See the full story with video at the UAMS News site.

Claudia Bressie’s tumor was non-cancerous, but it was aggressive and dangerous. Months of consultations at top universities and treatments proved ineffective for the San Francisco woman, until her journey brought her to UAMS.

It began in 2017 when Bressie started having swelling, popping and clicking around her jaw. The discomfort grew from there to what felt like stabbing pain accompanied by dizziness and vertigo.

Suen demonstrates how he and Day surgically removed Bressie’s tumor.

Because tenosynovial giant cell tumors have a high rate of recurrence, Bressie and her physicians were concerned about the possibility of operating in that very delicate area multiple times. What’s more, her surgical options had a high risk of her losing the ability to use her jaw and facial muscles and her hearing.

Bressie’s pharmaceutical sales experience gave her the helpful background knowledge to be an effective advocate for herself. She began learning all she could about her condition and treatment options.

“I went to multiple hospitals including UCSF, Stanford and MD Anderson. I felt pretty despondent with the different surgical methods the doctors were – recommending for me,” Bressie said. “My sister, a dentist who lives in Maryland, has a friend in Little Rock who serves as a board member at our Winthrop P. Rockefeller Cancer Institute with Dr. Suen.  He mentioned my case to Dr. Suen and out of the kindness of his heart he said, ‘Have her send me images and I’ll look over them.’ That’s how it began.

James Suen, M.D., a distinguished professor in the Department of Otolaryngology in the UAMS College of Medicine, is a world-renowned surgeon who specializes in a variety of complex otolaryngology cases.

Synovial giant cell tumors are very rare in the jaw joint and Suen had never seen one in 50 years of practice, although he has treated thousands of tumors in this area. Although these tumors are considered benign, they are very aggressive and difficult to cure. Her tumor had eroded through the bone over her jaw joint into the skull next to her brain.    After meeting with Suen, Bressie was confident in his approach to removing the tumor, which Suen said he felt he could do without disfiguring her face or compromising her ability to eat and talk normally.

J.D. Day, M.D., UAMS professor and chief of neurosurgery

It would be an – interdisciplinary approach. Suen asked J.D. Day, M.D., UAMS professor and chief of neurosurgery, to be involved with the case. While Suen would concentrate on the jaw and face, Day, who is an internationally known leader in skull base surgery, would focus on the sections nearest the brain. Together, the two surgeons consulted with Bressie, studied her images closely, and felt they could remove the tumor, get clean margins, and hopefully prevent recurrence.

“My sister came with me to my visit. Dr. Suen and Dr. Day seemed confident. And we felt good about their approach. I said, ‘We can stop here. Dr. Suen and Dr. Day are the ones!’”

“The tumor is not classified as a cancer, but it is very aggressive and acts like a cancer,” Suen said. “When we studied her scans, we saw the tumor had destroyed the jaw joint bone and was inside  her skull and sitting  next to her brain.”

In the surgery, Suen took away small bits of the tumor at a time checking for margins to avoid radical resection. You can’t take away too much at one time, he said, because the patient  would  end up with major complications.

The surgeons approached the tumor by opening and peeling back the right side of her face and scalp. Day removed the tumor inside the skull. Suen removed the tumor in and around the jaw joint. Once they got rid of all of it, they reconstructed her face.

You can hardly see any scar. “She looks amazing,” Suen said. “It turned out well. I’m pleased with that.”

“The way Dr. Suen and Dr. Day did my surgery was the best for me as far as an outcome for not having long-term issues. There’s a lot that can go wrong if you don’t know what you’re doing.”

Bressie noticed immediately after surgery that seemingly unrelated pain in her left knee was gone.

“That was just more confirmation of how aggressive the tumor was, already starting to affect her brain,” Suen said.

Bressie comes from an active family and is grateful this hasn’t slowed her down too much. The married mother of three enjoys tennis, downhill skiing, running and paddle boarding. She was cleared to run again after her visit with Suen in June.

“I was a little cautious to go all in because I didn’t want any setbacks.

She received good news from her most recent visit. There was no evidence of recurrence of the tumor. Suen called that an excellent sign.

“If she goes out two years without a recurrence, there is a good chance she is cured,” he said.

