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Pediatric otolaryngologist and Principal Investigator Keiko Hirose, MD, knows well the risk of CMV infection in utero. Her lab studies the interaction of immune cells and damage to the inner ear.

CMV is a common virus that rarely causes problems in healthy individuals. Women who experience CMV infection during pregnancy can pass the virus to the fetus, and this can cause severe disease or no disease at all, and symptoms may not be obvious for months or years after birth. The most common of these late symptoms include hearing loss and developmental delay.

According to Hirose, timing of exposure to CMV is an important factor.

“The blood-labyrinth and blood-brain barriers protect the ear and brain from infections, but before birth and in young infants, these barriers are not fully developed,” she explained.

According to Hirose, little is known about the mechanisms that control the normal development of the blood-labyrinth barrier or what events could disrupt this normal development.   It is also not understood how CMV affects the developing ear, which cells are infected, and which cells are damaged by the virus or by the host immune response to the virus.  The study plans to address some of these unknowns by investigating the following areas:

• Explore the timing of the developing blood-labyrinth barrier in healthy newborn mice and in mice born with CMV infection
• Determine which cells are impacted by the virus and if that cell death contributes to hearing loss
• Explore the role of interferons – proteins that help the immune system fight infections – in CMV-induced hearing loss

Collaborators on the project include University of Alabama-Birmingham pediatric infectious disease specialist William Britt, MD;  WashU Associate Professor of Otolaryngology Mark Rutherford, PhD; and Michael Hoa, MD, a specialist in auditory development and restoration at NIH.

The goal is to improve our understanding of how the immune system works in the inner ear, what immune elements are critical for preventing and eliminating infections, and how immune function might contribute to inner ear damage and hearing loss.

To learn more about this work, please contact Keiko Hirose, MD.

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Formerly housed on the 11^th floor of the Center for Advanced Medicine, the division now occupies one full hallway on the 5^th floor of Siteman’s new ambulatory care building. The move provides the team with a larger space, and one specifically designed for their patients.

For the first time, medical oncology and surgery are co-localized for head and neck cancer patients, with plans to integrate radiation oncology as well. This affords patients a true integrated, multi-disciplinary experience.

For Division Chief of Head and Neck Surgery Sid Puram, MD, PhD, the new space offers many new opportunities.

“The new ambulatory care building offers a dedicated space for cancer care, which is a major step forward for Siteman Cancer Center, Washington University, and the broader community we serve,” he said. “To be within a few feet of our fellow treating physicians in other specialties, offers streamlined care, ensures a multi-disciplinary approach, and maximizes participation in clinical trials that are pushing the frontier of head and neck cancer care.”

The new suite centralizes many of the services offered to patients and includes:

• seven exam rooms
• one procedure room
• two speech-language pathology evaluation rooms
• a research participation consent room
• office space for speech-language pathologists, medical assistants and other clinical staff

Technology integration in the new building is another major highlight. All exam rooms are equipped with fiberoptic scope towers, and all scope exams are uploaded to the cloud. In the near future, these will automatically be integrated into the Epic medical records system.

For Nurse Manager Laura Steinmetz, the move required some changes to workflow.

“Moving is never easy,” she said. “But we are enjoying the newness while we work out the kinks and adjust workflows to offer our patients the best care experience possible.”

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But it’s not just for surgery.

Audiology and Deaf Education students in WashU’s Program in Audiology and Communication Sciences (PACS) are taking advantage of the lab to review anatomy of the head and neck as part of their first-year course, Anatomy and Physiology of Speech and Hearing.

The collection of anatomical models and human specimens provides the students a unique hands-on approach to explore the structures they have only viewed in two dimensions as part of their classroom lectures.

Course instructor Brian Faddis, PhD, also manages the simulation lab. He has taught the course for almost 30 years and was eager to take advantage of the new facility.

“For years I lugged models and specimens over to the PACS classrooms in the CID Building,” he said. “Bringing the students to the laboratory provides them a more immersive experience by opening a wider array of equipment and other resources they can use.”

During the semester-long course, students will visit the lab three times, to review:

• head and neck anatomy, including bones and muscles of the region, as well as structures of the outer, middle and inner ear;
• the human brain; and
• airway structures related to speech and respiration.

