THE CLEVELAND CLINICFOUNDATION

Bridging Research + Clinical Care

Otolaryngology AdvancesA Physician Newsletter from The Cleveland Clinic Head and Neck Institute

Summer 2004

Ear, nose and throat care at The Cleveland Clinichas made giant strides over the past 10 yearsand the Clinic’s otolaryngology services are rec-ognized among the 10 best in the United Statesby U.S.News & World Report magazine. To rec-ognize the growth, multifac-eted interactions with otherdepartments, research col-laborations within and out-side of the institution and theoverall excellence of the fac-ulty and residency program,The Cleveland Clinic Boardof Governors recognized Otolaryngology as represent-ing the highest ideals of theorganization by conferringInstitute status. Only a selectfew groups have been accord-ed this designation.

The new name, “The Headand Neck Institute,” is con-temporary, encompassing allof the multiple facets thatembody the specialty today.

“As the Head and Neck Insti-tute, we formalize our stand-ing as one of America’s most distinctiveproviders of otolaryngology services,” says Mar-shall Strome, M.D., Institute chairman.“We arepositioned for greater achievement and an evenhigher national profile in years to come.”

Under Dr. Strome’s leadership, the Departmentof Otolaryngology and Communicative Disordershas grown to 32 full-time faculty, caring foradult and pediatric patients with routine orcomplex ear, nose and throat disorders, making

it one of the largest oto-laryngology programs inthe United States.

During a year that sawpatient visits and surgicalprocedures grow dramati-cally, faculty members contributed nearly 100 scientific publications topeer-reviewed medical jour-nals, were appointed tooffices in national societiesand journals, receivednumerous awards andgrants and served frequentlyas visiting professors.

At left, Marshall Strome,M.D., chairman of the newly

renamed Cleveland Clinic

Head and Neck Institute, con-

fers with Marilyn Davies, R.N. Above, a sample

of the banners designed to highlight the name

change in Cleveland.

Announcing theCleveland ClinicHead and NeckInstitute

Department of Otolaryngology and CommunicativeDisorders adopts new name

From the Chairman

Dear Colleagues:

This year, our former department — Otolaryngology and Communicative Disorders— was given Institute status and is now TheCleveland Clinic Head and Neck Institute.This designation has been accorded to only afew departments considered extraordinary inthe critical areas of patient care, research andteaching. Implicit in the designation wasnational and international stature. In namingthe Institute, a contemporary designation thatrepresented the diversity of our specialty waskey. Head and Neck encompassed all areas,e.g., otology, rhinology, facial plastics, etc.

Our role as educators will expand this year as we welcome the first class in the Clinic’snew medical school, The Cleveland ClinicLerner College of Medicine. The school has a five-year curriculum, dedicated to trainingphysician-scientists. A year of research is anintegral part of the educational experience.The Head and Neck Institute will welcomethese students into our laboratories.

The demand for our clinical services contin-ues to increase. Our new patient volume wasup 20% for the year and our operative loadincreased proportionately. As an example,more than 500 new malignancies were evalu-ated in the past year.

Our commitment to research was again ex-emplified by our residents being awarded twoof the Academy’s core research grants.This isa testimony to the dedication of our faculty asmentors and scientists.This issue of Otolar-yngology Advances is but a small vignetteof the accomplishments of our faculty. We aredelighted to share this publication with ourcolleagues and friends across the country.

Sincerely,

Marshall Strome, M.D., M.S., F.A.C.S.

Vocal Outcomes Remarkable After Dual Laser/Cryoablation Surgery for Glottic Carcinoma

A novel surgical approach to the treatment of early glottic carcinoma that combines endo-scopic CO2 laser resection and cryoablation isyielding remarkably positive outcomes withrespect to postoperative voice qualityand laryngeal function, reportresearchers from The Cleveland Clinic’s Voice Center.

The dual technique was introducedabout three years ago by MarshallStrome, M.D., chairman of the Cleve-land Clinic Head and Neck Institute,based on his hypothesis that destroy-ing an extra margin of tissue withcryoablation might enhance cancercontrol rates compared with lasertreatment alone. In their early follow-up of patients treated with the com-bined surgery, however, Dr. Stromeand his Voice Center colleagues weresurprised and delighted to find theprocedure was associated with a clear advantage relative to laser sur-gery with respect to postoperativevoice quality.

Overall, their evaluations showedpatients who underwent thelaser/cryo surgery were achievingphonatory function and vocal per-formance that was equal to or better than theirpreoperative status and that was even normal inmany individuals.

“We have never before seen voices like these in patients treated for laryngeal cancer, and theoutcomes are particularly extraordinary consid-ering that some of the patients we treated hadfairly large tumors,” says Dr. Strome.

Claudio F. Milstein, Ph.D., a speech-languagepathologist in the Clinic’s Voice Center, analyzedvoice and laryngeal function data from 22patients who underwent the surgery for stageTis-T2 laryngeal squamous cell carcinoma,including several in whom radiation therapyfailed. Evaluations of preoperative and serialpostoperative voice samples were performed in

blinded fashion by voice professionals, and allthe subjects were asked to self-rate their voiceoutcomes. In addition, all patients underwentvideostroboscopic examination.

All patients had moderate to severe impairmentpreoperatively, but after a mean postoperativefollow-up of 19 months (range, 3 to 38 months),most patients showed significant improvement,with 30% having normal voices and phonatoryfunction. The results of the patient ratings werealso highly favorable. About 72% indicated therewas a significant improvement when comparingtheir postop and preop voice and 14% consid-ered themselves as having achieved moderateimprovement.

The videostroboscopy studies revealed the surgi-cally created defects healed with volume restora-tion, temporally improved pliability and goodvibratory dynamics, reports Dr. Milstein.

