The complexities and nuances for successfully treating chronic sinusitis usually involves two medical specialists, an otolaryngologist-head and neck surgeon (also called an ENT) and an allergist/immunologist.

Patients with this condition usually see these two specialists in separate appointments.

Now USF Health is offering a merged clinic for patients with chronic sinusitis and related conditions where they will have one appointment with both an ENT and an allergist at the same time.

Farnaz Tabatabaian, MD, associate professor in the Department of Allergy and Immunology in the USF Health Morsani College of Medicine, and Mark Tabor, MD, associate professor in the Department of Otolaryngology Head and Neck Surgery in the USF Health Morsani College of Medicine, have combined their expertise and their clinics to form this new merged clinic.

The aim is to more effectively treat patients by being more efficient with the treatment plan, Dr. Tabatabaian said.

“We’re an academic institution so we see more complex conditions,” Dr. Tabatabaian said. “Bringing these two specialties into one clinic, one visit for the patient, makes incredible sense, not just for convenience but also for continuity of care and better outcomes. An ENT and an immunologist both in the room will better help meet the needs of patients experiencing the most complex sinusitis cases.”

Those with chronic sinusitis need the expertise of both an ENT and an allergist because they may need surgery to address the physical and structural problems, which the ENT will provide, and then also need allergy shots, antibiotics and, perhaps, biologics from the allergist to address the underlying immune and inflammatory response. Most patients will need both approaches but, as typically happens, the time between appointments allows the condition to return, causing patients to need further care and starting the cycle of treatments and procedures over again.

“Done separately, the condition isn’t fully treated, meaning patients may go back and forth with ENT and allergist appointments,” Dr. Tabor said. “The structural fix only lasts until the immune system flares up again and sinusitis returns, or the immune system is calmed and the barriers in the structure continue to limit and sinusitis returns. By addressing both structural and immune response at once, treating the two root causes together, patients will fare better for beating the return of sinusitis.”

“The therapies are available, but the collaborative environment in one clinical setting means we are offering precision medicine at its core,” Dr. Tabatabaian said. “Combining our clinics into one collaborative setting means we are taking great care of patients and also learning from each other as colleagues.”

The USF Health combined clinic is also a great educational opportunity for medical students, resident physicians and fellows. And for patients, the merged clinic also means greater access to clinical trials for new therapies.

Chronic rhinosinusitis is inflammation of the nasal and sinus linings, nasal blockage, rhinorrhea, facial pressure/pain and loss of sense of smell, and may include nasal polyps.

Patients seeking appointments at this new USF Health combined clinic will need to have a diagnosis of chronic sinusitis and have tried but not benefited from traditional therapies. Ask your physician about a referral to the clinic to see if your condition qualifies.

Otolaryngology is a mouthful to say, but as a medical specialty treating diseases and disorders of the ears, nose and throat, it’s a crucial one—and demand for its practitioners is growing along with the population in the Tampa Bay area.

In response, USF Health is expanding its Department of Otolaryngology-Head & Neck Surgery. Three otolaryngologists—commonly known as ear, nose and throat (ENT) doctors—have recently joined USF Health to contribute to that expansion. Each brings not only their own commitment to care but also their individual subspecialties to provide a wide variety of important services to patients.

Tapan Padhya, MD, chair of the Otolaryngology department.

“Their addition helps augment our research and surgical education efforts already ongoing within their respective subspecialties,” said Tapan Padhya, MD, professor and chair of the Otolaryngology department. “Our department is already recognized as a prominent academic ENT program in Florida and their addition and enthusiasm will only add to our regional and national reputation.”

Dr. Yaël Bensoussan is an attending laryngologist and an assistant professor in the Morsani College of Medicine. She has advanced expertise in voice, swallowing and upper airway evaluation and treatment.

Laryngologists are throat specialists who help patients with voice, swallowing and upper airway disorders. After Dr. Bensoussan finished her otolaryngology residency training in Canada at the University of Toronto, she completed additional years of training specializing in the throat at the University of Southern California in Los Angeles.

Dr. Bensoussan’s background also includes a degree in speech pathology and a prior career in music, which led her to her passion for voice and laryngeal disorders.

“I can tell when a singer has a problem,” Dr. Bensoussan said. When Dr. Bensoussan was younger, she was suddenly unable to sing because of nodules that had developed on her vocal cords. Working with a speech pathologist helped her regain her singing abilities, and the nodules disappeared with therapy.

Dr. Bensoussan has started the USF Health Voice Center, together with her speech pathology partner, Stephanie Watts, PhD, which provides services to people with voice, upper airway, and swallowing disorders and is the only academic voice center in the area.

