the magazine PDF - South Florida ENT Associates
Transcription
the magazine PDF - South Florida ENT Associates
winter 2014 SFENTA 145573_South Florida ENT.indd 1 3/21/14 2:23 PM Open the door to a world of sound There is a solution for those who do not receive significant benefit from hearing aids. Learn more about the Cochlear ™ Nucleus and the Cochlear Baha Systems. ® ® www.Cochlear.com/US ©2013 Cochlear Limited. All rights reserved. Hear Now. And Always and other trademarks and registered trademarks are the property of Cochlear Limited. FUN1731 ISS1 MAR13 SFENTA locations more info at sfenta.com AventurA, FL 21150 Biscayne Blvd., #102 Aventura, FL 33180 305-935-6000 305-682-8831 DorAL, FL 8726 NW 26th St., Unit #3 Doral, FL 33172 786-228-3164 9915 NW 41st St., #220 Doral, FL 33178 305-477-1133 777 East 25 St., #320 Hialeah, FL 33013 305-836-2044 HoLLywooD, FL 3850 Hollywood Blvd., #401 Hollywood, FL 33021 954-961-8153 2845 Aventura Blvd., #248 Aventura, FL 33180 305-531-7637 Ft. LAuDerDALe, FL 1317 SE 4th Ave. Fort Lauderdale, FL 33316 954-583-7770 21097 NE 27th Ct., #410 Aventura, FL 33180 305-932-6375 1625 SE 3rd Ave., #717 Fort Lauderdale, FL 33316 954-760-7836 HomesteAD, FL 925 N.E. 30th Terrace, #214 Homestead, FL 33030 305-245-5881 BocA rAton, FL 7900 Glades Rd. #340 Boca Raton, FL 33434 561-353-7377 3079 E. Commercial Blvd., 1st fl. Fort Lauderdale, FL 33308 954-776-0620 KenDALL, FL 8940 N. Kendall Dr., #504E Miami, FL 33176 305-595-6200 coconut Grove, FL 3661 S. Miami Ave., #409 Miami, FL 33133 305-854-5971 HALLAnDALe, FL 2100 E. Hallandale Bch Blvd., #405 Hallandale, FL 33009 954-454-0544 corAL GABLes, FL 6705 Red Rd., #704 Coral Gables, FL 33143 305-666-0203 6705 Red Rd., #602 Coral Gables, FL 33143 305-663-3380 747 Ponce De Leon Blvd., #305 Coral Gables, FL 33134 305-444-4903 HiALeAH, FL 7100 West 20 Ave., #315 Hialeah, FL 33016 305-558-1417 7100 West 20 Ave., #105 Hialeah, FL 33016 305-557-4016 4700 Sheridan St., Suite K Hollywood, FL 33021 954-966-7000 LiGHtHouse Point, FL 3126 N. Federal Highway Lighthouse Point, FL 33064 954-785-0900 nortH miAmi, FL 1190 NW 95 St., #200 Miami, FL 33150 305-691-2550 mArGAte, FL 5800 Colonial Dr., #105 Margate, FL 33063 954-974-4890 PemBroKe Pines, FL 601 N. Flamingo Rd., #106 Pembroke Pines, FL 33028 954-432-6620 954-431-8281 miAmi, FL 1321 NW 14 St., #204 Miami, FL 33125 305-325-0090 17913 NW 7 St., #102 Pembroke Pines, FL 33029 954-438-4380 1350 SW 57 Ave., #210 Miami, FL 33144 305-441-0744 500 N Hiatus Rd., #101 Pembroke Pines, FL 33026 954-438-7171 11760 SW 40th St., #743 Miami, FL 33175 305-225-5774 18501 Pines Blvd., #210 Pembroke Pines, FL 33029 954-237-2505 9275 SW 152nd St., #212 Miami, FL 33157 305-255-5995 305-254-9631 1444 Biscayne Blvd., #214 Miami, FL 33132 305-667-4515 786-456-8800 601 N. Flamingo Rd., #210 Pembroke Pines, FL 33028 954-438-1015 954-389-1414 15955 SW 96th St. #303 Miami, FL 33176 305-380-6773 351 NW 42nd Ave., #407 Miami, FL 33126 305-255-5774 LAuDerDALe LAKes, FL 4850 West Oakland Park Blvd., #102 Lauderdale Lakes, FL 33313 954-486-4180 miAmi BeAcH, FL 4302 Alton Rd., #650 Miami Beach, FL 33140 305-531-7637 weston, FL 17180 Royal Palm Blvd., #1 Weston, FL 33326 954-389-1414 17190 Royal Palm Blvd., #3 Weston, FL 33326 954-486-4180 page 2 145573_South Florida ENT.indd 2 3/21/14 2:23 PM Welcome back to the third edition of the South Florida ENT Magazine! We are pleased to inside this issue 2 Our Locations announce the introduction of our new SFENTA logo. We decided to replace our existing logo with a clean modern image, 4 Welcome to Our New Physicians 5 Rhinoplasty a fresh look that would be easily recognized on our website, social media platforms as well as print material. It is our hope that you find this new mark to be distinctive, inclusive of all our product lines and easily identifiable. The transition to the new logo will be gradual and take about a year to integrate into all our materials. 