this product for Drs. Thomas Carroll, Anh Hoang, Joseph Brown, and augmenting vocal fold tissue to improve phonation in Christopher Gulka. humans in January 2019. This marked the first—and currently only—FDA- approved product made from solubi- lized silk protein for medical use. “Our team is extremely pleased to have achieved FDA clearance for our Silk Voice product. This mile- stone provides us with the oppor- tunity to serve clinicians and their patients who seek novel and effective treatment for vocal fold insuffi- ciency,” said Jonathan Hartmann, Sofregen’s incoming Chief Executive Officer.

From bench to bedside With FDA clearance, the product will soon be introduced to human patients through a multicenter clinical study. Although Dr. Carroll and the Sofregen team are not involved in the study design or execution to ensure data integrity, they are excited to see its results.

6 HARVARD Otolaryngology In collaboration with Sofregen, Dr. Carroll is also soon be able to be performed by solo laryngologists and working on a novel delivery system for injecting Silk general otolaryngologists. In addition, the hope is that Voice into the vocal folds in the office setting. This now- Silk Voice’s tissue integration effect will lead to long-term patented device, which is shared between Dr. Carroll volume recovery, providing patients with a functioning and Sofregen, is a new kind of catheter that allows a voice without the need for surgery. single surgeon to inject materials into a patient’s vocal “The idea of using silk for vocal fold augmentation folds through the channel of a flexible scope passed stemmed from an academic basic science laboratory and through the nose and into the throat without the help is now being translated into the clinic where it can have of an assistant. an important impact on patients,” said Dr. Carroll. “Silk “Our hope is that this device provides an opportunity Voice is a great example of science moving from ‘bench for laryngologists, as well as general otolaryngologists, to bedside.’ We may have an opportunity to improve the SILKto treat vocal fold insufficiency. The idea is that clinicians access to treatment and overall care of patients with vocal will be able to deliver this substance using flexible fold insufficiency. I am hopeful when I consider future laryngoscopy skills, which could increase access to this applications of silk in treating more complicated laryngeal procedure in both the outpatient and inpatient settings. conditions.” l This could ultimately restore voice function sooner and in more patients,” said Dr. Carroll. DISCLOSURE Dr. Thomas Carroll shares a patent with Sofregen for the injection The combination of Silk Voice and its novel delivery catheter, is a shareholder in Sofregen, and serves on Sofregen’s Scientific Advisory Board. system has the potential to make vocal cord injection 1Gulka CP, Brown JE, Giordano JEM, et al. A novel silk-based vocal fold augmentation more accessible. A procedure that currently augmentation material: 6-month evaluation in a canine model. requires a trained laryngologist and an assistant may Laryngoscope. 2019 Aug;129(8):1856-1862. doi:10.1002/lary.27618.

(B) By disassembling Silk protein possesses unique and highly beneficial properties for the native fiber down tissue support and regeneration. into its constitutive proteins, ‘regenerated silk,’ i.e., aqueous (C) Aqueous silk solutions are next used to suspension, allows the fabricate highly porous, solid silk micro- opportunity for these particles, which have been engineered to proteins to be rebuilt C match the biomechanics of vocal fold tissue. into novel functional morphologies.

B

(A) The design pathway of the Silk Voice injectable begins with highly pure, medical grade silk protein fibers. Silk as a structural protein has highly advantageous properties for tissue support and regeneration, providing strength and D facilitating tissue ingrowth as it slowly reabsorbs in the body. (D) In the final formulation, silk microparticles are suspended into a crosslinked hyaluronic acid A carrier. A novel catheter was designed to deliver the silk microparticles through the working channel of a flexible endoscope, offering a bird’s- eye view during vocal fold injection and allowing the physician to perform the procedure unassisted.

HARVARD Otolaryngology 7

FEATURE 8 HARVARD Otolaryngology improve breastfeeding infants are to receiving tongue-tie surgery New research questionswhethertoomany Always Necessary Surgery Is Tongue-Tie ?

reastfeeding is developmentally important for newborns, but it doesn’t come easy for all. B Although it is recommended by several health organizations worldwide as the preferred infant feeding method, many mother-newborn dyads are having difficulty making breastfeeding successful due to latching trouble, limited weight gain, and mothers experiencing pain during the process. Tongue-tie and/or lip tether might be one of the causes of such difficulties. Both are conditions present at birth that restrict the tongue’s and lip’s range of motion, which can affect how a child eats and swallows. New parents often seek consultation if tongue-tie or lip tether are reported, as surgery to release tissue restriction is typically suggested. Known as a frenu- lectomy, this standard procedure removes the tissue bands that keep the tongue from moving freely or the lip from optimal position for latching. Many children have tissue that connects too tightly from the tongue to the “We have seen the number floor of the mouth, while others have a tight tissue under of tongue-tie and upper lip the lip connected to their upper gum. tether release surgeries increase Some doctors recommend newborns receive correc- dramatically nationwide without tive surgery right away. Others prefer to wait, as some cases of feeding issues resolve unrelated to the visible a high level of evidence to tongue-tie and/or lip tether. However, recent studies have show that these procedures are shown an increase in the number of surgeries despite effective in the improvement of limited medical evidence supporting the procedure. the breastfeeding process.” “We have seen the number of tongue-tie and upper —Dr. Hartnick lip tether release surgeries increase dramatically nation- wide without a high level of evidence to show that these procedures are effective in the improvement of the breastfeeding process,” says Christopher J. Hartnick, tion program at Mass. Eye and Ear and Massachusetts MD, MS, Director of Pediatric Otolaryngology at General Hospital. It consists of clinicians from different Massachusetts Eye and Ear and Professor of medical specialties, including pediatric otolaryngology, Otolaryngology–Head and Neck Surgery at Harvard pulmonology, gastroenterology, and speech-language Medical School. pathology. A subset of this team recently performed a preli- Instituting a multidisciplinary minary study to determine how many patients actually approach need tongue-tie surgery. This team, which included Dr. Despite a lack of medical literature linking surgery to Hartnick, Christen L. Caloway, MD, Gillian R. Diercks, improved breastfeeding, Dr. Hartnick notes that the U.S. MD, MPH, Cheryl J. Hersh, MS, CCC-SLP, Rebecca Kids’ Inpatient Database estimated a ten-fold increase in Baars, MS, CCC-SLP, CLC, and Sarah Sally, MS, CCC-SLP, tongue-tie surgeries from 1,279 in 1997 to 12,406 in 2012. CLC, of the Mass. Eye and Ear Pediatric Airway, Voice, Prompted by these rising rates and an influx of and Swallowing Center, examined 115 newborns who parents seeking second opinions, Dr. Hartnick and were referred in for tongue-tie surgery. colleagues formed a multidisciplinary feeding evalua- continued on page 10

HARVARD Otolaryngology 9 | Is Tongue-Tie Surgery Always Necessary? | continued FEATURE

Because it can be difficult to predict which infants will benefit most from surgery, each mother-newborn pair met with a pediatric speech-language pathologist first. The speech-language pathologists performed comprehensive feeding evaluations that included clinical history, oral exam, and assessment of breastfeeding with each patient. They then offered real-time feedback and strategies to address the hypothesized cause of their breastfeeding challenges. Published in JAMA Otolaryngology–Head and Neck Surgery, the study found that 63.5 percent of children who were referred in for surgery ended up not receiving it as determined by the comprehensive evaluation. Instead, parents chose not to select a surgical procedure to support successful breastfeeding of their newborns. For the other 36.5 percent of patients, 10 (8.7 percent) underwent lip tie surgery alone and 32 (27.8 percent) underwent both lip and tongue-tie surgery, although all of the referrals were for tongue-tie surgery specifically. “We’ve shown that the pathway of a multidisciplinary feeding evaluation is helping prevent babies from getting this procedure,” said Dr. Hartnick. “A feeding evaluation program implemented on a wider scale may help identify

The Pediatric Airway, Voice, and Swallowing Center team from left to right: Jessica Sorbo, Sarah Sally, Dr. Stephen Hardy, Rebecca Baars, Dr. Christopher Hartnick, Dr. Shannon Fracchia, and Cheryl Hersh.

