BREATHE AGAIN!!

CALIFORNIA

SINUS INSTITUTE

HEADQUARTERS

Palo Alto

1900 University Avenue, Suite 101

E. Palo Alto, CA 94303

Phone: 650-462-3131 Fax: 650-322-8228

San Ramon

5801 Norris Canyon Road, Suite 200

San Ramon, CA 94583

Phone: 925-807-1131 Fax : 925-866-1699

CSI TEAMJoseph Roberson, M.D.

CEO and Managing Partner

Winston Vaughan, M.D. Director California Sinus Institute

Rhoda Wynn, M.D.Fellow

Kathleen Low, N.P.Nurse Practitioner

Adelene ManitiMedical Assistant

Trenna (Teri) CottChief Operating Officer

Monica HellnerExecutive Assistant

Gino LiBeratiManager, Billing/Collections/Contracting

Philip LowtonAccounting Manager

Hyacinth ReyesOffice Manager, Palo Alto

Volume 4, Issue 2 February 2006

ONE YEAR ALREADY!It’s almost our One Year Anniversary. CSI was founded in March 2005 to serve as the premier center of excellence in Northern California for care, research and education of patients with and providers treating diseases related to the nose and sinuses.

This was a concept of Drs. Winston Vaughan and Joseph

Roberson – but the real gritty work to make CSI an active practice was done by so many individuals including our nursing staff, friends, family, advisors, and referring doctors – AND our patients! We can not say enough about how humbled and honored we are by the established and new patients who have continued to trust us with their health.

WHAT WE DO AT CSI:At CSI, we aim to provide the best care: especially, in difficult to treat sinus problems. Many of our patients are sent to us when others are baffled. Our doctors and staff are trained to provide the highest level of care, education and research related to common and severe cases. They continually attend and give courses, actively develop tools used in surgery, train junior doctors / practicing ENT doctors and publish articles.

Sinus Infections: Sinus infections are a very common problem. It is estimated that over 43 million Americans suffer from chronic sinus problems – making it according to the CDC - one of the leading causes of illness.

Bacteria, fungus, viruses and allergic reactions are the main culprits.

Acute bacterial sinusitis: is usually preceded by a cold, allergy attack or irritation by environmental pollutants. Unlike a cold or allergic reaction, bacterial sinusitis often requires a physician’s diagnosis and treatment with an antibiotic. Normally, mucus collecting in the sinuses drains into the nasal passages, but when you have a cold or allergy attack, your sinuses become inflamed and are unable to drain. This can lead to congestion and infection. Diagnosis of acute sinusitis is usually based on a physical examination and a discussion of your symptoms. Your doctor also may use x-rays (CT scans) of your sinuses or obtain a sample of your nasal discharge to test for bacteria.

When Acute Sinusitis Becomes Chronic: When you have frequent sinusitis, or the problem lasts over three months, it is often chronic sinusitis. Symptoms of

chronic sinusitis may be less severe than those of an acute infection; however, untreated chronic sinusitis can cause damage to the sinuses and surrounding structures. If your doctor thinks you have chronic sinusitis, intensive medical therapy may be prescribed. Surgery is sometimes necessary to remove physical obstructions that may contribute to chronic sinusitis.

Sinus Surgery: Surgery should be considered only if medical treatment fails or if there is an anatomical problem (like polyps) that cannot be corrected with medications. The extent and type of surgery is chosen to best suit the patient and the disease. Functional endoscopic sinus surgery (FESS) is recommended for certain types of sinus disease. With an endoscope, the surgeon can look directly into the nose, while at the same time, removing diseased tissue and polyps and clearing the narrow channels to the sinuses.

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What’s NEW in Sinus Surgery? The doctors at CSI have cared for some of the most complex surgical cases regionally involving the sinuses and noses. We continually strive to improve our techniques. Although many sinus-related problems can be treated with medicines, surgery may be needed in some patients. Whenever possible, CSI surgeons use newer, less deforming, and less painful techniques. Image-guided Computer Surgical Navigation: For more complex cases, CSI surgeons suggest using “surgical navigation” -- usually with a special type of CT or MRI scan -- in order to diminish the chance of complications and improve results. See www.calsinus.com for more info.

