Published: October 24, 2013

Academy Advocates Expanded National Coverage of Cochlear Implants for Sensorineural Hearing Loss

The Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) was established to provide independent guidance and expert advice to the Centers for Medicare and Medicaid Services (CMS) on specific clinical topics. MEDCAC input supplements CMS’ internal expertise. MEDCAC provides unbiased reviews and evaluations of medical literature, technology assessments (TAs), and data on the effectiveness and appropriateness of medical items and services that are covered (or may be eligible for coverage) under Medicare. MEDCAC judges and uses the strength of the available evidence to make recommendations on coverage to CMS. CMS selects a panel of up to 100 MEDCAC members who are experts in clinical and administrative medicine, biologic and physical sciences, public health administration, patient advocacy, health care data and information management and analysis, healthcare economics, and medical ethics. The panel meets about six times a year to review medical evidence for various topics, listen to public testimony, and provide advice about the quality of the evidence. For these meetings, CMS chooses 15 members who are knowledgeable on the topic to be discussed. CMS may also recruit non-MEDCAC members who have relevant expertise to provide additional input to panel members. The agency also invites independent experts to make formal presentations. On May 11, 2011, there was a MEDCAC meeting at the CMS head quarters in Baltimore. The topic for discussion was “Cochlear Implants (CI) for Sensorineural Hearing Loss.” During this meeting, MEDCAC considered and evaluated recent research (derived from the last revision [April 2005] of the National Coverage Determination [NCD] on CIs) on the health outcomes and quality of life (QOL) of unilateral and bilateral cochlear-implanted Medicare patients. To provide more context, we provide a summary of Medicare’s historical coverage for CI, a summary of the May 2011 MEDCAC meeting, and future implications for Medicare coverage for CI. Medicare Coverage for Cochlear Implants CMS first created the NCD for cochlear implants in 1986. Then, the agency covered post-lingual deaf patients. In 1992, the NCD was expanded to cover children with bilateral profound sensorineural hearing impairment with minimal or negligible benefit from hearing aids. In 1998, CMS further revised the NCD so it would reflect changes in technology and product labeling for CIs from the Food and Drug Administration (FDA). CMS last revised the CI NCD in April 2005. Currently, CMS covers cochlear implantation for the treatment of bilateral pre- or post-linguistic, moderate to profound sensorineural hearing loss in patients who demonstrate limited benefit from hearing aids (defined by test scores of =40 percent correct in the best aided listening condition on tape-recorded tests of open-set sentence cognition). In addition, the patient must also meet certain selection guidelines such as: • Have diagnosis of bilateral moderate to profound sensorineural hearing impairment with limited benefit from appropriate hearing (or vibrotactile) aids • Not have any contraindications to surgery • Not have any middle ear infection • Should be willing to undergo rehabilitation post-surgery • Should be implanted with an FDA approved CI • To view the full NCD on CIs, visit http://tinyurl.com/6xq9nt9 CMS also covers CIs in patients who fulfill the selection guidelines above and have hearing test scores ≥40 percent and ≤60 percent, and are enrolled with their providers in an FDA-approved clinical trial. It is important to note that, according to CMS staff, there have not been any clinical trial submissions. Also, the CI NCD does not address coverage for bilateral CI, which means that local Medicare contractors may use their discretion to determine coverage for bilateral CIs. This may potentially lead to inconsistent coverage patterns for CIs in various regions. According to data from Cochlear Americas, the average cost for each cochlear implantation is approximately $30,000. Given these high costs and that hearing loss is a top chronic condition in the U.S. (about 30 percent of Medicare beneficiaries suffer from some type of hearing loss), it was important for CMS to re-visit its coverage for CIs to determine if there was enough compelling evidence to support an expansion of coverage for these devices. This trend of CMS conducting reviews of data on health outcomes may become a general trajectory in CMS’ coverage policy development processes. Medical device and drug manufacturers will certainly need to take heed of these requirements and prepare in advance by conducting or sponsoring studies and randomized clinical trials and creating registries to provide more robust health outcomes data on their new products. Summary of the MEDCAC Meeting  As mentioned above, the MEDCAC panel that presided over the meeting consisted of primary care providers (nurse practitioners, family practitioners, geriatricians, and internists) and John K. Niparko MD, a leading expert in cochlear implantation. Because of its relevance to members, Academy staff and Jack J. Wazen MD, Implantable Hearing Devices Subcommittee member, attended the meeting as well as delegates from American Otological Society (including Debara L. Tucci, MD, who was invited as one of two speakers to give the panel background information on cochlear implantation), American Neurotology Society (including Craig A. Buchman, MD), American Academy of Audiology, American Speech-Language-Hearing Association, and the manufacturers of CI (Advanced Bionics, Cochlear Americas, and MED-EL). These subject matter experts also facilitated presentations supplying health outcomes data associated with bilateral and unilateral CIs. Prior to the meeting, CMS had commissioned the Agency for Healthcare Research and Quality (AHRQ) to conduct a TA, which was performed by the Tufts Evidence-Based Practice Center and completed in April 2011 with Dennis S. Poe, MD, serving as a consultant. In this TA, AHRQ concluded that the data it reviewed demonstrated efficacy of unilateral implants. AHRQ also determined that the current literature was of moderate quality with low to moderate level of evidence with regard to outcomes for bilateral cochlear implants. The study suggested further that larger studies using validated measures including specific health-related QOL measures are needed before determining long-term efficacy and the risks of bilateral implants compared to unilateral implants. To view the full TA, visit https://www.cms.gov/determinationprocess/downloads/id80TA.pdf. After listening to the various presentations from the subject matter experts, the MEDCAC panel answered (on a scale of confidence from one to five) 11 voting questions that addressed the use of CIs in adults with bilateral sensorineural moderate to profound hearing loss (HL) who show limited benefit from amplification. For example, the first voting question asked the panel’s confidence in whether there was enough evidence to determine if a unilateral CI improved health outcomes for adults with HL having tests scores of a. >40 percent and ≤50 percent  or b. >50 percent and ≤60 percent. Overall, the panel, as expected, closely mirrored the conclusion of the AHRQ assessment by agreeing there was inadequate data demonstrating the long-term benefits and improvements to QOL in Medicare patients with unilateral and bilateral CIs. You may view a compilation of the voting results at https://www.cms.gov/faca/downloads/id58a.pdf. Through its discussions, the panel determined an immediate need for future research using larger sample sizes, and which would cover the health-related QOL outcomes. The committee also recommended the development of registries, more studies to determine the impact of HL on caregivers (by finding out caregivers’ QOL post-implantation), and addressing the issue of dementia (HL may exacerbate dementia) in CI candidate’s functional status to develop coverage. Finally, the committee recommended future studies that show the impact of HL on the community. What’s next? If MEDCAC had concluded and recommended to CMS that there was sufficient strong data demonstrating positive health outcomes and QOL for Medicare patients with CIs, then CMS would have begun a process to modify its CI NCD. (This process is as follows: data gathering via National Coverage Analysis [NCA], then expanding coverage via revised NCD). As this was not the case, the next step is for interested parties such as specialty and national societies and device manufacturers to compile and submit more health outcomes and QOL data to CMS. Then CMS staff could notify MEDCAC to reconvene on the issue. At this point, CMS could also subsequently request another TA, and follow the process outlined above. As one would expect, this process may be lengthy, but the Academy will continue to address and facilitate it by working closely with interested parties to proceed with the agenda. If you have any questions, please contact Healthpolicy@entnet.org.

The Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) was established to provide independent guidance and expert advice to the Centers for Medicare and Medicaid Services (CMS) on specific clinical topics. MEDCAC input supplements CMS’ internal expertise. MEDCAC provides unbiased reviews and evaluations of medical literature, technology assessments (TAs), and data on the effectiveness and appropriateness of medical items and services that are covered (or may be eligible for coverage) under Medicare. MEDCAC judges and uses the strength of the available evidence to make recommendations on coverage to CMS.

CMS selects a panel of up to 100 MEDCAC members who are experts in clinical and administrative medicine, biologic and physical sciences, public health administration, patient advocacy, health care data and information management and analysis, healthcare economics, and medical ethics. The panel meets about six times a year to review medical evidence for various topics, listen to public testimony, and provide advice about the quality of the evidence. For these meetings, CMS chooses 15 members who are knowledgeable on the topic to be discussed. CMS may also recruit non-MEDCAC members who have relevant expertise to provide additional input to panel members. The agency also invites independent experts to make formal presentations.

On May 11, 2011, there was a MEDCAC meeting at the CMS head quarters in Baltimore. The topic for discussion was “Cochlear Implants (CI) for Sensorineural Hearing Loss.” During this meeting, MEDCAC considered and evaluated recent research (derived from the last revision [April 2005] of the National Coverage Determination [NCD] on CIs) on the health outcomes and quality of life (QOL) of unilateral and bilateral cochlear-implanted Medicare patients. To provide more context, we provide a summary of Medicare’s historical coverage for CI, a summary of the May 2011 MEDCAC meeting, and future implications for Medicare coverage for CI.

Medicare Coverage for Cochlear Implants
CMS first created the NCD for cochlear implants in 1986. Then, the agency covered post-lingual deaf patients. In 1992, the NCD was expanded to cover children with bilateral profound sensorineural hearing impairment with minimal or negligible benefit from hearing aids. In 1998, CMS further revised the NCD so it would reflect changes in technology and product labeling for CIs from the Food and Drug Administration (FDA). CMS last revised the CI NCD in April 2005. Currently, CMS covers cochlear implantation for the treatment of bilateral pre- or post-linguistic, moderate to profound sensorineural hearing loss in patients who demonstrate limited benefit from hearing aids (defined by test scores of =40 percent correct in the best aided listening condition on tape-recorded tests of open-set sentence cognition). In addition, the patient must also meet certain selection guidelines such as:

• Have diagnosis of bilateral moderate to profound sensorineural hearing impairment with limited benefit from appropriate hearing (or vibrotactile) aids
• Not have any contraindications to surgery
• Not have any middle ear infection
• Should be willing to undergo rehabilitation post-surgery
• Should be implanted with an FDA approved CI
• To view the full NCD on CIs, visit http://tinyurl.com/6xq9nt9

CMS also covers CIs in patients who fulfill the selection guidelines above and have hearing test scores ≥40 percent and ≤60 percent, and are enrolled with their providers in an FDA-approved clinical trial. It is important to note that, according to CMS staff, there have not been any clinical trial submissions. Also, the CI NCD does not address coverage for bilateral CI, which means that local Medicare contractors may use their discretion to determine coverage for bilateral CIs. This may potentially lead to inconsistent coverage patterns for CIs in various regions. According to data from Cochlear Americas, the average cost for each cochlear implantation is approximately $30,000. Given these high costs and that hearing loss is a top chronic condition in the U.S. (about 30 percent of Medicare beneficiaries suffer from some type of hearing loss), it was important for CMS to re-visit its coverage for CIs to determine if there was enough compelling evidence to support an expansion of coverage for these devices. This trend of CMS conducting reviews of data on health outcomes may become a general trajectory in CMS’ coverage policy development processes. Medical device and drug manufacturers will certainly need to take heed of these requirements and prepare in advance by conducting or sponsoring studies and randomized clinical trials and creating registries to provide more robust health outcomes data on their new products.

Summary of the MEDCAC Meeting 
As mentioned above, the MEDCAC panel that presided over the meeting consisted of primary care providers (nurse practitioners, family practitioners, geriatricians, and internists) and John K. Niparko MD, a leading expert in cochlear implantation. Because of its relevance to members, Academy staff and Jack J. Wazen MD, Implantable Hearing Devices Subcommittee member, attended the meeting as well as delegates from American Otological Society (including Debara L. Tucci, MD, who was invited as one of two speakers to give the panel background information on cochlear implantation), American Neurotology Society (including Craig A. Buchman, MD), American Academy of Audiology, American Speech-Language-Hearing Association, and the manufacturers of CI (Advanced Bionics, Cochlear Americas, and MED-EL). These subject matter experts also facilitated presentations supplying health outcomes data associated with bilateral and unilateral CIs.

Prior to the meeting, CMS had commissioned the Agency for Healthcare Research and Quality (AHRQ) to conduct a TA, which was performed by the Tufts Evidence-Based Practice Center and completed in April 2011 with Dennis S. Poe, MD, serving as a consultant. In this TA, AHRQ concluded that the data it reviewed demonstrated efficacy of unilateral implants. AHRQ also determined that the current literature was of moderate quality with low to moderate level of evidence with regard to outcomes for bilateral cochlear implants. The study suggested further that larger studies using validated measures including specific health-related QOL measures are needed before determining long-term efficacy and the risks of bilateral implants compared to unilateral implants. To view the full TA, visit https://www.cms.gov/determinationprocess/downloads/id80TA.pdf.

After listening to the various presentations from the subject matter experts, the MEDCAC panel answered (on a scale of confidence from one to five) 11 voting questions that addressed the use of CIs in adults with bilateral sensorineural moderate to profound hearing loss (HL) who show limited benefit from amplification. For example, the first voting question asked the panel’s confidence in whether there was enough evidence to determine if a unilateral CI improved health outcomes for adults with HL having tests scores of a. >40 percent and ≤50 percent  or b. >50 percent and ≤60 percent. Overall, the panel, as expected, closely mirrored the conclusion of the AHRQ assessment by agreeing there was inadequate data demonstrating the long-term benefits and improvements to QOL in Medicare patients with unilateral and bilateral CIs. You may view a compilation of the voting results at https://www.cms.gov/faca/downloads/id58a.pdf.

Through its discussions, the panel determined an immediate need for future research using larger sample sizes, and which would cover the health-related QOL outcomes. The committee also recommended the development of registries, more studies to determine the impact of HL on caregivers (by finding out caregivers’ QOL post-implantation), and addressing the issue of dementia (HL may exacerbate dementia) in CI candidate’s functional status to develop coverage. Finally, the committee recommended future studies that show the impact of HL on the community.

What’s next?
If MEDCAC had concluded and recommended to CMS that there was sufficient strong data demonstrating positive health outcomes and QOL for Medicare patients with CIs, then CMS would have begun a process to modify its CI NCD. (This process is as follows: data gathering via National Coverage Analysis [NCA], then expanding coverage via revised NCD). As this was not the case, the next step is for interested parties such as specialty and national societies and device manufacturers to compile and submit more health outcomes and QOL data to CMS. Then CMS staff could notify MEDCAC to reconvene on the issue. At this point, CMS could also subsequently request another TA, and follow the process outlined above. As one would expect, this process may be lengthy, but the Academy will continue to address and facilitate it by working closely with interested parties to proceed with the agenda.