10 HARVARD Otolaryngology about making the decision about having their newborn undergo surgery,” said Dr. Hartnick. “There can also be significant out of pocket costs for the procedure that parents need to take into consideration.” Having the child undergo a feeding evaluation identifies strategies that can help with breastfeeding based on the baby’s difficulties. If trialed for several days without improvement, parents can feel more confident in selecting the procedure for their infant. Future multicenter trials are planned and the researchers are now working on follow-up outcomes studies comparing infants who did and did not undergo An example of an infant with tongue-tie. tongue-tie surgery longer term. In the meantime, the study’s authors call for the development of best practice the underlying cause of their breastfeeding difficulty and guidelines to help with decision-making throughout the prevent infants from getting a surgery that might not be medical community. beneficial to improved breastfeeding.” “We’ve learned that an interdisciplinary collabora- tion is key to a thorough feeding evaluation,” said study A new way of thinking co-author and speech-language pathologist Cheryl Standard tongue-tie and upper lip tether release Hersh. “This is still a work in progress, but we have surgeries are relatively safe outpatient procedures per- learned a great deal about what we can do differently formed with local anesthetic, with risks, including pain to help our patients and their families. In doing so, we and infection, being similar to any surgical procedure. have been able to identify many babies who are having “Although the risks are low, many parents report breastfeeding problems that are not related to their experiencing guilt for not being able to provide the lip and tongue anatomy and are able to improve their basic role of the parent in feeding their baby and worry feeding with clinical strategies.” l

HARVARD Otolaryngology 11 FEATURE 12 HARVARD HIDDEN HEARINGLOSS: A 10-YearJourney Otolaryngology uncover anew potentialcause cochlear synaptopathy, scientists A decadeafterthediscovery of White markers for sensorineural hearing loss. Yellow markers for various types ofconductive hearing loss. I H G F E D C B A

ory nerve pathologyory osclerosis earfluidorinfection ympanic membrane perforation al atresia

rior canal dehiscence

T Audit Ot Haircellpa Aur Malleusfix Supe Middle Ossiculardisc indicate possible locations ation thology indicate possible locations ontinuity

common complaint heard in otology and audiology clinics is that patients have difficulties Aunderstanding speech in noisy environments. However, when their hearing sensitivity is measured and plotted on an audiogram, many of their hearing thresholds are in healthy ranges. For years, clinicians and investigators questioned the efficacy of the audiogram in revealing such issues, as they suspected more had to be happening in the inner ear than an audiogram could measure. In 2009, a team of investigators led by Sharon G. Kujawa, PhD, and M. Charles Liberman, PhD, of the Eaton-Peabody Laboratories (EPL) at Massachusetts Eye and Ear/Harvard Medical School, uncovered a new type of inner ear damage that could explain these poorly understood hearing complaints. In a study published in the Journal of Neuroscience, they described that the neural synapses responsible for the communication between the ear and the brain are “Over the past 10 years, the actually the most vulnerable structures in the inner ear. With age or noise exposure, many of these synaptic phenomenon of hidden hearing loss, connections disappear and decrease the fidelity of the which we originally demonstrated auditory information sent to the brain. in noise-exposed and aging mice, has “This finding changed the landscape of how we been documented in noise-exposed look at patients with hearing loss,” said Dr. Kujawa. chinchillas, rats, guinea pigs, “Conventional wisdom would suggest that sensorineural monkeys, and, most importantly, hearing loss is largely attributed to the loss of hair aging humans.” cells, the sensory cells of the inner ear that audiograms measure. But this study indicated something different.” —Drs. Liberman and Kujawa Dr. Kujawa and Dr. Liberman showed that noise and aging first damage the synapses connecting the hair cells to the nerve fibers carrying neural signals to the brain, mice, has been documented in noise-exposed chinchillas, even when the hair cells are not damaged. This is now rats, guinea pigs, monkeys, and, most importantly, aging known as cochlear synaptopathy. Since hair cell function humans. Furthermore, several EPL investigators have is what audiograms measure, this synaptic loss is typi- developed techniques based on gene therapy and drug cally undocumented, inspiring the popular term “hidden delivery that can protect the ear against noise exposure hearing loss.” and even regenerate the neural connections after damage. “Although much work remains to be done, includ- A decade of discoveries ing the challenge of accurately diagnosing the degree of This year marks the 10-year anniversary of the neural degeneration in human ears, the development of discovery of cochlear synaptopathy. Throughout the cures for this key aspect of hearing impairment is now a past decade, investigators around the world have aimed real possibility,” said Dr. Liberman. to uncover the prevalence, diagnosis, and functional In 2017, this work led to the National Institute on consequences of the condition. Deafness and Other Communication Disorders, part of Dr. Kujawa and Dr. Liberman note that over the past the National Institutes of Health, funding a team that 10 years, the phenomenon of hidden hearing loss, which includes Dr. Liberman and Dr. Kujawa, as well as they originally demonstrated in noise-exposed and aging continued on page 14

HARVARD Otolaryngology 13 FEATURE 14 HARVARD Otolaryngology | have found aconnection between cochlear synaptopathy of Ehime University Graduate of School Medicine, who Ear/Harvard Medical and School, Masahiro Okada, PhD, D. Bradley Welling, MD, PhD, FACS, of Mass. Eye and workthe of Dr. Maison and Dr. alongside Liberman developmentcould leadtothe also of future therapies. in human populations for cochlear synaptopathy, which is to work toward refinement the of diagnosticmeasures andmodels, two working with human goal subjects, their donated human temporal bones, one on focusing animal condition the tackle from multiple angles. EPL, withthe a P50 grant to combine efforts their and Stéphane F. Maison, PhD, and Daniel B. Polley, PhD, of

Hidden Hearing Loss: A10-Year | Loss: Journey Hearing Hidden One of most the recent discoveries of team this is Through four projects, including one studying may worsen intime.” speechof perception treatment, inabsence that, suggests study rely on their betterear. Our in rehabilitation asthey can still ear are reluctant often to engage hearing“People with inone loss —Dr. Maison

continued

said Dr. Maison. “If what we have in mice is observed of treatment, speech perception may worsen in time,” on better ear. their Ourstudy suggests that, in absence reluctantengage to in rehabilitation canstill as they rely brain. that auditory the tothe relays nerve signals electrical the connections innerbetween ear’s the cells and sensory conductive impairment leadstoloss of synaptic the Maison inadult micein2015,showing that longstanding and behavioralsocial, difficulties.” hearing lossasymmetric have rates higher of academic, are especially important considering that children with cochlear synaptopathy,” said Dr. Maison. findings “The can leadto speech recognition difficulties consistent with was loud clearly enough tobe audible. affectedthan sidethehealthy the even side,when speech degrees had lower speech recognition scores on the hearing impairments of moderate to moderately severe They foundthat patients with longstanding conductive loss, but normal on sensorineural function hearing tests. Ear with either an acute or chronic conductive hearing patients visited who an audiology clinic at Mass. Eye and team retrospectively reviewed hearing the profiles of 240 an inability tohear softsounds. ear is impaired, leading to a reduction in sound levels and sound transmission the loss occurs, through middle the brainthe tointerpret sound. When conductive hearing converted that into signals are electrical transmitted to middle ear before getting inner earto the arewhere they canal, reaching eardrum the and tiny the bones of the damaging effects. suggest of that ear the underuse might have also similar causes of condition. the This study, however,the first is to aging, and of use ototoxic have drugs identified been loss maydegeneration leadtonerve leftuntreated. when and conditions that cause chronic conductive hearing and sound deprivation. Their work suggests ear infections The effects of sounddeprivation of The effects

“People with hearing loss in one ear are often This work validates previous research led by Dr. “Our results suggest that chronic sound deprivation In astudy recently published in In healthy ears, sound waves travel through ear the With cochlear synaptopathy, noise exposure, ‘normal’ Ear and Hearing and Ear , this , this applicable to humans, there is a possibility that unilateral gators hope to use their findings to improve the sensiti- sound deprivation may affect the good ear as well. I vity and specificity of hearing tests in order to identify would recommend that clinicians consider providing hidden hearing loss and define how this condition amplification in the management of unilateral conduc- evolves in time. tive hearing loss.” “Establishing diagnostic indicators for hidden hearing loss in humans is important as recent animal Looking toward the next 10 years research suggests that reconnecting the nerve to the Ten years after the landmark discovery of cochlear sensory cells of the inner ear is possible,” said Dr. Maison. synaptopathy, investigators are getting closer to under- Additional insights and the establishment of a standing what hidden hearing loss is, what causes it, reliable diagnosis will also help clinicians choose the and how to identify it in patients. They even continue to right candidates for clinical trials and determine the describe possible causes as seen with Dr. Maison’s and efficacy of a treatment. Dr. Liberman’s recent study. “With our work, we have the potential to help a lot of As these P50 projects continue to expand, the investi- people and that’s encouraging,” said Dr. Maison. l

Chronic Sound Deprivation: Conductive Hearing Loss, indicated by white markers

Cochlear Synaptopathy: Sensorineural Hearing Loss, indicated by yellow markers

HARVARD Otolaryngology 15 Farewell Class of 2019

Harvard Medical School Celebrates 2019 Otolaryngology Graduation and Seventh Annual Meeting Faculty and staff from the Department of Otolaryngology–Head and Neck Surgery at Harvard Medical School gathered in the Meltzer Auditorium at Massachusetts Eye and Ear on Friday, June 21, to celebrate the 2019 graduating class of residents and fellows. Five chief residents and 11 clinical fellows graduated from a program led by Harvard Medical School’s Vice Chair of Otolaryngology Education Stacey T. Gray, MD, Associate Otolaryngology Residency Director Kevin S. Emerick, MD, and Walter Augustus Lecompte Professor and Chair of Otolaryngology–Head and Neck Surgery D. Bradley Welling, MD, PhD, FACS. “We are so proud of what our graduating residents and fellows have accomplished during their time with us,” said Dr. Gray. “We are excited to see where they are headed next and proud to have them representing our program worldwide.” The Joseph B. Nadol, Jr., MD, Graduation Lectureship was given by Carol R. Bradford, MD, FACS, Executive Vice Dean for Academic Affairs at the University of Michigan Medical School. In her talk, she expressed the importance of work-life balance. In order to succeed in the field of medicine, she advised that one must “take care of themself in order to take care of others.” At the end of the ceremony, graduating resident Yin Ren, MD, PhD, was awarded the Jeffrey P. Harris, MD, PhD, Research Prize for his FOCUS research project, “Towards personalized precision medicine for vestibular schwannoma and hearing loss.” Prior to the graduation ceremony, the day began with the department’s seventh annual meeting, an event that brings together faculty, residents, and fellows from each of our institutions. The meeting featured Chief Resident research talks on topics from discovering biomarkers for chronic rhinosinusitis to the impact of hospital market competition on the adoption of transoral robotic surgery. These talks were followed by a poster session highlighting the work of all of our residents. The annual meeting was concluded with faculty presentations by Jeffrey R. Holt, PhD, Professor of Otolaryngology–Head and Neck Surgery at Harvard Medical School, and Jeremy D. Richmon, MD, Associate Professor of Otolaryngology–Head and Neck Surgery at OTOLARYNGOLOGY EDUCATION OTOLARYNGOLOGY Harvard Medical School.

