The American Academy of Otolaryngology – Head and Neck Surgery announces 2022 elections results


The 2022 election results are in, and our very own Douglas Backous, MD, was voted in as President-Elect for the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS). We invite you to read Dr. Backous’ vision for the role, and how he plans to leverage his years of experience to best serve his colleagues and all our patients.

Dr. Backous’ vision for the role

With hard work, clear vision and bold leadership the AAO-HNS responded to the challenges of the Covid-19 pandemic by becoming an essential resource of information for otolaryngologists throughout the world. Our newly adopted strategic plan embraces key areas which will require all of us to truly come together as “one” to build an organization which empowers members to achieve our vision of excellence in ear, nose, and throat care. 

A renewed commitment to fostering physician health, wellness, and resiliency in our specialty goes hand-in-hand with creating more sustained opportunities for our colleagues from under-represented groups to thrive, lead and mentor future leaders. By building our understanding of the socioeconomic determinants which create care disparities, we as an academy can work more efficiently to ensure our clinical pathways and quality initiatives include metrics for removing barriers to equitable healthcare. We need more practicing physicians to advocate, on a grassroots and national level, for timely access to appropriate, cost-effective and evidence-informed care. We also deserve to be rewarded fairly for the work we do in an ever-changing and complex healthcare system. Business of medicine priorities and the creation of the private practice study group will stoke innovation and identify changes the academy can support to improve the working environment in private, employed and academic practice settings. Providing steady leadership, a sharp focus on adhering to the strategic plan, and an eye for continuous improvement of implementation strategies is my vision and is my motivation to serve. We have a great blueprint; we need to continue to execute and show results. 

What experience Dr. Backous brings to the role

I am a practicing neurotologist with special interest in value-based healthcare delivery. I completed the Executive Development Program at the Foster School of Business at the University of Washington in 2011 and received the ACS/AAO-HNS Health Policy Scholarship at Brandeis University in 2021. I completed four years as a member-at-large, private practice, with the academy in 2021. I held leadership positions in a multispecialty group, a hospital-based practice model and now in private practice. I currently serve on the 3-P committee for the AAO-HNS and continue to work with my congressional representatives to support otolaryngology and the house of medicine at-large. I am passionate about inclusive diversity, have great respect for the women in leadership in our academy, and want to create opportunities to identify new members who will rise into leadership positions. 

Looking forward

Building on the great work of past presidents, engaging our specialty societies along with members from the BOG, YPO, WIO and others requires curiosity, patience, humility, respect, and the ability to find joy in watching others succeed. I have great confidence in our academy administrative team led by Dr. James Denneny and look forward to engaging with his succession planning process. I believe the president should know when to engage the CEO and when to step back and let his staff do their jobs. 

I am passionate about our academy and believe we could create much needed and sustained change in our world. I believe being president of the AAO-HNS is an awesome opportunity to serve my colleagues and all our patients. 

So you’ve got shoulder pain?


If you were born prior to 1970, your shoulder pain probably came on without any significant accident, most likely a small action that you have done loads of times before which never bothered before this one time. Maybe you reached out for a pitcher of something or put an item on an upper shelf. Or maybe you just tried to put on your seatbelt. Maybe you didn’t do anything at all and simply woke up one day with pain that wouldn’t go away. I’d bet now you have a hard time raising your arm, and if you are considering going to a doctor, you’re likely having a hard time sleeping. Nobody wants to see the doctor after all, and it takes something dramatic to drive you there.

If this scenario describes you, you probably have rotator cuff dysfunction. Rotator cuff dysfunction is a spectrum of disease, ranging from rotator cuff bursitis all the way to something called rotator cuff arthropathy.

Let’s start with the least and make our way to the worst.


Impingement is the very least in the way of rotator cuff dysfunction. Basically, it implies that there is a movement issue with the shoulder, which is causing the cuff to rub on the undersurface of its boney covering called the acromion. Imagine rubbing your skin so much that it got red, and then continuing to rub the skin raw. That’s a little like impingement. The solution of choice is the common sense one…stop the irritating rubbing. That is the equivalent to physical therapy. Once you get the shoulder movements corrected, your rotator cuff should stop hurting.