If you have any questions, please contact Healthpolicy@entnet.org.

More from August 2011 - Vol. 30 No. 08
What is MedPAC?
Tricia Bardon Assistant Director, Health Policy The Medicare Payment Advisory Commission (MedPAC) is an independent Congressional agency established by the Balanced Budget Act of 1997 to advise the U.S. Congress on issues affecting the Medicare program. The commission’s statutory mandate is quite broad. In addition to advising the Congress on payments to private health plans participating in Medicare and providers in Medicare’s traditional fee-for-service program, MedPAC is also tasked with analyzing access to care, quality of care, and other issues affecting Medicare. The commission’s 17 members bring diverse expertise in the financing and delivery of healthcare services. Commissioners are appointed to three-year terms (subject to renewal) by the Comptroller General and serve part time. Commissioners appointments are staggered; the terms of five or six commissioners expire each year. To view the backgrounds of current appointees, please visit http://www.medpac.gov/meetings.cfm. The commission is supported by an executive director and a staff of analysts, who typically have backgrounds in economics, health policy, public health, or medicine. MedPAC meets publicly to discuss policy issues and formulate its recommendations to Congress. In the course of these meetings, commissioners consider the results of staff research, presentations by policy experts, and comments from interested parties such as specialty societies like the Academy. Commission members and staff also seek input on Medicare issues through frequent meetings with individuals interested in the program, including staff from congressional committees and the Centers for Medicare & Medicaid Services (CMS), healthcare researchers, healthcare providers, and beneficiary advocates. Two reports (issued in March and June each year) are the primary outlet for commission recommendations. In addition to these reports and others on subjects requested by Congress, MedPAC advises the Congress through other avenues, including comments on reports and proposed regulations issued by the Secretary of the Department of Health and Human Services, testimony, and briefings for congressional staff1. Each year, the commission recommends pay increases or cuts for all parts of Medicare. On March 14, 2011, for fiscal year 2012, MedPAC recommended a 1 percent increase to the Medicare Physician Fee Schedule (MPFS). This potential increase to the MPFS might be difficult to accomplish as Congress continues to quarrel over federal spending levels. MedPAC’s recommendations are designed to maintain enough cost pressure to encourage efficiency, while limiting out-of-pocket costs for Medicare beneficiaries. Although Congress does not always accept MedPAC’s recommendations, the commission’s proposals play a vital role in the Congress’ budgetary discussions and considerations. The Academy attends MedPAC meetings that are relevant to otolaryngology—head and neck surgery, paying close attention to agenda items and recommendations that could impact members. Academy staff may also attend meetings with members who are experienced in payment policies and can offer expert testimonies. As MedPAC staff provide recommendations for future changes to the Medicare program, it is important for Academy staff to follow this organization closely to ensure we fully understand the changing healthcare environment. This enables the Academy to communicate future changes in Medicare payment to members and can impact the direction of our advocacy strategic initiatives. Last year, the commission discussed several options to reduce the growth of in-office ancillary services (IOAS), such as advanced imaging services, because it felt that these services were a main catalyst for increasing healthcare costs. Generally, although the Stark law prohibits physicians from self-referring patients for services, it does not apply to certain services such as advanced imaging. The options that the commission proposed to reduce the growth of IOAS included requiring prior authorizations for self-referred imaging services performed in physician’s offices, removing imaging services from the IOAS exception, reducing payment rates for in-office imaging services, etc. After Academy staff and the Imaging Committee analyzed these options and their potential impact on the specialty, we determined that if implemented they would pose significant access to care problems for Medicare patients. As a result, the Academy collaborated with other specialty societies and sent a letter opposing these options. In its June report, MedPAC recommended these options to Congress. Academy staff continues to track this issue and advocate for members as well as monitor MedPAC meetings for other potentially problematic proposals that may negatively impact otolaryngologists’ abilities to provide high quality care to patients. During the April 2011 MedPAC meeting, there was a discussion titled, “Improving the accuracy of payments to physicians and other health professionals.” It involved MedPAC’s desire to find alternative approaches to valuing physician payment. From this meeting, MedPAC staff was asked to review hospital operating room logs to accurately measure and designate physician time allotted to office procedures. Doing this might impact the current Medicare system, which uses the Resource-Based Relative Value Scale (RBRVS). Such discussions, though not exclusive to otolaryngologist—head and neck surgeons are certainly important to all medical specialties. If you have any further questions on MedPAC or would like to obtain meeting transcripts, please visit http://www.medpac.gov/meetings.cfm or contact healthpolicy@entnet.org. To obtain updates on the Academy’s regulatory advocacy endeavors, visit http://www.entnet.org/Practice/CMS-News.cfm. We encourage members to write us with relevant topics of interest in health policy and practice management. Please email us at healthpolicy@entnet.org. *About MedPAC page. Medicare Payment Advisory Commisssion website. Available at http://www.medpac.gov/about.cfm. Accessed May 23, 2011.
Open to All Members: Health Policy Educational Sessions at the 2011 Annual Meeting
Be sure to attend these excellent educational sessions  available during the 2011 Annual Meeting & OTO EXPO to learn about important coverage issues that impact you. Sunday, September 11 10:30-11:50 a.m.  Moscone Center Room 134 3P Mini-Seminar on Academy Advocacy for Physician Payment: New Strategies.  Declining reimbursement over many years continues to threaten the viability of physician practices across specialties and practice settings. This seminar will provide updates on the efforts of our Academy to advocate for fair reimbursement for our members in increasingly challenging public and private payer environments. Monday, September 12 2-3 p.m.  Marriot Marquis Yerba Buena Ballroom 4-5 At “Understanding the RUC Process and Survey Instrument,” you will learn about the AMA’s Current Procedural Terminology (CPT) and Specialty Society/Relative Value Update Committee (RUC) processes, and why it is so crucial for you to fill out the RUC surveys you receive in order for your Academy representatives to advocate for appropriate values at the AMA meetings. Monday, September 12 4-5:30 p.m.  Marriot Marquis Yerba Buena Ballroom 6 At the Third Annual Medicare Contractor Advisory Committee (CAC) Session, you will learn about the importance of getting involved in these local meetings held in your area, the role of your local CAC, and the impact of local policies on your practice, as well as how you can avoid and prepare for any potential audits by the Recovery Audit Contractors (RACs). The facilitator for this session, Arthur Lurvey, MD, medical director for Palmetto GBA (Medicare administrative contractor for California, Hawaii, and Nevada) will also conduct one-on-one meetings with members who are facing reimbursement and coverage issues with any Medicare policies. Wednesday, September 14  10:30 – 11:50 a.m.  Moscone Center Room 309 ICD-9- Transition Hurdles to ICD-10 Diagnostic Coding Miniseminar.  This miniseminar will cover the required October 1, 2013, transition from ICD-9-CM to ICD 10 for all U.S. healthcare providers. During this session, the speaker will provide an overview of the ICD-10 transition, identify and crosswalk groups of ICD- 9 codes that pertain to otolaryngology—head and neck surgery, and much more. We will display the trend results of the 2011 Socioeconomic Survey in the lobby of the Moscone Center. Please stop by and view the latest productivity, revenue, operations, and other practice patterns for otolaryngology—head and neck surgery.
Annual Meeting Miniseminar on Healthcare Delivery Systems
Join your colleagues at the  AAO-HNSF Annual Meeting  & OTO EXPO for a robust and interactive discussion on existing and emerging healthcare delivery systems. The miniseminar, “Healthcare for All? Economics, Politics and Delivery Systems,” is sponsored by the AAO-HNS Board of Governors’ Legislative Representatives Committee and will be held 10:30 to 11:50 am on September 12. The session will examine national and international experiences of single-payer and similar healthcare systems, their impact on otolaryngologist—head and neck surgeons and patients, and the politics surrounding the “universal” healthcare debate in the United States. Panelists for the program collectively have experience in a breadth of healthcare systems including private, academic, Health Maintenance Organizations, and government programs in the United States, Canada and United Kingdom. They will provide an evidence-based comparison of worldwide government healthcare systems, offering perspectives on the challenges and successes associated with such models. The panelists are moderator Mimi S. Kokoska, MD, MHCM, VISN 11 chief surgical consultant, Veterans Affairs, and professor at Indiana University; Joy L. Trimmer, JD, senior director of AAO-HNS Government Affairs; Lee  D. Eisenberg, MD, MPH, AAO-HNS Board Coordinator for Governmental Relations and member of ENT and Allergy Associates, LLP; Brendan C. Stack, MD, professor and vice chairman of the University of Arkansas for Medical Sciences; Mark Taylor, MD, MSc, MHCM, senior physician executive, Ontario, Canada; and Martin J. Burton, MA, DM, consultant otolaryngologist, Radcliffe NHS Trust and senior lecturer at Oxford University, UK.
Boot Camp for Rising Chief Residents
Rahul K. Shah, M.D., George Washington University School of Medicine, Children’s National Medical Center, Washington, D.C. As an academic pediatric otolaryngologist, I am fortunate to be able to work with students, residents and fellows.  I was surprised to see the mutual excitement at the Rising Chief Resident Boot Camp on Saturday, May 14, 2011, at the University of Pennsylvania Surgical Simulation Center in Philadelphia.  The course directors, Academy members, Ellen Deutsch, Sonya Malekzadeh, Kelly Malloy, and Luv Javia, enthusiastically prepared a day-long session for rising chief residents. The goal of the day, from my perspective, was two-fold. First, to have residents simulate techniques and patient management which they will be encountering as chief resident; and second, to help them with the non-academic part of transitioning to chief residency and beyond. The stations included virtual and real temporal bone stations, microvascular and plastic (local flap) suturing stations, a robotic surgery station, and mannequins for stations on management of mock cases. In attendance were approximately 16 residents and two dozen faculty members. The high ratio of faculty members to residents was fascinating in that the faculty members uniformly saw the immense value of the simulation course.  The course not only provided immediate benefits for the attendees, but the faculty were also impressed by what the future holds for this modality of training for medical education and even for attendings. A decade prior, who would have considered that there would be a primer course for rising chief residents or for incoming residents (as this group also holds in July of each year)? Of course, there are many programs that have crash courses or brief update courses; however, to my knowledge, a simulation course with a one-day commitment toward focused education for a specific cohort of training level is novel. The American College of Surgeons has discussed the role of regional simulation centers that can be used for resident education, as well as maintenance of certification, and the model  is very tempting for otolaryngologists. Many of the faculty teaching the course were excited to practice using the robot and to also refresh some of our knowledge in areas that we did not routinely see in our practice. There were simulation scenarios that had the participants participate in a mock case scenario with a mannequin. The atmosphere was jovial yet competitive – the residents wanted to do their best and were really focusing on optimizing the outcome for their mannequin. The faculty were shocked by the reality of the mannequins – the controllers were able to have the mannequins tongue swell, make the chest rise, and even allow participants to actually make a cricothyroidectomy. The technology of mannequins has progressed to such an extent that it helps the residents feel that they are caring for a real patient. Interestingly, it was illuminating to watch the residents during the “difficult conversations” with the patient and his or her family in a role-play situation after they participated in the case scenario.  It is never easy to have these difficult conversations, and the residents were fortunate to have had this experience. The course directors should be applauded for putting this course on. I am sure in a few years when the downstream effects of the course manifest, our patients will ultimately benefit as the residents caring for these patients may have actually practiced the exact situation that they were in prior to seeing a specific patient. Furthermore, the course had a seminar on what the rising chief resident should be aware of when beginning a job search. Again, this portion of the course resonated with faculty members as we were wishing that we had this information at their level. We encourage members to write us with any topic of interest and we will try to research and discuss the issue.  Members’ names are published only after they have been contacted directly by Academy staff and have given consent to the use of their names.  Please email the Academy at qualityimprovement@entnet.net to engage us in a patient safety and quality discussion that is pertinent to your practice.
The ENT Advocacy Network Recruitment Drive Returns
Help Build Our ENT Advocacy Network by Recruiting New Advocates. During the 2011 AAO-HNSF Annual Meeting & OTO EXPO, members are challenged to recruit U.S. AAO-HNS members for the ENT Advocacy Network to help strengthen otolaryngology’s voice and influence in the legislative and political arenas. Urge your colleagues to sign up for the ENT Advocacy Network using forms available to download in advance from the Legislative and Political Affairs website (www.entnet.org/advocacy). Forms will also be available onsite at the ENT PAC Booth. Participation in the recruitment drive will be recognized in several ways. The top recruiter will receive a prize of a $200 American Express gift card, and the top two recruiters will be awarded one (1) Honor Point and be featured in the BOG eNews and The ENT Advocate. New ENT Advocacy Network members and contest recruiters will receive an “Advocacy Goodie Bag,” which can be picked up at the ENT PAC Booth (limit one per person). The recruitment drive will officially run from September 1 – October 1, 2011. For more information, please contact the Government Affairs team at govtaffairs@entnet.org, or visit www.entnet.org/advocacy.
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Exclusive Events for ENT PAC Members during Annual Meeting!*