“I understand and sympathize with our doctors who are under a tremendous amount of pressure, with an ever increasing patient load,” Bressie said. “Dr. Suen carries the same challenges with grace and dignity. He slows down to take the time to treat each patient as if they’re family. He is a master at what he does by addressing your disease with precision, clarity and confidence. Dr. Suen is both empathetic and calming towards the patient’s fear and uncertainty. I’m blessed to have found him!”

Two years and several hospitals and doctors later, Bressie had a diagnosis from physicians at the University of California, San Francisco (UCSF): tenosynovial giant cell tumor. It is rare. And in most occurrences, the tumors appear in the knee joint and sometimes the hip. (A synovium is the covering of any joint found between bones like the elbows, shoulders, knees or hips.) Bressie’s tumor was in her TMJ joint, on the right side and very close to her brain.

By Amy Widner

The University of Arkansas for Medical Sciences (UAMS) has been recognized by U.S. News & World Report as having the best hospital in the state, and its ear, nose and throat (ENT) department was ranked among the top 50 nationwide.

“Our health care professionals and support staff at UAMS are dedicated to providing the best possible care for Arkansas, and it shows,” said UAMS Chancellor Cam Patterson, M.D., MBA. “They continue to provide the best quality care, even in the challenging times presented by the COVID-19 pandemic. This is an acknowledgment of their hard work, and I give them my full congratulations.”

The UAMS ENT department was ranked 44th in the nation on the 2020-2021 list, which was released today.

“I am very proud that our department was, once again, ranked in the top 50 programs nationwide. We have a great team of faculty, fellows, residents and nurses in our department, who really set the bar for excellence,” said John L. Dornhoffer, M.D., who leads the ENT program and is chair of the Department of Otolaryngology — Head and Neck Surgery.

“Our program is unique in Arkansas and is on par with some of the best programs in the nation. We cover all the subspecialties in our field, and our faculty are fellowship-trained and respected for their expertise. They publish textbooks and dozens of peer-reviewed manuscripts each year and lecture internationally. Equally as important, they are consistently rated well on patient satisfaction surveys.”

Other UAMS services and procedures singled out as “high performing” include:

Regional Recognition

• COPD
• Colon cancer surgery
• Heart failure
• Hip replacement
• Knee replacement
• Lung cancer surgery

“Each of these programs is an asset to UAMS and the state,” said Stephen A. Mette, M.D., senior vice chancellor for UAMS Health clinical programs and UAMS Medical Center CEO. “Recognition like this is a reflection of the reputation these programs have been able to build among their peers in the health care industry, patients and the wider community. Behind each title lies a lot of hard work and dedication by individual teams that are working together to provide better health care for Arkansans.”

The Best Hospitals ranking indicates quality complex care for challenging health conditions and for common elective procedures. “High performing” ratings designate specialty care that is significantly better than the national average, as measured by factors such as patient outcomes, volume, quality of nursing and other care-related indicators. These rankings are designed to assist patients and their doctors in making informed decisions about where to receive care for common conditions and elective procedures.

For the 2020-21 rankings and ratings, U.S. News evaluated more than 4,500 medical centers nationwide in 26 specialties, 10 procedures and conditions. In the 16 specialty areas, 134 hospitals were ranked in at least one specialty. In rankings by state and metro area, U.S. News recognized best regional hospitals based on high performing rankings across multiple areas of care.

U.S. News & World Report is the global leader in quality rankings that empower people to make better, more informed decisions about important issues affecting their lives. A digital news and information company focused on education, health, money, travel, cars and civic, USNews.com provides consumer advice, rankings and analysis to serve people making complex decisions throughout all stages of life. Founded in 1933, U.S. News is headquartered in Washington, D.C.

