AMERICAN SOCIETY OF PEDIATRIC OTOLARYNGOLOGY! SPRING 2014

! PAGE 1

Officers & CommitteesPRESIDENT Bob Ward, MDPRESIDENT ELECT Marci Lesperance, MDSECRETARY Marci Lesperance, MDTREASURER Bruce Maddern, MDDIRECTORS AT LARGE David White, MD Ron Mitchell, MD Blake Papsin, MDBY LAWS: Peter Koltai, MDAD HOC YOUNG MEMBERS Gresham Richter, MDAD HOC SUBCERTIFICATION Richard Rosenfeld, MD, MPHAUDIT J. Scott McMurray, MDBOARD OF GOVERNORS Michael Cunningham, MDDEVELOPMENT Richard Rosenfeld, MD, MPHEDUCATION/CURRICULUM Kenny Chan, MDFELLOWSHIP Chris Hartnick, MDFINANCE Kay Chang, MDINFORMATION/TECHNOLOGY David White, MDLONG RANGE PLANNING Daniela Carvalho, MDMEMBERSHIP/CREDENTIALS James Thomsen, MDNOMINATING Joe Kerschner, MDPATIENT SAFETY & QUALITY Rahul Shah, MDPROGRAM Paul Krakovitz, MDRESEARCH Albert Park, MDNEWSLETTER EDITOR Julie Wei, MD

ASPO NEWSLETTERPresident’s ReportBob Ward, MD

MISSION STATEMENT

The mission of ASPO is to foster excellence in the care of children with otorhinolaryngologic disorders. The cornerstone to achieve this laudable undertaking is education. As ambassadors for our subspecialty, our primary focus is to spread our knowledge and cutting edge research among our members and to health care providers at large. We hope to inspire our younger colleagues to grab on to our exciting subspecialty and carry us forward. With this in mind we are preparing our spring meeting, which will be

held at Caesar’s Palace in Las Vegas from May 14-18th. We rejoin the combined societies after a great breakout meeting in Crystal City last year. Paul Krakovitz and the members of the program committee have worked incredibly hard to ensure a stimulating and educational program for the attendees. It is truly impossible to adequately recognize and praise this group- their commitment and dedication has been inspiring. The scientific program they have put together will continue our tradition of education and knowledge sharing, presenting some of the finest clinical and basic research currently performed in the field of pediatric otolaryngology.

Education can be carried out in a variety of ways, both on a macro as well as micro scale. One great influence for me in multiple ways has been participating in medical missions in developing countries. What began as a source of inspiration for me to see the impact on the individual resident accompanying me on this “journey” has matured into my involvement with what is now referred to as Global Health initiatives. The process has been remarkable and profoundly educational. Everyone who participates in these missions is deeply affected by the experience, which is life changing in many cases, reinvigorating the spirit and drives to carry out their

American Society of Pediatric Otolaryngology (ASPO) exists to foster excellence in the care of children with otolaryngologic disorders through education and research and thereby enhance the

profession of Pediatric Otolaryngology

AMERICAN SOCIETY OF PEDIATRIC OTOLARYNGOLOGY! SPRING 2014

! PAGE 2

PRESIDENT’S REPORT CONTINUED“mission” as a physician. When we are unencumbered on these medical trips from our routine we realize that our work and efforts represent the best of our humanity. There are no financial incentives, no status symbols, no academic perks—it is about how we as doctors attempt to heal. But, beyond teaching surgical skills, an important component of educating our trainees is teaching the ethics of our profession. The delivery of care in a foreign country with scarce resources, financial hardships, and tremendous culture differences is daunting. The methods of altruism are challenged and not as easy as one would want or think they should be. How our global efforts are viewed can vary tremendously. An important component of education is teaching our trainees the ethics of our profession. There has developed a concern over the ethics of global health involvement. We are realizing that we need to understand how our efforts are viewed by the people and places we are attempting to help.

The guest speakers joining us at our spring meeting reflect and define those attributes important for transmitting our mission of education -- humanity, mentorship, dedication, and excellence. I am honored to introduce Loung Ung as one of our invited guests and speakers. She will open our meeting as the Kershner lecturer Friday afternoon and kicks off the theme of “Ethics of International Medicine.” Ung’s articulate accounts about life as a refugee brings an understanding to the other side of the lens of humanitarianism. We will continue our international focus during the Bluestone lecture entitled “Airway without Borders” given by Israeli pediatric otolaryngologist, Ari DeRowe. American born, Ari’s professional life has been in the Mideast. His lecture will focus on maintaining the principles, morals, and ethics of being a doctor while faced with the unique challenge of treating children from regions with political conflict.

We are fortunate to have Roger Crumley give the Karl Storz lecture on the history of laryngeal re-innervation. Dr. Crumley is a pioneer in the neuro-muscular study of the larynx. Roger is a true renaissance man. His esteemed career as an academic surgeon, researcher, and department chair has progressed our field of otolaryngology in a meaningful way. He defines mentor.

Throughout the year on so many occasions I have seen and experienced the tremendous hard work and dedication of ASPO members. The executive board works diligently to represent our organization with the various linked organizations and societies. The committees and chairpersons are committed to our membership and help to move ASPO forward. This has been the transition year of our administrative leadership as well. We have now partnered with the American College of Surgeons. We have gotten to know each other over the first twelve months and the benefits of our collaboration will continue.

