Video 2020: Mark Shikowitz, MD, MBA

Press Release: Dr. Mark Jay Shikowitz

Get to know Otolaryngologist Dr. Mark J. Shikowitz, who serves patients in New Hyde Park, New York. 

Dr. Shikowitz is a board-certified otolaryngologist who sees patients for a variety of surgical issues associated with the ear, norse & throat, as well as the head and neck. He also takes a special interest in pediatric otolaryngology, and treats adults and adolescents alike. Dr. Shikowitz holds several titles, including Director of The Zucker Sinus Center of Otolaryngology and Communicative Disorders at Long Island Jewish Medical Center and Vice Chairman of Otolaryngology and Communicative Disorders at Long Island Jewish Medical Center, as well as Vice Chairman of Otolaryngology and Communicative Disorders at North Shore University Hospital. Long Island Jewish Medical Center is one of the cornerstones of Northwell Health, providing the full spectrum of clinical healthcare services for patients of all ages. North Shore University Hospital is also a part of Northwell Health, offering care in all medical and surgical specialties, including cardiovascular services, cancer care, orthopedics, maternal-fetal medicine, and women’s health services.

FindATopDoc Profile: Mark Shikowitz, MD, MBA

Mark Shikowitz, MD, MBA, started on his professional journey in 1981 when he obtained his Medical Degree from the The University of Dominica School of Medicine in Roseau, Dominica. He continued to expand his knowledge with his internship in General Surgery at Maimonides Medical Center in Brooklyn, New York, his residency in Otolaryngology at Long Island Jewish Medical Center and his residency in head and neck surgery at New Hyde Park. Dr. Mark Shikowitz is also board certified in otolaryngology, facial cosmetic surgery, and head and neck surgery. Dr. Mark Shikowitz also secured memberships with several respected societies and groups pertaining to his profession, including the American Medical Association, the New York Academy of Sciences, the American Academy of Otolaryngology, the Society for Ear, Nose and Throat Advances in Children, the Long Island Society of Otolaryngology of Head and Neck Surgery, the Association for Research in Otolaryngology, and the American Broncho-Esophagological Association. He attributes his success to his hard work and innovative surgery and procedures while he is actively involved in medical missions around the world. For more information about Dr. Mark Shikowitz, please visit https://www.findatopdoc.com/doctor/8125581-Mark-Shikowitz-Ear-Nose-and-Throat-Doctor-ENT.

Mark Shikowitz, MD

Mark Shikowitz, MD, MBA, is a leading expert in otolaryngology with more than three decades of practice in his field. In his current capacity as Otolaryngologist with Northwell HealthSystem, which he joined in 1986, he reveals extraordinary expertise in sinus surgery, facial cosmetic surgery, head and neck surgery, pituitary tumor surgery, balloon sinuplasty, and endoscopic skull based surgery. Dr. Shikowitz is the Director of the The Zucker Sinus Center of Otolaryngology – Head and Neck Surgery at Long Island Jewish Medical Center and Vice Chairman of Otolaryngology – Head and Neck Surgery at Long Island Jewish Medical Center and North Shore University Hospital. To complement his clinical functions, Dr. Mark Shikowitz is also a Professor of Otolaryngology at Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. With his work revered around the globe, he is also actively involved in speaking engagements in Australia and Europe, where he travels annually to lecture on sinus surgery at Bristol University in England. Furthermore, Dr. Mark Shikowitz is the author of “Speech and swallowing rehabilitation following devastating caustic ingestion: techniques and indicators for success”. In addition to his coursework, Dr. Mark Shikowitz also completed post-doctoral research on the human papillomavirus and subsequent tumors at the National Institute of Health in Maryland. For more information about Dr. Mark Shikowitz, please visit https://www.northwell.edu/find-care/find-a-doctor/otolaryngology/dr-mark-jay-shikowitz-md-mba-11315410.