“I’ve always had the dream to open a multidisciplinary voice center to make sure we all work together to provide the best care for patients,” Dr. Bensoussan said. “My goal is to introduce innovation within our center. To bring in new equipment so we can continue to provide expert care to our patients.”

Yael Bensoussan, MD, is a laryngologist that specializes in voice, airway and swallowing disorders involving the voice box and the throat.

The rapid growth of the Department of Otolaryngology-Head and Neck Surgery is what attracted Dr. Bensoussan to USF Health.

“It’s really exciting to hop on a wagon that’s going fast, right?” she said. “Clearly, this was one of the biggest growing departments. I can contribute to the growth, and that’s the exciting part of the job, for sure.”

Dr. Nickel is also trying to be as minimally invasive in his treatments as possible. He uses a robot with articulating arms and 4K cameras to remove cancerous tumors in two to three hours. Prior to the use of robots, the surgery to remove the tumors could take about 10 hours and leave considerable scarring.

“It’s amazing,” he said. “What that allows us to do is to minimize co-morbidities and maximize function while still treating the cancer.”

He continued, “In using robotics, we can give less radiation and chemotherapy on the back end, which helps patients mend tremendously.”

USF Health offers patients and doctors the latest in technology and equipment. “We’re very fortunate to practice here because we have state-of-the-art equipment,” Dr. Nickel said. “The robot we are using is the best available. We really have a team that understands this type of minimally invasive surgery.”

Sometimes a patient will lose his or her jaw because of cancer, and Dr. Nickel specializes in microvascular free tissue reconstruction. That involves taking muscles and bones from another part of the patient’s body, such as the arm or leg, and transposing it to the jaw. Using a microscope, Dr. Nickel then sews blood vessels back together. The new tissue allows the patient to restore form and function.

Christopher Nickel, MD, has clinical expertise is in treating cancers of the head and neck.

What bought Dr. Nickel, who did his residency training at USF Health, back?

“The growth here has been incredible,” he said. “The commitment at USF is really helping us take off and become a cutting-edge department.”

Dr. Lindsey Ryan is an assistant professor at the Morsani College of Medicine. She is a rhinologist, which focuses on treating diseases and conditions of the nasal cavity and sinuses—including chronic sinusitis, nasal polyps, allergic rhinitis, deviated nasal septum and sinonasal tumors.

Skull-based surgery is a specialty for Dr. Ryan. She can remove tumors from the nasal cavity and front of the brain using an endoscope, which is a minimally invasive technique.

“(The technique) gives patients the opportunity to potentially have everything done through the nose,” Dr. Ryan said. “There’s no external deformity; other people wouldn’t even know that you had surgery.”

Dr. Ryan also specializes in treating sinus polyps, which are benign growths on the lining of a nasal passage or the sinuses. About 30 percent of patients with chronic sinusitis, a long-lasting inflammation and infection of the sinuses, have sinus polyps. If medications fail, those patients will require endoscopic surgery.

Dr. Ryan did her residency training at USF Health before completing a fellowship training in rhinology and skull based surgery.

“I did my five years of residency training here, and so I’m really excited to come back and join with the faculty that trained me and made me the otolaryngologist that I am today,” she said. “I’m very excited about it.”

Dr. Ryan said she wants to reciprocate the residency education she received by educating other residents.

“I feel like I had excellent training here,” she said. “So, to be able to educate the next generation of otolaryngologist-head and neck surgeons is really important to me.”

Lindsey Ryan, MD, is a rhinologist. She focuses on treating diseases and conditions of the nasal cavity and sinuses.

Dr. Ryan is looking forward to working in an interprofessional environment to improve patient outcomes.

“That’s pretty unique actually to have the ability to provide multidisciplinary care for patients,” she said. “Being able to grow and expand—that’s our goal. And it’s definitely my goal.”

Allen Parent sees something beautiful in faded muscle cars. A 1965 Pontiac GTO is his current rehab project.

All that had to be put on hold when the retired machinist discovered a lump on the left side of his neck in late 2018.

Mr. Parent, of Brookville, Fla., was diagnosed with squamous cell mouth cancer, a head and neck cancer, and referred for treatment to Tapan Padhya, MD, USF Health department chair of Otolaryngology, and Matthew Mifsud, MD, a USF Health head and neck surgeon and otolaryngologist.

Allen Parent near his current rehab project, a 1965 GTO.   Photo by Allison Long | USF Health

About four percent of all cancer cases diagnosed in the United States each year involve the head and neck, according to the American Society of Clinical Oncology. This year, head and neck cancer will affect an estimated 66,630 people.

