for over 30 years, providing excellent ent care to florida ... · for over 30 years, providing...
TRANSCRIPT
summer 2018
For over 30 years, providing excellent ENT care to Florida patients.
Inspire therapy is a breakthrough sleep apnea treatment that works inside your body with your natural breathing process. Simply turn
Inspire therapy on before you go to bed and off when you wake up. No mask, no hose, no noise.
INSPIRE THERAPY IS NOW AVAILABLE AT SOUTH FLORIDA ENT
Visit InspireSleep.com to learn more, view important safety information and to find a doctor at South Florida ENT who can determine if Inspire is right for you
Discover Inspire therapy
TREAT SLEEP APNEA
WITHOUT A MASK
Medical
Welcome to the sixth edition of our
magazine. South Florida ENT Associates
continues to serve the community by
adding new physicians that deliver the
highest quality medical care to our patients
and by expanding our office locations in the
Tri-County area. We continue to equip our
offices with the most advanced technology to aid in the diagnosis
and treatment of adults and children with ENT problems.
Our group is dedicated to provide individualized care and to be
responsive to our patient’s concerns and needs. We value the
relationship that we have with the physicians and healthcare
workers in South Florida and appreciate being able to practice
medicine in the finest hospitals and ambulatory surgical centers in
the state.
We will continue to move forward with our efforts to meet
the needs of the community and to set goals for ourselves to
continuously improve the medical care that we feel is so important
to our fellow physicians, patients and their families.
Sincerely,
Frank G. Kronberg, M.D., F.A.C.S.
President, South Florida ENT Associates
Welcome back to the sixth edition of the South Florida ENT Magazine!
inside this issue4 Our Locations
5 Meet Our New Physicians
6 Otoharmonics Levo System “From ‘I just have to live with it’ to ‘I have my life back’”
8 When It’s Not Just a Frog in Your Throat
i Clarifix: An Office Based Solution for Runny Nose
j The Physicians of SFENTA
l South Florida ENT Associates Delivers Quick Results and Ultra-Low Radiation Dose with MiniCAT
n Further Advances in the Treatment of Sinusitis
p A Proven Alternative for Obstructive Sleep Apnea Patients Who Can’t Tolerate CPAP
r SFENTA is Helping to Improve Nasal Breathing Without Altering Appearance
s Penicillin Allergy Testing
SFENTA Magazine is designed and published by Custom Medical Design Group. To advertise in an upcoming issue please contact us at: 800.246.1637 or visit us at CustomMedicalMagazine.com. This publication may not be reproduced in part or whole without the express written consent of Custom Medical Design Group.
8181 NW 154th Street, Suite 200 • Miami Lakes, FL 33016 • sfenta.com
page 3
Thank You to Our Sponsors• CityNationalBank• Cochlear• CredentialMyDoc.com Web-based Credentialing Software (912) 655-1559 [email protected] www.credentialmydoc.com• GroupBenefitConcepts,Inc.• InspireMedicalSystems,Inc.• Kramer,Green,Zuckerman,Greene &Buchsbaum,P.A.
• Nosich&Ganz, Attorneys at Law 75ValenciaAve.,Suite1100 CoralGables,FL33134 Phone:305-442-4800 website:ngattorneys.com• SEOversite• Studio3Marketing
Inspire therapy is a breakthrough sleep apnea treatment that works inside your body with your natural breathing process. Simply turn
Inspire therapy on before you go to bed and off when you wake up. No mask, no hose, no noise.
INSPIRE THERAPY IS NOW AVAILABLE AT SOUTH FLORIDA ENT
Visit InspireSleep.com to learn more, view important safety information and to find a doctor at South Florida ENT who can determine if Inspire is right for you
