www.entnet.orgCurrent IssueArchivesAnnual MeetingAdvertise with the BulletinENTConnectMay 2015 - Vol. 34 No. 04Leading EdgeINFORMING THE VOTE Workforce issues past and futureBy James C. Denneny III, MD, AAO-HNS/F EVP/CEO One of the key components when discussing what the evolving healthcare delivery system will look like relates to workforce issues. Attempts to incorporate all of the pertinent variables that will act as predictive markers for future needs have been fraught with difficulties. Questions arise such as how many providers will be needed to serve a future population, how can these providers be optimally distributed, what should be the demographics for the workforce, and what will be the scope of practice of these providers? There have been a number of studies done attempting to answer these questions. Despite the variety of studies undertaken, consensus has been difficult to reach—not only related to physicians in general—but otolaryngologists specifically. Currently, Congress is debating workforce issues as they tackle GME funding issues. We are rapidly approaching a situation where there will not be enough ACGME-certified post-graduate residency positions for all U.S. medical school graduates. While working on an unrelated project, I came across the “Report on Manpower Resources and Needs in Otorhinolaryngology” produced by the American Council of Otolaryngology in July 1975. I thought it would be interesting to review its recommendations in light of current conditions and predictions of future needs for otolaryngology. This study and report were produced by the Otolaryngology Committee on Manpower Analysis, chaired by John E. Bordley, MD. The project was jointly supported by the American Council of Otolaryngology and the National Institute of Neurological Diseases and Stroke. The group made recommendations in a number of areas. In 1975 they felt there was an unmet need for 500 otolaryngologists. At that time approximately 250 residents were being trained per year in otolaryngology programs. They predicted at that rate supply would meet the demand by 1985. This was based on the average otolaryngologist seeing 420 patients per month with a predicted increase of 11 percent over the ensuing 10 years. Currently, approximately 300 residents are being trained per year, but the program length has increased since 1975. Ideal ratios in today’s world range from 2.8 otolaryngologists per 100,000 to 3.4 per 100,000 of population. Our most recent socioeconomic survey showed that the average otolaryngologist sees 28 new patients and 53 established patients per week, which represents a decline from 1975. The 1975 study also recognized the serious need to increase the number of women and minorities who entered otolaryngology residency training programs. At that time there were 0.8 percent women, 1.3 percent African-Americans, and 7.9 percent Asians in otolaryngology residency programs. Currently, the ACGME database for 2013-2014 indicates that there are 33 percent women, 15 percent Asian, 2.8 percent Hispanic, 2.1 percent African-American, and 18 percent unknown. Many of these advances were directly related to the study recommendation that recruitment of a more diverse physician population would better serve the diversity of the population in general. Another significant recommendation relating to residency training that changed the growth of otolaryngology was the recognition of the need to strengthen training programs to include teaching the specialties within otolaryngology residency programs. “Competent teachers in the specialty should be recruited for our faculties, rather than sending the trainees into other disciplines for experience.” This particular directive resulted in many specialties flourishing and, in turn, significant advances in treatment of patients with these problems. The 1975 recommendations also mentioned that post residency fellowships should be increased, with the goal being the “support for the advanced research training of those otolaryngologists interested in a career of research.” Fellowships have taken on a role of advanced clinical training as well as providing a framework for research in the current paradigm. Additionally, the report touted the value of providing training “in the rudiments of office practice,” and every effort should be made to establish required courses in medical school “designed to give practical instruction in diagnosis of the common disorders in our field.” “Constant effort should be maintained to develop a strong and currently appropriate program for continuing education. Serious consideration should be given to the question of making it mandatory for maintaining board certification.” A strong CME program including Practice Management offerings are among “anchor” services provided to our Members by the AAO-HNSF. The wisdom of our predecessors is obvious after reading this thought-provoking document. The obvious value of selecting visionary leaders was clearly demonstrated in this endeavor. Hopefully, we will continue this tradition as we craft the future landscape for otolaryngology. I want to encourage everyone to vote in this year’s AAO-HNS election. This year’s elections will commence on May 6 online and close on June 8. We have an excellent slate of candidates. Please review the posted materials in last month’s Bulletin and at entnet.org and choose your leaders.No political gridlock hereBy Gayle E. Woodson, MD, AAO-HNS/F President It is election time again for the AAO-HNS! At a time when there is so much polarization in our nation’s governance, it is comforting to know that our Academy does not suffer from political gridlock. The April issue of the Bulletin contained the statements of candidates who have agreed to stand for leadership positions in our Academy. The dedicated members of our Nominating Committee worked hard to identify Members who have demonstrated commitment to our mission, have agreed to serve, and who inspire confidence in their ability to move us forward. Thus we have an excellent slate of candidates. Since the last Academy election, a task force, chaired by Richard W. Waguespack, MD, thoroughly reviewed our election process, tracing its evolution and comparing our practices to those of comparable organizations. In contrast to many societies, we do have an actual election rather than a presentation of a slate to be confirmed. And our Nominating Committee is structured and charged to consider a large cadre of nominees and volunteers to maximize inclusivity. Thus, we were surprised to learn that our organization is not significantly better than others in terms of voter participation. I would like to think that this is because of the confidence that Members have in the Nominating Committee, but there are undoubtedly other factors at play. The task force identified the time delay between the announcement of the candidates and the actual balloting as a potential suppressor of voter engagement. There seems to be no benefit from this time gap, but it could impair momentum. You can look at last month’s issue, then, for the candidate statements, and follow links to the video statements of the presidential candidates to see and hear them speak. And participate in setting the course of your Academy by voting. So think about what the candidates have to say. Who comes closest to articulating your personal vision of what our Academy should be? And vote to have a voice in steering this organization.More than half of all data breaches are in healthcare: Is your practice protected?The healthcare industry suffers more data breaches than any other business segment—a total of 51 percent of all breaches. Cybercriminals target healthcare organizations because personal patient information is more valuable to exploit than credit card numbers. Ensure your practice is protected. The Doctors Company’s core medical malpractice insurance policy includes CyberGuard®, aggressive, broad coverage for claims arising from the theft, loss, or accidental transmission of confidential patient or financial information, as well as the cost of data recovery. The American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) has partnered with The Doctors Company, an Academy Advantage Premier Partner, to provide Academy members with this exclusive insurance program since 2003. Visit http://ow.ly/G7jMY to learn more about how CyberGuard can protect your practice from data breach risks. As the nation’s largest physician-owned medical malpractice insurer—insuring over 1,000 otolaryngologists nationwide—The Doctors Company has unparalleled insight into the broad range of claims in otolaryngology. And backed by the financial strength of $4.3 billion in assets and a membership of 75,000 physicians, The Doctors Company offers AAO-HNS members a unique combination of coverage features, aggressive claims defense, and unrivaled protection. Qualified AAO-HNS members receive a