New Focus on the Head and Neck
Treatments in these ares - including surgery for cancer - require special precision and finesse.
YOU’D THINK AMERICA’S OLDEST MEDICAL SPECIALTY WOULD HAVE A simple name. But ear, nose and throat doctors, as they are commonly known, call their field otolaryngology—pronounced oh-toe-LAIR-in-GOL-oh-gee. Otolaryngologists are physicians who are specially trained to manage and treat patients with diseases and disorders of the ear, nose, throat and related structures of the head and neck. If this specialty is the nation’s oldest—as the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) says—it’s also the newest department established at Saint Barnabas Medical Center. Jean Anderson Eloy, M.D., was named chair of Otolaryngology–Head and Neck Surgery in May 2017. He has been practicing with Saint Barnabas for about a year and a half.
“I have always been intrigued by the complex anatomy of the head and neck, and the intricate details involved,” Dr. Eloy says. “I also like that the surgery we perform can make significant improvements in the quality of one’s life.”
That’s because these diseases affect our key senses and our ability to communicate. Otolaryngologists are trained in both the medical and surgical treatment of hearing loss, ear infections, balance disorders, ear noise (tinnitus), some cranial nerve disorders and congenital disorders of the outer and inner ear. About 35 million people develop chronic sinusitis each year, making it one of the most common health complaints. Treating nasal cavity and sinus issues is one of the primary skills of otolaryngologists. These specialists also treat diseases of the throat, larynx (voice box) and the upper esophagus, including voice and swallowing disorders. These issues can affect speaking, singing, eating and the sense of smell.
The head and neck also house functions associated with sight and the cosmetic appearance of the face. Otolaryngologists are trained to treat infections, benign (noncancerous) and malignant (cancerous) tumors and facial trauma and deformities of the face, and they perform both cosmetic plastic and reconstructive surgery.
Dr. Eloy, a native of Haiti, studied medicine at Rutgers New Jersey Medical School with a fellowship at the University of Miami’s Jackson Memorial Hospital. He is currently a professor and vice chair of Otolaryngology—Head and Neck Surgery at Rutgers New Jersey Medical School, and serves as director of Rhinology and Sinus Surgery, director of Otolaryngology Research and co-director of the Endoscopic Skull-Base Surgery Program.
THE HEAD AND NECK: WHAT SURGERY CAN DO
Otolaryngologists (ear, nose and throat specialists) can perform both cosmetic plastic surgery and reconstructive surgery on structures of the nose, ears, mouth, throat and face. They also operate on both benign (noncancerous) and malignant (cancerous) tumors in the thyroid, parathyroid, mouth, voice box and upper esophagus. Even the nose.
“There are a number of nasal cancers, including squamous cell carcinomas, mature B-cell non-Hodgkin’s lymphomas, adenocarcinomas and melanomas,” says Jean Anderson Eloy, M.D., chair of Otolaryngology–Head and Neck Surgery at Saint Barnabas Medical Center.
Because of the locations of these cancers in the head and neck, surgeons must work with extreme precision not to disrupt the senses they control—hearing, smell, taste and sight—or damage critical nerves and blood vessels nearby. “During sinus or skull surgery, you often deal with tumors that are just millimeters from important structures such as the carotid artery and the brain,” says Dr. Eloy.
Depending on where a tumor is, head and neck surgeons sometimes use image guidance to help locate the area in which they want to operate. They may take a computed tomography (CT) scan before surgery and superimpose the image onto the patient’s skull. “We use it like GPS to show us exactly where we are in the surgery,” says the doctor.
Endoscopic skull-base surgery is a minimally invasive technique that uses the skull’s natural openings—the nose, the mouth and the area above the eyes—as a pathway through which to locate and treat lesions, often those found on the underside of the brain, sparing the need for a surgical opening of the skull (craniotomy). An ear, nose and throat surgeon makes a small opening inside the nose to allow a neurosurgeon to remove a growth through an endoscope, a thin, lighted tube. A magnetic resonance imaging (MRI) scan may be performed by a radiologist after the surgery to confirm that all necessary tissue has been removed. In some institutions, the MRI can be done during the surgery if an intraoperative MRI is available.
Dr. Eloy treats cancer of the head and neck area, including sinus cancer, which is rare and extremely difficult to operate on because of the location. “Often those cancers go into the brain,” he says, and the doctor must balance the need to remove all malignant tissue against the need to spare nearby areas that control vision and smell. This surgery requires a multidisciplinary approach, with oncologists, ophthalmologists and other specialists as part of the treatment team. Says Dr. Eloy: “This is to provide the best chance not just of survival but also of unimpaired quality of life.”
TREATING SINUS WOES
Chronic sinusitis is thought to affect about 16 percent of the population. Also known as chronic rhinosinusitis, it is diagnosed when the cavities around nasal passages (sinuses) become inflamed and swollen for at least 12 weeks, despite treatment. It can interfere with mucus drainage and make breathing through the nose difficult. It also leads to swelling, pain and tenderness around the eyes and face. Causes include infections, allergies, structural issues, growths in the sinuses called nasal polyps or a deviated nasal septum. In some rare cases, the infection can spread into the brain and be fatal.
“Chronic sinus disease is a huge health burden in the U.S. population,” says Jean Anderson Eloy, M.D., chair of Otolaryngology–Head and Neck Surgery at Saint Barnabas Medical Center. “It decreases quality of life and work productivity and has a high association with depression. This is a deadlier disease than most people think.”
Sometimes medication, in the form of steroidal nasal sprays or allergy treatments, can alleviate sinusitis. When it doesn’t, surgery can open the blockage. “Surgery is not a definitive treatment, though,” says Dr. Eloy. “It allows patients to manage the condition with medication afterward.” Nearly all sinus surgery is done on an outpatient basis.
Surgery can also correct a deviated septum and reshape other internal structures to make breathing easier and reduce the risk of sinus infection. These procedures too are almost always done as outpatient surgery.