Thirty-six million Americans have hearing loss and over half of those 36 million Americans are under the age of 65.  One in three developed their hearing loss as a result of exposure to noise, causing noise-induced hearing loss (NIHL).  Hearing loss is an increasing health concern in this nation that is often preventable.  In response to the growing number of Americans suffering from hearing loss, the American Academy of Audiology has launched National Audiology Awareness Month.

Hearing loss can be caused by exposure to loud noises, ear infections, trauma or ear disease, harm to the inner ear and ear drum, illness, certain medications, and deterioration due to the normal aging process. The amount of noise Americans are exposed to today plays an important role in the recent increase of hearing loss across the nation. It is no longer just a health concern for seniors.

Have you stopped going to restaurants and social gatherings? Do you keep to yourself when in noisy environments? If you answered yes, you may have a hearing problem. Some signs of hearing loss are: trouble hearing conversation in a noisy environment such as restaurants, difficulty or inability to hear people talking to you without looking at them, and/or a constant ringing in your ears.

An audiologist is a licensed and clinically experienced health-care professional who specializes in evaluating, diagnosing, treating, and managing people with hearing loss and balance disorders. The first step in treatment of a hearing problem is to get your hearing evaluated by an audiologist. A hearing evaluation will determine the degree of hearing loss you have and what can be done. Although most hearing loss is permanent, an audiologist can offer excellent treatment options, which may include hearing aids, assistive listening devices, and hearing rehabilitation.

Thyroid nodules are common. A nodule is palpable in 5% of the general population and visible on ultrasound in approximately 50%. When does a nodule warrant further investigation and treatment? Whenever considering management and workup of a nodule, risk factors for malignancy should be sought from the patient. That would include a history of radiation, nodule growth, hoarseness, dysphagia, and a family history of thyroid cancer or multiple endocrine neoplasia (MEN) syndromes. Other red flags include the extremes of age (younger than 20 or older than 70) and male gender, as these populations have a higher incidence of malignancy when a nodule is discovered.

A family history of medullary carcinoma of the thyroid should trigger genetic testing for the RET proto-oncogene. Incidentalomas (a tumor found by coincidence without any clinical symptoms or suspicion) among at-risk patients, those greater than 1 cm and palpable nodules should be evaluated further with ultrasound. Further work-up with ultrasound guided needle biopsy is indicated when the nodule is hypoechoic or mixed and greater than 1 cm or when there are features that have a strong correlation with malignancy. These concerning features include irregular margins, microcalcifications, increased vascularity, and extracapsular growth. Multinodular goiters have the same risk of cancer as a solitary nodule. Therefore, the nodules within a goiter that demonstrate any concerning sonographic findings should be biopsied as well.

Thyroid FNA (fine needle aspiration) has a sensitivity and specificity of 95% and is the test of choice to determine risk of malignancy. Typically, FNA results are grouped into one of the following four categories: benign, suspicious, malignant, or indeterminate. Benign nodules under 4 cm should be followed with ultrasound and biopsies should be repeated if significant growth is demonstrated. Nodules greater than 4 cm should be removed regardless of the FNA findings, as sampling error becomes a concern as the nodule size increases. Suspicious nodules may be further evaluated with a hemithyroidectomy, intraoperative frozen section, and total thyroidectomy, as indicated, if carcinoma is demonstrated.

The majority of patients who undergo hemithyroidectomy will maintain adequate thyroid function and will not require thyroid hormone replacement. Malignant lesions are typically removed with a total thyroidectomy. This recommendation is made based on the high incidence of multifocal carcinoma and for the purposes of postoperative radioactive iodine, which is most effective when the thyroid remnant is minimized. Other pathologic features found on FNA that raise concern for underlying malignancy, but are not diagnostic and are therefore “indeterminate,” include follicular neoplasm (15% risk of malignancy), Hurthle cells (14% risk of malignancy) and atypical cells (65% risks of malignancy).

Thyroidectomy is generally a safe and well-tolerated operation. Most patients who have a hemithyroidectomy can return home the same day, but patients who have a total thyroidectomy are typically monitored overnight due to the potential for hypocalcemia. Temporary hypocalcemia is expected to occur in 25 to 50% of patients undergoing total thyroidectomy, necessitating temporary calcium and Vitamin D supplementation.