New this year, 2011 ENT PAC Leadership Club members are invited to an exclusive “Investors Briefing,” hosted by the ENT PAC Board of Advisors, on September 12, 2011, during the Annual Meeting & OTO EXPO. ENT PAC Leadership Club members will receive an “insider’s” update on current federal legislative activities, upcoming elections, and new PAC programs. Members can expect a dynamic presentation outlining the politics and policy fueling efforts on Capitol Hill. Members of the ENT PAC Chairman’s Club ($1,000+ donors) are also invited to attend a luncheon roundtable with the ENT PAC Board of Advisors on September 13, 2011. Additionally, in recognition of the generous contributions received in 2011, all ENT PAC members are invited to an exclusive donor reception on Sunday evening, September 11, 2011, at the Moscone Center. U.S. AAO-HNS members who make donations to ENT PAC prior to or during the Annual Meeting & OTO EXPO are invited to the event. PAC members can also view their names and the names of their colleagues on the 2011 “Wall of Donors” located at the ENT PAC Booth. For more information on becoming a member of ENT PAC, please visit www.entnet.org/entpac (U.S. AAO-HNS member log-in required) or contact ENT PAC staff at entpac@entnet.org. *Contributions to ENT PAC are not deductible as charitable contributions for federal income tax purposes.  Contributions are voluntary, and all members of the American Academy of Otolaryngology-Head and Neck Surgery have the right to refuse to contribute without reprisal. Federal law prohibits ENT PAC from accepting contributions from foreign nationals. By law, if your contributions are made using a personal check or credit card, ENT PAC may use your contribution only to support candidates in federal elections.  All corporate contributions to ENT PAC will be used for educational and administrative fees of ENT PAC, and other activities permissible under federal law. Federal law equires ENT PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year.
Legislative and Political Advocacy Opportunities in San Francisco
Visit the ENT PAC Booth, the Government Affairs “hub,”  at the AAO-HNSF Annual  Meeting & OTO EXPO in San Francisco to learn more about how you can support the Academy’s legislative and political advocacy efforts on Capitol Hill. ENT PAC, the political action committee of the AAO-HNS, financially supports incumbent Members of Congress and viable candidates who will champion the specialty’s legislative priorities. The ENT PAC Booth will be located in the Moscone Center near the shuttle bus drop-off area. Stop by the ENT PAC Booth to: • Obtain information on becoming a 2011 ENT PAC donor;* • View the renowned ENT PAC “Wall of Donors” for 2011; • View copies of the new ENT PAC “Investors Report;” • Join the ENT Advocacy Network to receive timely updates on political and legislative issues impacting otolaryngology—head and neck surgery and a free subscription to a biweekly • e-Newsletter, The ENT Advocate; • Pick up forms to participate in the 2011 ENT Advocacy Network Recruitment Drive; • Receive the latest updates on federal legislation impacting the specialty; • Register for the Key Contacts Network – a network of members dedicated to helping advance the AAO-HNS grassroots efforts by strengthening their personal legislative contacts; and • Learn ways to effectively advocate on behalf of the specialty.
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Are You an ENT PAC Member for 2011? Deadline for Recognition Opportunity Extended
U.S. AAO-HNS members who contribute to ENT PAC before Friday, August 12, 2011, will be recognized on the acclaimed “Donor Wall” displayed proudly during the 2011 AAO-HNSF Annual Meeting & OTO EXPO in San Francisco. To make a contribution, visit the ENT PAC website at www.entnet.org/entpac (U.S. AAO-HNS log-in required) or contact staff at entpac@entnet.org. *Contributions to ENT PAC are not deductible as charitable contributions for federal income tax purposes. Contributions are voluntary, and all members of the American Academy of Otolaryngology—Head and Neck Surgery have the right to refuse to contribute without reprisal. Federal law prohibits ENT PAC from accepting contributions from foreign nationals. By law, if your contributions are made using a personal check or credit card, ENT PAC may use your contribution only to support candidates in federal elections. All corporate contributions to ENT PAC will be used for educational and administrative fees of ENT PAC, and other activities permissible under federal law. Federal law requires ENT PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year.
Be a Legislative Insider
Join the AAO-HNS ENT Advocacy Network Today In addition to the periodic updates in the Bulletin, the AAO-HNS Government Affairs team provides members with timely updates on key legislative and political initiatives in the U.S. Congress and in the states through the ENT Advocacy Network, a free member benefit. ENT Advocacy Network members receive The ENT Advocate, a biweekly e-newsletter, containing the most up-to-date news in the political and legislative arenas. Members are also kept informed through periodic “Action Alert” emails with easy instructions on contacting their legislators. As a member of the ENT Advocacy Network, there is no obligation other than a desire to be educated on the legislative issues impacting your patients, specialty, and livelihood. Join nearly 1,500 of your colleagues who have already signed up to receive “insider” legislative and political information faster via the ENT Advocacy Network. Enrollment is easy —simply email govtaffairs@entnet.org or call 1-703-535-3795. You can also sign up online by visiting www.entnet.org/advocacy.
Legislative Action: Defending Patient Safety
For many years, the AAO-HNS has been at odds with the American Academy of Audiology (AAA) regarding their desire for unlimited direct access to Medicare patients without a physician referral. The AAO-HNS and others in the medical community have opposed such legislative efforts due to significant cost to the system and patient safety concerns. Unfortunately, on June 3, 2011, U.S. Representative Mike Ross (D-AR), re-ignited AAA’s efforts by introducing H.R. 2140, the “Medicare Hearing Healthcare Enhancement Act of 2011.” Despite its seemingly positive title, H.R. 2140 is an inappropriate, and  potentially dangerous, expansion of audiology services. Although audiologists play a critical role in providing quality hearing healthcare, their desire to independently diagnose hearing disorders transcends their level of training and expertise. Hearing and balance disorders are medical conditions and require, by necessity, a full patient history and physical examination by a physician. In its 2007 report on audiology direct access, the Centers for Medicare and Medicaid Services (CMS) declared that referrals from physicians are the “key means by which the Medicare program assures that beneficiaries are receiving medically necessary services, and avoids potential payment for asymptomatic screening tests that are not covered by Medicare …” Bypassing a physician evaluation and referral can lead to a misdiagnosis and inappropriate treatment that could cause lasting, and expensive, damage to patients. The AAO-HNS strongly believes  a physician-led hearing healthcare  team with coordination of services is  the best approach for providing the  highest quality care to patients. To that end, the AAO-HNS initiated and  actively participated in past negotiations with the AAA to identify ways to increase seniors’ access to our non- physician colleagues without jeopardizing patient safety. Unfortunately, the AAA withdrew its support of compromise legislation and has continued efforts to advance the recycled language included in H.R. 2140. Following introduction of H.R. 2140, the AAO-HNS Government Affairs  team began efforts anew to educate Members of Congress about the dangers associated with providing audiologists with unlimited direct access to Medicare patients. The Academy sent an opposition letter to every member of the U.S. House of Representatives on June 6, 2011,  and also solicited support for our position from various state medical societies,  state otolaryngology societies, and national physician groups. As of June 30, 2011, 115 organizations had  joined our effort to oppose H.R. 2140. In addition, a legislative “Action Alert” was sent to all AAO-HNS members encouraging them to contact their U.S. Representative in opposition to H.R. 2140. If you would like to learn more about AAO-HNS federal legislative priorities and/or efforts, visit the Legislative and Political Affairs webpage at www.entnet.org/advocacy or contact the AAO-HNS Government Affairs team at govtaffairs@entnet.org.
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Hal Foster, MD, Endowment Campaign Update
To meet responsibilities to AAO-HNS members, further the mission, and encourage future physician leaders, AAO-HNS/F relies on a broad base of support, including private philanthropy, corporate sponsorships, and foundation grants. From these sources, we have a strong foundation on which to build. But a living, thriving organization cannot grow in the long term on sponsorships and annual donations alone. We need reliable revenue – something that we can count on year in and year out. In October 2009, the AAO-HNS/F Boards of Directors initiated the Hal Foster, MD, Endowment Campaign, with a phase one goal of $15 million raised within 10 years and an ultimate goal of $30 million to provide a sustained source of funding for the future. Since then, nearly $5.6 million has been raised in outright cash and planned gifts, much of it through significant commitments made by our leaders. The Hal Foster, MD, Endowment Society is a special recognition status to be held only by donors to the endowment campaign who pledge a planned gift or cash gift of $50,000 or greater by December 31, 2011. We are grateful to the Founding Donors for their visionary contributions. Founding Donors will be honored through a commemorative display at our headquarters, in communications, publicly at events, through special annual meeting recognition, and by awarding of special medallions. Hal Foster, MD, Endowment donors also enjoy recognition as Life Members of the Millennium Society. We are pleased to work with members between now and the end of 2011 to ensure that any individual who would like to become a Founding Donor has the opportunity to do so. To learn more please contact 1-703-535-3717, development@entnet.org, or visit www.entnet.org/endowment. In Their Own Words – Founding Donors of the  Hal Foster, MD, Endowment  We published our first series of Founding Donor quotations in our June Donor Spotlight (www.entnet.org/spotlight). Here are additional thoughts from a few of our newest Founding Donors about the importance of giving back. “We’re honored to be part of this important society. Both patients and physicians have benefitted from the Academy’s leadership for more than 100 years. This organization is vital to advancing the profession, international collaboration, and inspiring young minds through valued research and education.” – Kenneth W. Altman, MD, PhD,  and Courtney Altman   “As a young physician practicing otology/neurotology, the opportunities the AAO-HNS/F has provided me for leadership development, education, and networking have been essential to my growth and advancement. Through the Hal Foster, MD, Endowment Society I recognize the opportunity to support the AAO-HNS/F in its mission of attracting the best and the brightest to our specialty and to continuing vital programs for young physicians pursuing the specialty in the future.” – Seilesh Babu, MD, and Abbey Crooks-Babu, MD   “We can help patients one at a time in our day-to-day practice and we can shape current practice through our research and teaching, but through the Hal Foster, MD, Endowment, we will be able to build and influence the long-term future of our specialty.” – Neil Bhattacharyya, MD,  and Anjini Bhattacharyya, MD     “Our contribution to the Academy is made to honor and sustain its vision for education, research, and patient care. I, like every single ENT resident and surgeon, have benefitted greatly from the Academy’s educational products. I have seen the Academy honor my father, Dr. H.K. Chandrasekhar, for his far-reaching public service work, and I have seen it enable me to develop my leadership abilities. The Academy is a place and an idea that welcomes all otolaryngologists, women and men, and all races, as family and, as family, encourages each to develop their own skills and succeed. By donating to the Academy’s fund, we can help this organization — our organization —  chart the right course for the best in otolaryngology in the future.” –  Sujana S. Chandrasekhar, MD,  and Kris Ramanathan   “As an active member of the AAO-HNS since residency, the AAO-HNS has provided me with support for all facets of my career. As a resident, I utilized the Home Study Course, COCLIA, and the SIPAC monographs and now enjoy being able to contribute to the AAO-HNSF educational mission through guideline review, Patient of the Month, and Academy U educational modules. I have also enjoyed the opportunity to undergo legislative training and appreciate the on-going advocacy efforts that the AAO-HNS provides at both the state and national levels. In addition, I appreciate the value that the AAO-HNS puts on research, and I am a proud recipient of a grant administered through the CORE grants process. Because I know that the AAO-HNS is watching out for me, I can focus more on my practice.” – Stacey L. Ishman, MD, and Jim McCarthy “As a private practitioner in otolaryngology—head and neck surgery, I have come to rely on the AAO-HNS’ leadership and voice for our specialty. Through participation in activities like the Board of Governors and its committees, I learned directly the value of the organization’s grassroots arm. This gift enables me to express my dedicated support of the mission of a fine organization that has enabled me to grow both personally and professionally. The specialty has been good to my family and we just feel this gift is the right thing to do.” – Barry Jacobs, MD,  and MaryLynn Jacobs “From my initial Academy meeting I attended as a first-year resident until now, the Academy has played a pivotal role in my education and maturation as a head and neck surgeon. Through education, advocacy, and intellectual fellowship, the Academy has provided the framework on which I stand in the development of my career. It is an honor to be able to contribute to the Hal Foster, MD, Endowment to ensure the viability of our Academy to provide this same excellent support to the next generation of otolaryngologist—head and neck surgeons.” – James L. Netterville, MD   “Our Academy’s unconditional support to our education and advocacy should always be reciprocated by the tireless volunteerism and generous giving of its members. This synergy will enable the advancement of otolaryngology for generations to come.” – J. Pablo Stolovitzky, MD, and Silvia Stolovitzky     “Our Academy is our future.” – Peak Woo, MD
Flexible Schedules: An Alternative for a More Satisfying, Productive Career
