B R C Rhinologic Society Program Abstracts 2005€¦ · American Rhinologic Society Program...

AmericanRhinologic

Society

ProgramAbstracts

2005

Combined Otolaryngological Spring Meetings

Boca Raton R

esort & Club

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Table of Contents

Mission Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Educational Objectives . . . . . . . . . . . . . . . . . . . . . . . iii

Target Audience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Statement of Need . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Activity Goal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

Accreditation Statement . . . . . . . . . . . . . . . . . . . . . . iv

Conflict of Interest Statement. . . . . . . . . . . . . . . . . . iv

Disclosure Statements. . . . . . . . . . . . . . . . . . . . . . . . . v

ARS Officers and Board of Directors . . . . . . . . . . . vii

ARS Committee Chairs . . . . . . . . . . . . . . . . . . . . . . viii

ARS Past Presidents . . . . . . . . . . . . . . . . . . . . . . . . . . ix

ARS Schedule for COSM 2005 . . . . . . . . . . . . . . . . . xi

General Meeting Rooms. . . . . . . . . . . . . . . . . . . . . . xii

Program and Abstracts . . . . . . . . . . . . . . . . . . . . . . . . 1

Awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63Golden Head Mirror Honor Award . . . . . . . . . . 63Dr. Maurice H. Cottle Honor Award . . . . . . . . . 65ARS Investigation Award. . . . . . . . . . . . . . . . . . . 67ARS Poster Awards . . . . . . . . . . . . . . . . . . . . . . . . 68International Research Award Winners . . . . . . . 69

Memberhip Listing . . . . . . . . . . . . . . . . . . . . . . . . . . 70

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Mission StatementThe American Rhinologic Society’s mission is toserve, represent and advance the science and theethical practice of rhinology. The Society promotesexcellence in patient care, research and education in Rhinology and Sinusology. The AmericanRhinologic Society is dedicated to providingcommunication and fellowship to the members of the Rhinologic Community through ongoing medical education, patient advocacy, and socialprograms.

Educational ObjectivesThe program will consist of presentations fromabstracts selected by the program committeethrough a blinded review process. The specificobjectives are as follows: • The participants should become more familiar

with the diagnostic and treatment modalities inpatients with chronic rhinosinusitis.

• The participants should gain better understand-ing of the basic science and pathophysiology ofchronic rhinosinusitis.

• The participants should understand morecompletely the impact of various surgicalprocedures for chronic rhinosinusitis.

• The participants should have more insight intoadvanced rhinologic techniques and proceduresfor treatment of neoplastic disease and pathologyof the anterior of skull base.

Target AudienceBoard certified and board eligible physicians as wellas residents-in-training in otolaryngology-head andneck surgery.

Statement of NeedThe most common chronic disease in the UnitedStates is chronic sinusitis and is notoriously difficultto treat. Further study both on the basic sciencelevel and in clinical matters is necessary and

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required to create greater understanding of thepathogenesis of this crippling disease and ways toimprove treatment outcomes.

Activity Goal: It is the goal of this activity to improve patientoutcomes and care of patients with chronic sinusitisby providing medical information on group studiesand findings in research and clinical practice.

Accreditation Statement:The American Rhinologic Society is accredited bythe Accreditation Council for Continuing MedicalEducation to provide continuing medical educationfor physicians.

The American Rhinologic Society designates thiseducational activity for a maximum of 8 category 1credit(s) toward the AMA Physician’s RecognitionAward. Each physician should claim only thosehours that he/she actually spent on the educationalactivity.

Corporate SponsorsThe American Rhinologic Society wishes to thankthe following Corporate Sponsors for their unre-stricted grants which in their entirety are to awardresearch grants. These sponsors do not contribute tothe continuing medical education of these meetings.

Platinum:Aventis PharmaceuticalsGyrus ENT

Gold:Karl Storz Endoscopy-America, Inc.Naryx Pharma, Inc.

Bronze:GE Medical Systems Navigation & VisualizationRichard Wolf Medical Instruments Corp.

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Conflict of Interest Statement:The “Faculty Disclosure Policy” of The AmericanRhinologic Society requires that presentersparticipating in a CME activity disclose to theaudience any significant financial interest or otherrelationship an author or presenter has with themanufacturer(s) of any product(s) discussed in aneducational presentation. Presenters are required to disclose any significant relationship(s) with a pharmaceutical or equipment company whichmight pose a potential, apparent or real conflict ofinterest with regard to their contribution to theactivity, and any discussions of unlabeled or investi-gational use of any commercial product or devicenot yet approved for use in the United States.

The following faculty/presenters have indicatedthese disclosures:

John DelGaudio, MD AstraZeneca - GrantSupport

Larry Duberstein, MD Clerical help in writingpaper and data collection.My presentation willinclude discussion ofZileuton for Prevention ofNasal Polyp Recurrence.

Tony Kille, MD Project mentor (Dr. DianeHeatley) serves as VicePresident of Med-Systems,Inc, maker of SinuCleansereti pots.

Raymond Sacks, MD Medronic Xomed -Sponsored Equipment forStudy

Timothy Smith, MD National Institutes ofHealth Grant Funding

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The following faculty have indicated that theyhave no disclosures

Alessandro de Alarcon, MDVijay Anand, MDPete Batra, MDMiguel Neil Bravo, MDSeth Brown, MDJohn DelGaudio, MDJohn DelGaudio, MDLarry Duberstein, MDMarc Dubin, MDKaren Fong, MDJames Hadley, MDKim Hewitt, MDAlexis Jackman, MDAnita Jeyakumar, MDHan Joseph, MDAshutosh Kacker, MDRobert Kern, MDSiobhan Kuhar, MDFrederick Kuhn, MDAndrew Lane, MDRichard Lebowitz, MDJivianne Lee, MDJern-Lin Leong, MDQuang Luu, MDUsama Mahmood, MDKevin McMains, MDWilliam Moretz III, MDAli Moshaver, MDJeffrey Neal, MDJonathan Owens, MDSpencer Payne, MDRoberto Puxeddu, MDHassan Ramadan, MDJoseph Raviv, MDEric Roffman, MDRaymond Sacks, MDRodney Schlosser, MD

Jeffrey Shaari, MDMichele St Martin, MDBenjamin Stong, MDMatthew Stumpe, MDVo-Nguyen Trang, MDMatteo Trimarchi, MDTrang Vo-Nguyen, MDWesley Whatley, MDBradford Woodworth, MDAltan Yildirim, MD

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AMERICAN RHINOLOGIC SOCIETY

Officers and Board of Directors2004-2005

PresidentJoseph B. Jacobs, MD

President-Elect/Program ChairmanMichael J. Sillers, MD

Secretary/Second Vice PresidentMarvin P. Fried, MD

TreasurerDavid Kennedy, MD

Past PresidentJames A. Hadley, MD

First Vice PresidentHoward L. Levine, MD

Board of DirectorsMartin J. Citardi, MD Scott M. Graham, MD Peter H. Hwang, MD Steven C. Marks, MD Thomas A. Tami, MD Winston C. Vaughan, MD

Consultants to the BoardKelvin C. Lee, MD Todd A. Loehrl, MD Richard Orlandi, MD Kathleen Yaremchuk, MD

AdministratorWendi Perez

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Committee Chairs

Audit CommitteeStilianos Kountakis, MD

Awards CommitteeAllen Seiden, MD

By-Laws CommitteeWilliam Bolger, MD

CME CommitteeJames Palmer, MD

Corporate Liaison CommitteePaul Toffel, MD

CredentialsPeter Hwang, MD

Education CommitteeTodd Kingdom, MD

Information Technology CommitteeMartin Citardi, MD

Membership CommitteeKaren Fong, MD

Patient Advocacy CommitteeMichael Setzen, MD

Pediatric Rhinology CommitteeRodney Lusk, MD

Program CommitteeMichael Sillers, MD

Research Grant CommitteeThomas Tami, MD

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Past Presidents

1954 – 1955 Maurice H. Cottle, M.D.*1955 – 1956 Ralph H. Riggs, M.D*1956 – 1957 Walter E. E. Loch, M.D*1958 – 1959 Kenneth H. Hinderer, MD*1959 – 1960 Roland M. Loring, M.D*1960 – 1961 Ivan W. Philpott, M.D*1962 – 1963 Raymond I. Hilsinger, M.D*1963 – 1964 H. Ashton Thomas, M.D*1964 – 1965 Carl B. Sputh, M.D.1966 – 1967 Walter J. Aagesen, M.D.1967 – 1968 Richard Hadley, M.D.*1968 – 1969 Henry L. Williams, M.D.*1970 – 1971 Charles A. Tucker, M.D.*1971 – 1972 Pat A. Barelli, M.D.1972 – 1973 Gerald F. Joseph, M.D.1973 – 1974 Manuel R. Wexler, M.D*1974 – 1975 George H. Drumheiler, MD*1975 – 1976 Joseph W. West, M.D.*1976 – 1977 Albert Steiner, M.D*1977 – 1978 Anthony Failla, M.D*1978 – 1979 Clifford F. Lake, M.D*1979 – 1980 W. K. Locklin, M.D.1981 – 1982 Eugene B. Kern, M.D.1982 – 1983 Carlos G. Benavides, M.D.1983 – 1984 Leon Neiman, M.D.1984 – 1985 George C. Facer, M.D.1985 – 1986 Larry E. Duberstein, M.D.1986 – 1987 Glenn W. Drumheiler, DO1987 – 1988 Alvin Katz, M.D.1988 – 1989 Donald Leopold, M.D.1990 – 1991 Pierre Arbour, M.D.1991 – 1992 Fred Stucker, M.D.1992 – 1993 David W. Kennedy, M.D.1993 – 1994 Sandord R. Hoffman, M.D.1994 – 1995 Richard J. Trevino, M.D.1995 – 1996 Vijay K. Anand, M.D.1996 – 1997 Dale H. Rice, M.D.

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1997 – 1998 Michael S. Benninger, M.D.1998 – 1999 William Panje, M.D.1999 – 2000 Charles W. Gross, M.D.2000 – 2001 Frederick A. Kuhn, M.D.2001 – 2002 Paul Toffel, M.D.2002 – 2003 Donald C. Lanza, M.D.2003 – 2004 James A. Hadley, MD2004 – 2005 Joseph B. Jacobs, MD

*Deceased

ARS SCHEDULE FOR COSM 2005Boca Raton Resort & Club

Boca Raton, FLMay 12-14, 2005

THURSDAY 5/12/05

4:00 – 5:00 Patient Advocacy CommitteeMeeting (Room/Building: KingmanNE-Tower)

3:00 – 5:30 Executive Committee Meeting(Room/Building: Bassford-Tower)

5:30 – 8:30 Board of Directors Meeting(Room/Building: Addison BallroomEast-Mizner)

FRIDAY 5/13/05

1:00 – 5:00 Scientific Meeting(Room/Building: Estate Ballroom-Mizner)

6:00 – 11:00 Corporate Affiliates Reception(Room/Building: Valencia-Cloister)

SATURDAY 5/14/05

8:00 – 12:00 Scientific Meeting(Room/Building: Estate

12:30 – 2:00 Fellowship Directors Meeting(Room/Building: Tower Card-Tower)Ballroom – Mizner)Grand Pre-Assembly-Mizner)

5:30 – 7:00 Combined Poster Session(Room/Building:

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Upcoming Dates

September 24, 2005ARS 51st Annual Meeting

GENERAL MEETING ROOMS:

Speaker Ready Room:Veranda Salon I

Registration:Registration North

Headquarters Office:Veranda Salon II

Exhibit Hall:Grand Ballroom

Press Office:Veranda Salon III

Spouse HospitalityLounge:Kingman SE

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American Rhinologic SocietyCOSM 2005 — Boca Raton Resort & Club

Boca Raton, FL

May 13, 2005 - May 14, 2005

Friday May 14, 2005

1:00 pm – 1:10 pm

Welcome and Introduction

Joseph B, Jacobs, MD, PresidentMichael Sillers, MD, President-Elect

Moderators:

John DelGaudio, MDJoseph Han, MD

1:10 pm(Abstract ID # 864)

“Evidence Supporting Endoscopic SinusSurgery In The Management Of Adult

Chronic Rhinosinusitis”

Timothy L. Smith, MDPeter Batra, MDAllen Seiden, MD

Maureen Hannley, PhDMilwaukee, WI

Disclosure: No disclosures reported

Objectives: Evidence based medicine calls for a criticalevaluation of the scientific evidence for treatments of disease.This report synthesizes the available evidence on the use ofendoscopic sinus surgery (ESS) in the management of adultchronic rhinosinusitis (CRS) examining the clinical question: “In adults with CRS who have failed medical management,does ESS improve symptoms and/or quality of life (QOL)?”

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Methods: The American Rhinologic Society and the AmericanAcademy of Otolaryngology convened a steering committeecomposed of the authors. Primary research articles evaluatedfor this report were identified using appropriate search termsand a Medline search. Two authors independently reviewedeach article. Articles were assigned an evidence level based on accepted guidelines (level 1= randomized trials; level 2= prospective cohort studies with comparison group; level 3= case-control studies; level 4 = retrospective case series; level 5 = expert opinion).

Results: We identified 586 abstracts to review, retrieved 75articles for full review and included 45 articles in our report. Thevast majority of articles represented level 4 evidence (n=42)while two articles represented level 5 evidence. One article wasidentified that qualified for level 2 evidence. All of these articlesgenerally supported the finding that ESS improves symptomsand/or QOL in adult patients with CRS.

Conclusions: There is substantial level 4 evidence withsupporting level 2 evidence that ESS is effective in improvingsymptoms and/or QOL in adult patients with CRS. Futureresearch efforts should focus on prospective studies that includeappropriate comparison groups in their design.


“Endoscopic Transphenoidal Pituitary Surgerywith Real Time Intraoperative MRI (IMRI)”

Vijay Anand, MDTheodore Schwartz , MDDavid Henry HIltzik, MD

Ashutosh Kacker, MDNew York, NY

Disclosure: Dr. Anand is a consultant for GE Medical Systemsand Sinucare.

Objective: To report and demonstrate the technique, results,and complications of combined endoscopic and IMRI surgicaltreatment of pituitary disease from both a technical and surgicalperspective.

Methods: Retrospective chart review of 10 endoscopic,endonasal resections of 10 pituitary macroadenomas using thePolestar N-10 IMRI (Medtronic) system in a tertiary healthcarefacility. The patient demographics, tumor measurements, andpostoperative symptoms and complications were assessed. Theeffect of the magnetic field on the cathode ray tube (CRT)

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screen, the image quality of the IMRI images, and IMRIdetection of residual tumor were also evaluated. Results: IMRIimages were obtained in all cases and were of sufficiently highquality to demonstrate adequate decompression of the opticchiasm and the removal of all suprasellar tumor. However, therewas significant distortion of the CRT screen regardless of theviewing angle, which was overcome with a wall-mountedplasma screen. Residual tumor was found with IMRI andresected endoscopically in three cases. In two other cases,suspected residual tumor on IMRI was examined endoscopic-ally and found to be normal post-operative change. In two cases no tumor was seen on the IMRI. Five patients who hadpreoperative progressive visual loss preoperatively improveddramatically post resection and two who had increased insulingrowth factor-1 (IGF-1) preoperatively normalized postopera-tively. No delayed CSF leaks or any other complicationsoccurred.

Conclusion: Combining intraoperative endoscopy and IMRI is an effective surgical modality for pituitary surgery. Eachtechnology provides complimentary information, which canassist the surgeon in safely maximizing the extent of resection.


“Antibiotic Sensitivities of CoagulaseNegative Staphylococcus from Purulent Sinus

Secretions”

Marc G. Dubin, MDFrederick A. Kuhn, MD

Robert E. Sonnenburg, MDChristopher T. Melroy, MD

Savannah, GA

Disclosure: No disclosures reported.

Introduction: Culture directed antibiotic therapy for chronicbacterial sinusitis is imperative. Frequently, however, sinuscultures are reported as “coagulase negative staphylococcus(CNS)” which microbiologists view as normal and thereforeantibiotic sensitivities are not provided.

Methods: From January 1, 2001 through June 30, 2001 allcultures that were reported as CNS were re-examined by themicrobiology lab to determine the antibiotic sensitivities.

Results: During this six month period, 53 cultures werereported as CNS. Of the organisms that were tested against thefollowing specific antibiotics, 76% were resistant to amoxicillin/

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clavulinic acid, 76% were resistant to oxicillin, 76% wereresistant to cefazolin, 84% were resistant to ciprofloxacin and79% were resistant to levafloxacin. CNS was least resistant totrimethoprim/sulfa (36%), tetracycline (26%), gentamycin (18%),and vancomycin (0%). When only the cultures that grew inheavy or moderate concentrations were evaluated (n=16), theresistance pattern did not change compared to those that hadrare/light growth (n=37).

Conclusion: Reports of CNS growth without antibioticsensitivities may result in inadequate antimicrobial therapy. Ifconsidered a potential true pathogen, this organism has a highincidence of antibiotic resistance and may be difficult to treatwithout knowledge of antibiotic sensitivities.

1:31 pmDiscussion

1:40 pm(Abstract ID 870)

“Association of Nasopharyngeal andLaryngopharyngeal Reflux with Post-Nasal

Drip Symptomatology”

John DelGaudio, MDSarah Wise, MD

Atlanta, GA

Disclosure: Astra Zeneca - grant support, speakers bureauMedtronic Xomed - consultant Schering Plough - speaker’sbureau

Introduction: Patients often report post-nasal drip (PND), butobjective rhinosinusitis and allergy findings are frequentlyabsent. In this study, we evaluate the association between PNDand pharyngeal reflux.

Methods: Sixty-eight total patients underwent 24-hour pHtesting, including chronic rhinosinusitis (CRS) patientspersistently symptomatic following endoscopic sinus surgery(ESS), CRS control patients successfully treated by ESS, andnormal controls. The pH probes contained nasopharyngeal(NP), upper esophageal sphincter (UES), and lower esophagealsphincter (LES) sensors. Patients also completed the RefluxSymptom Scale (RSS) and Sinonasal Outcome Test-20 (SNOT-20)questionnaires. The survey items addressing PNDsymptomatology were compared to NP reflux below pH 4

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and pH 5 (defined as >1 events), and UES reflux (defined as >7 events).

Results: Pearson analyses revealed a positive correlation of r = .86 between the RSS and SNOT-20 for PND items. For NP reflux below pH 4, no significant difference existed between those patients with and without reflux for PNDsymptomatology on the RSS or SNOT-20 (p > .05). However, for NP reflux below pH 5, patients with reflux exhibitedsignificantly more PND symptoms on both the RSS (p = .018)and the SNOT-20 (p = .030) than those patients without reflux.Finally, patients with UES reflux had significantly more PNDsymptomatology on the SNOT-20 (p = .030) compared to thosewithout UES reflux. However, PND symptomatology did notdiffer significantly between UES reflux groups on the RSS (p > .05).

Conclusion: Objective evidence of NP and UES reflux exists inpatients reporting PND; reflux treatment may reduce PNDcomplaints.

1:47 pm(Abstract ID# 871)

“Systemic Absorption of Gentamicin Nasal Irrigations”

Wesley Whatley, MDCharles MacDonald, MD

LeAnn Fox, RNRakesh Chandra, MD

Memphis, TN

Disclosures: No Disclosures reported.

Objective: To determine if gentamicin nasal irrigation issystemically absorbed, and to identify any ototoxic side effectsrelated to its use. Design: Retrospective review of 12 patientstreated with gentamicin nasal irrigations (30 cc of 80 mg/Lsolution used twice daily).