To treat Mr. Parent’s cancer, Dr. Mifsud had to remove parts of his left mouth and jaw. He reconstructed the jaw with muscle, bone and tissues taken from Mr. Parent’s right leg. The result left him with noticeable cosmetic deformities.

“There was a big lump (of tissue) hanging,” said Mr. Parent, adding, “you catch it in zippers.”

Allen Parent before his surgery with Julia Toman, MD. Photos courtesy of Dr. Toman

Mr. Parent after his surgery Dr. Toman. Photos courtesy of Dr. Toman

Dr. Mifsud said that while many cancers and their scars can be covered up with clothing, “You can’t hide cancers of the head and neck.”

To deal with the visible loose tissue, Dr. Mifsud recommended that Mr. Parent see Julia Toman, MD, a USF Health facial plastic surgeon, in 2020 after Mr. Parent had finished his cancer treatments. She was able to repair the loose tissue and make his face appear more symmetrical.

“To be able to do procedures that allow people to be seen on the outside the way they feel on the inside really affirms people’s quality of life,” Dr. Toman said.

“They both (Drs. Mifsud and Toman) did a great job and I am appreciative for everybody that was involved,” Mr. Parent said.

Allen Parent is grateful for his treatment by Drs. Mifsud and Toman. Photo by: Allison Long | USF Health

Now that his more than two-year-journey with cancer is completed, Mr. Parent is planning trips on his beloved Harley Davidson.

“If you have cancer, it’s not the end of the world,” said Mr. Parent, 69. “The best thing to do is just look at the positive side of things cause, there’s always a brighter day ahead.”

Watch the video above to learn more about Mr. Parent’s journey.

Dr. Matthew Mifsud

Dr. Julia Toman

         –Study results published in recent New England Journal of Medicine-

A recent New England Journal of Medicine article reporting that upper airway stimulation reduces the severity of obstructive sleep apnea included the USF Health Morsani College of Medicine as a site in the international clinical study.

Tapan Padhya, MD, professor and director of the Division of Head and Neck Oncology and co-director of the multidisciplinary USF ENT Sleep and Snoring Clinic, was one of the investigators for the trial conducted at 22 leading medical centers across the United States and Europe.

Dr. Padhya led the USF arm of the Stimulation Therapy for Apnea Reduction (STAR) Trial at Tampa General Hospital, and was among the authors of the study results published Jan. 9 in the NEJM.

Tapan Padhya, M.D, led the USF-TGH arm of the international sleep apnea stimulation therapy study.

The researchers tested an implantable device delivering mild electronic stimulation to the upper airway during sleep to prevent the tongue from collapsing and obstructing the airway.  The Inspire Upper Airway Stimulation device was implanted in patients who were unable to accept or adhere to sleep apnea treatment with a bedside machine known as CPAP, which provides continuous positive airway pressure to keep upper airways open.

The alternative therapy worked well in reducing interruptions in sleep, alleviating the symptoms of obstructive sleep apnea including snoring and daytime drowsiness, and improving quality of life.

While several options – including a various upper airway surgeries and custom-made removable oral appliances – area available for treating sleep apnea, CPAP has been the gold standard treatment for people with moderate to severe sleep apnea.  But, its effectiveness depends on patient compliance, and some people have trouble adjusting to sleeping with system’s face mask and head strap, so adherence to the regimen can be poor.

“CPAP is still the gold standard,” Dr. Padhya said, “but this (implantable device) technology is an extremely effective treatment option for a broad swath of patients who are unable to use or won’t tolerate the mask.”

The technology for the Inspire  implant is similar to that used in cardiac pacemakers.  The system is designed to be permanent with a change of the stimulator’s battery every seven to nine years.

The study published in NEJM “definitely addresses a sweet spot for research to benefit the undertreated sleep apnea population,” said Dr. Padhya, adding that USF was one of the top sites in the country for recruiting study participants.

“Our participation in a study at this level highlights the value of the academic partnership between USF Health and TGH in collaborating to address important research questions with applications for advances in patient care.”

More than 18 million Americans suffer from obstructive sleep apnea, characterized by repeat episodes of upper airway collapse during sleep in which patients frequently stop breathing for a minute or longer.  The sleep disorder can lead to daytime sleepiness, depression, weight gain, industrial accidents, reduced productivity and diminished quality of life.

Dr. Tapan Padhya, right, and Dr. David Smith, chair of the USF Health Morsani College of Medicine’s Department of Surgery, operate on a patient with obstructive sleep apnea.