I wish all of you an informative and exciting spring meeting. This is a chance to share with our colleagues, renew friendships, forge new relationships, and enjoy our time together. We can stand proud of our organization and its accomplishments. Thank you for allowing me to serve as your president this past year. It has been an honor that I will always cherish. See you on the strip!

AMERICAN SOCIETY OF PEDIATRIC OTOLARYNGOLOGY! SPRING 2014

! PAGE 3

SECRETARY’S REPORTMarci Lesperance, MDPlease be sure to review your profile in the online Membership Directory, where you can confirm your membership type, update your contact information as well as a photo.

ASPO agreed to sign on with AAO-HNS on a letter that opposes HR 4035, a bill championed by audiologists to give them direct, unlimited access to Medicare patients, without a physician referral.

The Board of Directors has approved the following slate of officers proposed by the Nominating Committee, for election at the ASPO Business Meeting in Las Vegas, Nevada. We hope to see you there!

President-Elect: Kenny Chan, MDSecretary: Anna Messner, MDDirector-at-Large: Chris Hartnick, MD

Item # of action

Motion/Action Item Result Responsible party

ITEM A MOTION: Ratification of electronic votes and prior minutes (Spring 2013, Sept 2013)

Approved (8-0)

ITEM #2 ACTION: Send electronic documents to Bernadette to be organized on the website, and ship the paper records to her for scanning and uploading

No vote Secretary

ITEM # 2 ACTION: Manage process for international travel award

No vote Education Committee

ITEM #2 ACTION: Update website material on international opportunities.

No vote Information Technology Committee

ITEM #2 ACTION: Explore ASPO creating or adopting a code of ethics.

No vote President

ITEM # 5 ACTION: Create budget for 2014 ASPO meeting No vote President, Program

Committee, Treasurer

ITEM #9 VOTE: Hold 2017 breakout meeting in Austin TX

Approved, 5-4. Long Range Planning

Committee, ACSITEM #10 VOTE: Switch to JP Morgan for financial

management. Approved, 8-0 Finance

Committee

Summary of decisions and actions, Fall 2013 Board Meeting:

Future COSM & ASPO MeetingsCOSM, May 14- May 18, 2014Caesar’s Palace, Las Vegas, NV

COSM, April 22-26, 2015 Sheraton Boston, Boston, MA

COSM, May 18-22, 2016Hyatt Regency Chicago, Chicago, Illinois

COSM, April 26-30, 2017Manchester Grand Hyatt, San Diego, CA

ASPO Breakout meeting, May 5-7, 2017 (tentative)Hilton Austin, Austin, Texas

AMERICAN SOCIETY OF PEDIATRIC OTOLARYNGOLOGY! SPRING 2014

! PAGE 4

PROGRAM UPDATEPaul Krakovitz, MD, ChairRobert Ward, MD, PresidentASPO 2014 is just around the corner:

When: May 16-18 (Friday-Sunday)

Where: Las Vegas Nevada, Caesars Palace

Program Schedule: http://aspo.us/upcomingspring/

A year has passed since the great success of last year’s ASPO in Crystal City. Following the accomplishment of that meeting is a daunting task. Anderson Cooper once said he refuses to be nervous because he hates being uncomfortable. Freely, I admit to having concerns, but Anderson’s words make sense to me. Even more so I had a lot of help from the program committee (David Brown, Shelagh Cofer, Stacey Ishman, Kathy Sie, Nira Goldstein, and Carla Giannoni), Bernadette Trubatisky of ACS, and our president Bob Ward. But the real reason this program will succeed is because of the energy and talent of the ASPO membership as well as the young generation of otolaryngology residents, fellows, and students who submitted almost 300 abstracts and 25 mini-seminars.

Highlights of the Academic Program:

This year’s ASPO meeting boasts 50 podium presentations, 8 panels, and 3 invited lectures.

Friday afternoon kicks off the theme of the meeting, “Ethics of International Medicine.” The Kerschner lecture will be given by Loung Ung. I highly recommend you read her bio-sketch in this newsletter. Ms. Ung is a heavyweight in activism, writing, and film. She is the author of the critically acclaimed national best-seller books First They Killed My Father: A Daughter of Cambodia Remembers, Lucky Child: A Daughter of Cambodia Reunites with the Sister She Left Behind, and LuLu in the Sky. Her books have been published in over 14 languages and have won dozens of international awards. There will be a book signing for those interested following the program on Friday.

Next on Friday, we continue our international focus during the Bluestone lecture entitled “Airway without Borders” which will be given by internationally known pediatric otolaryngologist Ari Derowe. Dr. Derowe was born in the United States and moved to Israel when he was 12. His lecture will focus on his personal experience caring for children living in politically charged countries along the Israeli border.

TREASURER’S REPORTBruce R. Maddern, MD

Another year has come and gone in the treasurer’s office. All continues to be well financially with your society.

Members may have noticed a few changes over the past year, most notably with how you pay dues. ACS has now taken over administrative dues collection and notification services. There are multiple avenues for payment. Hopefully, this will make things easier for all. Many thanks to ACS, especially Bernadette Trubatisky, for the help in transition. If you have any dues questions you can contact her at btrubatisky@facs.org or you can always call me.