Awards and Honors Clinical Fellow Teaching Award Annual Poster Session Jennifer A. Brooks, MD, MPH Anuraag Parikh, MD 1st Place Poster Award Chief Resident Teaching Award “Multiplexed immunofluorescence and Katie M. Phillips, MD, and multispectral imaging-based quantification of Rosh K. V. Sethi, MD, MPH tumor and immune cell populations reveals spatial relationships in oral cavity SCC” William W. Montgomery, MD, Yin Ren, MD, PhD Faculty Teaching Award 2nd Place Poster Award Carleton Eduardo Corrales, MD “Tumor penetrating delivery of nanoparticles to human vestibular schwannomas” Harvard Otolaryngology Resident Well-Being Award Dr. Yin Ren receives the Jeffrey P. Harris, MD, PhD, Research Prize from Dr. Brad Welling. Mark A. Varvares, MD, FACS Jeffrey P. Harris, MD, PhD, Research Prize Presented to one of the graduating chiefs for their FOCUS research project. Yin Ren, MD, PhD “Towards personalized prevision medicine for vestibular schwannoma and hearing loss”

Dr. Carol Bradford gives the graduation address.

16 HARVARD Otolaryngology

Graduating Class of 2019 Residents Ashton E. Lehmann, MD, is known for her ability to balance an earnest demeanor with a sunny disposition. As a clinician and surgeon, she is dedicated and thorough. She fully understands the weight and responsibility that comes with being a surgeon. Anyone can see how deeply she cares for her patients. From a research perspective, she immersed herself in the world of basic science during her residency. She worked with Ralph B. Metson, MD, on Photo by Aram Boghosian Aram by Photo seeking a biomarker for chronic rhinosinusitis. The 2019 graduating class of residents from left to right: Drs. Katie Phillips, Yin Ren, Rosh Sethi, Her work resulted in multiple national Ashton Lehmann, and Brian Lin. presentations and publications. She is now a rhinology and endoscopic skull base surgery published several publications, and won led him to be involved in a multitude of fellow at Mass. Eye and Ear/Harvard Medical many awards, including the John J. Conley, presentations and publications. He is known School. MD, Resident Research Award at the for being generous with his knowledge, often Triological Society for this work. She is now offering mentorship to medical students and Known for his ability to deeply connect with pursuing a rhinology/anterior skull base other trainees. He is thoughtful and kind patients, Brian M. Lin, MD, ScM, excels as fellowship at Stanford University. toward his patients, and a team player in the a clinician and surgeon. The operating room. He is now at the University devotion he has for each of Starting his residency with a background in of Michigan pursuing a fellowship in head his patients shines through developing nanotechnology tools to study and neck oncologic surgery. his passionate, honest, and the cancer genome, Yin Ren, MD, PhD, supportive nature. He joined explored the personalization Clinical Fellows, Mass. Eye and Ear our program as a seven-year of precision medicine for research track resident. Working with Gary C. vestibular schwannoma and Catherine G. Banks, MBChB, FRACS Curhan, MD, and Konstantina M. Stankovic, hearing loss for his resident Rhinology MD, PhD, FACS, he spent his dedicated FOCUS project. Under the Fellowship Directors: Ralph B. Metson, MD, research time looking into risk factors for guidance of Konstantina M. Stacey T. Gray, MD, Eric H. Holbrook, MD hearing loss. This work resulted in many Stankovic, MD, PhD, FACS, this work led to Future Plans: Department of Otolaryngology national presentations and publications. He an Academy CORE grant and a New England and Head and Neck Surgery, The Prince of additionally won the Academy Humanitarian Otolaryngological Society Research Grant Wales Hospital and Sydney Eye Hospital, Resident Travel Grant for a medical mission along with several first author publications University of New South Wales Sydney, trip to Tamatave, Madagascar. He is now and national presentations. As a clinician, Australia at Johns Hopkins University pursuing a he is always prepared and approachable. fellowship in neurotology. He is also known for being organized and Jennifer A. Brooks, MD, MPH efficient. He is now continuing his work as Thyroid and Parathyroid Surgery A natural leader, Katie M. Phillips, MD, is the the neurotology fellow at the University of Fellowship Director: definition of responsible and Gregory W. California, San Diego. mature. She’s respectful and Randolph, MD, FACS, FACE Future Plans: Faculty, Boston Children’s thoughtful in how she leads a Praised for his consistent professionalism, Hospital/Harvard Medical School team, and these qualities are Rosh K. V. Sethi, MD, MPH, is known exemplified in the care she for being a team leader Christen L. Caloway, MD provides her patients. Early and educator. During his Pediatric Otolaryngology on in her residency, she developed a research residency, Dr. Sethi explored Fellowship Director: Christopher J. interest in chronic rhinosinusitis (CRS). Work- a full range of research Hartnick, MD, MS ing alongside Ahmad R. Sedaghat, MD, PhD, initiatives, including Future Plans: Director of Pediatric FACS, she measured quality of life in CRS examining the impact of Otolaryngology, Rutgers New Jersey patients for her resident FOCUS project. She hospital market competition on the adoption Medical School has presented nationally and internationally, of medical technology. All of his initiatives continued on page 18

HARVARD Otolaryngology 17 The 2019 graduating class of Mass. Eye and Ear fellows from left to right: Drs. Christen Caloway, Qasim Husain, Catherine Banks, Joel Fontanarosa, Nicholas Dewyer, and Jacqueline Greene. Not pictured: Dr. Jennifer Brooks.

Nicholas A. Dewyer, MD Clinical Fellows, Pediatric Rounak B. Rawal, MD Neurotology Otolaryngology, Future Plans: Attending Otolaryngology/ Fellowship Director: Daniel J. Lee, MD, FACS Boston Children’s Hospital Head and Neck Surgeon, Connecticut Future Plans: Director of Otology, Fellowship Director: Reza Rahbar, DMD, MD Pediatric Otolaryngology, Clinical Instructor, Neurotology, and Skull Base Surgery, Department of Surgery (Otolaryngology), Jaime Doody, MB, BCh Yale University School of Medicine University of Arizona, Department of Future Plans: Clinical Assistant Professor Otolaryngology–Head and Neck Surgery in Pediatric Otolaryngology, University Cher Xue Zhao, MD Joel Fontanarosa, MD, PhD North Carolina, Chapel Hill Future Plans: Faculty, Pediatric Otolaryngology, Mass. Eye and Ear/ Head and Neck Oncology/ Joshua Gurberg, MD Harvard Medical School Microvascular Surgery Future Plans: Pediatric Otolaryngologist, Fellowship Directors: Daniel G. Deschler, MD, Montreal Children’s Hospital, Assistant The 2019 graduating class of Boston Children’s FACS, Jeremy D. Richmon, MD Professor of Otolaryngology and Hospital fellows from left to right: Drs. Jaime Future Plans: Faculty, University of Pediatric Surgery, McGill University Doody, Rounak Rawal, Cher Xue Zhao, and Joshua Gurberg with Otolaryngologist-in-Chief Rochester and the Wilmot Cancer Center Dr. Michael Cunningham (center). Jacqueline J. Greene, MD Facial Plastic and Reconstructive Surgery Fellowship Director: Tessa A. Hadlock, MD Future Plans: Assistant Professor, Division of Otolaryngology–Head and Neck Surgery, University of California, San Diego Qasim Husain, MD Rhinology Fellowship Directors: Ralph B. Metson, MD, Stacey T. Gray, MD, Eric H. Holbrook, MD Future Plans: Coastal Ear, Nose, Throat, Private Practice, New Jersey

18 HARVARD Otolaryngology New Trainees

The Otolaryngology–Head and University Feinberg School of Medicine, New Clinical Fellows Neck Surgery Residency Program where he received a fellowship for his basic Mass. Eye and Ear at Harvard Medical School science research in cancer epigenetics and also conducted clinical research in head and neck Head and Neck Oncology/ Meet our PGY-1 Residents cancer. Dr. Suresh graduated from medical Microvascular Surgery Originally from Las Vegas, school summa cum laude and with honors for Andrew J. Holcomb, MD