8 The Physicians of SFENTA k What Do I Do If I Have a Voice Problem? l Surgical Correction of Hearing Loss We are excited about this new look! As we make this transition, please rest assured that SFENTA is still the same caring, compassionate n Your Face – Your Voice and dedicated health organization that we’ve always been. We’re so thankful for all of your support and partnership both in the past and o Treatment for Head and Neck Cancer as we move forward! Sincerely, Jonathan D. Cooper, M.D. President, South Florida ENT Associates 14750 NW 77th Court, Suite 200 • Miami Lakes, FL 33016 • sfenta.com Medical SFENTA Magazine is designed and published by Custom Medical Design Group. To advertise in an upcoming issue please contact us at: 800.246.1637 or visit us at CustomMedicalMagazine.com. This publication may not be reproduced in part or whole without the express written consent of Custom Medical Design Group. page 3 145573_South Florida ENT.indd 3 3/21/14 2:23 PM Welcome to Our New Physicians AlAn Chen hAo Chu, M.D.: Dr. Alan Chu attended Brown University as an undergraduate and graduated magna cum laude in 2004. He then received his Doctor of Medicine degree from Alpert Medical School of Brown University in 2008, and went on to complete his internship and residency training in Otolaryngology Head and Neck Surgery at UCLA Medical Center in Los Angeles, CA. Dr. Chu provides an unparalleled quality of care and is highly regarded by his patients and peers. Dr. Chu specializes in the treatment of disorders of the head and neck region in both adult and pediatric populations. His diverse training allows him to treat all aspects of ear, nose and throat including sinus disease, thyroid and parathyroid disease, head and neck cancer, allergy, voice disorders, sleep apnea, and swallowing disorder. He is a highly skilled and experienced otolaryngologist currently providing state-of-the-art treatment in the day-to-day care of his patients. Actively involved in the field of otolaryngology, Dr. Chu participated in several research studies throughout his years of experience, and has also published his work leading journals regarding the latest developments and treatments. SinA JoorAbChi, D.o.: Dr. Sina Joorabchi completed his undergraduate training at the University of Michigan. Afterward, he obtained his medical degree from the Michigan State University College of Osteopathic Medicine. Subsequently, Dr. Joorabchi completed his internship and residency training in Otolaryngology and Facial Plastic Surgery at the St. John Providence Health System in Madison Heights, MI. Dr. Joorabchi holds professional memberships with the following associations: American Osteopathic Association, American Osteopathic College of Otolaryngology – Head and Neck Surgery, American Academy of Otolaryngology- Head and Neck Surgery, American Academy of Cosmetic Surgery, American Academy of Otolaryngic Allergy. JAiro TorreS, M.D.: With more than two decades of experience as Otolaryngologist, Dr. Jairo Torres has seen his fair share of ear, nose and throat pathologies. Having treated a broad spectrum of conditions for both pediatric and adult patients, including ear infections, hearing loss, sinus problems, thyroid disorders, head and neck masses, and sleep apnea, he brings a wealth of expertise to our group. He is Board Certified in Otolaryngology- Head and Neck Surgery. Dr. Torres is a firm believer in the Planetree Philosophy, especially when it comes to family involvement. From his own experience, he knows that when he includes loved ones in the treatment process, the patients experience much better outcomes. After earning his Doctor of Medicine degree from University of the Valley Division of Health Sciences (Cali, Colombia) in 1983, Dr. Torres completed the University of the Valley OtolaryngologyHead and Neck Surgery Residency Program, and the Case Western Reserve University (Cleveland, OH) Otolaryngology International Fellowship Program in 1989. At Case Western Reserve University - University Hospitals of Cleveland, he also completed 2 years of General Surgery Residency Program in 2004, and then, the Otolaryngology-Head and Neck Surgery Residency Program in 2008. Dr. Torres conducted research during his residency program at Case Western Reserve University and has presented numerous podium presentations at Case Western Reserve University, Children’s Hospital of Central California and Fauquier Hospital in Virginia. He also published several ENT articles that appeared in Colombian medical journals. Prior to joining South Florida ENT Associates in 2013, Dr. Torres was a staff physician with Fauquier Health ENT in Virginia. The two years prior to that, Dr. Jairo Torres practiced as a Pediatric Otolaryngologist at Children’s Hospital Central California. Prior to that, he was a private practice physician in