CEENTA: The Here and Now
Feb 01, 2016 08:00AM ● Published by Jason Huddle
CEENTA: The Here and Now
People – young and old – in Cabarrus County are receiving the latest in medical products and services, thanks to the research studies taking place here as well as the passionate physicians behind them.
Charlotte Eye Ear Nose & Throat (CEENTA) opened its Concord location in 2012. This was a much-welcomed addition to the selection of specialty physicians in Cabarrus County. As the name implies, patients here are treated from the neck, up.
Cochlear Ear Implants
Dr. Nichlas Stowell specializes in Otolaryngology – the study of diseases of the ear and throat. He chose his specialty while earning his graduate medical degree and has been with CEENTA since 2012.
“I’ve been interested in hearing since Vanderbilt, took training and applied it to this community,” he says.
Many of us have seen cochlear ear implant recipients on the Internet and through social media: individuals who have never heard the voices of loved ones suddenly become wide eyed, shedding happy tears as they realize their world has changed forever.
“They (cochlear implants) have been around since the 1970s, but have become much more common in the last 10 years; they were under very strict protocols then. Now three companies make them,” Dr. Stowell explains.
According to nidcd.nih.gov, “A cochlear implant is a small, complex electronic device that can help to provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing. The implant consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin.”
The implant consists of:
• A microphone: picks up sound from the environment;
• A speech processor: selects and arranges sounds picked up by the microphone;
• A transmitter and receiver/stimulator: receive signals from the speech processor and convert them into electric impulses;
• An electrode array: a group of electrodes that collects the impulses from the stimulator and sends them to different regions of the auditory nerve.
Before the advent of the implant, the hearing impaired had no choice but to wear hearing aids. “Hearing aids have changed because of digital technology,” Dr. Stowell says. “They’re smaller and much better tolerated because you can adjust them better. You used to have to adjust them with a screwdriver. Now you set them on a platform and reset them with the computer. They improve quality of life.”
While conventional hearing aids amplify sounds so that a hard-of-hearing person can detect them, a cochlear implant stimulates the auditory nerve. “Signals generated by the implant are sent by way of the auditory nerve to the brain, which recognizes the signals as sound. Hearing through a cochlear implant is different from normal hearing and takes time to learn or relearn. However, it allows many people to recognize warning signals, understand other sounds in the environment, and enjoy a conversation in person or by telephone,” nidcd.nih.gov says.
The cochlear implants are for children who are born deaf – they can grow to have normal speech and language – and for those adults who had normal hearing and became deaf later in life. Glen Compton Sr., 81, is one of those adults. He received an implant in his left ear in August 2015.
“I had a problem when I was in the service with a deck gun going off near my head. My helmet was off and my earpiece had gotten twisted. My left ear was closer to the gun. I’m not saying it’s what affected my hearing, but my ear sure did ring.
“Then I worked in schools for 35 years – as a principal for 24 years – then I retired. I went back to help one principal and realized I wasn’t hearing things I should have heard. Friends told me I needed to get my hearing checked…I started wearing hearing aids in 1997 or ’98.
“I heard that CEENTA had a surgeon that operated on two of my friends, but the doctor said what they had done would not work for me. I went two to three more years with new hearing aids, but I began stammering and stuttering. They recommended I see Dr. Stowell and he said I’d be eligible for one (cochlear implant) for my left ear. All I had to pay for was a pneumonia vaccine and a flu shot – about $180. I understand they have been added to the list for Medicare.
“Dr. Stowell did the surgery (outpatient surgery at CHS NorthEast), right behind my ear, at the base of my skull. He cut the nerves loose and put a sound processor under the skin; it’s like a small knot. He tied my nerve into that knot. I have a lot of hair at 81 so I can almost hide the thing. He gave me all this equipment in a briefcase: two processors that I can put into the electronic charger in my house and two more that come with batteries that I pick up at CEENTA. If I were going fishing for the weekend, they would last the day or more.”
Since cochlear implants can take a year to reach their true potential, Comptom is participating in auditory rehabilitation, utilizing activities at home meant to optimize the use of the implant and how it works. These exercises can include relearning differentiating between specific sounds or identifying words.
“Dr. Stowell told me not to get discouraged,” Compton says. “On a test, I missed 80 percent of the words without any help. With the implant, I got 40 of 80 right. I’m also hearing sounds in music, sounds I’ve never heard before.”
