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Ear, Nose & Throat Institute Opens at University Hospitals
Adults and children with hearing loss, nasal polyps, voice disorders, skull base disease, head or neck cancer, or other otolaryngology-related conditions now have easier access to comprehensive care at the new University Hospitals (UH) Ear, Nose & Throat Institute.
Formally established in October, the institute streamlines the delivery of ENT services — diagnostic and therapeutic — with a team of 13 adult and pediatric otolaryngologists, head and neck surgeons, therapists and specially trained nurses available in one location.
Dr. Cliff Megerian, vice chairman of the UH Case Medical Center (UHCMC) Department of Otolaryngology and director of UHCMC Otology, Neurotology and Cochlear Implants, believes there is tremendous value in bringing diverse but related specialties together. He says the institute model provides a better approach to managing complex ENT cases than traditional methods.
“In the not so distant past, ear, nose and throat specialists worked separately and at many different facilities,” he says. “As patients were referred from one specialist to the next, they needed separate appointments, making care disjointed and difficult. With the UH ENT Institute, we now have an overarching organizational structure. Instead of service providers designated by specialty, we’ve created a single medical body for all ENT patients under a single umbrella. Here they can see all their doctors, nurses and therapists at a ‘one-stop shop.’”
With the former model of care, a patient with head or neck cancer would see a surgeon, an oncologist, a radiation oncologist and perhaps a speech and swallowing therapist at different times in different locations. At the UH ENT Institute, all these practitioners work together side-by-side to coordinate medical care.
“Our key message to patients and area physicians is that the UH ENT Institute is focused on patients and what’s best for them, as opposed to being centered on specialists,” says Dr. Megerian.
The UH ENT Institute is comprised of eight centers of excellence:
- Ear, Hearing & Balance Center
- Nose, Sinus & Allergy Center
- Audiology & Cochlear Implant Center
- Head & Neck Cancer Center
- Pediatric Ear, Nose & Throat Center
- Laryngology & Voice Disorders Center
- Community Ear, Nose & Throat Center
- The ENT Translational & Basic Science Research Center
In the Ear, Hearing and Balance Center, co-directed by Dr. Megerian and Dr. Maroun Semaan, a wide variety of tumors and other disorders of the brain and skull base are diagnosed and treated both nonsurgically and surgically. Common problems include acoustic neuromas, meningiomas, arteriovenous malformations, and cholesteatomas. Each new case is discussed by a team of specialists who tailor a plan of care to the needs of the individual patient. Because many of the team members also hold appointments in the UH Seidman Cancer Center, the Neurological Institute coordination of care for patients with such tumors is seamless.
In the Nose, Sinus and Allergy Center patients with breathing difficulties, sinus headaches, allergies, chronic infection, congestion, deviated septums and much more receive diagnostic and therapeutic services. In most cases, patients are treated non-surgically, but a full range of advanced surgical procedures including balloon sinuplasty are available onsite. Trans-nasal anterior skull base procedures are also performed by this group. Drs. Chad Zender, Tony Reisman and Hassan Abbass are vital to this Center.
The Audiology and Cochlear Implant Center, led by Dr. Gail Murray in collaboration with Drs. Megerian and Semaan, is one of the largest in the nation, performing more than 600 implants (100 in 2011 alone) since the center formally opened in 2002. Many of the patients have been babies with profound hearing loss.
“Currently, we are one of the biggest multi-disciplinary teams providing this type of care to children and families, and we are seeing wonderful results,” says Dr. Megerian.
The Head and Neck Cancer Center provides care for patients as part of the UH Seidman Cancer Center, where advanced technology-based treatments such as CyberKnife radiosurgery, Gamma Knife radiosurgery, and TomoTherapy are available. Minimally invasive robot-assisted ENT surgery is also offered here, as is access to national clinical trials. Dr. Pierre Lavertu director of Head and Neck Surgery and Oncology at UHCMC, leads the team which also includes Drs. Rod Rezaee and Chad Zender.
“We have medical oncologists, radiation oncologists, surgeons and others who specialize in treating many forms of head and neck cancer, including cancer of the tongue, mouth, tonsils, larynx, nose and sinuses, carotid and thyroid. The team also works closely with UH neurosurgeons,” says Dr. Lavertu. “By working together under the same roof at the same time, within 20 feet of each other, we’re able to minimize the number of trips patients must make to the hospital, reducing their stress and financial expenses. Plus, this arrangement facilitates communication among specialists, which is always to the benefit of the patient.”