Colombia for 16 years, where he served as an ENT clinic director. riChArD ViVero, M.D.: Dr. Richard J. Vivero, a native of South Florida, is a board certified Otolaryngologist -Head and Neck surgeon and a fellowship-trained Laryngologist. He graduated from Harvard College with a B.A. in Biology and returned home to earn his M.D. from the University of Miami Miller School Of Medicine, receiving honors with each degree. Dr. Vivero continued his education with a fiveyear residency in Otolaryngology at the University of Miami/ Jackson Memorial Hospital. There, he was elected Chief Resident in his final year. Desiring additional expertise in voice and airway disorders, Dr. Vivero returned to Harvard to complete a fellowship in Laryngology and Laryngeal Surgery at Massachusetts General Hospital/Harvard Medical School under the guidance of the world-renowned Dr. Steven M. Zeitels. While at the Massachusetts General Hospital Voice Center, Dr. Vivero learned the latest and most advanced techniques to manage benign and cancerous lesions of the voicebox and airway, including awake laser surgery, endoscopic cancer treatment, medialization laryngoplasty, Botox, and other vocal cord procedures. In addition, he received advanced training in the management of professional voice users, including singers, actors, lawyers, and teachers, to ensure the best vocal outcomes. He has published significantly in this area and has presented at multiple national meetings regarding his work. page 4 145573_South Florida ENT.indd 4 3/21/14 2:23 PM Rhinoplasty by andres bustillo, m.d., f.a.c.s. Rhinoplasty, or cosmetic nasal surgery, can result in an amazing improvement in the overall appearance of a person. However, there are limitations to what can be achieved with the surgery. There are technical limitations that may be due to the overall size, shape, and skin of the nose. In addition, it must be remembered that the nose’s primary function is breathing. For example, a very dramatic thinning of the nose can sacrifice breathing. My personal philosophy regarding rhinoplasty was fashioned through a fusion of the craft I learned from my mentors and my personal experience after performing hundreds of nasal surgeries. As with all thought processes, it is an evolving one. I learn every day after evaluating every one of my surgical results. I continuously strive to deliver a natural result that will last throughout the patient’s life. Open vs Closed Rhinoplasty For the last fifteen years there has been a great debate on whether the rhinoplasty operation should be performed in an open or a closed fashion. However, these are only approaches. They are called approaches because they are simply the method the surgeon uses to assess the areas of the nose that need to be altered. They are not techniques. Techniques are the methods that the surgeon uses to change or alter the specific anatomic areas of the nose. The “open” approach involves an incision in the columella, or the column between the nostrils. The “closed” approach involves a series of incisions inside the nose. One approach is not better than the other. They are different and each one is used for different types of noses. Having the operation performed in one way does not guarantee a better result. Instead, I believe that there are noses that may be better served with the closed approach and some that are better treated with the open approach. I perform both the open and closed approaches, depending on the nose. Reductive vs Structural Rhinoplasty performed in a reductive manner. In fact, there are still many surgeons that perform rhinoplasty in this fashion. In reductive rhinoplasty, the surgeon removes much of the bone and cartilage to achieve a smaller nose. The nasal tip is reduced in size by cutting off and removing portions of the nasal tip cartilages. In essence, the structural framework of the nose is weakened and destroyed. While most of these noses have a satisfactory appearance in the immediate post-operative period, their shape can continuously change for several years, as the healing and scarring forces take over a nose that has lost all of its structural support. In addition, removal of nasal tip cartilages can result in severe breathing difficulty that can be very difficult to correct. Experience has taught modern rhinoplasty surgeons that simply cutting away the nasal tip cartilages can lead