UAMS is the state’s only health sciences university, with colleges of Medicine, Nursing, Pharmacy, Health Professions and Public Health; a graduate school; hospital; a main campus in Little Rock; a Northwest Arkansas regional campus in Fayetteville; a statewide network of regional campuses; and seven institutes: the Winthrop P. Rockefeller Cancer Institute, Jackson T. Stephens Spine & Neurosciences Institute, Harvey & Bernice Jones Eye Institute, Psychiatric Research Institute, Donald W. Reynolds Institute on Aging, Translational Research Institute and Institute for Digital Health & Innovation. UAMS includes UAMS Health, a statewide health system that encompasses all of UAMS’ clinical enterprise including its hospital, regional clinics and clinics it operates or staffs in cooperation with other providers. UAMS is the only adult Level 1 trauma center in the state. U.S. News & World Report named UAMS Medical Center the state’s Best Hospital; ranked its ear, nose and throat program among the top 50 nationwide; and named six areas as high performing — cancer, colon cancer surgery, heart failure, hip replacement, knee replacement and lung cancer surgery. UAMS has 2,727 students, 870 medical residents and five dental residents. It is the state’s largest public employer with more than 10,000 employees, including 1,200 physicians who provide care to patients at UAMS, its regional campuses, Arkansas Children’s Hospital, the VA Medical Center and Baptist Health. Visit www.uams.edu or www.uamshealth.com. Find us on Facebook, Twitter, YouTube or Instagram.

One morning last fall, the 8-year-old sat up in bed at Arkansas Children’s Hospital in Little Rock, sorting through thimble-size models of Spider-Man, Thor and other superheroes he’d stored in an empty Pringles tube.

Holding out a cupped palm full of the characters, he offered a toy to his doctor, Gresham Richter, as a gift.

“He wants you to choose one hero,” Mikhail’s translator, Nazira Khaidakova, told the physician, who selected the Incredible Hulk.

Mikhail was preparing for treatment of a venous malformation. He’s among the international patients from countries such as Israel, Russia, China and Ukraine who have sought help for related conditions at the children’s hospital.

Richter — a professor and pediatric otolaryngology chief at the University of Arkansas for Medical Sciences and Arkansas Children’s Hospital — says his team is one of a few in the U.S. known for work on the group of conditions called vascular anomalies.

“You would probably not suspect you would have an international referral pattern [in Arkansas],” he says, “[but] it’s because of the expertise, and because it’s been supported by the hospital.

“We’re breaking down the barriers here … for them to get treatment.”

Richter says word of mouth, such as through online support groups, has brought a handful of patients from Eastern Europe for treatment with the Little Rock team over the past few years.

While those countries are industrialized, their hospitals and doctors don’t have “the technology, the lasers or the knowledge base” to offer the best possible treatment to patients, he says.

Through the translator, Mikhail’s mother, Mariia Pak, said their journey began when Mikhail was just 4 months old and the family noticed a lesion on his cheek. In photos, it appears as a smudge-like mark — like a grown-up’s thumbprint — creating a small bulge inside his upper lip.

The family unsuccessfully consulted specialists in Russia and Germany before hearing about the Arkansas program, she said. Pak began communicating with Richter’s team with the help of email and Google Translate.

But as they scheduled his first procedure in July of 2019, visa issues cropped up, she said. They’d had to appeal to the Russian Consulate for help, explaining Mikhail’s condition and that they had already paid for his procedures.

With their travel documents sorted out, the family boarded the first of three planes for a 24-hour journey to Little Rock, one of two such trips they’d take this year.

You get pretty connected with the families,” Richter says.

‘Not Like a Cancer’

According to a 2016 article in the journal Cardiovascular Diagnosis and Therapy, about 1-2 of every 10,000 people are born with a venous malformation, in which some veins don’t develop normally.

Structural problems make the veins bulge or expand. Depending on where the malformation is, it can cause swelling, darkened bluish patches on the skin or functional difficulties, potentially interfering with important processes like breathing.

Thought to be linked to a genetic mutation, venous malformations are challenging for doctors to treat, in part because they tend to come back.

“This is not like a cancer that grows within something, and you can take it out,” Richter says. “It’s part of the normal architecture that’s there; it’s part of the normal tissue.”

Richter traces his interest in vascular anomalies back to early research he did on pulmonary hypertension, which can reshape blood vessels in the lungs, as well as his taking part in difficult 30-hour surgeries earlier in his career.

“We were resecting these massive malformations, and they would bleed the whole time,” he says. “I said to myself, ‘There’s got to be a better way to do this.'”

He now uses “multimodal” treatments that can include surgery, laser and drug treatment. In Mikhail’s case, Richter incorporated laser therapy called selective photothermolysis and an injection of bleomycin, a chemotherapy. The dual-pronged treatment should shrink the veins and attack cells to keep the abnormality from returning.

