Voice and Throat Disorders In This Section: Airway Stenosis Chronic Cough Dysphagia (difficulty swallowing) Spasmodic Dysphonia Zenker’s Diverticulum Airway Stenosis ​Author: Ahmed M.S. Soliman, MD Overview: The term stenosis refers to the abnormal narrowing of a tube-shaped organ. In the human airway, the three main areas where this can occur are in the larynx (voice box), subglottis (just below the vocal folds), and trachea (windpipe). The main cause of laryngeal narrowing is having had a breathing tube in place. Other causes include certain autoimmune/rheumatological conditions (Wegener’s granulomatosis, Sarcoidosis Relapsing polychondritis, Amyloidosis), trauma to the neck or voice box, and surgery, or radiation to the larynx. Symptoms: Symptoms include noisy breathing, coughing, and shortness of breath. It is frequently misdiagnosed as asthma. The symptoms may become quite severe and life threatening. What to Expect at Your Otolaryngologist Office Visit: Evaluation will start with a complete examination of the head and neck. It will also include examination of the nose, voice box and the throat using a laryngoscope. Your doctor may order a chest X-ray, CT or other tests as appropriate. If you have had any of these already done, please bring them with you to the visit. Treatment: Treatment usually starts with evaluation of the larynx, subglottis, and trachea in the operating room. Endoscopic treatment with the laser and dilation is usually successful although sometimes, surgical reconstruction through the neck is necessary. Chronic Cough Author: Ahmed M.S. Soliman, MD Overview: A chronic cough is a cough that persists for eight or more weeks. Chronic cough can lead to exhaustion, rib fractures, vomiting, hoarseness and lightheadedness. Symptoms: Chronic cough is a symptom and not a diagnosis. It is typically the result of an underlying condition or health factor. The most common of these include tobacco use, certain blood pressure medications, asthma, chronic rhinosinusitis, and acid reflux. Other causes of chronic cough include respiratory infections, and chronic bronchitis. What to Expect at Your Otolaryngologist Office Visit: Evaluation will start with a complete examination of the head and neck. It will also include examination of the nose, voice box and the throat using a laryngoscope. You may be given some food to eat while the doctor examines your throat (called flexible evaluation of swallowing or FEES). Your doctor may order a chest X-ray, modified barium swallow, esophagram, sinus CT or other tests as appropriate. If you have had any of these already done, please bring them with you to the visit. Treatment: Treatment will depend upon what the underlying cause or causes. This may include dietary and behavioral modifications, antibiotics, antireflux medications, inhalers, etc. Dysphagia (difficulty swallowing) Authors: Nausheen Jamal, MD – Department of Otolaryngology-Head & Neck Surgery, Lewis Katz School of Medicine, Temple University Overview: Dysphagia refers to any difficulty swallowing that a person may have. This difficulty may occur in many different forms and will affect a person’s ability to eat or drink in the upper digestive tract – in other words, anywhere from the lips down to the stomach. Causes of dysphagia vary as well. These include weakness of throat muscles, “pouches” within the throat or food pipe, narrowing of the throat or food pipe, muscle spasms, trouble with coordination within the throat or food pipe, or even issues with the teeth or dentures. Sometimes other medical conditions can lead to dysphagia. These include medications, prior stroke, any tumors, and prior surgeries. Trouble with swallowing can cause drastic quality of life issues. In addition, it can lead to serious medical complications, such as pneumonia, malnutrition, and undesired weight loss. Symptoms: ​ Coughing and choking during eating Extra time needed to eat meals Avoiding or having difficulty with certain food consistencies because of swallowing difficulty Drooling Difficulty chewing Difficulty starting a swallow Waking up at night choking or drooling Food coming back up into the throat or nose during eating Feeling food stick in the throat or chest History of pneumonia Weight loss and malnutrition What to Expect at Your Otolaryngologist Office Visit: A careful examination of your mouth and throat will provide your doctor with a lot of information. Your otolaryngologist may perform specialized tests, including a laryngoscopy (“scope” procedure through your nose and into your throat), a swallow evaluation, and possibly even a procedure to look in your food pipe. It is possible that your otolaryngologist will order specialized testing, including x-ray swallow tests (such as a barium swallow or modified barium swallow). You may be given a referral to see a speech pathologist who is also trained in swallow disorders. Treatment: Because the causes of swallow