to functional and aesthetic complications. Today’s advanced rhinoplasty techniques shy away from removing the important structural elements from the nose. Instead of removing cartilage, I reshape it using specialized techniques. With the use of special sutures, the nasal tip cartilages are reshaped, to give a more defined nasal tip. Because the sutures allow the surgeon to control the exact shape, this technique allows more predicable results. By placing the sutures on different locations on the nasal tip Over the past decade, great advances have been made in the art and science of rhinoplasty. In the past, rhinoplasty was page 5 145573_South Florida ENT.indd 5 3/21/14 2:23 PM Consultation cartilages, the surgeon can change the shape of the cartilage without removing or cutting them. The consultation process begins with a discussion about the specific issues and concerns regarding the appearance of the nose. Any functional problems are discussed at this time. For example, the patient should communicate whether there is nasal obstruction. This is often corrected during the rhinoplasty procedure. Is Rhinoplasty For You? The decision about having the rhinoplasty operation is a very important and personal one. You should consult with your surgeon and your family. For most patients that undergo the procedure, the results are life changing. Patients describe an increase in confidence and boost in self-esteem. They can become more comfortable in social settings and feel better about how they photograph. In fact, many patients wonder why they waited so long to have the procedure done. Pre-operative The ideal candidate for rhinoplasty is a healthy person who is not content with their nose and would like to have Post-operative it improved. There is no ideal age for rhinoplasty, as I perform rhinoplasty in patients ranging from age fifteen and on. Female patients can undergo the rhinoplasty operation at age fifteen and male patients from sixteen on. The patient must have the proper expectation before undergoing surgery. Although with modern rhinoplasty techniques, results are better than they ever were, there are still limitations. It is important that the patient have a good understanding of what can be achieved. Clear communication between the patient and the surgeon is very important. I use computer imaging to help me communicate with my patients. Surgeons are human and therefore are not perfect. While most rhinoplasty patients enjoy the benefits of an improved nasal contour and profile, it is important to remember that surgery, like all other human actions, is not perfect. A skilled rhinoplasty surgeon can achieve near perfection. This achievement results from the coming together of artistic skill, impeccable surgical technique, and proper healing forces within the nose. However, even when the result is excellent, there will still be minor imperfections. This is normal and expected, as surgery is not a perfect science. A thorough physical examination is then performed. Pre-operative pictures are then taken and computer imaging is done. Computer imaging involves the digital manipulation of the patient’s picture to evaluate various nasal and tip contours. This is a fantastic communication tool that allows the wishes of the patient to be aligned with the surgeon. In fact, I want the patient to participate in the process, so that I can have their input when making the computer-generated image. I will always give the patient a computer-generated image that I believe is achievable. Using computer imaging will allow me to have a clear understanding of the patient’s aesthetic goal and allow the patient to have a clear understanding of what I think is surgically possible. Surgery Surgery is performed in a certified facility under general anesthesia, administered by a board certified anesthesiologist. The procedure takes about two hours and patients are discharged home the same day. The post-operative period is usually painless and bruising is minimal in most cases. Most patients can return to work Andres Bustillo, M.D., F.A.C.S. Facial Plastic Surgery 6705 Red Road, Suite 706 Coral Gables, FL 33143 305-663-3380 www.drbustillo.com page 6 145573_South Florida ENT.indd 6 3/21/14 2:23 PM PENTAX SPOTLIGHT GRAPHIC B 100% Pentax Medical Gray C 0 M 2 Y 0 K 68 PENTAX MEDICAL World Leaders in Speech, Voice, and Swallowing Instrumentation dell.com/Healthcare dell.com/Healthcare dell.com/Healthcare dell.com/Healthcare dell.com/Healthcare ©2013 PENTAX America, Inc. All rights reserved. All company and product names and marks contained within are federally registered trademarks, trademarks or service marks of PENTAX of America, Inc. www.kaypentax.com MK-442 Rev: A GOOD THINGS COME IN SMALL PACKAGES Want to enjoy hands-free cell phone conversations, direct connectivity to TV, and amazing sound clarity all from a virtually invisible* hearing aid? Experience Xino Wireless. © 2013 Starkey. All Rights Reserved. 