program discount of 5 percent and a claims-free credit of up to 25 percent, as well as participation in the company’s multiyear dividend program. AAO-HNS members also have access to industry-leading patient safety tools and programs, including free live- and web-based CME, resources to help with the ICD-10 transition, on-site surveys, and informed consent resources at www.thedoctors.com/patientsafety. Members also receive the industry’s most aggressive defense, beginning with the promise never to settle a claim without a member’s consent, where permitted by law. This relentless defense also includes Litigation Education Retreats, which help members facing claims to master defense tactics, and educational videos showcasing actual claims experiences at www.youtube.com/doctorscompany. Created in 2007, the Tribute® Plan is an unrivaled benefit that rewards The Doctors Company’s members for their loyalty and their dedication to superior patient care with a significant financial award at retirement. How significant? The highest award to date to an otolaryngologist and AAO-HNS member was $33,554. Learn more about this groundbreaking benefit at www.thedoctors.com/tribute. Join your AAO-HNS colleagues as a member of The Doctors Company—find out how affordable the best medical malpractice coverage for otolaryngologists can be at www.thedoctors.com. What your peers are saying: testimonials from otolaryngologist members “The Doctors Company seems to always have the doctor’s best interest in mind and strives to control premium cost.” “Excellent company geared toward doctors and their best interests.” Source: The Doctors Company 2014 Member Experience SurveyTMJ Next GenerationIs ‘otosclerosis’ a misnomer?By Kenneth H. Brookler, MD, MS Presented at the Otolaryngology Historical Society Meeting, September 22, 2014 Otosclerosis was first described as ankylosis of the stapes by Antonio Maria Valsalva in 1704 and continued by Joseph Toynbee in 1857 in his Museum Catalogue. Adam Politzer, MD, in Washington, DC, in 1893 gave a paper titled “Peculiar Affection of the Labyrinthine Capsule as a Frequent Cause of Deafness.” On the same program was Lawrence Turnbull, MD, who described “progressive or proliferous sclerosis” as a non-suppurative disease of the middle ear for which he performed an operation he termed “otosclerectomy.” In an 1897 publication, regarding the term “otosclerosis,” Dr. Politzer preferred the term “capsulitis labyrinthi,” but understood that it had gained acceptance and in the 1901 edition of his textbook a chapter for the first time titled “Otosclerosis” was included. Gray’s Anatomy in 1917, “Otosclerosis: Idiopathic Degenerative Deafness,” first introduced that the term “otosclerosis” is a misnomer. S.R. Guild, MD, in the 1944 paper “histologic otosclerosis” in post mortem histopathology makes the case for otic capsule otosclerosis without oval window findings. He did not support the idea that otosclerosis begins in the fissula ante fenestram. In 1953, a paper attributed to Dr. Guild was called upon to defend the 1944 paper where he indicated that otosclerosis could not produce a “nerve” hearing loss. He was willing to concede this as possible. The discussion at this meeting began the concept of “cochlear otosclerosis.” Temporal bone imaging evolved so that a “radiologic otosclerosis” diagnosis could be reached and computerized tomography had matured by 2000 to almost overlay the equivalent slice histopathology. The routine use of CT applied to many clinical otologic conditions revealed otic capsule disorders that were classified as otosclerosis but without oval window involvement. In 1968, Barry Anson, MD, in describing the embryology of the otic capsule said: “Arrest in development may occur in another, importantly, in the region of the fissula ante fenestram”… where sometimes “a chondral mass persists even through infancy, in the fissular tract.” “This is the predictive site for the occurrence of otosclerosis … cartilage may be the precursor of otosclerosis.” Ruth Gussen, MD, in 1968 said: “The histologic structure of the labyrinthine capsule is usually considered to be normal unless otosclerotic bone is present replacing portions of the original capsule. An area of predilection for otosclerotic involvement is definitely agreed upon within the fissula ante fenestram. However, otosclerotic foci also develop within the capsule with no relation to this area of predilection.” Because of her basic premise she failed to recognize that osteoclasts and osteoblasts in the otic capsule could result from a different origin. A century since the term otosclerosis was coined molecular biology of bone, especially “osteoclastogenesis,” explains the underlying mechanisms of bone physiology and pathology. In 2005, osteoprotegerin (OPG) and TNF-α along with a lacuno-canalicular network were identified in the otic capsule. Simultaneously, the effect of TNF-α on hair cells was described. In 2014, sodium fluoride was found to induce apoptosis in cultured rat chondrocytes. On August 1, 2014, stapedectomy stapes fragments osteoblasts were cultured and examined for rate of proliferation, degree of mineralization, and adhesiveness compared to osteoblasts cultured from normal bone specimens for orthopedic. They were found to proliferate slower, mineralize greater, and had more adhesive properties that the normal cultures osteoblasts and these properties could be reversed to normal with the addition of a bisphosphonate. FISSULA ANTE FENESTRAM IS THE ORIGIN OF THE PROCESS PRODUCING FIXATION OF THE STAPES: begins with recruitment of chondrocytes in the fissula ante fenestram to become osteoblasts, followed by the signaling between osteoblasts and osteoclasts as the process migrates over the oval window, as evidenced in histopathology. OTIC CAPSULE DEMINERALIZATION: (previously described as histologic otosclerosis) is an independent osteoclast-osteoblast-osteocyte, TNFα family cytokine driven disorder without fixation of the stapes. Questions to be considered: Is the term otosclerosis relevant or a misnomer today? Should “otosclerosis” be reserved for the observed presence in the oval window at surgery or on imaging? In the absence of oval window evidence, should otic capsule demineralization be otherwise characterized? Understanding the origin of the oval window pathology and the recent research, should sodium fluoride and bisphosphonates be considered in the medical management of the hearing loss? Since otosclerosis is clearly a misnomer should there be a movement to eliminate it from the daily nomenclature of otology? Do these findings suggest a potential variety of otic capsule disorders requiring more research and the development of a meaningful classification?SMART TALK TO SHARE WITH PATIENTSAge-related hearing lossAge-related hearing loss By Kourosh Parham, MD, PhD, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Connecticut Health, Farmington, CT/AAO-HNS Geriatric Otolaryngology Committee Part of an occasional patient-focused series on geriatric otolaryngological care May is Better Hearing and Speech Month, a time to raise public awareness about hearing and speech issues as well as available treatment options. This year we are focusing on the impact of hearing loss as related to age, from infants and children to working-age adults to the elderly. Otolaryngologists treat hearing loss in patients of all ages, helping to mitigate the impact hearing loss can have on one’s quality of life. You can learn more about Better Hearing and Speech Month online at www.entnet.org/BetterHearingSpeechMonth. Hearing loss is the most common sensory problem among older adults. Studies show that by 2060, 22 percent (92 million) of the population will be 85 or older, while 4 percent (18 million) of the population will be around 65 years old. Age-related hearing loss (ARHL, also known as presbycusis) is, by far, the leading cause of hearing loss in developed countries. Currently it affects 50 percent of 65-year-olds and more than 80 percent of those 85 years old and older. Evaluation The diagnosis of ARHL is based on patient history, physical examination, and a battery of audiologic tests, including an audiogram. ARHL is a progressive condition arising from changes in the inner ear (the cochlea) and the brain. Because of its deceptive nature, people frequently are less aware of their communication difficulties than the people around them and often discuss the hearing problem reluctantly with a physician at the insistence of family members. Hearing loss specifics over time Although early hearing loss is different for all and dependent on a number of factors, often the earliest sign of ARHL appears late in middle age. By this time, cochlear changes are advanced enough to affect hearing within the sound range that makes up our daily lives. Often the experience of loss causes a person to misidentify words that sound the same and then make up