Students also enjoy viewing a unique collection of stereoscopic slides of anatomic preparations. The collection was obtained by Max Goldstein, MD, founder of Central Institute for the Deaf, when he studied in Vienna in the early 1890s.

Audiology student Stephanie Bertino was surprised by what she saw.

“We always hear about these structures being so small they can fit on a dime, but getting to see the ossicles and cochlea with our own eyes it was hard to believe.” she said. “It makes the whole process of hearing even more fascinating because these tiny bones are what we rely on every day!”

Undergraduate student Gabriela Rojo loved the brain lab.

“It was so helpful to see and interact with the anatomy,” she said. “We were told to expect a few differences between the brains but seeing it up close in person was so cool! It was an amazing experience to be able to touch the brains and recognize the structures we have been learning.”

Though the lab was specifically designed for use by trainees in Otolaryngology, Neurosurgery and Ophthalmology, Faddis would like to see more campus groups take advantage of the facility. To learn more, visit the lab webpage.

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What is your current title, and how long have you been with WashU and what did you do before that?

My current title is Program Coordinator I. I have been around for over 26 years, with 21 of those years with PACS at WashU. Before that, I worked at Central Institute for the Deaf (CID) for approximately 5 ½ years. Initially, I was a Facilities Coordinator, then I transitioned to Information Systems Coordinator and finally I moved to the Professional Education department with Dr. William Clark and Beth Elliott.  In 2003, PACS officially transferred to WashU and the rest is history!

What do you like most about your work here?

I absolutely love what I do and enjoy working with the amazing people on our PACS team. They make coming to work each day so much fun and effortless. We truly make a fantastic team and complement each other perfectly. Most of us have been working together since our CID days, and they have come to be like my second family.

I have a variety of responsibilities in the department. One of my favorite and most fulfilling roles is working directly with our students. I enjoy being part of their academic journey and professional development, from when they are students to when they become alumni.

How would you describe life in the Miller household?

Life in the Miller household is pretty busy with our shared passion for soccer and our commitments to family. Our daughter Ava dedicated most of her time to club soccer for most of her young life, but now her time is spent navigating and adjusting to college life. My husband Brad has been coaching club soccer for over 11 years and continues to do so. Our schedule often involves attending and actively participating in various soccer events and spending quality time with family, and now that Ava is a freshman at Saint Louis University, we also make it a point to attend events (especially soccer) there.

Do you have a favorite activity or pastime?

I enjoy a variety of activities and pastimes. Apart from being a dedicated soccer mom and my husband’s and our daughter’s biggest fan, I also find joy in crafting, baking, and my newest passion – canning (such as making jams, sauces, jellies, and apple butter). I find these activities to be quite therapeutic. I wish I had more time to do them. Another favorite pastime of mine is celebrating St. Patrick’s Day in Dogtown, where we live. This holiday is very special to us, especially to my husband, who grew up there. Only the residents of Dogtown truly understand the unique feeling of this day. Additionally, we love to visit St. Augustine every summer to spend time with family. It’s a beautiful place with a rich history, and I always learn something new every time we visit.

Is there a special something at the top of your bucket list, and why?

At the top of my bucket list is traveling overseas, with Spain being the first place I’d love to visit. My grandfather came from a small town near Barcelona, and my great-great-great-grandfather was the Mayor of Madrid. I’m eager to explore Spain and delve into my family history. Our daughter is a freshman in the SLU Nursing Program and plans to spend a semester abroad at SLU’s campus in Madrid next year, so hopefully, this will be marked off my list soon.

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What is your current title and how long have you been with WashU ENT?

 I am an Audiologist and Speech Language Pathologist in the cochlear implant program.  I have been with the department for twenty-three years.  Before coming to Washington University, I worked in the otolaryngology department at SLU.  Prior to that I worked in various settings as a Speech Language Pathologist.

What do you like most about your work here?

I became interested in cochlear implants my junior year in college.  Even at that time, the strides recipients were making with the technology was fascinating.  I love working with people and getting to be a part of the journey these patients take with a cochlear implant.  Working with them to optimize their hearing and improve communication with the people around them is very rewarding.  In addition, I get to work with an amazing team of Audiologists and Otologists!

How would you describe life in the Vanderhoof household?

