Ear & Balance

The Otology-Neurotology division aims to deliver state-of-the-art care for patients with ear, balance and lateral skull base disorders. Our specialized physicians would work closely with audiologists, rehabilitation therapists and other professionals in order to formulate the best diagnosis, medical and surgical treatment of hearing and balance disorders.

Millions of people worldwide experience dizziness/vertigo, balance problems and hearing loss. These can be quite debilitating, affecting people’s sense of well-being, profession and livelihood. Symptoms are difficult to describe by the patient and quite challenging to diagnose and treat by the physicians. 65% of persons over 65 years of age experience vertigo or balance disorders, often on a daily basis. In the primary care setting, 70% of elderly patients present with dizziness/vertigo as a chief complaint. Over 30% of adults have experienced at least one episode of vertigo requiring a visit to the doctor. Vertigo and balance disorders can result in serious patient falls, resulting in fractures, intracranial bleeding and sometimes death. Vertigo and dizziness can also be the presenting symptoms of more serious diseases, such as stroke and brain hemorrhage. In the USA alone, the estimated cost of medical care for patients with dizziness and balance disorders exceeds one billion dollars yearly.

According to the WHO, 360 million people worldwide have disabling hearing loss, half of which are avoidable. One in Five Americans Age 12 and Older Experiences Hearing Loss Severe Enough to Hinder Communication. This is true for our region as well. Therefore, millions of patients could avoid the devastating effects of hearing loss with proper early diagnosis, treatment and rehabilitation. The rates of hearing loss worldwide have nearly doubled in the past 30 years. These conditions often start in childhood, where communication skills and overall development are greatly affected if not diagnosed and treated early. Causes and treatments vary greatly.

Service Offerings

Nose, Sinuses, & Apnea

Rhinology is the ENT subspecialty that has evolved as the result of our better knowledge and understanding of nasal and sinus anatomy and pathophysiology together with the formulation of surgical principles for the treatment of acute and chronic sinus disease. It refers to a large variety of very common conditions that vastly affect the patients’ quality of life, such as: Allergic and non-allergic rhinitis; acute and chronic sinusitis; nasal discomfort; nasal polyposis; loss of smell; cough; upper airway manifestations of systemic disease (i.e, Wegener’s Disease, Churg-Strauss Syndrome, sarcoidosis, cystic fibrosis, bronchiectasis) and of immunodeficiency.

Additionally, it provides assessment and treatment for septal deformities and other problems leading to nasal airway obstruction, nasal and sinus neoplasms.

Service Offerings

Snoring Clinic (Sleep Apnea Multi-Disciplinary Program):

Surgical Treatments

Service Offerings

Facial Surgery

Facial and plastic reconstructive surgery: covers various cosmetic and reconstructive facial procedures including rhinoplasty, various facial and eyelid procedure, post cancer and trauma reconstructions such as micro-vascular free tissue transfer and treatment of various craniofacial malformations. The department collaborates with other sections and offers complete facial cosmetic and reconstructive procedures including MOHS surgeries for skin cancers working closely with our dermatology colleagues. A leading oral/maxillofacial surgeon is part of our team in addition to an American board and fellowship trained oculoplastic surgeon. Procedures performed by our department and affiliated colleague include:

Rhinoplasty, Septorhinoplasty
Nasal reconstruction including post trauma or cancer resection
Facelift, neck lift, other facial rejuvenation procedures
Blepharoplasty
Facial reconstruction using skin graft, local flaps, regional flaps
Microvascular free flap reconstruction using bone, soft tissue or a combination: forearm free flaps, Fibula free flap, Lateral thigh free flap, others
Facial cancer resections using MOHS or other techniques with reconstruction through our facial team including a MOHS Dermatologic surgeon and oculoplastic surgeon when required.

Head, Neck & Voice

Benign and malignant Head and Neck tumors are extremely prevalent worldwide. There are more than 50,000 cases of head and neck cancer diagnosed each year in the USA alone. Because of smoking, alcohol and the recent discovery of the HPV’s role in head and neck cancers, these groups of tumors are ever increasing and require a specialized team to yield the best results in terms of survival, function and quality of life. In Lebanon there are hundreds of cases per year. The statistics are not completely accurate, however, care is not coordinated or standardized with many challenges including insurance coverage and a consistent lack team based approach in diagnosing and managing these patients.

