ENT and Allergy Magazine, Issue X - ENT & Allergy Associates

36 Pages·2014·7.17 MB·English

ENTA Clinical Case Spotlight
Finding Abnormality Before It Can Progress To Oral Cancer Oral Case #126
Abnormal cells from lab report showing an increase in nuclear to cytoplasmic ratio,
nuclear crowding with a loss of polarity, and irregular thickening of nuclear membranes.
Floor of the mouth lesion
Patient: Female, smoker, 65+.
Presentation: 10-20mm raised red verrucous, mildly ulcerated lesion on the floor
of mouth that had been present for more than a year. (Representative image above)
Brush Biopsy Results: Positive for dysplasia or carcinoma.
Scalpel Biopsy Results: Carcinoma in situ with severe dysplasia, negative for HPV.
Follow-Up: Two years post diagnosis, patient is doing well.
“Brush Biopsy allows for identification of atypia in suggestive
but not obviously malignant lesions via a minimally-invasive,
relatively comfortable technique…”
Gangadhar Sreepada, M.D.
Congratulations
For your continued committment to help
prevent oral cancer and protect your patients
The OralCDx BrushTest® is a minimally invasive diagnostic test that enables the
detection of pre-cancerous cells in the mouth before they can progress to cancer.
www.oralcdx.com
4
W 10 e
elcome to the th dition
ent a a m
of the and llergy ssociates agazine
Esteemed Colleagues,
T
hese past 12 months have witnessed enormous change in the medical field, including the
introduction of the Affordable Care Act.
And while we at ENT and Allergy Associates continue to adapt and adjust to this
transforming landscape, what will never change is our commitment to you and the patients
you have entrusted to our care. We are constantly striving to remain at the forefront of
clinical innovation, so we may continue to deliver the highest level of healthcare our mutual
Robert Green, M.D., F.A.C.S.
patients need and deserve, and to share those advances with you.
m

o Along those lines, allow me to proudly present the 10th Edition of the ENT and Allergy Associates Magazine. It is

c filled with physician authored articles containing news, information, and discovery. We hope you enjoy them.

.
Over the past year, we have continued to grow the footprint of our Practice, bring aboard more of the best and the
y
brightest otolaryngologists and related sub-specialists, allergists and hearing care professionals, and augment our
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state-of-the-art technology, so that we may remain fully able to serve our many communities.

r

e We’ve also developed and implemented a number of new tools and techniques designed to further enhance the

l patient experience we offer, at every turn.

l
Because everyone’s schedule requires greater flexibility, more and more of our physicians are seeing patients on
a
evenings and Saturdays. Because access and connectivity are increasingly important to superb care, we have created
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a call center (our Patient Rapid Response Center or PRRC) in which over 50 service professionals quickly field

n
patient calls, make same or next day appointments, and provide answers to varied questions. Not only is the PRRC

a a benefit to our calling patients, it also allows our clinical office staffs to fully focus on the needs of the patents