In an operating room, about 10 medical professionals gathered with Richter to assist with Mikhail’s procedure, donning protective glasses as a powerful laser hummed to life.

Richter also directs research at Arkansas Children’s Hospital on vascular anomalies, studies that are concentrated in a small number of U.S. labs, he says.

While experts now have a sense of what genes are linked to venous malformations, he thinks more research is needed to totally eradicate the condition. “I think we probably need another 10 years. … Right now, I don’t think we’re at a cure state.”

Background

Of all forms of facial clefts, the Tessier No. 3 (oro-nasal-ocular clefts) is the rarest and most challenging. In 2018, pediatric otolaryngologist and cleft specialist Larry D. Hartzell, M.D., and a team of surgeons at Arkansas Children’s Hospital/UAMS treated two patients with Tessier No. 3 clefts within months of each other.

Both were born at 38 weeks gestation and had multiple associated anomalies. While both patients had a bilateral cleft lip and palate, Patient 1 had a severe left-sided cleft and Patient 2 had a right-sided incomplete cleft. The multidisciplinary team included plastic surgeon Michael S. Golinko, M.D., now at Vanderbilt Children’s Hospital, and UAMS ophthalmologist John D. Pemberton, D.O.

The basic surgical sequence for both infants was a dorsal nasal Reiger flap to level the ala, cheek advancement flap along with medial canthal repositioning, and more traditional bilateral cleft lip repair using a modified Millard technique.

Both infants are still followed for routine cleft clinical and surgical care and evaluations such as annual 3-dimensional computed tomography scans to evaluate the soft tissue and bony growth.

Patient 1

The team began consulting on the case before birth because ultrasound imaging revealed the cleft lip. The patient also had a large hole in her skull through which brain matter was extruding, and it was clear she had several other anomalies. Examination after birth revealed the child had bilateral cleft lip and palate as well as a left-sided facial cleft. She was blind in her right eye and profoundly deaf.

The oculoplastic examination revealed details of the cleft as well as parts of the face that were shortened, displaced or rotated. For example, the upper lip was rotated about 45 degrees. Parts of the nose where it attaches to the lower face were rotated and near the eye. Her lower left eyelid was shortened.

As the patient underwent other surgeries to address the hole in her skull and other issues, the craniofacial team discussed best next steps. Main goals were to rotate parts of the nose down toward the upper lip, close the lip, close the eyelid and align structures like the eye and nose. The team opted to work in stages, using taping first at 2 months of age to better position tissues and bone for upcoming surgery.

At 4 months of age, Patient 1 underwent facial cleft repair, which included all three surgeons and a combination of techniques from the three disciplines.  Structures to be closed were marked on the patient’s face in advance with tattooing. The operative plan was devised in a “top-down” approach, which separated the surgery into three elements: nasal reconstruction/repositioning of the ala, cheek and eyelid repair, and bilateral cleft lip repair.

In brief, surgical techniques included the dorsal-nasal, or Reiger, flap for leveling the nasal ala, the Tenzel semicircular flap for mobilizing the medial aspect of the lower lid, the Mitek anchor for medial canthopexy, cheek advancement flaps, and a more typical bilateral cleft lip repair using fork flaps as described by Millard to provide additional tissue to create a nasal sill, as well as other advantages.

(Click on each picture for details)

Patient 2

Patient 2 was remarkably similar, although her cleft was less severe and on the right side of the face. She also had a massive hydrocephalus identified prior to birth and was delivered via planned C-section at 38 weeks. She also underwent neurological procedures before undergoing craniofacial repairs.

At 1 month of age, she underwent a lip adhesion by the Seibert technique. Of note, unrelated to the Tessier cleft, VP shunt-induced craniosynostosis developed in this patient, which ultimately necessitated total cranial vault remodeling with fronto-orbito advancement.

Upon oculoplastic examination, the team noted that Patient 2’s eyelid was lowered and rotated down. Unlike Patient 1, there was an island of soft tissue between the oral and ocular portions of the cleft. She had thick boney features in the prolabium that proved resistant to taping, necessitating an initial lip adhesion surgery.

Similar to Patient 1, a “top-down” approach was elected with design of a left sided, superolaterally based Reiger dorsal nasal flap with a modest back-cut.