Top row, preoperative views of a patient with a tumor occupying the

anterior two-thirds of the left vocal fold. Top left, breathing. Topright, phonation. Bottom row, the patient is seen two months after

laser resection and cryoablation. Bottom left, breathing. Bottomright, phonation. The lesion is gone and the left vocal fold appears

straight and smooth with a healthy mucosa.

continued on page 3

2

First Class Begins at Cleveland Clinic Lerner College of Medicine The first class of The Cleveland Clinic LernerCollege of Medicine began in July with a presti-gious faculty that will include members of theHead and Neck Institute staff.

There was tight competition for placement inthe class — about 600 students applied for the32 spots in the five-year program that combinesthe medical education and research programsat The Cleveland Clinic and Case Western

Reserve University to prepare physician-inves-tigators and scientists dedicated to advancing biomedical research and practice.

All Head and Neck Institute staff members areexpected to join the faculty. Already appointed as professors are Marshall Strome, M.D., M.S.,Ramon Esclamado, M.D., Gordon Hughes, M.D.,Robert Katz, M.D., Craig Newman, Ph.D., PeterWeber, M.D., and Judith White, M.D., Ph.D.

According to the National Academy of Sciences’Institute of Medicine, less than 2 percent of

physicians in the United States are currentlyprepared to perform clinical research.

“The Cleveland Clinic has long been committedto medical education and research in addition to its mission of providing extraordinary patientcare,” said Floyd D. Loop, M.D., chief executiveofficer of The Cleveland Clinic. “This historicpartnership will have a significant impact onmedicine, research and education.”

The school is named in honor of a $100 milliongift made by Al Lerner, longtime Cleveland businessman, friend of the Clinic and owner of the Cleveland Browns, who died in 2002.

The program has been extended to five years —two years in basic science disciplines and threein core clinical experience, elective rotationsand a research project unique to each student.Students may elect to extend their training evenfurther and obtain a doctoral degree in additionto their medical degree.

Case Western Reserve Universityof

Cleveland Clinic Lerner College of Medicine

Claudio F. Milstein, Ph.D., performs a videostroboscopy at the Cleveland Clinic Head and Neck Institute. By placing a rigid scope inside the patient’s mouth, he is able to examine the anatomy of the larynx and study vocalfunction. On the monitor, the larynx is seen while the patient is breathing. On the top are the arytenoid cartilagesand in the center and bottom are the vocal folds.

“Those findings are remarkable. Knowing thatcryoablation produces cell necrosis, we antici-pated seeing more scar tissue that would preventthe vocal folds from vibrating well and lead tohoarse voices. Instead, we noticed the tissueswere becoming more and more pliable over time,and the appearance was so normal in some casesthat an observer blinded to the status would noteven think surgery had been performed,” Dr.Milstein says.

The results from the voice studies and videostro-boscopy were presented at the Voice Foundationmeeting in Philadelphia in June.

The Cleveland Clinic Head and Neck

Institute is ranked among the most highly rated

ear, nose and throat programs in the United

States by U.S.News & World Report. The

Cleveland Clinic continues to be recognized as

one of "America's Best Hospitals" in the maga-

zine's annual survey. In 2004, The Cleveland

Clinic was ranked the nation's 4th best hospital.

continued from page 2

Vocal Outcomes

3

Audiologists and surgeons at The ClevelandClinic Implantable Hearing Device Center arecollaborating to use new technology to bringpatients into a better world of sound.

One of the newest devices available through theCenter is the BAHA Hearing System (Entific).Based on the principle of bone conduction, thesystem consists of an external sound processorattached to a small titanium implant placed inthe bone behind the ear. The BAHA Hearing Sys-tem is indicated for people with mixed or con-ductive hearing loss and single-sided deafness

(SSD). In SSD patients, the system is placed onthe deaf side and sound travels across the headthrough the skull bone to stimulate the cochleaof the opposite ear.

During the approximately 12 months the BAHAHearing System has been available through theCenter, members of The Cleveland Clinic Headand Neck Institute and their patients have beenhighly satisfied with it, reports Craig Newman,Ph.D., section head, Audiology.

“The BAHA Hearing System has really allowedus to fill unmet needs for these patients. It offersan exciting new level of hearing aid alternativesfor individuals we were not able to fit with con-ventional amplification, and it is demonstratinga very positive effect on quality of life,” he says.

Patients fitted with the BAHA Hearing Systemhave undergone pre- and post-implantationevaluations using the Hearing Handicap Inven-tory. The results of that instrument show thedevice has been associated with significantreductions in perceived handicap. Not only are

patients showing improved communicationfunction in a variety of listening situations, theyare also demonstrating improved psychologicalfunction, particularly as measured by experi-encing reduced frustration and isolation.

Now, a formal, 18-month prospective study hasbeen launched to quantify the BAHA HearingSystem’s benefits in SSD patients. Study endpoints include data from a number of objectivetests evaluating performance in understandingspeech, coping with various types of backgroundnoise and being able to localize sound alongwith various measures to track changes in per-ceived handicap and disability. Cost utility andcost-effectiveness are also being analyzed.

The study is being undertaken to see if benefitsreported in the short-term premarketing clinicaltrial are durable, Dr. Newman says.

“Currently published clinical trials for thisdevice only followed patients for two months, so we are interested in whether the benefits andpatient satisfaction persist. The econometricanalyses are also important so we can comparethis device with other types of amplification sys-tems and other medical devices and services,”he explains.

“The procedure for implantation of titaniumscrews takes less than 30 minutes, and the risksare minimal. There is the potential for infectionand failure of the screw to integrate with the bone,but those events are quite rare,” says Peter Weber,M.D., surgeon and program director.

Postoperative healing usually follows anuneventful course, although there is a three-month waiting period while the implantbecomes anchored before the sound processorcan be snapped onto its external portion. Theprocessor itself can usually be hidden beneaththe patient’s hair. Because the sound processordoes not come into direct contact with the skin,problems such as skin breakdown, headachesand pain that can be associated with other boneconduction hearing aids are avoided.