Valerie A. Flanary, MD Chair, WIO Awards Committee Assoc. Professor, Medical College of Wisc. The physician workforce is in a state of evolution. In the past, the field of medicine was predominantly male. The prototypical “doc” went in before dawn, came home late at night, and might even have made house calls. This was all in a day’s work. Today, busy lifestyles, technology, and a change in demographics with an increasing female presence have all helped to change the way medicine is practiced. Now, almost as many women graduate from medical school as do men. According to the Association of American Medical Colleges, 48 percent of graduates from medical school were female in 2010. In the specialty of otolaryngology, women represented 29 percent. With change comes the need to adapt to the new reality. Younger physicians and female physicians are looking for more flexibility in the way medicine is practiced. They are changing the accepted norms in the perception of a “typical” physician work week. Several studies have addressed career satisfaction in women associated with flexibility of work schedule. A study from the Archives of Surgery1  examined the impact of family and gender on career goals. This study suggested women who were single or had no children were likely to identify lifestyle rather than income as a motivator for subspecialty training. Ahmadiyeh, et al.,2 looked at career satisfaction of women in surgery. Women cited reasons related to personal time and family relationships as important for satisfaction. In 2004, Caniano, et al.,3 surveyed female pediatric surgeons and found that 84 percent believed that quality of life was the reason fewer women choose surgery. They also desired more time for personal interests and family. Flexible work hours have been studied in several specialties. Kaderli, et al.,1 surveyed women in surgery and established that while moderately satisfied with their careers, 20 percent of women would like more flexible hours and a decreased workload. Troppman, et al.,4 also surveyed female surgeons, and discovered that they would like more strategies to have alternative work schedules. Key factors for career satisfaction for women in emergency medicine5 also include schedule flexibility. Welch, et al.,6 compared medical schools in the Big Ten and their policies on part-time, maternity leave, child-care options, and benefits. When compared using a scale of 0-21, schools scored between 9.25 and 13.5. She concluded while no school scored consistently low or high, flexible policies will lead to more retention and diversity when these issues are raised by using such comparisons. In order to harness the resources of individuals who desire more flexibility in their schedules, many institutions and practices have become more creative with their schedules. This creativity allows for more productive and happier physicians. Of the 14 years of my practice, I have spent the majority of my career working less than what is typically considered a Full Time Equivalent (FTE). Having a busy surgeon husband and two small children, I chose to be in the office three days per week, taking calls, and maintaining a clinical practice similar to that of my colleagues. I was still able to participate in committees on departmental, institutional, and national levels, write a triological thesis. A study from Boston7 compared women with reduced work hours to those with full-time hours. Women with reduced hours demonstrated stronger family relationships and more career satisfaction than those with full-time hours. The New England Journal of Medicine8 studied part-time physicians and their practices. This study found that those pursuing non-traditional schedules tended to be from two physician families, younger physicians, or doctors nearing retirement. Physicians usually took full call even though they spent less time in the office setting. The study concluded that these schedules promote work and family balance. There are advantages and disadvantages for the individual and the healthcare system when choosing a flexible schedule. Many would argue that doctors who are fresh, fully engaged, and enjoy what they are doing may be as or more clinically productive than their cohorts. Individuals have several reasons for choosing more flexible work hours. These include family obligations, non-academic pursuits, and reaching the twilight of their careers, nearing retirement. We are no longer using the term part time. Part time typically refers to working fewer than 20 hours per week. While in-office duties may account for 20 or more hours, physicians spend time working outside of the workplace. Time spent on call, answering pages, and telephone calls, as well as email, writing, and charting can all be done out of the office. Technology allows access to charts, radiology, and even some elements of physical examination. Caniano, et al.,3 also showed that women who spent less time in the office and worked at home tended to work longer hours. While most would only consider the disadvantages of a non-traditional schedule, there are many more advantages to consider. The Medical College of Wisconsin has pioneered a very successful full professional effort program. Through this program, the Medical College is able to recruit and retain productive women and men with personal choices and family obligations that would be more feasible using a more flexible schedule, as well as retain the experience and expertise of full professors who would simply like to slow down. The full professional effort program was first implemented in 1987, allowing physicians to work 0.6 FTE or more and continue to receive benefits, including retirement, disability, and health insurance. Currently, there are 145 individuals participating in this program. Ninety-eight are women, with an average of 0.73 FTE. There are 47 men in the program with an average of 0.68 FTE. In all, there are 24 full professors, 32 associate professors, 88 assistant professors, and one instructor. Individuals and their departments are able to work together to structure a formula that provides the best schedule for the doctor and the practice. This may include less academic time, more office time, less operating time, and myriad other as yet determined possibilities. Before embarking on a less than full presence at the workplace, compensation, academic advancement, and peer perception have to be considered.  Compensation is based on several variables, including productivity, experience, and location. It is critical that we all start on a level playing ground.   Lo Sasso et al9 found a $16,819 gap in pay between newly trained male and female physicians. The study also states women in otolaryngology make $32,207 less than their male counterparts. If compensation is based on productivity, a definition of productivity should be negotiated and an equitable agreement reached. As for academic advancement, there are several factors impacting this process. Publications, research, committee service, and recognition all should be considered.  Much of the work performed for advancement can take place inside and outside of the office. Committee service on days in the office, writing at home, and teleconferencing with national committees are all acceptable means of getting the work done. Finally, peer perception can both positively and negatively impact flexible schedules. The fact is that both men and women can take advantage of a more flexible work schedule. Gender bias does still exist. Bucknall, et al.,10 surveyed medical students, patients, and male orthopedic surgeons. Sixty-two percent of female medical students would not consider orthopedics because of male dominance and disinterest. More female students had been exposed to negative attitudes regarding female surgeons. Shollen, et al.,11 surveyed faculty at a medical school and found women perceived more gender bias in promotion as well as salary. Flexible work schedules are a viable option for those seeking more flexibility in the work place. For both men and women, evidence suggests more career satisfaction and work/life integration. Before embarking down this path, there are several factors to be considered, including practice culture, call coverage, and compensation. For all surgeons, it may become the most desirable standard.  However, during this evolutionary phase, open discussions and understanding of expectations before engaging in the process are paramount to mutually satisfying arrangements. References 1. Kaderli, R., U. Guller, et al. (2010). “Women in surgery: a survey in Switzerland.” Arch Surg 145(11): 1119-1121. 2. Ahmadiyeh, N., N. L. Cho, et al. (2010). “Career satisfaction of women in surgery: perceptions, factors, and strategies.” J Am Coll Surg 210(1): 23-28. 3. Caniano, D.A. , R.E. Sonnino, and A.N. Paolo. (2004). “Keys to Career Satisfatcion; Insights from a Survey of Women Pediatric Surgeons.” J Pediatric Surg 39(6) 984-990 4. Troppmann, K. M., B. E. Palis, et al. (2009). “Women surgeons in the new millennium.” Arch Surg 144(7): 635-642. 5. Clern, K.J., S.B. Promes, et al. (2008). “Factors Enhancing Career Satisfaction Among Female Emergency Physicians” Ann Emerg Med. 51(6) 723-728. 6. Welch, J.L., S.E. Wiehe, et al. (2011). “Flexibility in faculty work-life policies at medical schools in the big ten conference.” J Women’s Health. 20(5) 725-732. 7. Grandis, J. R., W. E. Gooding, et al. (2004). “The gender gap in a surgical subspecialty: analysis of career and lifestyle factors.” Arch Otolaryngol Head Neck Surg 130(6): 695-702. 8. Darves, B. “Part-time physician practice on the rise.” New England J Med Career Center.  2010. 9. Lo Sasso, A. T., M. R. Richards, et al. (2011). “The $16,819 pay gap for newly trained physicians: the unexplained trend of men earning more than women.” Health Aff (Millwood) 30(2): 193-201. 10. Bucknall V, PB Pynsent.  Sex and the otrhopaedic surgeon:  a survey of patients, medical students, and male orthopaedic surgeon attitudes toward female orthopaedic surgeons.  Surgeon, 2009.  April 7(2):89-95. 11. Shollen, S. L., C. J. Bland, et al. (2009). “Organizational climate and family life: how these factors affect the status of women faculty at one medical school.” Acad Med 84(1): 87-94. 12. Barnett, R. C., K. C. Gareis, et al. (2005). “Career satisfaction and retention of a sample of women physicians who work reduced hours.” J Womens Health (Larchmt) 14(2): 146-153. 13. Wynn, R., R. M. Rosenfeld, et al. (2005). “Satisfaction and gender issues in otolaryngology residency.” Otolaryngol Head Neck Surg 132(6): 823-827. 14. Ferguson, B. J. and J. R. Grandis (2006). “Women in otolaryngology: closing the gender gap.” Curr Opin Otolaryngol Head Neck Surg 14(3): 159-163. 15. Schrager, S., A. Kolan, et al. (2007). “Is that your pager or mine: a survey of women academic family physicians in dual physician families.” WMJ 106(5): 251-255. 16. Goodyear, H. M. and F. Lynch (2007). “Flexible working: policies are supportive but culture and finances are not.” Postgrad Med J 83(985): 669-670. 17. Szczech, L. (2008). “Women in medicine: achieving tenure at home and work–prioritization is a personal decision.” Kidney Int 73(7): 793-794. 18. Morrissey, C. S. and M. L. Schmidt (2008). “Fixing the system, not the women: an innovative approach to faculty advancement.” J Womens Health (Larchmt) 17(8): 1399-1408. 19. Jackson, I., M. Bobbin, et al. (2009). “A survey of women urology residents regarding career choice and practice challenges.” J Womens Health (Larchmt) 18(11): 1867-1872. 20. Hebbard, P. C. and D. A. Wirtzfeld (2009). “Practice patterns and career satisfaction of Canadian female general surgeons.” Am J Surg 197(6): 721-727. 21. Cull, W. L., K. G. O’Connor, et al. (2010). “Part-time work among pediatricians expands.” Pediatrics 125(1): 152-157. 22. Dyrbye, L. N., T. D. Shanafelt, et al. (2010). “Physicians married or partnered to physicians: a comparative study in the American College of Surgeons.” J Am Coll Surg 211(5): 663-671.
World Voice Day 2011 Media Outreach Update
This year, the Academy celebrated the ninth annual World Voice Day, an international health observance day for the human voice, on April 16, 2011. The theme for the 2011 celebration of World Voice Day, “We Share a Voice,” called attention to the important role otolaryngologists play in  easing the burden of vocal disorders. There are so many ways in which the human voice links us all together. The voice is at the core of what connects and defines us as human beings. This year, the  Academy created a web page dedicated to World Voice Day, http://www.entnet.org/HealthInformation/worldVoiceDay.cfm. The web page has a wealth of information for the public and members; template press releases, fact sheets, radio PSA, patient information pamphlets, an interactive Voice Quiz, WVD posters and a podcast. The Academy also distributed a press release and a PR Minicampaign on WVD for the month of April. World Voice Day is an excellent vehicle to reach out to local and national media, including medical and health care reporters. In addition to Bulletin coverage, we received a great deal of media coverage from the following news outlets: • The Huffington Post • National Institutes of Health • Medscape • WebMD • Bowling Green State University • Duke University newsletter • University of Wisconsin-Madison newsletter • ENT Journal; and numerous local newspapers in various states and cities. World Voice Day was established as a special day of awareness, recognition, and celebration of the human voice. Commemorated each year on April 16th, World Voice Day owes its roots to a group of Brazilian voice care professionals who decided to celebrate the voice in 1999 by establishing Brazilian Voice Day. The American Academy of Otolaryngology—Head and Neck Surgery has sponsored the U.S. observance of World Voice Day since 2002. Since that time, this day has grown to become a global day of recognition. World Voice Day serves as an educational campaign to inform the public of the importance of the human voice and the need for preventative care. For more information about World Voice Day, please visit http://www.entnet.org/AboutUs/publicCampaigns.cfm or emailmstewart@entnet.org.
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Oral, Head, and Neck Cancer Awareness Week in New England
Each year the Academy observes Oral, Head & Neck Cancer Awareness Week (OHANCAW) coordinated by the Head and Neck Cancer Alliance. OHANCAW is dedicated to educating the public about these potentially life-threatening, but highly treatable cancers, and to promoting prevention, screening, and early detection. According to the American Cancer Society, head and neck cancers represent the sixth most common form of cancer in the U.S., with more than 50,000 cases diagnosed annually and more than 12,000 deaths. AAO-HNS Board of Director member Jerry M. Schreibstein, MD, and Barry R. Jacobs, MD, MSO-HSN, BOG Governor, and their practice, Ear, Nose & Throat Surgeons of Western New England in Springfield, MA, screened more than 160 individuals during OHANCAW and detected two oral cancers. For the past seven years, the physicians at Ear, Nose and & Throat Surgeons have joinded with the Massachusetts Society of Otolaryngology in observing OHANCAW.  By leveraging the relationships with their local hospital public relations department, radiation and medical oncology colleagues, and local media, they have built a highly successful screening program. In Springfield, media activities spanned a full week (May 8-14) during which OHANCAW was publicized in the local newspaper in English and Spanish, on the radio. “Working with our colleagues at the D’Amour Cancer Center at Baystate Medical Center in Springfield, we are able to run a highly efficient, multidisciplinary screening program.” said Dr.  Schreibstein. “Eighty-five percent of head and neck cancers are related to tobacco use,” he said. To help in this effort, screening participants were provided handouts on smoking cessation. “When oral, head, and neck cancers are diagnosed early, these potentially deadly diseases can be more easily treated, and the chances of survival increase.” The focus now turns to 2012. We encourage you to start brainstorming educational and outreach activities for OHANCAW next year. For more information, visit www.entnet.org/aboutus/oralheadneckcancer.cfm.
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Marcella R. Bothwell, MD, 2011 Practitioner Excellence Awardee