Methods: Serum gentamicin levels were assayed after thecourse treatment. Pure tone audiometry (PTA) and distortionproduct otoacoustic emissions (DP-OAE) at 7280, 5133, 3640 and2560 Hz were obtained before and after therapy. Results: Twelvepatients (age 4 to 74, mean 43) with chronic rhinosinusitis weretreated for 3 to 15 weeks (mean 7 weeks). All patients hadundergone previous endoscopic sinus surgery. Eight patientshad pretreatment cultures that grew resistant organisms(Pseudomonas, Proteus, or methacillin resistant Staphylococcusaureus), and three patients had cystic fibrosis. Ten of 12 patients

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(83%) had detectable serum levels of gentamicin. The meangentamicin level for patients with detectable serum levels was0.42 mcg/ml (range 0.3 to 0.7 mcg/ml). Four of 12 patients(33%) had serum gentamicin levels within the normal range forgentamicin trough (0.5 to 1.5 mcg/ml). Comparison of pre- andpost- treatment audiologic data revealed no significant changein PTA or DP-OAE, except for the right ear at 8000 Hz on PTA(p=0.035) where a mean of 7dB loss was observed. No patientreported vertigo at any time during treatment.

Conclusion: Gentamicin nasal irrigation may be systemicallyabsorbed, but the otologic consequences of this finding arequestionable. Nonetheless, patients receiving gentamicin nasalirrigations should be counseled regarding this possibility.

1:54 pm(Abstract ID# 874)

“Characterization of “Normal RespiratoryFlora” in Purulent sinus Secretions; “Normal

Flora” Is Not Necessarily “Normal”

Frederick Kuhn, MDMarc Dubin, MD

Ronnie Swain, MDChristopher Melroy, MD

Savannah, GA

Disclosures: No disclosures reported.

Introduction: Chronic bacterial sinusitis treatment in the era ofincreasing antibiotic resistance is problematic. Culture directedtherapy is crucial, however, sinus cultures are often reported as“normal flora” resulting in a therapeutic dilemma.

Methods: For six consecutive months, all sinus cultures frompreviously operated chronic sinusitis patients that werereported as “normal respiratory flora” were sub-cultured forspecific bacteria. Results: During this six month period, nineteencultures initially reported as normal flora were further speciatedwith 29 resultant pathogenic organisms. The most commonorganism was coagulase negative staphylococcus (CNS) (n=11).Additional organisms included Staphylococcus aureus (n=4),Alpha hemolyltic streptococcus (n=3), Corynbacterium (n=3),Pseudomonas (n=2), Enterococcus (n=2), Streptococcuspneumonia (n=2), Klebsiella (n=1), and Bacteroides fragilis(n=1). Of the organisms initially classified as “normal flora”73% were resistant to amoxicillin/clavulinic acid, 38% wereresistant to clindamycin, 62% were resistant to ciprofloxacin and 58% were resistant to levafloxacin.

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Conclusion: Reports of “normal flora” from grossly purulentsinus secretions may be misleading and lead to inappropriateantimicrobial therapy. It is possible that a true pathogen can befound with speciation of all organisms in the mixed culture.Furthermore, these organisms exhibit a high incidence ofantibiotic resistance. Increased bacterial resistance and changesin bacterial flora have made empiric treatment of sinusitis moredifficult. Culture directed therapy has become much moreimportant, however, cultures reported as “normal flora”confound the problem.

2:01 p.m.Discussion

Moderators:

Peter Hwang, MDKelvin Lee, MD


“Minocycline Accelerates Recovery afterOlfactory Axotomy in Mice”

Joseph Raviv, MDAlan Robinson, PhD

Claus-Peter Richer, MD, PhDDavid Conley, MD

Chicago, IL


Introduction: Apoptotic death of olfactory sensory neurons(OSNs) has been implicated in most cases of peripheral smellloss. Minocycline, an antibiotic with anti-apoptotic properties, iscurrently under trial for the management of a wide range ofother neurologic disorders associated with increased apoptosis;effects on olfaction are unknown. The standard experimentalmodel of OSN apoptosis is surgical axotomy resulting in therapid death of all neurons within 72 hours; recovery occurs bythe regeneration of new OSNs over the next several weeks.Decreased OSN death and more rapid electrical recoveryfollowing axotomy have been demonstrated in mice whereinapoptosis was genetically inhibited. In the current study,minocycline will be utilized in an attempt to duplicate theimproved outcome seen in the genetically inhibited mice.

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Methods: Unilateral olfactory axotomy was performed in twogroups of mice: controls and those treated with minocycline (1 mg/kg) 24 hours prior to axotomy and daily for 4 days post-op. Electrical olfactory responses and histology wereassessed at days 0, 2, 12, 15, 18, 19, and 21 post injury.

Results: Anatomic and electrical recovery in minocyclinetreated mice occurred earlier than in wild type mice, similar toresults in genetically altered mice.

Conclusion: Minocycline increases the speed of recoveryfollowing olfactory axotomy in mice. These findings support thefollowing hypothesis: minocycline blocks OSN apoptosis postaxotomy and surviving neurons re-sprout axons and synapsewith the bulb. Minocycline may be useful in the management ofa wide range of olfactory disorders.


“Quantitative Comparison of Nasal Irrigation Devices Based on

Mucociliary Transport Time”

Tony Kille, MDDiane Heatley, MD

Glen Leverson, Madison, WI

Disclosure: Dr. Heatley is Vice President of Med-Systems, Inc.,the manufacturer of SinuCleanse. All devices and supplies usedin this study were donated by the respective companies assamples.

Introduction: Chronic rhinosinusitis is associated withalterations in the normal circulation of mucus through thesinuses and nasal cavity. This circulation is dependent upon the mucociliary transport (MCT) system. More rapid MCT isassociated with improved sinonasal symptoms. Clinical studiessupport the use of nasal irrigation in the treatment of chronicsinusitis, but the ideal mode of delivery has not beenestablished. The purpose of this study was to compare fourcommercially available irrigation devices based on changes inMCT time.

Methods: MCT can be quantified using the saccharin clearancetest (measuring the time to perceive a sweet taste after placingseveral particles of saccharin on the anterior portion of theinferior turbinate). Subjects participated in four sessions. Duringeach session, MCT was measured at baseline, and at 10 and

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60 minutes following nasal irrigation using one of the followingdevices: 1) Hydropulse™ (pulsating positive pressure flow), 2) Sinus Rinse™ (squeeze bottle), 3) SinuCleanse™ (neti pot),and 4) Rinoflow™ (inhaled mist). MCT time was recorded inseconds and converted to percent change from baseline.

Results: Thirty-five subjects completed all sessions. Irrigationwith Hydropulse™ and SinuCleanse™ resulted in faster MCTboth at 10 and 60 minutes. Irrigation with Sinus Rinse™resulted in faster MCT at 10 minutes but not at 60 minutes.Irrigation with Rinoflow™ resulted in no statistically significantchange in MCT. Comparing irrigation devices to each other,however, revealed no statistically significant difference betweenthem. Conclusions: Irrigation hastens MCT using nearly alldevices.


“Prediction of Response to Surgery in AllergicPatients with Chronic Sinusitis in Children”

Hassan H Ramadan, MDMorgantown, WV


Objective: Allergic rhinitis (AR) is an important morbidcondition in children with chronic rhinosinusitis (CRS). Theoutcome of endoscopic sinus surgery (ESS) in children with AR is not well known. The study goal was to determinewhether children with AR who are undergoing (ESS) will havea poor outcome.

Design: We conducted a cohort study in a tertiary carechildren’s hospital setting.

Patients and Methods: The study population consisted of 141patients who underwent ESS between January 1994 andDecember 2002. The mean age was 7 years (range, 3 to 13). Theoutcome of ESS was measured at least one year after theoperation. A questionnaire was mailed to the caretakers tomeasure success. Those who required revision subsequentlywere considered as failures.

Results: Multivariate logistic regression analysis was performedwith allergic rhinitis as an independent variable and outcomemeasured as success of procedure. The overall success rate was80%. Univariate analysis showed that children with allergy hada 77% success rate compared to children with no allergy whohad an 84% success rate (P = 0.25). Children with AR who wereon treatment prior to surgery had an 84% success rate comparedto 65% for those children with AR but were not treated (P=0.02).

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Conclusion: ESS in children with allergic rhinitis does not havea poorer outcome. Treatment of the allergy prior to surgery,however may improve the success of ESS.

2:31 pmDiscussion

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“The Role of the Underlying Bone inInverting Papilloma”

Alexis Hope Jackman, MDJames Nathan Palmer, MD

Micheal D Feldman, MDAlexander Grant Chiu, MD

Philadelphia, PA


Introduction: Inverting Papilloma (IP) is a benign but locallyaggressive sinonasal tumor. Rate of recurrence of IP has largelybeen attributed to incomplete tumor resection. Successfulsurgical management depends on preoperative and intraopera-tive identification and resection of tumor margins especially thedeep margin. In this paper, preoperative radiological studiesand histopathological specimens are examined to better under-stand the involvement of the bone underlying an invertedpapilloma.

Materials & Methods: A prospective study of six patients withIP treated with endoscopic or endoscopic-assisted resection over an eight-month period was conducted. Preoperativeradiographic studies were analyzed with respect to bonychanges in the area of the tumor pedicle. Intraoperative patho-logic specimens, which were taken as a wedge of bone with anattached piece of tumor pedicle, were reviewed by a patholo-gist. Results: Radiographic osteitic bony changes in the region of the tumor pedicle were evident on CT scans. On pathologicanaylsis, IP was seen to extend into bony crevices but noisolated rests of epithelium were embedded within the bone inall six cases.

Conclusion: Despite the lack of histopathologic findings oftumor involvement at the bony interface, radiographic osteiticbony changes were seen at site of tumor attachment. Theirregularity of the surface of the bone at the interface betweentumor mucosa may play a role in the rate of recurrence, andhaving a direct effect on the intraoperative handling of the deep tumor margin.

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“Efficacy of Draf I Surgery for Chronic Frontal Sinusitis”

Joseph Han, MDSamuel Becker, MD

Thuy-Anh Nguyen, BACharles Gross, MDCharlottesville, VA


Introduction: Although Draf I surgery is commonly used toaddress chronic frontal sinusitis, the efficacy of this procedurefor frontal sinus disease has not been sufficiently demonstrated.The objective of this study was to determine the effectiveness ofDraf I surgery for chronic frontal sinusitis.

Methods: Patients with both clinical and radiographic evidenceof chronic frontal sinusitis who underwent a Draf I procedure asinitial surgical treatment between 1998 and 2004 were reviewedretrospectively. Data on severity and location of mucosalthickening was collected from CT scans using the Lund-Mackayscale. Demographic data, comorbidities, management, post-operative recovery, and follow-up data were collected.

Results: Seventy-seven patients, representing 121 diseasedfrontal sinuses met inclusion criteria. Respiratory comorbiditieswere asthma alone (8.3%), asthma and polyps (6.6%), aspirintriad (5.8%), and cystic fibrosis (0.8%). Nineteen (15.7%) of the121 frontal sinuses belonged to smokers. Fourteen (11.5%) of 121 frontal sinuses exhibited post-operative clinical andradiographic evidence of disease. Of these 14 frontal sinuses, 10 (8.3%) underwent revision surgery. Smokers were no morelikely to undergo revision procedures than non-smokers(p<0.05). Frontal sinuses belonging to patients with aspirintriad, or with both nasal polyposis and asthma were more likelyto fail Draf I surgery (p<0.05). Average follow-up time was 14months.

Conclusions: The Draf I procedure is effective 88.5% of the timeas initial surgery for chronic frontal sinusitis in this study.Patients with aspirin triad, or both asthma and polyposis aremore likely to fail this procedure and may require moreaggressive surgical treatment.

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“Recalcitrant Rhinosinusitis With Polyps IsAssociated With Altered Expression Of Genes

Associated With Innate Immunity”

Andrew P. Lane, MDQuynh-Ai Truong-Tran,

Robert A. Schleimer, PhDBaltimore, MD


Introduction: The role of innate immunity in the pathophysiolo-gy of chronic rhinosinusitis is poorly understood. In this study,sinonasal expression of toll-like receptors (TLRs), complementcomponents, and serum amyloid A (SAA) was examined inpatients undergoing sinus surgery for chronic rhinosinusitis(CRS).

Methods: Ten controls and thirty subjects with medicallyunresponsive CRS were prospectively enrolled prior toundergoing endoscopic sinus surgery. Ethmoid mucosa wasobtained and processed for RNA extraction. Real-time PCR was employed to determine expression of TLRs and acute phase proteins. Subjects were followed for at least 6 monthspost-operatively with nasal endoscopy to assess for polyprecurrence. Results: TLR and acute phase protein mRNAwas detected in both control and CRS ethmoid mucosa. Ascompared to controls, CRS was associated with significantlylower expression of TLR3, 5, 6, 7, 8, 9 and 10. Patients with earlyrecurrence of polyps after surgery had significantly greaterexpression of TLR9 and SAA, and decreased expression ofTLR2, when compared to patients who did not. There was atrend towards increased acute phase protein expression in the recalcitrant CRS group that did not achieve statisticalsignificance. Conclusions: This study identifies differences inthe expression of innate immune system components in thesinonasal mucosa of CRS patients who experience earlyrecurrence of polyps despite aggressive medical and surgicaltherapy. This study also demonstrates reduced expression ofseveral TLRs in CRS as compared to controls. Whether thesedifferences play a role in pathogenesis or are merelymanifestations of disease activity requires further investigation.

3:01 pmDiscussion

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3:10 pm – 3:30pmBreak

3:30 pm – 4:00 pmPanel: Inflammatory Mediators in CRS

Jan Gosepath, MDBradley Marple, MD

Moderators:

James Palmer, MDRichard Orlandi, MD

4:00 pm(Abstract #891)

“Expression of Cycloxygenase andLipoxygenase Enzymes In Nasal Mucosa

of Cystic Fibrosis Patients”

Jonathan Owens, MDKenneth Shroyer, MD, PhD

Todd Kingdom, MDDenver, CO

Disclosures: No disclosures reported.

Introduction: A large proportion of cystic fibrosis patientssuffers from chronic rhinosinusitis. To date no studies haveevaluated the contribution of arachidonic acid metabolites tothis pathophysiology. Our study was performed to evaluate theexpression of cyclooxygenase and lipoxygenase enzymes innasal mucosa of cystic fibrosis patients.

Methods: Expression of the enzymes cycloxygenase-1 and -2(COX-1 and COX-2), 5-lipoxygenase (5-LO), 12-lipoxygenase(12-LO), and 15-lipoxygenase (15-LO) was evaluated in archivednasal mucosal tissue of cystic fibrosis (CF) patients usingimmunohistochemical techniques. These results were comparedto a control group of patients without history of cystic fibrosisor rhinosinusitis.

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Results: Characteristic staining patterns of epithelium andsubmucosal glands were noted for each enzyme. Statisticallysignificant (p <0.05) differences in staining of columnarepithelium were noted for COX-2 (apical cell layer and glandcytoplasm) and 12-LO (full-thickness cytoplasm and nucleus)between control and CF specimens. Significant differences ofstaining of submucosal glands were noted for COX-2(cytoplasm) and 12-LO (cytoplasm) were noted between controland CF specimens. No significant differences were noted for thestaining of COX-1, 5-LO, or 15-LO between the groups.Conclusions: Significant differences in nasal mucosal expressionof COX-2 and 12-LO enzymes exist between cystic fibrosispatients and controls. This suggests differences in arachidonicacid metabolism and inflammatory mediator productionbetween these two groups. Whether these differences aregenotypic or occur in response to preexisting inflammation isuncertain and merits further study.


“Differences in Skull Base Defect Size:Endoscopy versus Computed Tomography”

John DelGaudio, MDNicolas McLean, MD

Sarah Wise, MDPatricia Hudgins, MD

Atlanta, Georgia

Disclosure: Astra Zeneca - speaker’s bureau Medtronic Xomed -consultant Schering Plough - speaker’s bureau

Background: Endoscopic skull base defect repair is performedfrequently among experienced rhinologic surgeons. High-resolution computed tomographic (CT) scans are paramount topreoperative planning. We compared skull base defect size onaxial CT scans and reformations to operative findings.

Methods: A retrospective chart and film review of patientsundergoing skull base defect repair was performed to comparedefect size on endoscopy to defect size on CT scan. Aneuroradiologist, blinded to endoscopy findings, reviewed allscans. CT was performed at 0.625-3.00 mm slice thickness in theaxial plane, with sagittal and coronal reformations generatedfrom the axial data set. Skull base defect measurements wereperformed on a workstation. Results: Skull base defects wereseen at CT in 18/19 patients. Average CT defect size was 10.1 mm (range 0-30 mm). Average endoscopic defect size

15

was 7.8 mm (range 0-20 mm). Endoscopic defect size waswithin 2 mm of radiologic defect size in only 42.1% of cases. Inpatients with 2 mm discrepancies or greater, CT measurementsoverestimated defect size by an average of 9.1 mm (range 3-20mm). In 3/19 patients, radiologic defects were either notidentified or were underestimated.

Conclusion: CT and endoscopic measurements of skull basedefect size are often discrepant. Surgical implications for defectrepair will be discussed.


“Surgical Outcomes of Drillout Procedures for Management of Complicated

Frontal Sinus Pathology”

Pete S. Batra, MDDonald C. Lanza, MD

Cleveland, Ohio


Introduction: Standard endoscopic techniques allow formanagement of majority of frontal sinus pathology. However,the purely endoscopic approach has its limitations, especially in the setting of iatrogenic frontal sinus disease with new bone formation. The purpose of this report is two-fold: (1) todetermine the incidence and (2) the efficacy of drilloutprocedures in the management of frontal sinus disease in atertiary rhinology practice.

Methods: Retrospective data analysis was performed on allpatients undergoing frontal sinus surgery, and more specificallydrillout procedures, from May 1999 to April 2004. The incidenceof drillout surgery was determined. Demographic data,symptomatology, type of drillout procedure, and primarypathology were determined. Outcome was assessed based onsubjective symptomatology and objective endoscopic patencypostoperatively. Results: A total of 186 patients underwent 207 frontal sinus procedures during this time period; twenty-five patients (13.4%) required a total of 30 (14.5%) drilloutprocedures. The patients had undergone an average of 3.2 procedures (range 0 – 9) prior to surgical intervention; four cases were primary and 26 cases were revision procedures.The breakdown of the procedures was as follows: Draf III – 17,trans-septal frontal sinusotomy – 6, Draf II – 5, and Draf IB – 2.The indications included mucocele (11 cases), frontal sinusitis (6 cases), tumors (5 cases), invasive fungal sinusitis (2 cases),and CSF leak (1 case). Postoperatively, headache symptoma-

16

tology resolved in 32%, improved in 56%, and remainedunchanged in 12% of the patients. Endoscopic patency of theneo-ostium was noted in 23 cases (92%). Average follow-up was16.3 months ranging from 3 to 46 months.

Conclusions: In this series, drillout procedures weresuccessfully utilized in 25 patients and, thus, may serve as animportant adjunct to the standard endoscopic techniques formanagement of complex frontal sinus disease. Since theprocedure was only utilized 30 times over a 5-year period, it isreserved for specific circumstances in carefully selected patients.