The Cleveland Clinic’s team approach involvingaudiologists and otolaryngologists is fundamen-tal to achieving the best outcomes for patients

treated through the Implantable Hearing DeviceCenter. Both types of specialists are involved inthe preoperative evaluation of candidates for thevarious available technologies, which include

Bone-Anchored Hearing System Fills Important NicheIndicated for mixed or conductive hearing loss, single-sided deafness

Semi-implantable Device Offers AlternativeFor High-Frequency Hearing Loss

Members of The Cleveland ClinicImplantable Hearing Device Center haverecently begun to identify patients withhigh-frequency hearing loss who would begood candidates for another new technol-ogy — a semi-implantable hearing aid(RetroX; Gyrus ENT). That device consistsof a hollow titanium tube and a minia-ture digital signal processing hearing aid.The tube is surgically implanted frombehind the ear and enters the ear canal;the hearing aid snaps onto the externalend of the tube behind the ear where it isreadily concealed.

“By allowing the ear to remain completelyopen, this device reduces the occlusioneffect associated with conventional hear-ing aids. Therefore, patients who are suf-fering from high-frequency hearing losscan enjoy the benefits of improved speechclarity while their own voices continue tosound natural,” says Craig Newman, Ph.D.

The surgical procedure to implant thetitanium tube is done under local anes-thesia, and a simulator module is alsoavailable for the RetroX so that candidateswill have a chance to test out the systembefore having surgery.

“The RetroX appears to be a very gooddevice that may be applicable to a largesegment of the population suffering fromhearing loss problems, and we look for-ward to starting to use it in the very nearfuture,” says Peter Weber, M.D.

continued on page 10

4

When used with appropriate care and caution,Venturi principle atomizers do not appear to beassociated with a high potential contaminationrisk, according to research at The ClevelandClinic Head and Neck Institute.

Prompted by the results of a recent laboratorystudy reporting a high rate of contaminationassociated with the use of these devices, Cleve-land Clinic otolaryngologists undertook aninvestigation to evaluate the presence of bacter-ial colonization in devices in use at their busyreferral center. They inoculated blood agarplates with spray samples and reservoir solutionfrom 15 atomizers that had been in clinical usefor 30 days.

Microbiological evaluation after five days ofincubation showed bacterial growth was rareand minimal when it did occur. Only three(20%) plates were positive and each grew only a single colony that was determined to representa bacterial concentration within the sample of<1 colony forming unit/ml. Furthermore, eachof the three positive cultures was obtained fromseparate bottles and they represented reservoir aswell as spray samples.

Based on those findings, the researchers con-cluded the likelihood of significant contamin-ation was low and that the bacterial growthfound was probably the result of plate exposureduring processing.

“Considering that Venturi principle atomizersoperate using negative pressure and are oftenused in patients with transmissible sinonasalinfections, there is a solid theoretical basis toexpect a risk for contamination. Concern aboutthat issue was particularly stirred by the resultsof a recent study that found a 100% contamina-tion rate. However, that trial used an artificialtest setting in which the atomizers were immersedand sprayed into a bacteria-containing broth,while our study evaluated the risk as it pertainsto the real world of clinical practice,” says PeteS. Batra, M.D.

“With Venturi atomizers being used so widely, it had generally been assumed that the risk oftheir contamination was low. Although recently

reported data suggested that belief may bewrong, fortunately, our study supports the safetyof these devices when they are used with appro-priate protocols for preventing contamination,”says Martin J. Citardi, M.D.

The atomizers tested were selected from fourseparate exam rooms and had been used dailyin consecutive patients by two rhinologists. Thecontents of the bottles included 4% lidocaine(n=3), 2% lidocaine (n=4) and 0.05% oxy-metazoline (n=8). The positive cultures werefrom two 4% lidocaine bottles and one atomizercontaining oxymetazoline.

“Lidocaine, especially at a concentration of 4%,has antibacterial effects, and both lidocaine for-mulations contain methylparaben as preserva-tive that may inhibit bacterial growth. However,there is nothing in the oxymetazoline solutionthat would protect against atomizer contamina-tion,” Dr. Batra says.

The study methods were designed to maximizethe likelihood of finding contamination, butalso to replicate the conditions of clinical use.Taking the worst-case clinical scenario, all ofthe atomizers tested had been used for 30 days,which represents the maximum period of usebefore the devices are emptied and subjected tothorough cleaning and sterilization. Sampleswere obtained by both spraying the bottle con-tents directly onto the plate and withdrawing asample from the reservoir, recognizing that boththe tip and the medication reservoir may becontaminated. However, in accordance withusual practice, each bottle tip was first wipedwith 70% isopropyl alcohol and sprayed towarda trash receptacle before the study specimenswere obtained.

Dr. Batra notes that the latter measures are part of the protocol for using Venturi atomizers atThe Cleveland Clinic that focuses on reducingthe risk of device contamination and spread ofnosocomial infection. Based on preference ofthe physician user, the spray is either deliveredwith a disposable plastic protector placed overthe atomizer tip (Rhinoguard, Micromedics) or with a nasal speculum inserted to dilate the

nares and prevent the atomizer from coming indirect contact with the nasal vestibule.

After they have been in use for 30 days, theatomizers are replaced with sterilized devices.Cleaning and sterilization involves washingwith a proteolytic detergent and autoclaving

using steam for metal-tip bottles and gas foratomizers with a plastic tip. To avoid iatrogeniccross-contamination, the rhinologists practicemeticulous handwashing, routinely wear glovesand don masks when performing endoscopy.