“These implants are the most advanced technologically, and they’re permanent,” Dr. Stowell says, adding, “What I tell people now is that, when people tell you there is nothing they can do for your hearing, there is always something you can do.”
Ultra-wide Field Retinal Photography
Dr. Omar Punjabi is a retina specialist at the Concord office of CEENTA. He participates in Ultra-wide Field (UWF) retinal imaging research.
As the light-sensitive layer at the back of the eye, the retina covers about 65 percent of the eye’s interior surface. Its cells convert light into visual signals that are then carried to the brain. But what happens when conventional photography can’t reach an outlying part of the retina and an important diagnosis is missed?
“Eye diseases like macular degeneration (AMD) and diabetic eye disease are the two leading causes of blindness in the United States, affecting millions of people,” Dr. Punjabi says. “Ultra-wide field retinal imaging is a newer technique that has rapidly gained popularity and clinical application among eye doctors.”
What makes UWF imaging so revolutionary is its ability to photograph, in one shot, about 82 percent of the retina – versus about 35 percent with conventional techniques – in a high-resolution, digital format that can be electronically sent to and shared with other physicians. According to Dr. Punjabi, research indicates that 66 percent of eye conditions are located outside the boundaries of conventional photography.
“It has changed the way retina specialists approach screening, diagnosis and treatment selection of retinal diseases, and has even influenced the definition and grading of retinal disease,” he says.
Diabetic Retinopathy (DR) is the most common eye disease afflicting diabetics. Blood vessels in the retina can bleed, leak fluid and produce lesions.
“Because these lesions are outside the area of the retina that can be visualized with traditional photography, it is important to use UWF imaging to examine the periphery to accurately assess the severity of DR and evaluate the likelihood of progression,” Dr. Punjabi explains. “Early diagnosis, categorization and management of diabetic retinopathy are critical in prevention of sight-threatening complications, and can potentially save Medicare millions of dollars.”
The enhanced quality and resolution of UWF images also breaks ground in cases of Retinal Vein Occlusion (RVO): a common cause of vision loss in patients with high blood pressure; Uveitis: a condition that involves inflammation of the inside of the eye; peripheral vascular abnormalities: disorders – often rare congenital disorders like Coats disease and retinal hemangiomas (benign tumors) in infants and children – that principally affect the retinal edges; and systemic diseases attributed to cardiovascular disease, particularly heart failure and stroke.
“Correlations between retinal pathology (diseases) and the risk for development or progression of systemic diseases are now being tested,” Dr. Punjabi says, “but the ability to examine the retinal vasculature in high resolution with multimodal UWF imaging will improve our understanding of this association.”
He sees this easy-to-use technology being used as “telemedicine” by non-eye physicians, technicians and photographers. The scans can be shared with ophthalmologists and retina specialists efficiently and cost-effectively. It also brings the patient into the technology.
“Patients are fascinated to see detailed pictures of their actual retinas,” Dr. Punjabi shares. “This improves the patient’s eye exam experience. Patients listen intently as eye doctors describe anatomical features and clinical findings. Patients who have had retinal pathology identified are more motivated to adhere to treatment and follow-up instructions, even lifestyle changes.
“OptosTM – the most commonly used camera to obtain UWF retinal images – is available to CEENTA patients and has improved patient care significantly,” he adds. “As more novel treatment options and approaches for retinal disease become available, the clinical rationale for incorporating multimodal UWF retinal imaging into screening, diagnosis, monitoring and management will continue to expand. UWF retinal imaging will likely play an increasingly central role in our daily clinical practice, ensuring that we do not miss critical signs in the retinal periphery.”
Steroid-releasing Sinus Implants
When Charlotte Eye Ear Nose & Throat merged with Concord’s Carolina ENT Specialists, Dr. Johns (Jon) Langford was brought into the fold.
“I trained at Duke and did a facial plastics fellowship. Then I was in practice with Peter Chikes and we merged our practice with CEENTA about five years ago. I have been in Concord since 1995,” Langford explains. “Though I did facial plastics, I do a lot of sinus work now. Sinus disease. That’s what certainly excites me – both pediatric and adult. There are lots of people with sinus disease or breathing through the nose.”
According to intersectent.com, “One in eight adults is affected by chronic sinusitis each year, making it one of the most common health conditions in the U.S. Diseased sinus linings become swollen (inflamed), preventing natural drainage, leading to chronic infections and nasal blockage.
“Nasal polyps are seen in severe cases of chronic sinusitis as a result of increased swelling of the sinus lining. Larger growths or groups of nasal polyps often block your nasal passages, leading to breathing problems, lost sense of smell and frequent infections.”
