Featured in NNBW: People: Dr. Nancy Wang joins Nevada ENT and Hearing Associates

Nevada ENT and Hearing Associates announced this month the addition of a new physician in Dr. Nancy Wang.

Wang graduated from Stanford University in 2011, earning her degree in biological sciences, with a focus on neuroscience. She earned her medical degree at University of California, Davis, and completed a five-year residency in Otolaryngology Head and Neck Surgery at University of California, San Francisco.
According to a Nevada ENT press release, she has earned accolades in recent years for her research and academic aptitude, including the Firestone medal, Merck Manual Award, induction into the Alpha Omega Alpha society, and the Muriel Steele Society Honor Roll.

Ask the Doctor- Protect Yourself From Wildfire Smoke!

Check out Dr. Josh Meier on KTVN’s Ask the Doctor – Protect Yourself From Wildfire Smoke!





Nevada ENT and Hearing Associates announced April 19 that Reno Tahoe Sinus Center founder Dr. Josh Meier has been named a Fellow of the American College of Surgeons (FACS).

Dr. Meier was among 1,993 surgeons from around the world to be initiated into the American College of Surgeons (ACS), according to a press release. Dr. Meier brings a highly specialized approach to the area, as he most-senior-fellowship trained rhinologist in Northern Nevada and Northeastern California. Dr. Meier is also the only Fellow of the American Rhinologic Society (FARS) in Nevada.

Dr. Meier is a Northern Nevada native who relocated with his family to practice medicine in his home state. He graduated from medical school from the University of Southern California at the top of his class.

Dr. Meier completed his residency training at the Massachusetts Eye and Ear Infirmary in the Harvard Combined Program in Otolaryngology — Head and Neck Surgery. He then completed a rhinology fellowship (endoscopic sinus and anterior skull base surgery) at Harvard Medical School and MEEI. In 2017, Dr. Meier founded Reno Tahoe Sinus Center.

The ACS is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the quality of care for the surgical patient. The College is dedicated to the ethical and competent practice of surgery.

Its achievements have established it as an important advocate for all surgical patients. The College has more than 82,000 members and is the largest organization of surgeons in the world.

An applicant for Fellowship must be a graduate from an approved medical school; must have completed advanced training in one of the 14 surgical specialties recognized by the College; must possess certification by an American surgical specialty board or appropriate certification by the Royal College of Physicians and Surgeons of Canada; and must have been in practice for at least one year.

Prior to admission into Fellowship, the surgeon must further demonstrate ethical fitness and professional proficiency, and his or her acceptance as a Fellow of the College must be approved by three-fourths of its Board of Regents.

Read More: https://www.nnbw.com/news/2021/apr/29/people-dr-josh-meier-named-fellow-american-college/

Dr. Meier featured on KTVN’s “Ask the Doctor” – discussing COVID-19 and smell loss

Dr. Josh Meier was featured on KTVN’s “Ask the Doctor” on June 8th.  He discussed COVID-19 associated smell loss and what Nevada ENT and the Reno Tahoe Sinus Center are doing to keep our patients safe during the COVID-19 pandemic.


Dr. Meier featured on Channel 2 KTVN’s “Ask the Doctor” Discussing Chronic Sinusitis

KTVN Channel 2 – Reno Tahoe Sparks News, Weather, Video

American Rhinologic Society Press Release Regarding COVID-19

The press release below is from the American Rhinologic Society, and I wanted to include it on our blog in order to provide resources for further reading on how COVID-19 is affecting rhinology.
Josh Meier, M.D. F.A.R.S. F.A.C.S.

Press Release – April 14, 2020
Dear Colleagues,

The fight against COVID-19 is in full swing, and we are beginning to see some peer-reviewed contributions in the literature. These data-driven studies are much stronger than the anecdotal reports we have been forced to rely on in the early stages of the crisis. Specifically, the association of Covid-19 infection with smell loss has been strengthened and I would like to draw your attention to the 3 new articles in IFAR noted below:

The use of google trends to investigate the loss of smell related searches during COVID‐19 outbreak

A primer on viral‐associated olfactory loss in the era of COVID‐19

Association of chemosensory dysfunction and Covid‐19 in patients presenting with influenza‐like symptoms

There have been some encouraging signs in the battle against COVID-19 over the past week. This has caused many us to begin consideration of the question of when and how we can return to some degree of normal operations. There is still much we need to learn about the virus, which will have major implications going forward. We are not clear on when asymptomatic but infected patients are capable of spreading the virus, whether immunity is durable and whether chronic carrier states exist. Moreover, scientists do not yet agree on whether large droplets vs. much smaller aerosols can both serve as mechanisms of SARS-CoV-2 spread. (Lewis, D. Nature vol. 580, 9 April 2020) The answers to these questions will obviously affect both office and operating room policies going forward. To that end, I would like to draw your attention to the below study that begins the process of analyzing aerosol production with the use of common rhinologic tools. The clinical relevance is not yet clear, but studies such as this are a first step back in the direction of normalcy.