The bilateral lip repair was performed similarly to Patient 1, with the exception of the already performed lip adhesion and still very protrusive premaxilla, which necessitated a vomer setback to better align the premaxillary segment with the lateral segments and reduce tension on the lip repair. This lip adhesion tissue was released from the lateral lip flaps and prolabial tissue and later joined together to line the premaxilla creating a separation from the lip mucosa.

The early postoperative course for Patient 2 was complicated by a minor wound infection at the glabella region managed with local wound care in addition to mild hypertrophic scarring.

(Click on each picture for details)

Follow-Ups

Both patients required subsequent palate surgeries and may require subsequent plastics surgeries to touch up aspects of the initial repair.

Discussion

Hartzell said these rare cases resulted in a unique opportunity to individualize care for these patients.

“I had never seen or treated a Tessier 3 during my training process, so when I began treating these patients, I was reaching out to mentors and consulting with my team at UAMS to find the best course of action,” Hartzell said. “I had to use principles that I learned in my training and in my practice and apply those in multiple ways – plus the collaborative effort of working with other specialties. In the end, we pooled skills and knowledge in a way that I truly believe gave the best outcome for these patients.”

Both continue to receive care at Arkansas Children’s.

“Both girls, especially Patient 1, had poor initial prognosis and might not have survived,” Hartzell said. “They have actually surprised us all and continue to do really well. As they continue to get their care here, we continue to learn from them. And as rare as these cases are, I have since treated another patient – so the contributions of these patients and the lessons learned from this collaborative effort continue to have an impact.”

A more detailed report was published in the Journal of Craniofacial Surgery in October 2018.

After setting a goal to best themselves, the residents in the Department of Otolaryngology-Head and Neck Surgery ended up besting most of the nation at this year’s in-service exam.

UAMS scored in the top three or four among the 100-plus ENT residency programs in the nation. The in-service exams for each specialty are good practice for the board exams they take at the end of their residency.

“We decided to set a bar and then the residents took it from there,” said Abby Nolder, M.D., residency program director. “There’s always been an expectation for them to do well, but we never really set a benchmark, something to aim for. Once we did, the residents independently revamped their in-service review schedule, made it a priority, and they really exceeded even our high expectations.”

The residents met once a week, sometimes twice, to review and practice together. Some made flashcards to review at any free time in the unpredictable life of a resident. The department also invested in an online study tool to help the residents quiz themselves. The residents who needed the most help bringing their scores up also took practice tests every three months to monitor their improvement.

While residents are known to be competitive – and there was a monetary prize for the top score – resident Zachary Anderson, M.D., said the group developed a culture of mutual support that emerged as the true driving force behind their success.

“Everyone was pulling everybody else along to make sure we did as well as we could, collectively,” Anderson said. “At the end of the day, it’s more than just a test score. Excelling gives everyone in the program the confidence that, No. 1, we’re being well-trained; and No. 2., it taught us that we can work well together as a team. And finally, there’s just the simple fact that it fills  me with a lot of confidence knowing that I have all those answers in my memory bank now, that I can pull them out even under pressure. It makes me feel like I’m prepared to go off on my own as a physician.”

The ENT residents are Anderson; Terrell Bibb, M.D.; Mary Catherine Brown, M.D.; Erin Creighton, M.D.; Olivia Daigle, M.D.; Quinn Dunlap, M.D.; Victoria Gau, M.D.; Blake Hollowoa, M.D.; Anvesh Kompelli, M.D.; Tyler Merrill, M.D.; Sriram Navuluri, M.D.; Cody Page, M.D.; Shep Russell, M.D.; Mariah Small, M.D.; and Don Vickers, M.D.

John L. Dornhoffer, M.D., is chair of the department.

Faculty

The Department of Otolaryngology – Head and Neck Surgery is excited to welcome Jumin Sunde, M.D., to our Head and Neck Surgery Team. After earning his medical degree from the University of Alabama at Birmingham, Sunde served both his internship and residency at UAMS. He was fellowship-trained in head and neck oncologic and microvascular surgery at the University of Michigan. Prior to returning to UAMS, he served as an assistant professor at the University of Mississippi Medical Center.