Nevada, Ryan A. Bartholomew, outstanding performance in otolaryngology

MD, is a graduate of Duke and in his junior clerkships. He was also Facial Plastic and Reconstructive University. There, he studied elected to Alpha Omega Alpha and the Surgery neuroscience and philosophy, Gold Humanism Honor Society. Matthew Q. Miller, MD and was a member of the Yin Laboratory A native of Edina, Minnesota, for an additional year. He then earned his Michael Pei-hong Wu, MD, medical degree from Harvard Medical School. graduated summa cum laude Neurotology Dr. Bartholomew has published several from Harvard College with a Divya Chari, MD articles investigating the contributions of degree in molecular and cellular the basal ganglia to modulating behavior biology. He subsequently attended Harvard using optogenetic and 3D motion capture Medical School, where he completed the techniques in mice. During medical Harvard-Massachusetts Institute of Technology Pediatric Otolaryngology school, he was involved in clinical research joint MD program within the Division of Health Asitha Jayawardena, MD, MPH in otolaryngology. He has interests in Sciences and Technology. During medical translational research, surgical innovation, school, Dr. Wu spent a year examining the and medical education. presence and role of cilia in human cancers. Elliana Kirsh DeVore, MD, He has participated in multiple research Rhinology grew up in Cincinnati, Ohio, projects, with primary interests in the cancer Aria Jafari, MD and graduated summa cum microenvironment, highly multiplexed laude from the University of imaging modalities for analysis of pathologic Cincinnati, College-Conservatory specimens, and surgical outcomes. An avid Rhinology of Music with a degree in voice performance. cellist, he is also interested in the intersection Ashton E. Lehmann, MD Following her undergraduate work, she between music, health, and quality of life. pursued a career as a professional opera Originally from Montgomery, singer, performing internationally in opera New Jersey, Roy Xiao, MD, productions, concerts, and music festivals. attended Princeton University Thyroid and Parathyroid During this time, her desire to understand the for his undergraduate studies in Surgery physiologic processes underlying the voice chemistry and computer science. Ayaka J. Iwata, MS, MD transformed her passion for performance to His senior thesis resulted in a patented that of science. She returned to the University catalytic system for water purification and of Cincinnati to earn a second degree in the American Chemical Society Division of neurobiology. She was awarded the University Boston Children’s Hospital Inorganic Chemistry Award. He then attended of Cincinnati Presidential Leadership Medal Pediatric Otolaryngology the Cleveland Clinic Lerner College of of Excellence. She then went on to receive Medicine of Case Western Reserve University her medical doctorate from Harvard Medical for his medical and master’s degrees. There, School. Dr. DeVore’s research is dedicated he worked on numerous studies investigating to improving outcomes for patients with clinical outcomes for patients with head complex airway problems, including those and neck cancers. He also completed a with voice disorders. one-year fellowship at the National Institute Andrew E. Sara Gallant, MD Bluher, MD Hailing from Dallas, Texas, on Deafness and Other Communication Krish Suresh, MD, received Disorders, part of the National Institutes his undergraduate and of Health, through the Medical Research medical education in Chicago Scholars Program. His research interests at Northwestern University. include the efficiency of healthcare systems, Graduating magna cum laude, he studied immunotherapy for head and neck cancers, biology and computer science. He gained and surgical quality improvement. Erika Aiden (Eliot) early acceptance to the Northwestern Mercier, MD Shearer, MD, PhD

HARVARD Otolaryngology 19 Alumni Profile

Paul E. Hammerschlag, MD, FACS, HMS Otolaryngology Resident, Class of 1977

Building a career as an ear surgeon

that he first heard of the Massachusetts Following his residency, Dr. Hammerschlag Eye and Ear/Harvard Medical School completed a general otolaryngology residency program and was encouraged by fellowship at Mass. Eye and Ear and his professors to apply. remained on faculty until 1978. After an additional year in Seattle on the faculty at the Before he began his residency at Mass. Eye University of Washington, Dr. Hammerschlag and Ear, however, he completed a pediatric established his roots in New York. internship at the University of Washington in Seattle, followed by a one-year general Throughout his nearly 40-year tenure surgery residency with Virginia Mason at NYU, he has devoted his practice to Hospital. treating multiple otologic and neurotologic problems. Today, he covers a fellow and “At the onset of my residency at Mass. Eye or Paul E. Hammerschlag, MD, FACS, resident otology/neurotology clinic. His and Ear, I was able to see from first-hand his journey to becoming an otologist esteemed career has also included regular experience how prominent and important is somewhat unique. While he grew contributions to articles, textbooks, and the institution was,” Dr. Hammerschlag Fup watching his father care for patients as periodicals, sharing his insights in roundtable commented. “It was an incredibly remark- an obstetrician, he has also had a bilateral discussions with colleagues, and lecturing able experience for me. I remember it sensorineural hearing loss (SNHL) from a across the country and around the world. being some of the busiest, most exciting, young age. and fastest years of my life.” Dr. Hammerschlag has additionally spent Now a semi-retired ear surgeon and much of his career teaching and mentoring During residency, Dr. Hammerschlag cochlear implant patient himself, Dr. the next generation of otolaryngologists. spent his time studying with Harold F. Hammerschlag reflects on his career in Schuknecht, MD, former Harvard Medical “Over time, I have been humbled by the otolaryngology. School Chair of Otolaryngology, and opportunity to care for patients and their “Between my hearing loss and my father other faculty. He is still very grateful to families,” said Dr. Hammerschlag. “I have being a physician, pursuing a career in Dr. Schuknecht for embracing his hearing also enjoyed and been challenged by medicine was always a natural thought for loss in ways others hadn’t. teaching residents and fellows.” me,” said Dr. Hammerschlag, an Associate “After a bout of fluctuating SNHL during Now, he is adjusting to semi-retirement Professor of Otolaryngology at New York my general surgery residency, there were with nonmedical ventures, which include University (NYU). questions by others about how it might traveling, reading, renovating a New York “When I was in high school, I had the interfere with my ability to perform in townhouse, enjoying family, attending opportunity to watch a well-known New residency,” Dr. Hammerschlag explained. university courses, and completing York surgeon perform stapes surgery. That “Dr. Schuknecht indicated that it should subspecialty journal peer reviews. was the moment I knew I was attracted to not be an issue for me at Mass. Eye and Over the years, Dr. Hammerschlag has been the field of otolaryngology. In an inchoate Ear. Moreover, in his own inimitable way, able to connect with patients on a level way, I contemplated that I might have an Dr. Schuknecht was the best teacher I was most doctors aren’t. He believes that being intrinsic and possibly insightful connection fortunate enough to encounter. I hasten to a cochlear implant user himself has enabled to those with hearing loss.” add that there were other terrific faculty as him to bring more understanding to his well, resulting in a broad and meaningful A native of New York, Dr. Hammerschlag’s hearing loss patients and their families. training experience for those of us in the studies began at NYU for his undergraduate program.” “My story isn’t much different than those degree, followed by becoming a Doctor of others, but possibly understanding of Science candidate at the Johns Hopkins “I will always have an intangible connection more of what some of my patients have Bloomberg School of Public Health. He to Mass. Eye and Ear. It gave me a superb gone through and helping them has been then attended medical school at the Albert foundation to build on in terms of my truly rewarding,” Dr. Hammerschlag said. l Einstein College of Medicine. It was there professional career,” he added.

20 HARVARD Otolaryngology Alumni Profile

Lara A. Thompson, PhD, Jenks Vestibular Physiology Laboratory of Massachusetts Eye and Ear/Harvard Medical School, Class of 2013

Finding the right balance between research and medicine

“I wanted to do something where I could Historically Black Colleges and Universities apply my engineering background toward (HBCUs) nationwide, UDC is one of only medicine,” said Dr. Thompson. “I had an three HBCUs to offer an undergraduate