4:21 pmDiscussion


“Powered Turbinoplasty – The Long TermResults As Compared To Electrocautery

And Submucosal Turbinoplasty”

Raymond Sacks, MDNiell Boustred, MD

Hornsby, New South WalesAustralia

Disclosure: Study funded by Medtronic Xomed in terms of theprovision of both Submucosal Turbinate Debrider blades as wellas 3.5 mm tricut microdebrider blades

Introduction: Allergic rhinitis is a common condition effecting alarge number of patients across Australia. Although most ofthese patients respond well to medical treatment, there remainsa significant number who have ongoing nasal obstruction andrequire surgical intervention. Surgical intervention has rangedfrom complete turbinectomy through to cauterization of theturbinate mucosa and submucosal turbinate cauterization. Themajor problem with turbinate resection is the loss of the mucosawhich has physiological functions in terms of maintenance andhumidification of the nasal airflow system. Crusting is also acommon post-operative problem in these patients. Cauterizationto the turbinate mucosa has a very poor long term success and again causes mucosal damage. Submucosal turbinatecauterizations are short lived and require periodic repeating. A submucosal resection of the turbinate or a powered turbino-plasty would hopefully give a long term solution to the problem.

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Method: Two separate randomized studies with 50 patients ineach group were introduced into the study based on failedmedical management of nasal obstruction secondary toturbinate congestion. All patients were randomized into eitherleft or right turbinate to be treated with the Xomed submucosalturbinate debrider. The opposite turbinate was treated bysubmucosal cauterization in the first study and by poweredturbinoplasty in the second study. The following parameterswere measured at 1 week, 1 month, 4 months and 1 year. 1.Patient VAS scores for nasal obstruction, anterior and posteriorrhinorrhoea. 2. Examiner (blinded) VAS scores for both anteriorrhinoscopy and nasoendoscopy 3. Acoustic rhinometry 4. Complications – bleeding, crusting, pain/discomfort.

Results: Nasal obstruction: At 4 months overall improvementfor all groups but at 1 year significant advantage ofturbinoplasty over submucosal turbinate resection and in turnadvantage over electrocautery Rhinorrhoea: No significantdifference in all three groups. Anterior Rhinoscopy/Endoscopy:Overall deterioration in electrocautery but no significantdifference between submucosal resection and turbinoplasty at 1 year. Rhinometry: Powered turbinoplasty significantly betterthan the other two groups at 1 month, 4 months and still at 1 year.

Conclusion: Powered turbinoplasty gives a consistent, reliableresult which gives long term relief of obstructive symptomswithout significant risk of complication and is cost effective,technically straight forward and highly predictable. The surgicaltechnique of powered turbinoplasty and the results of the twostudies will be presented.


“Effect of Estrogen on Olfactory Neuron Proliferation”

Karen J Fong, MDRachel J Woo, BS

Portland, OR

Disclosure: Supported by an ARS New Investigator’s ResearchGrant and the Medical Research Foundation of Oregon.

Introduction: The olfactory mucosa has the unique ability toregenerate neurons throughout life, making it an importantsystem for the study of neuronal development, differentiation,and plasticity. The effects of estrogen on these processes havenot been studied, although it is well-recognized in the brain thatestrogen can affect the developmental processes of neurons at

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multiple levels. The objective of this study is to determinewhether estrogen affects the rate of proliferation of olfactoryreceptor neuron precursors.

Materials and Methods: Adult female ovariectomized Sprague-Dawley rats were divided into two groups. Group 1(“estrogen-replacement”) received 17beta-estradiol at a level of20ug/kg-bw/day (n=6) and group 2 (“controls”) receivedvehicle alone (n=6) via a subcutaneously implanted microsmoticpump for a period of 2 weeks. To label dividing cells, allanimals were administered a single dose of 5-bromo-2’-deoxyuridine (BrdU; a thymidine analog) intravenously onehour prior to sacrifice. Tissues were then processed for frozensections and immunohistochemistry was performed using ananti-BrdU monoclonal antibody. BrdU-labeled cells werecounted from serial cross-sections through the nasal cavity. Rawcounts were divided by the total length of olfactory epitheliumcounted to yield a labeling index. Statistical comparison of thelabeling index between the groups was analyzed using aStudent’s t-test.

Results: Comparison between the two groups showedsignificantly higher numbers of BrdU-labeled cells in theestrogen-replacement group (6.2+/-0.8) vs. controls (4.1+/-0.8;p<0.05).

Conclusion: These preliminary results suggest that systemicestrogen levels may play a role in olfactory neuron proliferation.Supported by an ARS New Investigator’s Research Grant.


“Innate Antimicrobial Activity Of SinusSecretions In Patients With/Without

Chronic Rhinosinusitis”

Jivianne T Lee, MDJames N Palmer, MD

Alexander G Chiu, MDDavid W Kennedy, MD

Philadelphia, PA


Introduction: Both nasal and bronchoalveolar secretions havebeen found to possess inherent antimicrobial properties thatparticipate in the innate host defense of the respiratory tract.Such microbicidal capabilities are believed to be conferred bythe presence of intrinsic antibacterial polypeptides, which are

19

produced by respiratory epithelia and secreted into the airwaymilieu. The purpose of this study was to determine if sinussecretions exhibited the same innate antimicrobial activity astheir upper and lower airway counterparts, and if suchbactericidal capabilities differed in patients with and withoutchronic rhinosinusitis.

Method: Maxillary sinus fluid was obtained from 12 subjectswithout a history of sinus disease via antral lavage. All patientsdenied having any previous history of sinus infection andshowed no radiographic evidence of sinus pathology either onCT scan or MRI. Similar specimens were also procured from 8 subjects with a history of chronic rhinosinusitis. In the lattergroup, antral lavage was performed immediately prior tofunctional endoscopic sinus surgery. Following specimencollection, both radial diffusion assays (RDA) and colony formingunit (CFU) microassays were used to test the antimicrobialeffects of the samples against various microbes in vitro. Zonesof clearance (no bacterial growth) and CFU counts weremeasured for each assay respectively.

Results: All 12 specimens obtained from patients without ahistory of rhinosinusitis failed to demonstrate any antimicrobialproperties, showing no zones of clearance (-30RDU) on radialdiffusion assays. In contrast, 6/8 samples acquired frompatients with a history of chronic rhinosinusitis exhibitedmicrobicidal effects when incubated with various microbes invitro.

Conclusions: Maxillary sinus fluid obtained from normalsubjects do not appear to exhibit the same microbicidal effectsas their upper and lower airway counterparts. However, whenacquired from patients with a history of chronic rhinosinusitis,antimicrobial properties are evident. Thus, previous or activeinfection may be necessary to induce the production ofantibacterial polypeptides responsible for such microbicidalcapabilities.

4:51 pmDiscussion

5:00 pmBusiness Meeting – Members Only

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Saturday May 14, 2005

8:00 am – 8:15 amIntroduction, Poster and Awards Presentation

Todd Kingdom, MDAllen Seiden, MDModerators:

Todd Loehrl, MDRonald Swain, Jr. MD

8:15 am(Abstract ID # 897)

“Lobular Capillary Hemangioma Of The Nasal Cavity: A Retrospective

Study On 40 Patients”

Roberto Puxeddu, MDMarco Berlucchi, MD

Gian Peppino Ledda, MDPiero Nicolai, MD

Cagliari, Italy


Introduction: Lobular capillary hemangioma (LCH) or pyogenicgranuloma is a benign lesion of unknown etiology that must beincluded in the differential diagnosis of vascular lesions of thenasal cavity. The present retrospective study, which is based ona large cohort of patients with LCH, has analyzed the clinicalpresentation, histological and radiological findings, as well asthe treatment strategy of this uncommon disease.

Methods: The clinical records of 40 patients affected by LCH,who were treated in the period January 1993–December 2003 attwo university hospitals, were reviewed. The study groupconsisted of 21 males and 19 females, with a mean age of 40years (range: 10 mo–72 yr). Data concerning symptoms, possibleetiologic factors, endoscopic findings, CT or MR (wheneveravailable), and treatment were collected.

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Results: Previous nasal trauma and pregnancy were identifiedas possible causative factors in 6 (15%) and 2 (5%) patients,respectively. The main presenting symptoms were unilateralepistaxis (95%) and nasal obstruction (35%). The lesions rangedin size from 1 to 8 cm and mainly involved the nasal septum(45%) and the nasal vestibule (17.5%). In the 8 (20%) patientswith large lesions radiological evaluation was helpful not onlyin assessing the extent, but also in suggesting the possiblediagnosis. All patients underwent endoscopic resection underlocal (72.5%) or general (27.5%) anesthesia. At present (meanfollow-up: 53 months), no recurrence has been observed.

Conclusions: To the best of our knowledge, this is the largestseries of patients with LCH of the sinonasal tract reported todate. Whenever the mass is considerable in size, differentiationfrom other vascular lesions (i.e., angiofibroma, angiosarcoma)may be difficult. In these circumstances, information obtainedwith imaging techniques (site of origin, pattern of growth andvascularization) may indeed suggest a correct diagnosis withoutresorting to biopsy. Endoscopic surgery is the treatment ofchoice even for large lesions, which do not require preoperativeembolization.


“Subjective Headache Before And AfterEndoscopic Sinus Surgery”

William H Moretz III, MDStilianos E. Kountakis, MD

Augusta, GA


Objectives: To demonstrate the effect of endoscopic sinussurgery on subjective headache scores in patients diagnosedwith chronic rhinosinusitis (CRS) with or without nasal polyps.

Methods: Retrospective analysis of prospectively collected datafrom 201 patients over a three-year period. Headache and Sino-Nasal Outcomes Test (SNOT-20) mean scores were comparedpreoperatively and two years postoperatively on patientsdiagnosed with CRS with or without nasal polyps.

Results: Two hundred one patients underwent surgicalmanagement of CRS with or without nasal polyps over a 3 yearperiod. One hundred four patients were male, 97 female, with amean age of 49 (range 18-80) years. Polyps were present in 78patients with CRS. The mean subjective headache score basedon a 0-10 visual analog scale improved from 4.7 preoperativelyto 0.8, two years postoperatively (p<0.0001). The meanheadache score of 123 patients without polyps was larger

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compared to 78 patients with polyps (5.1 vs. 4.1 respectively,p<0.05). As previously reported, the mean overall preoperativeand postoperative SNOT-20 scores were 28.7 and 6.7,respectively (p<0.0001).

Conclusion: Headache is a common symptom with CRS, present in 70.1% of our patients undergoing FESS for CRS withor without nasal polyps. An overall decrease in mean headachescores was noted at two year follow-up.


“Progression of Sinus Disease in theIntubated Patient”

Spencer Payne, MDMichael S. Benninger, MD

Detroit, MI


Introduction: Sinus disease in the intubated patient remains afrequent reason behind otolaryngologic consultation to theIntensive Care Unit. Previous prospective studies have oftenbeen limited to only one CT scan of the sinuses. The purpose ofthis study was to verify the development of sinus disease in theorotracheally intubated patient and determine a radiographicpattern of its progression if present.

Methods: The charts of all patients admitted to the hospitalwith a diagnosis of aneurysm or subarachnoid hemorrhage overthe past year were evaluated. Patients who were orotracheallyintubated with at least one post-intubation computedtomography (CT) scan of the head were included. CT scansobtained after the initiation of antibiotics or tracheostomy wereexcluded. The Lund-Mackay system was used to evaluate thescans.

Results: A total of 36 patients with 130 scans were evaluated.Analysis revealed a significant trend toward increasing severityof sinus disease over the first seven days of intubation (R2=.36,P<.05). The presence of a nasogastric tube (NGT) resulted in ahigher R2 value (0.49 vs. 0.28, P<0.001) but the trend remainedsignificant for both groups.

Conclusions: This study shows that the presence and pro-gression of sinus findings is fairly common in the intubatedpatient and that while the placement of an NGT increased therate of development of sinus findings, the lack of one did notpreclude sinus disease. Clinical exam remains a more importantindicator of disease when evaluating the ICU patient forsinusitis.

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8:36 amDiscussion

8:45 am(Abstract #906)

“Cocaine-Induced Midline DestructiveLesions (CIMDL): Cocaine Concentration isMore Significant Than Time of Exposure”

Matteo Trimarchi, MDAnna Rita Miluzio, PhD

Pier Carlo Marchisio, MDMario Bussi, MD

Milano, Italy

Disclosures: No disclosures to report

Background: Estimates of the current number of regular cocaineusers in the United States of America (at least once per month)vary, but 1.75 million is a widely accepted figure within theresearch community. Cocaine-induced lesions may causeextensive destruction of the osteocartilaginous structures of thenose, sinuses and palate but its pathogenesis is still unknown.

Study Design: This study was meant to evaluate the occurrenceof increased apoptosis and aberrant mitosis induced by cocainein vitro. We measured the effect of cocaine in vitro on humanepithelial cells (HaCat cells) at different concentrations andtimes of exposure. Material and methods. HaCat cells wereincubated with cocaine: treatment of 2.5 mM, 5 mM and 10 mM of drug for 1 and 6 hours of exposure was analysed forapoptotic cells detection by TUNEL assay; aberrant mitosis wereinvestigated by immunofluorescence assay, using a monoclonalanti-tubuline antibody (20C6) after HaCat cells exposure to 10 mM and 100 mM of cocaine for 24, 48 hours.

Results: After 1 h of treatment apoptotic cells increased in atime dependent manner compared to the control group (p 0,01):2.5 mM, 5 mM and 10 mM of cocaine induced 16%, 45% and84% of apoptosis respectively. We found high density ofaberrant mitoses compared to the control group (p 0,01).

Conclusion: Effect of drug concentration is more significantthan time of exposure and this process may explain the severemidline destructive lesions in some patients using high doses ofcocaine compulsively and continuously.

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8:52 a.m.(Abstract ID # 907)

“Comparison of Three Techniques forTranssphenoidal Pituitary Surgery”

Jeffrey Gardner Neal, MDJohn D. Osguthorpe, MD

John S. Kulbersh, B.S.Rodney J. Schlosser, MD

Charleston, SC


Objectives: To compare three different techniques fortranssphenoidal pituitary surgery: 1) sublabial transseptalapproach with microscopic resection; 2) transnasal transseptalapproach with endoscopic resection; and 3) endoscopic approachwith endoscopic resection.

Study Design: Retrospective review.

Methods: Fifty pituitary surgeries performed by the sameneurosurgeon were reviewed. Demographic, radiographic andclinical data were collected. Results: Fifteen patients underwentsublabial transseptal approach with microscopic tumorresection, 21 patients underwent the transnasal transseptalapproach with endoscopic tumor resection and 14 underwentboth an endoscopic approach and endoscopic tumor resection.There were a total of 20 complications in the sublabial group, 13 transnasal, and 6 endoscopic complications. CSF leakincidence was sublabial 53%, transnasal 47%, and endoscopic28%. Lumbar drains were required in 40% of sublabial, 38% oftransnasal, and 7% of endoscopic approaches. Nasal packingwas used in 100% of sublabial and transnasal approaches and0% of endoscopic approaches. Mean recurrence rate and follow-up was sublabial 6.6% (50 months), transnasal 9.5% (11 months),and endoscopic 0% (7 months). Average hospital stay wassublabial 8.3 days, transnasal 6.2 days, and endoscopic 3.4 days(p<.05).

Conclusions: Transsphenoidal pituitary surgery has evolvedover the past several decades, as advances in technology havebeen the catalyst for less invasive surgeries. Less invasiveapproaches, such as transnasal approach with endoscopicresection of tumor and endoscopic approach with endoscopictumor resection have less morbidity and a shorter hospital staythan traditional sublabial approaches. Continued follow-up isneeded to confirm long-term benefits and similar recurrencerates.

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8:59 a.m.(Abstract ID # 910)

“Regional Analysis of Sinonasal Ciliary Beat Frequency in Normal Subjects”

Jeffrey M. Shaari, MDJames N. Palmer, MD

Alexander G. Chiu, MDNoam A. Cohen, MD

Philadelphia, PA


Introduction: Mucociliary clearance, a primary host defensemechanism, depends on mucus production and its clearance bythe coordinated beating of cilia lining the airways. Numerousinvestigations have analyzed ciliary activity in brushings fromthe inferior turbinate. To date, only one study has investigatedwhether the inferior turbinate is representative of sinonasalciliary activity. We analyzed ciliary beat frequency (CBF) fromthe inferior turbinate, uncinate process and sphenoethmoidrecess in non-sinusitis patients to determine regional variabilityof ciliary activity within the sinonasal cavity.

Methods: Explants of sinonasal epithelium were analyzed at37°C. Beating cilia were visualized with differential interferencecontrast microscopy. Images were captured using a high speeddigital camera with a sampling rate of 250 frames per second. Aone dimensional tracking algorithm analyzed individual pixelgrayscale values within each frame of the video. The differencesin grayscale were plotted as a time dependent waveform andfrequency was calculated as the inverse of the peak-to-peakdistance. A minimum of three areas of beating cilia wereanalyzed per regional sample. Statistical analysis wasperformed with repeated-measures ANOVA. Results Completesampling of all three sites was accomplished in seven patients.Although a trend of accelerated CBF was noted in the inferiorturbinate, this was not found to be statistically significant(p¡Ü0.05). The mean CBF for all sights in all patients was 12.1Hz¡À 2.9Hz, in agreement with published values.

Conclusions: This study demonstrates no regional differencesin CBF within the sinonasal cavity, supporting previous workand validating analysis of inferior turbinate cilia.

9:06 a.mDiscussion

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Moderators:

Todd Kingdom, MDPeter Doble, MD


“Long-term Zileuton Post-surgical Prophylaxis for Nasal Polyposis”

Larry Duberstein, MDMemphis, TN

Disclosure: Advisor to Critical Therapuetics, Inc.

Introduction: Nasal polyp regrowth is common followingpolypectomy. It has been reported anecdotally that patients withnasal polyposis treated surgically and followed by zileuton, a 5 lipoxygenase (5-LO) inhibitor, exhibit normal liver functionand have less polyp recurrence.

Methods: Thirty-one adult patients, 11 of whom failed initialmontelukast treatment, underwent nasal polypectomy followedby preventive treatment with zileuton (600 mg QID, TID,and/or BID), second generation antihistamines, and topicalglucocorticoids for 4 months to 5 years (4 months–1 year, n=7;1-2 years, n=11; and 2-5 years, n=13). Typically, patients wereprescribed zileuton 600 mg QID and were subsequently taperedto 600 mg BID. Patients were regularly monitored by serialotolaryngologic examination and routine serial liver functiontests. Results: All patients, regardless of zileuton dose schedule,tolerated the regimen with no elevation in liver function testsover the upper limit of normal. Reported side effects werelimited to rigors and chills in one patient. Most patients (26/31)experienced no recurrence of nasal polyps, including 2/5 of themontelukast failures. Of those patients that recurred, prescribeddoses were then increased to 600 mg QID with no further polypregrowth. Conclusions: These 31 cases are illustrative of thesafety and tolerability of zileuton, a 5-LO inhibitor, when usedin a prophylactic regimen following nasal polypectomy. Patientshad no evidence of liver toxicity, and only one patientexperienced side effects. The majority of patients had nodocumented polyp recurrence during the observation period.

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“Overexpression Of Leukotriene C4 Synthase (LTC4S) And Plasminogen

Activator Inhibitor 1 (PAI 1) Gene PromoterPolymorphisms In Sinusitis”

Alessandro de Alarcon, MDJohn W Steinke, PhD

Joseph K Han, MDLarry Borish, MDCharlottesville, VA


Introduction: Studies have described polymorphisms in genesinvolved with both leukotriene synthesis and remodeling. TheLTC4S gene is involved in regulation of leukotrienes, a C-toA base exchange in the promoter region influences geneexpression. The PAI-1 gene is associated with tissue fibrosis, 4G or 5G residues in the promoter region have been associatedwith altered transcription. The role of these polymorphisms was investigated in patients with sinusitis and polyps. Study Design: Prospective study of patients undergoing endoscopicsinus surgery at a university hospital between 1996 and 2004.