Discover Inspire therapy
TREAT SLEEP APNEA
WITHOUT A MASK
page4
AventurA, FL
21150 Biscayne Blvd., #102
Aventura, FL 33180
305-935-6000
305-682-8831
2845 Aventura Blvd., #248
Aventura, FL 33180
305-531-7637
21097 NE 27th Ct., #410
Aventura, FL 33180
305-932-6375
BocA rAton, FL
7900GladesRd.#340
Boca Raton, FL 33434
561-353-7377
coconut creek, FL
4515 Wiles Rd. #201
Coconut Creek, FL 33073
954-943-1418
coconut Grove, FL
3661 S. Miami Ave., #409
Miami, FL 33133
305-854-5971
corAL GABLes, FL
6705 Red Rd., #706
CoralGables,FL33143
305-666-0203
6705 Red Rd., #602
CoralGables,FL33143
305-663-3380
747 Ponce De Leon Blvd., #305
CoralGables,FL33134
305-444-4903
DorAL, FL
8726 NW 26th St., Unit #3
Doral, FL 33172
786-228-3164
9915 NW 41st St., #220
Doral, FL 33178
305-477-1133
Ft. LAuDerDALe, FL
3079 E. Commercial Blvd., 1st fl.
Fort Lauderdale, FL 33308
954-776-0620
415 SE 12th St.
Fort Lauderdale, FL 33316
954-760-7836
HALLAnDALe, FL
2100 E. Hallandale Bch Blvd., #405
Hallandale, FL 33009
954-454-0544
HiALeAH, FL
7100 West 20th Ave., #404
Hialeah, FL 33016
305-558-1417
7100 West 20th Ave., #608
Hialeah, FL 33016
305-557-4016
777 East 25 St., #320
Hialeah, FL 33013
305-836-2044
HoLLywooD, FL
4700SheridanSt.,SuiteK
Hollywood, FL 33021
954-966-7000
3800 Johnson St., Suite A,
Hollywood, FL 33021
954-961-8153
HomesteAD, FL
925 N.E. 30th Terrace, #214
Homestead, FL 33030
305-245-5881
JuPiter, FL
500 University Blvd. #208
Jupiter, FL 33458
561-624-5311
kenDALL, FL
8940N.KendallDr.,#504E
Miami, FL 33176
305-595-6200
9275 SW 152nd St., #212
Miami, FL 33157
305-255-5995
15955 SW 96th St. #303
Miami, FL 33196
305-380-6773
LAuDerDALe LAkes, FL
4850 West Oakland Park Blvd., #102
Lauderdale Lakes, FL 33313
954-486-4180
LiGHtHouse Point, FL
3126 N. Federal Highway
Lighthouse Point, FL 33064
954-785-0900
mArGAte, FL
5800 Colonial Dr., #105
Margate, FL 33063
954-974-4890
miAmi, FL
1350 SW 57 Ave., #210
Miami, FL 33144
305-441-0744
11760 SW 40th St., #743
Miami, FL 33175
305-225-5774
1444 Biscayne Blvd., #214
Miami, FL 33132
786-456-8800
13101 S. Dixie Highway, #310
Miami, FL 33156
305-666-2722
1330 Coral Way, #403
Miami, FL 33145
305-325-0090
miAmi BeAcH, FL
4302 Alton Rd., #115
Miami Beach, FL 33140
305-667-4515
nortH miAmi, FL
1190 NW 95 St., #200
Miami, FL 33150
305-691-2550
1801 NE 123rd St., #315
North Miami, FL 33181
786-507-4151
PemBroke Pines, FL
601 N. Flamingo Rd., #106
Pembroke Pines, FL 33028
954-432-6620
954-431-8281
17913 NW 7 St., #102
Pembroke Pines, FL 33029
954-438-4380
500 N Hiatus Rd., #101
Pembroke Pines, FL 33026
954-438-7171
18501 Pines Blvd., #210
Pembroke Pines, FL 33029
954-237-2505
601 N. Flamingo Rd., #210
Pembroke Pines, FL 33028
954-438-1015
PomPAno BeAcH, FL
601 E. Sample Rd., #105
Pompano Beach, FL 33064
954-773-2383
weston, FL
17190 Royal Palm Blvd., #3
Weston, FL 33326
954-486-4180
2500 Weston Rd., #103
Weston, FL 33331
954-389-1414
SFENTA locationsmore info at sfenta.com
page 5
ArieL GroBmAn, m.D.:Dr.ArielGrobmanis an Otolaryngologist and South Florida native.HegraduatedCumLaudefromtheUniversity of Maryland Scholar’s Program earninghisB.S.inPsychology.Dr.Grobmanthen received his Medical Degree from
theUniversityOfMiamiMillerSchoolOfMedicine,wherehegraduatedinthetopofhisclass.HewasthenacceptedintotheUniversity of Miami/Jackson Memorial Hospital-Department of Otolaryngology where he completed his internship and residencytraining.
WhileinresidencyDr.Grobmanreceivedextensivetraining inallaspectsofOtolaryngologyfromworldrenownedfaculty. He learned advanced techniques in surgery of the ear and skullbase,advancedairwaymanagement,endoscopicmanagementofsinonasaldisorders,facialplasticsurgery,aswellasthemedicalandsurgicaltreatmentofheadandneckdiseases.Inaddition,heconductedclinicalandbasicscienceresearch,producednumerouspublicationsinpeer-reviewedjournals,andpresentedhisworkatmultiplenationalscientificmeetings.Dr.Grobmanwaselectedastheheadofresidentresearchduringhischiefresidentyear.
Dr.Grobmanhascompletedadvancedcoursesinsurgeryofthetemporalboneandcochlearimplantation,endoscopicsinussurgeryandfacialplasticsurgery.
Dr.GrobmanisfluentinEnglish,SpanishandHebrewand treatsadultsandchildrenforawidevarietyofear,noseand throatconditions.
Areas of expertise: • Hearingloss• Vertigoandvestibulardisorders• PrimaryandRevisionEndoscopicSinusSurgery• MinimallyInvasiveBalloonSinuplasty• NasalAirwayObstruction• AllergicConditions• ThyroidandParathyroidDisease• SalivaryGlandDisorders• BenignandMalignantHeadandNeckTumors• Disordersofthefacialnerve• Facialplasticsurgeryandscarrevision
XAvier veGA , m.D.:Dr.XavierVegagrewupinEcuador.Hereceivedhismedicaldegree from the Universidad San Francisco deQuitoin2003.Hethenpursuedaresearchfellowship at the prestigious CARIM institute inMaastricht,TheNetherlands.Heiscertified
bytheEducationalCommissionforForeignMedicalGraduates.Hecompleteda5yearACGMEaccreditedOtolaryngology–HeadandNeckSurgeryresidencyatSouthernIllinoisUniversity–SchoolofMedicineinSpringfield,IllinoiswhereheservedasChiefResidentduringhislastyearoftraining.Dr.Vegahaspresentedhis research work at national meetings and also has several publications.HeisBoardCertifiedbytheAmericanAcademyofOtolaryngology–HeadandNeckSurgery.