Bursitis is commonly diagnosed by healthcare providers, but believe it or not, it isn’t well understood. Since the word ends in “itis”, it should imply underlying inflammation. However, there aren’t actually any studies that show true inflammation. In any case, we still call it bursitis for historical reasons and because sometimes the bursa is thickened which can cause a painful snapping. Again, the mainstays of treatment focus on correcting movement abnormalities in physical therapy. Pain is treated orally with things  like acetaminophen or ibuprofen. Ideally one does not need a steroid injection. 

Rotator cuff tendinosis

Rotator cuff tendinosis is a condition that implies degeneration without any indication of rotator cuff tear on imaging studies such as ultrasound or MRI. Pain tends to start in the shoulder area and radiate down the lateral arm to the level of the elbow. Pain can be unremitting and sometimes be the cause of “breakaway” weakness, which is painful weakness that can be overcome if one really wants or needs to. Treatment is nonoperative. Surgery is not the solution here.

Rotator cuff tears

Rotator cuff tears come in multiple flavors. There are two important distinctions to make:

  • Partial or full thickness
  • Traumatic or atraumatic

For the purposes of this discussion, we have assumed an atraumatic tear, which leads to one algorithm of treatment versus a traumatic tear, which leads to surgery. Assuming an atraumatic tear, the first treatments should be nonsurgical again, but if those don’t work, one may need a rotator cuff repair. Sometimes rotator cuff tears are unrepairable, but there are some relatively newer procedures like a superior capsular reconstruction that might relieve pain.

Rotator cuff arthropathy

The most severe kind of rotator cuff issue is actually a special kind of arthritis associated with not having a rotator cuff around for a long time. The symptoms are all those listed before but usually worse. In this case the pain is crunchy, and the weakness is profound. Sometimes patients can’t lift their arms at all. The ultimate solution for cuff tear arthropathy is a specific joint replacement called a reverse total shoulder arthroplasty. Unfortunately, because the rotator cuff has been gone for too long and the cartilage surface of the joint has been destroyed, a primary repair of the tendon is neither possible nor beneficial.

Come see us!

If any of this sounds familiar to you, you may want to give your doctor a call or start some physical therapy. If you feel more independent, checking into rotator cuff rehabilitation on the internet may be a good idea. But if none of that works and your life is starting to center around shoulder pain, come on in, and we will do our best to get you fixed up.

Book an appointment today!

Thank you!

March is Women’s History Month and it’s a great opportunity to acknowledge the contributions of the women at Proliance Surgeons. Thank you to our Doctors, Nurses, Physician Assistants, and office staff for providing exceptional care to our patients. Thank you to all the women in the corporate office for your leadership, guidance, and dedication to making Proliance a great place to work. Finally, thank you to the women that make up the communities that we serve for all that you do, and trusting Proliance Surgeons with your care.

If you would like to send “thank you” message to one of the wonderful women at Proliance Surgeons, click on the button below and fill out the form. The Marketing Team will use your message to design a thank you card and send it to the intended recipient.

Thank you, and happy Women’s History Month!

Meet our Doctors

During pregnancy, stretching of the abdominal muscles is common.

We all have fibers (called fascia) that provide structural integrity to our abdominal wall. The fascia surrounds the mid-abdominal rectus abdominus muscles (think, the 6-pack area of your stomach). Ideally after childbirth, your fascia should return to pre-pregnancy state.

However, it’s important to note not all bodies achieve this result. In fact, about 60% of post-pregnancy women are diagnosed with diastasis recti following pregnancy, and while it’s not the only cause of this diagnosis, it’s a prevalent one.

Diastasis recti is the medical term for excessive stretch of the abdominal tissues, causing damage to the fascia that give your abdominal wall structural strength.

Some women, especially petite women who have large babies, find that their fascia fibers have been too far stretched to return to normal state. Accordingly, the rectus muscles may stay extremely thinned out or become lateralized on each side. There are differing degrees of diastasis – most women have mild degrees of diastasis with little impact, but for some, the resulting long-term loss of core strength can be significant.

What are the Symptoms?