Materials & Methods: Demographic data and sinus tissue werecollected on patients. Patients were classified into four groups:Controls, Chronic hyperplastic eosinophilic sinusitis (CHES),Aspirin exacerbated respiratory disease (AERD), and Chronicinflammatory sinusitis (CIS). DNA was analyzed for the LTC4Sand the PAI-1 promoter polymorphisms using standard PCRtechniques. Results: There were 136 patients with 72 femalesand 64 males (mean age = 42 years). Fifty-six people were inthe control group, 14 in the CIS, 45 in the CHES, and 21 in theAERD. The LTC4S allelic frequencies were: Controls: A=0.19,C=0.81; CIS: A=0.27, C=0.73; CHES: A=0.30, C=0.70; AERD:A=0.31, C=0.69. The A allele was more frequent in CHES vs.Controls (p=0.06). The PAI-1 Allele frequencies were: Controls:5G=0.59, 4G=0.41; CIS: 5G=0.46, 4G=0.54; CHES: 5G=0.55,4G=0.45; AERD: 5G=0.55, 4G=0.45. For the PAI-1 gene, thegenetic variance between the four groups was not statisticallydifferent (p>0.05).

Conclusions: There appears to be a genetic component thatcontributes to nasal polyp formation in sinusitis.

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“In Vivo Optical Coherence Tomography Of The Nasal Mucosa”

Usama MahmoodJames M Ridgway, MDZhongping Chen, MD

Brian J Wong, MDIrvine, CA


Introduction: Optical coherence tomography (OCT) is anemerging imaging modality which uses light to produce in vivohigh resolution cross-sectional images (10-microns) of tissues todepths of up to 3 mm. OCT is analogous to ultrasound, butrelies upon interferometry and low-coherence optical sources toproduce images of tissue structure at the histologic level. In thisstudy, OCT was used to image the mucosa overlying the nasalseptum and turbinates in order to obtain information regardingnormative in vivo tissue micro-structure.

Methods: An OCT system employing a Michaelson interferom-eter and a 1.3-micron broadband light source was incorporatedinto a fiber-optic imaging device that was inserted into the nasalcavity. Cross-sectional tomographic images of the anterior andposterior nasal septum, turbinates, and vestibule were acquiredin 30 patients in either the office or O.R. during surgicalendoscopy.

Results: OCT images of the nasal mucosa identified the distinctboundaries between the epithelium, lamina propria, andunderlying bone/cartilaginous tissue. Within the laminapropria, features consistent with glands, ducts, and bloodvessels were clearly identified. The thickness of the epitheliumand lamina propria was tabulated, as well. In patients whounderwent decongestant therapy, before and after imagesshowed distinct morphologic changes in the mucosa.

Conclusion: This study demonstrates the potential of using OCT to produce high-resolution images of the nasal mucosa. As an in vivo tissue micro-structural imaging modality, OCT may be valuable in studying the impact of allergic andinfectious disease on the nasal mucosa, and monitor itsresponse to pharmacologic therapy.

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9:36 amDiscussion


“The Incidence Of Concurrent Osteitis In Patients With Chronic Rhinosinusitis:

A Clinicopathologic Study”

Jivianne T Lee, MDJames N Palmer, MD

Alexander G Chiu, MDDavid W Kennedy, MD

Philadelphia, PA


Introduction: The pathogenesis of chronic rhinosinusits (CRS)has been found to be multifactorial, with environmental,general host, and local anatomic factors all contributing to itsdevelopment. Recent animal studies have demonstrated thatlocal osteitis of the underlying bone may also play a critical rolein the elaboration of CRS by inducing persistent inflammatorychanges in the surrounding mucosa. The purpose of this studywas to determine the incidence rate of osteitis in patients withCRS undergoing functional endoscopic sinus surgery (FESS).

Methods: From January to July 2003, a prospective study wasperformed on 121 patients undergoing FESS for CRS. Age,number of previous surgeries, Lund McKay scores, radio-graphic bony characteristics, and pathologic findings were alldocumented. The presence of concurrent osteitis was assessedusing both radiographic (neosteogenesis) and pathologic (bonyinflammation) criteria. Results: The mean age of the patientswas 44.3 years. 58% of the cases were revision surgeries, witheach patient having an average of 2.2 operative procedures inthe past. Computed tomography (CT) demonstrated neosteo-genesis in 36% of patients, while 53% showed pathologicevidence of osteitis upon histological analysis of surgicalspecimens. Conclusions: Concurrent osteitis can be found in 36-53% of patients with CRS, using both radiographic andpathologic criteria respectively. This clinical finding correlateswell with previous evidence of bone involvement in CRS foundin animal models, further reaffirming the role of underlyingosteitis in the pathogenesis of CRS.

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“Chronic Rhinosinusitis with Nasal Polyps: Further Evaluation of the

Superantigen Hypothesis”

Robert C. Kern, MDDavid B. Conley, MD

Kristin A. Seiberling, MDRobert P Schleimer, PhD

Chicago, IL


Introduction: The hallmark of chronic rhinosinusitis and nasalpolyposis (CRS/NP) is tissue infiltration with lymphocytes andeosinophils. Although the cause(s) of this inflammation remainsunknown, attention has centered on 2 etiologic agents:Alternaria and Staphylococcus aureus. Current evidencesuggests that both organisms may be capable of triggering aTH1/TH2 response with local recruitment and activation ofeosinophils. A molecular mechanism whereby Alternaria elicitsthese effects has not yet been proposed, but Staphylococcusoften secretes toxins with known superantigen capabilities.Superantigens (SAG) are believed to trigger the eosinophilicand lymphocytic tissue infiltration in related disorders such asasthma and atopic dermatitis, with evidence supporting a rolefor SAG in about 50% of CRS/NP patients. The current studywill attempt to distinguish between CRS/NP patients with andwithout tissue evidence of SAG exposure.

Methods: Analysis of 19 CRS/NP patients undergoing ESS.9/19 showed strong evidence and 10/19 showed minimalevidence of exposure to SAG based on TCR Vâ expressionpatterns determined by flow cytometry. We are presentlyanalyzing the two groups using immunohistochemistry forexpression of CD3, CD20, IL5, MBP, EG2, CD38, routinehistology and clinical features. RESULTS: Preliminary resultsindicate no difference between the 2 groups in terms of Lund-McKay scores, tissue eosinophilia or CD3+ cells/hpf. A trendwas noted for increased CD20+ cells/hpf.

Conclusions: The current results suggest that Vâ skewing is notassociated with distinct mucosal pathology with the possibleexception of CD20 positive B cells. Results will be interpreted inlight of current theories of CRS/NP.

31


“Medical and Surgical Considerations inPatients with Samter’s Triad”

Kevin Christopher McMains, MDLarry Borish, MD

Stilianos E. Kountakis, MDAugusta, GA


Objective: To report on objective and subjective outcomes ofpatients with Samter’s triad treated with functional endoscopicsinus surgery (FESS), and correlate these results with aspirindesensitization in these patients.

Methods: Retrospective analysis of prospectively collected datain 15 patients requiring revision FESS after failing maximummedical therapy and prior sinus surgery for chronicrhinosinusitis in the context of Samter’s triad. Five patientsunderwent aspirin desensitization (DS) while 10 did not (NDS).These patients represent a subset of patients previouslyreported who were treated in a tertiary Rhinology setting over a3 year period (1999-2001). CT scans were graded according tothe Lund-Mackay grading scale and symptom scores wereassessed using the SNOT-20 outcomes instrument. Endoscopywas scored according to the RhinoSinusitis Task Forcemethodology. All patients had a minimum 2 year follow-up.Results: Preoperative CT scores were 20.1+/-1.9 for NDSpatients and 20.4+/-2.0 for DS patients (p=NS). Pre-op andpost-op SNOT-20 scores for NDS patients were 31.8+/-3.9 and8.8+/-1.7 respectively as compared to 32.0+/-3.6 and 7.3+/-1.7for DS patients (p=NS). Pre-op and post-op endoscopy scoresfor NDS patients were 7.6+/-1.2 an 2.0 +/-0.4 respectively ascompared to 7.6+/-1.3 and 1.1+/-0.4 for DS patients (p=NS). Of DS patients, none required additional surgery while 8 of 10 NDS patients required additional revision during the follow-up period (p=0.003).

Conclusion: Revision FESS benefits patients with Samter’striad; however, the addition of aspirin desensitization decreasesthe likelihood that patients with Samter’s will require additionalsurgical intervention over a two-year period.

32

10:06 amDiscussion

10:15 am – 10:35 amBreak

Moderator:

Stilianos Kountakis, MD10:35 am

(Abstract ID # 924)

“Endoscopic Management Of The Frontal Sinus Outflow Tract For Fractures Of The Frontal Sinus: A New Alternative

To Obliteration”

Jacob Steiger, MDJivianne T Lee, MD

James N Palmer, MDAlexander G Chiu, MD

Philadelphia, PA


Introduction: Frontal sinus fractures associated with potentialobstruction of the frontal sinus outflow tract have traditionallybeen treated with open reduction and concomitant frontal sinusobliteration. Such an approach was adopted because previoussurgical attempts at restoration of frontal sinus ventilation oftenfailed due to subsequent scarring and stenosis of the nasofrontaldrainage path, leading to frontal sinus disease and potentiallyfatal long term sequelae. However, the advent of more advancedendoscopic techniques has enabled more meticulous dissectionof the frontal recess to be performed, resulting in greater successrates with respect to both the establishment and maintenance offrontal sinus outflow tract patency. The purpose of this studywas to determine if transnasal endoscopic frontal sinusotomywas an effective approach in the management of the frontalsinus outflow tract following fractures of the frontal sinus andrepresented a viable alternative to obliteration

33

Methods: A prospective study was performed on four patientswho presented with frontal sinus fractures from December 2003to August 2004. All underwent endoscopic frontal sinusotomywith either open or endoscopically assisted reduction andfixation. Frontal sinus outflow tract patency was determined by direct endoscopic visualization after 6 months to 1 year offollow-up.

Results: Three of the 4 patients presented with isolated anteriortable frontal sinus fractures. Two of the 3 were successfullyreduced via a transnasal endoscopic approach without anexternal incision, while the third was repaired through a frontalsinus trephination under endoscopic visualization. The fourthpatient possessed both an anterior table fracture and posteriortable dehiscence, which was reduced through a preexistingfacial laceration. All four patients underwent endoscopic frontalrecess dissection to open the frontal sinus outflow tract in thesame setting. After a follow-up of up to 1 year, all 4 patientswere found to have patent frontal sinus drainage pathwayswithout any adverse sequelae.

Conclusions: Frontal sinus fractures with concurrentobstruction of the frontal sinus outflow tract may no longernecessitate frontal sinus obliteration. Simultaneous transnasalendoscopic frontal recess dissection during the time of fracturerepair has been found to successfully open and maintain thefrontal sinus drainage pathway. Longer follow-up is necessaryto determine if such patency can be sustained in the future.

10:42 am(Abstract #877)

“Invasive Fungal Sinusitis: What is theAppropriate Follow-up?”

John DelGaudio, MDKristen Otto, MD

Atlanta, GA


Introduction: Early detection and aggressive surgical andmedical management have been associated with higher overallsurvival rates among patients with invasive fungal sinusitis(IFS). With improved survival comes the question of how toappropriately manage these patients once disease stability hasbeen achieved. Previous reports suggest follow-up only as long as the patients remain immunocompromised. This studyattempts to answer the question of long-term clinical follow-up,and define a regimen suitable for ensuring minimal post-treatment complications.

34

Methods: A retrospective review included all patients diagnosedwith IFS between 1988 and 2004. The study group includedpatients who survived the initial treatment course, with at least30 days of post-treatment follow-up of their IFS. Patient recordswere reviewed for significant complications, evidence of chronicsinus disease, the clinical status of their underlying medicalcomorbidities, and frequency and mode of follow-up.

Results: Thirteen patients were included. The average follow-up time was 611 days. Significant complications included onepatient with acute bacterial sinusitis with resultant visual loss,one patient with chronic osteomyelitis, and two patients whodied of recurrent IFS. Chronic crusting and bone sequestrationwas a major problem in three patients. Six of thirteen patientshad persistent chronic rhinosinusitis. All complications werenoted to occur after initial disease eradication was thought tohave taken place.

Conclusions: Significant complications of IFS can occur aftermedical remission and recovery of immune competence.Patients with invasive fungal sinusitis should be followed long-term, with endoscopy and aggressive debridement, untilremucosalization of the sinuses, resolution of crusting, andcessation of bony sequestration have occurred.

10:49 amDiscussion

35

10:55 am – 11:25 am

PanelControversies in Frontal Sinus Surgery

Moderator:

Frederick Kuhn, MDPanelists:

Martin Citradi, MDBoris Karanfilov, MD

36

11:25 am – 11:55 amPatient Advocacy Committee Panel

“Correct Coding for Better Reimbursement in Rhinology”

Moderator:

Michael Setzen, MDPanelists:

Joseph B. Jacobs, MD – “How to Code Appropriately in the Office”

Michael Sillers, MD – “FESS/Turbinate Surgery/Septoplasty-How I Code”

Michael Setzen, MD –“Image Guidance/Post Op Debridement-Documentation, Guidelines and Coding”

11:55 am

Closing Remarks

Joseph B. Jacobs, MDMichael Sillers, MD

37

The following presentations were withdrawn from the program:

Abstract ID #879

“Skull Base And Orbital Erosion In Allergic Fungal Sinusitis(AFS) And Non-AFS Sinusitis”

Mark Ghegan, MDRodney Schlosser, MDCharleston, South Carolina

Abstract ID #875

“Surfactant-Associated Proteins In Human Sinus Mucosa”

Bradford Woodworth, MDJeffrey Neal, MDRodney Schlosser, MDBaatz John, MDCharleston, SC

Abstract #898

“Improvement Of Health Outcomes Using Clarithromycin In The Management Of Acute Rhinosinusitis”

James A Hadley, MDAmeet Singh, MDRochester, NY

38

WITHDRAWN

POSTER PRESENTATIONSCOSM 2005

Poster/Abstract ID # 917

“Endoscopic Medial Maxillectomy forSinonasal Neoplasms and Chronic

Maxillary Sinusitis”

Bradford A. Woodworth, MDRyan O. Parker, BS

Rodney J. Schlosser, MDCharleston, SC

To be presented by Dr. Rodney Schlosser and/or Dr. Jeff Neal in Dr.Woodworth’s absence.

Disclosure: Rodney J. Schlosser MD - BrainLab consultantAventis consultant

Introduction: Endoscopic medial maxillectomy (EMM) has beenrecently described as an alternative technique to openmaxillectomy for benign sinonasal neoplasms. Few reports,however, discuss the efficacy of EMM for treatment ofinflammatory disease of the maxillary sinus. We evaluate theefficacy of EMM in treating both sinonasal neoplasms andinflammatory disease.

Methods: A retrospective review of patients who underwentEMM between December 2002 and September 2004 wasperformed. All patients were treated with EMM alone or as part of an endoscopic sinus surgery procedure. Standarddemographic data, operative technique, and postoperativefollow up times were collected. Results: Twenty-eight patients(average age 57 years) underwent 33 EMMs for invertedpapillomas (n=6), hemangiopericytoma (n=1), ameloblastoma(n=1), squamous cell carcinoma (n=1) or chronic maxillarysinusitis refractory to maxillary antrostomy (n=24). All patientswith inflammatory disease failed prior sinus surgery, including9 Caldwell-Luc procedures. Average follow-up for neoplasmswas 14 months (range, 7-23 months) with no recurrences and forinflammatory disease was 14.5 months (range, 4-22 months).One patient with maxillary sinusitis recurred and was managedmedically. Our only complication was one nasolacrimal ductinjury.

Conclusion: Endoscopic medial maxillectomy is both a safe andeffective treatment for appropriate maxillary neoplasms and forchronic maxillary sinusitis refractory to standard medical andendoscopic surgical management.

39


“Nasal Septal Suture Technique VersusNasal Packing After Septoplasty”

Altan Yildirim, MDSivas, Turkey


Background: To determine the effects of nasal septal suturetechnique versus nasal packing on eustachian tube function andarterial blood gas changes.

Methods: Eighty patients whom have been performedseptoplasty were studied. Patients with no middle ear diseaseand have A type tympanograms between ± 50 mmH2O wereincluded. Mucoperichondrial flaps of nasal septum weresutured with 5/0 Vicril in forty of them. Nasal packing wasperformed for 48 hours in the other forty patients. Acoustictympanometry and PH, PCO2, O2 analysis of arterial bloodwere performed preoperatively and 48 hours postoperatively.Preoperative results of the parameters of nasal septal suturegroup and nasal packing group were statistically comparedwith independent sample t test. Preoperative and postoperativeresults of the parameters of each group were also statisticallycompared with paired sample t test.

Results: There were no statistically difference between nasalseptal suture group and nasal packing group for thepreoperative results of acoustic tympanometry and PH, PCO2,O2 analysis of arterial blood. Although mean values ofpostoperative acoustic tympanometry and PCO2, O2 analysis of arterial blood were clinically worse than preoperative values for both groups, the differences between preoperativeand postoperative results for nasal suture group were notstatistically significant, but the differences between preoperativeand postoperative results for nasal packing group werestatistically significant.

Conclusion: The effects of nasal septal suture for eustachianfunction and arterial blood gas changes are better than nasalpacking.

40


“Comparison of Laser vs. Surface Touch Registration for

Image-Guided Sinus Surgery”

Bradford A. Woodworth, MDGavin W. Davis, BA


To be presented by Dr. Rodney Schlosser and/or Dr. Jeff Neal in Dr.Woodworth’s absence.

Disclosure: Rodney Schlosser MD - BrainLab ConsultantAventis Consultant

Introduction: Use of image guidance systems has become morepopular in endoscopic sinus surgery. The laser registrationtechnique has been previously used, however, a less expensivesurface touch registration technique has recently beendeveloped. We compared the accuracy and duration of laserand surface touch registration techniques.

Materials/Methods: Localization accuracy after laser andsurface touch registration was examined following 15endoscopic sinonasal procedures between July and September2004. Compared anatomic locations included the nasofrontalangle, nasolabial angle, posterior maxillary walls, skull base,and posterior vomer. For each localization point the degree oferror (in millimeters) was measured in superior-inferior (SI),anterior-posterior (AP), and right-left (RL) dimensions by anindependent observer blinded to registration technique. Theduration of each registration was recorded for both techniques.Results: Laser registration was significantly faster (mean 20seconds) than surface touch registration (mean 20 vs. 63seconds, respectively, p<0.05). Laser registration was accuratewithin 0.3 mm in the SI direction, 0.4 mm in the AP direction,and 0.4 mm in the RL direction. Surface touch registration wasaccurate within 0.3 mm in the SI direction, 0.4 mm in the APdirection, and 0.3 mm in the RL direction. There was nosignificant difference between techniques for any anatomicpoint. In 97.7% of all points, accuracy was within 2 mm or lessfor both the laser and surface touch registration.

Conclusion: Surface touch registration is significantly slowerthan laser registration, but has virtually no difference inaccuracy. Both techniques compare very favorably to theaccuracy of other systems reported in the literature.