Dr.Vegamanagesandtreatsdisordersaffectingtheears,nose,throat,headandneck.Heenjoysworkingwithpatientsofallages.HeisfluentinbothEnglishandSpanish.
rAFAeL i. GArciA, m.D., F.A.c.s.: Dr.RafaelI.GarciawasbornandraisedinPuertoRico.HegraduatedfromtheUniversityofPuertoRicoSchoolofMedicine,wherehe also completed his postgraduate training inOtolaryngology-HeadandneckSurgery.Shortlythereafter,hemovedtoBuffalo,
NY were he received his fellowship training in Head and Neck OncologicSurgeryfromRoswellParkCancerInstitute.Aftercompletinghistraining,Dr.GarciareturnedtoPuertoRico,wherehe was assistant professor of Otolaryngology-Head and Neck SurgeryattheUniversityofPuertoRico.In2002,herelocatedto ElPaso,Texastopracticehisspecialty.
Dr.GarciahasbeenboardcertifiedbytheAmericanBoardofOtolaryngologysince1994.Amongothers,heisafellowoftheAmericanCollegeofSurgeons,AmericanAcademyofOtolaryngology-HeadandNeckSurgery,andtheAmericanHeadandNeckSociety.Hepracticesallfieldsofthespecialtywithparticular interest in the management and treatment of head and neckcancer,thyroidandparathyroidconditions.
Dr.GarciaisfluentinEnglishandSpanish.
Meet Our New Physicians
page 6page 6
byMarissaLand,Au.D.,CCC-A,FAAA MarkT.Agrama,M.D.
Foroneinfivepeople,tinnitus (or ‘ringing in the ears’) can have a substantial impact on their quality oflife.Fromanxietytosleepdisturbance,theeffectsoftinnitus can reach into every aspect of your well-being.Ifanyofthisdescribeswhatyouareexperiencing,wemaybeabletohelpwithanew,cutting edgetechnology.
Tinnitus,whileperceivedintheear,actuallyoccursinthebrain.Whenthedelicatelittlehair cellsinsidethecochleaaredamagedorover–stimulated, theresultistinnitus.Todate,thereisnocureforthiscondition.Thenumberofpeopleaffectedisgrowingfastandstatisticsshowthatoneinfivepeoplesufferfromtinnitus.Tinnitus is also the leading “souvenir” that veterans retain fromservice.Althoughtinnitusisoftendescribedas‘ringingintheears’,the variety of sounds and combinations that people perceive areaswidespreadasthecondition.Theonsetandcauseisasvariedasthesoundspeoplehear.Regardlessofhowitbeganandwhatitsoundslike,tinnituscanrangefromabothersome
conditiontoadebilitatingone,impactingnotonlytheday–to–daylivesoftheindividualsaffected,buttheirfamiliesandlovedonesaswell.
ThisiswheretheLevoSystemcomesin.Throughaseriesofinteractiveactivities,theprecisesoundofyourtinnituswillbeidentified,givingyouthemeanstounderstandanddemonstratetoothersthesoundyoulivewith.Youruniquesoundisthenusedtocreateanindividualizedtherapyforyoutouseathomewhileyousleep.
Otoharmonics Levo System“From ‘I just have to live with it’ to ‘I have my life back’”
page 7
User-friendly,patentedLevosoftwareon a provided Apple iPod Touch will allowyoutolistentoyourpersonalizedsoundmatchathome.Customfitearbuds,designedtoensurecomfortduringsleep,allowforoptimalpositioning and controlled delivery of soundtherapy.Usednightly,youwillbeabletoshareyourindividualizedprogress and determine needed improvementsovertime.
Like ‘defragging’ a computer’s hard drive,thebrainefficientlyreorganizesitselfwhilewesleep.Selectivelyremoving the unnecessary bits of information,ourbrainprioritizesnewand stored information to lock in learningandmemory.Asaresult,newneuralconnectionsarecreated,reroutedorreducedtomakewayfornewlearningandproblemsolvingactivities.ByusingtheLevoSystematnight,patientsleveragethebrain’snaturalabilitytodiminishtheeffectsoftinnitusovertime.
Some patients have shown a 65% improvement in the impact ofthetinnitusontheirqualityoflife,whichishuge!Inthepast,healthcareproviderswouldessentiallysay,“there’snothing we can do for you” or “you just have to learn to live with it” and try to use other means and therapy to help tinnituspatientsmanage,butwiththeLevoSystem,wedon’thavetosaythatanymore.Thereisnowhopeforpatients
struggling with debilitating tinnitus who want to regain their qualityoflifeback,andwithLevo,wehopethiscanbejustthehelptheyneed.
MarissaLand,Au.D.,CCC-A,FAAABoard Certified in Audiology Levo System ProviderJupiter,Florida561-624-5311
MarkT.Agrama,M.D.Board Certified in Otolaryngology & Sleep MedicineJupiter,Florida561-624-5311
Group Benefit Concepts, Inc.
[email protected] Pines Blvd, Suite 220 • Pembroke Pines, Fl 33029
Office (954) 447-6900 • Fax (954) 272-7300
We are the benefits partners South Florida ENT Associates relies on for their group benefits.
We shop all the carriers for Group Health, Dental, Disability, LTC, Life, Retirement Plans, Supplemental
Benefits for you. We look for innovative products with a service driven approach, while keeping our
clients Health Care reform Compliant.
Bruce B. Chaskin, V.P. Group Insurance
Member FDIC citynational.com
Lending A HandCity National Bank is a full service commercial bank. We lent more than $3 billion last year.
