An Update from the Rhinology and Skull Base Division

Innovations in Ear, Nose & Throat | Fall 2021

With a focus on strategic growth and innovative care delivery, the Rhinology and Skull Base Division within the University Hospitals Ear, Nose & Throat Institute continues to experience rising patient demand.

Kenneth Rodriguez, MD

Kenneth Rodriguez, MD, Chief of Rhinology and Skull Base Surgery at UH Cleveland Medical Center, shares key updates, including personalizing patient navigation, participating in novel research initiatives and expanding telehealth and regional care to Northeast Ohio communities.

Personalized Care Navigation

In her new role as UH Skull Base Surgery Coordinator, Jordan Kirkegaard, PA-C, is providing a single point of contact for patients undergoing surgery for lateral or anterior skull base lesions.

“These patients have a complicated pathway of care. Typically, for lesions around the pituitary gland that we address through the nose, they see ENT, neurosurgery, ophthalmology and endocrinology,” Dr. Rodriguez says. “The concept of having a dedicated person like Jordan is to ensure that there is always someone there for patients to reach directly to assist with questions or scheduling and escalate concerns as needed.”

With her advanced clinical knowledge and excellent communication skills, Kirkegaard has proven to be well-suited to helping patients cope with this care pathway. 

“My role is to create a seamless experience for patients, making sure that they have appointments and imaging scheduled in preparation for the day of surgery and following them at appropriate intervals post-operatively,” Kirkegaard says. “When you need complicated medical and surgical management, it can feel very overwhelming. We want to ensure that we’re helping patients navigate their diagnoses.”

Since joining the team in fall 2021, she is also seeing patients in clinic as part of the sinus team and will be providing outreach to local neurosurgeons, otolaryngologists and audiology groups. From a research perspective, Kirkegaard is coordinating monthly tumor board meetings and tracking patient outcomes in databases for future studies.

Novel Research Initiatives

• NIH Study of Dementia | Dr. Rodriguez is participating in a National Institutes of Health $5.5 million, five-year grant aimed at collecting biospecimens to measure alpha-synuclein, a protein marker for dementia with Lewy bodies and Parkinson’s disease dementia. He was recruited to the study by Steven Gunzler, MD, a neurologist at the University Hospitals Neurological Institute Parkinson’s and Movement Disorders Center.

“Olfactory mucosa and olfactory nerves may play a key role in the spread of Parkinson’s disease pathology from the peripheral tissues into the brain,” Dr. Gunzler says. “Preliminary data suggest that olfactory mucosa swabbing could help physicians measure misfolded alpha-synuclein to establish the diagnosis of Parkinson’s disease or dementia with Lewy bodies, or potentially measure cognitive and motor severity. The olfactory cleft is a unique place in your body where a cranial nerve is sitting on the surface, so we are able to collect specimen using swabs with minimal trauma.”

Additionally, tissue is obtained from skin punches and colon biopsies as other arms of the study.   

• Sinusitis Guidelines for Cystic Fibrosis | In collaboration with thought leaders around the country, Dr. Rodriguez contributed to a recently submitted article, “Cystic Fibrosis Otolaryngology Guidelines,” to the International Forum on Allergy and Rhinology. “My section dealt with sinusitis as it related to cystic fibrosis, and we explored the literature and provided recommendations based on the current data. Our hope is this will provide an up-to-date treatment pathway, as well as outline areas for further research in the future.”

• A recently completed project on angled nasal endoscopes was submitted for publication. The team studied whether complete maxillary sinus surgery could be performed with utilization of a 0-degree scope alone, versus a 70-degree scope.  “Our data demonstrated that, without utilization of an angled scope, complete sinus surgery could not be performed in the majority of individuals,” Dr. Rodriquez says.

• Data collection is under way to explore the frequency with which image guidance is utilized during sinus surgery. “We are highlighting the difference between the number of uses for an attending versus a resident, but also points that are considered to be critical: without image guidance, harm could have been caused because we would not have known that a critical structure lay on the other side,” Dr. Rodriquez says. 

Innovative Vasomotor Rhinitis Treatment

As patients age, they often develop excessive clear nasal drainage. “It becomes a quality-of-life burden for those who have to blot their nose constantly,” Dr. Rodriguez notes.

First-line treatment for the condition is medical therapy, but this requires consistent long-term utilization for continued benefit. In the past, the surgical option for excessive clear nasal drainage was a vidian neurectomy, but this can lead to postoperative dry eye, creating a new, potentially bothersome problem.

University Hospitals now offers ClariFix® cryotherapy, a safe, minimally invasive procedure that treats persistent clear nasal drainage. A device with a small balloon is placed within the nasal cavity over the nerve supply that causes the nose to run but not in a region that can affect tear production. An extremely cold liquid is then placed within the balloon, causing damage to the nerve supply, thereby decreasing nasal drainage. This procedure has proven to be robust for at least one year. This is a very safe and highly beneficial procedure to treat a very common issue that decreases quality of life.

Expanding Rhinology Care

As Medical Director of Telehealth for UH, Brian D’Anza, MD, an Otolaryngologist-Rhinologist in the UH Ear, Nose & Throat Institute, began working with senior leadership prior to the coronavirus pandemic to develop a unified telehealth program throughout the UH system.

“Having Dr. D’Anza in our department, we were fortunate that we were already doing virtual visits when COVID hit,” Dr. Rodriguez says. “What the pandemic did was force everyone to adapt quickly to virtual platforms, and Dr. D’Anza was instrumental in making this process as easy as could be expected.  Since then, virtual visits have become a valuable tool that both patients and providers are embracing.”

Additionally, practitioners are improving accessibility to advanced rhinology care by extending services into local communities.

• Courtney McAvinew, CNP joined our team last year and sees rhinology patients at University Hospitals Suburban Health Center, University Hospitals Minoff Health Center, University Hospitals Westlake Health Center and Akron ENT Associates.
• Nipun Chhabra, MD, continues to serve patients through St. John Westshore and the VA.
• Recently hired physicians, fellowship-trained in sinus surgery, are providing leading nasal care to rhinology patients throughout Northeast Ohio.
• • Akron: John Gerka Stuyt, MD
  • Parma: William Colby Brown, MD

“Positioning these top-notch providers strategically throughout the region is part of University Hospitals’ ongoing effort to care for people where they want to be seen,” Dr. Rodriguez says.

To reach the UH Ear, Nose & Throat Institute, call 216-868-8943.

Contributing Expert:
Kenneth Rodriguez, MD
Otolaryngology-Rhinology
Chief of Rhinology and Skull Base Surgery
University Hospitals Ear, Nose & Throat Institute
Assistant Professor
Case Western Reserve University School of Medicine