t standing before them. We believe it’s a true win/win. And because customer service has never been more important to
patients, we have created a dedicated team whose members visit every one of our sites, teaching and refreshing
n
our staff on best practices.
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All of these initiatives are focused on one thing…our ability to best serve the needs of the patients whose care you
have entrusted to us.
We send our sincerest gratitude to our sponsors for helping us to make this educational magazine possible, and
encourage you to consider their superior products and services, as we ourselves do.
We are honored to continue our relationship with you through 2014 and beyond. As always, please feel free to
contact us with any comments, suggestions, or questions you may have about our magazine or our Practice
as a whole.
Sincerely,
Robert Green, MD, FACS
President, ENTA
ENT & Allergy is designed and published by Custom Medical Design Group • 1.800.246.1637 • www.CustomMedicalMagazine.com. To advertise in an upcoming issue please
Medical contact Dave Lewcon at 508.278.6521 • This publication may not be reproduced in part or whole without the express written consent of Custom Medical Design Group.
MATRx System
Tap/Pap Hybrid
Our dental practice focuses on the treatment of
Obstructive Sleep Apnea using oral appliance therapy.
More Than CPAP
For over 20 years we have been treating patients
successfully using state of the art devices to help
patients breath more effectively and obtain a better
night’s sleep.
We are proud to be one of the few offices in the
country to be trained and experienced in the use of
the MATRx system and TAP/PAP hybrid therapy and
have already seen amazing results utilizing these
Jeffrey S. Rein, DDS, F.A.G.D. & Neal Seltzer, DMD, F.A.G.D.
technologies. The MATRx helps predict the success of
Dr.’s Jeffrey S. Rein and Neal Seltzer are both Diplomates
using oral appliances to treat obstructive sleep apnea.
of the American Board of Dental Sleep Medicine;
Diplomates of the Academy of Clinical Sleep Disorder
We invite you to contact us to explore these powerful
Disciplines; and Diplomates of the American Sleep and
Breathing Academy. treatment options for your patients.
Treatment of All Levels of Obstructive Sleep Apnea Including the Severe Patient.
101 Hillside Avenue, Suite A • Williston Park, NY 11596
[phone] • [email protected]
lidentalsleepmedicine.com
6
O L
ur OcatiOns
HACKENSACK
RADIOLOGY GROUP
Astoria Garden City Port Jefferson
31-19 Newtown Avenue 990 Stewart Avenue 251 East Oakland Avenue providing the highest quality
Suite 201 Suite 610 Port Jefferson, NY 11777
patient care to help you
Astoria, NY 11102 Garden City, NY 11530 [phone]
Phone: [phone] [phone]
make all the right decisions
Poughkeepsie
Bay Ridge - East Hackensack
21 Reade Place
802 64th Street, Suite 3A-E 385 Prospect Avenue Suite 3200
Brooklyn, NY 11220 2nd Floor Poughkeepsie, NY 12601 All imaging is not the same. You have
[phone] Hackensack, NJ 07601 [phone]
[phone] taken great care to select the right primary
Bay Ridge - West Purchase
7333 6th Avenue Hoboken care doctor or specialist, now consider
3020 Westchester Avenue
Brooklyn, NY 11209 79 Hudson Street
Suite 303 your radiologist. We have more than 30
[phone] Suite 303
Purchase, NY 10577
Hoboken, NJ 07030
[phone] radiologists who are Board Certified, Sub-
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mm 2B1a0y-s3id3 e2, 6NthY A 1v1e3.,6 G0round Floor Lake Success Riverhead Specialty trained and ready to meet your
[phone] 3003 New Hyde Park Road 292 Shade Tree Lane imaging needs from head to toe.
o o Suite 409 Aquebogue, NY 11931
Bridgewater Lake Success, NY 11042 [phone] Board Certified and Sub-Specialty Trained in:
cc 245 Route 22, 3rd Floor [phone]
. . B(9r0id8g) e7w22at-e1r0, 2N2J 08807 Middletown S11h3r1e Bwrsobadu Srtyreet • PET/CT • MRI • Digital Mammography
yy 75 Crystal Run Road Shrewsbury, NJ 07719 • CT • Breast MRI • Fluoroscopy
g Brooklyn Heights BMuiidlddilnetgo Bw,n S, uNitYe 21200941 [phone] • Nuclear Medicine • Brain Spectroscopy • Bone Density
r g 3(10 0P iCerardempoannt PPllaazzaa )West [phone] Sleepy Hollow • Ultrasound • Prostate Spectroscopy • Digital X-Ray