I want to thank the Academy membership for such an important honor among such other practitioners who were well-qualified. The Academy has asked me to better introduce myself. So, I will happily share my experiences, which I have gained in our most privileged profession that allows us inside the personal lives of those patients we touch on a daily basis. I grew up in Missouri as the youngest of four children. I had the small-town home life that Norman Rockwell would be proud of, where people treat everyone with the respect they deserve despite educational or community status. I loved the state and planned to spend my life’s work there. I was at Mizzou, proudly cheering on our “Tigers” for medical school and residency. Study moved me to St. Louis Children’s Hospital for a pediatric fellowship. During residency and fellowship, I had tremendous mentors including David S. Parsons, MD, Harlan R. Muntz, MD, and Rod P. Lusk, MD, just to name a few. Undeniably I was fortunate to be trained by world-class teachers in pediatric airway and sinus surgery. Recently, however, the beach air of California called my name and I moved to San Diego to be part of Rady Children’s Hospital as a partner. We are affiliated with UCSD, which gives me the academic privileges to both keep up my clinical research and share my skills and experience with the young residents who will be the next generation of our profession. While not at official work, humanitarian outreach and exploring the world have also been exceedingly important for me. I am now planning my third trip to Vietnam this fall for a medical mission. I have also traveled to China and Russia as an ambassador of American medicine. When overseas, meeting people in their homes, hospitals, and places of worship expands my horizons. For that gift given me, I welcome teaching their medical professionals some of our latest techniques. While over many years I have spent time doing basic and clinical research, I have noted that clinical practice helps one child at a time but clinical outcomes research can influence many children. Taking that a step further, I have taken several active roles in politically promoting causes that are important to our field to keep up the high quality of care our patients deserve. I have observed that the big picture of health care and its delivery needs to be addressed by those knowledgeable in the field and at some point would like to follow my interests into political office. I would like to thank all those who have trained me, worked beside me, and all people that I have interacted with because we all are a composite of our experiences.
Virginia Society of Otolaryngology/Head and Neck Surgery Board of Directors.
Pennsylvania and Virginia Receive BOG Model Society Awards
The Pennsylvania Academy of Otolaryngology—Head and Neck Surgery (PAO-HNS) is the well-deserved recipient of the Board of Governors (BOG) 2011 Model Society Award. The Academy is represented on the BOG by Helen F. Krause, MD, as governor, Karen A. Rizzo, MD, as legislative representative, and Jason G. Newman, MD, as public relations representative. The PAO-HNS has participated in several public awareness activities. Each spring and fall, a member of PAO-HNS leadership provides otologic examinations at the DePaul School for Hearing and Speech. This effort is highlighted by newspaper, radio, and local cable TV PSAs throughout the state. Every May, PAO-HNS members conduct free health and neck cancer screenings for the Philadelphia community. The PAO-HNS is extremely active in state legislative issues. The Academy’s leaders and lobbyist have successfully stopped bills in the past two legislative sessions. The PAO-HNS also partnered with the Pennsylvania Medical Society and other specialty societies to support legislation requiring all healthcare providers to wear an ID badge identifying their licensure in print larger than their name. This “truth in advertising” bill was signed into law in late 2010. This year, the BOG also chose to recognize the Virginia Society of Otolaryngology/Head and Neck Surgery (VSO/HNS) with the Model Society Honorable Mention Award for their work in providing free screenings for head and neck cancer at the Richmond International Raceway. VSO/HNS also works closely with the state legislature on issues of importance to their members. The society is represented on the BOG by Andrew Heller, MD, as governor, Kelley Melissa Dodson, MD, as legislative representative, and Jeffery J. Kuhn, MD, as public relations representative. VSO/HNS also wants to recognize the dedication of Evan R. Reiter, MD, the previous legislative representative, who greatly contributed to their successes. The Pennsylvania Academy of Otolaryngology—Head and Neck Surgery and the Virginia Society of Otolaryngology/Head and Neck Surgery will be recognized for their exemplary efforts at the Board of Governor’s General Assembly meeting on Monday afternoon, September 12, in San Francisco. MarketPlace Sale on Educational Products Find sales of 50-75 percent off educational products at the Academy MarketPlace. A complete list of products on sale is available at www.entnet.org/marketplace as well as a complete inventory of SiPacs, monographs, and the Slide Lecture Series. This is your last chance to purchase these valuable education resources (quantities are limited): • Snoring and Sleep Apnea, 2nd edition, Dennis D. Diaz, MD; Edward M. Weaver, MD, MPH • Common Emergencies of the Head and Neck 2nd Edition, Mark F. Williams, MD • Cochlear Implants, David S. Haynes, MD; May Y. Huang, MD; Peter S. Roland, MD • Evaluation and Management of Neck Mass and Adenophathy in Children, James S. Batti, MD; Scott R. Schoem, MD • Advanced Endoscopic Sinus Surgery, Richard R. Orlandi, MD; Carl H. Snyderman, MD Email memberservices@entnet.org for more information.
Residents Day at the Annual Meeting
Monday, September 12, 2011, is officially “Residents Day” at the Annual Meeting. See the schedule below for special event details. Monday, September 12 • Section for Residents and Fellows (SRF) General Assembly—2:30-4:30 pm • Mentor and Mentee Skills: Tools from Residency to Practice and Beyond; Business of Medicine—10:30-11:50 am, supported by the Women in Otolaryngology Committee, and Young Physicians Committee Mona M. Abaza, MD, MS (Moderator); Mark K. Wax, MD; Marvin P. Fried, MD; Chandra M. Ivey, MD; Ronald B. Kuppersmith, MD, MBA; Monica Tadros, MD • Development & Millennium Society-Sponsored Resident Event—9:00-11:00 pm, B Restaurant & Bar, 720 Howard Street, San Francisco. Other Highlighted Resident Events (Every Day)   • Free Instruction Courses for residents who are Academy members • Poster Presentations • ENT Careers Live! Booth # 238 • AcademyU Learning Lab – Esplanade Level, Moscone Center Sunday, September 11 • AAO-HNSF Academic Bowl; General (Interactive) 10:30-11:50 am, Supported by the Education Steering Committee J. David Osguthorpe, MD (Moderator); Mark K. Wax, MD Tuesday, September 13 • SRF Miniseminar—10:30-11:50 am, “Practice Considerations and Contracts for New Employment,” Moderator—Angela K. Sturm-O’Brien, MD, Presenters—Robert M. Glazer, MPA; Marvin P. Fried, MD; Daniel Zacharia; and Soha N. Ghossaini, MD Members in the News The Intersocietal Commission for the Accreditation of Computed Tomography Laboratories (ICACTL) recently announced the appointment of Gavin Setzen, MD, as President-Elect of the Board of Directors. As a representative of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS), Dr. Setzen was elected to a two-year term as ICACTL President-Elect beginning in 2011. Dr. Setzen has been a dedicated member of the AAO-HNS since 1995, and also contributed to the development of the ICACTL’s standards. He also serves on the Intersocietal Accreditation Commission (IAC) Board of Directors. Dr. Setzen is President of Albany ENT & Allergy Services, PC in Albany, NY, and is also an educator, serving as clinical assistant professor in the Division of Otolaryngology at Albany Medical College.
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Candidates for Secretary, Board of Governors, 2011 (Vote for One)
Wendy B. Stern, MD Qualifications and Experience When I opened my private practice 20 years ago in Massachusetts, I got a loan, hired a staff, and bought some equipment. I was a member of our Academy, but had no inkling of the BOG. Time and circumstances have led me down a fulfilling path. I am now the senior partner in a four-person group with a support staff of 36. I have served as board member, president, and currently am the Public Relations representative for my state society. I’ve been a member and co-chair of the BOG PR committee and will soon serve as the chair of the Academy Media and Public Relations Committee. I participate in the Joint Surgical Advocacy Conference (JSAC) and have served as a lecturer and panelist in many settings. Given the Academy’s strategic plan, outline  and prioritize your goals for the BOG? The BOG is the grassroots voice of our membership and serves as a conduit for information to and from our Academy. As BOG Secretary, I will facilitate this flow through work with our member societies, BOG committees, and the BOG miniseminar. I look forward to the opportunity to serve our otolaryngologic community in this exciting time. Hayes H. Wanamaker, MD Qualifications and Experience Over the last 20 years, I have had a broad range of clinical, academic, and management experience which I can use for the benefit of the BOG. I have a teaching appointment at Upstate Medical University, supervise residents and 15 attendings as chief of ENT at Crouse Hospital, and serve on the medical executive committee. I have dealt with scope of practice, pay for call, and EMTALA issues. As president of a 430-member IPA, I have gained invaluable experience in management, carrier relations, coding, and reimbursement issues. Most recently I have helped lead the effort to strike down a New York State law preventing otolaryngologists from dispensing hearing aids, gaining experience in political advocacy. I serve on several nonprofit boards, including the Salvation Army, the Crouse Health Foundation, and the Guardian Angel Society, which provides scholarships for inner city children to attend private schools. Given the Academy’s strategic plan, outline  and prioritize your goals for the BOG? The Academy has a comprehensive strategic plan encompassing advocacy and health policy, research and quality, education and knowledge, membership strength and unity, and sustainability. All of these goals require dedicated effort from across the Academy membership. This is a time of great challenge and change. My goal as secretary of the BOG is to help provide our members with the knowledge, skills, and resources to navigate these challenges. Our more established members need help modifying what had worked in the past. Our newer members need guidance to establish successful practices in an uncertain environment. We all need resources, education, and assistance coping with the onslaught of state and federal mandates and regulations as well as constant threats from insurance companies. The more we can help our colleagues with these issues, the better they will be able to focus their time on their continuing medical education, patient care, and public health.
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Candidates for Chair-Elect, Board of Governors, 2011 (Vote for One)
Paul M. Imber, DO Qualifications and Experience I am humbled to be nominated for this prestigious position, and if elected I will dedicate myself to the service of the Board of Governors and the Academy. During 29 years of practicing ENT, I have had the opportunity to serve many organizations in a variety of capacities. I have served in the following leadership positions: • President, Medical Staff, Riverside Hospital Medical Staff President, Delaware State Osteopathic Medical Society • President, American Osteopathic College of Otolaryngology–Head & Neck Surgery • President, Congregation Beth Shalom, Wilmington, DE • Current president, Delaware Academy of Otolaryngology–Head & Neck Surgery • Current vice, chairman and associate professor of otolaryngology, Philadelphia College of Osteopathic Medicine • Current section chief, otolaryngology, Christiana Care Health Systems My involvement in the Academy has included many years on the BOG, as well as chair of the Rules and Regulations Committee, and vice chair and current chair of the Legislative Representatives Committee. As Chair of Leg Rep, I have had the opportunity to represent the BOG advocacy positions in the ENT Today newsletter and in a presentation to the Indiana ENT Society. Each of these positions has provided me training in organizational leadership, committee process, leadership development, and organizational fiscal responsibility. Given the Academy’s strategic plan, outline  and prioritize your goals for the BOG? The Academy’s Strategic Plan provides a multifaceted program to facilitate the vision — empowering ENT doctors to deliver the best patient care. I propose that this includes the ability to practice in the most collaborative, interactive, and open healthcare environment, unfettered by meaningless rules and regulations. This will require: • Ongoing specialty collaboration to continue to develop best practices clinical guidelines • Legislative advocacy to guide state and federal policymakers as they shape the implementation of the Affordable Care Act • Leadership development to assure the continued successes of the Academy; and • Fundraising to grow the annual fund and the endowment. The BOG was developed to be the grassroots organization for the Academy, having the pulse of the broad membership across subspecialties, state lines, and the academic and private practice setting. It is in this capacity that the BOG has, and must continue, to take the leadership role in unifying advocacy, leadership training, and fundraising. These would be my priorities if elected to serve. Denis C. Lafreniere, MD Qualifications and Experience It is an honor to run for chair-elect of the BOG. I believe I am qualified for this position based on my years of experience as a practicing physician, teacher, and an advocate for our profession. I have been a faculty member of the University of Connecticut since 1992, where I am professor and chief of the division of otolaryngology. I have served as president of the Connecticut ENT Society, and in that role represented our Society as Governor in the BOG. I am currently serving the BOG as the chair for the Socioeconomic and Grassroots Committee. I have been a strong advocate for the members of our Academy both locally and nationally. Given the Academy’s strategic plan, outline  and prioritize your goals for the BOG? The goal of our Academy is to help improve the lives of our patients. As chair-elect of the BOG, I will work tirelessly to create an environment that allows our members to achieve these goals. Vote during the BOG General Assembly, Monday, September 12, 2011 Ballots are distributed and voting takes place during the BOG General Assembly meeting on Monday, September 12, 2011, between 5:00-7:00 PM. The positions of chair-elect and secretary will be elected by the BOG members present at the fall meeting, no proxy votes are allowed. Only governors or designated Alternate Governors attending the meeting in lieu of a Governor shall have the power to vote on any matter before the Board of Governors. Don’t Forget to Vote for AAO-HNS Leaders, too. • Secretary-Treasurer Elect • Director-at-Large (Academic) • Director-at-Large (Private Practice) • Audit Committee • Nominating Committee (Academic) • Nominating Committee (Private Practice) The online ballot closes August 18. Go to www.entnet.org/Community/public/candidates2011.cfm to vote.
Peter Abramson, MD BOG Secretary
The AAO-HNSF Annual Meeting & OTO EXPO 2011: The BOG Time Is Now
