More from December 2012 - Vol. 31 No. 12
Andrew G. Shuman, MD, Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
The story of Clementine Paddleford, a laryngeal cancer survivor, who thereafter became the most famous culinary journalist of her time, would be remarkable in any era. The fact that she accomplished this feat 80 years ago makes it simply extraordinary.
Through archival research, the oft-forgotten tale of Clementine Paddleford may be shared with a new generation. An aspiring journalist from Kansas, Paddleford developed hoarseness shortly after arriving in New York in 1931; subsequent workup confirmed laryngeal cancer. Perhaps no individual better encapsulates the potential consequences of head and neck cancer than does a food writer; speech and swallowing are truly indispensable.
In an era when vocal rehabilitation after total laryngectomy was severely limited and conservation laryngeal procedures were still being developed, Paddleford and her surgeon at New York Hospital agreed to proceed with partial laryngectomy.
Thereafter, she persevered, never accepting that she was disabled. Her permanent metal tracheotomy tube morphed into a fashion statement, and her distinctive dysphonia became her calling card.
Paddleford penned a column with a weekly readership measured in the millions, and served as the food editor for a major newspaper in Manhattan during a decades-long tenure. She would pilot an airplane across the country, writing about regional cuisine decades before the topic became popular.
Paddleford’s success reminds us that cancer survivorship is not only measured in months or years. Even in modern surgical oncology’s infancy, functional outcomes were carefully considered, and quality of life was prized. As a testament to individual willpower and the ability of doctors and patients to forge partnerships with common goals, Paddleford’s legacy lives on.
*Based on Dr Shuman’s presentation at the Otolaryngology Historical Society’s 2012 meeting at the Cosmos Club, Washington, DC, September 10, 2012.
For a fuller description, please see the October issue of Otolaryngology–Head and Neck Surgery. Avishay Golz, MD, Rambam, Health Care Campus and Bruce Rappaport Faculty of Medicine
The Technion Department of Otolaryngology-Head and Neck Surgery, Haifa, Israel
Until 1911, there was no Ear Nose and Throat (ENT) specialist in Eretz-Israel. Moshe Sherman, MD, an ENT specialist, disembarked at the port of Jaffa on August 4, 1911. He acquired his medical education in Odessa and Berlin, graduated from the University of Dorpat (now Tartu), Estonia, and pursued postgraduate studies in otolaryngology in Moscow, Russia.
Dr. Sherman was the first otolaryngologist in the country and remained the sole specialist for almost one year. He lived and worked in Jaffa and every six months he went to Jerusalem for two weeks to examine patients and perform small operations. In January 1912, Dr. Sherman, together with five other physicians, laid the foundation for the first doctors’ organization in Israel—the Israel Medical Association of today.
Between 1911 and 1948, when the State of Israel was established, more than 100 otolaryngologists arrived in Israel and were dispersed throughout the country.
Karl Berenfeld, MD, opened the country’s first ENT department in 1925 at Bikur Holim Hospital in Jerusalem. Dr. Berenfeld studied medicine in Vienna, and practiced otolaryngology, also in Vienna, under the famous professors Markus Hajek, Gustav Alexander, and Heinrich Neumann.
Dr. Sherman and Dr. Berenfeld, together with other otolaryngologists, brought modern and advanced European medicine to Israel. Many left their imprint on the development of ENT medicine in the country, laying the foundation of today’s otolaryngologic services, both in clinical and academic spheres.
ENT medicine, like the other fields of medicine, evolved following the establishment of the State of Israel in 1948. Many departments were opened and equipped with the best modern instruments and technology. Department heads are the pupils of our pioneer physicians.
The book Otolaryngology in Eretz-Israel: 1911-1948 is dedicated to the memory of these pioneer physicians, to their work and their achievements. They should be remembered and cherished by their successors and all physicians in Israel.
The book (in Hebrew) can be purchased through the publisher Itay Bahur: www.bahurbooks.com or contact: email@example.com
Otolaryngology Historical Society
Many thanks to Professor Golz, who donated a copy of Otolaryngology in Eretz-Israel: 1911-1948 to the AAO-HNS Foundation’s historical collection, managed by the History Factory, Chantilly, VA. For inquiries, email firstname.lastname@example.org or call 1-703-631-0500.Reminder: If you have not yet renewed your OHS membership this year, email email@example.com or call 1-703-535-3738. Not yet a member? Visit http://www.entnet.org/HealthInformation/otolaryngologyHistoricalSociety.cfm. Anthony G. Del Signore, MD, Mount Sinai School of Medicine, Resident Travel Grantee
Ian M. Humphreys, DO, Michigan State University/Detroit Medical Center, Resident Travel Grantee
In July, we joined a medical missions trip led by Global ENT Outreach to Phnom Penh, Cambodia. This was the largest volunteer group to date for our host organization and included the following team members: Shaheen M. Counts, MD; Anthony G. Del Signore, MD; Ian M. Humphreys, DO; Marta Sandoval, MD; Richard Wagner, MD; and Charles Z. Weingarten, MD. We feel the experiences afforded to us by the AAO-HNSF Humanitarian Travel Grant were truly remarkable.