Photo by John Spaulding by Photo interest in medicine but wanted to work in degree in biomedical engineering. academia and remain an engineer. That is Dr. Thompson was also asked to initiate how I found the HST program. It was the and build the CBRE Laboratory at UDC, right balance between research, medicine, which is a research laboratory focused on and engineering.” balance and gait, particularly in the aging As an HST student, Dr. Thompson explored population. This laboratory utilizes sensor or Lara A. Thompson, PhD, her implants and prostheses of the inner ear, technology and engineering principles to interests in the arts and sciences specifically vestibular implants. She was provide clinical diagnostics on individuals began at a young age. It came by drawn to the vestibular implant because whose gait and motion have been impaired Fno surprise when she chose to study it affects a different part of the inner ear due to age, injury, or stroke. than one typically hears about. Most mechanical engineering at the University “At one point growing up, I enjoyed working often, hearing aids and cochlear implants of Massachusetts Lowell. with living things in addition to wanting to are discussed. However, vertigo and have a career that allowed me to build and “My childhood interests in creative disequilibrium tied to the vestibular system create,” Dr. Thompson remarked. “Now I get endeavors didn’t equate to engineering are major concerns and fit well with her to do both.” when I was growing up, but now looking previous training and interests. back, those interests definitely shaped To date, Dr. Thompson has been a lead Dr. Thompson began working in the my career,” said Dr. Thompson. investigator of several grants from the Jenks Vestibular Physiology Laboratory at National Science Foundation (NSF), includ- Now the Director of the Center for Bio- Massachusetts Eye and Ear/Harvard Medical ing a research initiation award, an early- mechanical and Rehabilitation Engineering School under the guidance of Richard F. concept grant for exploratory research (CBRE) Laboratory and Associate Lewis, MD. She worked on investigating award, and a targeted infusion project Professor of Mechanical Engineering at postural control tied to the development award. She is also a co-investigator on two the University of the District of Columbia of prototype prosthesis in non-human DoD grants and the lead investigator on a (UDC), Dr. Thompson has found a way primates. She also investigated postural project sponsored by the Department to apply her engineering background to responses for balancing tasks of increasing of Aging and Community Living. advancing balance and gait research. difficulties and characterized the effects of After earning her bachelor’s degree, an invasive vestibular implant on posture. In recognition of her contributions, Dr. Thompson was honored as an HBCU STEM Dr. Thompson studied aeronautical and “Working with Dr. Lewis and being a witness Innovator at the annual Black Engineer astronautical engineering at Stanford to his ideas really made this program special of the Year Awards conference and was a University. She then worked at the Charles in my mind,” said Dr. Thompson. “There featured scientist in NSF’s Science Nation Stark Draper Laboratory, Inc. for two were also only three institutions nationwide in early 2019. She was also acknowledged years as a mechanical engineer, working working with vestibular prostheses at the nationally as a Diverse Issues of Higher on several Department of Defense (DoD) time. We were treading on new ground, Education Emerging Scholar in 2017. projects and creating models for various which both challenged and prepared me.” applications. “In many ways, my career is still just getting In 2013, Dr. Thompson earned her doctorate off of the ground, and that is exciting,” said Wanting to do more with medicine, she in biomedical engineering and immediately Dr. Thompson. “My goal is to really leave a then returned to school for her doctorate joined UDC to build a biomedical engineering footprint on the field from both a research degree, enrolling in the joint Harvard program. She was responsible for writing the and education perspective. I’m proud of the Medical School-Massachusetts Institute initial program proposal and got full board programs I’ve helped build and am looking of Technology Health Sciences and approval in 2014. Of approximately 100 Technology (HST) program. forward to seeing how they grow.” l

HARVARD Otolaryngology 21

Alumni Giving Society

Department of Otolaryngology Current Alumni Giving Society Head and Neck Surgery members for fiscal year 2019 from October 1, 2018, to September 30, 2019, are listed The Alumni Giving Society of the Department of Otolaryngology– below. With your gift of $1,000 or Head and Neck Surgery at Harvard Medical School more, you will be included in the The Department of Otolaryngology–Head and Neck Surgery at Massachusetts Eye and 2020 Alumni Giving Society. Ear/Harvard Medical School established the Alumni Giving Society in 2015 to recognize faculty and alumni who make gifts of $1,000 or more during the fiscal year (October 1– September 30). Participation is a way to stay connected and to help deliver the finest CHAMPION: teaching experience for today’s otolaryngology trainees. Gifts of $25,000 or higher Our alumni know from firsthand experience that support of the vital work of our students Ralph B. Metson, MD and faculty in the Department of Otolaryngology–Head and Neck Surgery helps drive continued achievement across all areas of education, research, and patient care. To date, VISIONARY: we have 31 members whom we thank for their generosity and for partnering with us to Gifts of $10,000 to $24,999 achieve our department goals and institutional mission. Michael S. Cohen, MD If you are not a member, please consider joining your colleagues today by making a gift Eric H. Holbrook, MD with the enclosed envelope. As a member, you may designate your gift in the way that is Michael B. Rho, MD, FACS most meaningful to you. INNOVATOR: To learn more, please contact Julie Dutcher in the Development Office at 617-573-3350. Gifts of $5,000 to $9,999 Wade W. Han, MD, OD, FAAO Alumni Giving Society Alumni Leaders John B. Lazor, MD, MBA, FACS Leadership Daniel G. Deschler, MD, FACS Derrick T. Lin, MD, FACS D. Bradley Welling, MD, PhD, FACS Richard E. Gliklich, MD, ’93, ’94 Edward J. Reardon, MD

Walter Augustus Lecompte Donald G. Keamy, Jr., MD, MPH PIONEER: Professor and Chair of Otolaryngology– Paul M. Konowitz, MD, FACS Head and Neck Surgery, John B. Lazor, MD, MBA, FACS, ’95, ’96 Gifts of $2,500 to $4,999 Harvard Medical School Jon B. Liland, MD, ’72 Barry J. Benjamin, MD Chief of Otolaryngology– Derrick T. Lin, MD, FACS, ’98, ’02 Samir M. Bhatt, MD Head and Neck Surgery, Leila A. Mankarious, MD Nicolas Y. BuSaba, MD, FACS Mass. Eye and Ear/ William W. McClerkin, MD, ’73 Terry J. Garfinkle, MD, MBA Massachusetts General Hospital Ralph B. Metson, MD, ’87 Richard E. Gliklich, MD Mark A. Varvares, MD, FACS, ’91, ’92 Michael M. Paparella, MD Christopher J. Hartnick, MD, MS Associate Chair of Otolaryngology– Herbert Silverstein, MD, FACS, ’66 Daniel J. Lee, MD, FACS Head and Neck Surgery, Leila A. Mankarious, MD Harvard Medical School Cliff A. Megerian, MD President, Harvard Otolaryngology Harvard faculty, alumni, and residents at the 2019 American Academy of Otolaryngology– Joseph B. Nadol, Jr., MD Alumni Association Head and Neck Surgery meeting. Steven D. Rauch, MD Jeremy D. Richmon, MD Phillip C. Song, MD D. Bradley Welling, MD, PhD, FACS

FRIEND: Gifts of $1,000 to $2,499 Megan E. Abbott, MD James P. Hughes, MD William W. McClerkin, MD Eugene N. Myers, MD, FACS, FRCS Edin (Hon) Adrian J. Priesol, MD Sunil Puria, PhD Herbert Silverstein, MD, FACS Feodor Ung, MD Mark A. Varvares, MD, FACS

22 HARVARD Otolaryngology

HIGHLIGHTS

News from every corner of the Harvard Medical School Otolaryngology–Head and Neck Surgery Department.

New Faculty Hamid Motallebzadeh, PhD, is an Instructor New Leadership in Otolaryngology–Head Iván Coto Hernández, PhD, is an Instructor David H. Jung, MD, PhD, and Neck Surgery at in Otolaryngology–Head and FACS, has been named Harvard Medical School. Neck Surgery at Harvard the Medical Director of the With a doctorate degree Medical School and investi- Joseph B. Nadol, Jr., MD, in biomedical engineering gator at Mass. Eye and Ear. Otolaryngology Surgical from McGill University Dr. Coto Hernández Training Laboratory at and postdoctoral training completed his doctoral Mass. Eye and Ear. from Stanford University and Mass. Eye and studies in nanoscience at Ear/Harvard Medical School, his research the Italian Institute of Technology and the focuses on acoustics, hearing mechanics, and University of Genoa, followed by postdoctoral newborn hearing screening. Specifically, his Alice Z. Maxfield, MD, training at the University of Paris-Sud and research approach includes multi-physics and has been named the Mass. Eye and Ear/Harvard Medical School. multi-scale biomechanics of auditory systems Otolaryngology Residency His research focuses on super-resolution and artificial intelligence in medicine. Site Director for Brigham microscopy development and its application and Women’s Hospital. to the study of cranial and peripheral nerve George A. Scangas, MD, is an Instructor disorders. in Otolaryngology–Head and Neck Surgery whose Shmuel Erez Davidi, MD, has joined Mass. practice will join Mass. Eye Eye and Ear, Braintree and Ear, Emerson Place to care for patients with this winter. He earned balance disorders. He HMS Promotion his undergraduate and earned his medical degree medical degrees from the from the Ruth and Bruce University of Pennsylvania, before pursuing Rappaport Faculty of otolaryngology residency and rhinology Medicine in Haifa, Israel Craig A. Jones, MD, fellowship training at Mass. Eye and Ear/ before completing his internship at Sheba FAAOA, Instructor in Harvard Medical School. An expert in Medical Center and otolaryngology–head Otolaryngology– rhinology and endoscopic skull base surgery, and neck surgery training at Kaplan Medical Head and Neck Dr. Scangas combines his clinical interest of Center in Rehovot, Israel. He then completed Surgery, Part-Time caring for patients with diseases of the nose a vestibular disorders fellowship at Mass. Eye and sinuses with his research on medical and and Ear/Harvard Medical School. His clinical surgical outcomes to help improve quality of interests include diseases of the ear, general life for his patients. adult otolaryngology, and balance disorders. David A. Wolraich, MD, will join Mass. Eye Karl R. Koehler, PhD, has joined the F.M. and Ear, Longwood in Kirby Neurobiology Center December as a compre- research staff at Boston hensive otolaryngologist. Children’s Hospital/ A graduate of Harvard Harvard Medical School. University, he earned With a doctorate in his medical degree from medical neuroscience and the Albert Einstein postdoctoral fellowship College of Medicine before completing his training from the Indiana University School otolaryngology training at the University of Medicine, his research focuses on using of Pennsylvania. Joining our department the organoid culture system as a platform to from DuPage Medical Group in Chicago, develop regenerative therapies for the inner Dr. Wolraich will see patients with a wide ear and various craniofacial tissues. The overall range of ear, nose, and throat conditions. aim of his work is to create new tools to study His clinical interests include minimally human sensory organ development, function, invasive surgery, head and neck surgery, The Recurrent and Superior Laryngeal and regeneration. robotic surgery, sinus disorders, thyroid Nerves textbook, authored by Gregory and parathyroid disorders, parotid masses, W. Randolph, MD, FACS, FACE, was obstructive sleep apnea, snoring disorders, recently translated into Russian, and airway and voice disorders. widening its reach to new surgeons worldwide.