– Medical Equipment Financing – Business Term Loans – Equipment/Inventory Financing – Accounts Receivable Lending – Capital Improvement Loans – Professional Lines of Credit – Owner-Occupied Commercial Mortgages – SBA Loans – Residential Mortgages* – Home Equity Lines of Credit*
Please visit any of our banking centers from Miami to Orlando or call us 305-577-7333.
* Loans are subject to credit and collateral approval.
0216-1 ENTad.indd 1 2/18/18 5:36 PM
page8
byRichardJ.Vivero,M.D.,F.A.C.S.
Hoarseness or voice change is a commonconditionthataffectsindividuals on a daily basis throughout theUnitedStates.Itcanrangeinseverity from a raspy or coarse voice tonovoiceatall.Acommoncause
islaryngitisorinflammationofthevocalfoldsrelatedtoanillness,whichresolveswithinonetotwoweeks.Incertaincases,hoarsenessmayberelatedtovocalfoldparalysisorimmobilityofthevocalfold,whichpreventsoneorbothofthevocalfoldsfromopeningorclosing.
Asinglenerve,therecurrentlaryngealnerve,controlsthevocalfold.Thenerverunsfromthebrain down each side of the neck and into the chestbeforereturningtothevoicebox.Ifthenerveisinjuredinanyway,thevocalfoldmaystopmoving.Commonexamplesincludesurgeriesoftheneckorchest,suchasthyroidectomy,lungsurgery,orheartsurgery.Tumors,includingthyroidnodulesorlungmassesamongothers,may also apply pressure or invade the nerve resultinginlossoffunction.Alternatively,thenervecanbeaffectedbyaninfection,suchasavirus,whichimpactsitsabilitytotransmitsignalstothevocalfold.Fortunately,viralinjuriesofthevocal fold can recover spontaneously at times resultinginnormalvoicing.
Vocal fold paralysis can present with varying degreesofsymptomseverity.Mildsymptomsmayincludesubtlechanges,suchaschangesinvoicepitchorloudness.Apersonmayappreciatethattheycannotyellacrossaroomorgettheattentionofcabonthestreet.Alternatively,thevoicemaysoundraspyorhighpitched.More severe symptoms can include severe breathiness or thesoundofairescapingwhentalking.Voicechangesmaybeaccompaniedbydifficultyswallowing,particularlyliquids,whichcanresultincoughingwheneating.
Hopeisnotlostifthevocalfoldstopsfunctioning.Therearevarious options to help rehabilitate the voice ranging from voicetherapytovarioussurgicalprocedures.Voicetherapy
is similar to physical therapy with exercises designed to help patientsregainnormalvoicefunction.Surgicalrehabilitationoptions include vocal fold injections and or placement of animplant.Vocalfoldinjectionsaredesignedtomovethevocal fold to the middle position to allow for full closure when talking.Itcanbeaccomplishedintheofficeoroperatingroomunderlocalanesthesiaorgeneralanesthesia.Thereareboth short term and long term injection options depending ontheneedsofthepatient.Longtermrehabilitationcanbeachieved via a permanent implant placed into the voicebox in theoperatingroom.Theobjectivewithalltreatmentoptionsistoregainnormalvoicing.
If you have a persisting hoarseness that lasts greater than 2weeks,youshouldobtainaconsultationwithaboard-certifiedEars,Nose,andThroat(ENT)surgeontoevaluateyourvocalfoldfunction.Laryngoscopy,avocalfoldexam,can be performed in-office to help identify the reason for the hoarseness.Atreatmentplancanthenbedevisedtohelpyoualongtheroadtorecovery.
RichardJ.Vivero,M.D.,F.A.C.S.Voice & Airway DisordersBoard Certified in OtolaryngologyMiami,Florida305-667-4515
When It’s Not Just a Frog in Your Throat
bySinaJoorabchi,D.O.,F.A.A.O.A.
Allergic and nonallergic rhinitis are estimatedtoaffectnearly60millionpeopleintheUnitedStates.Theseterms are used to describe conditions associated with arunnynose.
Therearemanydifferentcausesofthesedisorderssuchasallergies,chemicalirritants,foods,weatherchanges or strong odors to name afew.Theseconditionswerelargely treated with medications such as nasal sprays and oral antihistamines.Manypeoplewhoutilizethesemedicationsstillsufferfromthegeneralrunnynoseorpostnasaldrip,therebyultimatelyelectingforasurgicalfix.Thefavoredsurgery,PosteriorNasalNeurectomy(PNN),wasefficacious in its purpose but limited with its need for general anesthesia.Now,anofficebasedcryotherapyhasbecomereadily available to perform the PNN under local anesthesia withlittletonodiscomfort.TheClarifix,acryotherapydeviceutilizedtoperformtheprocedure,offersaquickfixforrunnynosewithnodowntimeorneedforgeneralanesthesia.Thereis no removal or cutting of tissue as the device is used to cryofreezetheregionoftheposteriornasalnervefor30-60secondspersideofthenasalcavity.Thoughgenerallywell
tolerated,somepatientswillreport an ice cream headache for a short moment after theprocedure.TheClarifixis
successful in four out of five patients and most of them see an improvement between 2 to 6 weeks after theprocedure.Overall,Clarifixoffersagreat,quickfixoptionforpatientswhosufferfromrunny nose and can eliminate the need for nasal medications alltogether.
SinaJoorabchi,D.O.,F.A.A.O.A.Board Certified in Otolaryngology & Facial Plastic SurgeryPembrokePines,Florida954-438-7171
page 9
Clarifix: An Office Based Solution for Runny Nose
WilliamJ.Brown,M.D.,F.A.C.S.
page10
BradfordD.Ress,M.D.