Suite 1301, Brooklyn, NY 11201
er New Rochelle 358 North Broadway
[phone] 145 Huguenot Street, Suite 610 Suite 203 Wall Street - NYC White Plains
l l e Bronx N(9e1w4) R 2o3c5h-e1l8le8,8 NY 10801 S(9le1e4p)y 6 H31o-l3lo0w53, NY 10591 1Su50it eB 1ro0a1d5way 735rd S Foluotohr Broadway
l 1200 Waters Place, Suite 110 New York, NY 10038 White Plains, NY 10601
al Bronx, NY 10461 New Windsor Southampton [phone] [phone] • Nationally recognized radiology team.
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d 103 Executive Drive 365 County Road, 39A
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n New Windsor, NY 12553 Unit #3 1211 Hamburg Turnpike 485 Route 1 South
d 670 Stoneleigh Avenue [phone] Southampton, NY 11968 Suite 205 Building B, Suite 350 about your Digital Mammography and get results in as little as 20 minutes!
a Building #665 Suite 205 [phone] Wayne, NJ 07470 Iselin, NJ 08830
n Carmel, NY 10512 Old Bridge [phone] [phone]
t [phone] • Breast Biopsies offered on site for faster results.
The Renaissance Plaza Staten Island
na 3663 Route 9 North West Nyack Yonkers
East Side - NYC 1 Teleport Drive • IV sedation appointments are available for claustrophobic and pediatric patients.
e t 210 East 86th Street, 9th Floor SOulidt eB 1r0id2ge, NJ 08857 Suite 200 1Su Citreo 2sfi0e1ld Avenue 9Su84it eN 4o0r0th Broadway
New York, NY 10028 [phone] Staten Island, NY 10314 West Nyack, NY 10994 Yonkers, NY 10701 • Ultra low dose CT scans and digital x-ray with both reducing radiation dose 50% - 80% per exam.
n [phone] [phone] [phone] [phone]
e Englewood O69r0a Kdienldlerkamack Road Tuckahoe West Side - NYC Yorktown • New wide bore MRI minimizes patient claustrophobia while providing the latest technology.
177 North Dean Street Suite 101 1 Elm Street 620 Columbus Avenue 2649 Strang Blvd • PICC Line Insertion.
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Englewood, NJ 07631 [phone] Tuckahoe, NY 10707 New York, NY 10024 Yorktown Heights, NY 10598
[phone] [phone] [phone] [phone] HACKENSACK RADIOLOGY GROUP, P.A.
Parsippany
Fifth Avenue - NYC 3219 Route 46 East Corporate Office
261 5th Avenue, Suite 901 Suite 203
New York, NY 10016 Parsippany, NJ 07054 560 White Plains Road, Suite 615
[phone] [phone]
Tarrytown, NY 10591
NEWMAN STREET IMAGING NEW CENTURY IMAGING
Fishkill Patchogue
[phone]
200 Westage Business Center 475 East Main Street 30 South Newman Street • Hackensack • NJ 555 Kinderkamack Road • Oradell • NJ
Suite 224 Suite 109
Fishkill, NY 12524 Patchogue, NY 11772
[phone] [phone] Call us today, see us today. 1-855-ENTA-DOC 201.488.2660 • www.hrgimaging.com
Quick appointments! Both centers are open Monday-Saturday with early morning
w w w . e n t a n d a l l e r g y . c o m
and late evening time slots available during the work week.
HACKENSACK
RADIOLOGY GROUP
providing the highest quality
patient care to help you
make all the right decisions
All imaging is not the same. You have
taken great care to select the right primary
care doctor or specialist, now consider
your radiologist. We have more than 30
radiologists who are Board Certified, Sub-
Specialty trained and ready to meet your
imaging needs from head to toe.
Board Certified and Sub-Specialty Trained in:
• PET/CT • MRI • Digital Mammography
• CT • Breast MRI • Fluoroscopy
• Nuclear Medicine • Brain Spectroscopy • Bone Density
• Ultrasound • Prostate Spectroscopy • Digital X-Ray
• Nationally recognized radiology team.
• Speak with your radiologist in person between the hours of 9 A.M. - 4 P.M. Monday through Friday
about your Digital Mammography and get results in as little as 20 minutes!
• Breast Biopsies offered on site for faster results.
• IV sedation appointments are available for claustrophobic and pediatric patients.
• Ultra low dose CT scans and digital x-ray with both reducing radiation dose 50% - 80% per exam.
• New wide bore MRI minimizes patient claustrophobia while providing the latest technology.
• PICC Line Insertion.
HACKENSACK RADIOLOGY GROUP, P.A.
NEWMAN STREET IMAGING NEW CENTURY IMAGING
30 South Newman Street • Hackensack • NJ 555 Kinderkamack Road • Oradell • NJ
201.488.2660 • www.hrgimaging.com
Quick appointments! Both centers are open Monday-Saturday with early morning
and late evening time slots available during the work week.
8
t l B f a g d
he ink etWeen ood llergies and roWth eficiency
Harshna Mehta, M.D.
Allergy, Asthma and Immunology
ENT and Allergy Associates, LLP
T
he prevalence of recognized food allergies is rising
around the globe, with an estimated six million
children affected in the US alone. (1-2) The majority
of these children are managed by strict avoidance
of the triggering food. Several of the most common food
allergens, particularly milk and wheat, may comprise a
major portion of a developing child’s diet. In addition, Bock
et al. reported that 6 to 8% of children are diagnosed with
a food allergy in the first 3 years of life, a recognized vital
m period for growth. (3) This has the potential for placing
millions of children at risk for growth deficiency.