41


“Imaging Of The Internal Carotid ArteryAnd Adjacent Skull Base With

Three-Dimensional CT Angiography For Preoperative Planning And

Intraoperative Surgical Navigation”

Jern-Lin Leong, MDPete S Batra, MD

Martin J Citardi, MDCleveland, OH

Disclosure: Disclosure MJC GE Healthcare Navigation.consultant, 2003-present CBYON, consultant, 1999-2003

Introduction: Three-dimensional computed tomographicangiography (3DCTA) demonstrates the spatial relationships ofthe internal carotid artery (ICA) and adjacent skull base. Thisimaging modality may be incorporated into intraoperativesurgical navigation during endoscopic approaches to the skullbase.

Methods: The charts of all patients who had undergone 3DCTAimaging between July, 2002 and June, 2004 were reviewed. For3DCTA, 1 mm axial CT scan images were obtained withsimultaneous intravenous contrast bolus on a multi-detector CTscanner (VolumeZoom, Siemens, Munich, Germany). Coronaland sagittal images were reconstructed using the CBYON Suiteversion 2.6-2.8 (CBYON, Mountain View, CA). The CBYONSuite was also used for creating CTA images through itsvolume-rendering protocols. Both standard axial, coronal andsagittal images as well as 3DCTA images were used fordiagnostic evaluation, preoperative planning and surgicalnavigation.

Results: A total of 20 patients had 20 3DCTA studies performedfor diagnostic evaluation and/or preoperative planning and in16 instances, the 3DCTA images were used during intraopera-tive surgical navigation. The diagnoses included neoplasm (7 malignant and 3 benign), fibro-osseous lesions (2), fungalsphenoiditis (2), CSF leak (2), mucocele (1) and other (3).Computer-enabled CT image review was performed in all cases.Images generated by 3DCTA facilitated the definition of theanatomic relationships between the ICA and skull base lesion.During intraoperative surgical navigation, the 3DCTA providedcritical information about the ICA location and adjacent skullbase anatomy in the operative field.

42

Conclusions: 3DCTA is a useful means for assessing the ICAand its relationship to skull base lesions. Incorporation of3DCTA into intraoperative surgical navigation facilitates thecomprehension of operative field anatomy in the ICA region. As a result, this imaging technique, especially when combinedwith intraoperative surgical navigation, may enhance surgicaloutcomes. Furthermore, this strategy extends the applications of minimally invasive endoscopic approaches to the skull base.

43


“Sildenafil (Viagra) And NasalCongestion: Results Of A Randomized

Placebo-Controlled Study”

Matteo Trimarchi, MDAndrea Salonia, MD

Francesco Montorsi, MDMario Bussi, MD

Milano, Italy

Disclosure: No disclosure reported

Background: Nasal congestion may be a side effect aftersubministration of Viagra. The aim of this study was to evaluatethe impact of VIAGRA over nasal airway parameters in youngpotent men.

Methods: Eleven men (age: 26+/-1.8) with normal BMI (25.7+/-0.5) and without nasal respiratory disorders wereenrolled in this study. All men underwent an evaluation ofsystolic (SBP) and diastolic blood pressure (DBP), heart rate(HR), SpO2%, acustic rhinometry and nasal endoscopy beforeand after placebo or VIAGRA (50 mg) plus visual sexualstimulation (vss). Nasal examination was performed using 0°rigid telescopes, 4 mm in diameter and digital images of eachpatient were archived. Statistical analysis was based on theStudent’s T test for a direct comparison and the Kruskal-Wallistest (K-W) for multiple comparison.

Results: A direct comparison analysis showed that, after drugadministration + vss, MCA2 was significantly lower either afterplacebo (p=0.03) or VIAGRA (p=0.003). However, the K-Wanalysis of the post-stimulation values did not demonstrate anysignificant difference among these compounds (p=0.48; DF=2).On the contrary, VOL2 was significantly lower after VIAGRA +vss (p=0.01) but not after placebo + vss (p=0.18). All the otherparameters did not show any significant fluctuations.Rhinoscopy showed a peculiar increasing of the volume of theinferior turbinates, with a subjective difference between placeboand VIAGRA.

Conclusions: These preliminary results show that VIAGRAreduces the nasal volume and that a sexual stimulation mightdecrease by itself the nasal airflow.

44


“Suture Medialization of the Middle Turbinate”

Kim Hewitt, MDRichard R. Orlandi, MD

Salt Lake City, UT


Introduction: Adhesion of the middle turbinate to the lateralnasal wall is a common complication following endoscopicsinus surgery (ESS). The potential outcome of middle turbinatelateralization is obstruction of the maxillary, ethmoid, andfrontal sinuses, resulting in recurrent sinus disease and oftennecessitating revision surgery. Various absorbable materials andinert stents have been developed to prevent middle turbinateadhesion to the lateral nasal wall. Suture medialization of themiddle turbinate to the nasal septum with an absorbable suturehas the potential to prevent lateralization as well. We report ourexperience with this technique.

Methods: A retrospective chart review of patients undergoingESS was performed to evaluate the occurrence of middleturbinate scarring to the lateral nasal wall following suturemedialization. Patients were excluded if they had previouslyundergone removal of the middle turbinate of if they wereundergoing middle turbinate resection as a part of their currentprocedure (e.g., cerebrospinal fluid leak repair, skull base tumorresection, etc.).

Results: Eighty-four patient charts met inclusion criteria. 155sides middle turbinates were suture medialized. Seventeen(11.0%) middle turbinates developed adhesions in 15 patients.Thirteen of the 17 adhesions were easily divided in the clinicduring routine postoperative endoscopic care. 138 (89.0%)middle turbinates were free of scarring.

Conclusion: The development of adhesions following suturemedialization of the middle turbinate is uncommon. Suturemedialization should be considered as an alternative to middle meatal packing to prevent middle turbinate adhesions following ESS.

45


“Use of Anteriorly-Based Pericranial Flapin Frontal Sinus Obliteration”

Ali Moshaver, MDJeffery R Harris, MD

Hadi Seikaly, MDEdmonton, AB Canada


Objective: In an era of endoscopic sinus surgery, frontal sinusobliteration continues to remain an important treatment optionin chronic frontal sinus disease. Numerous avascularobliterative materials including fat, muscle, cancellous bone,and hydroxyapatite have been used in this procedure. In thispaper, we describe a vascularized anteriorly-based pericranialflap to obliterate frontal sinus. Study design: Retrospective chartreview of patients referred to tertiary care hospital between1996-2003.

Methods: Records of the patients who underwent thisprocedure were reviewed. Demographics, indications,immediate and late complications were recorded. Phonequestionnaire was used to assess patient satisfaction with theoutcome.

Results: A total of 12 patients underwent frontal sinusobliteration using this technique. Mean follow-up was 40months. None of the patients developed recurrent frontalsinusitis. All of the patients were pleased with the outcome.

Conclusion: Pericranial flap is a highly vascularized flap that iseasily harvested and is an effective and viable modality forobliterating frontal sinus.

46


“Early Orbital Involvement in InvasiveFungal Sinusitis”

Benjamin Collin Stong, MDJohn Michael DelGaudio, MD

Atlanta, GA


Background: Invasive fungal sinusitis is a rare conditionoccurring in immunocompromised patients. It represents adiagnostically and therapeutically challenging disease with highassociated morbidity. Classically, orbital involvement is ahallmark of advanced disease and follows involvement of theparanasal sinuses and nasal soft tissues.

Objective/Hypothesis: We identified 5 patients with a primaryorbital presentation of invasive fungal sinusitis that hadminimal to no sinus symptoms.

Methods: A retrospective review of all patients diagnosed withinvasive fungal sinusitis at a single tertiary care institutionbetween 1987 and 2004.

Results: Sixteen patients (34%) out of 49, who met inclusioncriteria, had orbital involvement during their disease course.Five of those patients (10%) presented primarily with orbitalsymptoms early in the course of their disease. Symptomsincluded proptosis, chemosis, and/or vision loss or changeswith minimal or no symptoms related to their sinonasal softtissues. Three of the patients had aspergillus on pathology, onehad mucormycosis, and one pathology result was unknown.

Conclusions: Invasive fungal sinusitis requires aggressive, earlyintervention, necessitating early diagnosis. This series demon-strates that patients with invasive fungal sinusitis can presentprimarily with orbital involvement with minimal sinus findingsearly in the course of their disease. Invasive fungal sinusitisshould be included in the differential diagnosis of patientspresenting primarily with orbital signs and symptoms,especially in immunocompromised patients.

47


“Retrospective Review of EndonasalDacrocystorhinostomy with Mucosal Flap

Procedure (Wormald Procedure)”

Raymond Sacks, MDMartin Forer, MD

Niell Boustred, MDHornsby, New South Wales Australia

Disclosure: No Disclosures reported

Introduction: The intranasal approach for dacrocystorhinostomy(DCR) is more than 100 years old with Caldwell describing theapproach in 1893. There have been many different techniquestried with varying success rate. The external DCR is still favoredby most ophthalmologists as the most effective procedure toalleviate nasal lacrimal duct obstruction. The reported successrates have varied from 80-95%. The endonasal approach withlaser has a varied success rate from 60-86% and otherinvestigators using mechanical means have reported a slightlyhigher success rate. Tsirbas and Wormald reported a 91%success rate in 44 DCRs using the mucosal flap procedure. Thisstudy aimed at assessing both the success rate and the patientsatisfaction scores of endonasal and external DCR.

Methods: 121 patient records were reviewed. Data included preand post-operative Jones I and II tests, valsalva bubble testingand endoscopic fluorescein test results. Telephone interviewswere held with 117 of the 121 patients to assess the patientsatisfaction score. Factors taken into account included length ofhospitalization, post-operative pain and bleeding, time back towork and cosmetic implications. A comparison was then madewith a group of 20 patients who had been subjected to externalapproach surgery. Results: Endonasal DCR gave a 97% successrate which is comparable to any study of external DCR. Patientsatisfaction scores were significantly higher with endonasalDCR.

Conclusion: Endonasal DCR with mucosal flap procedure is ahighly predictable, repeatable and technically simple procedureto master and to teach. The absence of an external facial scar isalso more of an issue to patients than we have previously beenled to believe. The surgical technique and results will bepresented.

48


“Singulair Use in Patients with Sinusitis,Nasal Polyps and Allergy”

Siobhan Kuhar, MDSteven Parnes, MDGavin Setzen, MD

Albany, NY

Disclosure: A portion of this study was funded through a grantto Dr. Parnes by Merck Pharmaceuticals

Introduction: Singulair is a leukotriene inhibitor used to treatinflammatory upper airway disease. Our experience withSingulair has included treatment of patients with chronicsinusitis, nasal polyposis and allergy.

Methods: A questionnaire evaluating the benefits of Singulairon sinus symptoms was mailed to 120 patients, 63 responseswere obtained, 48 patients were taking Singulair (13 patientsreceived immunotherapy alone and 2 patients were takingAccolate). Patient symptoms were evaluated on a five-pointscale and the data were collapsed into three categories(improved, not improved, or worse). Patients with nasalpolyposis and chronic sinusitis, not taking Singulair, wererandomized after polypectomy to Singulair or Placebo in adouble-blind study and evaluated for one year. Twenty-onepatients were enrolled, eleven patients completed the 12 monthstudy.

Results: In the questionnaire, 72.2% of patients reportedmoderate to severe nasal and sinus symptoms and >40% ofpatients were taking Singulair for over one year. Sinussymptoms of nasal obstruction/stuffiness, post-nasal drip, facial pressure/pain, headache and cough were significantlyimproved (p<0.001-0.05). Most patients with asthma hadimprovement in their asthma (80%) primarily a decrease innumber of attacks (68.8%). Patients randomized to Singulairafter FESS with polypectomy demonstrated a trend of improvedsinus symptoms and decreased polyp regrowth as compared tothe Placebo control group.

Conclusions: In our practices, Singulair is a well toleratedmedication that provides measureable sinus symptom relief inpatients with sinusitis, polyposis and allergy.

49


“Deposition Of Aerosolized Particles In The Maxillary Sinuses Before

And After Endoscopic Sinus Surgery”

Michele Bauchet St Martin, MDCory James Hitzman, BChE

Timothy Scott Wiedmann, PhDFranklin L Rimell, MD

Minneapolis, MN


Introduction: Topical drug delivery is currently underinvestigation for a number of diseases of the nose and paranasalsinuses. Such therapy is theoretically appealing because ittargets medication directly to its site of action, thereby allowingfor higher concentration in the paranasal sinuses as well asavoiding systemic side effects. Furthermore, recent studies havesupported the assertion that topical therapy is beneficial in avariety of conditions that underlie chronic sinusitis. Currentliterature has documented a very low particle depositionefficiency of aerosolized particles into the paranasal sinuses.Mathematical modelling of particle deposition suggests thatthree factors influence the deposition efficiency: particle size,pressure gradient between the nasal cavity and sinus, and sizeof the sinus ostium. Of these, ostium size is the most dominantfactor. We therefore sought to determine if maxillary antrostomyand ethmoidectomy would increase the delivery of aerosolizedparticles into the maxillary sinuses.

Methods: Five cadaver specimens underwent pre- and post-operative scintigraphy following administration of aerosolizedTc-99M aqueous solution via the nasal cavity. Five minute staticimages were then obtained with a gamma camera and regionsof interest (ROI) were drawn around the maxillary sinuses.Counts per minute in the pre- and postoperative ROIs werethen compared using the paired t-test.

Results: Results indicated a significant increase in deposition ofradioactivity in the maxillary sinuses in the postoperative state(p<0.01).

Conclusions: Topical therapy for chronic sinusitis may be morefeasible in the postoperative population and warrants furtherclinical investigation.

50


“Endoscopic Resection Of Sinonasal Hemangiomas

And Hemangiopericytomas”

Rodney J Schlosser, MDTerry Day, MDCharleston, SC

Disclosure: BrainLAB Consultant

Introduction: Endoscopic resection of benign sinonasalneoplasms, such as inverted papilloma, has been well described.There are limited case reports of endoscopic resection of benignvascular tumors, such as hemangiomas, angiofibromas, or lowgrade malignant vascular neoplasms, such as hemangioperi-cytomas.

Methods: Retrospective review of sinonasal hemangiomas andhemangiopericytomas resected endoscopically at our institution.

Results: A total of five cases were identified which included 3 males and 2 females with an average age of 43.8 years. Threehemangiomas and two hemangiopericytomas were resectedendoscopically with no recurrences at a mean follow-up of 13.6 months (range 2-30 months). Three tumors involved theskull base, two of these underwent pre-operative embolization.The only complication was a CSF leak that occurred in onepatient as tumor was removed from the cribriform plate, andthis was repaired at the same procedure immediately aftertumor resection. Average tumor size was 5.9 cm x 3.1 cm withall tumors at least 2.5 cm in greatest dimension (largest tumorwas 12 cm in greatest dimension).

Conclusion: Large vascular neoplasms of the sinonasal cavity,such as hemangiomas and hemangiopericytomas, can be safelyremoved using endoscopic techniques. Pre-operativeembolization may be useful in larger tumors with skull baseinvolvement. Regardless of resection technique, patients musthave long-term endoscopic follow-up in order to detectrecurrences.

51

WITHDRAWN


“The Bacteriology of Sinus InfectionsPersisting After Endoscopic

Sinus Surgery”

Miguel Neil Carlos Bravo, MDIan J. Witterick, MDTony Mazzulli, MD

Sigmund Krajden, MDCincinnati, OH


Objective: To determine the bacteriology in sinus infections thatpersist after adequately performed endoscopic sinus surgeryDesign: cross-sectional Setting: Mount Sinai Hospital, Toronto,ON St Joseph Health Center, Toronto, ON

Abstract: Sinus infections that fail to resolve despite achievingadequate ventilation and mucociliary clearance throughendoscopic sinus surgery were compared to the typicalbacteriology found in uncomplicated chronic sinusitis. Theauthors were careful in excluding cases that simply requiredrevision surgery or had immunologic deficiencies. As there areno surgical options in this situation, the main treatmentmodalities revert to antibiotic selection and delivery.

Results: Intra-operative cultures from fifty-eight sinusesobtained through the natural middle meatal ostium yieldedbacteriology similar to previous findings in the literature forchronic sinusitis, with the more prevalent pathogens beingStaphylococcus aureus (25.9%), Haemophilus influenzae (8.6%)and Streptococcus pneumoniae (6.9%). In twenty-five sinusesthat had persistent infections despite being deemed “adequatelyventilated and draining” through endoscopic surgery, we foundthat the major pathogens were Staphylococcus aureus (48%) andPseudomonas aeruginosa (40%).

Conclusion & Significance: Persisting sinus infections aftertechnically adequate endoscopic sinus surgery have a higherincidence of Staphylococcus aureus and Pseudomonasaeruginosa, which has implications in the eventual medicalmanagement of these cases.

52


“Use Of Topical Epoxy Glue As AnAlternate To Chemical Cauterization In

The Management Of UncomplicatedAnterior Epistaxis: A Pilot Study”

Ashutosh Kacker, MDSheldon P Hersh, MD

New York, NY


Use of topical epoxy glue as an alternate to chemicalcauterization in the management of uncomplicated anteriorepistaxis - a pilot study hypothesis epistaxis occurs in 1 of every7 people and is classified on the basis of the primary bleedingsite as anterior or posterior. Hemorrhage is most commonlyanterior, originating from the nasal septum. We propose the useof 2-octyl cyanoacrylate (2OCA) glue, topically as an alternateto cauterization. The application of 2OCA has the distinctadvantage of avoiding discomfort as well as prevent thecomplications of cauterizations of the nasal septum. SettingOffice-based study performed after obtaining IRB consent.

Material and Methods: All patients with uncomplicatedanterior epistaxis were recruited for the study. The treatmentprotocol included control of epistaxis using topicalvasoconstrictor agents followed by the application of 2-octylcyanoacrylate glue in the study patients. The patients whorefuse to participate in the study or fail treatment will be treatedwith chemical cauterization using Silver nitrate sticks.ResultsTen patients were enrolled for the study in the who had theapplication of the 2OCA glue. All ten patients had nodiscomfort or recurrent epistaxis in the 3 months follow-up.There were no complications.

Conclusion: The use of 2OCA glue, topically to control anterioruncomplicated epistaxis is an alternate to electrical or chemicalcauterization with minimal pain or discomfort.

53


“Respiratory Epithelial AdenomatoidHamartoma of the Sinonasal Tract

with Osseous Differentiation: A Case Report and Literature Review”

Eric Roffman, MDSoly Baredes, MD

Rutherford, NJ


Respiratory epithelial adenomatoid hamartoma (REAH) is arare sinonasal/nasopharyngeal lesion first described in 1995.Only 50 cases have been reported in the world literature. Ofthese fifty cases, chondroid and/or osseous differentiationwithin these lesions, otherwise termed chondro-osseous andrespiratory epithelial (CORE) hamartomas, has been describedin fourteen. We report a case of a 59 year old male with a COREhamartoma involving the left posterior nasal cavity, ethmoidsinus, and sphenoid sinus. He presented with a three yearhistory of progressive left nasal obstruction and left sidedheadaches. CT scan revealed an ill defined heterogeneous,partially ossified left sinonasal mass resulting in mild left nasalcavity and sphenoid sinus expansion. An intranasal biopsy wasperformed and pathology revealed REAH. He was later takenback to the OR for partial endoscopic resection in order toestablish a comfortable nasal airway. Follow-up after 6 monthsshowed no evidence of regrowth on nasal endoscopy, and thepatient reported a patent left nasal airway. Due to the rarity ofthese sinonasal lesions, the otorhinolaryngic literaturedescribing REAH and CORE hamartomas is quite limited. Yet,awareness of these entities is extremely important becausegrossly and histopathologically, these benign tumors appearexceedingly similar to both inverted papillomas and well-differentiated adenocarcinoma, particularly when chondro-osseous differentiation is absent. Failure to include thesepathologic entities in one’s differential diagnosis could result inunnecessary radical surgery. The literature regarding REAH andCORE hamartomas is reviewed, and their distinction fromrelated entities of the sinonasal tract and nasopharynx isdiscussed.

