the magazine PDF - South Florida ENT Associates

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