 

My Video

Researchers transplant regenerated oesophagus

Tissue engineering has been used to construct natural oesophagi, which in combination with bone marrow stem cellshave been safely and effectively transplanted in rats. The study, published in Nature Communications, shows that the transplanted organs remain patent and display regeneration of nerves, muscles, epithelial cells and blood vessels.

The new method has been developed by researchers at Karolinska Institutet in Sweden, within an international collaboration lead by Professor Paolo Macchiarini. The technique to grow human tissues and organs, so called tissue engineering, has been employed so far to produce urinary bladder, trachea and blood vessels, which have also been used clinically. However, despite several attempts, it has been proven difficult to grow tissue to replace a damaged oesophagus.

In this new study, the researchers created the bioengineered organs by using oesophagi from rats and removing all the cells. With the cells gone, a scaffold remains in which the structure as well as mechanical and chemical properties of the organ are preserved. The produced scaffolds were then reseeded with cells from the bone marrow. The adhering cells have low immunogenicity which minimizes the risk of immune reaction and graft rejection and also eliminates the need for immunosuppressive drugs. The cells adhered to the biological scaffold and started to show organ-specific characteristics within three weeks.

The cultured tissues were used to replace segments of the oesophagus in rats. All rats survived and after two weeks the researchers found indications of the major components in the regenerated graft: epithelium, muscle cells, blood vessels and nerves.

“We believe that these very promising findings represent major advances towards the clinical translation of tissue engineered esophagi”, says Paolo Macchiarini, Director of Advanced center for translational regenerative medicine (ACTREM) at Karolinska Institutet.

Tissue engineered organs could improve survival and quality of life for the hundreds of thousands of patients yearly diagnosed with oesophageal disorders such as cancer, congenital anomalies or trauma. Today the patients’ own intestine or stomach is used for esophageal replacements, but satisfactory function rarely achieved. Cultured tissue might eliminate this current need and likely improve surgery-related mortality, morbidity and functional outcome.

The current study was conducted in collaboration with the Texas Heart Institute in the U.S., as well as universities in Italy, Russia, and Germany. It was supported financially by, among others, the Swedish Research Council, the Stockholm County Council through the ALF agreement, and the European Union’s Seventh Framework Programme. The equipment used in the study was developed by the company Harvard Apparatus Regenerative Technology.

Picture courtesy of www.sciencedaily.com

http://www.medicalnewstoday.com/releases/275511.php

Hearing loss affects old people’s personality

As people approach old age, they generally become less outgoing. New research from the University of Gothenburg shows that this change in personality is amplified among people with impaired hearing. The findings emphasise the importance of acknowledging and treating hearing loss in the elderly population.

The researchers studied 400 individuals 80-98 years old over a six-year period. Every two years, the subjects were assessed in terms of physical and mental measures as well as personality aspects such as extraversion, which reflects the inclination to be outgoing, and emotional stability. The results show that even if the emotional stability remained constant over the period, the participants became less outgoing.

Interestingly, the researchers were not able to connect the observed changes to physical and cognitive impairments or to age-related difficulties finding social activities. The only factor that could be linked to reduced extraversion was hearing loss.

‘To our knowledge, this is the first time a link between hearing and personality changes has been established in longitudinal studies. Surprisingly, we did not find that declining overall health and functional capacity make people less outgoing. But hearing loss directly affects the quality of social situations. If the perceived quality of social interaction goes down, it may eventually affect whether and how we relate to others,’ says Anne Ingeborg Berg, PhD, licensed psychologist and researcher at the Department of Psychology, University of Gothenburg.

The study yields interesting knowledge about personality development late in life, and also points to the importance of acknowledging and treating hearing loss among the elderly.

The utilisation of hearing aids did not affect the correlation found, which suggests that there is a need for support in the use of aids such as hearing devices.

‘Our previous studies have shown that outgoing individuals are happier with their lives. It is hypothesised that an outgoing personality reflects a positive approach to life, but it also probably shows how important it is for most people to share both joy and sadness with others. Even if we can’t conclude anything about causal relationships, we can guess that the link between hearing loss and social withdrawal forms a potential threat to older people’s wellbeing,’ says Berg.