54


“Total Serum Ige Level Change After Six Weeks Of Terbinafine Therapy For Chronic Sinusitis”

Frederick A. Kuhn, MDMarc G. Dubin, MD

Farid Kianifard, PhDAmir Tavakkol, PhD

Savannah, GA

Disclosure: This study was paid for by Novartis Pharmaceuti-cals. F. Kianifard and A. Tavikkol are employees of Novartis.

Introduction: Recently, the theory that chronic sinusitis iscaused by fungus has been popularized. Based on empiricevidence that patients with sinusitis improved while takingterbinafine for oncychomycosis, Novartis PharmaceuticalCorporation investigated the efficacy of oral anti-fungaltreatment for chronic sinusitis. Although the final analysis of theprimary study is not yet complete, the data for evaluation of thetotal serum IgE levels is available.

Methods: A double blind placebo controlled study wasperformed in subjects with chronic sinusitis. Total serum IgElevels were collected at time zero and after six weeks oftreatment with either placebo or 625 mg terbinafine. Results:There were 21 patients who started the trial with an elevatedIgE. Twelve of these patients were treated with terbanifine,while nine were treated with placebo. Nine (75%) of the twelvesubjects with elevated total IgE who were treated withterbanifine had a decrease in their total serum IgE after six,weeks while only four (44%) of nine controls decreased. Subjectswith normal IgE levels tended to have stable levels throughoutthe time period regardless of treatment modality.

Conclusion: 75% of subjects with elevated total IgE who weretreated with terbanifine had a decrease in their total serum IgElevel over the treatment period as compared to 44% of subjectstreated with placebo. The mechanism of this decrease isunknown, however, it could be postulated that it decreased theantigen load (i.e. fungus) or the drug modulated aninflammatory or immune response.

55


“Studies in Paranasal Sinusitis”

Larry Edwin Duberstein, MDMemphis, TN


There are an estimated 32 million people suffering from chronicsinusitis in the United States today. Of those millions, about halfoccur in the southeast region alone with recurring symptomsafter their first treatment. Focusing medical efforts to the correctarea of disease would decrease medical costs, in that patientswould be making fewer trips to the doctor and purchasingfewer rounds of medications. In order to effectively treat thisdisease, we propose to medicate the underlying infected bonewithin the nose in addition to the mucus, rather than the mucusalone. To treat infected bone, the patient was placed on anintravenous antibiotic regimen that lasts for about twelveweeks. In addition, nasa decongestants and pain relievers wereprescribed to reduce some of the symptoms. During the weeklyvisit, the patient was asked to rank their symptoms from one toten. The data was then compiled to determine whichsymptom(s) had the largest change over time. Statisticalanalysis were done in order to subjectively estimate the time ittook for the antibiotics to be most effective. The objectiveoutlook to this study involved assembling weekly nasal sinusphotographs into a sinusitis scale of magnitude. We present anadditional cohort of patients with this therapy and present newresults. The analysis showed the largest percent of changes insymptoms related to bone, headache and facial pain. Thoughthe sample size of data is larger, it was assumed that this trendwill continue as studies are done on a larger sample size. Onaverage, the treatment was most effective after 9.5 weeks.

56


“Anterior Ethmoid Mucocele AfterPosterior Fossa Radiotherapy”

Matthew Ryan Stumpe, MDRose Mary Stocks, MD

Rakesh Kumar Chandra, MDMemphis, TN

Disclosure: Dr Chandra Glaxo-Smith-Kline speaker.

Background: Mucoceles of the paranasal sinuses may developfollowing facial trauma or as a complication of sinus/cranialsurgery. Chronic sinus inflammation and allergic disease arepossible cofactors in the development of these lesions. Sphenoidmucoceles have also been described as a complication ofradiotherapy in patients with nasopharyngeal carcinoma. Wereport the case of an 11-year-old male with a right anteriorethmoid mucocele that developed after radiotherapy for a rightoccipital anaplastic astrocytoma.

Case Report: The patient underwent neurosurgical resection ofthe occiptal lesion followed by six weeks of external beamradiotherapy and concomitant chemotherapy withtemozolomide. Pre- and post-operative imaging revealed noevidence of the mucocele. Radiation was delivered in singledaily fractions, with a total tumor dose of 59.4 Gy. Following theconclusion of radiotherapy, the patient reported progressiveheadache. Magnetic resonance imaging of the brain with andwithout IV contrast five months after therapy revealed ananterior ethmoid mass, consistent with a mucocele. A coronalCT of the maxillofacial area without contrast confirmed thisfinding. This patient subsequently underwent image-guidedendoscopic sinus surgery for marsupialization of the lesion.Pathology demonstrated no evidence of malignancy. The patienthas done well postoperatively.

Significance: This case highlights the observation thatmucoceles may develop secondary to radiation in sites remotefrom the epicenter of therapy.

57


“A Case Report On Primary IntestinalType Sinonasal Adenocarcinoma”

Trang Vo-Nguyen, MDHolly C. Boyer, MD

Minneapolis, MN


A case report on primary intestinal type sinonasaladenocarcinoma objectives: To discuss the risk factors,diagnosis, prognosis, and management of sinonasaladenocarcinoma.

Methods: Case report.

Results: An 81yo man with history of nasal congestion and left-sided facial pain for three months. Patient had failed twocourses of oral antibiotic prior to being seen in the OtolaryngologyClinic. On nasal endoscopy, patient was found to have a whitish mass in the area of the left middle meatus. CT scan ofthe sinuses revealed a large mass involving the left maxillary,ethmoid, and sphenoid sinuses suggestive of a papilloma. Thepatient was treated with surgical resection using endoscopictechnique. Pathology report came back as primary intestinaltype sinonasal adenocarcinoma. A decision was made to followthe patient closely with repeat CT sinuses with no furtherintervention.

Conclusions: Sinonasal adenocarcinoma is a rare malignancy ofthe sinuses. The disease is commonly associated with wood andtextile workers. The symptoms are non-specific, and vary fromnasal obstruction to epistaxis. Histologic evaluation is the onlymeans of diagnosis. Different histologic subtypes includepapillary, alveolar, and solid forms. Factors that influenceprognosis are tumor stage and intracranial involvement. Small,low-grade tumors that do not significantly extend passed thenasal cavity can be treated with surgery alone. All other tumorsshould be treated with a planned combination of surgery andradiation therapy.

58


“Treatment Of EmbryonalRhabomyosarcoma Of The Sinus And Orbit With Chemotherapy,

Radiation, And Endoscopic Surgery”

Quang Cat Luu, MDJoseph Lasky, MD

Theodore Moore, MDMarilene Wang, MD

Los Angeles, CA


Educational Objective: To discuss evaluation and managementof a case of a teenage girl with parameningeal embryonalrhabdomyosarcoma who presented with right eye blindness.Objectives: This is a report of an unusual case of a teenage girlwith parameningeal embryonal rhabdomyosarcoma whopresented with right eye blindness and a nasal mass.Radiographic findings, pathology, operative technique, andtreatment course will be presented. Study Design: Case report

Methods: A 14 year-old girl presented with sudden onset ofright-sided blindness and a nasal mass. Initial work-upincluded an MRI and biopsy of the nasal mass. Her subsequenttreatment and clinical course are reported.

Results: MRI demonstrated a lobulated, partially enhancing softtissue mass centered in the posterior right ethmoid andsphenoid sinuses, with superior extension into the sellar region,splaying the right optic nerve. Biopsy of the nasal mass revealedembryonal rhabdomyosarcoma. The patient was treated withvincristine, actinomycin, and cytoxan, as well as radiationtherapy. She had dramatic shrinkage of her tumor mass afterradiation and several courses of chemotherapy. She thenunderwent endoscopic removal of the tumor from the rightethmoid and sphenoid sinuses. She is continuing to receivechemotherapy postoperatively and has regained lightperception in the right eye.

Conclusions: Parameningeal embryonal rhabdomyosarcoma inthe sphenoid/ethmoid sinus is a rare tumor which can respondwell to chemotherapy and radiation. Surgical resection ofresidual tumor is indicated following chemotherapy andradiation.

59


“Mycobacterium Chelonae Sinusitis InChildren With Cystic Fibrosis”

Seth M. Brown, MDJoan K. DeCelie-Germana, MD

Gerald D. Zahtz, MDMark J. Shikowitz, MD

Bronx, NY


Introduction: Mycobacterium chelonae (M. chelonae) is aubiquitous organism that is infrequently a pathogen. Thisorganism, when involved in infections, most commonly causeskeratitis or wound infections. However, it is an extremely rarecause of sinusitis, with only two cases of M. chelonae sinusitisreported in the literature. It is an important entity to recognizebecause eradication of this organism can be very difficult withpatients often requiring greater than 6 months of tripleantibiotics including intravenous treatment and multiplesurgical procedures.

Methods: We report two young female patients who areroutinely followed at our Cystic Fibrosis (CF) Center. The firstpatient had sinusitis refractory to medical therapy and was M.chelonae positive on cultures. Subsequent bronchoscopyconfirmed the organism in the lungs. The second patient hadpositive endoscopic directed sinus cultures after M. chelonaewas noted in the lungs. Results: One patient had an aggressivesinus procedure and now has negative sinus cultures andimprovement in her lung disease. The second did not havesurgery and remains colonized. Conclusions: We note twochildren with classic CF and M. chelonae sinusitis. Thequestions arise whether disease in the lungs is affected by areservoir in the sinuses and should sinus cultures anddebridement be performed in all cases in the CF population.Since M. chelonae can be an unusual cause of sinusitis, it needsto be considered in patients with refractory sinus disease,particularly those with CF. As these and more cases are noted,treatment recommendations will continue to be developed.

60


“Bilateral Intracranial MucocelesFollowing Endoscopic Repair ofEncephaloceles: A Case Report”

Richard Adam Lebowitz, MDElisa Lynskey, MD

Joseph Barry Jacobs, MDNew York, NY


A 33 yo male patient initially presented with an altered mentalstatus and CSF rhinorrhea. He was diagnosed with a largebenign epidermoid tumor, massive hydrocephalus, and bilateralnasal encephaloceles. He underwent placement of a ventriculo-peritoneal shunt followed by endoscopic encephalocele resec-tion, and extracranial repair of the skull base defects. Thepatient did well post-operatively, with resolution of the CSFrhinorrhea. Two years later, a routine surveillance MRIdemonstrated the presence of bilateral anterior cranial fossamucoceles. The mucoceles were successfully drained via atransnasal endoscopic approach, however, the patientdeveloped recurrent CSF rhinorrhea and pneumocephalus. Thepatient subsequently underwent repair of the anterior skull basedefect and cranialization of the frontal sinus via a frontalcraniotomy. We will discuss treatment options and decisionmaking in the treatment encephaloceles and mucoceles.

61


“Treatment of Idiopathic SuddenSensorineural Hearing Loss”

Anita Jeyakumar, MDDavid Francis, MDTimothy Doerr, MD

Rochester, NY


Objectives: To investigate treatment regimens and theirefficacies, as well as evaluating the potential prognosticcorrelates and allowing comparison between local and nationalstandards of care for sudden sensorineural hearing loss.

Study Design: A retrospective evidence-based case series wasdone of 104 patients seen at the University of Rochester,Department of Otolaryngology between 1999 and 2002.Treatment modalities included (1) observation, (2) steroids, and(3) steroids with antivirals. Results: The study demonstrates thatsteroid treatment, alone or in combination with antivirals,results in a significant improvement rate compared toobservation.

Significance: The therapeutic role of corticosteroids and/orcorticosteroids with antivirals for sudden sensorineural hearingloss has yet to be fully elucidated, however, in cases wheredeafness is profound and of recent onset, a therapeutic trial isindicated.

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63

Golden Head Mirror Honor AwardFor Meritorious Teaching

in Rhinology

The Golden Head Mirror Honor Award was first givenby Dr. Maurice Cottle to colleagues who were chosenbecause of “Meritorious Teaching in Rhinology”. Thefirst pair of Golden Head Mirror Cuff Links was given byDr. Cottle to Dr. George Fisher in 1948.

AVijay Anand, USPierre Arbour, USHarold Arlen, USWalter J. Aagesen, USTomas L. Aguara, Mexico

BPat A. Barelli, USFred W. Beck, US*Carlos G. Benavidee, USMichael Benninger, USBernard Blomfield, US*Max Bornstein, US*

CJamie Carillo, Mexico*James Chessen, US*Maurice H. Cottle, US*

DEfrain Davalos, MexicoH.A.E. van Dishoeck, TheNetherlands*George H. Drumheller, US*Glen W. Drumheller, USLarry E. Duberstein, US

FGeorge W. Facer, USAnthony Faills, US*George G. Fisher, US*Douglas W. Frericha, USAmos D. Friend, US*

GIrwin E. Ganor, USNorman E. Ginsberg, US*VernonD. Gray, US*Charles Gross, USHarvey C. Gunderson, US

HRichard B. Hadley, US*Robert M. Hansen, US*Edward W. Harris, US*Raymond L. Hilsinger, US*Kenneth H. Hinderer, US*Leland R. House, USSandy Hoffman, USEgbert Huizing, TheNetherlands

JGerald F. Joseph, US

KAlvin Katz, USDavid Kennedy, USEugene Kern, USJohn Kirchner, USDaniel D. Klaff, US*Zvonimir Krajina, CroatiaFrederick A. Kuhn, US

LClifford F. Lake, US*Donald Lanza, USDonald Leopold, USWalter E.E. Loch, US*W. Kaye Lochlin, USFausto Lopez-Infante,MexicoRoland M. Loring, US*Frank Lucente, US

MHenry Merriman, US*Lewis E. Morrison, US

NWilliam J. Neidlinger, US*Roberto Nevews-Pinto,BrazilLeon Neiman, US

OJoseph H. Ogura, US*Harold Owens, US

PCharles J. Patrillo, US*Ivan W. Philpott, US*Loring W. Pratt, US

RFrederico Reyes, MexicoRalph H. Riggs, USZvi Henry Rosen, Israel

SPiefer H. Schmidt, The

NetherlandsThomas C. Smersh, USMaynard P. Smith, USPinckney W. Snelling, US*Carl B. Sputh, USHeinz Stammberger,AustriaAlbert Steiner, US*Sydney L. Stevens, US*Fred Stucker, USGiorgio Sulsenti, ItalyEdward A. Swartz, US

TWilliam H. Tenny, USH. Ashton Thomas, US*Paul H. Toffel, USRichard Trevino, USCharles A. Tucker, US

WRichard C. Webster, US*Alvin P. Wenger, USJoseph W. West, US*Manual R. Wexter, US*Henry L. Williams, US*Russell I. Williams, US

* Deceased

64

Dr. Maurice H. Cottle Honor Award

For Outstanding Clinical and LaboratoryIncestigation in Rhinology

First Place Gold Medal Winners

1978The Nasal Cycle in the Laboratory AnimalWinston M. Campbell, MD, Mayo Clinic, Rochester, MNEugene B. Kern, MD, Mayo Clinic, Rochester, MN

1979The Physiologic Regulation of Nasal AirwayResistance During Hypoxia and HypercapniaT.V. McCaffrey, MD, Mayo Clinic, Rochester, MNEugene B. Kern, M.D., Mayo Clinic, Rochester, MN

1980 (Two Awards Given)Growth Patters of the Rabbit Nasal Bone Region –A Combined Serial Gross Radiographic Studywith Metallic ImplantsBernard C. Sarnat, MD, Los Angeles, CAAbbee Selman, DDS, Los Angeles, CA

Sleep Disturbances Secondary to Nasal ObstructionKerry D. Olsen, MD, Mayo Clinic, Rochester, MNEugene B. Kern, MD, Mayo Clinic, Rochester, MNPhillip R. Westbrook, MD, Mayo Clinic, Rochester, MN

1984Nasal Problems in Wood Furniture Workers-AStudy of Symptoms and Physiological VariablesBorje Drettner, MD, SwedenBo Wihlelnisson, MD, Sweden

1987Eustachian Tube and Nasal Function DuringPregnancy – A Prosepective StudyCraig S. Derkay, MD, Pittsburgh, PA

65

66

1988The Effects of Kiebsiella Ozenae on Ciliary Activityin Vitro: Implications for Atrophic RhinitisJonathan Ferguson, MD, Mayo Clinic, Rochester, MN

1990The in Vivo and in Vitro Effect in Phnylephirine(Neo Synephrine) on Nasal Ciliary Beat Frequencyand Mucoolliary TransportP. Perry Phillips, MD, Mayo Clinic, Rochester, MN

1991Ultrastructural Changes in the OlfactoryEpithelium in Alzheimer’s DiseaseBruce Jafek, MD, University of Colorado, Denver, CO

1992A Scanning Electron Microscopic Study ofMsoking and Age Related Changes in HumanNasal EpitheliumSteven Kushnick, MD, New York, NY

1993Mucociliary Functionin Endothelins 1, 2 & 3Finn Ambie, MD, Mayo Clinic, Rochester, MN

1996Capsacin’s Effect on Rat Nasal Mucosa SubstanceP ReleaseFrederick A. Kuhn, MD, Savannah, GA

1999Subacute Effects of Ozone-Exposure on CultivatedHuman Respiratory MucosaJoseph Gosepath, MD, D. Schaefer, MD, C. Broomer, MD, L. Klimek, MD, R.G. Amedee, MD,W.J. Mann, MD, Mainz, Germany

2000Capsacin’s Effect on Trigenonal Nuciens SubstanceP ReleaseFrederick A. Kuhn, MD, Savannah, GA

67

2002Bioengineering of Cartilage Using Human NasalChondrocytes Propagated in Microcarrier SpinnerCultureAlan H. Shikani, MD, David J. Fink, Ph.D., AfshinSohrabi, M.H.S., Phong Phan, BS, Anna Polotsky, MD,David S. Hungerford, MD, Carmelita G. Frondoza,Ph.D, San Diego, CA

2004Composition Of Hyaluronan Affects WoundHealing In The Rabbit Maxillary Sinus Matthew Proctor, M.D., Kery Proctor, M.D., Xian ZhengShu, PhD., L.D. McGill, DVM,PhD., Glenn D.Prestwich, PhD., Richard R. Orlandi, M.D.