HARVARD Otolaryngology 23 Awards, Grants, and Honors Daniel G. Deschler, MD, FACS, has been at the Annual USH Connections Conference

HIGHLIGHTS Dunia E. Abdul-Aziz, MD, is the recipient appointed co-chair of the Thesis Committee in July. This award is presented to of the 2019 American Academy of for the Triological Society and to the Salivary esteemed honorees for their dedication Otolaryngology–Head and Neck Surgery Malignancy Guidelines Panel of the American and commitment to the Usher syndrome Foundation Bobby R. Alford Endowed Society of Clinical Oncology. community. Research Award for her proposal, “Regula- Allen L. Feng, MD, Mass. Eye and Ear/ Elliott D. Kozin, MD, the Mass. Eye and tion of hair cell differentiation by histone Harvard Medical School otolaryngology Ear Neskey-Coghlan Fellow in Neurotology, demethylase Lsd1.” She also recently resident, received a 2019 American Academy was named a 2019 star reviewer for the received the Hearing Health Foundation of Otolaryngology–Head and Neck Surgery Journal of Otolaryngology–Head and Neck Emerging Research Grant for her work, Foundation CORE Resident Research Grant Surgery. He was also recently nominated “Targeting epigenetics to restore hair cells,” for his work, “Biomechanical analysis of force for the Politzer award at the Politzer Society and an American Neurotology Society grant loadings during suspension microlaryngology.” Meeting in Warsaw, Poland and was asked for her work, “Targeting epigenetic modifying to serve as a member of the steering Shekhar K. Gadkaree, MD, Mass. Eye and enzymes for hair cell regeneration.” committee for the Procedural Learning and Ear/Harvard Medical School otolaryngology Safety Collaborative. Donald J. Annino, Jr., MD, DMD, resident, has been awarded a Sections for completed his 10th face transplant this Residents and Fellows-in-Training (SRF) Richard F. Lewis, MD, has been awarded summer at Brigham and Women’s Hospital. Leadership Grant from the American Academy a National Institutes of Health R56 grant Mass. Eye and Ear/Harvard Medical School of Otolaryngology–Head and Neck Surgery. through the National Institute on Deafness otolaryngology residents Allen L. Feng, and Other Communication Disorders. Graduate students of the Speech and Hearing MD, Nicholas B. Abt, MD, and Alessandra This grant will help fund Dr. Lewis’ human Bioscience and Technology (SHBT) program, Colaianni, MD, were on the surgical team vestibular implant work. and Natalie Justicz, MD, Eric R. Barbarite, Janani Iyer and Kameron Clayton, received MD, Lauren E. Miller, MD, MBA, and the 2019 Amelia-Peabody Scholarship. This Greg R. Licameli, MD, is the recipient of the Krish Suresh, MD, were instrumental in scholarship is given annually to SHBT students 2019 Trevor McGill Excellence in Teaching the postoperative care. to support their research initiatives at Mass. Award at Boston Children’s Hospital. Eye and Ear. Thomas L. Carroll, MD, was named an Robin W. Lindsay, MD, was named asso- honorary member of the Mexican Voice Nate Jowett, MD, FRCSC, has been ciate editor of facial plastic and reconstructive Foundation and editor of Chronic Cough. awarded the American Academy of Facial surgery for The Laryngoscope. She also Plastic and Reconstructive Surgery Research co-chaired the facial plastics section of COSM Jenny X. Chen, MD, Mass. Eye and Ear/ Scholar Award through the Academy CORE this past May in Austin, Texas. Harvard Medical School otolaryngology program. This funding will help advance resident, has been appointed a resident Ronit Malka, MD, of the Berthiaume work on a neuroprosthetic device for member of the Accreditation Council for Surgical Photonics and Engineering hemifacial reanimation. Alongside Luk H. Graduate Medical Education (ACGME) Review Laboratory at Mass. Eye and Ear, received a Vandenberghe, PhD, Dr. Jowett has also Committee for Otolaryngology–Head and 2019 American Academy of Otolaryngology– been awarded a Charles H. Hood Foundation Neck Surgery. Head and Neck Surgery Foundation CORE Child Health Research Award. This funding Resident Research Grant for her proposal, Michael J. Cunningham, MD, FACS, was will support research into gene therapy for “Quantitative model for decompression invited to be the Percy Ireland Orator at the peripheral nerve repair. surgery in Bell’s palsy.” 28th Annual Percy Ireland Academic Day for David H. Jung, MD, PhD, FACS, has been the Department of Otolaryngology–Head and Suresh Mohan, MD, Mass. Eye and Ear/ awarded a Department of Defense Hearing Neck Surgery at the University of Toronto in Harvard Medical School otolaryngology Restoration Research Program Translational May. His topic was “Juvenile nasopharyngeal resident, received the 2019 Plastic Surgery Research Award for his work, “Novel small angiofibroma: Etiologic conundrum, surgical Foundation/American Society for Peripheral molecule TrkB and TrkC agonists for cochlear challenge, and recidivism risk.” Nerve Combined Research Grant for his synaptic regeneration.” This project is a proposal, “Neuronal and Schwann cell Adeeb Derakhshan, MD, Mass. Eye and collaboration between Mass. Eye and Ear, the transcriptional states in peripheral nerve Ear/Harvard Medical School otolaryngology University of Southern California, Vanderbilt regeneration.” resident, was awarded the 2019 American University Medical Center, and Akouos. Academy of Facial Plastic and Reconstructive Gregory W. Randolph, MD, FACS, FACE, Vivek Kanumuri, MD, Mass. Eye and Ear/ Surgery Leslie Bernstein Resident Research recently chaired the World Congress on Harvard Medical School otolaryngology Grant for his proposal, “The effect of electrical Thyroid Cancer 3.5 in Rome, Italy. stimulation of Schwann cell states along resident, was awarded third place at the New nerve grafts.” The work will be conducted in England Otolaryngological Society meeting for Edward J. Reardon, MD, received the Lira the Mass. Eye and Ear Berthiaume Surgical his talk, “Novel approaches to inner ear gene Award for Clinical Excellence from Beth Photonics and Engineering Laboratory with delivery.” Israel Deaconess Hospital-Milton. This award recognizes one outstanding physician each mentor Nate Jowett, MD, FRCSC, and Margaret A. Kenna, MD, MPH, FACS, year for their commitment to medicine and co-investigator and fellow resident Suresh FAAP, was awarded the 2019 USH Foresight compassion toward patients. Mohan, MD. Award from the Usher Syndrome Coalition

24 HARVARD Otolaryngology HIGHLIGHTS

The Remenschneider Laboratory at Mass. Eye and Ear has received a Department of Defense Phase 1 SBIR grant for their work on 3D-printed tympanic membranes. Titled “Innovative solution to tympanic mem- brane repair,” this work involves Aaron K. Remenschneider, MD, MPH, Neskey-Coghlan Neurotology Fellow Elliott D. Kozin, MD, and Harvard University PhD candidate Nicole Black. The Pathologist has named Peter M. Sadow, MD, PhD, one of the top 100 influential people internationally in the field of pathology. The listing is based on a coalition of reader nominations and expert panel opinions. Howard C. Shane, PhD, is the 2019 recipient of the Frank R. Kleffner Lifetime Clinical Career Award from the American Speech- Language-Hearing Association. This award recognizes an individual’s outstanding contributions to communication sciences and disorders over a period of at least 20 years. The award is given in honor of Frank R. Kleffner, a former American Speech-Language- Hearing Association president, who worked tirelessly over his lifetime to professionalize and expand the foundation’s charitable goals. David A. Shaye, MD, MPH, FACS, has been awarded the 2019 Arnold P. Gold Foundation Humanism in Medicine Award by the American Academy of Otolaryngology– Head and Neck Surgery. Jennifer J. Shin, MD, SM, is the recipient of the Outstanding Award of Citizenship, Professionalism, and Service at Brigham and Women’s Hospital. Carolyn Sweeney, PhD, of the Takesian Laboratory at Mass. Eye and Ear, has been awarded an F32 Ruth L. Kirschstein National Research Service Award from the Mass. Eye and Ear Wins ACGME Back to Bedside Grant National Institute on Deafness and Other Communication Disorders for her proposal, Mass. Eye and Ear has been awarded an Accreditation Council for “Serotonin regulation of VIP interneurons Graduate Medical Education (ACGME) Back to Bedside grant. The and auditory learning.” Back to Bedside initiative is designed to empower residents and Lucas G. Vattino, PhD, of the Takesian fellows to develop transformative projects that foster meaning and Laboratory at Mass. Eye and Ear, has been joy in their work. selected as a Pew Latin American Fellow by the Pew Charitable Trusts. This honor is The Mass. Eye and Ear team, which is initially focusing on patients given to 10 postdoctoral fellows from six undergoing major head and neck surgery, is led by Harvard Medical Latin American countries and provides two School otolaryngology residents Alessandra Colaianni, MD, Ashley L. years of funding to conduct research in Miller, MD, Suresh Mohan, MD, Krupa R. Patel, MD, Tara E. Mokhtari, the U.S. Dr. Vattino will explore the neural circuitry that allows the brain to interpret MD, and Ciersten A. Burks, MD. Stacey T. Gray, MD, and Mark A. and respond appropriately to sound. Varvares, MD, FACS, are the project mentors.