The study, conducted by Anne Ingeborg Berg and Boo Johansson from the ADA – Gero Group, Department of Psychology, University of Gothenburg, was published in Journal of Personality.

http://www.medicalnewstoday.com/releases/274847.php

Picture courtesy of www.dailymail.co.uk

 

Patients Blame H&N Therapy for Lasting Speech Issues

SCOTTSDALE, Ariz. — Patients with oropharyngeal cancer reported significant voice and speech impairment for up to 2 years after chemoradiation therapy, but most of their doctors saw no evidence of it, data from a prospective study showed.

Two years after treatment, a fourth of patients said their voice and speech remained below baseline levels, whereas none of their clinicians noted any impairment. At no time did as many as 10% of clinicians report patients with speech and voice issues, whereas the proportion of patients reporting problems ranged as high as 56%.

The likelihood of patient-reported difficulties with oral communication increased with the radiation dose to the glottic larynx, reported Jeffrey M. Vainshtein, MD, and colleagues at theMultidisciplinary Head and Neck Cancer Symposium.

“Our findings highlight the critical role of patient-reported outcomes in identifying areas of improvement of our current therapies, which may ultimately translate into improvements in quality of life for our patients,” Vainshtein, of the University of Michigan in Ann Arbor, said during a press briefing.

Dysphagia and xerostomia are recognized adverse effects of chemoradiation for head and neck cancer and have been studied extensively in recent years. In contrast, a paucity of information exists relative to the effects of chemoradiation on voice and speech quality, Vainshtein said.

To examine the issue, investigators assessed voice and speech outcomes in 93 patients who underwent chemoradiation for oropharyngeal cancer, using intensity-modulated radiation therapy (IMRT). At baseline, and then every 3 to 6 months after finishing treatment, patients completed two validated questionnaires: Head and Neck Quality of Life (HNQOL) and University of Washington Quality of Life (UWQOL).

At the same intervals, the patients’ physicians reported their assessments in accordance with the Common Terminology Criteria for Adverse Events.

All of the patients had locally advanced stage III/IV oropharyngeal cancer and received treatment in two clinical trials of organ-sparing IMRT. Radiation therapy protocols were designed to minimize the radiation dose to the pharyngeal constrictors, salivary glands, oral cavity, glottic larynx, supraglottic larynx, and esophagus.

Vainshtein and colleagues analyzed patient questionnaires to identify factors associated with voice and speech impairment, in addition to the frequency of impairment.

By the HNQOL communication domain and speech impairment domain of the UWQOL, radiotherapy-induced speech impairment reached a maximum in the first month after treatment. Impairment then decreased in subsequent assessments, stabilizing at 12 to 18 months.

The proportion of patients reporting post-treatment speech and voice impairment followed a time pattern consistent with speech impairment reflected in answers to the questionnaires. By the HNQOL, 68% of patients said their voice and speech quality were impaired versus baseline, decreasing to 56% at 3 months, 46% at 6 months, 33% at 12 months, 31% at 18 months, and 24% at 24 months.

By the UWQOL, the proportion of patients reporting worsening of voice and speech quality after treatment was 41%, 26%, 29%, 28%, 15%, and 22% at the assessments from 1 to 24 months after finishing therapy.

In contrast, few physicians included voice and speech impairment in their adverse event reports. Vainshtein said 7% of physicians reported grade 1 toxicity with respect to worsening of voice and speech at 3 months, 5% at 6 months, and 0% thereafter.

Comparing treatment characteristics and patient-reported voice quality worsening, investigators found an association between radiation dose to the larynx and patient-reported impairment at 6 and 12 months. Reported impairment at 6 months increased from 25% with a cumulative radiation dose of <20 Gy to 59% at >30-40 Gy, 50% at 40-50 Gy, and 64% with laryngeal doses >50 Gy (P=0.02).