Sinus CT Scan / X-rays at CSI: We now offer same day Xoran Sinus CT scans. This is done in our offices - it takes 20 minutes and uses only 10% of the radiation used by other scanners. Our staff will perform and review the films with the patient the day of their visit. No need to go away and come back days / weeks later for the review and opinion. Call 650-462-3131 to arrange for a sinus scan and consultation with one of our providers. For more information on this scan visit - xorantech.com

Nasal Endoscopy: How do we look into your nose / sinuses? When patients come to CSI with a nose or sinus related problem, we may want to perform a nasal endoscopy. This is a surgical procedure using sterile small cameras to look through the nostrils. This may allow us to: obtain drainage for culture, evaluate previous surgery, scar, openings, masses, polyps, causes of blockage and evaluate healing or complications of surgery. We may also obtain specimens / biopsy for pathology evaluation or remove old blood, foreign material, packing and scabs/ scar /blockage. During this procedure, we educate you and others: We use 3-D-like video glasses and TV screens that allow the patient and others to see inside the nose.

Step 1: Patient is scanned in our new mini-CT scanner

Step 2: CT images and related anatomy are immediately available for review in our offices

Diseases Treated and Services provided include:

Diseases of the sinuses and noseEpistaxis / Nosebleeds Endoscopic Sinus Surgery Frontal Sinusitis Management SinusitisNasal obstructionComputer Guided SurgeryMucoceles / AbscessesBacterial InfectionsFungal SinusitisRevision CasesEncephaloceles

•Advanced endoscopic techniques to avoid external approaches and improve outcomes •Culture directed medical management •Prevention of increased antibiotic drug resistance by use of cultures to select treatment •Orbital and Optic Nerve Decompression / Grave’s disease / Sinus induced Eye infections •Tear Duct surgery / endoscopic DCR for Watery eyes - Epiphora •Sinonasal trauma management •Choanal Atresia Repair •Complications of Prior Surgeries •Sinonasal tumors /polyps /masses•Smell / Taste Problems•CSF leak repair

What We Do cont’d.

DISEASES TREATED & SERVICES PROVIDED

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NEWS: Upcoming Events & Projects

CSI has had the opportunity to present at many local and national meetings. These include meetings in Los Angeles, Houston, Salt Lake City, the Cleveland Clinic, Stanford, Phoenix, Boise, Washington DC, Fresno, Loma Linda Medical Center, San Jose and Monterey.

At the annual International ENT Academy meetings in Los Angeles, CSI presented the latest research activities with a new tool for chronic sinusitis—Sinuplasty. (See above.) Other presentations included: our recent research on blood loss during sinus surgery and nationwide trends concerning the use of computer navigation. CSI also held courses on: medical legal issues, advanced computer surgical navigation and medical management of sinus problems. Kathleen NP conducted a course on nasal Endoscopy for nurse practioners.

At community outreach events, CSI had presentations for ENT physicians, local practitioners and other specialists including pulmonologists and allergists concerning the care of sinusitis.

As we look to 2006, we plan to hold many more educational and interactive sessions. These include public and CME seminars at the brand new Four Seasons Hotel next to our East Palo Alto offices.

In February and March – several doctors will be visiting to interview for CSI’s 2007 Rhinology Fellowship. These doctors hope to follow in the footsteps of past CSI Fellows: Drs. Chris Church, Alex Chiu, Ankit Patel, Ed Hepworth and our current fellow Dr. Rhoda Wynn. This fellowship remains one of the most sought after and the first on the West Coast.

Another educational offering is the CSI Mini-Fellowship. These are intensive programs designed for practicing ENT doctors from across the U.S.A. who are interested in improving their medical and surgical management of difficult sinus patients. Participants are “immersed “ into the daily practice at CSI. They observe the faculty and staff in the care of patients for 2 full days.

CSI – Fresno: CSI is attempting to “bring the office to our clients” of the Central Valley. We are attempting to create a closer affiliation with the largest allergy and asthma group in the Fresno-Visalia area. Stay tuned for more information.

CSI is actively involved in research to improve the diagnosis and management of diseases related to the nose and sinuses. We are constantly updating protocols and studies. Our doctors, fellows and nursing staff may discuss these studies with you.