for this problem by using the situation to understand the meaning. Age-related high-pitched hearing loss results in difficulty hearing consonants and makes hearing in noisy places more difficult. Often these high-pitched sounds work to separate syllables and words from one another. Without them, words tend to run together and sound “mumbled.” As voices of children and women tend to have a higher pitch, the person with hearing loss may complain that women speak too softly or that “my grandchildren mumble.” Over the years, as a person’s hearing loss increases to include lower-pitched sounds, the loss is a bigger problem. This may result in a person’s lessening ability to understand difficult issues and to think and reason as quickly as would be normal. This means that hearing in noisy places and hearing accented or fast speech becomes more challenging. A common complaint from the person may be, “I can hear the words, but I can’t understand them.” People find what work-arounds as they can to cope. Some ask others to speak louder or more slowly, while others avoid conversation and social activity. There are also social ramifications to this attribute of age-related hearing loss. Difficulties hearing on the telephone, particularly cell phones in which quality of sound may fluctuate with the strength of the network signal, serve as a barrier to their effective use as an alternative to face-to-face communication. Related problems with hearing loss Besides speech sounds, other important high-frequency warning sounds (alarms, ringing tones, turn signals, etc.) also become more difficult to hear. Reduced ability to hear alarms raises concern about safety. For example, older individuals with hearing loss have been shown to be at increased risk of motor vehicle accidents while driving. Besides difficulty in hearing communication sounds and alarms, other auditory functions are also impaired such as the accuracy of detecting sound sources. As hearing loss severity increases, overall function diminishes among older individuals. It has long been speculated that inability to communicate effectively, and potential decreased overall functional status, will lead to social isolation. This association was not affected by use of hearing aids. Social isolation has significant implications for the well-being of geriatric patients: lonely or isolated older adults are at greater risk for development and progression of cardiovascular disease and are more than twice as likely to develop Alzheimer’s disease. Thus besides the insidious nature of the disorder, the isolation associated with hearing loss may be another factor that leads to delayed presentation and diagnosis, primarily because there is little pressure to seek care for communication difficulties. Inherent difficulties in communication, which result in compounding psychosocial effects such as isolation, may precipitate psychiatric disorders such as depression, but whether hearing loss can contribute to depression remains a subject of debate. Tinnitus Another symptom that affects the well-being of patients with sensorineural hearing loss is tinnitus (intrinsic noises not heard by others). The incidence of tinnitus increases with age: Tinnitus affects 15 percent of the general population and 33 percent of geriatric persons. Presence of tinnitus by itself is not an independent risk factor for depression, but older individuals who perceive their tinnitus to be a problem or have problems with tinnitus when going to bed often display depression symptoms. In patients who also have ARHL, tinnitus can be a source of emotional and sleep disorders, difficulties in concentration, and social problems. In geriatric patients, it has been shown that tinnitus is associated with worse control of congestive heart failure in geriatric patients and may have important clinical implications for the early identification of patients who need more aggressive management of heart failure. Managing hearing loss Based on the results of medical evaluation, candidacy for different rehabilitation strategies is considered. Depending on the severity of hearing loss, interventions could include improved communication strategies and modification of listening environment, to personal assistive devices and hearing aids, to cochlear implantation. While these strategies are principally directed at compensating for peripheral hearing loss, our understanding of age-related changes in the brain, including cognitive changes, have significant impact on rehabilitation strategies. Prevention A number of factors have been recognized as contributing to the development of ARHL. These might be broadly classified into two categories: intrinsic and extrinsic. Intrinsic factors are host factors and are primarily genetic (including gender and race). There are family genetics that we are born with and those we can help—health issues such as diabetes, hypertension, diabetes, and stroke. Managing these factors can have a critical role in prevention of ARHL. Because ARHL is a progressive condition, awareness of these factors is important not just to the older population, but also the young since their impact is not appreciated until decades later. Individuals with ARHL often report a family history of hearing loss among parents, siblings, and close relatives. Therefore, it has been presumed that ARHL has a genetic component that influences the age of onset and severity of the loss. Challenges in separation of environmental from genetic factors have made it difficult to assess the contribution of genetics to ARHL. Overall, the heritability estimates suggest that up to 55 percent of the variance ARHL is attributable to genes. This means in a large group of biologically related people, hearing sensitivity is more similar than in a group in the same general environment, but who are unrelated. Modifiable risk factors The influence of genetics is likely to be modulated by a set of non-genetic factors. Cardiovascular disease, high blood pressure, and diabetes are well recognized as risk factors. Older persons with moderate-to-severe hearing loss have a significantly higher likelihood of reporting previous stroke, but it should be emphasized that ARHL is not predictive of increased risk of stroke. Chronic kidney disease and systemic inflammation may contribute to progression of ARHL. A common thread among these disorders is vascular disease/arteriosclerosis. Environmental factors There is also a set of modifiable environmental factors that have been identified. Noise exposure and cigarette smoking are the best established risk factors. Among older adults, history of exposure to workplace noise raises the risk of cardiovascular disease and angina, and severe exposure was associated with risk of stroke. There is much concern about recreational noise exposure, particularly given prevalence of personal listening devices among the younger population. Smoking-related worsening of hearing loss with age is likely mediated by vascular disease. Long-time smokers with occupational noise exposure tend to have higher risk of permanent sensorineural hearing loss. Oxidative stress is one possible mechanism for the aging process, and cochlear oxidative stress has been implicated in ARHL. Diets rich in antioxidants have been suggested to reduce ARHL and there is some evidence that healthy diets tend to be associated with better high frequency thresholds in adults.The impact of hearing loss on working-aged individualsExpanded from the print editionBy Dale Tylor, MD, MPH, Washington Hospital, Fremont, CA, Media and Public Relations Committee May is Better Hearing and Speech Month, a time to raise public awareness about hearing and speech issues as well as available treatment options. This year we are focusing on the impact of hearing loss as related to age, from infants and children to working-age adults to the elderly. Otolaryngologists treat hearing loss in patients of all ages, helping to mitigate the impact hearing loss can have on one’s quality of life. You can learn more about Better Hearing and Speech Month online at www.entnet.org/BetterHearingSpeechMonth.. The most common chronic sensory disorder in adults is hearing impairment, and it impacts about 16 percent of Americans aged 20-69 in at least one ear, totaling more than 29 million people in this country. Risk factors for hearing loss include male gender, Caucasian race, and history of smoking, diabetes, cardiovascular disease, and noise exposure, with increasing education being protective.1 The impact of hearing loss on employment and income is marked. Compared with peers with normal hearing, those with hearing loss are more likely to be unemployed or partially employed (adjusted odds ratio, 2.2), more likely to have no wage income whatsoever (adjusted odds ratio, 2.5), and have a lower annual wage by almost $8,000 ($23,481 vs. $31,272), but not be more likely to receive Supplemental Security