“Sometimes it’s related to allergies, smoke exposure, definitely exposure to irritants,” Dr. Langford says. “Some people have no risk factors.”
Surgery removes the polyps that cause inflammation and infection, but symptoms can return. Currently, however, Dr. Langford is, as he describes himself, the “local principle investigator” in an ongoing study called Resolve II.
“There are 30 of these study sites in the country, but we’re the only one in North Carolina. We’re about halfway through the study so the results aren’t anywhere close to being published,” Langford says.
“Resolve II is a study designed to evaluate whether a new investigational, dissolvable, steroid-releasing sinus product can reduce the symptoms of nasal blockage that return after endoscopic sinus surgery (ESS),” intersectent.com says.
The brand is Propel and the product’s official name is the Propel Steroid Releasing Implant. The applicator looks like a 12-inch or so plastic wand. A flexible mesh-like webbing – called a stent – is loaded into the tip, then inserted into the patient’s sinus. The implant expands to fit the sinus precisely and gives off a steroid over 30 days, delivering it directly to the tissue. It dissolves over those 30 days without the patient even realizing it.
A definite benefit is that the procedure takes place at the CEENTA office while the patients are wide-awake. Its non-invasiveness allows them to return to their daily routine right away.
“To ensure patient comfort, the doctor will numb the nose and sinuses using nasal spray. The procedure requires no incisions and will take only a few minutes,” intersectent.com
says. “The recovery from the procedure is expected to be similar to a dentist’s visit, with some numbness around the nose and face immediately following the procedure. Minor nose bleeding might also be observed for a few minutes after the procedure.”
Michelle Coleman, 31, is a participant in the study. “I have had quite a journey,” she says. “I lost my smell about four years before I met Dr. Langford, but figured it was allergies, although I’d never had allergies. Then my husband and I had our first child and, silly as it might sound, I couldn’t smell him.”
At the end of 2013, Coleman and her husband made a pact that 2014 would be their year of health. So Coleman embarked on consulting with three specialists about her loss of smell. Dr. Langford was the third and the one she felt most comfortable with.
“In his 25 years of medicine, Dr. Langford told me he had never seen such bad polyps (in both sinuses). There was so much infection and disease,” Coleman shares. “When he did the surgery, I actually had fungus growing inside my sinuses. Afterward, I still had a couple sinus infections so we did another CT scan and it looked like I still had some diseased tissue. He needed to go in again. He did the surgery and brought in every tool under the sun to make sure he got everything. Then he inserted temporary stent implants. I didn’t feel them. Since then, I just had my second baby and I’m finally able to enjoy a lot of things that people take for granted. I thank Dr. Langford every time I see him.
“Since having my second child, my polyps are starting to come back. After I stop nursing, he wants to try a new type of steroid stent. I told him I will be the guinea pig and ‘you just tell me what I need to do.’ I think it’s cool that we can try something there in the office instead of going under anesthesia.”
Dr. Langford is still accepting participants for the Resolve II study and, while the patients in this particular study are actually compensated and not charged, in-office treatment outside the study is not typically covered my medical insurance plans.
“Some insurance companies approve these sorts of things in the operating room. They don’t approve most of this stuff for the office,” Dr. Langford explains. “I do think that, oftentimes, coverage is driven by the science. It costs less to keep patients healthy.”
So, as with most new technologies that often become the norm, insurance coverage should one day catch up. In the meantime, individuals interested in participating in the Resolve II study must meet the following requirements to be considered:
• Be 18 years of age or older;
• Have had sinus surgery on both ethmoid sinuses;
• Have not had sinus surgery in the past three months;
• Have continuing symptoms of chronic sinusitis such as congestion, runny nose, facial pain/pressure, or altered smell and/or taste;
• Have current medical treatment for continuing symptoms that is not working effectively.
“This is the only company that’s this far along in the production of these products,” Dr. Langford says. “In the future, I think there will be more direct antibiotic-eluting devices and more minimally invasive ways to address the issues. It’s the evolution of sinus surgery.”
It’s gratifying to hear and see the excitement of these local medical specialists. Research never stops. Neither does giving their patients the relief and hope they’re searching for. And it’s right here in Cabarrus County.
NOTE: Neither CEENTA nor any of the physicians interviewed for this article have any financial interests in relation to specific product manufacturers.
Written By: Kimberly Cassell
Photos Courtesy: CEENTA