4/13 TJAD2606-00-EE-ST *Individual results may vary. Invisibility may vary based on your ear’s anatomy. page 7 145573_South Florida ENT.indd 7 3/21/14 2:23 PM Agustin Arrieta, M.D. William J. Brown, M.D., F.A.C.S. Richard Callari, M.D. A. Clifford Foster, M.D., F.A.C.S. Paul Foster, M.D., F.A.C.S. Scott Goldberg, M.D., F.A.C.S. David Jassir, M.D. Sina Joorabchi, D.O. Paul Kleidermacher, M.D., F.A.A.O.A. Moises Kravecas, M.D. Frank Kronberg, M.D., F.A.C.S. Rolando Molina, M.D. Daniel Morse, M.D., F.A.C.S. Kim Murray, M.D. Anish Parekh, M.D. Francisco Pernas, M.D. Mark Sukenik, M.D. Steven Tarkan, M.D. Jairo Torres, M.D. Julio Torres, M.D., F.A.C.S. Richard Vivero, M.D. Alan Chen Hao Chu, M.D. Jonathan Cooper, M.D. Lawrence Grobman, M.D., F.A.C.S. Horacio Groisman, M.D., F.A.A.O.A. page 8 145573_South Florida ENT.indd 8 3/21/14 2:24 PM William Ditkowsky, M.D., F.A.C.S. Brian Dougherty, M.D., F.A.C.S. Carl Drucker, M.D., F.A.C.S. Alberto Fernandez, M.D., F.A.C.S. Steven Fletcher, M.D., F.A.C.S. Kendall L. Hanft, M.D., F.A.C.S. Jorge Helo, M.D. Sabine Hesse, M.D., F.A.C.S. Edward Hillman, M.D., F.A.C.S. Abraham Jaguan, M.D. Todd A. Kupferman, M.D., F.A.A.O.A. Meron J. Levitats, M.D. Robert Maliner, M.D., F.A.C.S. Felipe Martinez, M.D., F.A.C.S. Moises Mitrani, M.D., F.A.C.S. Michael Owens, M.D., F.A.C.S. Bradford D. Ress, M.D. Eugene Rivera, M.D. Ignacio Rodriguez, M.D. Craig Shapiro, D.O., F.A.O.C.O.O. Vijaykumar Zaveri, M.D. page 9 145573_South Florida ENT.indd 9 3/21/14 2:24 PM Thank You to Our Sponsors We are really lending. City National Bank is a full service commercial bank. We lent more than $1 billion last year. • AlK,Inc. • Pentax • CityNationalBank • Siemens • Cochlear • SinusDynamics – Medical Equipment Financing – Business Term Loans – Equipment/Inventory Financing – Accounts Receivable Lending – Capital Improvement Loans – Professional Lines of Credit – Owner-Occupied Commercial Mortgages – SBA Loans – Residential Mortgages* – Home Equity Lines of Credit* • DellServices • Starkey Please visit any of our banking centers from Miami to Orlando or call us 305-577-7333. • GroupBenefitConcepts,Inc. • Sunovion Member FDIC • IntersectENT,Inc. • Nosich&Ganz, AttorneysatLaw 75ValenciaAve.,Suite1100 CoralGables,FL33134 Phone:305-442-4800 website:ngattorneys.com • ThePrinting&Graphics Connection,Inc. 823N.W.133rdCourt Miami,FL33182 305-222-6144 Fax:305-222-6142 www.pgcprinting.com citynational.com * Loans are subject to credit and collateral approval. 0923-1 ENTad.indd 1 9/28/13 2:49 PM Breakthrough Treatment in Sinus Surgery Opens sinus. Delivers anti-inflammatory medication. Maintains surgical opening. PROPEL is clinically proven to improve surgical results for chronic sinusitis sufferers.1 PROPEL® Mometasone Furoate Implant For more information consult your physician or visit www.PROPELOPENS.com 1) Han JK, Marple BF, Smith TL et al. Int Forum Allergy Rhinol. 2012; 2:271-279. The PROPEL and the PROPEL mini sinus implants are intended for use following ethmoid sinus surgery to maintain patency. For more information, consult your physician or visit www.intersectENT.com to view prescribing information including indications, contraindications, warnings, precautions and adverse events. Caution: Federal law (USA) restricts this product to sale by or on the order of a physician. ©2013 Intersect ENT, Inc. MPM 00028 Rev. A page10 SFL_ent_sd_Rev2.indd 1 145573_South Florida ENT.indd 10 Group Benefit Concepts, Inc. We are the benefits partners South Florida ENT Associates relies on for their group benefits. We shop all the carriers for Group Health, Dental, Disability, LTC, Life, Retirement Plans, Supplemental Benefits for you. We look for innovative products with a service driven approach, while keeping our clients Health Care reform Compliant. Bruce B. Chaskin, V.P. Group