There is never a dull moment in the Vanderhoof household with everyone coming and going. My husband, Tim, and I have two daughters. Our oldest daughter Elise is a creative writing major at Webster University and lives at home. Our youngest daughter Amara is a junior in high school and is involved in several sports. Tim has retired from the public school system but keeps busy with odd jobs and volunteer work. Last but not least, our Doberman Willow and Weimaraner Luna who are always right there in the thick of things!

Do you have a favorite activity or pastime?

I have many different interests, not necessarily one favorite activity.  If my daughters are involved in something that is my priority, watching them and supporting their interests.  I enjoy being outside, taking a walk or going on a hike with the dogs.  My husband’s family has a small cabin on a lake in Northern Minnesota, it is beautiful there and we enjoy many lake activities each summer.

Is there a special something at the top of your bucket list, and why?

We love to travel so there are numerous places I would like to visit that are on the bucket list.  Believe it or not, one thing I have always wanted to do is fly a plane.  I’m not sure it will ever happen, but you never know!

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Poster Presentations

Cross-Sectional Area of Skeletal Muscle Is Associated With Swallowing Function in Oral Cancer
Nikhil T. Vettikattu, Seth E. Amos, Andre Burnham, Lauren Ottenstein, Mark W. El-Deiry, Nicole C. Schmitt

Metabolomic Profiling of Nodal Metastasis in HPV-Negative Head and Neck Squamous Cell Carcinoma
Chareeni E. Kurukulasuriya, Wesley Cai, W. Temple Andrews, Richard A. Harbison, Umamaheswar Duvvuri

Opioid Dependency After Craniomaxillofacial Trauma Surgery
Amrita Hari-Raj, Sai Challapalli, Matt Keller, Joanna Buss, Dorina Kallogjeri, Jay Piccirillo, Emily Spataro

Use of Topical Furosemide to Reduce Nasal Polyp Relapse and Intraoperative Bleeding: A Systematic Review
Jenilkumar H. Patel, Andrew Parker, Milee Patel, Mahant Malempati, Nicholas Mankowski, Edward D. McCoul

Oral Diet Outcomes After Submental Island Flap Reconstruction of Oral Cavity and Oropharyngeal Cancer Defects
Michael Wu, Matthew Kovoor, Derrick Lin, Jeremy D. Richmon, Daniel G. Deschler

Inflammatory-Arthritis Associated Sinusitis: A Unique Form of Vasculitis?
Amrita Bhat, Collin Diffie, Rebecca Chernock, Lauren Roland, John Schneider, Nyssa Farrell

Oral Presentations

Long-Term Outcomes of HPV+ Squamous Cell Carcinoma of Unknown Primary Treated With Transoral Surgery
Thomas Barrett, Kwasi A. Enin, Patrik Pipkorn, Evan Graboyes, Paul Zolkind, Richard Harbison, Jason T. Rich, Anthony J. Apicelli, Peter Oppelt, Hiram Gay, Douglas Adkins, Wade Thorstad, Sidharth V. Puram, Ryan S. Jackson

Speech Performance Following Intraoperative Correction of Cochlear Implant Electrode Array Tip Fold-Overs
Miriam Smetak, Matthew Shew, Jordan Varghese, Cameron Wick, Nedim Durakovic, Craig Buchman, Jacques Herzog

Great Debate: Controversies in Cochlear Implantation: The Value of Emerging Technology
Craig Buchman

Complications of Pediatric Rhinosinusitis in the COVID-19 Era
Amrita N. Bhat, Johnny C. Wang, David W. Molter, Maithilee D. Menezes, Kate Dunsky, Judith Lieu

Updated Results: Impact of Margins in HPV-Related Oropharyngeal Squamous Cell Carcinoma Treated With Robotic Surgery
William A. Strober, Dorina Kallogjeri, Molly N. Huston, Matthew L. Rohlfing, Jay F. Piccirillo

Development and Validation of a Shortened Severity Measurement Tool for Tinnitus
Lauren E. Mueller, Emma R. Dear, Juan A. Turcios, Harrison J. Smith, Madelyn Frumkin, Thomas L. Rodebaugh, Dorina Kallogjeri, Jay F. Piccirillo