Income.2 Those with hearing loss may be looked over for a promotion or raise, and may be less comfortable with advocating for themselves at the workplace. Psychomotor speed and executive function can be impaired with hearing loss in later middle age, to the extent that a drop of 25 dB in hearing was equivalent to an age difference of seven years. Hearing aids seem to improve cognitive function scores of those with hearing loss.3 It can be difficult to remember something that wasn’t heard correctly in the first place. Hearing loss can have a dramatic negative impact on one’s relationship with their significant other. It has been demonstrated that the hearing loss of a spouse can be predictive of poorer physical, psychological, and social well being in their partner, and this seems to be even more prominent when the male partner is the one with the hearing loss.4 Men in their 20s to 50s with acquired bilateral sensorineural hearing loss, when compared to normal hearing men, have poorer sexual health in all domains examined including erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction.5 Otolaryngologists should question patients about their hearing, even when it is not their presenting complaint. Diagnosing this problem, and treating it, can lead to dramatic improvements in the patient’s (and their loved ones) socioeconomic status and quality of life. References Agrawal Y, Platz EA, Niparko JK. Risk factors for hearing loss in US adults: data from the National Health and Nutrition Examination Survey, 1999 to 2002. Otol Neurotol. 2009 Feb 30(2):139-145. Jung D, Bhattacharyya N. Association of hearing loss with decreased employment and income among adults in the United States. Ann Otol Rhinol Laryngol. 2012 Dec: 121(12):771-775. Lin FR. Hearing loss and cognition among older adults in the United States. J Gerontol A Biol Sci Med Sci. 2011 Oct 66(10):1131-1136. Wallhagen MI et al. Impact of self-assessed hearing loss on a spouse: a longitudinal analysis of couples. J Gerontol A Biol Sci Med Sci. 2004 May 59(3):S190-196. Bakir S, et al. Relationship between hearing loss and sexual dysfunction. J Laryngol Otol. 2013 Feb 127(2):142-147.The real cost of hearing loss on infants and childrenExpanded from the print editionBy Dale Tylor, MD, MPH, Washington Hospital, Fremont, CA, Media and Public Relations Committee May is Better Hearing and Speech Month, a time to raise public awareness about hearing and speech issues as well as available treatment options. This year we are focusing on the impact of hearing loss as related to age, from infants and children to working-age adults to the elderly. Otolaryngologists treat hearing loss in patients of all ages, helping to mitigate the impact hearing loss can have on one’s quality of life. You can learn more about Better Hearing and Speech Month online at www.entnet.org/BetterHearingSpeechMonth. In the United States, two to three of every 1,000 children born have a detectable hearing loss in at least one ear. Further, more than 1 million children ages 1 to 19 years have bilateral mild-to-severe hearing loss, and around 3 million children have unilateral mild-to-severe hearing loss.1 Hearing loss in children can cause significant language impairments. Because educational success is substantially impacted by a child’s language and communications skills, those with hearing loss face significant academic challenges. The behavioral effects of hearing loss can mimic attention deficit disorders, cognitive or learning issues, or language processing problems. The lifetime educational cost per child of moderate or worse hearing loss in the absence of other disabilities is $115,600.2 Even children with unilateral hearing losses face significant language deficits, and have been found to have lower scores of language comprehension and oral expression than their normal hearing siblings.3 Those with unilateral loss or mild bilateral hearing loss also face educational impacts, with up to 35 percent failing a grade and up to 41 percent receiving educational assistance.4 School-aged children with hearing loss report significantly more fatigue than their normal hearing peers, which also can have negative academic and psychosocial effects.5 Parents of children with hearing impairment also are affected, and have been found to have impairment in almost all domains of health-related quality of life.6 Health disparities have been noted for children with hearing loss, with hearing services more limited for children from racial and socioeconomic minorities. Those in areas of lower median income and those of non-white or non-Asian minorities are less likely to receive cochlear implants, for example, and even when implanted can demonstrate worse speech and language outcomes. It should be noted that universal neonatal hearing screening and school-related screening programs have significantly improved detection of pediatric hearing loss, allowing for earlier treatment. Rehabilitation of hearing loss, such as with hearing aid(s), cochlear implant(s), speech therapy, or with individualized education plans, can help to positively impact the quality of life of these children. References NIH/NIDCD. Statistical Report: Prevalence of Hearing Loss in U.S. Children, 2005. Available at: http://www.nidcd.nih.gov/funding/programs/hb/outcomes/Pages/report.aspx Grosse SD. Education cost savings from early detection of hearing loss: new findings. Volta Voices. 2007;14:38-40. Lieu JEC, et al. Unilateral Hearing Loss Is Associated With Worse Speech-Language Scores in Children. 2010 Jun; 125(6):e1348-1355. Tharpe AM. Unilateral and Mild Bilateral Hearing Loss in Children: Past and Current Perspectives. Trends Amplif. 2008 Mar; 12(1):7-15. Hornsby BW, et al. Subjective fatigue in children with hearing loss: some preliminary findings. Am J Audiol. 2014 Mar; 23(1):129-134. Aras I, et al. Health related quality of life in parents of children with speech and hearing impairment. Int J Pediatr Otorhinolaryngol. 2014 Feb;78(20):323-329.Why Dallas?Dallas is the perfect choice for exceptional meetings, boasting the title of America’s best sports city, the nation’s largest urban arts district, the best shopping in the Southwest, 14 exciting entertainment districts, a vibrant dining scene, impressive accommodations, and stellar meeting spaces. With more than $15 billion in new development, Dallas is destined to be a city of innovation, excitement, and success for years to come. Easy accessibility Easily accessible from all major United States cities as well as Mexico, Latin America, and Canada. Less than four hours by air from any North American city. Dallas/Ft. Worth (DFW) International Airport services 38 international destinations with nonstop flights—nearly 2,000 flights daily. Major airline hub with locally-based American Airlines as its largest carrier in the world. Airports Council International survey ranks DFW “Best Airport in North America” for customer service. Dallas Love Field Airport, one of the finest general-purpose airports in the world, served by Southwest Airlines, the largest domestic carrier in the United States. Not far from anywhere Atlanta, GA 2 hours Boston, MA 3 ½ hours Chicago, IL 2 hours, 20 minutes Cincinnati, OH 2 hours, 10 minutes Grand Rapids, MI 2 hours, 20 minutes Los Angeles, CA 3 hours, 20 minutes Miami, FL 2 hours, 45 minutes New Orleans, LA 1 hour, 20 minutes New York, NY 3 hours, 30 minutes Philadelphia, PA 3 hours San Francisco, CA 4 hours Seattle, WA 4 hours, 15 minutes Destination appeal The Dallas-Fort Worth area is the No. 1 destination in Texas. DART—one of the nation’s fastest-growing rail lines with the longest light rail system in the United States. Cosmopolitan, 14 entertainment districts, Western heritage culture, and more. Nightlife and entertainment From clubs, pubs, lounges, and roof-top patios to the No. 1 shopping destination in the Southwest. Top-tier golf courses, public parks, lakes, and reservoirs within the Dallas area. Home to five professional sports teams. World-class dining More than 9,000 restaurants in the DFW area. Famous celebrity chefs include Dean Fearing, Stephan Pyles, Wolfgang Puck, and Kent Rathbun. Join us in Dallas for this world-class event!OTO EXPO℠: Happy trails to Dallas!Not only is the AAO-HNSF Annual Meeting & OTO EXPO℠ the premier event for our specialty, it’s now an award-winning event! Trade Show Executive recently named the OTO EXPO℠ one of the 50 Fastest-Growing Shows of 2014, a testament to the increasing number of companies that exhibit at our show. For you, this means even more access to the latest technologies and products. If you attend only one trade show this year, make it the award-winning OTO EXPO℠, where more exhibitors mean more value. Hours This year allows attendees more opportunities to visit the OTO EXPO℠. We listened to our attendees requesting more time to be able to visit the OTO EXPO℠ and have responded. The OTO