Insurance [email protected] 18459 Pines Blvd, Suite 220 • Pembroke Pines, Fl 33029 Office (954) 447-6900 • Fax (954) 272-7300 10/10/2013 9:00:46 AM 3/21/14 2:24 PM What Do I Do If I Have a Voice Problem? By Richard J. Vivero, M.D. A person’s voice serves as their vocal signature. In many social situations, it defines our interactions with the people around us. When our voice fails to work for us, it can result in unintended social isolation and poor performance. Studies have shown that up to thirty percent of Americans suffer from a voice problem at some point in their lives. Up to 28 million Americans are affected daily in their work activities. It is for this reason that voice problems should not be ignored, especially those that persist for greater than 2 weeks. The first step in managing a voice problem is a formal evaluation by an otolaryngologist (ENT). A laryngologist, a subspecialist otolaryngologist, is a physician who is especially trained to deal with voice and airway issues. The evaluation consists of a routine head and neck exam and a special video exam of the vocal cords known as a videostroboscopy. The video exam takes very close images of the vocal cords and allows the physician to see their function in slow motion. South Florida ENT is fortunate to have the only fully high definition videostroboscopy system in South Florida, which allows for the most detailed and comprehensive examination of the voicebox. The videostrobe can help identify very subtle changes in the vocal cords that may adversely impact a patient’s voice. Voice problems vary widely in their cause. At times, it may be related to a compensatory behavior to changes following a cold or the effect of laryngopharyngeal reflux (LPR or “silent reflux). These reasons can often be treated with medicine or voice therapy. More insidious causes, such as nodules, polyps, or even certain laryngeal cancers, may require surgery. A laryngologist is skilled in performing minimally invasive surgery to remove only the disease while preserving the normal vocal cord for the best vocal outcome. Some procedures, such as vocal fold injections, can be performed in the office to avoid lost time at work or with friends. Voice therapy, performed by a licensed speech language pathologist (SLP), may be used as an additional treatment following surgery to encourage the best vocal habits and prevent recurrence of the underlying problem. The good news is that many patients do well and are able to regain their previous vocal function. By working with a laryngologist and a voice therapist, many patients find their voice is better than when they started, and they are now more eager to engage both socially and professionally. If you should find that you are not happy with your voice, make an appointment today at one of our convenient locations in Kendall, Coral Gables, or Biscayne. Further information can also be found at www.viveromd.com. Richard J. Vivero, M.D. Voice & Airway Surgeon South Florida ENT Associates, PA 305-667-4515 viveromd.com page 11 145573_South Florida ENT.indd 11 3/21/14 2:24 PM Surgical Correction of Hearing Loss By Bradford D. Ress, M.D. Hearing loss affects approximately 30% of all people over 60 years of age and about 15% of those between 40 and 59. Hearing loss is often associated with tinnitus, social isolation, anger and frustration. People who treat their hearing loss demonstrate improvement in these symptoms. Although the majority of people with hearing loss can be helped with the use of hearing aids, there are several causes of hearing loss that are best treated with surgery. Tympanic Membrane Perforation: Perforations of the tympanic membrane can be caused by physical trauma, barotrauma or infection. Perforations typically result in conductive hearing loss and an increased risk of ear infection. Repair of the perforation, called tympanoplasty, is an outpatient procedure that can be performed through the ear canal or through a small incision behind the ear. An autologous tissue graft, harvested from scalp fascia, is used to “patch” the tympanic membrane. Otosclerosis: Otosclerosis is a calcification process of the stapes bone, impeding its movement and resulting in conductive hearing loss. If the hearing loss is significant enough, microsurgical correction, called stapedotomy, may be indicated. Stapedotomy is performed through the ear canal. A