RichardCallari,M.D.AgustinArrieta,M.D.
PaulFoster,M.D.,F.A.C.S.
EdwardHillman,M.D.,F.A.C.S.
AlanChenHaoChu,M.D.
AdamWeisstuch,M.D. VijaykumarZaveri,M.D.JayYoung,M.D.
MarkAgrama,M.D.
TravisLewis,M.D.
AbrahamJaguan,M.D. SinaJoorabchi,D.O.,F.A.A.O.A.
DavidJassir,M.D. AndrewJohnson,M.D.
RolandoMolina,M.D.MoisesMitrani,M.D.,F.A.C.S.FelipeMartinez,M.D.,F.A.C.S. EamonMcLaughlin,M.D.
EugeneRivera,M.D. AndrewSchell,M.D.IgnacioRodriguez,M.D.AndrewRivera,M.D.
ScottGoldberg,M.D.,F.A.C.S. LawrenceGrobman,M.D.,F.A.C.S.ArielGrobman,M.D.
PeterVolsky,M.D.
RafaelI.Garcia,M.D.,F.A.C.S.
JonathanCooper,M.D.
page 11
CraigShapiro,D.O.,F.A.O.C.O.O.
AlbertoFernandez,M.D.,F.A.C.S.CarlDrucker,M.D.,F.A.C.S.
DanielMorse,M.D.,F.A.C.S.
BrianDougherty,M.D.,F.A.C.S.
HinaGupta,M.D. KendallL.Hanft,M.D.,F.A.C.S. SabineHesse,M.D.,F.A.C.S.JorgeHelo,M.D.
AnishParekh,M.D.MichaelOwens,M.D.,F.A.C.S. FranciscoPernas,M.D.KimMurray,M.D.
HoracioGroisman,M.D.,F.A.A.O.A.
StevenFletcher,M.D.,F.A.C.S.
MoisesKravecas,M.D. ToddA.Kupferman,M.D.,F.A.A.O.A.
FrankKronberg,M.D.,F.A.C.S. SherryLevine,M.D.PaulKleidermacher,M.D.,F.A.A.O.A.
JulioTorres,M.D.,F.A.C.S. RichardVivero,M.D.MarkSukenik,M.D. XavierVega,M.D.
minicAt, an in-office, point-of-care (Poc) computed tomography (ct) scanner, saves time for patients and ensures low dose exposure during diagnostic sinus and earscans.
WithoutMiniCAT,itcantakeupto3weeksforapatient to attend his or her first appointment andgetaCTscanfromaradiologist.Then,itcantake another 1-3 weeks to schedule a follow-up appointment and plan any necessary medical procedures.ByprovidingaMiniCATinfiveoftheirofficelocations,SouthFloridaENTAssociates conveniently reduces the number of appointments patients needtoschedule.
MiniCAT scans take anywhere from 10-30secondsandprovideresultsimmediately,enablingthedoctorto make a diagnosis and discuss treatment the day of the patient’s initialappointment.Patientsareseatedandawakeduringthescan,andtheopendesignoftheMiniCATprovidescomfort,speed,andease.
Patients sent for a CT sinus and ear scan might want reassurancethatthescannerkeepsradiationtoaminimum.Parents can become especially concerned when their child needsaCTscanofhisorherhead.MiniCATradiationdose
is approximately 11 times less than that of a conventional head CT1andabout1.45timeslessthanthatofonemonthofnaturally occurring background radiation1.
South Florida ENT Associates has earned accreditation
page 12
South Florida ENT Associates Delivers Quick Results and Ultra-Low Radiation Dose with MiniCAT
“By providing a MiniCAT in five of their office locations, South Florida ENT Associates conveniently reduces the number of appointments patients need to schedule.”
page 13
throughthenationallyrecognizedIntersocietalCommissionforAccreditation(IAC),guaranteeingqualityuseoftheMiniCAT.Thismedicalimagingcertificationandhealthcaremonitoringorganizationisdedicatedtoensuringqualitypatientcare.
South Florida ENT Associates has maintained highly skilled physicians,acompetentstaff,andadvancedtechnologiesformorethansixyears.MiniCATstandsapartfromitscompetitors,mostnotablyinofferinglower-doseprotocolsspecificallydesignedforsmallchildren.
South Florida ENT Associates has five convenient CT locationsinbothBrowardandMiami-Dadecounties.ToinquireorscheduleyourCTscanforyoursinusorear,contactanyofthebelowlocations.
• 4700SheridanStreet,SuiteK Hollywood,FL33021
Phone:(954)966-7000
• 8940N.KendallDrive,Suite504E Miami,FL33176
Phone:(305)595-6200
• 747PonceDeLeonBlvd.,Suite305 CoralGables,FL33134
Phone:(305)444-4903
• 2500WestonRoad,Suite103 Weston,FL33331
Phone:(954)389-1414 • 9915NW41stStreet,Suite220
Doral,FL33178 Phone:(305)477-1133
FormoreinformationaboutMiniCAT™CTscanners,producedbyXoranTechnologiessince2001,pleasevisit www.xorantech.com.
**MiniCATisatrademarkofXoranTechnologiesInc.allrightsreserved.
References:http://xorantech.com/RadiationDose1
Further Advances in the Treatment of Sinusitis
byFrankKronberg,M.D.