EXPO℠ will now be open Sunday and Monday, 10:00 am – 5:00 pm, and Tuesday, 9:00 am – 3:00 pm. Food Dallas is a world-renowned food destination that attendees and exhibitors can experience on the OTO EXPO℠ hall floor! The OTO EXPO℠ will host concession stands offering fresh and locally sourced food with high-quality ingredients to enjoy. Every full conference or daily registrant will receive meal voucher(s) with their registration materials to be redeemed at any of the concession stands in the exhibit hall during OTO EXPO℠ hours, Sunday through Tuesday. Some of the food destinations to enjoy include sushi, grab-and-go sandwiches, tacos, and carving stations featuring top round steak, roasted potatoes, and vegetables. New products Every year our exhibitors introduce new products in the OTO EXPO℠ and this year won’t be any different. This year there will be new releases of laryngeal instruments, retractors, stapes prostheses, and needle holders. The list of new-to-the-market medical devices includes septal plugs, strobolights, stroboscopes, touch audiometers, and a device designed to eliminate acid reflux into the throat and lungs. On the technical side there will be new virtual medical scribes, apps for education charts, and neurostimulation-based therapy for the treatment of tinnitus. All of these items are created to improve your practice and aid you in providing the very best in patient care. You have to see it to believe it. Hands-On Training and the Product Theater Returning is the highly successful Hands-On Training venue and our Product Theater. Last year was the first time for our Hands-On Training venue and it was an amazing success. Hands-on Training on the OTO EXPO℠ floor provides you with the best product training opportunity in otolaryngology. These two-hour training sessions allow participants to preview the newest innovations in otolaryngology surgical tools on cadaveric specimens. Space is limited for this unique opportunity. The AAO-HNSF Product Theater is your opportunity to extend your learning beyond the classroom with AAO-HNSF corporate sponsors. Review recent scientific studies and information or watch a live demonstration performed by a leader in the field. Sessions are booked in conjunction with OTO EXPOSM hours and will be prominently displayed around the Exhibit Hall. Contact David Buckner at email@example.com or 703-535-3718 for more information on these two venues. Ready to register? Visit www.entannualmeeting.org to register now and for the most current information on the 2015 Annual Meeting & OTO EXPO℠.Annual Meeting committee meetingsAAO-HNS Business Meeting Saturday, September 26, 2015 11:30 AM – 11:45 AM AAO-HNS/F Board of Directors Breakfast (by invitation only) Saturday, September 26, 2015 7:00 AM – 8:00 AM AAO-HNS/F Board of Directors Lunch (by invitation only) Saturday, September 26, 2015 12:00 PM – 1:00 PM AAO-HNS/F Board of Directors Meeting Saturday, September 26, 2015 8:00 AM – 11:30 AM AAO-HNS/F Executive Committee Meeting (by invitation only) Friday, September 25, 2015 5:00 PM – 7:00 PM Adhoc/Alternative Payment Model Workgroup Monday, September 28, 2015 9:45 AM – 10:45 AM Airway and Swallowing Committee Monday, September 28, 2015 9:45 AM – 10:45 AM Allergy, Asthma and Immunology Committee Tuesday, September 29, 2015 9:45 AM – 10:45 AM Board of Governors (BOG) Executive Committee (by invitation only) Sunday, September 27, 2015 3:30 PM – 5:30 PM Board of Governors (BOG) General Assembly Monday, September 28, 2015 5:00 PM – 7:00 PM Board of Governors (BOG) Leaders Training Luncheon Saturday, September 26, 2015 12:00 PM – 1:00 PM Board of Governors (BOG) Legislative Affairs Committee Saturday, September 26, 2015 1:00 PM – 2:45 PM Board of Governors (BOG) Rules and Regulations Committee Saturday, September 26, 2015 11:00 AM – 11:55 AM Board of Governors (BOG) Socioeconomic and Grassroots Committee Saturday, September 26, 2015 3:00 PM – 4:45 PM Complementary/Integrative Medicine Committee Monday, September 28, 2015 2:15 PM – 3:15 PM Core Otolaryngology and Practice Management Education Committee Monday, September 28, 2015 2:15 PM – 3:15 PM CORE Study Section Saturday, September 26, 2015 3:30 PM – 4:30 PM CPT and Relative Value Committee Monday, September 28, 2015 2:15 PM – 3:15 PM Credentials and Membership Committee Saturday, September 26, 2015 1:00 PM – 2:00 PM Development Committee Saturday, September 26, 2015 1:00 PM – 2:00 PM Diversity Committee Sunday, September 27, 2015 2:15 PM – 3:15 PM Education Steering Committee Saturday, September 26, 2015 4:00 PM – 6:00 PM Endocrine Surgery Committee Tuesday, September 29, 2015 2:15 PM – 3:15 PM ENT PAC Board of Advisors (by invitation only) Sunday, September 27, 2015 2:00 PM – 4:00 PM Equilibrium Committee Monday, September 28, 2015 2:15 PM – 3:15 PM Ethics Committee Saturday, September 26, 2015 3:30 PM – 4:30 PM Facial Plastic and Reconstructive Surgery Education Committee Monday, September 28, 2015 2:15 PM – 3:15 PM Finance and Investment Subcommittee (FISC) Saturday, September 26, 2015 3:00 PM – 4:15 PM General Otolaryngology Education Committee Sunday, September 27, 2015 2:15 PM – 3:15 PM Geriatric Otolaryngology Committee Tuesday, September 29, 2015 9:45 AM – 10:45 AM Head and Neck Surgery and Oncology Committee Tuesday, September 29, 2015 2:15 PM – 3:15 PM Head and Neck Surgery Education Committee Tuesday, September 29, 2015 9:45 AM – 10:45 AM Hearing Committee Tuesday, September 29, 2015 9:45 AM – 10:45 AM History and Archives Committee Sunday, September 27, 2015 7:00 AM – 8:00 AM Humanitarian Efforts Committee Monday, September 28, 2015 2:15 PM – 3:15 PM Humanitarian Efforts Committee Forum Sunday, September 27, 2015 1:00 PM – 3:15 PM Imaging Committee Tuesday, September 29, 2015 9:45 AM – 10:45 AM Implantable Hearing Devices Committee Sunday, September 27, 2015 7:00 AM – 8:00 AM Infectious Disease Committee Sunday, September 27, 2015 7:00 AM – 8:00 AM Instruction Course Advisory Committee Tuesday, September 29, 2015 2:15 PM – 3:15 PM International Assembly Sunday, September 27, 2015 3:30 PM – 5:30 PM International Otolaryngology Committee Monday, September 28, 2015 9:45 AM – 10:45 AM International Steering Committee Tuesday, September 29, 2015 2:15 PM – 3:15 PM Joint Education Committees Meeting Sunday, September 27, 2015 7:00 AM – 8:00 AM Journal Editoral Board Meeting Tuesday, September 29, 2015 6:00 AM – 7:15 AM Laryngology and Bronchoesophagology Education Committee Sunday, September 27, 2015 2:15 PM – 3:15 PM Media and Public Relations Committee Monday, September 28, 2015 9:45 AM – 10:45 AM Medical Devices and Drugs Committee Sunday, September 27, 2015 7:00 AM – 8:00 AM Medical Informatics Committee Saturday, September 26, 2015 2:15 PM – 3:15 PM Microvascular Committee Tuesday, September 29, 2015 9:45 AM – 10:45 AM Nominating Committee (by invitation only) Saturday, September 26, 2015 1:00 PM – 2:00 PM Otology and Neurotology Education Committee Tuesday, September 29, 2015 9:30 AM – 10:30 AM Outcomes Research and Evidence Based Medicine Committee Saturday, September 26, 2015 1:00 PM – 2:00 PM Panamerican Committee Tuesday, September 29, 2015 9:45 AM – 10:45 AM Patient Safety and Quality Improvement Committee Sunday, September 27, 2015 7:00 AM – 8:00 AM Pediatric Otolaryngology Committee Sunday, September 27, 2015 7:00 AM – 8:00 AM Pediatric Otolaryngology Education Committee Monday, September 28, 2015 9:45 AM – 10:45 AM Performance Measures Task Force Saturday, September 26, 2015 5:30 PM – 6:30 PM Physician Payment Policy Workgroup Monday, September 28, 2015 3:30 PM – 5:30 PM Physician Resource Committee Saturday, September 26, 2015 3:30 PM – 4:30 PM Plastic and Reconstructive Surgery Committee Monday, September 28, 2015 9:45 AM – 10:45 AM Program Advisory Committee Saturday, September 26, 2015 1:00 PM – 2:00 PM Meeting Advisory Committee Monday, September 28, 2015 2:15 PM – 3:15 PM Registry Task Force Saturday, September 26, 2015 4:30 PM – 5:30 PM Research and Quality Steering Committee Sunday, September 27, 2015 2:15 PM – 3:15 PM Rhinology and Allergy Education Committee Monday, September 28, 2015 9:45 AM – 10:45 AM Rhinology and Paranasal Sinus Committee Sunday, September 27, 2015 7:00 AM – 8:00 AM Robotic Surgery Task Force Saturday, September 26, 2015 2:15 PM – 3:15 PM Science and Education Committee Saturday, September 26, 2015 2:15 PM – 3:15 PM Section for Residents and Fellows-in-Training (SRF) Governing Council Tuesday, September 29, 2015 2:15 PM – 3:15 PM Section for Residents and Fellows-in-Training (SRF) General Assembly Tuesday, September 29, 2015 7:00 AM – 9:00 AM Skull Base Surgery Committee Saturday, September 26, 2015 1:00 PM – 2:00 PM Sleep Disorders Committee Saturday, September 26, 2015 2:15 PM – 3:15 PM Specialty Society Advisory Council Tuesday, September 29, 2015 2:15 PM – 3:15 PM Surgical Simulation Task Force Tuesday, September 29, 2015 2:15 PM – 3:15 PM Trauma Committee