laser is used to remove the stapes superstructure and to make a tiny opening in the footplate of the stapes. A prosthesis is inserted into the opening and attached to the incus, improving hearing. A tiny piece of fat, harvested from the ear lobe, is draped around the base of the prosthesis to help seal the opening. Chronic Ear Disease: Chronic ear infections, such as recurrent or chronic otitis media, chronic mastoiditis and cholesteatoma (skin growing in the middle ear) can cause erosion of the middle ear bones and the mastoid bone and result in hearing loss. To remove the disease, a microsurgical procedure called tympanoplasty/mastoidectomy is performed. This entails removing the diseased tissue by surgically removing it from mastoid and middle ear, rebuilding the ear drum and reconstructing the middle ear bones with a prosthesis that is used to connect the ear drum to the stapes (ossiculoplasty). BAHA: Bone Anchored Hearing Aid (BAHA) is a procedure to implant a titanium fixture and abutment into the bone of the skull behind the ear. The BAHA procedure is performed in order to rehabilitate hearing in patients who have single-sided deafness, conductive hearing loss, and/ or congenital ear deformities in which traditional hearing aids are not practical. The BAHA surgery “Although the majority of people with hearing loss can be helped with the use of hearing aids, there are several causes of hearing loss that are best treated with surgery.” page 12 145573_South Florida ENT.indd 12 is performed through a skin flap created behind the ear. An area of tissue under the flap is thinned so that no hair will grow on the flap and it will become densely adherent to the skull. This will help prevent future skin irritation. The abutment is implanted 3/21/14 2:24 PM into the skull through a small drill hole. Once healed, the external device, a hearing aid that delivers sound through vibrations, is attached to the abutment. The vibrations bypass the middle ear hearing mechanism and directly stimulate the cochlea. Cochlear Implant: Cochlear implantation is an operation to implant an electronic device into the cochlea in order to assist in restoring hearing to people with profound hearing loss or deafness. There are two parts to the device. The internal processor is the part that is implanted. The external processor is worn outside the ear, like a hearing aid. Cochlear implantation is microsurgery, performed through an incision behind the ear. The implant is seated in a well created in the skull bone behind the ear and access to the cochlea is gained by drilling through the mastoid bone. The electrode array is inserted into the cochlea. Once activated, the cochlear implant bypasses the middle and inner ear hearing mechanisms and provides sound information to the brain by transmitting electrical signals directly to the hearing nerve. Bradford D. Ress, M.D. 7900 Glades Rd., Suite 340 Boca Raton, FL 33434 561-353-7377 resshearing.com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iemens eCharger page 13 145573_South Florida ENT.indd 13 3/21/14 2:24 PM Your Face – Your Voice by Frank G. Kronberg, M.D., F.A.C.S. and Luis Aulet, M.A. Two of the most important physical attributes that make you…You!! What happens when you are told that you have to undergo a surgical procedure that may affect your voice or your facial movement? Your first reaction may be Why? Then you may be concerned, anxious and sometimes just plain scared. You could even choose not to undergo a procedure that is indicated. Usually, the surgery cannot be avoided or delayed when dealing with cancer or the possibility of having cancer. Once you are educated about the surgical procedure and understand the risks, benefits, and potential complications, you should be able to accept the necessity for undergoing the procedure. One of the tools that have been developed to help the doctor with surgical procedures such as a parotidectomy or thyroidectomy is the intraoperative nerve integrity monitor. The concept of intraoperative nerve monitoring has been in existence for over a century. However, its use started to gain more acceptance during the mid 1960’s and more recently over the past 25 years. The monitoring devices have become much more sophisticated thru the years. Usually the surgeon or their assistant will continuously monitor nerve function during the operative procedure. At