The goal of the Head and Neck oncology division is to deliver state-of-the-art Head and Neck surgery service, using the latest techniques and most advanced equipment. Patients will be cared for with a personal touch, by a group of humane and highly qualified healthcare personnel, who will work together as a well-integrated team to deliver the best, individualized and efficient care to all our patients.

Potential donors have already been contacted to support the head and neck oncology program through a fund that will cover cost for needy patients and special procedures. This fund will also be potentially used for research and education.

Service Offerings

Cancer of the larynx is diagnosed by physical examination through fiber-optic laryngoscopy in the clinic, radiologic studies, and direct laryngoscopy and biopsy in the operating room. Surgical treatment of laryngeal tumors includes localized resection using endoscopic techniques ( LASER), partial laryngectomies (Supra-glottic, hemi and supra cricoid laryngectomies). These are all designed to maximize cure and minimize speech and swallowing difficulties. In cases of advanced cancer, total laryngectomies are performed with tracheo-esophageal prosthesis placement for speech rehabilitation. Other adjunctive treatments for laryngeal cancer include radiation and chemotherapy. Patients are discussed at a multi-disciplinary tumor board that includes experts in oncology, radiotherapy, reconstructive surgery, pathology, radiology, speech/swallowing therapy and others.

Parotid, sub-mandibular and minor salary gland tumors are usually treated surgically. These are a complex heterogeneous group of tumors that require advanced expertise to avoid injury to important structures, such as the facial nerve during parotidectomy. These tumors may also require additional therapy, such as radiation after surgery. Benign lesions of the salivary glands are treated as well, and these include stones, cysts and various benign growths. Diseases in the salivary glands that are commonly encountered include:

Stones (sialolithiasis) | Cysts (salivary cysts and branchial cysts) | Pleomorphic adenoma | Warthin’s tumor | Lipomas | Mucoepidermoid carcinoma | Squamous cell carcinoma | Adenoid cystic carcinoma | Acinic cell cancer | Rhabdomyosarcoma | Other sarcomas | Metastatic cancers | Other tumors

The oropharynx is a challenging area because of its intricate anatomy and implications for speech, swallowing and breathing. Tumors of this area are usually malignant (squamous cell carcinoma) and are treated by surgery, radiation and chemotherapy or combinations of the above. There is a steep worldwide rise in oral and oropharyngeal cancers because of their strong association with the HPV virus (in addition to smoking and alcohol mainly). A careful study of the tumor location, extent and patient overall health status will performed by our team of experts and the best treatment will be designed after a multi-disciplinary tumor board discussion that includes oncologists, radiation therapists, radiologists, pathologists, speech and swallowing therapists, reconstructive and the Head and Neck surgeons who coordinate the team. This group includes tumors of the tonsils, tongue base, palate and pharynx. Surgeries offered for this area include:

Wide field or radical tonsillectomy | Partial or total palatectomy | Pharyngectomy, laryngopharyngectomy | Tongue base resection, partial or total glossectomy

As with oropharyngeal cancers, these are usually squamous cell carcinoma, and also impact speech and swallowing. These tumors are usually treated with surgery, with possible radiation therapy post operatively for more advanced tumors. Removal of the neck lymph nodes are usually performed with these tumors, as with the other tumors discussed (selective neck dissection, modified radical neck dissection and radical neck dissection). Reconstruction is performed at the same setting using primary closure, skin grafts, local and regional flaps and distant micro-vascular free tissue transfer for functional rehabilitation. As with other tumors, our speech and swallowing therapists work closely with the surgeons to help optimize patient recovery. Procedures performed include the following:

Buccal mucosa excision | Partial, hemi-glossectomy and total glossectomy | Palatectomy | Mandibular resection and reconstruction (partial, marginal, total mandibulectomy), composite resections.

5. Head and Neck skin cancers are wide spread, especially in areas with increased sun exposures. These include most commonly basal cell carcinoma, squamous cell carcinoma and melanomas. They can grow to be quite large, destructive and may spread to the neck lymph nodes, and even metastasize to other sites. Treatment include surgical resection, reconstruction including local, regional or fee flaps and the removal of the appropriate lymph nodes when indicated: lympho-scintigraphy is available to detect the lymph nodes involved. This group of tumors is often treated through a multi-disciplinary approach in conjunction with other specialties including plastic surgery, oculoplastic surgery, dermatology, oncology and radiation oncology.