The financial health of ASPO remains quite sound. Our endowment funds continue to grow through sound investment and the remarkable generosity of its members. Operating monies remain stable with predictable income and expenses. We will have the needed funds for the long term future to support our diverse educational, research and outreach programs.

As always it is a pleasure to serve the society and its members.

AMERICAN SOCIETY OF PEDIATRIC OTOLARYNGOLOGY! SPRING 2014

! PAGE 5

Saturday morning the focus of the meeting is innovations in airway surgery. The Karl Storz Lecture will be given by Dr. Roger Crumley on the history of laryngeal re-innervation. Dr. Crumley is a pioneer in the neuro-muscular study of the larynx. His accomplished research has allowed for significant advancements in the treatment of vocal fold immobility.

Saturday afternoon brings concurrent sessions. The 2 room format will allow for more diverse audience interests. You are welcome and encouraged to explore between the two rooms, find topics that pique your interest, and learn what research is being performed in our field.

Sunday morning is a mixture of excellent podium presentations as well as panels. Diverse clinically relevant topics including rhinology and vestibular disorders are features for Sunday. Please remember the meeting adjourns at noon on Sunday.

Social Events:

I’ve always been a person who believes everything in moderation, including moderation. In addition to the myriad of distractions in Las Vegas, we have a few excellent social events to really get you going.

Friday morning prior to the meeting kick-off will be the ASPO 5k Fun Run. You can sign up on the website. It would be a shame if you missed out. Start time is 7:30am. If you want to come for a nice jog and see the Vegas strip in the cool desert morning or prefer to push yourself, then I will see you bright and early on Friday.

Friday evening is time for wine and cheese with the poster authors.

Saturday night: This year instead of a formal banquet, we are having a President’s Reception and Social event. The event is being held the Paris hotel, on the balcony at the Chateau Club. The balcony overlooks the strip and the Bellagio Fountains. Paris is a 5 minute walk from Caesars. Not to worry--there will be plenty of food and an open bar. This is not your

father’s ASPO banquet, and there will not be a formal sit-down dinner. With a DJ and plenty of space, the vibe should be perfect for talking, networking and socializing. You will probably recognize the first place medal from the Fun Run around my neck. Come say hello. For those who want to go their own way, the event will wind down by 9ish. For the adventurous in the group, the club comes alive to the public at 10pm. Complementary access to the Chateau Club comes with entrance to the President’s Reception and Social Event. To sign up for the Presidents Reception To register for this event please visit the COSM Website.

The Preakness horse race is Saturday of ASPO. The line-up is not set. But I would bet on the 5th horse in the 6th race to show, if its name is Chips Ahoy. For a more sure thing, bet on this year’s ASPO to be a fantastic meeting.

See you in Las Vegas!

Author, activist, and lecturer, Loung Ung was only 5 years old when the Khmer Rouge soldiers stormed into her native city of Phnom Penh. Four years later, in one of the bloodiest episodes of the 20th century, some two million Cambodians – out of a population of seven

million – died at the hands of the infamous Pol Pot and the Khmer Rouge regime. Among the victims were both Loung’s parents, two sisters, and 20 other relatives. In 1980, Loung and her older brother Meng escaped to the United States.

Since 1995, Loung has made over thirty trips back to Cambodia and has devoted herself to helping her native land heal from the traumas of war. With this mission in mind, she has worked as an activist to end violence against women, child soldiers, and the Campaign for a Landmine Free World, the last of which, she served as the spokesperson from 1997-2005.

AMERICAN SOCIETY OF PEDIATRIC OTOLARYNGOLOGY! SPRING 2014

! PAGE 6

In 2013, Loung expanded her activism reach by becoming one of the writers of ‘Girl Rising’, a groundbreaking film directed by Academy Award nominee Richard Robbins which tells the stories of 9 extraordinary girls from 9 countries and the power of education to change the world.

As a writer, Loung’s books have allowed her to share her message about the costs of war and the need for reconciliation to a wider audience. Her national bestselling memoir, First They Killed My Father: A Daughter of Cambodia Remembers, published by HarperCollins Publishers in 2000 was the recipient of the 2001 Asian/Pacific American Librarians’ Association award for “Excellence in Adult Non-fiction Literature”, and has been selected for many schools and universities reading programs in the U.S. and internationally. This book has been published in 14 countries and translated into German, Dutch, Norwegian, Danish, French, Spanish, Italian, Cambodian, and Japanese. Loung’s other works include Lucky Child, and Lulu in the Sky, both of which are also taught in schools and universities.

In recognition of her work, The World Economic Forum selected Loung as one of the “100 Global Youth Leaders of Tomorrow.” She has been featured in The New York Times, Washington Post, USA Today, London Sunday Times, Glamour, and more. Loung has also appeared on numerous televisions and radio shows, including CNN, the Diane Rheme Show, Talk of the Nation, Weekend Edition, Fresh Air with Terry Gross, and The Today Show. In addition, she has been the subject of an hour-long documentary for the German ARTE, Japanese NHK, and U.S. NECN, and has spoken widely at numerous forums, including Stanford University, Singapore American, the UN Conferences on Women in Beijing, Against Racism and Discriminations in Durban, South Africa, and Child Soldiers in Kathmandu, Nepal.

When she is not writing or traveling, Loung lives in Cleveland, Ohio with her husband where she is food

taster and partner at a trio of Belgian Bar, French restaurant, and American microbrewery.