Women with significant diastasis recti say that they are always consciously holding their abdomen “in” by engaging their rectus muscles, and when they relax, the abdomen protrudes as if they were 4-6 months pregnant. The tension this creates on the edges of the muscles can cause pain, especially by the end of the day.

Additionally, the lack of structural support of the anterior abdominal wall can result in lower back pain over time. Many women find it impossible to develop core strength, which is well-understood to be important in overall health.

Patients with diastasis can also experience pelvic floor muscle spasms. It’s important to note that pelvic floor issues will likely not resolve with diastasis repair, so separate management is recommended. If you are having pelvic floor muscle spasms, consult with a Urogynecologists who specializes in the pelvic floor.

If you are experiencing the symptoms above, your provider will conduct a physical examination to further understand the cause behind your symptoms. In my practice, we examine for a weakness of tissues of the middle of the abdomen centered at the belly button when laying down on your back. When the rectus muscles are tensed or engaged, the weakness of the middle of the abdomen allows pressing into the abdomen, as well as definition of the edge of the muscles giving an estimate of the width of the muscle separation.


Is it Diastasis Recti or a Hernia?

It is necessary to distinguish symptomatic diastasis recti from typical hernias. In the case of a typical hernia, there is an actual tear in the fascia and the internal fat or even bowel/intestine can protrude out, in danger of becoming “stuck” or “incarcerated.” The blood supply to the bowel may become compromised, leading to bowel “strangulation.”

In the case of diastasis, there is a severe stretch, but no tear in the fascia. Accordingly, there isn’t a danger of bowel incarceration or strangulation.  

Unfortunately, women are typically told that because there is no danger of bowel incarceration or strangulation, there is no need to worry about their symptoms, and no treatment for diastasis.

In my opinion, when diastasis is severe, the symptoms of pain and functional impact on activities of life make it similar to a large ventral hernia. Depending on the severity of symptoms and examination findings, I offer patients abdominal wall reconstruction. 

Abdominal Wall Reconstruction:

What is it?

Abdominal wall reconstruction involves removal of the stretched out, thin mid-abdominal fascia, placing the muscles back to the midline, and reinforcing the midline with mesh (synthetic) or biologic matrix (a sheet of specially prepared biologic tissue) to prevent breakdown and strengthen the area. This procedure can be performed with or without a tummy tuck (abdominoplasty) depending on the degree of redundancy of the skin and soft tissue of the mid and lower abdomen. Abdominal wall reconstruction is typically covered by insurance; however, the tummy tuck component usually is not. 

The goal of abdominal wall reconstruction is to address abdominal wall pain symptoms related to symptomatic diastasis recti, but also to return the patient to a functional abdominal wall. We aim to restore anterior abdominal wall integrity and to allow core strengthening and exercise potential, with optimal overall health in mind.  

What isn’t it?

It’s important to note, that the abdominal wall reconstruction should be distinguished from a tummy tuck or abdominoplasty. The abdominoplasty portion is usually a separate cost that insurance does not cover.

Some women turn to plastic surgery for their diastasis recti condition. Plastic surgeons focus on the skin and underlying fatty layer and sometimes will imbricate (cinch-up) the fascia. They may even use overlay mesh reinforcement, but they do not excise the weakened fascia or place the muscles back to their midline position with underlying reinforcement as with abdominal wall reconstruction.

Additional Considerations:

  • Abdominal wall reconstruction for diastasis recti is not commonly offered by general surgeons, so you will need to do some research around your residence.  
  • It’s necessary to be certain you are not planning to become pregnant again.  
  • The abdominal wall reconstruction surgery is usually a 2.5 – 4-hour operation and requires a 2 – 3-day hospitalization.
  • There are temporary drainage tubes that remain for 10 – 14-days, and by two weeks most women are off narcotic pain medications.  
  • By one-month patients feel back to normal, and at 8 weeks you are allowed to begin exercising the abdomen and working on re-establishing core strength.
  • For mild or moderate diastasis recti, physical therapy can be a helpful treatment, and should be a consideration for initial management before surgery is considered. 