Permanent hypoparathyroidism is much less common, seen in less than 1% of patients who undergo total thyroidectomy. Similarly, temporary recurrent laryngeal nerve injury occurs in approximately 10% of total thyroidectomy patients, whereas permanent recurrent laryngeal nerve injury occurs less than 1% of the time.

A recent advance in thyroidectomy is intraoperative nerve monitoring with electrodes imbedded in special endotracheal tubes. Multiple studies have not demonstrated a statistically significant reduction in nerve injuries utilizing this technology, but it can be helpful in identifying and preserving nerves that have an aberrant course.

Other advances have focused on “minimally invasive” techniques, primarily aimed at minimizing the neck scar seen in thyroidectomy. The typical thyroidectomy scar was approximately 10 cm. In most patients, this can be reduced to 4.5 cm and is set in a horizontal neck crease, which usually heals nicely. Endoscopic approaches to the thyroid with a smaller incision in the neck (2.5 cm), or incisions in the axilla with subcutaneous tunnels to the neck, have reduced neck scarring further. Trade-offs in scar aesthetics that are improved by endoscopic techniques must be balanced with potential increased time, expense, and additional personnel needed to perform these approaches, and therefore they have not been widely accepted.

In recognition of the profession of physician assistants, National Physician Assistant Week is held Oct 6th-12th. We are pleased to introduce our staff of talented PAs:

Donna Silvernail graduated from the Albany/Med Hudson Valley Physician Assistant Program with honors in August 2001. Her training rotations included Pediatrics & Family Medicine, General Surgery & Emergency medicine as well as Neurology & Orthopedics.

Since graduation, Donna has specialized in the areas of surgery and orthopedics. In addition, throughout her career Donna has been involved with the development of patient treatment protocols as well as Patient Education Programs. Donna is a member of the American Academy of Physician Assistants and is certified by the National Commission on Certification of Physician Assistants. Earlier in her career, Donna also trained as a physical therapist assistant graduating from Maria College of Albany.

Donna is a member of the American Academy of Otolaryngology - Head & Neck Surgery and the American Academy of Otolaryngic Allergy.

Maggie West-Bump received her Bachelor’s degree in Biology from Siena College. She graduated from the Albany Med/Hudson Valley Physician Assistant program in 2001.



Since graduation she has had extensive experience with Family Practice and Cardiology. Maggie has lectured as adjunct faculty at Hudson Valley Community College for the Paramedic Program. She is certified by the National Commission on Certification of Physician Assistants and is a member of the Amercian Association of Physician Assistants and the New York State Society of Physician Assistants.

Maggie is a member of the American Academy of Otolaryngology - Head & Neck Surgery and the American Academy of Otolaryngic Allergy.

Rob Nadratowski received his Bachelor of Science degree in Health Studies at Boston University in Boston, MA in 2000. He continued his education at Albany Medical College where he received a Master of Science degree in Physician Assistant Studies in 2005. He has worked in areas of Ophthalmology, Occupational Medicine and Urgent Care Medicine since then. He has a special interest in the management of reactive airway disease and asthma, and management of combined airway allergy. Rob is a member of the American Academy of Physician Assistants and is certified by the National Commission on Certification of Physician Assistants.

Rob is a member of the American Academy of Otolaryngology - Head & Neck Surgery and the American Academy of Otolaryngic Allergy.

Robyn Smith received her Bachelor of Science degree in Communication Disorders and Sciences at the State University of New York at Geneseo, in Geneseo NY in 1997. She continued her education at the University of Virginia and received a degree of Master of Education in Audiology in 1999. She then practiced Audiology at Massachusetts Eye & Ear Infirmary in Boston MA, and UMAss Memorial Hospital in Worcester MA. Robyn then decided to further her career and education at Albany Medical College where she received a Master of Science degree in Physician Assistant Studies in 2004. As a Physician Assistant, she has worked in the areas of Otorhinolaryngology and Asthma & Allergy since then. Being a Physician Assistant and Audiologist, she has a unique perspective in the management of diseases of the ear and hearing. She also has special interest in allergy, reactive airway disease and asthma, along with management of combined airway and allergy. Robyn is certified by the National Commission on Certification of Physician Assistants.

Robyn is a member of the American Academy of Otolaryngology - Head & Neck Surgery and the American Academy of Otolaryngic Allergy.