Praise for Loung Ung’s books

“I encourage everyone to read Lucky Child, a deeply moving and very important book. Equal to the strength of the book is the woman who wrote it.”

Angelina Jolie, actor and UNHCR Goodwill Ambassador

“First They Killed My Father is a story of triumph of a child’s indomitable spirit over the tyranny of the Khmer Rouge … Despite the heartaches, I could not put the book down until I reached the end. Meeting Loung in person merely reaffirmed my admiration for her.”

Queen Noor of Jordan, author and humanitarian

“First They Killed My Father left me gasping for air. Loung Ung plunges her readers into a Kafkaesque world – her childhood robbed by Pol Pot’s Khmer Rouge – and forces them to experience the mass murder, starvation, and disease that claimed half her beloved family. In the end, the horror of the Cambodian genocide is matched only by the author’s unbreakable spirit.”

Iris Chang, author of The Rape of Nanking

“Lucky Child is a tender, searing journey of two sisters, two worlds, two destinies. It is about the long-term consequences of war – how it changes everything, annihilates, uproots and separates families. And it is about how humans triumph, building lives wherever they land and finding their way back to each other."

Eve Ensler, activist, author, playwright of The Vagina Monologues

AMERICAN SOCIETY OF PEDIATRIC OTOLARYNGOLOGY! SPRING 2014

! PAGE 7

LONG RANGE STRATEGIC PLANNINGDaniela Carvalho, MD, Chair

We are entering the 4th year of the ASPO Mini-Mentoring program. This program was started in the fall of 2010 and continues to help increase the number of residents who are exposed to an active, tertiary care Pediatric Otolaryngology practice and educate more ENT residents about the wide range of complex care that is provided by Pediatric Otolaryngologists. One of the residents that participated in the Mini-Mentorship program this year wrote, “The ASPO mini-mentorship program was a great way to get more exposure to pediatric otolaryngology. I hope it can continue for years to come. This provided me with great exposure to see tertiary pediatric patients, cases and clinic opportunities. It also helped consolidate my desire to pursue a fellowship in pediatric otolaryngology.”

We strongly encourage all ASPO members to reach out to residents and residency programs that would likely benefit from the Mini-Mentorship.

The LRSP has been working for several months on the ASPO breakout session of 2017. After discussions and negotiations the plans are now final: Austin, TX, here we go!

And finally, we are proud to announce that he ASPO database for international observers has been up and running and has been helping several foreign physicians interested in learning more about tertiary Pediatric Otolaryngology in the US.

If you have any ideas or suggestions for the LRSP committee please contact us at dcarvalho@rchsd.org

MEMBERSHIP COMMITTEEJim Thomsen, MD, Chair

The on-line process for application was fully in place at the beginning of the application season. There was a tremendous amount of support from the American College of Surgeons representative Bernadette Trubatisky. We are all indebted to her for her help and support.

We received a total of 29 Fellow Applications and 27 Full Member Applications. Each committee member received an equal number of applications and reported their review to Ms. Trubatisky who collated the data in spread sheet form and forwarded it to the committee chair. At the time of this report the majority of the applications are complete and free of deficiencies. Within the next 7 days any application with a final deficiency will be rejected. The applicants will be notified prior to the meeting if there application is complete and being submitted to the board or if it is deficient and will be rejected.

FELLOWSHIP COMMITTEEChris Hartnick, MD Chair

At this year’s ASPO meeting and during the fel lowship committee session, Dr. Michael Cunningham has graciously agreed to come and review the new rules and regulations for the ACGME requirements for ACGME accredited pediatric otolaryngology fellowships, both for new programs applying for the first time as well as for established programs who will need upcoming visits and evaluations in the future.

AMERICAN SOCIETY OF PEDIATRIC OTOLARYNGOLOGY! SPRING 2014

! PAGE 8

RESEARCH COMMITTEEAlbert H. Park, MD, Chair

The CORE study section reviewed 18 applications for ASPO related grants on March 22. The final scores will be sent to the committee shortly. The ASPO research committee (RC) will review the top scorers and make a recommendation to the Board for funding. Nine reviewers attended the CORE study section. Thanks to John Germiller, Nira Goldstein, Steven Goudy, John Greinwald, Judy Lieu, Stephen Maturo, Renee Parks and Debra Weinberger for taking time from their busy schedule to review these grants.

Two ASPO grant applicants used the mentor program. The feedback from the applicants was overwhelmingly positive. I would like to thank Kenneth Lee and Maria Pena for their invaluable help as mentors. I would also like to thank the other mentors who have volunteered in this program.

There have been 10 new survey requests since December. Three were from ASPO committees or taskforces and 7 from the ASPO membership. This number is the largest I have seen as chair. Thanks to John Germiller, Judy Lieu, Emily Boss, Steve Goudy,

Robert Reilly and Henry Ou for reviewing these numerous survey requests.

A research pediatric clinical network is being organized under the ASPO RC. The goal is to develop a consortium of institutions open to any ASPO member to provide a centralized platform for multiinstitutional pediatric otolaryngology clinical trials. The advantages include enhanced sharing of resources, opportunities to facilitate grant applications/funding and important studies, and increased national prestige for our profession. This organization should enable us to enroll trials that require large numbers. The multiinstitutional structure of this group will also allow us to enroll patients with rare or less common conditions. The inaugural meeting will be held May 15 8-9pm. Please contact me if you wish to be involved or plan to attend this meeting.