Sunde will see patients in the Head and Neck Cancer Clinic in the Winthrop P. Rockefeller Cancer Institute. He joins fellowship-trained head and neck surgeons Mauricio A. Moreno, M.D.; Emre Vural, M.D.; Ozlem Tulunay Ugur, M.D.; and James Y. Suen, M.D., who are leaders in central Arkansas and contribute to research and surgical innovation on an international scale. Specifically, Sunde will complement the team’s work in advanced tumor removal by using newer techniques like robotics and microvascular reconstruction of complex head and neck issues in addition to traditional “open” surgery approaches.

Fellows

Charles Lane Anzalone, M.D., has joined the department for one year as the otology fellow. He will see patients in the UAMS Ear, Nose and Throat Clinic. He graduated from medical school at the University of Texas at Houston School of Medicine and he completed his residency at the Mayo Clinic. Lane’s favorite pastime is spending time with his two boys, ages 4 and 1. He also enjoys spending time outdoors, fishing, hunting and reading.  Lane is excited about the opportunity to work and learn from Drs. Dornhoffer and Walker.

Quinn A. Dunlap, M.D., is the department’s first Head and Neck Surgery Fellow.  Quinn completed medical school at the University of Alabama at Birmingham and served his residency at UAMS.  We are excited that Quinn will continue with the department for an additional year.  Quinn’s favorite procedure is a parotid with neck dissection and he is looking forward to working with the Head and Neck Surgery Team.  Quinn credits the strong relationship between residents and faculty as one of the factors in his decision to complete his fellowship training at UAMS.

MaryRoz Timbang, M.D., is the department’s new pediatric otolaryngology fellow, based at Arkansas Children’s Hospital. Timbang earned her medical degree from Case Western Reserve.  She completed her residency in otolaryngology – head and neck surgery at University of California, Davis Medical School.  She enjoys spending time with her family, drawing, painting, hiking, piano and baking.

Residents

Aryan Shay, M.D., joined the department’s residency program after completing medical school at Rush Medical College.  Aryan is from San Diego, California.  He enjoys snowboarding, exercising, music festivals, and exploring the outdoors.  Aryan selected UAMS because of the faculty’s reputation, resident wellness, diverse training experience and location.

Chrystal Lau, M.D., is from Little Rock and completed her medical school training at UAMS. She joined the department as a PGY-1 resident.  Chrystal enjoys spending time with family, sharing culinary and outdoor adventures with her boyfriend, unwinding with watercolor and acrylics, and struggling to keep her orchids alive. Chrystal likes the culture and close community within the UAMS program and UAMS provided the opportunity to stay close to loved ones.

Celeste Gibson, M.D., is a Little Rock native and she completed her medical school training at UAMS. During her free time, she enjoys long-distance running, scuba diving, surfing, and baking. Celeste chose ENT as a specialty primarily because of her experience with the UAMS ENT department as a medical student. She loved the camaraderie between the residents and between the residents and faculty. Everyone is genuinely happy to be here.

 Fellowship-trained surgeon Jumin Sunde, M.D., has joined the University of Arkansas for Medical Sciences (UAMS) as part of the Head and Neck Surgery team, which treats head and neck cancers, benign tumors, traumatic injuries and other conditions.

Sunde sees patients in the Head and Neck Cancer Clinic in the Winthrop P. Rockefeller Cancer Institute. He joins fellowship-trained head and neck surgeons Mauricio A. Moreno, M.D.; Emre Vural, M.D.; James Y. Suen, M.D.; and Ozlem E. Tulunay Ugur, M.D., who are leaders in central Arkansas and contribute to research and surgical innovation on an international scale. They treat squamous cell carcinoma, thyroid cancer, parathyroid tumors, vascular malformations, salivary gland tumors, skull base tumors, traumatic injuries, and other complex issues involving the head and neck, providing reconstructive surgeries where necessary.

Specifically, Sunde will complement the team’s work in advanced tumor removal and reconstruction by using newer techniques like robotics as well as traditional surgical approaches and microvascular reconstruction of complex head and neck defects.

“Dr. Sunde is a welcome addition to the program, where we have a long history of outstanding patient outcomes using modern treatment paradigms and innovative patient care protocols. We have excellent cancer outcomes for patients combined with short inpatient stays and low complication rates,” said Moreno, who is director of the Head and Neck Surgery Division. “Dr. Sunde completed his residency at UAMS, so he knows our team well and is committed to building upon – and expanding with his unique skills – this legacy of excellence.”

