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 g 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 d 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. e 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 (516) 200-1771 • [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 (631) 928-0188 Phone: (718) 971-2490 (516) 222-1881 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 (718) 748-5225 Hackensack, NJ 07601 (845) 471-4086 (201) 883-1062 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 (718) 833-0515 Suite 303 Purchase, NY 10577 Hoboken, NJ 07030 (914) 253-8070 radiologists who are Board Certified, Sub- Bayside (201) 792-1109 mm 2B1a0y-s3id3 e2, 6NthY A 1v1e3.,6 G0round Floor Lake Success Riverhead Specialty trained and ready to meet your (718) 631-8899 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 (631) 727-8050 Board Certified and Sub-Specialty Trained in: cc 245 Route 22, 3rd Floor (516) 775-2800 . . 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 (732) 389-3388 • Nuclear Medicine • Brain Spectroscopy • Bone Density r g 3(10 0P iCerardempoannt PPllaazzaa )West (888) 350-1368 Sleepy Hollow • Ultrasound • Prostate Spectroscopy • Digital X-Ray Suite 1301, Brooklyn, NY 11201 er New Rochelle 358 North Broadway (718) 208-4449 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 (212) 571-0355 (914) 949-3888 • Nationally recognized radiology team. (718) 863-4366 d 103 Executive Drive 365 County Road, 39A a 3rd Floor, Suite 500 Benton Plaza Wayne Woodbridge (Iselin) Carmel • Speak with your radiologist in person between the hours of 9 A.M. - 4 P.M. Monday through Friday n New Windsor, NY 12553 Unit #3 1211 Hamburg Turnpike 485 Route 1 South d 670 Stoneleigh Avenue (845) 562-0760 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 (631) 283-1142 Wayne, NJ 07470 Iselin, NJ 08830 n Carmel, NY 10512 Old Bridge (973) 633-0808 (732) 549-3934 t (845) 279-9500 • 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 (732) 679-7575 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 (212) 722-5570 (718) 370-0072 (845) 727-1370 (914) 963-8588 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. South Penthouse Oradell, NJ 07649 Suite 2A 2nd Floor Suite 206 Englewood, NJ 07631 (201) 722-9850 Tuckahoe, NY 10707 New York, NY 10024 Yorktown Heights, NY 10598 (201) 567-2771 (914) 961-2515 (212) 600-9411 (914) 245-2681 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 (212) 679-3499 (973) 394-1818 Tarrytown, NY 10591 NEWMAN STREET IMAGING NEW CENTURY IMAGING Fishkill Patchogue (914)333-5800 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 (845) 896-1809 (631) 654-3833 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 o c . y g r 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.