Sunday, September 27, 2015 2:15 PM – 3:15 PM Voice Committee Sunday, September 27, 2015 2:15 PM – 3:15 PM Women in Otolarnygology (WIO) Endowment Committee Monday, September 28, 2015 9:45 AM – 10:45 AM Women in Otolarnygology (WIO) General Assembly Monday, September 28, 2015 7:00 AM – 9:00 AM Women in Otolaryngology (WIO) Awards Committee Monday, September 28, 2015 9:45 AM – 10:45 AM Women in Otolaryngology (WIO) Communications Committee Monday, September 28, 2015 2:15 PM – 3:15 PM Women in Otolaryngology (WIO) Council on Committees Tuesday, September 29, 2015 2:15 PM – 3:15 PM Women in Otolaryngology (WIO) Governing Council Meeting Tuesday, September 29, 2015 2:15 PM – 3:15 PM Women in Otolaryngology (WIO) Leadership Development and Mentorship Committee Sunday, September 27, 2015 2:15 PM – 3:15 PM Women in Otolaryngology (WIO) Program Committee Sunday, September 27, 2015 7:00 AM – 8:00 AM Women in Otolaryngology (WIO) Research and Survey Committee Saturday, September 26, 2015 3:30 PM – 4:30 PM Young Physicians Section (YPS) General Assembly Tuesday, September 29, 2015 4:30 PM – 6:30 PMAnnual Meeting & OTO EXPO News BriefsClinical Fundamentals and MOC prep Clinical Fundamentals, now included within the Maintenance of Certification track, are an extremely important offering during our meeting that allow Members to satisfy the ABOto’s Clinical Fundamentals requirement for Part III of Maintenance of Certification. In addition to participating in the Clinical Fundamental courses during the Annual Meeting, you may also satisfy the Clinical Fundamentals requirement for Part III of Maintenance of Certification by viewing online versions of the instruction courses of the same title that were presented during the Annual Meeting. The courses are available in AAO-HNSF’s online library at www.entnet.org/content/clinical-fundamentals. In addition to the seven Clinical Fundamental live courses, seven review courses will be presented, covering facial plastic surgery, general otolaryngology, rhinology and allergy, head and neck surgery, pediatric otolaryngology, laryngology/bronchoesophagology, and otology. Poster Presentations The Poster Meet-and-Greet presentations will take place Monday from 9:45 to 10:45 am in the Poster Hall. While enjoying refreshments and a mid-morning break, learn about the latest advancements in research directly from the sources. Ask questions and share experiences with poster presenters for a truly interactive session. AAO-HNSF Annual Meeting schedule-at-a-glance The AAO-HNSF Annual Meeting schedule-at-a-glance is available in various formats at: www.entannualmeeting.org/15/node/1.Meeting coordinators explain changesWe recently sat down with the Coordinator for the Instruction Course Program, Sukgi S. Choi, MD, and the Coordinator for the Scientific Program, Eben L. Rosenthal, MD, to talk about this year’s Annual Meeting & OTO EXPO℠. Bulletin: What can you tell us about this year’s event? Dr. Choi: We have traditionally had a very distinct morning and afternoon program. This year, we have improved the entire program by offering content throughout the entire day. Miniseminars, Instruction Courses, and Oral Sessions now run simultaneously. This will allow for great variety in topics and content throughout the day, creating an individualized learning experience for each attendee. And even better, Instruction Courses are now included in the registration fee. The Annual Meeting is now an all-inclusive learning event with more choices for attendees to design a schedule that fits their needs. Our improved program offers significantly more value than ever before. Dr. Rosenthal: Additionally, the program has been redesigned to give attendees unopposed time in the morning and afternoon for attending committee meetings and exploring the OTO EXPO℠. The early morning committee meetings made it very difficult for those with significant time zone changes and those who had morning lectures. We remain committed to creating all-day tracks that will bring the highest-quality material together in a way that the attendee can easily identify a series of talks that fit with the topics they are most interested in. Bulletin: The Oral Presentations are always popular. Will there be any changes this year? Dr. Rosenthal: The shorter Oral Presentations that were incorporated into the program two years ago improved the pace and interaction within the Oral Sessions. In addition to continuing that format, this year we are adding video presentations. These will focus on the technical aspects of surgical technique and will be an effective way for experienced surgeons to communicate novel techniques. We look forward to growing this aspect of the program. We will again offer the “Best of Orals” to recognize the best in original research being conducted by our Members. This was one of the best-attended lectures last year and demonstrates the quality of the work being presented at this unique forum. Bulletin: How and why were these changes determined? Dr. Choi: When Dr. Rosenthal and I first started in our roles as coordinators, we both knew we wanted to change the entire structure of the meeting. In fact, I think that’s why we were chosen to work together. Feedback from evaluations and honest, frank discussions with Members told us that attendees were looking for change, so we conducted an in-depth review of the meeting structure, analyzed three years’ of attendee, exhibitor, and Member data, and benchmarked the meeting structure and education program of other medical societies. We then identified potential changes to the meeting, including the integration of the program, and discussed these options with the Boards of Directors and the Science and Education Committee. Various committees provided input, as well. Bulletin: How do these changes add value? Dr. Rosenthal: By integrating the program and carefully scheduling committee meetings to not interfere with the Scientific Program, attendees can now enjoy education content for the entire 3 ½ days. And because there are no additional fees for Instruction Courses, attendees have access to more learning opportunities than ever before. It’s truly a brand-new meeting and sure to please returning attendees and first-time attendees alike.One easy fee + four days of world-class learning = amazing valueAttendee feedback told us you wanted a straightforward payment structure, so we’re giving it to you. Now, pay one convenient and affordable price for four days of world-class learning. No more separate fees for add-ons*, no confusion about what’s included. Your registration fee includes access to Miniseminars, Scientific Oral Presentations, Instruction Courses, Poster Presentations, and so much more! Now it’s easier than ever to experience all that the Annual Meeting has to offer, including: Earn CME credit. Earn up to 25.5 AMA PRA Category 1 Credits™ with your choice of more than 500 continuing education sessions that arm you with new skills you can put into practice right away. Credit will be awarded to physicians when documented by the submission of the 2015 Annual Meeting & OTO EXPO℠ Evaluation. Get the exact information you need. Sessions are arranged according to tracks to provide the most beneficial information for your particular needs. Get excited. There’s nothing like spending time with people who share your interests to re-energize and inspire you. Tap the minds of leaders. This is your chance to ask the best and brightest leaders in the otolaryngology community your most pressing questions. See and touch the latest devices. More than 300 exhibitors in the OTO EXPO℠ offer hands-on demonstrations and Q&A about innovative new products and technology. Expand your network. Share experiences, insights, and perspectives with talented professionals who can help you succeed. Make your voice heard. At the AAO-HNSF Annual Meeting, you can meet with Academy Advocacy staff to learn the latest legislative updates that impact the future of otolaryngology. Become a stronger professional. We promise you’ll leave Dallas inspired, smarter, and better than ever. Enjoy a fabulous destination. Centrally located and easy to get to, Dallas offers a pleasing climate and endless sports, arts, entertainment, and dining options. Save even more money by registering before July 10 for the Early Registration Discount. *Saturday workshops remain separate.You spoke, we listenedDiscover exciting changes as we take the 2015 Annual Meeting & OTO EXPO℠ to new heights The AAO-HNSF 2015 Annual Meeting & OTO EXPO℠ will be a meeting like no other you’ve ever attended. The AAO-HNSF Program Advisory Committee and Instruction Course Advisory Committee are pleased to announce a broad range of changes to this year’s event. These changes will enhance your experience and better meet your professional needs. You’ll experience even more of what you’ve come to expect at the world’s premier event for otolaryngologist-head and