Over the years many advances have been made to make sinus surgery safer,lesspainfulandlessinvasive.Theadventofendoscopes,computerizedimage guided sinus surgery and balloon sinuplasty has enabled the ENT
surgeon to treat and cure patients with sinus disease with dramaticallyimprovedoutcomes.Newtechnologycontinuesinthisfield–includingtheuseofIntersectENT’sPROPEL,PROPELContourandSINUVAimplants.
About Chronic Sinusitis
Onein7adultsareaffectedby Chronic Sinusitis each year,makingitoneofthe most common heath conditions in the United States.Thesymptomsofsinusitis can feel like a never-ending cold and can include nasalandfacialcongestion,adecreasedsenseofsmellandoccasionallytaste,facialpainorpressure,andapersistentpostnasaldripandcough.Othersymptomsmayincludeadiscolorednasaldrainage,headaches,earcongestion,fatigue,depressionandinseverecases-visionloss,meningitisanddeath.
The sinuses are air-filled cavities located within the bones aroundthenoseandeyesthatallowforairflowanddrainage.Inchronicsinusitis,thesinusliningsbecomeswollen,preventingnaturaldrainageofthepathways,leadingtochronicinfectionsandnasalblockage.
One of our greatest obstacles in sinus surgery as ENTs has been dealing with obstruction of the sinuses and sinus openings(ostia).Theostiaandsinusescanbeblockedbythickenedmembranessecondarytoallergies,infection,polypsandanatomicalblockages.
Treatment of Chronic Sinusitis
Thetreatmentforchronicsinusitisincludes:antibiotics,nasal
steroidsprays,antihistamines,oralsteroids,decongestantsandasalastresort-surgery.Sinussurgeryisusedtoalleviatesymptoms related to chronic sinusitis when conservative managementfails.
During nasal and sinus surgery the ENT surgeon will enter the sinuses through the nostrils with the use of a scope,CTguidanceandballoonstoopentheblockedsinuspathwaysandcleanouttheinfection.Openingtheinflamedsinus pathways allows the sinuses to drain better and improvesairflow.
Whilesurgeryprovidesabenefittomanypatients,inflammationandscarringcantakeplace,eveninthefirst30days following surgery which diminishes the impact of the surgeryandcausesthesymptomstoreturn.
Advancements in Sinus Surgery
Over the past year the sinus surgeons at South Florida ENT have been using new technology which has been clinically proventoreduceinflammationandscarringinthesinuses–thePROPEL,PROPELContourandSINUVAimplants.
ThePROPELandSINUVAimplants,whichcontainMometasoneFuroate,abioabsorbablesteroid,aredrugeluting(releasing)stentsdevelopedbyIntersectENT. They are implanted after surgery to assist in treating
page14
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chronic rhinosinusitis and their purpose is to keep the sinus openings from scarring and to locally deliver a topical steroid tothesinusmucosa.Theimplantdeliverssteroidsovera 30dayperiod(orinthecaseofSINUVA–over90days)priortodissolving.
The PROPEL implant is a tiny coiled device that is inserted intoanopensurgicalcavity.Ithasa“spring-likedesign”whichconforms to the patient’s surgical anatomy and props open thesinuscavity.Onceithasbeenplaced,thestentexpandstokeepthesurgicalsiteopen,allowingthestenttoslowlyreleasethesteroidandtoreduceinflammationduringhealing.Thisresultsinmoreconsistentlyopensinusesandfasterhealing.
The PROPEL Contour is a dissolvable drug eluting sinus stent that is placed in the frontal sinuses (the sinuses in the forehead above the eyebrows) or the maxillary sinuses (the sinusesinthecheek–belowtheeyeandovertheupperteeth)immediately after surgery to keep the sinus ostia open and to preventtheopeningsfromclosingorscarring.ThePROPELContour incorporates an hourglass design that conforms to the sinus openings and delivers medication and mechanical supportwhereitisneededtooptimizesurgicaloutcomes.
The SINUVA implant is one of the latest advances in the treatment of sinus disease and nasal polyps and has been proven to shrink nasal polyps and reduce nasal obstruction andcongestion.SINUVAmaybeanalternativetosurgeryand other treatment options for adults who have already had ethmoidsinussurgery.PlacementoftheSINUVAimplantiscarriedoutinthedoctor’soffice.Afteranesthetizingtheinside the nose the SINUVA implant is placed in the ethmoid sinus area where there are polyps or other thickened mucosa withtheuseofthescope.Onceinplacetheimplantreleasesthe topical steroid to the surrounding tissue and decreases the swelling in the area and will shrink and in some cases completelyeliminatethepolypoidtissue.SINUVAofferssustained relief from nasal congestion and obstruction for upto90days.Inaddition,SINUVAhasalsobeenshowntoimproveapatient’simpairedsenseofsmell.
Ingeneral,withtheuseoftheseimplants,theincidenceof
sinusocclusionorrestenosisgoesdownby60%andtheneedforfurthersurgerygoesdownby75%toabout2%.At30daystheneedforpost-opinterventionwasdownby38%andtheneedfororalsteroidinterventionwasdownby56%.Theimplants have also been shown to decrease nasal polyposis by 46%anddecreasesignificantadhesionsby70%.
Insummary,throughtechnology,sinussurgeryhasbecomemuchsafer,lesstraumaticandhasagreatersuccessratethaninthepast.SouthFloridaENTAssociates’patientshavebenefited greatly from the most recent surgical and scientific advancesinsinusandnasalsurgery.Theyareabletobreathebetter,sleepbetterandhaveanimprovedqualityoflife.