After nearly 20 hours of travel we reached the Cambodian capital of Phnom Penh. Our team of surgeons, nurses, medical students, and public health educators met for the first time in a tiny hotel. Our nationalities, ethnicities, and languages were diverse, but we shared a unified vision of providing otologic care and training to these people in need.
Only 30 years prior, an act of unspeakable genocide targeted the educated and professionals in this area; an entire generation of physicians, health educators, and nurses were eradicated. Today, a fractured healthcare system with poor infrastructure, limited resources, and inexperienced health professionals exists. Rehabilitative efforts, including a nascent otolaryngology residency-training program at the National Hospital Preah Ang Duong, are underway. However, otologic care in particular is poorly understood and under delivered.
The week began with a dedicated otologic clinic to further evaluate patients initially screened by Cambodian otolaryngologists. Many patients traveled great distances from the surrounding countryside to obtain long awaited care. In total, 120 patients were evaluated using either a teaching microscope or video endoscope. Forty-five surgeries were scheduled subsequently for the remainder of the week.
We saw a diverse spectrum of pathology, and patients including congenital malformations, chronic otorrhea, tympanic membrane perforations, cholesteatoma, and otosclerosis. Accordingly, surgical interventions focused on the management of chronic ear disease, with tympanoplasty and tympanomastoidectomy being the most frequent surgical procedures.
One goal reigned supreme: to create a dry, safe ear. Given the lack of readily available inhalational anesthesia, the majority of the procedures were performed under local anesthesia and intravenous sedation. All patients were admitted for overnight observation and subsequently discharged home with follow-up care to be provided by the Cambodian otolaryngologists.
Both in the clinic and operating room we had frequent opportunities to teach evaluative and diagnostic strategies, as well as surgical techniques. Despite obvious cultural and language barriers, we focused our collective efforts to achieve our mission. In the end, we provided high quality demonstrative surgery and instruction that serves as a model for continued development of the Cambodian otolaryngology training program.
Not only did we gain an appreciation for the difficulty of providing otologic care in a relatively impoverished part of the world with limited resources and a fractured health system, we also experienced the role of surgeon educator. In the end, our cultural awareness and sense of humanistic professionalism flourished throughout our Cambodian experience.
We are completely indebted to the support provided by the AAO-HNSF Humanitarian Efforts Committee and the Alcon Foundation for this wonderful experience and are confident that it has solidified our commitment to future mission endeavors. As the medical community has come to expect, part of the annual rulemaking process conducted by the Centers for Medicare and Medicaid Services (CMS) includes the annual issuance of new and modified CPT codes, developed by the American Medical Association’s (AMA) Current Procedural Terminology (CPT) Editorial Panel, for the coming year. In addition, CMS includes new, or updated, values—also known as relative value units (RVUs)—for medical services, which have undergone review by the American Medical Association’s Relative Update Committee (AMA RUC). CMS has the discretion to accept the RUC’s RVU recommendations for physician work, and their recommendations for direct practice expense inputs, or they may exercise their administrative authority and elect to assign a different value, or practice expense inputs, for medical procedures paid for by Medicare. The final value, as determined by CMS, is then publicly released in the final Medicare Physician Fee Schedule (MPFS) rule for the following calendar year.
The Academy is an active participant in both the AMA RUC valuation of otolaryngology-head and neck services, and the CMS annual rulemaking processes. As part of those efforts, we want to ensure members are informed and prepared for key changes to CPT codes and valuations related to otolaryngology-head and neck surgery serviced for CY 2013. The following outlines a list of coding changes, including new and revised CPT codes, and codes that were reviewed by the AMA RUC and could have modified Medicare reimbursement values for 2013:
In CY 2013, several new CPT codes will be introduced, including:
Two new codes to report pediatric polysomnography for children under the age of six. These services will be reported using new CPT codes 95782 and 95783.
Two new codes to report intraoperative neurophysiology monitoring in the operating room. This also includes new introductory language in that section of the CPT book. These services will be reported using new CPT codes 95940 and 95941.
Codes Reviewed by the AMA RUC
The AMA RUC reviewed several codes relating to otolaryngology and their RUC-approved values were submitted to CMS for final determination for the CY 2013 final rule. Members should be prepared for modified relative value units for some, or all, of these procedures in CY 2013. It is critical to note that once the final MPFS is issued by CMS, typically on or about November 1 of each year. Academy health policy staff will summarize the final rule and alert members to any critical changes in reimbursement for any of the following medical procedures. Services that were reviewed include:
31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)
40490 Biopsy of lip
69200 Removal foreign body from external auditory canal; without general anesthesia
69433 Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia
13132 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm
13151 Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm
13152 Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm
New codes for pediatric polysomnogoraphy
95782 younger than six years, sleep staging with four or more additional parameters of sleep, attended by a technologist
95783 younger than six years, sleep staging with four or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist
New add-on codes for intraoperative neurophysiology monitoring
+95940 Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure.)
+95941 Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (List separately in addition to code for primary procedure.)
As noted above, health policy staff will provide members with a detailed summary of CMS approved values for the above services once they are issued in the 2013 final MPFS. Should members have any questions regarding the above information in the meantime, email firstname.lastname@example.org.