“Different centers may practice different usageprotocols and have a different patient mix,” saysDr. Batra. “Since those features can influenceatomizer contamination, we would encourageother studies assessing the risk of contamina-tion associated with standard conditions of use.Meanwhile, all clinicians should continue touse these devices with care and caution, espe-cially in patients who have active infection orimmunosuppression.”

In the future, the researchers hope to expandtheir study to a larger scale to see how it com-pares with their current results. In addition, they hope to examine the risk of contaminationassociated with other devices used in the nose.

Mark Rizzi, M.D., a Cleveland Clinic Head and Neck Institute resident, presented thisresearch at the 2003 American Rhinologic Society Fall Meeting in Orlando. The finalpaper, co-authored by Dr. Batra, Dr. Citardi, Dr. Rizzi, Geraldine Hall, Ph.D., and Donald C. Lanza, M.D., is in press for the AmericanJournal of Rhinology.

Venturi Atomizers Not at High Risk of Contamination in Clinical-Practice Study

Used appropriately,

Venturi principle atomizers

do not have a high risk

of contamination.

5

The Cleveland Clinic Head and Neck Instituteheld its third annual Otolaryngology Sympo-sium in Florida in March, and the attendance,program content and participant feedback haveimproved every year, says David Greene, M.D.,course director and head of otolaryngology forCleveland Clinic Florida.

The first three-day Cleveland Clinic Otolaryn-gology Symposium in March 2002 was attendedby more than 100 participants from across thecountry and led by a faculty from The Cleve-land Clinic Foundation and Cleveland ClinicFlorida. In its second year in 2003, the sympo-sium drew more than 150 attendees, expandedto include a one-day companion course on oto-laryngology for primary care doctors and addedseveral prominent guest speakers. In 2004,attendance at both the ENT and primary carephysician programs rose again, with more than200 participants.

Since its inception, the Naples, Fla., programhas evoked extremely positive feedback from theattendees, and many have come back year afteryear, calling themselves “CCF course groupies,”says Dr. Greene.

The 2004 guest faculty included world-renownedfacial plastic surgeons Eugene Tardy, M.D., andDean Toriumi, M.D., teaching rhinoplasty andfacial plastic surgery; Richard Goode, M.D., aleader in new methods for treating sleep apneaand facial plastic surgery; and Greg Postma, M.D.,a laryngologist and pioneer in the use of trans-nasal esophagoscopy.

The symposium was the brainchild of Dr.Greene, who proposed the idea to his ClevelandClinic colleagues after they delivered the entireprogram for the three-day annual meeting ofthe Israeli National Academy of Otolaryngologyin 2001.

“Dr. Isaac Eliachar, then our section head forlaryngotracheal reconstruction, was principal indeveloping the National Academy program andenlisted our participation as faculty. Reflecting

on the success of that event, it occurred to methat if the Clinic’s department members couldpresent an entire course to physicians in anoth-er country, why not do the same right here inFlorida?”Dr. Greene says.

Immediately upon returning home, he begandesigning the symposium, focusing on develop-ing a program that would fulfill the educationalneeds of practicing ENTs by teaching skills fornewly developed and highly practical techniques.The first year, the program focused on sleepapnea, sinusitis and nasal surgery. Based onparticipant feedback, presentations in facialplastic surgery and transnasal esophagoscopywere added the next year.

“I spend a lot of time talking to our attendees,who I refer to as our associate course directors,

and we continue communicating after themeeting so I can find out what we are doingright and determine how to make the programbetter in the future,” Dr. Greene says. “Thissymposium is entirely geared to help practicingotolaryngologists learn what they need in orderto do a better job, and because of the relevanceof its topics and the way the course is organ-ized, attendees are able to begin using much of what they learned as soon as they return towork on Monday.”

Both the atmosphere and format of the sym-posium are highly conducive to learning, heexplains. There are didactic presentations,demonstrations using multimedia technologyand interactive sessions devoted to case presen-tations and panel discussions during whichattendees can review personal cases and provideopinions. One-on-one interaction with the fac-ulty is also encouraged.

The symposium also incorporates mind-stim-ulating presentations on advances in the field.At the first meeting, Marshall Strome, M.D.,Chairman and Professor, Cleveland Clinic Headand Neck Institute, gave the keynote addressand described his experience as the first surgeonto perform a total larynx transplant. In 2004,Dr. Strome discussed exciting data on outstand-ing voice preservation and cure rate with hisinnovative approach to combining laser exci-sion and cryotherapy for the treatment of earlyglottic carcinoma. Dr. Greene has also presentednew data on his research with tongue-basedablation using low-temperature radiofrequencymolecular disassociation as a treatment forsleep apnea.

Department members Drs. Martin Citardi andDonald Lanza discussed advanced approaches totumors of the skull base and endoscopic treat-ment of frontal sinusitis.

Cleveland Clinic Otolaryngology Symposium in Florida Continues to Generate Positive Reviews

PLAN AHEAD

The 2005 Otolaryngology Symposiumin Florida is scheduled for March 17-19.It will be held at the Registry Resort,Naples, Fla., and will again featureworld-renowned experts Eugene Tardy,M.D., Martin Citardi, M.D., and GregPostma, M.D. Robert Ossoff, D.M.D.,M.D., will also join the guest faculty thisyear. Topics will include cutting-edgedevelopments in fields ranging fromendoscopic surgery to rhinoplasty andtransnasal esophagoscopy.

For registration information, call877/675-7223, ext. 44366.

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Improving care in Lithuaniais the mission for one doctor

Traveling to rural Lithuania to perform complexsurgeries and train local surgeons has becomean annual activity for Edward Fine, M.D., Ph.D.,an otolaryngologist at The Cleveland Clinic.

Dr. Fine has been traveling to an impoverishedarea of Lithuania with other health care profes-sionals, including otolaryngologists, oral-max-illofacial surgeons, anesthesiologists, dentistsand nurses for about seven years. Sponsored byBALFAS, a Lithuanian relief organization, theteam’s primary goal is to help surgeons in thearea learn surgical techniques and improve theirequipment, allowing them to provide higher-quality care on their own, Dr. Fine explains.