Current/ Past studies include:

Nebulized Medications in the Treatment of Sinus Diseases

Effect of Carbon Dioxide Levels on Blood Loss during Endoscopic Sinus Surgery

Use of Alternative Therapies in Sinus Management

Emergence of Increasing Drug Resistance in Chronic Sinusitis

Use of culture-directed therapy for acute infections in chronic sinus patients

Microbiology of acute infections in chronic sinus patients.

Use of Anti-Fungals and Steroids in the Management of Allergic Fungal Sinusitis

Impact of revision endoscopic sinus surgery with surgical navigation

Impact of nebulized therapies on psychological outcome measures

Instrumentation and Computer Navigation for Endoscopic Sinus Surgery

Use / development of Sinuplasty technology in FESS

RESEARCH

SINUPLASTY-First in the U.S.A. Sinuplasty: This involves a new tool developed right here in Menlo Park, California! Small balloons are used during surgery to expand the sinus drainage holes - it’s like angioplasty for the heart applied to the sinuses instead – hopefully leading to faster recovery, no packing and much less pain than current endoscopic sinus surgery. This represents a new, minimally invasive treatment option for some sinus patients.

We are very excited about this approach and we were the first to perform it in the United States. CSI conducts courses for other physicians about this new approach / device. See: www.Acclarent.com for any additional information.

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2. SELECT THE “NEWSLETTER” LINK

3. COMPLETE AND SUBMIT THE NEWSLETTER SUBSCRIPTION FORM

save a tree! CALIFORNIA SINUS INSTITUTE WWW.CALSINUS.COM

1900 University Avenue, Suite 101, E. Palo Alto, CA 94303

Sinusitis

Bacterial Infections

Epistaxis

Nasal Obstruction

Allergic Fungal Sinusitis

Functional Endoscopic Sinus Surgery

Image Guided Surgical Navigation

Frontal Sinusitis Manage-ment

Revision Cases

Orbital and Optic Nerve Decompression

Epiphora

Sinosanal Tumor and Trauma

Choanal Atresia

www.calsinus.com

info@calsinus.com

www.californiaearinstitute.com

info@californiaearinstitute.com

Advanced Capabilities

MY CSI APPOINTMENTWhat should patients bring to a CSI appointment?:

Health Insurance Card / Information A friend or family member to take notes / help with questions A list of all medications you are taking A list of your questions /concerns A copy of your XRAYS / CT scans (not the reports - get the actual films) Copies of records from doctors related to your sinuses / nose / allergies / lungs.

Completed FORMS available on www.calsinus.com

Dr. Winston Vaughan: was founder and director of the Stanford Sinus Center. He co-founded the California Sinus Institute and Foundation in 2005. He completed his residency in Otolaryngology/Head and Neck Surgery at Stanford University, then spent a dedicated year pursuing an advanced fellowship in complex Sinus Surgery and Rhinology in Georgia. He has attended and taught several sinus courses. His special interests include Sinusitis and Functional Endoscopic Sinus Surgery, especially in patients who have had previous surgeries or who have complex /extensive diseases

Dr. Rhoda Wynn: is the current fellow at CSI. She completed college at Brown University then medical school at Baylor in Texas. Her residency in ENT was at SUNY Downstate in Brooklyn NY. She joined CSI in July 2005. She has published over 20 journal articles and book chapters. She is particularly interested in Sinuplasty and revision sinus surgery with navigation.

Kathleen Low, RN, NP: is one of the first Nurse Practitioners in the Bay Area to focus in Otolaryngology. She obtained a Bachelor of Science in Nursing in Ohio and then completed a Masters at UCSF to become a NP. She worked as an intensive care nurse at Stanford then joined Dr. Vaughan and the ENT Dept. at Stanford in 1999. She coordinates the sinus research activities at CSI and sees patients on Tuesdays and Fridays in our Palo Alto office. Her special interests include the medical management of complex infections and patient education.

Adelene Maniti, CCMA: joined CSI in April 2005. She worked as a phlebotomist at the Mills-Pennisula Hospital then served as a medical assistant in the Allergy Dept at the Palo Alto Medical Foundation. She is currently pursuing work towards a Bachelor of Nursing from San Jose City College. Adelene also serves as the administrative assistant at CSI and coordinates courses, lectures and our fellowships.

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