disorders vary, so do the treatments. Generally speaking, swallow disorders that are caused by issues of weakness or lack of muscle coordination are treated with swallow therapy, which is like physical therapy for the swallowing muscles of the throat. This therapy is performed by a speech pathologist. Swallow disorders that are caused by areas of narrowing, “pouches,” certain types of muscle spasms, voice box movement disorders, or tumors are typically treated with surgery. Most of these surgeries are performed endoscopically, meaning that they are performed through the mouth without a need for incisions in the neck. Sometimes, however, a surgery that requires an incision in the neck is needed. Most surgeries require staying in the hospital for at least one night following the operation. A few minimally invasive surgeries may allow discharge on the same day as the operation. Your doctor will discuss if surgery is the right option for you, and what an operation might involve. Spasmodic Dysphonia Author: Ahmed M.S. Soliman, MD Overview: Spasmodic dysphonia (SD) is a rare neurologic disorder in which the larynx experiences involuntary spasms. There are three forms of the condition, adductor SD, Abductor SD, and Mixed SD, each with distinct vocal symptoms. It is estimated that roughly 50,000 people in North America have some form of SD. The condition usually sets in gradually during middle age, and is more likely to affect woman than men. Symptoms: Adductor SD, the most common form, causes the vocal folds to involuntarily close while speaking. The speech of someone with adductor SD sounds choppy, strained or strangled. Abductor SD is much less common and causes the vocal folds to involuntarily open with speaking that they do not vibrate properly. As a result, the voice may sound soft, weak or breathy. Mixed SD has features of both types and is rare. What to Expect at Your Otolaryngologist Office Visit: Evaluation will start with a complete examination of the head and neck. It will also include examination of the larynx or voice box using a laryngoscope. The examination is often videotaped and played back. Your doctor may order an MRI of your brain, and evaluation by Neurology and Speech Pathology. Treatment: Treatment usually involves weakening of the overactive muscle group with botulinum toxin. This treatment is usually done in the office and is highly successful. Voice therapy is often used as an adjunct to treatment. Rarely surgical procedures of the larynx are performed for this. Zenker’s Diverticulum Author: Ahmed M.S. Soliman, MD Overview: Zenker's diverticulum is a pouch that forms in the throat, where the esophagus meets the uppr part of the throat called the pharynx. The pouch forms by pushing through a weakened portion of the pharynx and balloons outward. The condition tends to occur in patients over 60 years but may occur in younger patients. It does not appear to be hereditary. Symptoms: The main symptom of Zenker's diverticulum is dysphagia, or difficulty swallowing. Undigested food or liquid can rise back into the throat and mouth even hours after swallowing. Other symptoms include choking, a buildup of mucous in the throat, bad breath, hoarseness, and recurrent pneumonias. What to Expect at Your Otolaryngologist Office Visit: Evaluation will start with a complete examination of the head and neck. It will also include examination of the voice box and the pharynx using a flexible laryngoscope. You may be given some food to eat while the doctor examines your throat (called flexible evaluation of swallowing or FEES). If you have had a swallowing test, please bring it with you. Otherwise, your doctor will likely order one. Treatment: In cases of mild dysphagia, Zenker's diverticulum can be treated with lifestyle changes. These include: Avoiding fatty, spicy and acidic foods, thoroughly chewing foods before swallowing, drinking lots of water after eating. If the dysphagia is severe, there are a variety of surgical options. The exact procedure our surgeons use will depends on the size and location of the diverticulum and include: ​ Cricopharyngeal myotomy: This procedure is ideal for removing small diverticula. It can be performed directly through the mouth with the laser or through a small incision in the neck. Endoscopic diverticulotomy: This option involves dividing the wall between the esophagus and the diverticulum using the laser or a special staper/cut device. Once the wall is divided, food particles stuck inside the pouch are free to drain into the esophagus. The vast majority of Zenker’s diverticula are treated successfully in this minimally invasive manner. Diverticulectomy and cricopharyngeal myotomy: This procedure is the complete removal of the pouch along with a cricopharyngeal myotomy and is used for a small percentage of patients where the sac is very large or cannot be accessed through the mouth. It is done through a small neck incision.