These tumors include benign and malignant tumors of the thyroid gland. Benign tumors include cysts, multi nodular goiter, adenomas and others. Thyroid cancers include most commonly well differentiated tumors (papillary and follicular). Benign tumors are removed by partial or hemi-thyroidectomy, leaving a remnant of functional thyroid gland. Total and subtotal thyroidectomies are usually performed for cancers in addition to post-operative treatment with radioactive iodine when indicated. Intra operative recurrent laryngeal nerve monitoring (NIMS) is available to identify more easily this nerve, which affects the voice and airway. Advanced thyroid cancers sometimes require resection of additional structures in the airway and swallowing apparatus (pharynx) with the possible need for reconstruction. The evaluation and management of voice disorders as a result of these surgeries is handled by the otolaryngology and speech therapy teams.

Endoscopic resection of benign and malignant tumors is performed using the latest technology, such as endoscopic image-guided surgery, where the surgeon knows at any point, where the instruments are anatomically, with the help of CT scan, and/or MRI fusion images. This permits the removal of lesions and tumors in a very delicate area, close to vital functions, while preserving function and avoiding complications. Malignant sino-nasal tumors are also removed endoscopically, and may occasionally require open surgery with reconstruction when indicated. Sino-nasal tumors can sometimes invade the skull base and go into the intracranial cavity. In these cases, a multidisciplinary team including otolaryngologists and neurosurgeons work together to excise these tumors.

The combined knowledge and expertise of these specialists, along with others, form a skull base multidisciplinary team, which results in much better outcomes. Some it he diseases treated include:

Inverted papilloma | Meningo and encephalocele | Gliomas | Cerebro spinal fluid leaks | Dermoid cysts | Hemangiomas | Mucoceles | Squamous cell carcinoma | Sinonasal undifferentiated carcinoma | Olfactory neuroblastoma (esthesio-neuroblastoma) | Sarcomas | Lymphomas | Mucosal melanomas | Hemangiopericytoma | Metastatic tumors

Many neurovascular tumors present in the Head and Neck region. These are usually treated surgically by total removal. They include paragangliomas that can present around the carotid artery bifurcation (carotid body tumors) or may involve vital nerves such as the vagus nerve (vagal paragangliomas). Neural tumors can also involve any nerve in the head and Neck, such as vagal schwannoma, facial nerve or sympathetic chain schwannomas. These are removed with the assistance of the intra-operative nerve monitors, in order to preserve function when possible. In cases where the nerve has to be sacrificed, surgical reconstruction is performed through nerved grafting (e.g.: facial nerve grafting, hypoglossal-facial anastomosis, sural nerve graft and others).

Head and Neck cancer is quite prevalent in the region due to high rates of smoking, especially the water pipe (hookah), which has much greater carcinogenic potential than cigarettes. Water pipe (Hookah or Hubble Bubble) use has increased dramatically, especially among the younger generation. There are practically very few, if any, well organized, united specialized advanced Head and Neck cancer teams in the region.

In addition, the Head and Neck section will support practically all the other services within Dr. Sabri and team's reach. Services provided will include tracheotomies, airway surgery, reconstructive surgery for the upper aero-digestive tract, skull base and others. The Head and Neck section will attract patients regionally and internationally because of the complex nature of the cases involved. The high quality of the services presented to these patients with complex and often devastating diseases, will also help generate high visibility for the Otolaryngology - Head and Neck surgery service.

Laryngology / Voice & Services

Patients with voice and swallowing problems related to the upper alimentary tract, of benign or malignant origin, that can be treated either through procedures or medically.

Diagnostic laryngoscopy / videostroboscopy
Voice assessment
Swallowing assessment (Fiberoptic endoscopic evaluation of swallowing (FEES)
Microlaryngeal surgery including LASER Procedures
Office-based procedures
Voice and swallowing therapy (Speech and Language Pathology service)
Supportive service to other medical specialties (Neurology, Thoracic Surgery, Neurosurgery)

“According to the American Speech-Language-Hearing Association (ASHA) 6% of the population have speech, voice or language disorders. The prevalence in the region is expected to be higher however, unfortunately, there are no official statistics regarding the prevalence of voice disorders for neither Lebanon nor the Arab region.”

Team

Laryngologist ( a part time candidate is identified)
Speech and Language Pathologist specialized in voice and swallowing disorders
Nurse
Neurophysiologist (for laryngeal electromyography - Neurology department)