On September 11, 2011, the otolaryngology community will come together for the most informative educational forum that our specialty offers. San Francisco offers a dramatic background for four days of learning, advocacy, education, and reconnecting with colleagues. This has been a year of tremendous challenge for physicians. The healthcare reform act has changed the landscape for physicians at all stages of practice. Residents face a new future, newly practicing otolaryngologists must integrate the new changes into their practices while trying to build a patient base, and otolaryngologists in the prime of their careers will be integrating new mandated changes and compliance responsibilities into established practices. Where there is challenge, there is opportunity. While there is much uncertainty about the coming months and years, the Board of Governors (BOG) has planned an informative and stimulating slate of events to keep all of us aware of and knowledgeable about the new landscape of healthcare in general and otolaryngology specifically. The BOG is committed to bringing the most current information about critical topics we will be facing in the coming year as well as updating the membership on progress made throughout the previous year. This allows us to be proactive in our advocacy efforts. The BOG Executive Committee, BOG staff at the Academy, and committee members have worked diligently to put together an exciting slate of meetings that will leave attendees excited about the year to come and well-prepared to turn the challenges ahead into opportunities for their own practices and the specialty as a whole. BOG activities kick off on Saturday morning with committee meetings. The Legislative Representatives Committee is first on the schedule. This committee will focus on several of the current state and federal legislative agendas. The Academy legislative affairs team will give an up-to-date review of legislative activities that will affect our practice. The BOG Leaders Training session will be held after the Legislative Committee meeting on Saturday morning. This session will review methods to enhance the productivity and efficiency of member societies. This session will also feature Kathleen Yaremchuk, MD, who will be discussing the Physician Quality Reporting System. The Development and Fundraising Task Force will focus on ways to sustain our Foundation’s high quality objectives and goals. In the Socioeconomic & Grassroots Committee, current salient issues facing our practices on a day-to-day basis are discussed. These include such topics as practice management, reimbursement, peer review, and hospital-physician interaction. At 5:00 pm on Monday, September 12, the annual BOG General Assembly Meeting will be held. The assembly is not just for the BOG society representatives; anyone interested is encouraged to attend. At the assembly, committee chairpersons and BOG officers will provide updates on a full slate of legislative and socioeconomic issues that have been addressed in committee and review goals for the upcoming year. The General Assembly will also feature elections of new officers.  For a full schedule of BOG-related events, please visit the Academy’s website. On Tuesday morning, the annual BOG Executive Committee Miniseminar will be presented. This year’s miniseminar is “Hot Topics in Otolaryngology: 2011.” The focus of this year’s miniseminar will be four topics that are at the forefront of current practice of medicine. Lawrence Geller, MBA, will offer a status report on the Accountable Care Organization model and how physician practices  can strategically prepare for this paradigm. Raymund King, MD, JD, a board-certified otolaryngologist and attorney, will be covering the topic of physician-hospital joint ventures. Dr. King’s unique perspective will be exceedingly informative in helping the practicing physician understand the intricacies of these relationships. The BOG is also delighted to have Michael J. Koriwchak, MD, a practicing otolaryngologist and founder of the popular blog “The Wired EMR Doctor,” who will give a brief review of electronic medical records, meaningful use, and an update on the government reimbursement efforts. Also, Rick G. Love, MD, will bring us up to date on pay for Emergency Department call coverage. There will be plenty of time for questions and panelist comments. All who are attending the Academy meeting are welcomed and encouraged to attend the BOG meeting and affiliated activities. It will be definitely worth your time! For more information on how to become active in the Board of Governors, visit the Academy’s website or contact Richard Carson, Senior Manager, Component Relations, at 1-703-535-3726 or at bog@entnet.org. I look forward to seeing all of you in San Francisco. The May column “The World’s Otolaryngology Fair: The AAO-HNSF Annual Meeting & OTO EXPO” was mistakenly attributed to Michael D. Seidman, MD. The author of that column was actually Gavin Setzen, MD, BOG, Immediate Past Chair.
David R. Nielsen, MD, AAO-HNS/F EVP/CEO
The Changing Role of the Otolaryngologist
Embedded in nearly every question that comes to the Academy these days is a sense of a more “global” uncertainty — a concern about how our roles as physicians, surgeons, teachers, learners, and professionals are changing. Familiarity is a powerful influence, and all of us know how difficult it can be to leave our “comfort zones” and adapt to necessary change; or more importantly, how hard it is to effectively drive and implement needed change. There is much that we cannot predict with certainty today. How will we provide better access to affordable healthcare to 46 million underserved and previously uninsured people? How will we avert a financial meltdown of Medicare as healthcare costs rise? Or how can we systematically eliminate preventable errors in healthcare, such as “Wrong Site/Wrong Side” surgery; or “Wrong Drug/Wrong Dose/Wrong Patient” errors? With restrictions on resident duty hours, how can the next generation of physicians master the ever-expanding knowledge base, and gain the clinical experience needed to be better than the previous generation? With all the changes implied and explicitly outlined in the elements of legislation and regulation in healthcare reform, it is helpful to stop for a moment and discuss what will NOT change. And within that discussion we can find some reassurance. What will NOT change is our role as professionals, our altruism, putting public health and patients’ needs ahead of personal gain; voluntary self-regulation; and transparency, disclosing competing interests. What will NOT change is our united voice in ensuring that true clinical improvement, more effective medical and surgical care, and a healthier population must be the target metrics of quality measures, not just reducing costs or improving administrative efficiency. What will NOT change is the leadership role that otolaryngologists will play in advancing the basic science, clinical applications, and health services improvements that are essential to improve care. Scenario planning is one tool that is used by organizations to strategically plan for the future. There are some likely scenarios for which we must be prepared, that we may not currently be ready for. Rather than striking fear in our hearts, or evoking uncertainty in our minds, these considerations can be exhilarating and challenging in exactly the positive way that medical training and practice can be. What are some of the roles, changes, and challenges that we will continue to address? What will our future look like? Changes in graduate  medical training • Large amphitheaters of students are replaced with learner-centered educational systems with screens, keyboards, interactivity, and individually paced simulation. • With advanced training tools, both cognitive and procedural, we train to mastery and proficiency, not just competency. • Systems learning adapts the new generation to methods of life-long learning that change physician behavior in ways that are feasible, measurable, continuous, and documented. Changes in continuing  medical education • While didactic learning will still have its place, much of it is replaced with mobile learning tools, shared systems, multidisciplinary access to broader and more specific content. • Clinically useful educational content is accessed in real time at the point of care. • Content includes decision support with systems approaches, evidence-based clinical practice guidelines, perform- ance measures and reference links. • Interactivity expands with cloud computing, actively shared knowledge, and community. • Higher levels of integration of all content will link enduring and printed materials, live content, published academic journals with clinical action and EMR/registry documentation and benchmarking for continuous improvement. Changes in practice • Simulation is more than a teaching or training tool. Practice and preparation for patient care, with both cognitive and procedural skills sets, will become a regular part of clinical work. • Simulated “warm-ups,” rehearsals, and virtual escapes are linked to the specific anatomy of individual patients through integration of imaging, haptics, and clinical information. • Simulation “boot camps” expand and offer continuous opportunity to upgrade skills, and apply new technology and techniques. • Augmented reality allows sharing of surgical experience and perspectives on a global scale. • Robotics expand, link with imaging data, improve approaches, reduce invasiveness, and heighten accuracy. As we contemplate the expected rapid changes in the next generation, focusing on enduring principles, ensuring patient-centered care, and engaging in solution-based conversations will assure us that we need not fear the future, but embrace it with enthusiasm and courage. There has never been a better time to be a physician!
J. Regan Thomas, MD AAO-HNS/F President
Excitement Building for Annual Meeting
August is here! The proverbial “dog-days” of summer are anything but hazy and lazy for those otolaryngologist—head and neck surgeons who can feel the excitement building around the upcoming AAO-HNSF Annual Meeting & OTO EXPO. This issue of the Bulletin focuses that excitement on the OTO EXPO.  As the world’s largest gathering of otolaryngologists, the American Academy of Otolaryngology—Head and Neck Surgery Foundation’s Annual Meeting & OTO EXPO is also the premier event to showcase products and services for the specialty. The Hall will truly be bursting with action, as it has been sold out with a waiting list of exhibitors since late June! As we attendees learn of new research during our early morning sessions each day, it will be great to follow these sessions with a systematic review of product and service innovations in the Hall. Paul Bascomb, AAO-HNS program manager, exhibits, puts it this way, “The OTO EXPO offers attendees a hands-on opportunity to examine and try new tools and resources as a complement to the formal education taking place in sessions.” And visit www.entnet.org/annual_meeting for an interactive tour of the floor. Engage Through the BOG Interested in learning more about the grassroots arm of the AAO-HNS? Whether you are an official Board of Governors (BOG) representative or are just curious about what the BOG does and how you can become involved, make plans now to attend the BOG committee meetings in San Francisco on Saturday, September 10, starting at 8:00 am. These meetings are geared to address and discuss current issues, and potential problems, and possible solutions that affect otolaryngology—head and neck surgery, across the country from Capitol Hill to your backyard. On Monday, September 12, 5:00-7:00 pm, you are welcome to attend the BOG General Assembly meeting. Attendees will have the opportunity to listen to important updates from BOG committee chairs.  The elections for BOG officers are held during this meeting and the BOG is fortunate to have secured several outstanding candidates. Paul Imber, DO, Delaware, and Denis Lafreniere, MD, Connecticut, are running for BOG chair-elect, and Wendy Stern, MD, Massachusetts, and Hayes Wanamaker, MD, New York, are running for BOG member-at-large.  The BOG serves as a catalyst for solutions by working to build unity across the field of otolaryngology—head and neck surgery. John Conley Lecture on Medical Ethics, Guest Lecturer Marlee Matlin, Academy Award Winning Actress and Activist.  Dr. Conley defined professional ethics, Matlin’s keynote in his name will inspire a renewed commitment for excellence in our profession. Marlee Matlin received worldwide critical acclaim for her motion picture debut in Children of a Lesser God, earning her the Academy Award for Best Actress. At age 21, she became the youngest recipient of the Best Actress Oscar, making her one of only four actresses to receive that honor for a film debut. Since then, Matlin has starred in numerous feature films and television productions. For seven seasons, Matlin starred opposite Martin Sheen, on NBC’s Emmy Award winning series, The West Wing. She has also guest starred on ER, Judging Amy, and CSI: New York and My Name is Earl. In 2008, Matlin broke barriers when she joined the cast of ABC’s Dancing with the Stars. She was also a finalist on the most recent season of NBC’s The Celebrity Apprentice. She is the author of three novels for children, and an autobiography, “I Will Scream Later.” Matlin is also an activist for children and on health issues. Matlin served as host of PBS’s Emmy Award winning series People in Motion and, in 2007, was featured in the PBS documentary, Through Deaf Eyes. She is seen currently starring in Disney’s highly acclaimed Baby Einstein DVD series, teaching sign language to infants and toddlers. Matlin also serves as national celebrity spokesperson for the American Red Cross, encouraging Americans to donate blood, and has worked on behalf of closed captioning legislation requiring all televisions manufactured in the United States be equipped with this technology. So, don’t miss this dynamic and inspiring presentation.
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Looking to Hire? In Search of a Job?
The Academy is proud to announce the continuation of our on-site career center, ENT Careers, at the 2011 Annual Meeting & OTO EXPO.  A staff of experts will be on hand to help attendees answer questions about the services provided by ENT Careers, including how to use Event Connection to arrange onsite interviews, post jobs and resumes, and navigate the ENT Careers website. This is a valuable networking opportunity for job seekers and employers who will be together in one city, at the world’s largest gathering of otolaryngologists. Event Connection is the key to making the most out of the Annual Meeting & OTO EXPO. It allows employers and job seekers to flag profiles and/or job postings to indicate that they will be attending the annual meeting. Space is provided to leave messages about personal availability so that employers and job seekers can meet one-on-one during the conference. The ENT Careers booth will be equipped with computers and a printer to assist with inquires of all kinds. ENT Careers will be in the Exhibit Hall and open throughout the exhibit hours so attendees may take as much time as needed to: • Purchase contracts on ENT Careers • Register an account as a job seeker or employer • Post jobs and resumes online • Search Event Connection to set up interviews • Search for open positions on the ENT Careers site • Sign up for job alerts Why use ENT Careers? Whether you are a job seeker or an employer, ENT Careers is the official job board of AAO-HNS and is the pre-eminent career resource used by ENT professionals. No other job board can offer the volume of jobs or the number of candidates from one source. Employers can expect to receive qualified responses to their postings no matter what specialty and discipline they are hiring. Job seekers have the advantage of browsing the largest selection of ENT jobs online and making their job search more efficient by utilizing the robust suite of tools provided by the newly redesigned ENT Careers. This is a valuable opportunity to network with professionals in your field. Go to ENT Careers at www.healthecareers.com/aaohns to post your resume or job description, and indicate your attendance at the Annual Meeting & OTO EXPO. We look forward to seeing you at this year’s meeting!
Attend the Fifth Annual Academic Bowl at the 2011 Annual Meeting & OTO EXPO