Endonasal instrumentation and aerosolization risk in the era of COVID‐19: simulation, literature review, and proposed mitigation strategies

Thank you.

Robert Kern, MD, FARS
American Rhinologic Society

Sinonasal tumors

Tumors of the nasal cavity and paranasal sinuses are not common in the general population, but are commonly encountered in a rhinology practice.  When unilateral symptoms such as nasal obstruction, smell loss and epistaxis are present then evaluation by an otolaryngologist would be prudent.

The most common sinonasal tumor is an inverted papilloma.  These are also known as Schneiderian papillomas.  Fortunately these are benign tumors, but they can turn into squamous cell carcinoma eventually if not excised.  They can occur throughout the nasal cavity and paranasal sinuses.    Inverted papillomas can be quite large, but usually will have a distinct attachment site that can be identified on CT imaging by looking for an area of hyperostosis.  MRI imaging is helpful to further define the extent of tumor and to distinguish between tumor and blocked secretions.  Most tumors can be excised using traditional endoscopic sinus surgery techniques, and extended endoscopic approaches such as frontal sinus drillout and endoscopic medial maxillectomy can be used to remove tumors without external incisions.  Treatment of the attachment site should be treated with excision, drilling or cauterization to ensure complete removal of all of the tendrils of tumor to prevent recurrence.

Allergic fungal sinusitis can mimic a tumor with its unilaterality, however it is uncommon in the West.

Sinonasal malignancies are thankfully rare (1:500,000 to 1:1,000,000), but prompt diagnosis and management are key to ensure survival.  Squamous cell carcinoma, melanoma, sinonasal undifferentiated carcinoma, esthesioneuroblastoma, lymphoma and adenocarcinoma are the most common sinonasal malignancies.  For most sinonasal malignancies, except lymphoma, treatment is usually surgical resection, and depending on the tumor pathology, post operative radiation and chemotherapy.


Josh Meier, M.D. F.A.R.S.

Endoscopic Septoplasty

Endoscopic septoplasty is a newer technique where an endoscope is used to visualize the nasal cavity to straighten the nasal septum. Most people’s septum will be deviated to one side or the other, which is not a cause for concern. However in some people the deviation is significant enough that it results in nasal obstruction. If this is the case, then they would be a candidate for septoplasty. The incision is made on the side of the deviation, 1-2cm back from the most forward part of the septum. The mucosa is lifted up on this side, then the cartilage is incised and the flap is lifted on the other side. Deviated bone and cartilage is removed, and the deviation is reduced. The flaps are stitched together with an absorbable mattress suture. The vast majority of the time, stents and packing are not required.   This results in minimal post op pain, and Tylenol is adequate for postoperative pain control.   Neilmed rinses are begun the next day.   Not all people are candidates for endoscopic septoplasty, namely those with significant forward deviations, where a traditional approach is indicated. Please see the link below for an intraoperative video.   Frequently endoscopic septoplasty is performed concurrently with endoscopic sinus surger.y  In fact, inadequate septoplasty can be a reason for failure of surgery due to limited visualization of the sinuses while performing endoscopic sinus surgery.


Josh Meier, M.D. F.A.R.S.



Dr. Meier and Dr. Tolbert attend course on advanced endoscopic skull base techniques

Dr. Meier and Dr. Marshall Tolbert of Sierra Neurosurgery attended the University of Pittsburgh’s Endoscopic Endonasal Skull Base Course in December of 2018.  This four day course discussed the state of the art techniques involved in endoscopic management of cranial base disorders such as benign and malignant nasal tumors, CSF leaks, pituitary and other ventral skull base tumors.  The course involved lectures, prosections, live surgery and hands on dissections. This meeting was attended by dozens of rhinologists and neurosurgeons from around the world.  Dr. Meier and Dr. Tolbert are excited to return to Reno with the latest techniques to treat pituitary tumors in a minimally invasive fashion.