ARS Investigator Award

2004Assessment of Bacterial Biofilms in SinusitisJames N. Palmer, MD

2002Characterization of Eosinophil Peroxidase-InducedTissue Damage in Sinonasal Polyposis andChronic RhinosinusitisMartin J. Citardi, MD

Influence of Estrogen on Maturation of OlfactoryNeuronsKaren J. Fong, MD

2001Apoptosis in the Aging Olfactory MucosaDavid B. Conley, MD

68

ARS Poster Awards

COSM 20041st Place: Longterm effects of Floseal nasal packingafter ESSRakesh K Chandra, MD, David B. Conley, MD, RobertKern, MD

2nd Place: Evidence based use of topical nasalanesthesia for flexible transnasal endoscopy.Rhoda Wynn, MD, Boris L. Bentsianov, MD

3rd Place: Pnemocele of the maxillary sinus: casereport and literature reviewB. Todd Schaeffer, MD

Fall Annual Meeting – 20041st Place: “Modeling Pre & Post-Operative Airflowand Odorant Delivery Pattern in the Nasal Cavity:A Quantitative Evaluation of SurgicalIntervention”Kai Zhao, MD

2nd Place: “Presence of Sufactant Lamellar Bodiesin Normal and Diseased Sinus Mucosa” Bradford Woodworth, MD

3rd Place: “The Effect of Histamine on Rhinovirus-16 Infection in Airway Epithelial Cells”Yoo-Sam Chung, MD

69

International Research Award Winners

2004Development Of A Rhinovirus StudyModel Using Organ Culture Of Turbinate Mucosa Yong Ju Jang, MD, Si Hyeong Lee, MD, Hyon-Ja Kwon, MSc, Yoo-Sam Chung, MD,Bong-Jae Lee, MD

2003Nitric Oxide and Collagen Expression inAllergic Upper Airway DiseaseMarc A. Tewfik, MD, Julio F. Bernardes, MD,Jichuan Shan, MD, Michelle Robinson, MD,Saul Frenkiel, MD, David H. Edelman, MD

2002Recording of the Electro-Olfactogram(EOG) Using Externally Placed ElectrodesChurunal K. Hari, FRCS, Liwei Wang, PhD, Tim J.C. Jacob, PhD, San Diego, CA

FELLOWS

Tom Abelson, MDBeachwood, OH

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Benjamin Asher, MDNew York, NY

Michael Avidano, MDStockbridge, GA

Evan Bates, MDDallas, TX

Michael Benninger, MDDetroit, MI

Philip Bernstein, MDSacramento, CA

Bernard Bertrand, MDB5530 Belgium,

William Bolger, MD, FACSBethesda, MDTimothy R. Boyle, MDMarshfield, WI

Paul Brindley, MDHouston, TX

Steven Buck, MDBuffalo, NY

Richard Busch, MDBakersfield, CA

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C. Ron Cannon, MDFlowood, MS

James Chow, MDMaywood, IL

Martin J. Citardi, MDCleveland, OH

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Lanny Close, MDNew York, NY

David B Conley, MDChicago, IL

Jan S. Connelly, MDSpokane, WA

Paul Cook, MDIndianapolis, IN

Jacquelynne Corey, MDChicago, IL

Arthur Curtis, MDChicago, IL

Kim L. Dakin, MDOpelousas, LA

John Del Gaudio, MDAtlanta, GA

Norman Druck, MDChesterfield, MO

Robert Dunn, MDOrange, CA

Jay Dutton, MDChicago, IL

David Edelstein, MDNew York, NY

George Farrell, III, MDHobbs, NM

Berrylin Ferguson, MDPittsburgh, PA

Karen J. Fong, MDPortland, OR

Marvin P. Fried, MDBronx, NY

Andrew R. Ganz, MDNew York, NY

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70

MEMBERSHIP

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Neal Lofchy, MDChicago, IL

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Erik G Nelson, MDGurnee, IL

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Chesapeake, VA

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72

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Agnes Czibulka, MDGuilford, CT