The Education Steering Committee (ESC) of the American Academy of Otolaryngology—Head and Neck Surgery Foundation, with help from the Program Advisory Committee, is excited to present the Fifth Annual Academic Bowl. As part of the Sunday, September 11, morning program of our 2011 Annual Meeting & OTO EXPO, four of the top Otolaryngology residency programs in the country will compete against each other and the audience in a clinically oriented test of knowledge. Questions make use of images, videos, radiographs and lab results, and are created by our educational faculty or selected from popular educational materials such as the Home Study Course, Patient of the Month, and AcademyU®. The Academic Bowl will be a fun, interactive experience for competitors and audience members alike. (Audience members can participate anonymously using our wireless response system.) It is also an excellent way to earn continuing education credit and to review for Maintenance of Certification. This year’s participants will be Loyola University Medical Center, University of Mississippi Medical Center, Tulane University School of Medicine, and University of Texas Southwestern. Each team is made up of three residents who  each receive a travel grant to attend the meeting. The winning program will receive a two-year subscription to the Home Study Course for up to 10 of its residents, and the runner-up program wins a one-year subscription. The emcees for this year’s event will be our immediate past and present Coordinators for Education: J. David Osguthorpe, MD of the Medical University of South Carolina and Mark K. Wax, MD from Oregon Health Science University. We would like to extend special thanks and an invitation to the past Academic Bowl participants to attend the 2011 competition. • 2010: New York Medical College, Thomas Jefferson University, University of California (Irvine) and University of Iowa Hospitals and Clinics. • 2009: New Jersey Medical School, University of North Carolina Hospitals, Ohio State University Hospital, and Wake Forest University School of Medicine. • 2008: Medical College of Wisconsin, University of Nebraska, University of California – San Francisco, and West Virginia University • 2007: Louisiana State University – Shreveport, University of Utah, Cleveland Clinic Foundation, and National Capital Consortium-Bethesda Join us following the Opening Ceremony on Sunday, September 11, from 10:30 am-12:00 pm for this fun and exciting event.
Ear Trumpet, tin, dating from 1840-1900. Rosalind N. and David Myers Hearing Aid Collection
Otolaryngology Historical Society Annual Meeting and Reception
Monday, September 12, 2011 *Marines’ Memorial Club, Crystal Ballroom 609 Sutter Street, San Francisco, California 6:30 pm-8:30 pm Please join us for a delightful evening of celebration and fellowship featuring these historical presentations: Invited Speakers • “Dr. John M. Epley and the Epley Maneuver” Cathryn L. Epley • “Evolution of Facial Plastics in the 20th Century: Progress Born of War” Emma Cashman, MBBCh, MD, MRCSI  Harvard Medical School/Dana Farber Cancer Center • “History of Graduate Medical Education in Otolaryngology in the United States”  Richard K. Gurgel, MD, Stanford University • “The Evolution of Eustachian Tube Surgery: 300 Years and Counting”  Edward D. McCoul, MD, MPH, SUNY–Downstate Medical Center • “The Price Paid: Manipulation of Otolaryngologists by the Tobacco Industry to Obfuscate the Emerging Truth That Smoking Causes Cancer” Robert K. Jackler, MD, Stanford University OHS members receive advance notice and a complimentary ticket for the evening reception. For OHS members who wish to bring a guest, there is a $50 per ticket fee. If you are not a member of the OHS but wish to attend this event, there is a $75 fee. To register or apply for membership, please contact Irma Chavez at ichavez@entnet.org or call 1-703-535-3786. Attendees are encouraged to bring a book, artifact or medical instrument of historic interest (or photo of the same) to discuss at the meeting. *Shuttle buses from Moscone Center to Westin St Francis Hotel, Union Square, then walk two blocks to Marines’ Memorial Club.
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The 2011 AAO-HNSF Annual Meeting & OTO EXPO: Representing the Latest and Greatest of Otolaryngology
By Paul Bascomb,  Program Manager, Exhibits Planning for the 2011 AAO-HNSF Annual Meeting & OTO EXPO got off to a terrific start, and now that we are less than a month away, we  are proud to report that we have more than 275 exhibitors in place, covering well over 75,000 net square feet. We were at 99 percent capacity back in June! This speaks volumes because our exhibitors are not only excited to be a part of this annual event to interact and network with the 6,000+ attendees expected, but they have also shown that they understood the sense of urgency to sign up early to increase their opportunity to get a better position on the show floor. The Moscone Center in San Francisco will be the stage for this year’s Annual Meeting & OTO EXPO. Access to the exhibit hall is just one level down from registration and available from three escalators. At the top of the escalators, watch for the list of exhibitors prominently displayed. Once on the show floor, you will see that our exhibitor base spans a wide realm of products and services that those in the field of otolaryngology can utilize. From hearing devices, imaging equipment, and nasal surgery products to sleep/snoring products, instrumentation, practice management, surgical accessories, and voice restoration prostheses, there is  a lot for all to experience. Let’s not forget those agencies and institutions that will  be there to recruit. As in years past, we have attracted a healthy number of new companies to our event. This year is no exception, as 15  percent of our exhibitor base has never before exhibited at the AAO-HNSF Annual Meeting & OTO EXPO.  Be sure to seek them out using our new and improved mobile application that will allow you to find our exhibitors on your mobile device. To view the live floorplan, please follow this link: www.entannualmeeting.org/index.php/oto-expo. There is a lot to see at the show  this year! The exhibitors will be ready to showcase what they can offer and we will be ready to put on a great show for all parties involved. We look forward to welcoming our global audience to the 2011 American Academy of Otolaryngology—Head and Neck Surgery Foundation’s Annual Meeting & OTO EXPO in  San Francisco, CA, from September  11 – 14! Exhibitors at the 2011 Annual Meeting & OTO EXPO 1st Line Medical  2036 www.1stLineMedical.com 20th IFOS World Congress Seoul 2013   126 www.ifosseoul2013.com Acclarent (IRT Leader)   1709-A www.acclarent.com Acumed Instruments Corporation   107 Advanced Bionics    1619 www.advancedbionics.com Advanced Endoscopy Devices   1512 www.aed.md/ Alcon Laboratories Inc (IRT Member)  611 www.alcon.com All-American Allergy Alternatives, LLC   007 www.allamericanallergy.com AllMeds   1025 www.allmeds.com American Academy of Facial Plastic  & Reconstructive Surgery  1139 www.aafprs.org American Board of Otolaryngology   843 www.aboto.org American Cleft Palate-Craniofacial Association   017 www.acpa-cpf.org American Journal of  Rhinology & Allergy   1140 www.AJRA.com American Medical Systems      1135 American Society of Geriatric Otolaryngology   1750 www.geriatricotolaryngology.org Anatomy Gifts Registry   1805 www.agrtissue.org AnazaoHealth Corporation   142 www.anazaohealth.com Annals Publishing Company   1710 Anthony Products Inc/Gio Pelle   1731 Antigen Laboratories, Inc.   1520 www.antigenlab.com Apdyne Medical Co   1937 Apnex Medical Inc   343 www.apnexmedical.com Apple Biomedical Inc   1142 Arches Natural Products Inc   1413 www.tinnitusformula.com ArthroCare ENT   600 www.arthrocare.com ASL Pharmacy   1712 ATMOS Inc   201 www.atmosmed.com Atos Medical Inc.  738 Bassett Medical Center   011 www.bassett.org Bausch & Lomb   331 www.bausch.com Beaver-Visitec International   005 www.beaver-visitec.com Beutlich LP Pharmaceuticals   207 www.beutlich.com BFW Inc   400 www.bfwinc.com BHS International   128 www.bhsinternational.com Bien Air Surgery   1801 Biomet Microfixation   402 Blue Tree Publishing Inc   330 www.bluetreepublishing.com Boston Medical Products Inc   1233 www.bosmed.com Brainlab   919 www.brainlab.com Brazilian Association of ENT   1613 www.aborlccf.org.br/ CareCredit   1236 www.carecredit.com Carestream Health  (IRT Associate)  633 www.carestream.com/ENT Carl Zeiss Meditec Inc   1401 www.meditec.zeiss.com Carnegie Surgical LLC   147 www.carnegiesurgical.com Ceredas   1133 www.ceredas.com Checkpoint Surgical, LLC   1237 www.checkpointsurgical.com Clinicon Corporation   1836 www.clinicon.com Cobalt Medical Supply Inc   239 www.cobaltmed.com Cochlear Americas   701 www.cochlear.com Comfort Earx   1902 www.comfortearx.com Conescan   1419 Cook Medical   1341 www.cookmedical.com Cornerstone Therapeutics Inc.   102 www.crtx.com Covenant Healthcare   104 Covidien  624 www.respiratorysolutions.covidien.com CTRV Innovations  1834 www.fauteuil-trv.com Daiichi Sankyo   106 DEKA Medical Inc   1631 www.dekamedinc.com Dental Sleep Med Systems  & The Snoring Is Boring Team   442 www.getdentalsleep.com Designs for Vision Inc  432 www.dvimail.com Doc’s Duds  915 www.docsduds.com DocumENT  539 Eagle Surgical Products LLC  1943 www.electrolubesurgical.com Ear Nose & Throat Journal  540 Ecleris International  425 www.ecleris.com Ellman International  1241 www.ellman.com Elmed Incorporated  537 Elsevier  1232 Endocraft LLC  100 Endoscopy Support Services Inc  1928 EndoSoft  009 www.endosoft.com Endure Medical Inc  334 ENT & Audiology News  230 ENT Careers Live!  (Academy Advantage Partner)  238 www.entnet.org/Community/public/careers.cfm Entellus Medical (IRT Leader)  1117 www.entellusmedical.com ENTrigue Surgical, Inc  1511 www.entriguesurgical.com Envoy Medical  1841 www.envoymedical.com EPIC Hearing Healthcare  411 ESAOTE North America  1516 www.drsmart.com Ethicon Endo-Surgery  1709-B www.ethiconendo.com Eyemaginations (Academy  Advantage Premier Partner)  1835 www.ent.eyemaginations.com Fahl Medizintechnik Vertrieb GmbH  231 www.fahl.de Feather Safety Razor Co Ltd  1704 www.feather.co.jp Ferrell Duncan Clinic/Cox Health  430 www.coxhealth.com GE Healthcare  416 www.gehealthcare.com General Surgical  Company (India) PVT., LTD  840 Given Imaging  1540 www.givenimaging.com Global Medical Endoscopy  440 www.globalmedicalendoscopy.com Global Surgical Corp  1501 www.globalsurgical.com Global Surgical Corp  1601 www.globalsurgical.com Grace Medical Inc  1033 Grason-Stadler  511 www.grason-stadler.com Greenway Medical Technologies  2041 www.greenwaymedical.com Greer Laboratories Commercial  131 www.greerlabs.com Greer Laboratories Medical Affairs  130 www.greerlabs.com Group Health Physicians  235 www.ghpmd.org H.M.B. Endoscopy Products  1240 www.hmbendoscopy.com Health Management Associates  1804 www.PracticewithHealthManagement.com Healthworld International, Inc.  1514 www.healthworldintl.com Hemostasis, LLC  634 www.hemostasisllc.com/ Hemostatix Medical Technologies LLC  428 Hill Dermaceuticals Inc  1242 Hitachi Aloka Medical  112 www.aloka.com Holzer Clinic  243 www.holzerclinic.com Hood Laboratories Inc   639 www.hoodlabs.com ImThera Medical Inc  1339 www.imtheramedical.com InHealth Technologies  1925 innoForce Est.  742 Inspire Medical Systems  021 www.inspiresleep.com Insta-Mold Products Inc  520 Instrumentarium  541 Instrumentarium/Soredex   438 Insurance for the Medical Professional   1607 Integra Miltex  410 www.integralife.com Intelligent Hearing Systems  538 Interacoustics  101 www.interacoustics-us.com Interamerican Assoc of Ped Otorhinolaryngology   419 Intersect ENT   1939 www.intersectENT.com Intersocietal Accreditation  Commission (IAC)  311 Intuitive Surgical (IRT Associate)  401 www.intuitivesurgical.com Invotec International Inc  1332 IRIDEX  329 J. Morita Mfg. Corp.  404 JAMA & Archives Journals  110 pubs.ama-assn.org JEDMED Instrument Company  1001 www.jedmed.com Jullundur Surgical Works  941 www.jullsurgindia.com Kaiser Permanente  947 www.physiciancareers.kp.org Karger Publishers  134 www.karger.com KARL STORZ Endoscopy-America Inc.  1225 KARL STORZ Endoscopy- Latin America   1333 KayPENTAX  625 www.kaypentax.com Kirwan Surgical Products Inc  439 KLS Martin Group  433 Kurz Medical Inc  733 LABOMED  1440 www.laboamerica.com Laser Engineering, Inc  1641 Leica Microsystems Inc  116 www.leica-microsystems.com LifeCell Corporation a KCI Company  206 www.lifecell.com Lifestyle Lift (IRT Leader)  1013 www.lifestylelift.com Lippincott Williams & Wilkins/Wolters Kluwer Hlth  531 www.lww.com Lisa Laser USA  301 www.lisalaserusa.com Longtek Scientific Co. Ltd.  1421 Lumenis   1325 www.lumenis.com Maico Diagnostics   1701 Marina Medical Instruments   1636 Massaging Insoles by  Superior Health Inc  335 www.massaginginsoles.com Mayo Clinic Health System  1336 www.isj-mhs.net McKeon Products Inc  847 www.macksearplugs.com MD Logic EMR  1041 Medafor Inc  1433 MED-EL Corporation  1531 Medical Digital Developers (MDDev)  1036 www.mddev.com Medical Modeling Inc  1438 MediCapture Inc.  424 Medicor Imaging, a division  of LEAD Technologies  1748 www.leadtools.com Medifix Inc  1443 www.medifixinc.com Mediplast AB  115 www.mediplast.com Mediplay Inc  339 www.mediplay.com MedNet Locator Inc  1042 MedNet Technologies Inc  407 www.mednet-tech.com Medtronic Surgical Technologies   1101 www.medtronic.com Mentor Worldwide LLC   1709-C www.mentorwwllc.com/global-us/ Merrill Lynch   939 www.fa.ml.com/bob Merz Aesthetics  (formerly Bioform Med)  1407 www.radiesse-voice.com Micromedical Technologies Inc   1725 www.micromedical.com Micronix Systems Inc.  1926 Microsurgery Instruments Inc  838 Mimosa Acoustics Inc   341 www.mimosaacoustics.com Ministry Health Care    013 www.ministryhealth.org/recruitment MJD/TopDocs.com   1238 www.mjdpc.com Möller-Wedel GmbH   219 www.moeller-wedel.com MTI   617 National Affinity Services (Academy Advantage Partner)   140 www.nationalaffinity.net National Spasmodic  Dysphonia Association   414 Natus Medical Incorporated   1605 www.natus.com NeilMed Pharmaceuticals   1318 www.neilmed.com Neurosign   643 www.neurosign.com Neurovision Medical Products  148 www.neurovisionmedical.com NexTech 225 NextGen Healthcare  Information Systems Inc   1904 www.nextgen.com Nicos Group, Inc. – Euroclinic Division     441 www.nicosgroup.com NIDCD National Temporal  Bone Registry   1539 www.tbregistry.org NSI-ENT, LLC   948 www.nsi-us.com Officite (Academy Advantage Partner)  525 www.websitesforents.org Olsen Medical   1642 Olympus 801 On the Avenue Marketing   114 Ontium Medical Corporation   1757 www.ontium.com Optim LLC   1800 orlvision GmbH   124 OsteoMed   1638 www.osteomed.com Oticon Medical LLC   815 Otodynamics Ltd   1825 Otologics LLC   327 Otomed, Inc   516 www.otomed.com OtoSim   942 www.otosim.com Ototronix 1301 Panamerican Congress of Otolaryngology, Head & Neck   113 PARI Respiratory Equipment   630 www.PARI.com Parnell Pharmaceuticals Inc   321 www.parnellpharm.com Passy-Muir Inc   1736 www.passy-muir.com PBHS, Inc   1903 www.pbhs.com PeriOptix, Inc.   542 www.perioptix.com/ Phonak Hearing Systems   001 www.phonak.com Physician Assistants in Otorhinolaryngology   1901 Physician Owned Surgery Centers   1924 Plural Publishing Inc   305 Practice Flow Solutions   1014 Presbyterian Intercommunity Hospital   135 www.pih.net Prescott’s Inc   317 Primal Pictures Ltd 325 Prime Clinical Systems Inc   417 Pulmodyne, Inc.      1929 QED Medical   308 Quest Medical Inc   209 Radysans, Inc   133 www.radysans.com Reliance Medical Products Inc   1425 www.reliance-medical.com ReSound   1803 www.gnresound.com Restech   1537 www.restech.com Rex Medical, Inc.   2042 www.rex-medi.com RG Medical   338 www.rgmedical.com RGP, Inc.   1538 Richard Wolf Medical  Instruments Corporation   1507, 1606 www.richardwolfusa.com Robert Michael  Educational Institute LLC   213 www.rmei.com Rose Micro Solutions   342 www.rosemicrosolutions.com SAGE   743 www.sagepub.com Saline Soothers (Little Busy Bodies)   1547 www.salinesoothers.com Sandhill Scientific   1518 Scott & White Healthcare System   138 www.sw.org Seiler Precision Microscopes   212 www.seilerinst.com Serolab   1542 www.serolab.net