FrankKronberg,M.D.Board Certified in OtolaryngologyMiami,Florida305-595-6200
“...through technology, sinus surgery has become much safer, less traumatic and has a greater success rate than in the past.
page 16
byRolandoMolina,M.D. MarkAgrama,M.D. EamonMcLaughlin,M.D.
The prevalence of obstructive sleep apnea (OSA) is increasing in theUnitedStates.OSAleadstoimpairedqualityoflife,decreasedproductivityatwork,motorvehicleaccidents,aswellasdisruptedsleepforbedpartners.Ifleftuntreated,patients are at an increased risk of cardiovasculardisease,hypertension,diabetes,carotidandaorticarterydisease,pulmonaryhypertension,depression,andall-causemortality.The disease is currently under-diagnosed in the United States and itisestimatedthatupto30%of males and 15% of females could beaffected.
CPAP (continuous positive airway pressure) continues to be first-linetherapyforsleepapnea.Whilethesemasksworkverywellforsomepatients,manyfindthemcumbersomeanddisruptivetouse.Theoverallcomplianceforthesedevicesislessthan50%.InspiretherapyisanFDA-approvedtherapyfor patients with moderate-to-severe OSA who are unable to useCPAP.
SouthFloridaENTAssociatesnowhassurgeonsofferingInspiretherapyinMiami-Dade,Broward,andPalmBeachcounties.Inspireisaminimallyinvasiveimplantedsystemthat delivers mild stimulation to keep a patient’s airway openduringsleep.Thesafetyandefficacyhavebeenwellstudiedinover50peer-reviewedpublicationsandover3,000patients.Recent5-yearoutcomesdatacontinuestodemonstrate the excellent results seen in the original STAR trial,publishedintheNewEnglandJournalofMedicineinJanuary2014.
Dr.RolandoMolinaseespatientsinSouthMiami,Dr.EamonMcLaughlinseespatientsinMiamiandHollywood,and Dr.MarkAgramaseespatientsinPalmBeachGardens.To
A Proven Alternative for Obstructive Sleep Apnea Patients Who Can’t Tolerate CPAP
Reduction in AHI (78%) with Inspire Therapy Reduction in Bed Partner Reported Snoring (88%) with Inspire Therapy
learnmorevisitwww.inspiresleep.comorcall786-410-4707(Dr.Molina),954-289-0954(Dr.McLaughlin),or561-203-3685(Dr.Agrama)toscheduleanappointmenttoday.
Woodson et al. Upper Airway Stimulation for Obstructive Sleep Apnea: 5- Year Outcomes. Otolaryngol Head Neck Surg. Mar 2018.
Boon et al. Upper Airway Stimulation for Obstructive Sleep Apnea: Results from the ADHERE Registry. Otolaryngol Head Neck Surg. Mar 2018.
RolandoMolina,M.D.Board Certified in OtolaryngologyMiami,Florida786-410-4707
MarkT.Agrama,M.D.Board Certified in Otolaryngology & Sleep MedicineJupiter,Florida561-203-3685
EamonMcLaughlin,M.D.Board Certified in OtolaryngologyHollywood,Florida954-289-0954
8181 NW 154th Street, Suite 200Miami Lakes, FL 33016
sfenta.com
Consists of 55 board certified ear, nose, and throat physicians located throughout Miami-Dade, Broward, and Palm Beach Counties. SFENTA’s physicians have been caring for patients for over 30 years and we are proud to bring you the best care for ENT conditions in South Florida.
page 17
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High Patient Satisfaction with Inspire Therapy
High Patient Adherence of Inspire Therapy
page18
SFENTA is Helping to Improve Nasal Breathing Without Altering Appearance
CarlDrucker,M.D.
Your breathing improved
Are you experiencing any of the following symptoms?
• Nasal congestion or stuffiness
• Nasal blockage or obstruction
• Trouble breathing through your nose
• Trouble sleeping
• Unable to get enough air through your nose during exercise or exertion
Ifso,youmaybeoneofmorethan20millionAmericanssufferingfromnasalobstruction.Thisconditionrestrictsairflowthroughthenoseandoftennegativelyimpactsone’squalityoflife.Symptomsincludenasalcongestion,laborednasalbreathing,challengesgettingenoughairthenosewhileexercising,andtroublesleeping.
One common cause of nasal obstruction is nasal valve collapse(NVC),whichoccurswhenthelateral(side)wallcollapseswhenapersoninhales.NVC,septaldeviationand turbinate hypertrophy are the common causes of obstructioninnasalandsinuspatients.Youcanself-testforNVCbyperformingtheCottlemaneuver.Ifyourbreathingsignificantly improves when you pull your cheek to hold your nostriltotheside,itislikelythatyouhavesignificantNVC.Untilrecently,NVCwassignificantlyundertreatedbecause
conventional options typically require cartilage grafting from thenose,earorribs,carryriskofchangingappearanceandarewereoftenunsuccessful.
SFENTA is among the first in theregiontooffertheLATERAabsorbable nasal implant to addressNVC.Theimplantsupports the cartilage in your nose which may reduce nasal obstruction symptoms and help youbreathebetter.
Clinical research shows that the LATERA implant delivers significant nasal obstruction symptom relief by targeting oneofthecommonsourcesoftheproblem.Patientswhoreceive the LATERA implant were satisfied with their breathing(86%)andappearance(93%)results.Byaddingthe
LATERAimplanttoourarmamentarium,wearenowabletocomprehensivelyaddressthecausesofnasalobstruction.Weprideourselvesinbeingamongthefirsttoofferthisnewtreatment to our patients and staying at the forefront of medicineandpatientcare.