neck surgeons at competitive rates. Format For starters, the Scientific Program (Oral Presentations and Miniseminars) and Instruction Courses will now be blended, with Miniseminars, Oral talks, and Instruction Courses running simultaneously Sunday through Wednesday. We’ve redesigned the program to allow attendees more uninterrupted time on the OTO EXPO℠ show floor to explore the latest products and technology. Committee members will delight in a new schedule for meeting times that no longer conflict with the Scientific Program or Instruction Courses. Similar to the committee meetings, the Women in Otolaryngology (WIO) Section will be meeting on a new date and time. The Young Physicians Section (YPS) will hold its inaugural event Tuesday afternoon. Price But, that is not all! Our new registration pricing now includes Instruction Courses in the regular registration fee, giving you access to more than 500 hours of education content presented by otolaryngology experts. Now experience all aspects of the Annual Meeting at a single price point that brings a big bonus to early registrants. The AAO-HNSF Annual Meeting & OTO EXPO℠ is your meeting. It’s designed to deliver our Members and guests an incredible experience filled with world-class learning, networking, and inspiration. This year, you’ll experience all this and more in a brand-new way. Keep reading this issue of the Bulletin to learn more about our exciting new program.BOARD OF GOVERNORSBen Franklin and the Annual MeetingBy Stacey L. Ishman, MD, MPH, Chair, BOG Rules and Regulations Committee Like many of us, Ben Franklin was a busy man and in moments of self-reflection, recognized his deficiencies in a number of healthy habits, which he termed “virtues.” As I get ready to attend our Annual Meeting and the fall meeting of the Board of Governors (BOG), I find that these virtues continue to ring true today. These include: Set aside time for focused efforts. Always look for ways to do things better and faster. Set very few priorities and stick to them. Turn down things that are inconsistent with your priorities. Spot trouble ahead and solve problems immediately. Finish what’s important and stop doing what is no longer worthwhile. The Academy and its Annual Meeting provide us with options to address many of these virtues. Time and efficiency The Annual Meeting allows us to set aside time for education on myriad topics by national and international experts. As such, it often is a time when I am able to find ways to improve and optimize my practice. The scientific content and patient care pearls that I learn are the highlights of my meeting, but there is so much more to learn. This is especially true as the business of medicine and compliance take up increasing amounts of mental energy and time. The BOG Hot Topics Miniseminar is designed to address the latest in practice management updates and perspectives, and I find it to be an extremely high-yield session. In addition, the BOG committee meetings on Saturday, September 26, are focused on the legislative, socioeconomic, and grassroots issues affecting our specialty. They are open to anyone and are a great way to understand the efforts that the Academy and the BOG are making on our behalf. Prioritization In addition to these education opportunities, the Opening Ceremony at the Annual Meeting allows us to more clearly understand the priorities of our Academy as it strives to do more with less. This has led to a streamlining of operations in order to focus efforts on the core values of education, advocacy, sustainability, research, and quality. Toward this end, a new, smarter learning management system is being introduced to allow for easier access to existing and new educational content. Proactive focus Our Academy has understood the need for a focus on quality and safety far before they were buzzwords in the media. This proactive stance has led to our recognition as national leaders in Clinical Practice Guideline development. This same focus has resulted in ongoing creation of CMS Measures groups to be used by our Members for simplified PQRS reporting. At the same time, the staff and physician volunteers are evaluating national and state legislation and addressing payment issues with insurers. I continue to strive to master these virtues passed on by Ben Franklin and embraced by our Academy. Please join us as we witness them in action at the AAO-HNSF Annual Meeting & OTO EXPO℠ and BOG sessions. I hope to see you there.Boards of Directors approve registry, appropriate use criteriaFollowing extensive discussion during the strategic planning conference in March, the Boards of Directors took the bold step of authorizing the formation of a clinical data registry for our specialty. The Registry Task Force, chaired by Lisa E. Ishii, MD, MHS, has been directed to produce recommendations to the Boards of Directors regarding the type of registry as well as the vendor that we will select. The Foundation has been actively studying this project for the last 18 months and feels the time to act is now. The formation of a registry carries a multimillion dollar price tag. This “game changing” action will provide many benefits for our Members. A registry will allow direct reporting of quality measures to CMS, thus simplifying this process greatly. In addition, registries can support measure development, inform alternative payment models, assist with maintenance of certification, and demonstrate clinical effectiveness. Participants will have access to their data, which they can use in negotiations with payers. The boards also approved the creation of “appropriate use criteria,” which are an additional guidance tool that can be used in payer negotiations and can be incorporated into a registry. This will help our advocacy efforts when we negotiate on our Members’ behalf regarding national policies. In the upcoming months we will be presenting more detailed information on registries in general and the type of registry that best meets the needs of our Members. We feel this is an exciting opportunity for our specialty that will enable our Members to practice under all changing paradigms of the healthcare delivery system.A legacy of service in Kijabe, KenyaExpanded from the print editionBy Bridget Leann Hopewell, MD, University of Missouri, Humanitarian Travel Grant Awardee “She’s beautiful,” her father said when we asked how her first night after the surgery had been. Even when we asked how well she was eating, or if she’d been in any pain, all he would answer was, “beautiful,” as her mom quietly nodded. They had travelled many hours on a crowded bus from a UN refugee camp near the Kenyan-Somali border to AIC-CURE hospital to be seen by our team of surgeons. I traveled with colleagues David T. Chang, MD, Cameron Kirschner, MD, Eric J. Dobratz, MD, and Cooper Scurry, MD, to the picturesque mountainside town of Kijabe, Kenya. Teams of U.S. surgeons travel here several times a year to provide surgical service to affected children. This was Dr. Chang’s ninth trip to Kijabe and I was fortunate to be a part of a lineage of residents from the University of Missouri to accompany him on this trip. Because of the long-term relationship established between ENT teams and the staff of the AIC CURE hospital, we were able to start swiftly and efficiently. Patients were scheduled for us to see daily, spread out over two weeks. We ran two operating rooms. The nurses were very skilled and were the same people the team had worked with during the last trip. The operating rooms were large and had reliable electricity, sufficient instruments, and reasonably short turnover time. Patients were admitted to a 24-bed ward with two monitored beds as a “step-down” unit. The staff was very familiar with post-surgical lip and palate care. Care instructions in Swahili were accompanied by donated stuffed animals to complement their healing faces. This was my first, yet certainly not my last, medical mission trip as a physician. Dr. Chang’s trips should serve as a model for humanitarian medical trips in which service is given in an attitude of genuine mutual respect. We could not have accomplished what we did without the tremendous support of the staff at the AIC-CURE hospital, and they certainly continue our work throughout the entire year. I was privileged to accompany Dr. Chang, and I am grateful for the grant given by the AAO-HNSF Humanitarian Efforts Committee that made this trip possible.ICD-10: Where will you be when the switch flips October 1?ICD-10 will likely not be delayed again. Last year’s delay by itself was projected to cost the healthcare industry as a whole $6.8 billion. The House’s Energy and Commerce Subcommittee on Health debated ICD-10 implementation in detail during its February ICD-10 hearing where seven witnesses testified on both the potential positive and negative effects of ICD-10. As full Committee Chairman Fred Upton (R-MI) said, “The