None of these initiatives would have been successful without the contribution from many devoted ASPO members. There have been many hours of late phone conferences and emails. As I complete my position as chair of the ASPO RC, I would like to thank the ASPO leadership and members in being given the opportunity to contribute to this great committee.

2014 PEDIATRIC OTOLARYNGOLOGY CODING UPDATELarry M. Simon, MD, FAAPMember, AAO/HNS 3P WorkgroupAMA CPT Advisory Committee, Advisor Alternate for AAO/HNSBoard of Governors, AAO/HNS

2014 brought several important changes that Pediatric Otolaryngologists must be aware of. The first item is the recent delay in ICD-10CM, which was used as a funding mechanism to help to finance a one year extension of the Medicare Sustainable Growth Rate. At this point, it is actually unclear what the future holds for ICD-10CM, but until we receive further notice, practitioners should continue preparations with the expectation of an October 1, 2015 start date. The additional year can be used for further educational and testing efforts. From the

clinical perspective, the primary elements to focus on are documentation of co-morbid conditions and documenting with higher specificity/granularity. While ICD-10CM will include procedural codes, physicians will continue to report services using the AMA CPT code set. Further guidance on ICD-10 can be found at: http://www.entnet.org/Practice/International-Classification-of-Diseases-ICD.cfm.

The 2014 CPT Code set features modifications to the esophagoscopy codes. Rigid, flexible, and transnasal esophagoscopy codes have been separated into different sets to account for the differences in work, sedation/anesthesia, and equipment. Rigid esophagoscopy now falls under a 4319X sequence. Of greatest importance to Pediatric Otolaryngology is that code 43194 replaces 43215 for rigid esophagoscopy with removal of foreign body. Of note, 43125 still exists as a code, but it is now used to

AMERICAN SOCIETY OF PEDIATRIC OTOLARYNGOLOGY! SPRING 2014

! PAGE 9

report flexible transoral esophagoscopy with foreign body removal. From a reimbursement standpoint, the valuation of this new code represents an increase in physician work RVU from 2.60 to 3.0 a total RVU increase from 4.61 to 4.69. Transnasal esophagoscopy (TNE) now also has codes specific to it. 43197 is used to report diagnostic TNE, and 43198 will be used for TNE with biopsy single or multiple. It is also important to remember that surgical endoscopies (i.e. endoscopies where something is done) always include diagnostic endoscopies, and when a diagnostic endoscopy leads to a surgical intervention, only the intervention is reported. Additionally, control of bleeding that occurs as a result of the endoscopy is not separately reportable. Lastly, complete esophagoscopy must include examination of the gastroesophageal junction. It also may, but does not have to, include examination of the proximal stomach.

While not necessarily done often in the pediatric population, coding for chemodenervation of the larynx (e.g. using botulinum toxin) in the office is also changing. Prior to 2014, laryngeal electromyography (EMG) was reported separately when used for needle localization. However, code 64617 now includes EMG guidance. Additionally, the code is for unilateral injection, and it is appropriate to use modifier -50 for bilateral injections. Diagnostic laryngeal EMG (without chemodenervation) is still reported using

95865. Lastly, code 64617 is for percutaneous injections. For injections done using direct laryngoscopy in the operating room, use code 31570 or 31571.

Coding for cerumen removal also changed in 2014. Last year, code 69210 (cerumen removal) included otomicroscopy and applied to one or both ears. The new code does not include use of the microscope, and it is unilateral. Therefore, when the microscope is used, it is now appropriate to report code 92504 (Binocular microscopy) in addition to 69210 to capture the additional work of using the microscope. Additionally, modifier -50 can be appended to code 69210 to report bilateral work when both ears are cleaned. However, payer policy regarding both the use of 92504 and the -50 modifier varies, and despite the unilateral language of the code in CPT, CMS is not recognizing modifier -50 in 2014. Further guidance and information can be found on the website for the American Academy of Otolaryngology-Head and Neck Surgery at http://www.entnet.org/Practice/Revised-Coding-for-Cerumen-Removal.cfm.

The last change in the 2014 code set that relates to Pediatric Otolaryngology pertains to speech therapy codes. Previously, code 92506 was used report evaluations related to various types of communication disorders. This codes has not been replaced with code 92521, 92522, 92523, and 92524. These codes distinguish evaluations of speech fluency, speech sound production with and without evaluation of language comprehension, and analysis of voice and resonance. Further details regarding these codes can be found in the 2014 CPT manual (Current Procedure Terminology (CPT) 2013, American Medical Association.)

More information including these and other coding changes can be found at the AAO-HNS Coding Corner at http://www.entnet.org/practice/codingResources.cfm.

AMERICAN SOCIETY OF PEDIATRIC OTOLARYNGOLOGY! SPRING 2014

! PAGE 10

EDUCATION/CURRICULUMKenny Chan, MD, Chair Earn CME Credits through 2014 Pediatric Otolaryngology Webinar Series!

The American Society of Pediatric Otolaryngology in collaboration with the American Academy of Otolaryngology – Head & Neck Surgery Foundation successfully completed the 2013 Pediatric Otolaryngology Continuing Education Webinar Series recently. We would like you to consider registering for the 2014 series (www.aspo-cme.us).