“We have a videoteleconferencing system thatallows us to meet with our colleagues every one to two months. Patients are presented orreviewed and we offer advice on how to managetheir problems. If the case is too challenging,the surgery will be delayed until our visit, andwe then treat the patient while teaching the sur-geons,” he says.

Since most of the cases are screened throughvideoteleconferencing before the trip, the teamis able to spend one day in the clinic and fivedays in the operating room. While there, thegroup primarily treats craniofacial abnormali-ties, as well as post-traumatic injuries and somehead and neck problems.

“The videoteleconferencing system allows us tofollow up with patients and maintain an ongo-ing dialogue with the surgeons. This continuityof care improves the patients’ outcome,” Dr.Fine says.

As in many areas in the developing world, one of the biggest challenges surgeons in Lithuaniaface is the lack of modern equipment. Over theyears, several Cleveland Clinic Health Systemhospitals have contributed outdated equipmentto the organization — “equipment that, by ourstandards, is old or outdated but is a hugeimprovement over what they have there,” Dr.Fine explains.

“It is very rewarding to see the progress that has been made in a few years time. This seemsto encourage us to continue to support thesesurgeons in their desire to improve their healthcare,” he concludes.

Jewish-Palestinian groupworks to help in Middle East

Large numbers of Jewish and Palestinian peoplelive side by side in peace in the Cleveland area,and representatives from both groups have founda way to share their cooperative spirit with peo-ple in the Middle East.

Ishmael & Isaac, a local organization formed tounite people from both groups, believes workingto improve health and human services in Israeland the Palestinian territories is a good way toreach out in a nonpolitical way to the innocentpeople in both populations, explains Tom I. Abel-son, M.D. The group raised money at a dinnerheld in the United States to buy an ambulance forthe Jewish community in Beit She’an and to helpstart a pediatric oncology center in a Palestinianhospital in East Jerusalem.

Dr. Abelson, a Jewish otolaryngologist in TheCleveland Clinic Head and Neck Institute, accom-panied several leaders of the group on a trip toIsrael and the West Bank in November to see howtheir donations were being used and assess addi-tional ways to help. While there, he delivered a

lecture to medical professionals about the partialtonsillectomy technique developed by his Cleve-land Clinic colleague Peter Koltai, M.D.

“Ishmael & Isaac was founded on the belief thatencouraging constructive contact among peopleis a prime way we can provide hope in the Mid-dle East,” he explains. “We used the trip to learnhow to help provide health and humanitarianassistance to people living in very difficult cir-cumstances.”

Dr. Abelson and others who took the trip continueto be involved via videoconferencing in work toform a professional care community between thetwo populations. He hopes to join the group whenit travels to the Middle East again.

“We believe the more contacts there are and themore people work together, the greater the coop-eration there will be if and when peace happens,”he says. “Our goals are to develop solid relation-ships in Cleveland and to provide aid together inthe Middle East. Our hope is for peace.”

Academy gives career awardto Clinic’s Craig Newman

Craig W. Newman, Ph.D, received the JergerCareer Award for Research in Audiology given by the American Academy of Audiology in SaltLake City in April. The Jerger Career Award honors audiologists who have been productiveresearchers and who also have made significantcontributions to the practice and/or teaching ofaudiology. In announcing Dr. Newman’s honor,the American Academy of Audiology said thatDr. Newman “exemplifies what is best about our profession. He is an outstanding clinician-researcher, instrumental in developing clinicaloutcome measures for our profession, and mostrecently, he has brought evidence-based medi-cine to the profession of audiology.”

Dr. Newman’s research focuses on evaluatingthe benefits derived from medical, surgical andrehabilitative treatments for auditory andvestibular disorders. His areas of special interestinclude the study of tinnitus, clinical outcomemeasures and geriatric audiology.

Dr. Newman also was elected to the Academy’sBoard of Directors for a three-year term begin-ning July 1, 2004.

Staff News

Cleveland Clinic otolaryngologist Tom Abelson, M.D.,

(at right) is seen in Israel with Shimon Peres of the

Peres Center for Peace, a partner with the Cleveland

multifaith organization Ishmael & Isaac, which works

to improve life in the Middle East.

7

Marshall Strome, M.D.Chairman & ProfessorHead and Neck InstituteClinical Interests: head and neck surgery with specialinterests in laryngology; thyroid and parathyroid surgeryPhone: 216/444-6686; Fax: 216/445-9409

Tom Abelson, M.D.Solon and Beachwood Family Health CentersClinical Interests: voice medicine; pediatric otolaryn-gology; sinus disease; general otolaryngologyPhone: 440/519-6950; Fax: 440/519-1364

Daniel Alam, M.D.Section Head, Aesthetic and Reconstructive SurgeryClinical interests: plastic and reconstructive surgery;facial aesthetic surgery; head and neck microvascularreconstruction; facial paralysisPhone: 216/445-6561; Fax: 216/445-9409

Gilberto Alemar, M.D.Cleveland Clinic Florida in WestonClinical Interests: surgery of the nose and sinuses;sinusitis; voice and swallowing disorders; surgery of the head and neck tumors; sleep apnea and snoring;surgery for airway reconstructionPhone: 954/659-5786; Fax: 954/659-5787

Steven Ball, M.D.Strongsville Family Health and Surgery CenterClinical Interests: general otolaryngologyPhone: 440/878-2500; Fax: 440/878-2666

Pete Batra, M.D.Clinical Interests: paranasal sinus disease; sinonasaltumors; CSF leaks; allergyPhone: 216/444-0810Fax: 216/445-9409