A similar pattern emerged from the analysis of 12-month outcomes, as the proportion of patients reporting worsening of voice quality from baseline increased from 10% for laryngeal radiation doses <20 Gy to 63% of patients for cumulative doses >50 Gy (P=0.011).

“We observed similar findings for patient-reported voice quality worsening and speech impairment,” Vainshtein said. “The results were independent of other patient and treatment factors.”

Press briefing moderator Mitchell Machtay, MD, said he found the study eye opening.

“If you looked at radiation dose to larynx, not the area where the tumor was, I was struck by how doses of 20 to 30 Gy, which we don’t normally consider as very toxic high doses that can damage the voicebox, still caused a fair amount of damage,” said Machtay, of University Hospitals Case Medical Center in Cleveland.

The magnitude of disconnect between patient and physician assessments was one of the more surprising findings in the study.

“I don’t think it’s unique to head and neck cancer. I don’t think it’s unique to our study. I don’t think it’s unique to medicine,” Vainshtein said. “I think physicians tend to underestimate the effect of their treatment — whatever it is — on our patients.”

Some adverse effects can be subtle and do not become apparent during conversations with physicians, he continued. When the patients express their sentiments in a more formal manner, such as a questionnaire, the effects do emerge.

Some of the disconnect reflects differences in patients’ approaches to their illness and adverse effects of treatment, said Wade Thorstad, MD, of Washington University in St. Louis.

“There’s a group of patients, when you’re interviewing them about their symptoms, will tell it like it is and really explain things well,” said Thorstad, another participant in the press briefing. “There’s another group that is stoic, and they really underplay their issues before [their physician]. However, when they are filling out a questionnaire about their feelings about quality of life, I think you get a more honest assessment.”

Vainshtein and co-authors reported no relevant relationships with industry.

http://www.medpagetoday.com/MeetingCoverage/MHNCS/44439

 

 

After rhinoplasty, patients perceive differences in voice quality, but not in function

Patients who have undergone plastic surgery to change the appearance of their nose may also notice changes in the sound of their voice, reports a study in the February issue ofPlastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Changes in voice after rhinoplasty are perceptible to patients as well as to experts, but generally don’t cause problems with speech function, according to the new research by Dr. Kamran Khazaeni and colleagues of Mashhad University of Medical Sciences, Iran. However, they believe that patients considering rhinoplasty – especially those who use their voice professionally – should be aware of “potential voice alterations.”

Patients Perceive Voice Changes after Rhinoplasty

The researchers analyzed changes in voice quality in 27 patients undergoing rhinoplasty at two hospitals in Iran, where rhinoplasty is one of the most popular cosmetic procedures. The patients were 22 women and five men, average age 24 years. Twenty-two percent of the patients used their voice professionally.

After rhinoplasty, patients completed a standard questionnaire to rate perceived problems with their voice. In addition, recordings of the patients’ voices made before and after rhinoplasty were compared by trained listeners, who were unaware of whether they were hearing the “before or after” recordings.

The questionnaire responses showed worsening in some areas of voice quality: particularly in the physical and emotional subscales, reflecting patients’ perceptions of their voice and their emotional responses to it. There was no change on the functional subscale, reflecting the effects of voice on daily activities.

The trained listeners also perceived changes in voice quality, including an increase in “hyponasality” following rhinoplasty. Hyponasal speech reflects the sound of the voice when not enough air is moving through the nasal cavity – for example, in a person with a stuffy nose. “This observed increase in hyponasality perception demonstrates that the change in the patients’ voices is perceptible to trained listeners, but does not address whether this change is apparent in everyday life and in routine conversations,” according to Dr. Khazaeni and colleagues.

Changes May Reflect Narrowing of Nasal Cavity

An acoustic analysis suggested changes in the frequency and amplitude of certain sounds, which may be related to narrowing of the nasal cavity after rhinoplasty. “The changes in surface area of nasal cavity may increase airflow resistance and cause an increase in sound absorption and a decrease in passing sound amplitude,” according to the researchers.