CarlDrucker,M.D.Board Certified in OtolaryngologyMiami,Florida305-935-6000
“Clinical research shows that the LATERA implant delivers significant nasal obstruction symptom relief by targeting one of the common sources of the problem.”
page 19
byAdamWeisstuch,M.D.
Approximately10%oftheU.S.population reports having an allergic reactiontoapenicillinclassantibiotic.Most patients who report having the allergydonothaveatruedrugallergy.Infact,whentested,lessthan1%of
thepopulationistrulyallergic.Evenamongthosewhowereallergicaschildren,approximately80%losetheirsensitivityafter10years.
The majority of patients cannot recall a clear history of their allergy or report that their parents told them they wereallergic.Inadvertentover-reportingiscommonwherepatientsviewcommonsideeffectsasallergies,reactionstothe dyes in the liquid medications are reported or the patient had a viral infection that resulted in a rash but the reaction wasblamedontheantibiotic.Evenpatientswithtruehypersensitivities have demonstrated that most do not persist overtime.
The widespread reporting of penicillin allergy has created issues for patients and providers because less ideal antibioticsareoftenusedasalternatives.Thiscreatesissuesofresistance,suboptimaltreatments,increasedcostsforpatientsandothersideeffectsfromusingunnecessarybroadspectrummedications.
In this era of increased healthcare expenditure and with diseaseandillnessesdemonstratingincreaseddrugresistance,itismoreimportantthanevertominimizethecomplications
involvedwithpatientcareandprovideeasilyaccessible,optimal options for treating both simple and complicated diseases.Over-reportingofpenicillinallergyisabarrier to that but there is now a test that helps patients and their doctors clear the air and reintroduce preferred options forpatients.
Penicillin allergy testing is a simple skin test that can be done in an office that is adequately equipped for allergy testing.Itisperformedunderthesupervisionandguidanceofaqualifiedphysician.Thistestiscoveredbyallinsuranceplanswhenorderedontheappropriatepatient.Inouroffice,we are able to provide this service for patients in a safe environment so we can confirm their true allergy or prove that they do not have an allergy and can safely resume use ofpenicillinclassmedicationswhenindicated.Oncetheskintestisperformedandthepatientshowsnoreaction,weofferan oral challenge where the patient ingests penicillin in the office.Ifthepatienthasalocalorsystemicreactionfromtheskintestororalchallenge,thatistreatedbyourdoctorsin theoffice.Thepatientismonitoredintheofficethroughouttheprocess.
We encourage all of our patients with self-reported penicillin allergies to speak to their doctor about their candidacy for this testinordertohelpthemoptimizeboththeirshortandlong-termhealthcareneeds.
AdamWeisstuch,M.D.Board Certified in OtolaryngologyWeston,Florida954-389-1414
Penicillin Allergy Testing
CS262078
National Center for Emerging and Zoonotic Infectious Diseases
Division of Healthcare Quality Promotion
Is it Really a Penicillin Allergy?
Evaluation and Diagnosis of Penicillin Allergy for Healthcare Professionals
Did You Know? 5 Facts About Penicillin Allergy (Type 1, Immunoglobulin E (IgE)-mediated)1. Approximately 10% of all U.S. patients report having an allergic reaction to a penicillin class antibiotic in their past.
2. However, many patients who report penicillin allergies do not have true IgE-mediated reactions. When evaluated, fewer than
1% of the population are truly allergic to penicillins.1
3. Approximately 80% of patients with IgE-mediated penicillin allergy lose their sensitivity after 10 years.1
4. Broad-spectrum antibiotics are often used as an alternative to penicillins. The use of broad-spectrum antibiotics in patients
labeled “penicillin-allergic” is associated with higher healthcare costs, increased risk for antibiotic resistance, and suboptimal
antibiotic therapy.1
5. Correctly identifying those who are not actually penicillin-allergic can decrease unnecessary use of broad-spectrum antibiotics.1
10% of the population reports a penicillin allergy but <1% of the whole
population is truly allergic.
Before prescribing broad-spectrum antibiotics to a patient thought to be penicillin-allergic, evaluate the patient for
true penicillin allergy (IgE-mediated) by conducting a history and physical, and, when appropriate, a skin test and
challenge dose.
History and Physical ExaminationThe history and physical examination are important components
when evaluating a patient’s drug reactions.1
Questions to ask during the examination:
– What medication were you taking when the reaction occurred?
– What kind of reaction occurred?
– How long ago did the reaction occur?
– How was the reaction managed?
– What was the outcome?2
Characteristics of an IgE-mediated (Type 1) reaction:
– Reactions that occur immediately or usually within one hour1
– Hives: Multiple pink/red raised areas of skin that are intensely itchy3
– Angioedema: Localized edema without hives affecting the abdomen, face,
extremities, genitalia, oropharynx, or larynx4
– Wheezing and shortness of breath
– Anaphylaxis1 requires signs or symptoms in at least two of the following systems:
Skin: Hives, flushing, itching, and/or angioedema (continued on next page)
Broad-spectrum antibiotics are
often used as an alternative to
narrow-spectrum penicillins.
Using broad-spectrum antibiotics
can increase healthcare costs and
antibiotic resistance, and may
mean your patient receives less
than the best care.
Correctly identifying if your patient
is actually penicillin-allergic can
decrease these risks by reducing
unnecessary use of broad-
spectrum antibiotics.
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