Martin Citardi, M.D.Clinical Interests: revision sinus surgery; frontal sinussurgery; sinonasal neoplasia; computer-aided sinus sur-gery; endoscopic orbital decompression; endoscopic CSFleak repairPhone: 216/444-4515; Fax: 216/445-9409

Isaac Eliachar, M.D. Consultant StaffClinical Interests: medical otolaryngology Phone: 216/444-8231; Fax: 216/445-9409

Ramon Esclamado, M.D. Vice Chairman and ProfessorSection Head, Head and Neck Surgery Clinical Interests: head and neck surgery; micro-vascular reconstruction; laryngotracheal reconstructionPhone: 216/444-6695; Fax: 216/445-9409

Edward Fine, M.D., Ph.D.Westlake Family Health CenterClinical Interests: laryngology; sinonasal disease; facialcosmetics and reconstructionPhone: 440/899-5630; Fax: 440/899-5636

Richard Freeman, M.D., Ph.D.Westlake Family Health CenterClinical Interests: general otolaryngology; head andneck surgery; sinonasal diseasePhone: 440/899-5630; Fax: 440/899-5636

Michael Fritz, M.D.Clinical Interests: head and neck reconstructive surgery;soft tissue and microvascular reconstruction; rhinoplastyPhone: 216/444-2792; Fax: 216/445-9409Joint Appointment: MetroHealth Medical Center

David Greene, M.D.Head, Department of Otolaryngology, Cleveland Clinic Florida in NaplesClinical Interests: sleep apnea and snoring surgery; rhino-plasty; facial plastic surgery; endoscopic sinus surgery;laser surgery; facelift, blepharoplasty; skin cancer surgeryand reconstruction; minimally invasive facial rejuvenationPhone: 239/348-4081; Fax: 239/348-4355

Catherine Henry, M.D.Clinical Interests: medical otolaryngology; preventivemedicine; women’s health issues; asthmaPhone: 216/445-8464; Fax: 216/445-9409Joint Appointment: General Internal Medicine

Meet Our Staff (as of July 2004)

8

Douglas Hicks, Ph.D.Section Head, Speech and Language PathologyDirector, Voice CenterClinical Interests: voice science; voice disorders; care of the professional voicePhone: 216/444-5773; Fax: 216/445-9409

Keiko Hirose, M.D.Clinical Interests: pediatric ear surgery; hearing loss evaluation; cochlear implantation; basic scienceresearch in causes of deafness; general pediatric oto-laryngologyPhone: 216/444-6689; Fax: 216/445-9409

Gordon Hughes, M.D.Section Head, Otology and ProfessorClinical Interests: ear surgery for deafness and infection;facial paralysis; immunology of the ear; pediatric eardiseases; vertigo diagnosis and management; tumors of the earPhone: 216/444-5375; Fax: 216/445-9409

Steve Hunyadi Jr., M.D.Wooster ClinicClinical Interests: general otolaryngology; sinonasal disease and allergy; head and neck surgery; plastic andreconstructive surgery; pediatricsPhone: 330/287-4630; Fax: 330/287-4741

Robert Katz, M.D.Section Head, Community Otolaryngologyand Clinical ProfessorSolon Family Health CenterClinical Interests: pediatric otolaryngology; otology;head and neck surgery; general otolaryngologyPhone: 440/519-6950; Fax: 440/519-1364

Peter Koltai, M.D.Section Head, Pediatric OtolaryngologyClinical Interests: laryngotracheal reconstruction; post-traumatic craniofacial reconstruction; chronic middleear disease; chronic sinusitis; head and neck neoplasmsPhone: 216/445-5022; Fax: 216/445-9409

Alan Kominksy, M.D.Beachwood Family Health Center and Main CampusClinical Interests: adult and pediatric general otolaryn-gology; sinonasal diseasePhone: 216/444-1948; Fax: 216/445-9409

Paul Krakovitz, M.D.Clinical Interests: pediatric otolaryngology; head andneck disease; sinus disease; airway; voice and thyroiddisordersPhone: 216/444-3061; Fax: 216/445-9409Beachwood phone: 216/839-3740

Donald Lanza, M.D.Section Head, Nasal and Sinus DisordersClinical Interests: treatment of recalcitrant sinusitis;revision sinus surgery; assessment and treatment ofnasal obstruction; cerebrospinal fluid rhinorrhea;tumors of the anterior skull basePhone: 216/444-4939; Fax: 216/445-9409

Robert Lorenz, M.D.Clinical Interests: vocal cord paralysis; head and neckoncology; laryngotracheal reconstruction; skull basetumorsPhone: 216/444-3006; Fax: 216/445-9409

Claudio Milstein, Ph.D.Clinical Interests: voice disorders; care of the profession-al voice; aerodigestive tract disorders; laryngeal physiolo-gy; functional dysphonia; vocal cord dysfunctionPhone: 216/444-8677; Fax: 216/445-9409

Craig Newman, Ph.D.Section Head, Audiology and ProfessorClinical Interests: geriatric communication disorders;tinnitus; evoked potentials; hearing aids; outcomesresearchPhone: 216/445-8520; Fax: 216/445-9409

John G. Oas, M.D.Section Head, Vestibular & Balance DisordersClinical Interests: otolith disorders; benign paroxysmalpositional vertigo; adult and pediatric vestibular andbalance disorders; cervicogenic dizziness; vestibularrehabilitationPhone: 216/444-7001; Fax: 216/445-9409

George Ozbardakci, M.D.Lorain Family Health and Surgery CenterClinical Interests: sinus problems; hearing loss; hearingaids; snoring; sleep apnea; tonsils and adenoidsPhone: 440/204-7400; Fax: 440/204-7396

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Jay Roberts, M.D.Cleveland Clinic Florida in NaplesClinical Interests: thyroid and parathyroid surgery; otology; head and neck surgeryPhone: 239/348-4000; Fax: 239/348-4355