times, a technician may be available for the monitoring. The nerve integrity monitor (NIM) is an electromyographic computer monitoring system used by ENT-Head and Neck Surgeons to help monitor, identify and confirm motor nerve function. It is routinely being used to monitor cranial nerves during otolaryngology procedures involving the parotid gland, thyroid, neck, mastoid and middle ear surgery. Other uses include monitoring the facial nerve during acoustic neuroma and base of skull surgery. The basic technique involves the use of skin surface electrodes that are adjacent to the muscles that are being monitored. They are placed around the face and in the neck area when monitoring facial movement and shoulder function. The electrodes for monitoring the recurrent laryngeal nerve during thyroid and neck surgery are attached to the endotracheal tube at the level of the vocal cords. Studies have shown that the use of the nerve monitor has benefited patients with improved facial nerve and laryngeal function resulting in a decrease in the number of patients having complications such as hoarseness or facial nerve paralysis. While intraoperative nerve monitoring is another tool that can be used by the surgeon during delicate head and neck procedures, it by no means replaces a through knowledge of anatomy or meticulous surgical technique in performing these procedures. At the present time most head and neck surgeons in our practice use the NIM monitoring system. Although most surgeons in South Florida ENT Associates use the nerve monitor, it is still not considered a standard of care in the community. The Otolaryngologists in our practice strive to give our patients the benefit of utilizing the best and latest technology. Frank G. Kronberg, M.D., F.A.C.S. 8940 N. Kendall, Suite 504E Miami, FL 33176 305-595-6200 page 14 145573_South Florida ENT.indd 14 3/21/14 2:24 PM Treatment for Head and Neck Cancer By Sabine Hesse, M.D., F.A.C.S. The word “cancer” instills fear and uncertainty when patients hear it for the first time. Cancer of the head and neck is no exception. These include cancers of the oral cavity, pharynx, larynx, nose, and paranasal sinuses. In addition, there is skin cancer of the head and neck. One service that physicians provide is reconstructing defects that remain after a dermatologist performs skin cancer removal (Mohs procedure). therapists, as well as medical oncologists and radiation oncologists. In addition, extensive cancer resections will oftentimes involve a reconstruction with free flaps. In these cases, a plastic surgeon is needed. The spectrum of head and neck cancers has changed considerably over the years. In the past, cancers of the larynx comprised the majority of cancers seen in “The word “cancer” instills fear and uncertainty when patients hear it for the first time. Cancer of the head and neck is no exception.” the head and neck region. Currently, oropharngeal cancers—specifically cancers of the tonsils and base of tongue—are frequently seen. Smoking as well as excessive alcohol intake continue to be the primary risk factors for head and neck cancer. Human Papilloma Virus (HPV) has been shown to play a role in this changing pattern. Another change that is evolving is the increasing role of radiation and chemotherapy in the treatment of patients with advanced (Stage III and IV) cancers of the head and neck. With new chemotherapeutic agents available and new modalities for radiation treatments, the cure rates of advanced head and neck cancers have improved. The head and neck surgeon is the usual entry point for cancer care with these patients. Besides offering surgery, when appropriate, physicians provide follow-up care for the patient. This includes following the patients for a minimum of five years after treatment. Other specialists who are often involved include dentists, oral surgeons, speech therapists, nutritional Any persistent symptoms—including hoarseness, difficulty swallowing, throat or mouth pain, ear pain, or a persistent sore—should be evaluated by an ear, nose, and throat, head and neck surgeon. Sabine Hesse, M.D., F.A.C.S. 1317 SE 4th Ave. Ft. Lauderdale, FL 33316 954-583-7770 page 15 145573_South Florida ENT.indd 15 3/21/14 2:24 PM Topical Sinus Therapies Compounded Medications Your patient and customized solution is our priority. 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