In Summary:

If you are experiencing the symptoms of diastasis recti, it’s important to find the right care provider who can fully assess your symptoms and provide sound direction for your future. And if appropriate, abdominal wall reconstruction may be the solution you need to relieve pain and return to an active lifestyle. Re-establishing your core strength is an opportunity to create lifelong impact on your health.


In August of 2021, Proliance Surgeons partnered with Hall of Fame Health to provide healthcare to former NFL players, team employees, and their families.

CANTON, OHIO Hall of Fame Health, an entity of the Pro Football Hall of Fame recently announced the launch of a new designation it is placing on select health care providers, giving them the distinction of becoming a Hall of Fame Elite Care Center.

The first service line to roll out with this designation is orthopedic joint replacements, a natural fit for former football players. The initial group of Hall of Fame Elite Care Centers announced this December includes 25 locations and represents more than 100 physicians and includes such names as the Carrell Clinic in Dallas, NorthShore Orthopedic & Spine Institute in Chicago, Flagler Health+ in Florida and North Valley Surgery Center in Scottsdale. We are pleased to announce that Proliance Surgeons received this distinction as well!

Jeremy Hogue, CEO of Hall of Fame Health, said “Hall of Fame Health would continue adding locations within the joint replacement category. He said the total could reach 50 or more locations around the country, as there are many doctors and cities that they have simply yet to reach. And while that work continues, Hall of Fame Health is setting its sights on other focus areas and specialties it intends to roll out in the near future.”

Proliance Surgeons will continue its partnership with Hall of Fame Health for the foreseeable future and continue to provide exceptional outcomes, personally delivered!

  • Advanced Orthopaedics & Sports Medicine – Houston
  • Advanced Surgery Center of North County – San Diego
  • Andrews Institute for Orthopaedics & Sports Medicine – Gulf Breeze, Fla.
  • Aultman Health – Canton, Ohio
  • Azalea Orthopedics – Tyler, Texas
  • Beacon Orthopaedics & Sports Medicine – Cincinnati
  • Carrell Clinic – Dallas
  • Emory Orthopaedics & Spine Center – Atlanta
  • Flagler Health+ – St. Augustine, Fla.
  • Fondren Orthopedic Group – Houston
  • Midwest Orthopaedics at Rush – Chicago
  • North Central Surgical Center Hospital – Dallas
  • North Valley Surgery Center – Scottsdale, Ariz.
  • NorthShore Orthopaedic & Spine Institute – Skokie, Ill.
  • Proliance Surgeons – Seattle
  • Rothman Orthopaedic Institute - Paramus, NJ
  • Rothman Orthopaedic Institute - Philadelphia, PA
  • Rothman Orthopaedic Institute - New York, NY
  • Rothman Orthopaedic Institute - Orlando, FL
  • Tampa General Hospital, Orthopedics Institute – Tampa, Fla.
  • Texas Orthopaedic Associates – Dallas
  • Texas Orthopedic Hospital – Houston
  • Texas Orthopedics Surgery Center – Austin, Texas
  • Texas Orthopedics Sports & Rehabilitation Associates – Austin, Texas
  • Texas Spine & Joint Hospital – Tyler, Texas
  • Twin Cities Orthopedics – Minneapolis
  • University of California San Francisco Orthopaedic Institute – San Francisco
  • Vanderbilt University Medical Center – Nashville, Tenn.

Located in Canton, Ohio, the birthplace of the National Football League, the Pro Football Hall of Fame is a 501(c)(3) not-for-profit institution with the Mission to Honor the Heroes of the Game, Preserve its History, Promote its Values, & Celebrate Excellence Together.

The Pro Football Hall of Fame is accredited by the American Alliance of Museums. AAM accreditation is national recognition for the museum’s commitment to excellence and the highest professional standards of museum operation and public service.

Hundreds of thousands of fans from across the globe travel to Canton annually to experience an inspirational, interactive museum that chronicles America’s most popular sport.

Hall of Fame Health is an affiliate of the Pro Football Hall of Fame. Its mission is to provide former professional football players and their families with concierge-level access to world-class resources for all aspects of the health care system, from obtaining health insurance and other benefits, to navigating to the best doctors and health systems, and including resources in behavioral health across the various levels of care, including a crisis help line. While serving its football community, it also aims to impact communities across the country.