Sharon Sandridge, Ph.D.Clinical Interests: electrophysiologic assessment; state-of-the-art amplification options including assistive listening devices and digital hearing aids; tinnitus andolder adultsPhone: 216/445-8517; Fax: 216/445-9409

Suyu Shu, Ph.D.Research Interests: cellular immunology; cancerimmunotherapy; molecular biologyPhone: 216/445-3800; Fax: 216/445-3805Joint Appointment: Director, Center for SurgeryResearch

Peter Weber, M.D.Program Director and ProfessorClinical Interests: surgery for pediatric and adult ear disease including cochlear implants; implantable hear-ing aids; infectious cholesteatomas; acoustic neuromas;ear tumors; skull bone lesions; facial nerve disordersand vertigoPhone: 216/444-6689; Fax: 216/445-9409

Judith White, M.D., Ph.D.Assistant ProfessorClinical Interests: vestibular disorders; dizziness and balance; hearing problems; ear disease; vertigo Phone: 216/444-8552; Fax: 216/445-9409Beachwood phone: 216/839-3740

Benjamin G. Wood, M.D.Clinical Interests: oncologic surgery of the head andneck; skull base surgery; nasal/paranasal sinus surgeryPhone: 216/444-5700; Fax: 216/445-9409

Meet Our Staff (continued)

Introducing New StaffMichael Anthony Fritz, M.D., joined the staff of The Cleveland Clinic Head and Neck Institute on August 1.

Dr. Fritz recently completed a fellowship in facial plastic andreconstructive surgery at the University of Minnesota in Minne-apolis. He completed his otolaryngology residency and a generalsurgery internship at The Cleveland Clinic and received his med-ical degree from Ohio State University. His bachelor’s degree isfrom Duke University.

Dr. Fritz specializes in all facial plastic and reconstructive surgeryincluding microvascular free tissue transfer. His interests include

soft tissue and bony facial reconstruction, functional and aesthetic rhinoplasty and con-genital deformities. He will have a joint appointment with Cleveland’s MetroHealth MedicalCenter, where he will work two days a week.

He is board-certified in otolaryngology and is pursuing certification in facial plastic andreconstructive surgery. He is a member of The American Academy of Otolaryngology- Headand Neck Surgery and the American Academy of Facial Plastic and Reconstructive Surgery.

cochlear implants and a semi-implantablehearing aid (RetroX; Gyrus ENT), in addition to the BAHA Hearing System.

After initial audiology testing and examinationby the surgeon, candidates spend 60 to 90 min-utes with Dr. Newman learning how the systemworks, how to care for it and what to realisti-cally expect.

“The surgeons and audiologists in the Centerwork in concert along with speech pathologiststo evaluate patients carefully and ensure eachreceives appropriate care based on the uniquefeatures and the indications of the various im-plantable devices,” Dr. Weber says.

continued from page 4

BAHA

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Isaac Eliachar, M.D., creates the rotary-door sternohyoidmyocutaneous flap in a single-stage procedure, a technique he developed to minimize risk of rejection and maintain air-way patency, in this photo from the late 1980s. He retired inDecember after 20 years with The Cleveland Clinic.

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Isaac Eliachar, M.D., Retires from The Cleveland Clinic

Isaac Eliachar, M.D., retired in December after20 years with the Cleveland Clinic’s Departmentof Otolaryngology and Communicative Disor-ders, now the Head and Neck Institute. Hemaintained a high national and internationalprofile, publishing, lecturing and teaching, aswell as actively participating in and organizingacademic medical meetings and symposia.

Dr. Eliachar joined the full-time staff in 1985,having previously served as professor and chairof the Department of Otolaryngology, Head andNeck Surgery at Rambam Medical Center inIsrael. He specialized in the management of air-way disease and served as head of the Section ofLaryngotracheal Reconstruction, subsequentlyearning his second full professorship.

He was a tireless academic, advancing the artand science of laryngotracheal reconstruction.

One of his sentinel contributions was forward-ing the concept of “Tube Free Tracheostomywith Hands Free Speech Capabilities.”

Dr. Eliachar was an innovator, holding severalmedical device patents, predominantly utilizedin airway surgery. His publications exceed 200manuscripts in peer-reviewed journals andinvited chapters. The teaching courses he gaveannually at the American Academy of Oto-laryngology, Head and Neck Surgery werehighly acclaimed. He organized the first Sym-posium on Laryngotracheal Reconstruction in1991, followed in 1996 by a larger meeting inMonte Carlo.

Dr. Eliachar and his wife, Reeve, moved to Cali-fornia, yet he returned to Cleveland as a consul-tant during the summer.

The Northeast Ohio Au.D.Consortium FormsCollaborative Clinical Education TrainingProgram Is Created

The Head and Neck Institute at The ClevelandClinic Foundation (CCF), the School ofSpeech-Language Pathology and Audiologyat The University of Akron, and the School ofSpeech Pathology and Audiology at Kent StateUniversity have combined efforts to form TheNortheast Ohio Au.D. Consortium (NOAC).

The Consortium merges the strong assets oftwo university programs that focus on the sci-entific and clinical bases of audiology with the CCF Section of Audiology to offer studentsclinical exposure to the breadth and depth ofcontemporary diagnostic and rehabilitativeaudiology. The strengths of each institution,including academic and clinical faculties,resources and facilities, will be combined intoone unified Doctor of Audiology (Au.D.) pro-gram. The degree will be granted through TheUniversity of Akron or Kent State University,depending upon where the student is enrolled.

The NOAC’s mission is to prepare independent,fully competent professional audiologists whoprovide non-medical evaluation and treatmentfor people with hearing impairment.