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Advocacy Update Governor Shapiro unveiled his Fiscal Year 2024-2025 budget in February. This proposal represents an 8.4% increase ($3.7 billion) over the prior fiscal year. The Pennsylvania General Assembly will now grapple with the details with an eye towards final passage by the end of June. ​ The budget document shows an 8.5% increase in the Department of Health. Of note are three new initiatives: ​ 1. Ten million for the Long-Term Care Transformation Office 2. One million for Firearm Injury Prevention 3. Four million for Medical Debt Relief The entire budget tracking spreadsheet c an be accessed here: 2024-25 PA Budget ​ What we're watching... ​ Medical Licensure Compact Act Although Pennsylvania enacted a medical licensure compact act in 2016, it remains to be one of four states that continues to experience delays in implementation due to language concerns with the FBI over background checks. Once this obstacle is removed, final enactment will take place directly. We are tracking impact on otolaryngology. Septoplasty In December 2023, Highmark BC/BS issued a Policy Directive that stated that a twelve week course of either an intranasal antihistamine or intranasal steroid would be required prior to procedure approval. In February, Highmark issued a Policy Update that reduced the treatment course from twelve weeks to four weeks before approval would be granted. This policy change is to become effective on May 27, 2024. PAO, with AAO, is working on letters to Highmark, the Pennsylvania Insurance Commission, and the Senate and House Insurance Committees to indicate opposition to this policy change. Another septoplasty issue has arisen lately, Highmark’s refusal to reimburse for debridements after sinus surgery. Highmark claims that this procedure is not just part of post-operative care. This issue will be further flushed out with PAO actively expressing concerns with this issue. ​ ​ ​2024 General Assembly Session Dates STATE HOUSE OF REPRESENTATIVES June 3, 4, 5, 10, 11, 12, 17, 18, 24, 25, 26, 27, 28 STATE SENATE June 3, 4, 5, 10, 11, 12, 24, 25, 26, 27, 28, 29, 30

Member Benefits The following are the benefits you will receive as a member of PAO-HNS: ​ Soundings Newsletter Members receive hard copies of Soundings, the PAO-HNS member newsletter. ​ Legislative Representation Representation in the state legislature via our own lobbyist. ​ Direct Input with Medicare Representation on the Novitas Solutions Carrier Advisory Committee (CAC), which has input into local Medicare reimbursement policy. ​ Specialty Events Listings Members may post their specialty events at no cost. ​ Priority Review for ENT Journals Priority review for possible publication in ENT Journal, the official journal of the PAO-HNS. ​ National Representation Representation on the American Academy of Otolaryngology-Head Neck and Neck Surgery's Board of Governors. ​ Discounted Registration for Annual Science Meeting Discounted registration to our annual Scientific Meeting featuring CME-approved educational seminars focused on current otolaryngology topics and family-oriented social functions.

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Meeting Archive Congratulations to the following winners: First Place Oral Presentation: Effects of Hypoglassal Nerve Simulation Surgery on Rhinologic Quality of Life - A Cohort Study Glen D'Souza, MD Thomas Jefferson University ​ Second Place Oral Presentation: Cost Effectiveness of Non-Eco Planar Diffusion Weighted MRI in the Surveillance of Cholesteatoma Terral Patel, MD University of Pittsburgh Medical Center First Place Poster: The Use of Actigraphy to Assess Sleep Improvement After Parathyroidectomy Christopher Tseng, MD Penn State Health Medical Center Second Place Poster: Efficacy of Fibrin Sealants in Reducing Postoperative Complications in Facial Plastic Surgery Hanel Eberly Penn State Health Medical Center Resident Jeopardy Bowl Winner: Combined team from AHN, UPMC, PCOM Congratulations to the following winners: First Place Oral Presentation: Endoscopic Versus Microscopic Ear Surgery for Management of Cholesteatoma: A Cost Effectiveness Analysis Lauren Gardiner, MD University of Pittsburgh Medical Center Second Place Oral Presentation: The Effects of Adjuvant Radiotherapy on Survival in Elderly Patients with Advanced Head & Neck Squamous Cell Carcinoma Joann Butkus, MD Thomas Jefferson University Hospital First Place Poster: Acoustic Neuroma: A Surveillance, Epidemilogy, and End Results (SEER) Analysis Thomas Haupt, MD Howard University Second Place Poster: Viral Integration and Genomic