With recent advances in surgical technique and long-term outcomes, rhinoplasty has become an increasingly popular procedure in Iran, as in other countries. The growing number of patients undergoing this cosmetic surgery raises concerns about how it might affect various functions and quality of life. “Recently we have noticed patients who use their voice professionally asking if rhinoplasty changes their voice,” Dr. Khazaeni and coauthors write.

Based on the new results, the answer seems to be that changes in voice quality do occur after rhinoplasty. Subtle but significant changes are apparent to trained listeners. Patients themselves may also perceive changes to some extent, although they don’t seem to cause interference in the patient’s lives. “However, for individuals who rely on their voice for professional reasons, the surgeon should discuss these changes with the patient preoperatively and consider more conservative types of surgery,” the researchers conclude.

http://www.medicalnewstoday.com/releases/271894.php

Photo courtesy to Mayo Foundation

 

Pediatric ear infections cost health care system nearly $3 billion a year

Acute otitis media, or ear infection, is the most common ailment among kids of preschool age and younger in the U.S., primarily because these children have immature middle-ear drainage systems, higher exposure to respiratory illnesses and undeveloped immune systems.

And because it’s also the most common reason for antibiotic use among all children, the costs associated with acute otitis media (AOM) are under more scrutiny than ever by health care and government administrators, especially given today’s political and economic climate, strained health-care resources and cost-containment efforts.

While estimates of the economic impact of AOM have been formulated in the past, a new study by UCLA and Harvard University researchers is the first to use a national population database that gives a direct, head-to-head comparison of expenditures for pediatric patients diagnosed with ear infections and similar patients without ear infections.

The findings show that AOM is associated with significant increases in direct costs incurred by consumers and the health care system. With its high prevalence across the U.S., pediatric AOM accounts for approximately $2.88 billion in added health care expenses annually and is a significant health-care utilization concern.

The research is published in the current edition of the journal The Laryngoscope.

“Although the annual incidence of ear infection may be declining in the U.S., the number of kids affected remains high, and the public health implications of AOM are substantial,” said study co-author Dr. Nina Shapiro, director of pediatric otolaryngology at Mattel Children’s Hospital UCLA and a professor of head and neck surgery at the David Geffen School of Medicine at UCLA. “As our health care system continues to be vigorously discussed around the nation, efforts to control costs and allocate resources appropriately are of prime importance.”

For the study, the researchers examined records of pediatric patients under the age of 18 culled from the 2009 Medical Expenditure Panel Survey, a national survey conducted by the Agency for Health Research and Quality which serves a benchmark data-set specifically designed for the assessment of health care costs.

Of the 81.5 million children the researchers sampled, 8.7 million had received care for ear infections. The rates of visits to the doctor’s office, refills of prescription medications and health care costs associated with doctor visits were then compared between those with diagnosed ear infections and those without. The rates were adjusted for age, sex, region, race, ethnicity, insurance status and co-morbidities.

The researchers found that children with ear infections had an average of two additional outpatient visits, 0.2 emergency visits and 1.6 prescriptions filled, compared with those without ear infections.

Ear infections were associated with an incremental increase of $314 per child annually for outpatient health care and an average of $17 in additional costs for medications. This resulted in an overall $2.88 billion annual cost for ear infections.

“Although certain immunizations that target infection-causing bacteria may play a role in slightly reducing the overall rate of ear infections, millions of young kids will still have them,” Shapiro said. “The take-home message is that the common ear infection is an extremely costly entity with significant financial burdens on the health care system.”

Future studies on the health care cost associated with AOM may include analyzing the indirect costs, such as work and school days missed, gasoline costs and parking charges for outpatient visits, the researchers said.

http://www.medicalnewstoday.com/releases/271084.php

Picture courtesy of www.healthofchildren.com