Kamal Daghistani, MDSaudi Arabia,

Lawrence Danna, MDWest Monroe, LA

Terence Davidson, MDSan Diego, CA

74

MEMBERSHIP

William Davidson, MDLawrenceville, NJ

R. Alan Davis, MDBristol, TN

Douglas Dawson, MDMuscatine, IA

Larry H. Day, MDHattiesburg, MS

Thomas De Tar, MD, FACSPost Falls, ID

Richard De Vore, MDCincinnati, OH

James Denninghoff, MDColumbia, MO

Martin Desrosiers, MDCANADA

Michael DeVito, MDAlbany, NY

Laurence DiNardo, MDRichmond, VA

Linda Dindzans, MDMequon, WI

David Dinges, MDDalton, GA

Peter Doble, MDTwin Falls, ID

Thomas Dobleman, MDOmaha, NE

George Domb, MDRedding, CA

Paul Donald, MDSacramento, CA

James Donegan, MDLebanon, NH

Larry Duberstein, MDMemphis, TN

Wallace Duff, MDOmaha, NE

Thane Duncan, MDCordova, TN

James Duncavage, MDNashville, TN

Dory Durr, MDOutremont, Quebec, CANADA

Andrew Dzul, MDSt Clair Shrs, MI

John E. Eisenbeis, MDSaint Louis, MO

Lee Eisenberg, MDEnglewood, NJ

Precha Emko, MDSyracuse, NY

Joel Ernster, MDColorado Springs, CO

Karin Evan, MDMinneapolis, MN

Samer Fakhri, MD, FRCS(C)Houston, TX

Kenneth H. Farrell, MDFort Lauderdale, FL

Russell Faust, MD, PhDDetroit, MI

Bruce Feldman, MDChevy Chase, MDRobert Fieldman, MDWest Orange, NJ

Samuel Fisher, MDDurham, NC

Robert A. Fishman, MDSt Clair Shrs, MI

Phillip B. Flexon, MDSavannah, GA

Ray Fontenot, Jr., MDBeaumont, TX

Stephen Freifeld, MDSpringfield, NJ

Saul Frenkiel, MDCANADA H3T 1E2

Theodore H Gaylor, MDAllentown, PA

Clarence Gehris, MDLutherville, MDMark E. Gerber, MDEvanston, Il

John Gerwin, MDBirmingham, AL

75

MEMBERSHIP

Paul Gittelman, MDMamroneck, NY

Richard Gliklich, MDBoston, MA

Bradley E. Goff, MDCartersville, GA

Scott Gold, MDNew York, NY

Andrew Goldberg, MD, MSCESan Francisco, CA

Andrew Golde, MDAtlanta, GA

Richard L. Goode, MDStanford, CA

Roy Goodman, MDWhite Lake, MI

Harsha Gopal, MDChestnut Hill, MA

Benoit Gosselin, MDLebanon, NH

Jon Graham, MDSouth Miami, FL

William Gross, MDMurfreesboro, TN

Murray Grossan, MDLos Angeles, CA

Barbara Guillette, MDCranston, RI

Ray O. Gustafson, MDRochester, MN

Avraham Hampel, MDElkins Park, PA

Steven Handler, MDPhiladelphia, PA

William Harmand, MDSyracuse, NY

Scott Edwin Harrison, MDJackson, MS

Makoto Hasegawa, MDTokyo - 6206 - JAPAN,

H. Hearnsberger, III, MDLittle Rock, AR

Arthur Hengerer, MDRochester, NY

Peter Hillsamer, MDLafayette, IN

Daniel Hinckley, MDIdaho Falls, ID

Hunter Hoover, MDCharlotte, NC

John Houck, MDOklahoma City, OK

Mark Howell, MDJohnson City, TN

Abraham Hsieh, MDWalnut Creek, CA

Kenneth Hughes, MDLexington, KY

Michael K. Hurst, MDMorgantown, WV

Donald Ingram, MDFestus, MO

William David Isenhower, MDGreenwood, SC

Ian N. Jacobs, MDPhiladelphia, PA

John A. Jebeles, MDBirmingham, AL

John Jiu, MDJonesboro, AR

Stephanie Joe, MDChicago, IL

Jonas Johnson, MDPittsburgh, PA

Jordan Josephson, MDNew York, NY

Charles Juarbe, MDBayamon, PR

Slobodan Jugo, MDGreenville, KY

Zoheir J. Kaiser, MDSouth Hill, VA

John Kalafsky, MDNorfolk, VA

Paul Kaplan, MDPortland, OR

Jan L. Kasperbauer, MDRochester, MN

76

MEMBERSHIP

Edward Kass, MDWaukesha, WI

Matthew Kates, MDNew Rochelle, NY

John Keebler, MDMobile, AL

Stephen M Kelanic, MDAurora, IL

Michael Kelleher, MDSalisbury, MDRobert M. Kellman, MDSyracuse, NY

Marc Kerner, MDNorthridge, CA

Thomas Kidder, MDMilwaukee, WI

Charles Kimmelman, MDNew York, NY

Ronald Kirkland, MDJackson, TN

Joost L Knops, MDBellingham, WA

Robert Komorn, MDHouston, TX

Charles Koopmann, Jr., MDAnn Arbor, MI

Jodi M. Kornak, MDGreenfield, WI

Gary P Landrigan, MDBurlington, VT

William Lawson, MD, DDSNew York, NY

Amy D. Lazar, MDSummerville, NJ

Robert Lebovics, MDNew York, NY

Richard Lebowitz, MDNew York, NY

Kelvin Lee, MDNew York, NY

Phillip Lee, MDMason City, IA

Howard L. Levine, MDCleveland, OH

Sandra Lin, MDBaltimore, MD

Robert G. Lisk, MDGlen Birnie, MD

Todd A. Loehrl, MDWauwatosa, WI

Lloyd Loft, MDNew York, NY

Mark C. Loury, MDFt. Collins, CO

Ray J. Lousteau, MDNew Orleans, LA

Valerie Lund, MDUnited Kingdom,

Rodney Lusk, MDFort Collins, CO

Kiyoshi Makiyama, MD101-8309 JAPAN

Bruce T. Malenbaum, MDDurham, NC

Casey R. A. Manarey, MDBurnaby, BC CANADA

Aditi Mandpe, MDSan Francisco, CA

Jeffrey Manlove, MDSt. Paul, MN

Scott Manning, MDSeattle, WA

Louis Mariotti, MDSioux Falls, SD

Pierre Martin, MDCortland, NY

Richard A Martin, MDCape Girardeau, MO

Brian L. Matthews, MDWinston-Salem, NC

Kenneth Mattucci, MDManhasset, NY

Percy McDonald, MDPort Huron, MI

Robert McDonald, MDJefferson City, MO

Michael A. McGhee, MDBenton, AR

77

MEMBERSHIP

John T. McMahan, MD, FACSChicago, IL

Mark Mehle, MDLakewood, OH

Robert Merrell, Jr., MDDaytona Beach, FL

W. Davis Merritt, MDBoise, ID

Robert Meyers, MDDeerfield, IL

Harry C Midgley, III, MDJupiter, FL

Pradip Mistry, MDNorfolk, NE

Denise C. Monte, MDE. Setauket, NY

J. Spencer Mooney, MDBrookhaven, MS

Alice Morgan, MDCullman, AL

Charles Morgan, MDBirmingham, AL

David R Morledge, MDBakersfield, CA

Todd Morrow, MDWest Orange, NJ

Richard A. Morton, Jr., MDEl Paso, TX

Ron L. Moses, MDHouston, TX

Brooks Mullen, MDSequin, TX

Harlan Muntz, MDSalt Lake City, UT

Michael P Murphy, MDMinneapolis, MN

Andrew Murr, MDSan Fransisco, CA

John Murray, MDWest Palm Beach, FL

Robert Naclerio, MDChicago, IL

Ravi Nadarajah, MDIndiana, PA

Matthew Nagorsky, MDPhiladelphia, PA

David Nash, MDStoneham, MA

Michael Neuenschwander, MDRiverdale, GA

Brad Nitzberg, MDBoca Raton, FL

Michael Nordstrom, MDMilwaukee, WI

Joel Norris, MDWest Monroe, LA

Robert Oberhand, MDWestfield, NJ

Michael Paciorek, MDSyracuse, NY

Ariadna Papageorge, MDNew York, NY

Sanjay Parikh, MDBronx, NY

Albert Park, MDSalt Lake City, UT

Nigel Pashley, MDDenver, CO

Steven Peskind, MDPlano, TX

Gary Petrus, MDN Little Rock, AR

Perry Phillips, MDSheboygan, WI

Jay Piccirillo, MDSaint Louis, MO

William Pierce, MDBatavia, NY

Alan Pokorny, MDSpokane, WA

Edward Porubsky, MDAugusta, GA

William Potsic, MDPhiladelphia, PA

John C. Price, MDLutherville, MDChris Quilligan, MDFullerton, CA

78

MEMBERSHIP

Douglas E. Rapisarda, MDTwo Rivers, WI

Edward Reardon, MDQuincy, MA

Seth Reiner, MDLittleton, CO

Bruce Reisman, MDOceanside, CA

Evan Reiter, MDRichmond, VA

William Richtsmeier, MD, PhDCooperstown, NY

Ricardo A. Roa, MDHuntington, VA

Donald Rochen, DOWest Bloomfield, MI

Anthony Rogerson, MDMonroe, WI

John H Romanow, MDBurlington, MA

J. Lewis Romett, MDColorado Spring, CO

Thomas Romo, III, MDNew York, NY

Seth Rosenberg, MD FACSSarasota, FL

Douglas Ross, MDNew Haven, CT

Apostolos Rossos, MDHamilton, NJ

C. Allan Ruleman, Jr., MDMemphis, TN

Pedro J Rullan-Marin, MDSan Juan, Pr

Michael Sachs, MDNew York, NY

Salah Salman, MDBoston, MA

Anthony Sanders, MDColumbus, IN

J. R. Sarpa, MDBloomington, Indiana

Michael Saylor, MDHagerstown, MD

Stanley Schack, MDOmaha, NE

Scott Schaffer, MDGibsboro, NJ

Barry Schaitkin, MDPittsburgh, PA

Michael Scherl, MDWestwood, NJ

Todd Schneiderman, MDBridgewater, NJ

Michael L Schwartz, MDWest Palm Beach, FL

Michael Seicshnaydre, MDGulfport, MS

Peter Selz, MDDenison, TX

Brent Senior, MD, FACSChapel Hill, NC

Howard Shaffer, MDFort Worth, TX

Frank Shagets, Jr., MDJoplin, MO

Udayan K. Shah, MDPhiladelphia, PA

Stanley Shapshay, MDBoston, MA

Daniel Sharkey, MDStuart, FL

Pramod Kumar Sharma, MDSalt Lake City, UT

Alan Shikani, MDBaltimore, MDDavid Shoemaker, MDGreensboro, NC

Michael Shohet, MDNew York, NY

Joseph Siefker, MDMeridian, MS

John Simmons, MDJasper, AL

George Simpson, MDBuffalo, NY

Raj Sindwani, MD, FRCSSt. Louis, MO

79

MEMBERSHIP

Abraham Sinnreich, MDStaten Island, NY

David Slavit, MDNew York, NY

Bruce M. Smith, MDFort Collins, CO

Gary Snyder, MDBayside, NY

Carl Snyderman, MDPittsburgh, PA

Raymond Soletic, MDManhasset, NY

Sarah Stackpole, MDYonkers, NY

Kirk Steehler, DOErie, PA

Vernon H. Stensland, MDSioux Falls, SD

Carl W Stevens, II, MDEllisville, MS

Gerald Stinziano, MDBuffalo, NY

J. Pablo Stolovitzky, MDAtlanta, GA

William Stone, MDConcord, NH

John Stram, MDBoston, MA

Victor Strelzow, MDIrvine, CA

Scott P. Stringer, MD, MS, FACSJackson, MS

Mark Stroble, MDKirkwood, MO

Marshall Strome, MDCleveland, OH

Edward Bradley Strong, MDSacramento, CA

Joseph Sugerman, MDBeverly Hills, CA

Robert F. Tarpy, MDLafayette, LA

Barry Tatar, MDGlen Burnie, MD

John Taylor, MDLa Mesa, CA

Jeffrey Terrell, MDAnn Arbor, MI

Erica Thaler, MDPhiladelphia, PA

Lawrence Tom, MDPhiladelphia, PA

Stephen Toner, MDPanama City, FL

William Trimmer, MDReno, NV

Feodor Ung, MDLombard, IL

Giri Venkatraman, MDAtlanta, GA

Thomas Viner, MDIowa City, IA

Eugenia Vining, MDNew Haven, CT

David Volpi, MDNew York, NY

David L. Walner, MDNiles, IL

Marilene Wang, MDLos Angeles, CA

Mark Wax, MDPortland, OR

Debra Weinberger, MDHouston, TX

Samuel Welch, MD, PhD

Little Rock, AR

Barry Wenig, MDChicago, IL

Ralph F Wetmore, MDPhiladelphia, PA

Ernest A. Weymuller, Jr., MDSeattle, WA

Ronald Whitmire, MDGainesville, GA

Robert Williams, MDEast Aurora, NY

Leslie Williamson, MDSan Angelo, TX

80

MEMBERSHIP

Hobson L. Wilson, MDRockfledge, FL

Birgit Winther, MDCharlottesville, VA

B Tucker Woodson, MDMilwaukee, WI

J Robert Wyatt, MDMesquite, TX

Ken Yanagisawa, MDNew Haven, CT

Kathleen Yaremchuk, MDDearborn, MI

Matthew Yetter, MDWinston-Salem, NC

Anthony Yonkers, MDOmaha, NE

John K. Yoo, MDPasadena, TX

Mark Zacharek, MDDetroit, MI

Warren H. Zelman, MDGarden City, NYASSOCIATE

Ravi Agarwal, MDGlendale, AZ

George Boris, MDCulver City, CA

Holly Christine Boyer, MDMinneapolis, MN

Amy C. Brenski, MDDallas, TX

Grady L. Bryant, Jr., MDHermitage, TN

Brad Buell, MDBismarck, ND

Andrew Campbell, MDSheboygan, WI

Harry Cantrell, MDCamden, NJ

Daniel G. Carothers, MDChicago, IL

Rakesh K Chandra, MDGermantown, TN

Christopher Church, MDLoma Linda, CA

Randall Cohen, MDTuscon, AZ

Daryl G Colden, MD, FACSLawrence, MA

Michael Crawford, MD PCCouncil Bluffs, IA

Timothy D. Doerr, MDRochester, NY

Marc Dubin, MDSavannah, GA

Moshe Ephrat, MDNew Hyde Park, NY

Rick A. Fornelli, MDFairview, PA

Christine B Franzese, MDMadison, MS

Stephen Froman, MDCoraopolis, PA

Ryan Gallivan, MDBend, OR

Randal B Gibb, MDPayson, UT

Steven Goldman, MDBeachwood, OH

Bradley Goldstein, MDBaltimore, MD

John Griffin, MDMacon, GA

Anil Gungor, MDPittsburgh, PA

Ronda Hamaker, MDIndianapolis, IN

Joseph Han, MDCharlottesville, VA

Scott Hardeman, MDSt. Louis, MO

Richard L. Hebert, II, MDEunice, LA

Julius Hicks, MDBirmingham, AL

Eric H. Holbrook, MDBoston, MA

Darrell Hunsaker, MDSan Diego, CA

81

MEMBERSHIP

Steve Hunyadi, Jr, MDWooster, OH

Hanil Ibrahim, MDQuincy, MA

Hong-Ryul Jin, MDCheongju, SOUTH KOREA

Ashutosh Kacker, MDNew York, NY

Ken Kazahaya, MDPhiladelphia, PA

Savvas Kazanas, MDGREECE

Daniel R. Keech, MDAthens, TX

Matthew Kienstra, MDTampa, FL

Jean Kim, MDBaltimore, MDKenneth Mak, MDModesto, CA

Kevin McMains, MDAugusta, GA

Ralph Glen Owen, Jr., MDAugusta, GA

James Palmer, MDPhiladelphia, PA

Raymond V. Paolini Jr., MDBuffalo, NY

Alpen Patel, MDWashington, DC

Juan Portela, MDDorado, PR

Christine Puig, MDAuburn, WA

Ronald Pulli, MDPittsford, NY

Melissa Pynnonen, MDAnn Arbor, MI

Jean-Jacques Rafie, MDMcKinney, TX

William J. Remington, MDDecorah, IA

Jeffrey Roach, MDFitchburg, MA

Shawn E. Rogers, MDEdmonds, WA

David Rudman, MDOverland Park, KS

Matthew W. Ryan, MDGalveston, TX

Hamed Sajjadi, MDSan Jose, CA

Troy D Scheidt, MDColumbia, MO

Nina Shapiro, MDLos Angeles, CA

Gary Stadtmauer, MDNew York, NY

Ronnie Swain, Jr., MDMobile, AL

Hilary Timmis, Jr., MDBellvue, OH

Ewen Tseng, MDPlano, TX

Mahlon VanDelden, MDEvansville, IN

Michael Vietti, MDMansfield, OH

Manish Wani, MDKaty, TX

Kurtis A. Waters, MDBrainerd, MN

Edward Weaver, MD, MPHSeattle, WA

Jeffrey Werger, MD FRCSC FACSCANADA

Erin Daniel Wright, MDCANADA N6A 5B3

Bozena Barbara WrobelLong Beach, CA

James Yeh, MDRockville, MD

Gregory Zachmann, MDRoanoke, VA

Jill F. Zeitlin, MDBriarcliff Manor, NY

Jeffrey M Zimmerman, MDAmherst, NH

82

MEMBERSHIP

RESIDENT

Manoj T. Abraham, MDNew York, NY

Chad Afman, MDCincinnati, OH

Lee Michael Akst, MDCleveland, OH

Phillip G Allen, MDAlbany, GA

Bryan Ambro, MDPhiladelphia, PA

Manali S. Amin, MDOmaha, NE

Babak Azizzadeh, MDLos Angeles, CA

James C Banich, MDMaywood, IL

Steven W. Barthel, MDCleveland, Oh

Benjamin Bassichis, MDDallas, TX

Rami Batniji, MDAlbany, NY

Eric Baum, MDPhiladelphia, PA

Mary Beauchamp, MDMaywood, IL

Garrett H. Bennett, MDNew York, New York

Richard T. Bergstrom, MDShaker, OH

Salim S. Bhaloo, MDMadison Heights, MI

Rajendra Bhayami, MDNew York, NY

Dov Bloch, MD San Francisco, CA

David Bradley Bobbitt, MDCincinnati, OH

Michiel Bove, MDBronx, NY

Rebecca Brandsted, MDSt. Louis, MO

Russell Deane Briggs, MDGalveston, TX

John Brockenbrough, MDMaywood, IL

Laura Brown, MDBirmingham, AL

Seth M Brown, MDYonkers, Ny

Edward D Buckingham, MDGalveston, TX

Jose Busquets-Ferriol, MDPortland, OR

Henry Frederick Butehorn III, MDAlbany, NY

Allen Butler, MDAugusta, GA

Sydney Butts, MDBronx, NY

Benjamin Cable, MDIowa City, IA

Gerard Carvalho, MDRedwood City, CA

Jon Chadwell, MDCincinnati, OH

Stephen W. Chandler, MDMorgantown, WV

Binoy Chandy, MDShreveport, LA

Daniel Charous, MDPhiladelphia, PA

Judy L. Chen, MDStanford, CA

Margaret A. Chen, MDSan Diego, CA

Scott Chiang, MDLos Angeles, CA

Michael Cho, MDSan Francisco, CA

Kyle Choe, MDNew York, NY

Sung J Chung, MDCrescent Springs, KY

Noam Cohen, MDPhiladelphia, PA

83

MEMBERSHIP

C. Michael Collins, MDCincinnati, OH

James Connolly, MDJackson, MS

Anthony J Cornetta, MDPhiladelphia, PA

Jason Cundiff, MDChicago, IL

Linda Dahl, MDBronx, ny

Myra Danish, MDwest bloomfield, MI

George S Dawson, MDMorgantown, WV

Michael Decherd, MDDallas, TX

David Denman, MDOmaha, NE

Paul Di Biasse, MDSteubenville, OH

Jason A Diaz, MDSalt Lake City, UT

William Dickey, MDChicago, IL

E. Nicholas Digges, MDOmaha, NE

Joni Kristin Doherty, MDTopanga, CA

David Donaldson, MDBuffalo, NY

Alexander Donath, MDSt. Louis, MO

Wilson Dumornay, MDBronx, NY

Emily E. Epstein, MDSt. Louis, MO

Michelle Lee Facer, MDRochester, MN

Patrick C. Farrell, MDOmaha, NE

Oren Friedman, MDPhiladelphia, PA

Michael A. Fritz, MDCleveland, OH

Beverly Fulcher, MDJackson, MS

Chad Galer, MDOmaha, NE

Suzanne K Galli, MDNew York, NY

Courtney West Garrett, MDChicago, IL

John Gavin, MDAlbany, NY

Bobak Ghaheri, MDPortland, OR

Michael Gilbert, MDSalt Lake City, UT

Matthew Don Gillihan, MDBuffalo, NE

Michael B. Gluth, MDRochester, MN

Omar A. Gonzales-Yanes, MDPUERTO RICO 00926

Quinton Gopen, MDLos Angeles, CA

Joshua Gottschall, MDDetroit, MI

Satish Govindaraj, MDNew York, NY

Parul Goyal, MDSyracuse, NY

Felicia J Grisham, MDNashville, TN

Neil D. Gross, MDPortland, OR

Samuel Gubbels, MDPorland, OR

Akash Gupta, MDCincinnati, OH

Jahmal Hairston, MDCincinnati, OH

Chris Hampson, MDMaywood, IL

Christopher Hargunani, MDPortland, OR

Kevin C. Harris, MDMilwaukee, WI

84

MEMBERSHIP

Matthew Hearst, MDCincinnati, OH

Ryan Heffelfinger, MDPhiladelphia, PA

Edward Hepworth, MDMenlo Park, CA

Brian Herr, MDMaywood, IL

Derek K Hewitt, MDColumbia, MO

Micah J Hill, MDStanford, CA

Samuel Hill, MDDetroit, MI

Neil Hockstein, MDPhiladelphia, PA

Raymond Howard, MDRome, GA

Anna P. Hsu, MDLos Angeles, CA

Kevin J Hulett, MDMaywood, IL

Shannon Elizabeth Hunter, MDAsheville, NC

Keith Hurvitz, MDLos Angeles, CA

Masatuki Inouye, MDStanford, CA

Stacey Lynn Ishman, MDMilwaukee, WI

Chandra Ivey, MDCincinnati, OH

Ofer Jacobowitz, MDNew York, NY

David Jakobowicz, MDBronx, NY

Kenneth Johnson, MDBirmingham, AL

James Kallman, MDAnchorage, AK

Madan N. Kandula, MDBrookfield, WI

Seth Kanowitz, MDNew York, NY

Brian A. Kaplan, MDCharlottesville, VA

Andrew Karpenko, MDDetroit, MI

Scott M, Kaszuba, MDPearland, TX

Srinivas Kaza, MDDanville, PA

Mark L. Keller, MDOmaha, NE

John D. Kilde, MDMilwaukee, WI

Christopher J Kim, MDSunnyvale, CA

Eugene Kim, MDSan Francisco, CA

Eugene J. Kim, MDSan Francisco, CA

Seungwon Kim, MDSyracuse, NY

Sihun Alex Kim, MDDetroit, MI

Robert E King, MDMaywood, IL

Karen A Kolin, MDChapel, NC

Michael Kortbus, MDNew York, NY

Christina J Laane, MDSan Francisco, CA

Babak Larian, MDLos Angeles, CA

Christopher Larsen, MDKansas City, KS

Bryan Leatherman, MDLittle Rock, AR

Jivianne Lee, MDLos Angeles, CA

Walter Lee, MDUniversity Heights, OH

Jonathan M Levine, MDPhiladelphia, PA

Karen Lin, MDNew York, NY

85

MEMBERSHIP

Jonathan Lindman, MDBirmingham, AL

David A Litman, MDJohnstown, PA

Manuel Lopez, MDCincinnati, OH

Robert Lorenz, MDCleveland, Oh

Mindy MaccabeePortland, OR

Lance Manning, MDRochester, MN

Belinda Mantle, MDBirmingham, AL

Paul Martin, MDLoma Linda, CA

Peter F. Maurice, MDWashington, DC

Clement McDonald, MDIndianapolis, IN

James Wesley McIlwaine, MDSt. Louis, MO

Lee Ann McLaughlin, MDNew York, NY

Sean M McWilliams, MDBirmingham, AL

Cem Meco, MDAUSTRIA

Samuel M Medaris, MDOmaha, NE

Neelesh Mehendale, MDDallas, TX

Nicholas Mehta, MDCincinnati, OH

Matthew Meigs, MDTampa, FL

Jeremy Melker, MDGainsville, FL

Jonathan Mellema, MDCincinnati, OH

George A. Melnik, MDValparaiso, IN

Christopher Melroy, MDDurham, NC

Tanya K. Meyer, MDMilwaukee, WI

Oleg Militsakh, MDKansas City, KS

Brian T. Miller, MDSalt Lake, NY

Robert S. Miller, MDCincinnati, OH

Timothy Miller, MDSalt Lake City, UT

Ryan Mitchell, MDPontiac, MI

Ashkan Monfared, MDPalo Alto, CA

Christopher Muller, MDGalveston, TX

Karsten Munck, MDSan Francisco, CA

Srikanth I Naidu, MDMemphis, TN

Mandana Namiranian, MDChicago, IL

Michael Edward Navalta, MDQuezon City, MANILA

Brian Neff, MDPhiladelphia, PA

Mark Nelson, MDCleveland, OH

Chau T. Nguyen, MDTampa, FL

Hoa Van Nguyen, DOCalumet City, IL

Nghia Nguyen, MDDetroit, MI

Thomas O’Donnell, MDDanville, PA

Anit Patel, MDBronx, NY

Ankit M Patel, MDChicago, IL

Donald Perez, MDLoma Linda, CA

Joel R Perloff, MDPhiladelphia, PA

86

MEMBERSHIP

Timothy Pine, MDReno, NV

Jayant M Pinto, MDChicago, IL

Steven Pletcher, MDSan Francisco, CA

Glen T. Porter, MDGalveston, TX

Scott A. Powell, MDTampa, FL

Matthew Proctor, MDSalt Lake City, UT

Liana Puscas, MDSacramento, CA

Alexander Ramirez, MDSan Francisco, CA

Joseph Raviv, MDChicago, IL

Douglas Reh, MDPortland, OR

Patrick Reidy, MDDetroit, MI

Jacquelyn Reilly, MDSangus, MA

Dukhee Rhee, MDBayside, NY

Brynn E Richardson, MDOmaha, NE

Jeremy Richmon, MDSan Diego, CA

Anthony A. Rieder, MDWaukesha, WI

Nabil M. Rizk, MDEGYPT

Matthew Robertson, MDCincinnati, OH

Bret Rodgers, MDBoise, ID

Alexander A. Romashko, MDMaywood, IL

Walter Rooney, MDCincinnati, OH

David Rosenberg, MDNew York, NY

Marc Rosenthal, MDSicklerville, NJ

Adam Ross, MDPhiladelphia, PA

John Ryzenman, MDCincinnati, OH

Bassem M. Said, MDCleveland, OH

Frank Salamone, MDCincinnati, OH

Sharyar Samadi, MDPhiladelphia, PA

Mark Samaha, MDCANADA

Ruwanthi Samaranayake, MDAlameda, CA

Sreeedhar Samudrala, MDJackson, MS

Kenneth Sanders, MDShreveport, LA

Alicia Sanderson, MDSan Diego, CA

Jan Sasama, MDRochester, MN

Joseph Scharpf, MDCleveland, OH

Sara Scheid, MDPhiladelphia, PA

Michael Scheuller, MDSan Francisco, CA

James Schroeder, MDChicago, IL

Stacey L Schulze, MDMilwaukee, WI

Heather Schwartzbauer, MDCincinnati, OH

Joseph Scianna, MDMaywood, IL

Paul Scolieri, MDBethel Park, PA

Matthew Sdano, MDCincinnati, OH

Brook M. Seeley, MDSan Francisco, CA

87

MEMBERSHIP

Anand Shah, MDDetroit, MI

Ashish Shah, MDCincinnati, OH

Shefari Shah, MDChicago, IL

Weiru Shao, MDMinneapolis, MN

Samuel Shiley, MDPortland, OR

Lisa Shnayder, MDFair Lawn, NJ

Michel Siegel, MDHouston, TX

Jason B Sigmon, MDOmaha, NE

Damon Silverman, MDShaker Heights, OH

John Sinacori, MDSyracuse, NY

James Sipp, MDAtlanta, GA

Dana Smith, MDPortland, OR

Ronald Smith, MDDanville, PA

Mary C. Snyder, MDOmaha, NE

Clementino Solares, MDCleveland Heights, OH

Andrew Ryan Specter, MDPhiladelphia, PA

Michael Srodes, MDArlington, MA

Jacob D. Steiger, MDPhiladelphia, PA

Jeannine Stein, MDCleveland, OH

Alexander E. Stewart, MDNorth Charleston, SC

Howard Stupak, MDSan Francisco, CA

Das Subinoy, MDDurham, NC

Greg Swanson, MDDetroit, MI

Monica Tadros, MDWashington, DC

Su Teoh, MDIndianapolis, IN

Wyatt To, MDWeston, FL

Vincent Toma, MDW. Bloomfield, MI

Hannah Vargas, MDAlbany, NY

Cheryl Varner, MDJackson, MS

Konstantin Vasyukevich, MDBronx, NY

T Venkatesan, MDChicago, IL

Raul Vila, MDPUERTO RICO 00969

Daniel Viner, MDIowa City, IA

Daniel D Vukas, MDMatwood, IL

Bryan G Wachter, MDAnchorage, AK

Curtis Walsh, MDMaywood, IL

Bryan Wilcox, MDSyracuse, NY

Mark Williams, MDCincinnati, OH

Sarah K Wise, MDDecatur, Georgia

Gabriel Wong, MDBronx, NY

Bradford Woodworth, MDCharleston, SC

Rhoda Wynn, MDNew York, NY

Dorise Yang, MDChicago, IL

Thomas Yen, MDSan Francisco, CA

88

MEMBERSHIP

Dayton L. Young, MDOmaha, NE

Philip Young, MDLos Angeles, CA

Kathy Yu, MDCarraboro, NC

David Yun, MDBronx, NY

Warren Zager, MDPhiladelphia, PA

Jacob Zeiders, MDTampa, FL

Snailmail ZzztestSolon, OH

INTERNATIONAL

Claus Bachert, MD, Ph.D.Bellen, BELGIUM

Manuel Bernal-Sprekelsen, MD,PhDBARCELONA

Ozcan Cakmak, MDAnkara, TURKEY

A. Simon Carney, MDSOUTH AUSTRALIA 5018

Paolo Castelnuovo, MD20097, S. Donato Milanese, ITALY

Clive Anthony Chappel, MDAUSTRALIA NSW 2072

Seung-Kyu Chung, MDSeoul, SOUTH KOREA

Harvey Coates, MDAUSTRALIA

Elimeleh Deutsch, MD91004 ISRAEL

Frank Elsworth, MDAUSTRALIA

Alfio Ferlito, MDUdine, ITALY

Andrew Gordon, MDNEW ZEALAND

Jan Gosepath, MD, PhDGERMANY

Robinson Granados, MDBarranquilla, CO

Edgar Guerra, MD06470 MEXICO

Ahamefule Olu Ibekwe, MDSAUDI ARABIA

Steve P. Kloppers, MDChilliwack, BC

J Michael Klossek, MDFRANCE

Roee Landsberg, MDISRAEL

Ing Ruen Lim, MDSINGAPORE, 509740

Hsin-Ching Lin, MD, FARSFeng Shang City, TAIWAN

Wolf Mann, MDMainz, GERMANY

Ranko Mladina, MDCroatia 10.000

Mohsen Naraghi, MDTehran 15336, IRAN

Piero Nicolai, MDBrescia, ITALY

Pietro Palma, MDITALY

Kalpesh Patel, MDLondon, UNITED KINGDOM

Simon R Robinson, MDWellington, NEW ZEALAND

Hwan-Jung Roh, MDKOREA

Raymond Sacks, MDAUSTRALIA

Adrian Saurajen, MDSingapore, SINGAPORE

Pongsakorn Tantilipikorn, MDBangkok, THAILAND

Diana Tobon, MDMiami, FL

Matteo Trimarchi, MDMilano, ITALY

Richard L. Voegels, MDSao Paulo, BRAZIL

Hans-J Welkoborsky, MD, DDS,PhDGERMANY

89

MEMBERSHIP

Peter Wormald, MDWoodville South, SA

John W. Wyllie, MDDefiance, OH

Altan Yildirim, MDSivas, TURKEY

HONORARY

Thomas McDonald, MDRochester, MN

EMERITUS

Pat A. Barelli, MDOverland Park, KS

Stanley M. Blaugrund, MDNew York, NY

Charles Clark, III, MDDurham, NC

James Dudley, MDSan Fransisco, CA

David Fairbanks, MDBethesda, MDTierry Garcia, MDIndianapolis, IN

Howard Gelman, MDAnnapolis, MD

Charles W. Gross, MDCharlottesville, VA

Eugene Hesdorffer, MDJackson, MS

Charles Kaluza, DOPortland, OR

Herbert Kean, MDPhiladelphia, PA

Chandra Khasgiwala, MDAndover, MA

Anthony Maniglia, MDCleveland, OH

Jean Marti, MDSWITZERLAND

Robert McGrew, MDLittle Rock, AR

Winsor Morrison, MDHollister, MO

John Odess, MDChelsea, AL

Loring W. Pratt, MDFairfield, ME

Michael Riley, DOLargo, FL

Alan Sogg, MDRussell, OH

Edward Starinchak, MDGranville, OH

M. Eugene Tardy, MDChicago, IL

Charles Wine, MDOklahoma City, OK

LIFE

Pierre G. Arbour, MDBoynton Beach, FL

Edward Brandow, Jr., MDAlbany, NY

Herbert Camp, MDMidland, MI

Richard Carter, MDGreenwood, SC

Gerald English, MDEnglewood, CO

George Facer, MDRochester, MN

Ralph Gaskins, MDAtlanta, GA

Nathan A. Geurkink, MDLebanon, NH

Harold Groves, DOEugene, OR

Sanford Hoffman, MDBuffalo, NY

Frank L. Kardos, MDWayne, NJ

Assad Khoury, MDWashington, NY

Michael Knowland, MDSouth Portland, ME

90

MEMBERSHIP

Helen Krause, MDGibsonia, PA

William Lavelle, MDWorcester, MA

W. K. Locklin, MDPortage, MI

Richard Mabry, MDDuncanville, TX

William Mancoll, MDHartford, CT

Guy McFarland, MDIowa City, IA

Y. M. Naci, MDStartford, CT

Supote Phipatanakul, MDValley Park, MO

Vittal Rao, MDLaGrangeville, NY

Edward Razim, MDOak Brook, IL

C. Robinson, MDAlbuquerque, NM

John Sellers, MDNorfolk, VA

Carl Sputh, MDIndianapolis, IN

Richard Wehr, MDGreer, SC

Alvin Wenger, MDLand o Lakes, FL

Joseph West, MDKirkland, WA

Eiji Yanagisawa, MDNew Haven, CT

Richard Yules, MDBoca Raton, FL

AFFILIATE

Michael J. Chandler, MDNew York, NY

Erin J Ross, RNCleveland, OH

91

MEMBERSHIP

92

NOTES

93

NOTES

This scientific program has been partially supported by unrestrict-ed educational grants from Richard Wolf Medical InstrumentsCorporation and Xomed Surgical Products.

All activities of The American Rhinologic Society comply withthe Americans with Disability Act.

B R C Rhinologic Society Program Abstracts 2005€¦ · American Rhinologic Society Program...

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