The doctoral program consists of a continu-ous 4-year, post-baccalaureate course of studydesigned to integrate classroom, laboratoryand clinical experiences. The emphasis is onthe principles and practices underlying diag-nosis, treatment and provision of hearinghealth care services. Students complete theirfourth year of training (Supervised Profes-sional Experience) under the mentorship of clinical audiologists at CCF who assumeresponsibility as the primary clinical educa-tors for the students. Further training oppor-tunities through the new Cleveland ClinicLerner College of Medicine of Case WesternReserve University are anticipated.

“This unique affiliation among The Cleve-land Clinic, The University of Akron and KentState University will serve as a national modelfor Au.D. programs,” says Craig Newman, Ph.D.,head of the Cleveland Clinic Head and NeckInstitute’s Section of Audiology.

Paper by Judith Whiteattracts attention at meetingJudith White, M.D., Ph.D., attracted a great dealof attention for her paper “Canalith Reposition-ing of BPV, an Evidenced Based Review” at theCombined Otolaryngological Spring Meetings.The paper reported that a single 10-minute officetreatment based on a series of head and bodyturns is highly effective in resolving BenignParoxysmal Positional Vertigo. Based on a liter-ature review and data from many studies, Dr.White concluded that the procedure is effectiveup to 80 percent of the time. This comparedwith a 30 percent success rate for patients recov-ering on their own.

In Other Recent NewsMarshall Strome, M.D., presided over thelargest SUO meeting in history as president.Robert Kay, M.D., Cleveland Clinic chief ofstaff, gave the keynote address. Dr. Strome waselected to the Council of the LaryngologicalSociety. Donald Lanza, M.D., president of theRhinological So-ciety, presided over that soci-ety’s fall meeting. Martin Citardi, M.D., wasgiven a presidential citation. Peter Koltai, M.D.,remains secretary of ASPO. Keiko Hirose, M.D.,received a $225,000 grant from the Royal Na-tional Institute for the Deaf, England. She wasprogram director of the North East Ohio Oto-laryngologic Society.

THE CLEVELAND CLINICFOUNDATION

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CLEVELAND, OHPERMIT NO. 4184

Otolaryngology Advances offers information fromCleveland Clinic otolaryngologists, speech pathologistsand audiologists about state-of-the-art medical, surgicaland rehabilitative techniques. Please direct correspon-dence to:

Tom Abelson, M.D., Medical EditorHead and Neck Institute / A71The Cleveland Clinic Foundation9500 Euclid Avenue, Cleveland, OH 44195

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Established in 1921, The Cleveland Clinic Foundationprovides state-of-the-art care in a multispecialty aca-demic medical center that integrates clinical and hospitalcare with research and education in a private, not-for-profit group practice. Otolaryngology and Communica-tive Disorders services are offered at the main campus as well as at Cleveland Clinic family health centersthroughout Greater Cleveland.

Otolaryngology Advances is written for physicians andshould be relied upon for medical education purposesonly. It does not provide a complete overview of the top-ics covered, and should not replace the independentjudgment of a physician about the appropriateness orrisks of a procedure for a given patient.

© The Cleveland Clinic Foundation 2004

Vestibular Disorders Update 2004, a two-daycourse devoted to a review of multidisciplinaryadvances in the diagnosis and management ofdizzy patients, will be held at The ClevelandClinic on Nov. 5 and 6.

The course is designed for otolaryngologists,neurologists, primary care physicians, audiolo-gists and physical therapists. Attendees will learnthe latest in evaluation techniques, testing inter-pretation and methods for treatment andvestibular rehabilitation.

“There has been marked progress in the eval-uation and management of dizziness. New tech-niques enable diagnosis of vestibular disordersduring a concise office examination, and thereare some new, highly effective interventionsavailable,” says Judith F. White, M.D., Ph.D.,course director and a member of the Clinic’sSection of Vestibular & Balance Disorders.“Thepurpose of this course is to inform specialists,primary care physicians and associated medicalprofessionals about the new techniques andtechnologies to enhance their ability to diagnoseand treat vestibular disorders.”

Both days will include a morning session withdidactic lectures and an afternoon portion withsmall break-out groups for hands-on experiencein vestibular testing and rehabilitation tech-nique. Lectures will cover vestibular anatomy,physiology and common disorders, and therewill be special symposia on the upper cervicalspine in vestibular disorders as well as centralvestibular disorders.

Among the testing techniques that will betaught is the use of infrared videoFrenzel gog-gles. Patients wearing these goggles perceivethey are in darkness, but the examiner can fol-low their eye movements and analyze inputfrom the inner ear while the head is placed indifferent positions, Dr. White explains.

“With this tool, we can make many diagnosticdecisions during a brief, non-invasive office eval-uation rather than resorting to time-consuming,detailed vestibular testing in the laboratory.While the latter method is still appropriate insome cases, overall, careful history and physicalexam enable an accurate diagnosis in themajority of patients who are seen with com-plaints of dizziness at the initial visit,” she says.

Other topics to be covered include repositioningmaneuvers for the treatment of benign paroxys-mal positional vertigo, testing methods andrehabilitation strategies for other otolith disor-ders and more common vestibular disorders,including Meniere disease, labyrinthitis, vestibu-lar neuritis and migraine-associated dizziness.

Vestibular Disorders Update 2004 will be held at The Cleveland Clinic InterContinental Hoteland Conference Center. The faculty includes 18members of The Cleveland Clinic staff repre-senting the Head and Neck Institute and thedepartments of neurology, physical therapy,audiology and nursing.

Dr. White’s co-director is John G. Oas, M.D.

November Course to Focus on Advances in Vestibular Disorder Evaluation and ManagementHow to Refer Patients

Physicians can schedule appointmentsfor their patients at The ClevelandClinic Head and Neck Institute by calling 216/444-6691 from 7 a.m.to 11 p.m., seven days a week, or toll-free at 800/553-5056.

Visit our Web site at clevelandclinic.org/otol/