o
Previous studies have suggested that cow’s milk avoidance
c
has led to inadequate nutrient intake and poor growth.
.
(4-6) Due to growing concerns regarding nutritional status
y
of cow’s milk allergic children, the World Allergy Organi-

g zation published guidelines on the “Diagnosis and Ratio-
nale for Action against Cow’s Milk Allergy” (DRACMA),
r
which included recommendations for feeding cow’s milk
e
to allergic children.(7)

l

l A recent study, awaiting publication in The Journal of

a Pediatrics, evaluated the growth of children with food
allergies in a general pediatric population of nearly 10,000
d
children. (8) Remarkably, a difference in growth between

n children with and without food allergy was not seen in the
overall population, however, a significant difference was
a
found when the patients were stratified by class of insurance.
t
Food allergic patients with commercial insurance were

n found to be shorter and weighed less than non-food

e allergic patients. Similar findings were not seen in the state
insured group. It is unclear why the growth of children with
commercial insurance was affected whereas the growth of
children with state insurance is not. However, several studies
have identified increased early-childhood obesity rates in
low-income, urban children. (9-19) These issues may be
contributing to the findings as state insured children may
be bigger overall. Additionally, these food allergic children
may have easier access to processed foods that may be poor
substitutions for the allergen(s) in regards to nutritional children > 2 years of age. Reasons for this are unclear;
content but may contain a high caloric value. however, this may be because as solids become a larger por-
tion of the diet, parents/caregivers may not feel that milk
Regardless of insurance, milk allergic children >2 years are substitution is as necessary. Furthermore, milk substitutes
smaller in height and weight in comparison to matched coun- for this age group are lower in fat and most are very low in
terparts. These findings suggest that the recommendations protein or protein-free, thus even when used, they provide a
set forth are being appropriately implemented as there was poor nutritional substitute.
no growth impairment seen in children < 2 years of age, a
time during which milk is a major portion of the diet. How- In summary, physicians should be aware of the risk of
ever beyond this period, there was a significant effect in growth impairment in food allergic children and particular
9
The prevalence of recognized food allergies is rising around the globe,
with an estimated six million children affected in the US alone.
attention should be paid to growth parameters. Accurate overweight among US low-income preschool children:
diagnosis is paramount to ensure the validity of a food the Centers for Disease Control and Prevention pedi-
allergy diagnosis, especially because it may have significant atric nutrition surveillance, 1983 to 1995. Pediatrics.
effects on childhood development. Nutritional counseling 1998;101(1):E12. Epub 1998/01/07.
should be provided to the families of these children to 10. Ogden CL, Troiano RP, Briefel RR, Kuczmarski RJ, Flegal
better educate caregivers on appropriate nutritionally dense KM, Johnson CL. Prevalence of overweight among
substitutes to replace those foods that are being avoided. preschool children in the United States, 1971 through
e
1994. Pediatrics. 1997;99(4):E1. Epub 1997/04/01.
References n
11. Stettler N, Elliott MR, Kallan MJ, Auerbach SB,

1. Sicherer SH. Epidemiology of food allergy. J Allergy Kumanyika SK. High prevalence of overweight among t
Clin Immunol. 2011;127(3):594-602. Epub 2011/01/18. pediatric users of community health centers. Pediatrics.
a
2. Gupta RS, Springston EE, Kim JS, Smith B, Pongracic 2005;116(3):e381-8. Epub 2005/09/06.
n
JA, Wang X, et al. Food allergy knowledge, attitudes, 12. Freedman DS, Khan LK, Serdula MK, Ogden CL,

and beliefs of primary care physicians. Pediatrics. Dietz WH. Racial and ethnic differences in secular d
2010;125(1):126-32. Epub 2009/12/09. trends for childhood BMI, weight, and height. Obesity.
a
3. Bock SA. Prospective appraisal of complaints of adverse 2006;14(2):301-8. Epub 2006/03/31.
l
reactions to foods in children during the first 3 years of 13. Rappaport EB, Robbins JM. Overweight in Southeastern

life. Pediatrics. 1987;79(5):683-8. Epub 1987/05/01. Pennsylvania children: 2002 household health survey l

4. Christie L, Hine RJ, Parker JG, Burks W. Food allergies data. Public health reports. 2005;120(5):525-31. Epub e
in children affect nutrient intake and growth. Journal of 2005/10/18.
r
the American Dietetic Association. 2002;102(11):1648- 14. Sherry B, Jefferds ME, Grummer-Strawn LM. Accuracy
g
51. Epub 2002/11/27. of adolescent self-report of height and weight in assess-

5. Flammarion S, Santos C, Guimber D, Jouannic L, ing overweight status: a literature review. Archives of y

Thumerelle C, Gottrand F, et al. Diet and nutritional pediatrics & adolescent medicine. 2007;161(12):1154-61. .
status of children with food allergies. Pediatric allergy Epub 2007/12/07.
c
and immunology: official publication of the European 15. Strauss RS, Pollack HA. Epidemic increase in childhood
o
Society of Pediatric Allergy and Immunology. overweight, 1986-1998. JAMA: the journal of the