The purpose of this CME activity is to provide pertinent pediatric otolaryngologic topics relevant to the practicing otolaryngologist addressed by an expert faculty using a robust webinar format. The learning objectives clearly spell out a systematic learning methodology based on evidence-based medicine.

A maximum of 10.0 AMA PRA Category 1 Credit(s)TM can be obtained through this webinar series . Each presentation concludes with an assessment of the learner’s comprehension of the subject matter in the form of a post-test. Each presentation will be posted on-line based on the following schedule allowing the registrants to view the presentations at their pace. The presenters and topics of this year’s series are listed below.

This CME product is packaged so that the registrant can enter the series at anytime during the cycle of the series after registration. It has been discounted for AAO-HNS members to $695 and further discounted if you are also an active ASPO member to $550. Non-member tuition is $850. Registration details are available through the following website: www.aspo-cme.us

January Charles Bluestone Similar to Otitis Media, is Sinusitis a Disease of Humans?February Reza Rehbar Chocking and Aspiration in Children: Evaluation and ManagementMarch Rodney Lusk Social Media – A Blessing or a Curse for the Otolaryngologist?May Christopher Post Genetics & Pediatric Otolaryngology: 2014 UpdateJune John Maddalozzo Head and Neck Masses in the Pediatric PopulationJuly Rahul Shah Quality and Safety in Surgery: How to Become a Better SurgeonAugust Judith Lieu Unilateral Hearing Loss in ChildrenSeptember Karen Zur Evaluation and Management of Neurogenic Dysphonia in the

Pediatric PopulationOctober Norman Friedman

(moderator)Pediatric Sleep Medicine 2014: A Roundtable DiscussionScott Brietzke, Susan Garetz and Stacey Ishman (panelists)

November Dan Kirse Caustic Ingestion

AMERICAN SOCIETY OF PEDIATRIC OTOLARYNGOLOGY! SPRING 2014

! PAGE 11

Kris R. Jatana, MDGiven more than 3,500 button battery ingestions

occur nationally in the United States each year, the hazard of button battery injuries poses great danger to children. The number of serious complications or death from ingestion rose significantly from 2003 to 2010 compared to prior years. The most serious injuries seem to be linked to the 20 mm lithium batteries, which contain 3 Volts and are more likely to get stuck in a child’s esophagus given their size. Severe injury can occur in as little as 2 hours and the diagnosis is not always easy to make, when an unwitnessed ingestion occurs, given many children present with non-specific symptoms similar to common viral illnesses.

Injury prevention efforts have been led by the National Button Battery Task Force who has a defined mission: A col laborative effort of representatives from relevant organizations in industry, medicine, public health and government to develop, coordinate and implement strategies to reduce the incidence of button battery ingestion injuries in children.

“Working together with industry has been an important step in this injury prevention effort,” said Dr. Kris Jatana, Chair of the Industry Collaboration and Product Re-design Subcommittee. Several changes have already been implemented by some battery manufacturers, like Energizer, who has improved their packaging to make removal of batteries more challenging as well as started using a warning label sticker on one side of battery that has

to be removed before use. There are new voluntary electronic product safety standards, created by Underwriters Laboratories, which require that the button battery must be contained, and a tool or a minimum of 2 simultaneous independent movements are required to gain access to the battery.

Educational efforts to medical professionals as well as families/caregivers regarding this hazard are ongoing. “We must press on, until no more children are harmed by button battery ingestion,” said Dr. Ian Jacobs who serves as the task force chair.

The National Capital Poison Center continues to gather detailed national statistics, refine treatment guidelines and share expertise with physicians managing these cases. Please report all of your button battery ingestion cases to 202-625-3333.

ASPO members who hold leadership positions in this national task force, which is affiliated with the ABEA and AAP include: Ian Jacobs, MD, Children’s Hospital of Philadelphia; Kris Jatana, MD, Nationwide Children’s Hospital; Scott Schoem, MD, Connecticut Children’s Hospital; Gresham Richter, MD, Arkansas Children’s Hospital; and Reza Rahbar, MD, Boston Children’s Hospital; Jim Reilly, MD, Nemours Children’s Hospital; Peter Koltai, MD, Lucille Packard Children’s Hospital.

ASPO MEMBERS HELP LEAD NATIONAL EFFORTS TO REDUCE BUTTON BATTERY INJURIES IN CHILDREN

AMERICAN SOCIETY OF PEDIATRIC OTOLARYNGOLOGY! SPRING 2014

! PAGE 12

OBITUARY FOR LINDA BRODSKY MDRobert Ruben, MDNew York, NYSunday, March 30, 2014

There are few whose life can be considered more “value-added” to humanity than Linda Brodsky, M.D. (May 25, 1952 - February 13, 2014). Linda grew up on Long Island, NY, graduated from Bryn Mawr College with honors in1974, graduated from the Medical College of Pennsylvania 1979 and complete residency training at the Montefiore Hospital and Medical Center and the Albert Einstein College of Medicine in 1983. It was there, as the Chairperson of the Department at Einstein, that I first met Linda. Throughout the years of her residency she excelled clinically and had the energy to engage in substantial research. One of her earliest publications was an examination of the histopathology of subglottic hemangiomas. She then carried out research looking at the effects of tracheotomy on tracheal mucosa.