Sunde is also an assistant professor in the Department of Otolaryngology – Head and Neck Surgery. The department as a whole is a national and international leader and its ENT services are ranked among the top 50 in the nation by U.S. News and World Report.

Sunde comes to UAMS from the University of Mississippi, where he was an assistant professor. He earned his medical degree from the University of Alabama at Birmingham School of Medicine. He completed a residency and internship in head and neck surgery at UAMS and a fellowship in head and neck oncologic and microvascular surgery at the University of Michigan, which is also a leading academic institution for otolaryngology.

The Hearing and Balance program at UAMS brings together the best of audiology and ear, nose and throat care for a truly interdisciplinary approach that best suits patient needs.

Hearing and balance issues are common, especially in older adults. About one in three people between the ages of 65 and 74 has hearing loss. That number increases to nearly half of those over 75. Symptoms are often ignored or dismissed as part of the natural aging process. However, disruptions to hearing and balance can touch on almost all aspects of a person’s health and quality of life — from social interaction to cognition to dangerous falls and accidents. Difficulty hearing and understanding what is being said can create a significant barrier to providing care. In many cases, early intervention can halt or delay serious declines in overall health.

All-In-One Service

The UAMS Ear, Nose, and Throat and Audiology clinics offer patients a comprehensive and integrated approach to treating and rehabilitating their hearing loss. Both are conveniently located in the Jackson T. Stephens Spine & Neurosciences Institute on the UAMS campus in Little Rock. Options range from non-surgical treatment with hearing aids to a full surgical array of middle and inner ear procedures, including cochlear implants. Your patient’s needs can be covered in this one location, from start to finish.

The Hearing and Balance Team treats:

• Ear-related vertigo
• Meniere’s Disease
• Benign paroxysmal positional vertigo (BPPV)
• Superior canal dehiscence syndrome (SCDS)
• Chronic ear disease — cholesteatoma, tympanic membrane perforations, chronic mastoiditis
• Acoustic neuromas, glomus tumors, lateral skull base tumors
• Tinnitus

Adult Cochlear Implant Program

UAMS is home to the largest cochlear implant program in the state. We partner with all three cochlear implant manufacturers: Advanced Bionics, Cochlear Americas, and MED-EL. We offer hearing options to all hearing impaired patients, regardless of the severity of their loss. Medicare guidelines provide cochlear implant coverage for patients with bilateral moderate to severe hearing loss whose word understanding ability is moderate to poor. Most private insurance plans provide coverage for cochlear implant devices as well, making them accessible to a large population of patients. Our audiologists, nurse practitioners and surgeons work together to assess the needs and abilities of these patients in order to ensure a successful experience throughout the process.

Hearing Loss Surgeries

UAMS offers the highest quality hearing device implant surgery by fellowship-trained physicians available in the state.

John Dornhoffer, M.D., FACS, professor and chair of the Department of Otolaryngology — Head and Neck Surgery at UAMS, has performed more implant surgeries in Arkansas than anyone else working in the state. He lectures and trains fellows in implant surgeries on an international level. The Department of Otolaryngology as a whole is recognized by U.S. News & World Report as among the top 50 programs nationwide.

David D. Walker, M.D., has joined the Hearing and Balance Program at UAMS. Walker completed fellowship training in otology, neurotology and skull base surgery at Michigan Ear Institute, Farmington Hills, Michigan.

Surgical treatments include:

• Cochlear implantation
• Middle ear ossicular reconstruction
• Canaloplasty/Meatoplasty
• Otosclerosis surgery
• Baha® implantation
• Acoustic neuroma surgery

Non-surgical Options for Hearing Loss

Most patients do not need surgery and are well served by the highly trained audiologists on our team. Our audiologists provide complete diagnostic hearing evaluations to assess function and the communication needs. These results — along with thorough counseling — allows us to recommend appropriate hearing devices. Devices are fit using the most advanced verification measures. The UAMS Audiology Clinic offers a vast array of hearing devices, providing a solution for every type and severity of hearing loss. With advancements in technology, most of the hearing devices on the market today allow for connectivity to smart phones and other smart devices such as televisions and computers, improving patient comprehension in numerous environments.