Maintaining quality of life for patients is very important, as well, he says. “All physicians in each of the Centers of Excellence in the UH ENT Institute work together to optimize all of the Institute’s services, so that patients may retain as much function as possible. In essence, our multi-disciplinary team approach is state-of-the-art in and of itself.”
The Pediatric Ear, Nose and Throat Center, directed by Dr. James Arnold leverages the assets of UH Rainbow Babies & Children’s Hospital. Here, pediatric specialists offer comprehensive care to patients with hearing loss, chronic ear infections, sleep disorders, head and neck cancer, and swallowing and voice disorders.
“Everything is done in conjunction with pediatric specialists in other fields, such as neurology, plastic surgery and speech therapy,” says Dr. Arnold who is a pediatric otolaryngologist and department chair of Otolaryngology at UHCMC. “Everyone on the institute’s team brings specialty training and experience to the table. Moreover, all are committed to the multi-disciplinary approach, particularly with complex cases. Bottom line is we have the right people with the right training and the right attitude — they are all great with kids. This goes beyond just being a good provider of medical care.”
For children with craniofacial issues, Dr. Arnold provides evaluations in the UH ENT Institute’s Laryngology and Voice Disorders Center where pediatric-sized technology is available for a variety of evaluations.
“In this center, we can check a child’s palate, swallowing, breathing symptoms and speech production – including pattern, voice quality and fluency,” he says.
Led by Dr. Nicole Maronian, the Laryngology and Voice Disorders Center also focuses on patients — adult, as well as pediatric — with swallowing problems, vocal cord paresis and paralysis, spasmodic dysphonia, dysphagia, laryngeal carcinoma, Zenkers diverticulum, cricopharyngeal spasm, vocal cord lesions and tracheal narrowing.
“It’s about appropriate, aligned specialty care that’s in the patient’s best interests,” says Dr. Arnold. “And because we have a community arm, we offer easier access for patients whose primary care physicians want them to be seen by an otolaryngologist.”
The Community Ear, Nose and Throat Center, managed by UH’s fellowship-trained otolaryngologists and surgeons, including Drs. Hassan Abbass, and Fadi Abbass and overseen by Dr. Tony Reisman, is a virtual ‘center’ through which primary ENT physicians in Northeast Ohio provide care under the auspices of the UH ENT Institute in a wheel-and-spoke model. For years, UH has reportedly enjoyed very close relationships with many primary otolaryngology groups in the communities the hospital system serves. Now the groups who are associated with the new institute follow the same quality initiatives, standards of practice and evidence-based guidelines to ensure consistency of care.
This, according to Dr. Megerian, is simply a formalization of long-standing relationships. By working with ENT doctors through Northeast Ohio who enjoy their independence but want the benefits of being associated with a major medical center, UH can expand patient access to its services quickly and efficiently. In return, the ENT doctors receive educational support, research opportunities and concierge referral networks.
“What’s unique is that families can see our team at so many accessible locations throughout Northeast Ohio, based on what’s easiest for them,” says Dr. Megerian. “We’re an institute that truly embraces community access.”
In addition, Dr. Megerian notes the importance of research — specifically, the ENT Translational and Basic Science Research Center. Here, three full-time researchers, funded by NIH and other sponsored grants, find cures and treatments for some for some of the most pressing issues in ENT care.
“Surrounded by ENT physicians and patients, our researchers design experiments around needs. It’s practical research for real patient issues,” he says. And because this Research Center is part of the ENT Institute, patients have easy access to the latest treatments and clinical studies.
Dr. Megerian notes that UH ENT Institute offers unique benefits to all physicians who are part of the organization, as well as to their patients.
“The multi-disciplinary approach enriches the work environment which helps us retain exceptional practitioners and recruit new ones. Plus, the teaching and research aspects foster collaboration between subspecialists while giving students and fellows access to a diverse group of teachers,” he says. “The end result is that we’re breaking down walls between specialties and creating a patient care experience that’s much richer than ever before.”
For more information about University Hospitals Ear, Nose and Throat Institute or to refer a patient, call 216-844-6000 or visit UHhospitals.org/ent.
MD News January/February 2012, Cleveland/Akron/Canton