When Linda completed her residency I hoped that she would stay with us as faculty; however she and her husband, Dr. Saul Greenfield, went to Buffalo, where she rose to the rank of Professor of Otolaryngology at the State University of New York at Buffalo. There, Linda continued to make contributions to the basic sciences and to the understanding of clinical issues. Her landmark series of publications concerning the histopathology of tonsils infected or hypertrophied are classic for the field. She developed a classification of tonsil pathology which is now used worldwide. Amongst many other contributions to medical science is the book she wrote in collaboration with Joan Arvedson, Pediatric Swallowing and Feeding: Assessment and

Management, now undergoing planning for a third edition.

These and her many other contributions constitute an impressive and substantial body of work that has greatly enriched the field of Otolaryngology. She went on, however, to make game-changing contributions in yet another aspect of medicine. Driven, as she was, by a keen sense of justice, she recognized substantial discrimination against women physicians in general, and in particular in the medical schools of the state of New York. In 2000, she embarked upon a long, personally painful, costly, legal action which resulted in filing a claim of gender is discrimination with the United States Equal Employment Opportunity Commission. The case was settled in 2007 with the State University of New York at Buffalo and in 2008 with the hospital- the Kaleida Health system. The differences were resolved to the satisfaction of all parties on both federal claims and the parties chose to keep the terms of these resolutions confidential. The visible and lasting outcome of her eight-year tenacious struggle was the establishment of the

principle of equal pay for all women throughout New York State University, a contribution to society on a level that few are privileged to make.

Dr. Brodsky transformed her recognition of the prevalent discrimination against women in medicine

AMERICAN SOCIETY OF PEDIATRIC OTOLARYNGOLOGY! SPRING 2014

! PAGE 13

into her highly effective, ongoing effort to support and achieve equality for women physicians. She worked for equality through writings, talks, websites, and personal communications. Her spirit and attitude toward this issue is well expressed in this quotation from her blog:

“ ’Only She Who Attempts the Absurd Can Achieve the Impossible’ is the story of my fight against what I believed to be the injustices of systemic, entrenched bias against women, which I undertook with the hope that no woman would ever again have to unfairly suffer an injustice like the one I believed I had to face.”

Among the many other dimensions of her rich life, one was her profound commitment to her religion. I recall one Friday afternoon in São Paulo, Brazil when Dr. Brodsky wished to find an Orthodox synagogue – but it had to be one that would allow women to participate on an equal basis. This was located and I had the privilege of accompanying her, participating on an equal footing, in the Friday night services and then returning to our medical meeting in the hotel.

Central to her life was her family. Dr. Brodsky was not only a mother but also a mentor, confidant and friend for her three wonderful children, Jeremy, Dana, and Rebecca, who have embarked upon their own careers. In a relationship of outstanding mutuality, she was supportive of and supported by her lifelong beloved partner, her husband Dr. Saul Greenfield.

The text message that I received from Saul at 0750 Thursday the 13th of February 2014 was "Linda is gone” – she will be deeply missed by all who knew her, and, for many who may never have known her, she has made the world a better place.

1 Brodsky, L., Yoshpe, N.S., Ruben, R.J.: Clinicopathological Correlates of Congenital Subglottic Hemangiomas. Ann Otol Rhinol Laryngol 92 (Suppl 105) (1983) 4-18.2 Yoshpe, N.S., Brodsky, L., Ruben, R.J.: Histopathological Changes in Distal Tracheal Mucosa Following Tracheotomy in Beagle Puppies. Int J Ped Otorhinolaryngol 11 (1986) 47-60.3 Brodsky, L., Nagy, M., Volk, M., Stanievich, J., Moore, L.: The Relationship of Tonsil Bacterial Concentration to Surface Core Cultures in Chronic Tonsillar Disease in Children. In J Ped Otorhinolaryngol 21 (1991) 33-394 Brodsky L. Tonsillitis, tonsillectomy and adenoidectomy. In: Bailey, BJ, ed. Head and Neck Surgery-Otolaryngology, Philadelphia, Lippincott, 1993; 833-47.

AMERICAN SOCIETY OF PEDIATRIC OTOLARYNGOLOGY! SPRING 2014

! PAGE 14

ANNOUNCEMENTSCongratulations to Dr. Ron Eavey, who in

addition to serving as the Director of the Bill Wi lkerson Center  for Oto la r yngo logy and Communication Sciences, and the Guy M. Maness Professor and Chair of Otolaryngology of Vanderbilt Medical System, he has recently been appointed as the Executive Medical Director of the 50,000 member Vanderbilt Employee Health Plan.

David Parsons continues to lead surgical teams to the Third World.  We are returning to Vietnam in either late January or early February, 2015.  We will teach in the major medical centers of Hanoi and HoChiMinh City on a two week trip.  We take multiple teams all over the world but all the others a re f i l l ed for 2014 .  To lear n more , v i s i t www.parsonsministries.org or contact me at david@TIMEglobal.org.

David H. Darrow, M.D., D.D.S. received the Sylvan Stool Award for teaching and service at the annual meeting of the Society for Ear, Nose, and Throat Advances in Children held in Long Beach, CA in December. Dr. Darrow is Professor of Otolaryngology-Head & Neck Surgery at Eastern Vi rg in ia Medica l Schoo l and a t tend ing otolaryngologist at the Children’s Hospital of The King’s Daughters in Norfolk, VA. He is a former chair of the Section on Otolaryngology-Head & Neck Surgery at the American Academy of Pediatrics and former residency director for otolaryngology at EVMS.