The Audiology Clinic provides:

• Adult diagnostic hearing exams
• Hearing aid evaluations and fittings, including probe microphone verification measures
• Contralateral Routing of Sound (CROS) hearing aids to treat single-sided hearing loss
• Smartphone-compatible hearing aids
• Cochlear implant evaluation
• Cochlear implant device programming
• Balance studies

Looking Forward

On the forefront of a new decade, the UAMS Otolaryngology and Audiology programs find themselves on the forefront of growth and progress. The doctorate-level audiology academic program is preparing to merge into the outpatient clinic setting with the existing team. These shared efforts will be the foundation for a new clinical and research institute. This merger will open the door to new research opportunities and clinical trials for faculty and students, while allowing for new findings to be tested and implemented directly into a clinic setting.

Accepting New Patients

Call Anndi Cranford, APRN: 501-256-9041
AECranford@uams.edu

Call Brenda Speed, APRN: 501-707-7023
BOSpeed@uams.edu

David Walker, M.D.: DDWalker@uams.edu

John Dornhoffer, M.D.: DornhofferJohnL@uams.edu

Audiology: 501-686-5940

Clinic Fax: 501-686-8644
Transfers and Consults: 501-686-6080

Practicing otolaryngologists, head and neck surgeons, and affiliated partners are encouraged to save the date for the second annual Otolaryngology Diamond Conference, with confirmed speakers from the Mayo Clinic, M.D. Anderson, and Harvard Medical School.

The conference originally set for May 1-2, 2020 will be held in the spring of 2021.   It is presented by the Department of Otolaryngology — Head and Neck Surgery at the University of Arkansas for Medical Sciences. Department Chairman John Dornhoffer, M.D., FACS, also serves as course chairman.

The Diamond Conference provides a national meeting ground for the exchange of ideas, with presentations from invited speakers and UAMS faculty highlighting the latest research, clinical techniques and management practices vital to the practicing ear, nose and throat doctor.

Confirmed speakers include:

Christopher Hartnick, M.D., M.S.

Associate professor at Harvard Medical School and a pediatric otolaryngologist at the Massachusetts Eye and Ear Infirmary. He also is director of the Pediatric Otolaryngology Division and co-director of the Pediatric Airway, Voice, and Swallowing Center — a joint effort of the Massachusetts Eye and Ear Infirmary and Massachusetts General Hospital.

Colin Driscoll, M.D.

Faculty member at the Mayo Clinic in Rochester, Minnesota. Driscoll studies disorders involving the ear, temporal bone and skull base, with a special focus on skull base tumor treatment outcomes and cochlear implants.

Ehab Hanna, M.D., FACS

Professor and vice chair of the Department of Head and Neck Surgery at the University of Texas M.D. Anderson Cancer Center in Houston. His interests include the treatment of patients with skull base tumors and head and neck cancer.

For registration and conference information, visit otolaryngology.uams.edu.

State-of-the-art 12 station temporal bone lab

UAMS will host otology fellows and faculty on June 5-7, 2020 as part of the fifth annual International Otology Fellows Congress and Advanced Course in Ear and Skull Base Surgery.

Twenty-four otology fellows are invited to participate in the event, which will be held in the Jackson T. Stephens Spine & Neurosciences Institute and its state-of-the-art Yasargil Surgical Skills Laboratory and Education Center. The surgical skills lab has recently acquired a da Vinci robot, which will augment the surgical skills learning experience. Through lectures and extensive laboratory sessions, they will learn the latest in advanced surgical techniques for the inner ear.

“This is a unique opportunity for fellows to focus on surgical techniques that are well beyond the scope of a typical temporal bone course, while networking alongside other otology/neurotology fellows from around the world,” said John Dornhoffer, M.D., professor and chairman of the Department of Otolaryngology-Head and Neck Surgery and director of its Division of Otology and Neurotology, all in the UAMS College of Medicine.

da Vinci system

Otology refers to the treatment of middle ear disease and conductive hearing loss, whereas neurotology refers to treatment of the inner ear or its connection to the brain.

Dornhoffer serves as program chair, along with former UAMS faculty member Michael Gluth, M.D., now of the University of Chicago Medicine Pritzker School of Medicine.  Nine additional guest faculty from the United States, Germany and Belgium will provide lectures, laboratory instruction, and roundtable discussions.