United States is one of the few countries that has yet to adopt this most modern coding system. Australia was the first country to adopt ICD-10 in1998. Since then, Canada, China, France, Germany, Korea, South Africa, and Thailand—just to name a few—have all also implemented ICD-10. In the United States, Congress, through one vehicle or another, has prevented the adoption of ICD-10 for nearly a decade.” While several delays have taken place in the past, consensus shows that the switch will finally be flipped on October 1 of this year. Your Academy continues to work to facilitate the transition and help to make it as painless as possible. On the advocacy front, the Academy, along with numerous other organizations, signed onto a letter written to the Centers for Medicare and Medicaid Services (CMS), not urging for another delay of ICD-10, but rather urging CMS to publish further data on ICD-10 testing results, EHR vendor readiness, details on avoiding adverse impacts on quality measurement, risk mitigation plans, and more. (The letter is available online.) As for resources, the Academy has released an updated otolaryngology specific superbill that has a more expansive list of ICD-10 codes that serve a larger variety of subspecialist practices. In addition, Academy partner Optum has worked to make an otolaryngology specific ICD-10 Fast Finder Tool. Slides from the 2014 ICD-10 Annual Meeting Miniseminar provide simple questions to ask vendors and payers with solid examples on how to assess your claims at risk with an impact analysis and more. For more Academy resources, visit the Academy’s ICD-10 webpage. Reference http://energycommerce.house.gov/press-release/health-subcommittee-discusses-importance-and-readiness-icd-10-implementationImaging Committee has your course needs in mind in DallasThe American Academy of Otolaryngology—Head and Neck Surgery recognizes the importance of quality standards and accreditation for medical imaging and knows that Members look to the Academy to provide leadership on this issue. To this end, the Academy created the Imaging Committee, currently chaired by R. Christopher Miyamoto, MD, to provide resources for Members’ use and to monitor legislative and reimbursement developments. The Foundation also ensures training for continuing medical education (CME) is provided in this area. Each year at the AAO-HNSF Annual Meeting & OTO EXPOSM, the Foundation offers several courses related to head and neck imaging, with many courses specific to CT. These carefully crafted courses help Members learn about current best practices, coding changes, and potential reimbursement challenges as they pertain specifically to otolaryngologists providing head and neck imaging services. Further, participation in many of these expert-led courses qualifies for CME credit. As this year’s Annual Meeting draws closer, we will be sure to provide the specific lineup of imaging courses offered in Dallas. In the interim, if you would like to learn more, please visit our imaging page at www.entnet.org/content/imaging-services. See “You Spoke, We Listened” for more information about the AAO-HNSF Annual Meeting & OTO EXPOSM.The SGR bill passes: Advocacy does workBy James C. Denneny III, MD, AAO-HNS/F EVP/CEO The recent passage of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), by Congress signaled the end of a 14-year journey that included 17 short-term “patches” for Medicare’s flawed Sustainable Growth Rate (SGR) physician payment formula that was enacted in 1997. Not only did this landmark bipartisan bill address the yearly threat of significant decreases in Medicare physician payments, it also: Consolidated the quality reporting requirements for Medicare providers. Beginning in 2019, the Merit-Based Incentive Payment System (MIPS) will consolidate existing quality programs and focus on quality, resource use, meaningful use, and clinical practice improvement in a cohesive fashion. The quality measures chosen by CMS utilized by Qualified Clinical Data Registries (QCDR) will be automatically included. In addition, federal funding will be available to help physicians develop additional quality measures from 2015-2019. Halted the CMS-mandated conversion away from 10- and 90-day global packages to 0-day billing parameters. Pursuant to the provisions of H.R. 2, CMS is required to gather data related to the recommended changes to the global packages by the end of 2017, prior to initiation of any new policy. Established positive payment updates for five years. A .5 percent increase in Medicare physician payments will help provide stability as physicians transition to the new system. Incentivized participation in an Alternative Payment Model (APM). Physicians who partake in various APMs will receive a 5 percent bonus from 2019-2024. During the debate, it was both amazing and rewarding to listen to both Democrat and Republican legislators articulate the same arguments that organized medicine had been putting forward for more than a decade as to why this proposal needed to be passed. The critical bipartisan interaction between Speaker of the U.S. House of Representatives, John Boehner, and the House Minority Leader, Nancy Pelosi, is an excellent example of how meaningful legislation can be passed when a spirit of compromise exists. Following their lead, the U.S. Senate and President Obama passed and signed the bill respectively. Overall, 484 legislators supported H.R. 2 – a rare demonstration of bipartisanship in the volatile political environment on Capitol Hill. Why did this happen? The physician community had a unified message. What was different in 2014 and 2015 compared to previous years? For one, the price tag to repeal and replace the flawed SGR formula was the lowest it had been in some time. Also, an effective Congressional Doctors’ Caucus partnered with Committee leaders and the physician community to broker the historic compromise in early 2014. Despite the disappointment of not passing the bill last year, the physician community and its dedicated members persisted in bringing forth the rational arguments that eventually resulted in passage of this bill in April 2015. This was not an accident, but a result of years of work by multiple physician groups, including the AAO-HNS, to educate Members of Congress on the issues and the consequences of inaction. Personal relationships built and nurtured over many years, along with the consistency and appeal of the message, put this effort over the top. Tens of thousands of physicians, along with their staffs, persisted with the same compelling message, despite year after year of failure to achieve permanent repeal. Members of Congress kept hearing the same message through advocacy outreach and grassroots efforts. These included Capitol Hill visits, political fundraisers, phone calls, emails, and tweets – all with the same message. This culminated in the passage of this landmark legislation and the subsequent signing into law by President Obama. Our message was heard. I would like to salute our legislative advocacy team headed by Joy Trimmer, JD, and thank all of you who contacted their personal representatives and senators. The same strategy of building relationships and establishing trust while advocating for the best patient care has also demonstrated success in dealing with both CMS and private payers. Collaborative efforts within otolaryngology have recently been fruitful as demonstrated by the reversal of the ruling by CMS concerning implantable hearing devices ( AAO-HNS, ANS, AOS), acceptance of group reporting measures by CMS (AAO-HNS, ABOto), and United Healthcare’s reversal of its policy that stated balloon ostial dilatation was experimental (AAO-HNS, ARS). In today’s regulatory environment, and now with the implementation of H.R. 2, there is some concern among our Members about the ability for private practitioners, particularly those in small group practices, to participate in these quality-based programs, which on the surface seem quite complex. The Academy’s commitment to build an otolaryngology-specific Qualified Clinical Data Registry (QCDR) by 2016 will allow direct reporting of pertinent measures by participants to CMS, as well as provide additional quality and payment benefits to our Members. We feel this tool will allow otolaryngologists to continue to practice successfully in a variety of practice settings. With SGR repeal finally a reality, what’s next? The AAO-HNS will continue to work to advance our specialty’s legislative priorities (liability reform, truth in advertising, patient safety/scope of practice, GME funding, etc.), minimize the increasing regulatory burdens on our members, and address private payer concerns such as network tiering, bundling of procedures, and payment denials. With your help and perseverance, we will continue to engage in all efforts to give our members the tools to provide the best care for their patients.