HARVARD Otolaryngology 25 The following are select research advances from the Harvard Medical School Department of Otolaryngology–Head and Neck Surgery.

Basic Science Basic properties of hearing, Dr. Holt and colleagues then used the RESEARCH ADVANCES such as its sensitivity and approach in the ears of heterozygous mice Coat protein PKHD1L1 required frequency tuning, arise who carried one copy of the Beethoven gene for normal hearing in mice from the mechanical and one healthy Tmc1 gene. The approach In a study recently published responses in the cochlea. silenced the Beethoven mutation, left the in Nature Communications, Such responses have been healthy gene intact, promoted survival of a team of Harvard Medical measured extensively sensory hair cells, and prevented progressive School investigators including in the cochlear base of hearing loss. Further analysis revealed that Artur A. Indzhykulian, MD, laboratory mammals. Our the same strategy could be used to target PhD, discovered that the understanding of human more than 20 percent of dominant mutations coat protein of hair cell stereocilia, known as cochlear mechanics is that cause inherited human disease, including Polycystic Kidney and Hepatic Disease 1-Like largely founded on the 15 additional deafness mutations. 1 (PKHD1L1), is required for normal hearing assumption that cochlear György B, Nist-Lund C, Pan B, Asai Y, Karavitaki KD, in mice. The bundle of stereocilia on inner mechanics are similar in Kleinstiver BP, Garcia SP, Zaborowski MP, Solanes P, all mammals. Spataro S, Schneider BL, Joung JK, Géléoc GSG, Holt JR*, ear hair cells responds to subnanometer Corey DP. Allele-specific gene editing prevents deafness deflections produced by sound or head In this study, the researchers in a model of dominant progressive hearing loss. Nat Med. 2019 Jul;25(7):1123–1130. *corresponding movement. Stereocilia are interconnected by show that the anatomy and author a variety of links and also carry an electron- motion of the human cochlear partition differ dense surface coat. The study shows that in crucial ways from the generalized, classic PKHD1L1 mediates the surface coat at the A novel otoprotectant against view of mammalian cochlear mechanics. The cisplatin-induced ototoxicity surface of stereocilia. This coat may contribute results are important for understanding human to stereocilia adhesion or protect from hearing and comparing results from laboratory Cisplatin chemotherapy can induce a stereocilia fusion, but its molecular identity animals. permanent, irreversible hearing loss in remains unknown. cancer patients. This potential side effect is Raufer S, Guinan JJ Jr, Nakajima HH. Cochlear partition a major concern for patients, oncologists, From a database of hair cell-enriched trans- anatomy and motion in humans differ from the classic view of mammals. Proc Natl Acad Sci USA. 2019 Jul and otolaryngologists because it necessitates lated proteins, the investigators identified 9;116(28):13977–13982. changing treatment. To date, there are PKHD1L1, a large, mostly extracellular protein. few options available to treat or reverse Using serial immunogold scanning electron Allele-specific gene editing prevents the hearing loss induced by cisplatin. microscopy, they showed that PKHD1L1 is deafness in a model of dominant expressed at the tips of stereocilia, especially progressive hearing loss James G. Naples, MD, in the high-frequency regions of the cochlea. of Beth Israel Deaconess PKHD1L1-deficient mice lacked the surface Genetic hearing loss can arise from either Medical Center/Harvard coat at the upper, but not lower, regions of dominant or recessive mutations in more Medical School, has stereocilia and developed progressive hearing than one hundred genes. demonstrated in previous loss. Therefore, the investigators concluded To explore strategies for work that repurposing that PKHD1L1 is a component of the surface overcoming the conse- the cardiovascular therapy diltiazem as coat and is required for normal hearing in mice. quences of dominant hearing an intratympanic (IT) therapy in solution loss mutations, a team of Wu X, Ivanchenko MV, Al Jandal H, Cicconet M, reduces auditory threshold shifts in murine Indzhykulian AA, Corey DP. PKHD1L1 is a coat protein scientists led by Jeffrey R. and guinea pig models. His most recent work of hair-cell stereocilia and is required for normal Holt, PhD, from Boston Children’s Hospital/ has further explored repurposing diltiazem, hearing. Nat Commun. 2019 Aug 23;10(1):3801. Harvard Medical School, explored gene a calcium-channel blocker, for single IT dose editing using a novel CRISPR/Cas9 approach. Research questions similarity administration in a chitosan glycerophosphate of cochlear mechanics between The team screened 14 unique combinations (CGP) hydrogel. mammals of guide RNAs and Cas9 enzymes to disrupt CGP-diltiazem hydrogel allows for a more a dominant mutation, known as Beethoven, Research led by Hideko Heidi Nakajima, consistent, prolonged delivery of the in the gene for Transmembrane channel-like MD, PhD, featuring Stefan Raufer, PhD, therapy. This work has confirmed reduced 1 (Tmc1). They identified a Cas9 enzyme and John J. Guinan, Jr., PhD, of Mass. Eye auditory thresholds in a murine model. New and guide RNA combination that selectively and Ear/Harvard Medical School, reveals histological findings from this work suggest disrupted the Beethoven mutation but not newly discovered mechanics in human that diltiazem may offer protection from the correct, healthy Tmc1 gene. hearing. Published in PNAS, the study calls ototoxic effects at the level of the ribbon into question the classic view that cochlear synapse. This has potential to offer a novel, mechanics are similar in most mammals.

26 HARVARD Otolaryngology RESEARCH ADVANCESRESEARCH

translatable, and readily accessible therapy stimulate target auditory The team reviewed adult to patients who experience cisplatin-induced neurons. Recognizing this, a patients who underwent CRT hearing loss. team of investigators led by and presented for videofluoro- Naples JG, Ruckenstein MJ, Cox BC, et al. Intratympanic Julie G. Arenberg, MS, PhD, scopic swallow studies. They diltiazem-chitosan hydrogel as a novel otoprotectant of Mass. Eye and Ear/Harvard showed that swallow function against cisplatin-induced ototoxicity in a mouse model. Medical School, examined whether ENI objectively worsened after Otology & Neurotology. Accepted for publication, July 2019. quality differed between early-implanted CRT, but it did not correlate children and late-implanted adults. with patient-reported quality of life measures. The authors Differences in how the brain The team found that children exhibited suggest that reduced patient processes body translation for lower average auditory perception thres- awareness of swallow dysfun- perception and eye movements holds and most comfortable levels (MCLs) ction years after completion compared to adults, particularly with When our heads translate through space, of CRT has implications for focused stimulation. Lower detection levels our eyes move in the opposite direction to management of dysphagia in suggest a higher density of neurons for the keep gaze stable. However, to completely the face of physiologic decline. compensate for head movements, larger eye early-implanted children. However, neither movements are needed when the eyes are dynamic range nor channel-to-channel “This study demonstrates an important fixating on an object closer to the head. Past threshold variability differed between groups, mismatch between patient-reported studies have shown that the brain correctly suggesting that children’s range of perceptible experience and objective data,” states performs this computation via the translational current was shifted downward. Children Dr. Naunheim. “It indicates that we have vestibulo-ocular reflex (VOR). also demonstrated increased intracochlear to pay close attention to survivors of head resistance levels relative to the adult group, and neck cancer. Furthermore, it validates Since perception of motion possibly reflecting greater ossification or the notion that patient-reported outcome shares many anatomic tissue growth after CI surgery. measures provide a complementary and pathways with the VOR, a useful set of information that does not These results illustrate physical and percep- team led by Faisal Karmali, always correlate with objective testing.” PhD, of Mass. Eye and Ear/ tual differences related to the ENI of early-implanted children compared with Kirsh E, Naunheim MR, Holman A, Kammer R, Varvares Harvard Medical School, asked MA, Goldsmith T. Patient-reported versus physiologic whether the same computations might also late-implanted adults. Evidence from this swallowing outcomes in patients with head and neck affect motion perception. They found that study demonstrates a need for further cancer after chemoradiation. Laryngoscope. 2019 Sep;129(9):2059–2064. perception of translation did not scale with investigation of the ENI in CI users with varying hearing histories. fixation distance, while the VOR did. Thus, Health utility values as an outcome despite shared neuroanatomical pathways, the DiNino M, O’Brien G, Bierer SM, Jahn KN, Arenberg JG. measure in patients undergoing brain processes signals appropriately for the The estimated electrode-neuron interface in cochlear implant listeners is different for early-implanted children functional septorhinoplasty respective functional constraints. Specifically, and late-implanted adults. J Assoc Res Otolaryngol. eye movements require a transformation 2019 Jun;20(3):291–303. Nasal obstruction is one of the most common from a linear coordinate system to the angular presenting complaints of patients seen by motion of the eye, whereas perception occurs Dysphagia after treatment for otolaryngologists. Septorhinoplasties are one in a linear coordinate system. advanced head and neck cancer of the surgical options for these patients. Dysphagia, or swallowing difficulties, is a By measuring health utility values (HUVs) These findings further clarify our understand- frequent and debilitating symptom of after septorhinoplasty, the association of ing of neural processing, highlighting that radiotherapy-based treatments for head and nasal congestion with overall health can be differences between perception and action neck cancer, including chemoradiotherapy measured and the functional outcomes can arise from clear differences in functional goals. (CRT). Although the true extent of this be determined. King S, Benoit C, Bandealy N, Karmali F. The influence of problem is unknown, it has been estimated target distance on perceptual self-motion thresholds and A team of surgeons from the Division of the vestibulo-ocular reflex during interaural translation. that at least 50 percent of long-term head Facial Plastic and Reconstructive Surgery Prog Brain Res. 2019;248:197–208. and neck cancer survivors treated with an at Mass. Eye and Ear/Harvard Medical organ preservation approach have troubles School, including Robin W. Lindsay, MD, Clinical Practice with swallowing. and otolaryngology resident A Mass. Eye and Ear/Harvard Medical Shekhar K. Gadkaree, Cochlear implant listener School team including otolaryngology MD, reviewed 463 patients experience is different for resident Elliana Kirsh DeVore, MD, who underwent functional early-implanted children and Matthew R. Naunheim, MD, MBA, and septorhinoplasty and completed late-implanted adults Mark A. Varvares, MD, FACS, investigated the global quality of life survey, Cochlear implant (CI) programming is similar the relationship between patient-reported ED-5Q, before and after for all CI users despite limited understanding and physiologic swallowing measures, surgical correction of their 1 of the electrode-neuron interface (ENI), or including quality of life, after CRT for nasal obstruction. The global the ability of each CI electrode to effectively head and neck cancer. quality of life scores were continued on page 28