Margaret Skinner has been appointed to the Dysphagia Research Society ad hoc Multidisciplinary Scientific Advancement Committee. She had two podium presentations on Multidiscipl inar y Aerodigestive Clinic Experience in Children with Dysphagia, for which she received the National Foundation for Swallowing Disorders Award and the first place(tie) for best paper on multidisciplinary aerodigestive clinic cost analysis.

AAO-HNS Annual Meeting & Oto Expo 2014Orlando, FLSeptember 21 - 24, 2014www.entannualmeeting.org

SENTACHyatt Regency, St. Louis, MODecember 4 - December 7, 2014 www.sentac.org

UPCOMING MEETINGS

A Full Week of Pediatric Otolaryngology Courses in Toronto - October 2014

www.orlped.comOctober 14 & 15 - Int’l. Pediatric Temporal Bone DissectionOctober 14 & 15 - 5th Annual Int’l. Pediatric Vestibular &

Balance UpdateOctober 16 - 5th Toronto Int’l. Pediatric Endoscopic (Airway

and Esophageal)October 17 - Toronto Int’l. Open Airway SurgeryOctober 15-18 -8th Int’l. Symposium on Objective Measures

AMERICAN SOCIETY OF PEDIATRIC OTOLARYNGOLOGY! SPRING 2014

! PAGE 15

Airway Reconstruction Surgical Dissection Manual Propst EJ, Tirado Y, Abdulkader F, Estrada M, Campisi P, Forte V.Written by an international group of airway surgeons, this is an essential guide for residents and fellows as well as consultant Otolaryngologists – Head & Neck Surgeons who are responsible for managing airway conditions, but infrequently perform open airway surgeries. Complex tasks are broken into rudimentary steps so they can be mastered at any level. High-quality photos and diagrams of each surgical step convey information clearly and succinctly. “This will be a classic for many years to come.” – Dr. Robin T. Cotton, Cincinnati, USA“This publication …should be compulsory reading for our residents and fellows in training.” – Dr. Patrick J. Gullane, Toronto, Canada“This book…belongs on the bookshelf of all junior surgeons wishing to develop their surgical skills prior to operating on human beings.” – Dr. Philippe Monnier, Lausanne, Switzerland

Manual of Pediatric Balance Disorders Edited by Robert O'Reilly, MD, FACS, Thierry Morlet, PhD, and Sharing Cushing, MD, MSc, FRCSC, Book with DVDThe book addresses the emerging and important field of diagnosis and management of pediatric vestibular and balance disorders. The accompanying DVD includes videos, figures, self-assessment questions, and suggested readings.

ACS LIAISON FOR ASPOWebmaster: Bernadette TrubatiskyAdministrator, Association Management Servicesc/o ASPO HeadquartersAmerican College of Surgeons633 North Saint Clair StChicago, IL 60611-3211btrubatisky@facs.orgaspo@facs.org Tel. 312.202.5580Fax. 312.268.7267

BOOKS

SAVE THE DATE!The ASPO sponsored Pre-AAO resident/fellow

education conference in 2013, hosted by British Columbia Children’s Hospital, was attended by almost 60 residents! Based on the exceedingly positive feedback from attendees, ASPO will once again sponsor another pre-AAO education conference this year in Orlando at Nemours Children’s Hospital. Please encourage your residents to attend.

2nd Annual RESIDENT EDUCATION CONFERENCE NEMOURS CHILDREN’S HOSPITAL

REGISTRATION IS FREE, BUT REQUIRED. RSVP BY 9/06/14Registration Form Available Soon on ASPO Website

SEPTEMBER 20, 201412:30-7:00PM

12:30 pm - Welcome and IntroductionJulie L Wei, MD, Nemours Children’s Hospital, Orlando FL

12:45 pm – “Changes in Pediatric Otolaryngology”Anna Messner, MD, L u c i l e P a c k a r d Children’s Hospital (Stanford)

1:15 pm- "Surgical Excellence in BMT and T&A”Julie L Wei, MD, Nemours Children’s Hospital, Orlando FL (UCF)

1:45- Vascular MalformationsGresham Richter, MD, Arkansas Children's Hospital (UAMC)

2:15 pm- C h r o n i c R h i n o s i n u s i t i sRobert Chun, MD, Children’s Hospital of Wisconsin (MCW)

2:45 pm- Hearing LossJudith Lieu, MD, St. Louis Children’s Hospital (Wash U)

3:15 pm - BREAK

3:45 pm - DysphagiaJames Schroeder, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago (Northwestern)

4:15 pm – Complex Tonsillitis-Beyond Gr A. StrepJoseph Dohar, MD, Pittsburgh Children’s Hospital (UPMC)

4:45 pm - LaryngomalaciaDavid White, MD, Medical College of South Carolina

5:15 pm- Voice DisordersChristopher Hartnick, MD, Massachusetts Eye and Ear Infirmary (Harvard)

6:00 -7:00 pm Reception with ASPO Board of Directors and Fellowship Directors

Discovery Garden, Nemours Children’s Hospital 13535 Nemours Parkway

Orlando, FL 32827