Adverse Pathological Prognostic Factors in Surgically Treated HPV-Positive Oropharyngeal Squamous Cell Carcinoma
Salma Ramadon, Angela Mazul, Randal C. Paniello, Jose P. Zevallos, Patrik Pipkorn, Ryan S. Jackson, Sidharth V. Puram

Swallowing Outcomes of HPV+ OPSCC Survivors by POA(C)RT Dose in the MINT and E3311 Cohorts
Theresa Tharakan, Wade L. Thorstad, Douglas Adkins, Jose P. Zevallos, Sidhart V. Puram, Ryan S. Jackson

How to Approach Margins in Head and Neck Cancer: A Practitioner’s Guide
Sidharth V. Puram, Stephen Y. Kang, Mark A. Varvares

Keepin’ It Local: Mastering Local Flaps for Scalp Reconstruction
Jason T. Rich, Rosh K. V. Sethi

Immunophenotyping invasive fungal sinusitis survival
Lauren Roland

Great Debate: Refractory Epistaxis: To Operate or To Embolize?
John S. Schneider

Updated Results: Impact of Margins in HPV-Related Oropharyngeal Squamous Cell Carcinoma Treated With Robotic Surgery
Omar A. Karadaghy, Michael P. Wu, Marie Armache, Nadia L. Samaha, Rohith Bhethanabotla, Danielle M. Gillard, Swapnil V. Shah, Abigail E. Reid, Carole Fakhry, William R. R. Ryan, Jeremy Richom, Andrew J. Holcomb

Persistent lateral canal ageotropic nystagmus after cochlear implantation
Jordan Varghese, Mary Crumley, Lauren English, Belinda Sinks, Joel Goebel, Nedim Durakovic

Improving Multimodal Analgesic Use at Discharge After Inpatient and Outpatient Otolaryngologic Surgery
Karolina Plonowska-Hirschfeld

Amyloid and Tau Proteins: Potential Perilymph Biomarkers for Cochlear Implant Performance?
Amit Walia, Matthew A. Shew, Nedim Durakovic, Jacques A. Herzog, Melissa Manis, David M. Holtzman, Craig A. Buchman, Mark A. Rutherford

Intensity-Based Tonotopic Mapping: A Promising New Standard in Cochlear Implant Programming
Amit Walia, Amanda J. Ortmann, Jordan A. Varghese, Shannon Lefler, Matthew A. Shew, Jacques A. Herzog, Craig A. Buchman

Moderator/Panelist Roles

Molly Huston, MD, served as moderator for a session on Laryngology/Broncho-Esophagology.

Judith Lieu, MD, MSPH, will serve as a panelist for a session on Pediatric Sensorineural Hearing Loss: The First Visit.

Allison A. Ogden, MD, will serve as a panelist for a session on Not Just for Pretty Faces: Botulinum Toxin Use in the Salivary Glands.

Sidharth V. Puram, MD, PhD, and Patrik Pipkorn, MD, will serve as panelists for, Reconstructive Showdown, 2024.

Sidharth V. Puram, MD, PhD, and Ryan S. Jackson, MD, will serve as panelists for, HPV+ Oropharyngeal Squamous Cell Carcinoma: A Surgical Approach to Management.

Sidharth V. Puram, MD, PhD, will serve as panelist for Older Cancer Patients: To Operate or Not to Operate, Part 2.

Nyssa Farrell, MD, will serve as a panelist on, Endoscopic vs Open/hybrid Approaches to the Lateral Frontal Recess.

Ryan S. Jackson, MD, will serve as moderator for a session on, Late-Breaking Scientific Orals: Head and Neck Surgery.

Lauren Roland, MD, MSCI, will serve as moderator for a session of oral presentations on Rhinology/Allergy.

John S. Schneider, MD, MA, will serve as a panelist for, Put Me in Coach: Importance of Mentorship, Coaching, and Sponsorship.

Cameron Wick, MD, will serve as panelist for, Best of FLEX: Pearls and Pitfalls in Evaluation/Management of Ear Canal Masses and Temporal Bone Imaging for Surgical Decision Making.

Cameron Wick, MD, will serve as moderator for a panel discussion on, Dermatology for Otology – Management of Ear Canal Pathologies.