SheerVision, Inc.   1840 www.sheervision.com Shippert Medical Technologies Incorporated   1137 Simplicity EMR   1519 Simply Saline   1448 www.simplysalinepro.com Sinus Dynamics   1525 SKYCAP Products LLC   1340 Sleep Group Solutions   1706 www.sleepgs.com Smiths Medical   1609 SNAP Diagnostics LLC   1802 Sonic Innovations   1941 www.sonici.com Sonitus Medical, Inc.   1313 Sontec Instruments Inc   1827 Sonus-USA   313 Sophono, Inc.   1040 www.sophono.com Springer   937 Squip, Inc.    1417 www.squipusa.com Starion Instruments Inc   1141 www.microlinesurgical.com/ Starkey   717 www.StarkeyPro.com Stryker   825 www.stryker.com Summit Medical   1439 www.summitmedicalusa.com SurgiTel/General Scientific Corp   1830 www.surgitel.com Sutter Health Sacramento Sierra Region   234 www.checksutterfirst.org Synapsys  1637 www.synapsysusa.com Synthes Anspach   125 www.anspach.com/ Synthes CMF   119 www.synthes.com/sites/NA/Products/CMF/Pages/home.aspx TeleVox   739 The Airway Company   1931 www.TheAirwayCompany.com The Alkalol Company   2040 www.alkalolcompany.com The Doctors Company (Academy Advantage Premier Partner)   1700 www.thedoctors.com The French ENT Society   1933 www.sforl.org The Journal of Laryngology & Otology   132 www.journals.cambridge.org/jlo The Payroll Company (Academy Advantage Partner)  1900 www.academybenefitpartners.org The Snoring Center   1125 www.snoringcenter.com Thieme Medical Publishers   638 www.thieme.com Transtracheal Systems Inc   232 www.tto2.com TriCord Pharmaceuticals   1541 www.oasisnasal.com TrueVision Systems, Inc.   1842 www.truevisionsys.com United Endoscopy   1338 www.unitedendoscopy.com University Medical Center  Hamburg-Eppendorf   019 www.uke.de/voxel-man Ventus Medical  109 www.proventtherapy.com ViroPharma Medical Affairs   1447 www.viropharma.com Vision Sciences, Inc.  517 Vivosonic Inc   306 Waiting Room Solutions   1239 www.waitingroomsolutions.com Widex USA   837 www.widexusa.com Wiley-Blackwell   1702 www.wileyblackwell.com Worldpay (Academy Advantage Partner)  1342 www.worldpay.us/ Xoran Technologies Inc   1019 www.xorantech.com Yodle   1708 www.yodle.com Yuma Regional Medical Center   535 www.yumaregional.org Z-Medica Corporation   1625 www.z-medica.com es because our exhibitors are not only excited to be a part of this annual event to interact and network with the 6,000+ attendees expected, but they have also shown that they understood the sense of urgency to sign up early to increase their opportunity to get a better position on the show floor. The Moscone Center in San Francisco will be the stage for this year’s Annual Meeting & OTO EXPO. Access to the exhibit hall is just one level down from registration and available from three escalators. At the top of the escalators, watch for the list of exhibitors prominently displayed. Once on the show floor, you will see that our exhibitor base spans a wide realm of products and services that those in the field of otolaryngology can utilize. From hearing devices, imaging equipment, and nasal surgery products to sleep/snoring products, instrumentation, practice management, surgical accessories, and voice restoration prostheses, there is  a lot for all to experience. Let’s not forget those agencies and institutions that will  be there to recruit. As in years past, we have attracted a healthy number of new companies to our event. This year is no exception, as 15  percent of our exhibitor base has never before exhibited at the AAO-HNSF Annual Meeting & OTO EXPO.  Be sure to seek them out using our new and improved mobile application that will allow you to find our exhibitors on your mobile device. To view the live floorplan, please follow this link: www.entannualmeeting.org/index.php/oto-expo. There is a lot to see at the show  this year! The exhibitors will be ready to showcase what they can offer and we will be ready to put on a great show for all parties involved. We look forward to welcoming our global audience to the 2011 American Academy of Otolaryngology—Head and Neck Surgery Foundation’s Annual Meeting & OTO EXPO in  San Francisco, CA, from September  11 – 14! Exhibitors at the 2011 Annual Meeting & OTO EXPO 1st Line Medical  2036 www.1stLineMedical.com 20th IFOS World Congress Seoul 2013   126 www.ifosseoul2013.com Acclarent (IRT Leader)   1709-A www.acclarent.com Acumed Instruments Corporation   107 Advanced Bionics    1619 www.advancedbionics.com Advanced Endoscopy Devices   1512 www.aed.md/ Alcon Laboratories Inc (IRT Member)  611 www.alcon.com All-American Allergy Alternatives, LLC   007 www.allamericanallergy.com AllMeds   1025 www.allmeds.com American Academy of Facial Plastic  & Reconstructive Surgery  1139 www.aafprs.org American Board of Otolaryngology   843 www.aboto.org American Cleft Palate-Craniofacial Association   017 www.acpa-cpf.org American Journal of  Rhinology & Allergy   1140 www.AJRA.com American Medical Systems      1135 American Society of Geriatric Otolaryngology   1750 www.geriatricotolaryngology.org Anatomy Gifts Registry   1805 www.agrtissue.org AnazaoHealth Corporation   142 www.anazaohealth.com Annals Publishing Company   1710 Anthony Products Inc/Gio Pelle   1731 Antigen Laboratories, Inc.   1520 www.antigenlab.com Apdyne Medical Co   1937 Apnex Medical Inc   343 www.apnexmedical.com Apple Biomedical Inc   1142 Arches Natural Products Inc   1413 www.tinnitusformula.com ArthroCare ENT   600 www.arthrocare.com ASL Pharmacy   1712 ATMOS Inc   201 www.atmosmed.com Atos Medical Inc.  738 Bassett Medical Center   011 www.bassett.org Bausch & Lomb   331 www.bausch.com Beaver-Visitec International   005 www.beaver-visitec.com Beutlich LP Pharmaceuticals   207 www.beutlich.com BFW Inc   400 www.bfwinc.com BHS International   128 www.bhsinternational.com Bien Air Surgery   1801 Biomet Microfixation   402 Blue Tree Publishing Inc   330 www.bluetreepublishing.com Boston Medical Products Inc   1233 www.bosmed.com Brainlab   919 www.brainlab.com Brazilian Association of ENT   1613 www.aborlccf.org.br/ CareCredit   1236 www.carecredit.com Carestream Health  (IRT Associate)  633 www.carestream.com/ENT Carl Zeiss Meditec Inc   1401 www.meditec.zeiss.com Carnegie Surgical LLC   147 www.carnegiesurgical.com Ceredas   1133 www.ceredas.com Checkpoint Surgical, LLC   1237 www.checkpointsurgical.com Clinicon Corporation   1836 www.clinicon.com Cobalt Medical Supply Inc   239 www.cobaltmed.com Cochlear Americas   701 www.cochlear.com Comfort Earx   1902 www.comfortearx.com Conescan   1419 Cook Medical   1341 www.cookmedical.com Cornerstone Therapeutics Inc.   102 www.crtx.com Covenant Healthcare   104 Covidien  624 www.respiratorysolutions.covidien.com CTRV Innovations  1834 www.fauteuil-trv.com Daiichi Sankyo   106 DEKA Medical Inc   1631 www.dekamedinc.com Dental Sleep Med Systems  & The Snoring Is Boring Team   442 www.getdentalsleep.com Designs for Vision Inc  432 www.dvimail.com Doc’s Duds  915 www.docsduds.com DocumENT  539 Eagle Surgical Products LLC  1943 www.electrolubesurgical.com Ear Nose & Throat Journal  540 Ecleris International  425 www.ecleris.com Ellman International  1241 www.ellman.com Elmed Incorporated  537 Elsevier  1232 Endocraft LLC  100 Endoscopy Support Services Inc  1928 EndoSoft  009 www.endosoft.com Endure Medical Inc  334 ENT & Audiology News  230 ENT Careers Live!  (Academy Advantage Partner)  238 www.entnet.org/Community/public/careers.cfm Entellus Medical (IRT Leader)  1117 www.entellusmedical.com ENTrigue Surgical, Inc  1511 www.entriguesurgical.com Envoy Medical  1841 www.envoymedical.com EPIC Hearing Healthcare  411 ESAOTE North America  1516 www.drsmart.com Ethicon Endo-Surgery  1709-B www.ethiconendo.com Eyemaginations (Academy  Advantage Premier Partner)  1835 www.ent.eyemaginations.com Fahl Medizintechnik Vertrieb GmbH  231 www.fahl.de Feather Safety Razor Co Ltd  1704 www.feather.co.jp Ferrell Duncan Clinic/Cox Health  430 www.coxhealth.com GE Healthcare  416 www.gehealthcare.com General Surgical  Company (India) PVT., LTD  840 Given Imaging  1540 www.givenimaging.com Global Medical Endoscopy  440 www.globalmedicalendoscopy.com Global Surgical Corp  1501 www.globalsurgical.com Global Surgical Corp  1601 www.globalsurgical.com Grace Medical Inc  1033 Grason-Stadler  511 www.grason-stadler.com Greenway Medical Technologies  2041 www.greenwaymedical.com Greer Laboratories Commercial  131 www.greerlabs.com Greer Laboratories Medical Affairs  130 www.greerlabs.com Group Health Physicians  235 www.ghpmd.org H.M.B. Endoscopy Products  1240 www.hmbendoscopy.com Health Management Associates  1804 www.PracticewithHealthManagement.com Healthworld International, Inc.  1514 www.healthworldintl.com Hemostasis, LLC  634 www.hemostasisllc.com/ Hemostatix Medical Technologies LLC  428 Hill Dermaceuticals Inc  1242 Hitachi Aloka Medical  112 www.aloka.com Holzer Clinic  243 www.holzerclinic.com Hood Laboratories Inc   639 www.hoodlabs.com ImThera Medical Inc  1339 www.imtheramedical.com InHealth Technologies  1925 innoForce Est.  742 Inspire Medical Systems  021 www.inspiresleep.com Insta-Mold Products Inc  520 Instrumentarium  541 Instrumentarium/Soredex   438 Insurance for the Medical Professional   1607 Integra Miltex  410 www.integralife.com Intelligent Hearing Systems  538 Interacoustics  101 www.interacoustics-us.com Interamerican Assoc of Ped Otorhinolaryngology   419 Intersect ENT   1939 www.intersectENT.com Intersocietal Accreditation  Commission (IAC)  311 Intuitive Surgical (IRT Associate)  401 www.intuitivesurgical.com Invotec International Inc  1332 IRIDEX  329 J. Morita Mfg. Corp.  404 JAMA & Archives Journals  110 pubs.ama-assn.org JEDMED Instrument Company  1001 www.jedmed.com Jullundur Surgical Works  941 www.jullsurgindia.com Kaiser Permanente  947 www.physiciancareers.kp.org Karger Publishers  134 www.karger.com KARL STORZ Endoscopy-America Inc.  1225 KARL STORZ Endoscopy- Latin America   1333 KayPENTAX  625 www.kaypentax.com Kirwan Surgical Products Inc  439 KLS Martin Group  433 Kurz Medical Inc  733 LABOMED  1440 www.laboamerica.com Laser Engineering, Inc  1641 Leica Microsystems Inc  116 www.leica-microsystems.com LifeCell Corporation a KCI Company  206 www.lifecell.com Lifestyle Lift (IRT Leader)  1013 www.lifestylelift.com Lippincott Williams & Wilkins/Wolters Kluwer Hlth  531 www.lww.com Lisa Laser USA  301 www.lisalaserusa.com Longtek Scientific Co. Ltd.  1421 Lumenis   1325 www.lumenis.com Maico Diagnostics   1701 Marina Medical Instruments   1636 Massaging Insoles by  Superior Health Inc  335 www.massaginginsoles.com Mayo Clinic Health System  1336 www.isj-mhs.net McKeon Products Inc  847 www.macksearplugs.com MD Logic EMR  1041 Medafor Inc  1433 MED-EL Corporation  1531 Medical Digital Developers (MDDev)  1036 www.mddev.com Medical Modeling Inc  1438 MediCapture Inc.  424 Medicor Imaging, a division  of LEAD Technologies  1748 www.leadtools.com Medifix Inc  1443 www.medifixinc.com Mediplast AB  115 www.mediplast.com Mediplay Inc  339 www.mediplay.com MedNet Locator Inc  1042 MedNet Technologies Inc  407 www.mednet-tech.com Medtronic Surgical Technologies   1101 www.medtronic.com Mentor Worldwide LLC   1709-C www.mentorwwllc.com/global-us/ Merrill Lynch   939 www.fa.ml.com/bob Merz Aesthetics  (formerly Bioform Med)  1407 www.radiesse-voice.com Micromedical Technologies Inc   1725 www.micromedical.com Micronix Systems Inc.  1926 Microsurgery Instruments Inc  838 Mimosa Acoustics Inc   341 www.mimosaacoustics.com Ministry Health Care    013 www.ministryhealth.org/recruitment MJD/TopDocs.com   1238 www.mjdpc.com Möller-Wedel GmbH   219 www.moeller-wedel.com MTI   617 National Affinity Services (Academy Advantage Partner)   140 www.nationalaffinity.net National Spasmodic  Dysphonia Association   414 Natus Medical Incorporated   1605 www.natus.com NeilMed Pharmaceuticals   1318 www.neilmed.com Neurosign   643 www.neurosign.com Neurovision Medical Products  148 www.neurovisionmedical.com NexTech 225 NextGen Healthcare  Information Systems Inc   1904 www.nextgen.com Nicos Group, Inc. – Euroclinic Division     441 www.nicosgroup.com NIDCD National Temporal  Bone Registry   1539 www.tbregisty.org NSI-ENT, LLC   948 www.nsi-us.com Officite (Academy Advantage Partner)  525 www.websitesforents.org Olsen Medical   1642 Olympus 801 On the Avenue Marketing   114 Ontium Medical Corporation   1757 www.ontium.com Optim LLC   1800 orlvision GmbH   124 OsteoMed   1638 www.osteomed.com Oticon Medical LLC   815 Otodynamics Ltd   1825 Otologics LLC   327 Otomed, Inc   516 www.otomed.com OtoSim   942 www.otosim.com Ototronix 1301 Panamerican Congress of Otolaryngology, Head & Neck   113 PARI Respiratory Equipment   630 www.PARI.com Parnell Pharmaceuticals Inc   321 www.parnellpharm.com Passy-Muir Inc   1736 www.passy-muir.com PBHS, Inc   1903 www.pbhs.com PeriOptix, Inc.   542 www.perioptix.com/ Phonak Hearing Systems   001 www.phonak.com Physician Assistants in Otorhinolaryngology   1901 Physician Owned Surgery Centers   1924 Plural Publishing Inc   305 Practice Flow Solutions   1014 Presbyterian Intercommunity Hospital   135 www.pih.net Prescott’s Inc   317 Primal Pictures Ltd 325 Prime Clinical Systems Inc   417 Pulmodyne, Inc.      1929 QED Medical   308 Quest Medical Inc   209 Radysans, Inc   133 www.radysans.com Reliance Medical Products Inc   1425 www.reliance-medical.com ReSound   1803 www.gnresound.com Restech   1537 www.restech.com Rex Medical, Inc.   2042 www.rex-medi.com RG Medical   338 www.rgmedical.com RGP, Inc.   1538 Richard Wolf Medical  Instruments Corporation   1507, 1606 www.richardwolfusa.com Robert Michael  Educational Institute LLC   213 www.rmei.com Rose Micro Solutions   342 www.rosemicrosolutions.com SAGE   743 www.sagepub.com Saline Soothers (Little Busy Bodies)   1547 www.salinesoothers.com Sandhill Scientific   1518 Scott & White Healthcare System   138 www.sw.org Seiler Precision Microscopes   212 www.seilerinst.com Serolab   1542 www.serolab.net SheerVision, Inc.   1840 www.sheervision.com Shippert Medical Technologies Incorporated   1137 Simplicity EMR   1519 Simply Saline   1448 www.simplysalinepro.com Sinus Dynamics   1525 SKYCAP Products LLC   1340 Sleep Group Solutions   1706 www.sleepgs.com Smiths Medical   1609 SNAP Diagnostics LLC   1802 Sonic Innovations   1941 www.sonici.com Sonitus Medical, Inc.   1313 Sontec Instruments Inc   1827 Sonus-USA   313 Sophono, Inc.   1040 www.sophono.com Springer   937 Squip, Inc.    1417 www.squipusa.com Starion Instruments Inc   1141 www.microlinesurgical.com/ Starkey   717 www.StarkeyPro.com Stryker   825 www.stryker.com Summit Medical   1439 www.summitmedicalusa.com SurgiTel/General Scientific Corp   1830 www.surgitel.com Sutter Health Sacramento Sierra Region   234 www.checksutterfirst.org Synapsys  1637 www.synapsysusa.com Synthes Anspach   125 www.anspach.com/ Synthes CMF   119 www.synthes.com/sites/NA/Products/CMF/Pages/home.aspx TeleVox   739 The Airway Company   1931 www.TheAirwayCompany.com The Alkalol Company   2040 www.alkalolcompany.com The Doctors Company (Academy Advantage Premier Partner)   1700 www.thedoctors.com The French ENT Society   1933 www.sforl.org The Journal of Laryngology & Otology   132 www.journals.cambridge.org/jlo The Payroll Company (Academy Advantage Partner)  1900 www.academybenefitpartners.org The Snoring Center   1125 www.snoringcenter.com Thieme Medical Publishers   638 www.thieme.com Transtracheal Systems Inc   232 www.tto2.com TriCord Pharmaceuticals   1541 www.oasisnasal.com TrueVision Systems, Inc.   1842 www.truevisionsys.com United Endoscopy   1338 www.unitedendoscopy.com University Medical Center  Hamburg-Eppendorf   019 www.uke.de/voxel-man Ventus Medical  109 www.proventtherapy.com ViroPharma Medical Affairs   1447 www.viropharma.com Vision Sciences, Inc.  517 Vivosonic Inc   306 Waiting Room Solutions   1239 www.waitingroomsolutions.com Widex USA   837 www.widexusa.com Wiley-Blackwell   1702 www.wileyblackwell.com Worldpay (Academy Advantage Partner)  1342 www.worldpay.us/ Xoran Technologies Inc   1019 www.xorantech.com Yodle   1708 www.yodle.com Yuma Regional Medical Center   535 www.yumaregional.org Z-Medica Corporation   1625 www.z-medica.com