HARVARD Otolaryngology 27 converted to health utility values (HUVs) using Overall, this study showed that patients practice guidelines recommend against the population-based data for individuals with required minimal narcotics after rhinoplasty use of antihistamines and topical intranasal chronic diseases. (an average of only five tablets). In purely steroid therapy for isolated OME. However, functional rhinoplasty, the authors found there is minimal data focusing specifically on Through their analysis, the team demon- a statistically significant inverse correlation the subgroup of patients with OME concurrent strated that nasal obstruction is associated between perception of pain and perception with intranasal problems such as congestion,

RESEARCH ADVANCES with significant detriment to overall health, of functional outcome (P=.001). Patients who allergy, or formally diagnosed adenoid in line with other chronic conditions affecting experienced less pain than expected self- hypertrophy. the U.S. population. Overall mean preoperative reported an improved functional outcome. In HUV was 0.872 (0.01), compared to 1.00 for The data suggest that further research into contrast, patients who underwent rhinoplasty those with a perfect state of health. The the specific subset of patients with OME with simultaneous cosmetic changes had no lower HUV values for patients with a history and concomitant sinonasal symptoms would correlation between pain and perception of of previous nasal surgery demonstrates the help us to more fully understand treatment cosmetic or functional success. negative quality of life impact that failed nasal effects and individualized recommendations surgery has on patients and the importance This study, published in JAMA Facial Plastic for treating OME when it occurs concurrent of the correct diagnosis and treatment in Surgery, is the first to evaluate the relation- with AR. primary septorhinoplasty. ship between pain and patient satisfaction Roditi RE, Caradonna DS, Shin JJ. The proposed usage after rhinoplasty. It can be used to guide of intranasal steroids and antihistamines for otitis Another team led by Dr. Lindsay and preoperative counseling to optimize patient media with effusion. Curr Allergy Asthma Rep. 2019 Dr. Gadkaree then analyzed data from 185 Sep 5;19(10):47. outcomes after rhinoplasty. patients who had a history of previous nasal surgery and demonstrated that after Gadkaree SK, Shaye DA, Occhiogrosso J, Lee LN. Gender disparities present in Association between pain and patient satisfaction after functional septorhinoplasty, patients had an rhinoplasty. JAMA Facial Plast Surg. 2019 Sept 19. academic rank and leadership improvement in HUVs.2 This suggests patients positions despite overall equivalence with a history of prior nasal surgery may The proposed usage of intranasal in research productivity represent a unique cohort when assessing steroids and antihistamines for otitis A team of investigators including health utility outcomes. media with effusion Gregory W. Randolph, MD, 1Gadkaree SK, Fuller JC, Justicz NS, Weitzman RE, A recent invited article authored by Rachel FACS, FACE, of Mass. Eye and Derakhshan A, Mohan S, Lindsay RW. Health utility Ear/Harvard Medical School, values as an outcome measure in patients undergoing E. Roditi, MD, David S. Caradonna, MD, functional septorhinoplasty. JAMA Facial Plast Surg. and Jennifer J. Shin, MD, SM, of Harvard examined potential disparities 2019 May 23. Medical School, reviewed the relationship in scholarly performance 2Gadkaree SK, Fuller JC, Justicz NS, Derakhshan A, between allergic rhinitis (AR) and otitis media based on gender, academic rank, leadership Mohan S, Yu PK, Lindsay RW. A comparative health positions, and regional distribution of faculty utility value analysis of outcomes for patients following with effusion (OME) and current treatment septorhinoplasty with previous nasal surgery. JAMA paradigms. An association between these in accredited head and neck surgery fellow- Facial Plast Surg. 2019 Jun 13. disease states has been proposed and appears ships in the U.S. biologically feasible through a mechanism The study looked at 37 accredited Pain may affect patient satisfaction of eustachian tube dysfunction and allergic after rhinoplasty fellowships. A total of 732 faculty members inflammation affecting the “unified airway.” were included in the study, 153 (21 percent) Cosmetic and functional rhinoplasties are However, treatments typically offered for AR of which were female. Fifty‐eight males (89.2 outpatient surgical procedures have not been effective in the treatment of percent) held leadership positions, compared that can lead to significant OME in randomized controlled trials. to only seven females (10.8 percent). There improvement in quality of life. The authors reviewed the evidence for and was no significant difference in overall In light of the current opioid against antihistamine and topical intranasal productivity between male and female epidemic, surgeons strive to steroid use in the treatment of OME, and senior faculty. There were, however, regional balance successful surgical whether the treated OME occurred in isolation differences in productivity by gender. outcomes with responsible or concurrent with AR. Most of the literature pain control after surgery. The authors concluded that females are does not support a benefit and adverse effects Facial plastic surgeons from underrepresented in senior faculty and within from therapy do exist. Therefore, current Mass. Eye and Ear/Harvard three common leadership positions. They also Medical School, including noted that scholarly productivity for male Linda N. Lee, MD, FACS, and female senior faculty and for those in David A. Shaye, MD, MPH, leadership positions is similar. FACS, and otolaryngology Garstka ME, Randolph GW, Haddad AB, Nathan CO, resident Shekhar K. Gadkaree, Ibraheem K, Farag M, Deot N, Adib H, Hoof M, French K, Killackey MT, Kandil E. Gender disparities are present MD, prospectively studied in academic rank and leadership positions despite 104 rhinoplasty patients and examined overall equivalence in research productivity indices how pain correlated with patient-reported among senior members of American Head and Neck Society (AHNS) fellowship faculty. Head Neck. 2019 cosmetic and functional outcomes. From left to right: Drs. David Caradonna, Nov;41(11):3818–3825. Rachel Roditi, and Jennifer Shin.

28 HARVARD Otolaryngology Massachusetts Eye and Ear is top-ranked in the nation for otolaryngology care by U.S. News & World Report. In a report released by U.S. News & World Report and the physician network Doximity, the Department of Otolaryngology–Head and Neck Surgery at Mass. Eye and Ear/ Massachusetts General Hospital was ranked #2 in the nation for otolaryngology care.

A note from our Alumni Association We have undergone a reorganization and have big plans ahead. Keep an eye out for exciting alumni news online at: oto.hms.harvard.edu/alumni Save the date! Join us Monday, September 14, at our alumni reception during the 2020 Academy Meeting. It will be held at the Liberty Hotel in Boston, MA. A formal invitation will be sent closer to the event. Nonprofit Org. U.S. Postage HARVARD PAID Holliston, MA Otolaryngology Permit NO. 20 News from the Harvard Medical School Department of Otolaryngology–Head and Neck Surgery 243 Charles Street, Boston, MA 02114

Department of Otolaryngology Head and Neck Surgery

Massachusetts Eye and Ear Beth Israel Deaconess Medical Center Boston Children’s Hospital Brigham and Women’s Hospital Massachusetts General Hospital