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Hosted by the Practical Anatomy and Surgical Education lab at Saint Louis University, the event, held September 7 was co-directed by Washington University rhinologist Nyssa Farrell, MD, and Joe Brunworth, MD, from SLU.

The course provided ENT residents valuable exposure to sinonasal anatomy; functional endoscopic sinus surgery; frontal sinus surgery; and skull base surgery. Provided lectures included information on medical therapy for chronic sinusitis, nasal airway obstruction, and pediatric sinus disorders.

Faculty and residents from a number of academic medical centers across the Midwest were present, including WashU rhinologists John Schneider, MD, and Lauren Roland, MD, MSCI, in addition to Farrell. WashU residents in attendance were James Bao, MD, Samuel Cler, MD, Andrew Peterson, MD, MSCI, Javier Rincon, MD, and Daniel Romano, MD.

“The course overall was a huge success,” said Farrell. “Not only did it allow residents to interact and learn from prominent rhinologists across the Midwest, it also allowed them to work with residents of other training programs and to see how techniques can vary amongst surgeons.”

For third year ENT resident Andrew Peterson, MD, the benefits of the workshop were evident.

“The sinus course was fantastic,” he said. “The high faculty-to-resident ratio allowed for a useful cadaver dissection coupled with pertinent lectures throughout the day. I feel more prepared to address complex sinus and skull base disease moving forward.”

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The WashU contingent offered a pair of presentations at this year’s meeting:

• Factors Associated with Dizziness Handicap in Patients with Vestibular Schwannoma
  Nedim Durakovic, Nicholas Rapoport, Lauren English, Belinda Sinks, and Joel Goebel
• Is Superior Vestibular Neuritis the Bell’s Palsy of the VIIIth Nerve?
  Joel Goebel

Founded in 1960, the Society is named after Robert Barany, otolaryngologist at University of Uppsala, Sweden, who received the Nobel Prize in 1916 for his groundbreaking work on the function and pathology of the vestibular system.

The meeting is held every two years in a different city but returns to Uppsala every six years. The conference provides support for research and education and promotes evidence-based consensus and standardization regarding defining syndromes, diseases, diagnostic procedures, and treatments in the field of neurotology.

For Goebel, passing the torch to Durakovic was memorable and indicated that the opportunity to interact with the best in the field was exciting for his younger colleague.

“I think this trip will be a real catalyst for Nedim’s career,” suggested Goebel. “We enjoyed five beautiful days in Uppsala and between us gave two oral presentations and one panel discussion on the multidisciplinary team approach to dizziness. Vestibular medicine is an exciting field, and we never stop learning!”

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The procedure was developed ten years ago in Thailand but is still relatively new in the United States. Harbison learned the technique during his head and neck surgical oncology fellowship at Johns Hopkins University.

The thyroid gland produces hormones that play a critical role in regulating the body’s metabolism. According to the American Thyroid Association, more than 12% of the American population will develop some sort of thyroid disease, with women affected 5-8 times more than men.

For those facing surgery as a corrective measure, visible evidence of surgery or scarring can be a major concern, for both cosmetic and health privacy reasons.

Thyroid removal is often necessitated for a variety of serious condition, including:

• Presence of a cancerous or pre-cancerous nodule
• Enlarged symptomatic thyroid nodule
• Hyperthyroidism (overactive thyroid) that does not respond to other medical treatments

The procedure utilizes three small incisions made inside the lower lip. Through these incisions, the surgeon can place endoscopic and robotic instruments to remove the thyroid gland.

The procedure is feasible with both robotic and conventional endoscopic instrumentation providing significant ergonomic benefits for the surgeon, allowing them to operate with precision and comfort by looking directly at a screen.

“The head and neck surgery team at WashU performs hundreds of thyroid surgeries each year,” said Harbison. “The transoral approach offers a safe and effective alternative to conventional surgery, allowing patients to avoid visible neck scars.”

Transoral thyroidectomy has demonstrated highly reproducible results in high volume institutions. Post-operative care includes simple mouthwash 3X daily for several days, and most patients can eat a soft diet for dinner the evening following surgery. This technique represents a significant advancement in the field of thyroid surgery, aligning medical outcomes with patient concerns for better overall care.

For more information on transoral thyroidectomy, contact Alex Harbison, MD.

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