2011;22(2):161-5. Epub 2010/06/22. American Medical Association. 2001;286(22):2845-8. m
6. Meyer R, Venter C, Fox AT, Shah N. Practical dietary Epub 2001/12/12.
management of protein energy malnutrition in young 16. Thorpe LE, List DG, Marx T, May L, Helgerson SD,
children with cow's milk protein allergy. Pediatric Frieden TR. Childhood obesity in New York City
allergy and immunology: official publication of the elementary school students. American journal of public
European Society of Pediatric Allergy and Immunology. health. 2004;94(9):1496-500. Epub 2004/08/31.
2012;23(4):307-14. Epub 2012/03/23. 17. Whitaker RC, Orzol SM. Obesity among US urban
7. Berg A, Beyer K, et al. World Allergy Organization preschool children: relationships to race, ethnicity, and
(WAO) Diagnosis and Rationale for Action against socioeconomic status. Archives of pediatrics & adoles-
Cow's Milk Allergy (DRACMA) Guidelines. Pediatric cent medicine. 2006;160(6):578-84. Epub 2006/06/07.
allergy and immunology: official publication of the 18. Irigoyen M, Glassman ME, Chen S, Findley SE. Early
European Society of Pediatric Allergy and Immunology. onset of overweight and obesity among low-income
2010;21 Suppl 1- to 5-year olds in New York City. Journal of urban
8. Mehta H, Ramesh M, Feuille E, Groetch, Wang J. Growth health: bulletin of the New York Academy of Medicine.
Comparison in Children with and without Food Aller- 2008;85(4):545-54. Epub 2008/05/13.
gies in 2 Different Demographic Populations. Journal of 19. Taveras EM, Gillman MW, Kleinman KP, Rich-Edwards
Pediatics: submitted and accepted JW, Rifas-Shiman SL. Reducing racial/ethnic disparities
9. Mei Z, Scanlon KS, Grummer-Strawn LM, Freedman in childhood obesity: the role of early life risk factors.
DS, Yip R, Trowbridge FL. Increasing prevalence of JAMA pediatrics. 2013;167(8):731-8. Epub 2013/06/05.
10
t f h :
he uture is ere
ent B s t B o
s ring urgical reatment ack to the ffice
Daniel R. Gold, M.D.
Otolaryngology & Head and Neck Surgery
ENT and Allergy Associates, LLP
m

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.

y

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e
T
l he otolaryngologist is available to treat a variety Nasal airway surgery in office - The patency of the nasal

l of disorders in the head and neck area through airway can be reestablished through reduction of nasal
advanced diagnostic, medical and, when necessary, turbinates and mild septal deviation. Newer understanding
a
surgical intervention. The facial area is one of of the flow dynamics and functioning of the nasal airway
d
great concern to individuals and the utmost care must passage allows more precise modifications of nasal structures

n be taken in its treatment. We recognize that the role of a giving maximal benefit.
patient can be a stressful situation in many facets, especially
a
when surgery is being considered. The concerns can vary Surgical biopsy in office – Biopsy of thyroid, neck and

t
from those surrounding anesthesia to recovery period to lymph node masses under ultrasound guidance provide

n the uncertainty of a new “hospital environment”. In the last efficient and accurate diagnosis of potential disorders of
few years, advances in technology have allowed physicians the head and neck region. Advance cell handling and
e
to more readily perform effective surgical treatments processing allows accurate tissue diagnosis of a variety of
in the comfort of an outpatient office setting. In a local head and neck disorders.
otolaryngology office, many of those procedures once
relegated to the operating room can be safely and effectively Tonsillectomy in office – Reduction of palantine tonsil tissue
performed in the comfort of the exam chair. These procedures can be safely performed to treat issues of recurrent tonsillar
can now be done with local or minimal anesthesia. The post debri and significantly enlarged tonsils. These techniques
procedure recoveries have been shortened to hours or a may spare many individuals from needing to undergo the
few days. Patients can now undergo these procedures in an prolonged recovery of a formal tonsillectomy.
afternoon and many return to work the next day.
Voicebox surgery in office – Removal of vocal lesions and
So what can we offer our patients:
injection of medications can efficiently be performed under
Sinus surgery in office - Streamline dilatational balloon videoscopic guidance. Dr. Chikara shares his experience
technology and instrumentation allow the opening with us later in this issue.
of obstructed sinus ostia and remodeling of scarred/
blocked sinus cavities in a controlled and accurate fashion. This is an exciting time to be a physician and an ever
Utilizing minimally invasive techniques and precise tissue improving time to be a patient. Through leveraging of the
manipulation, the health of the sinuses can be restored with best information and technology, individuals today can live
minimal injury to surrounding normal structures. easier healthier lives.