Instability in HPV-Transformed Tonsillar Keratinocytes Emily Milarchi, MD Pennsylvania State University Resident ​Jeopardy Bowl Winner: ​Geisinger Medical Center Congratulations to the following winners: First Place Oral Presentation: Validity of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) in a Pediatric Population Kelly Daniels, MD UPMC Second Place Oral Presentation: Human Papilloma Virus Integration Strictly Correlates with Global Genome Instability in Head and Neck Cancer Max Hennessy, MD Penn State Health Third Place Oral Presentations: Survivorship, At What Cost? Understanding Financial Toxicity in Patients with Head and Neck Cancer: A Systematic Review Shivam Patel, MD Penn State Health Clinical and Immunological Profile of Patients with Immune-Related Adverse Effects Following Treatment with Immune Checkpoint Inhibitors Angela Alnemri, MD ​Thomas Jefferson University Hospital Resident Jeopardy Bowl Winner: UPMC Pittsburgh Congratulations to the following winners: ​First Place Poster: Implant Failure and Osteomyelitis in the Setting of Selective Serotonin Reuptake Inhibitor Usage: A Case Report & Review of the Literature Katie Melder, MD University of Pittsburgh Second Place Poster: Post treatment Surveillance in Sinonasal Malignancies Prachi Patel, MD Thomas Jefferson University Hospital First Place Oral Presentation: Multi-institutional study utilizing surgery + cesium-131 brachytherapy in recurrent head and neck cancer Adam Luginbuhl, MD Thomas Jefferson University Hospital Second Place Oral Presentation: Analysis of spatial relationships between CD8 and FoxP3 cells using digital imaging in head and neck squamous cell carcinoma Uche Nwagu, MD Thomas Jefferson University Hospital Second Place Oral Presentation: Clinical Implications of the Integration Status of HPV in Head and Neck Cancer Brandon LaBarge, MD Penn State Health Resident Quizzo winners: Will Kennedy, MD and Ravi Shah, MD from the University of Pennsylvania. Congratulations to the following winners: First Place Oral Presentation: A Computer-Learning Neural Network Algorithm for the Radiographic Assessment of Thyroid Nodules : A Pilot Study Kelly Daniels​ Sidney Kimmel Medical College at Thomas Jefferson University Second Place Oral Presentation: Assessment of cranial base repair techniques in a validated cadaveric CPAP model Chandala Chitguppi, MD Thomas Jefferson University Hospital ​First Place Poster: Innervation of the Cricothyroid Muscle by the Recurrent Laryngeal Nerve and Implications for Clinical Practice Thomas Kaffenberger, MD University of Pittsburgh Medical Center Second Place Poster: Impact of gender on upper airway stimulation outcomes Kelly Daniels Sidney Kimmel Medical College at Thomas Jefferson University​ Resident Jeopardy Bowl Winners: B. Swendseid, MD, M. Chaskes, MD and J. Goldfarb, MD from Thomas Jefferson University Hospital Congratulations to the following winners: First Place Oral Presentation: Defining the role of CD169 macrophages in lymph node metastasis Michael Topf, MD Lewis Katz School of Medicine at Temple University ​Second Place Oral Presentation: High-Level Disinfection of Otorhinolaryngology Clinical Instruments: An Evaluation of the Efficacy and Cost-effectiveness of Instrument Storage Jason Yu, MD University of Pennsylvania ​Second Place Oral Presentation: Identification of Causative Mutations in Two Unrelated Kindreds with Familial Nonmedullary Thyroid Cancer Using Next-Generation Sequencing Darrin Bann Penn State Health Milton S. Hershey Medical Center ​​First Place Poster: Quality of Life Comparison of exenterated versus non-exenterated patients with sinonasal and craniofacial malignancies Alexander Graf, MD Thomas Jefferson University Hospital ​ Second Place Poster: Perfusion Dynamics in Pedicled and Free Tissue Reconstruction: Infrared Thermography and Laser Fluorescence Video Angiography Tom Shokri, MD Penn State Health Milton S. Hershey Medical Center Resident Jeopardy Bowl Winners: UMPC & PCOM

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Sponsors and Exhibitors Plan to join us in June for the 2024 Annual Scientific Meeting. PAO-HNS is planning a great meeting filled with networking and educational opportunities for you. Exhibitor registration is now open! Click the above image to view the full prospectus. $6,000 Year-Round Sponsorship Opportunity $3,500 Exhibitor Package Additional Sponsorship Opportunities Available (see full prospectus) NEW REGISTRATION PROCESS We have a new registration system which is a two step process. STEP 1: Create profile/account Step 2: Register Create Account & Register Thank you for your support!