2018 Annual Message From The Chair
It is hard to believe that this is the 14th time I have issued an annual state-of-the-department report – tempus fugit! With each passing year I realize more and more the reasons why Stanford Otolaryngology-Head & Neck Surgery (OHNS) is special. We are blessed with a warm and collegial culture among our community of 286 faculty, trainees, and staff. We strive for, and achieve, excellence in all of our core missions: clinical care, education, and research. In clinical care, we have depth, breadth, and high levels of expertise in all of the specialty areas of contemporary OHNS. We enjoy the finest clinical facilities at Stanford and cutting edge technology in our clinics and operating rooms. Our remarkable group of clinician-scholars in training ensures a bright future for our field. Our peerless basic and translational science faculty are both immensely creative and highly productive.
Statistical Abstract 2018
Clinically, we have thriving faculty practices with 5,189 operative procedures (3152 adult, 2037 pediatric) and clinic visits of 25,538 adult (11,179 new patients) and 11,175 pediatric (3950 new patients). Our 53 Faculty and 21 Residents contributed some 222 peer reviewed publications in 2017. Our basic and translational researchers have 64 Extramural grants including 11 NIH R-01s, U01, P30, DoD, CIRM, etc. As we enter 2018 we are listed in the top 10 in US News (#9) and in the top 5 in NIH awards (#4). We are pleased that 2017 has been a highly productive year and look forward eagerly to 2018.
The core strength of Stanford OHNS is its outstanding faculty. In 2003, the year we became a department, we had 5 faculty. We begin 2018 with 53 faculty at Stanford (16 Professors, 6 Associate Professors, 21 Assistant Professors, 10 Instructors with an additional 5 affiliated faculty at the Santa Clara Valley Medical Center. We also have an increasing panel affiliates in our University Health Care Alliance offices in San Ramon and San Jose.
Stanford OHNS is well represented among the medical center and school leadership. Lloyd Minor is the School of Medicine Dean. Eben Rosenthal is the Ann & John Doerr Medical Director of the Stanford Cancer Center and Associate Director of Clinical Care for the Stanford Cancer Institute. Ed Damrose has begun his three year term as Stanford Health Care Chief of the Medical Staff this year and Peter Koltai is a recent past Chief of the Medical Staff at Stanford Children’s Hospital.
Welcoming New Faculty in 2017
During 2017, we welcomed 7 new faculty
Jon-Paul “JP” Pepper joins us after serving for 4 years on the USC faculty. Both his residency and facial plastic surgery fellowship were at University of Michigan. He also did a masters in stem cell biology and regenerative medicine at USC. JP now leads the Stanford Multidisciplinary Stanford Facial Nerve Center and conducts research in nerve healing and regeneration.
Iram Ahmad joins us after her residency and pediatric fellowship at the University of Iowa. She also did a masters in medical education at Iowa. Her clinical interest is in pediatric otology and she plans to study the auditory implications of CMV infection.
Tulio Valdez joins us after serving for 8 years on the University of Connecticut faculty. His residency was at Tufts and his pediatric fellowship at the Baylor-Texas Children’s Hospital. He also did a masters in clinical and translational research at UConn. Tulio’s research focuses on the development of short wave infrared imaging of middle ear pathologies.
Karuna Dewan joins us following her residency at the University of Tennessee and 2 year laryngology/swallowing fellowship at UCLA. She has both clinical and research interests in swallowing disorders and chronic cough.
Misha Amoils was both a Stanford undergraduate and completed our OHNS residency in June 2017. She joins our affiliated faculty at the Santa Clara Valley Medical Center and also contributes to resident teaching at the Palo Alto VA Medical Center.
Peter Santa Maria did his OHNS residency and PhD at the University of Western Australia. He spent 3 years as instructor in neurotology at Stanford during which he participated in both the Biodesign and SPARK (drug discovery) programs. After 3 years on faculty at the University of Western Australia he joins the Stanford faculty. His special interests include regeneration of the tympanic membrane and medical device development.
Kristen Steenerson trained in neurology at the Mayo Clinic and took advanced training in oto-neurology. She has special interests in vestibular disorders, vestibular migraine, and tinnitus. Her research involves refining the use of vestibular testing.
Recruitments underway for 2018
In 2018 we expect to add 3 additional faculty with searches underway in head and neck/ endocrine surgery (2) basic science as well as expanding our affiliated network in the South Bay and East Bay regions.
Our immensely talented trainee population includes 21 OHNS residents, 2 ACGME accredited fellows (pediatrics, neurotology), and 9 instructors (head & neck surgery, sinus surgery (2), facial plastics surgery, pediatric, laryngology, sleep surgery, and neurotology (2). We also have a number of graduate students, post-doctoral research fellows, instructors, and visiting scholars. Dozens of Stanford and visiting medical students are on rotation throughout the year.
We are in the second year of our NIH funded program (T32), intended to produce scientist-surgeons is under the faculty leadership of Alan Cheng. This program allows selected residents and fellows to undertake 2 years of funded research in addition to their 5 clinical years. Our T-32 research training program now has two tracks. One is a 7-year residency research track, which combines 5 years of clinical training in OHNS with 2 years of research training starting after the PGY2 year. The second is a 2-year post-residency track, which will be used to provide a research experience for those individuals that desire an extended research experience after residency training. Both tracks are post-doctoral fellowships for otolaryngology residents, with the main difference being that the first track has the research block in the middle of residency training and the second track has the research block after residency has been completed. Both tracks provide guidance on how to balance research and clinical responsibilities in order to prepare the trainees to become independent physician-scientists. Grace Kim (resident) and Taha Jan (fellow) are now engaged in research in our T32 program and both Jason Qian (R-2) and Tina Munjal (R-1) will join in coming years.
To accommodate this new program, and our departmental growth, Stanford OHNS was approved by the Otolaryngology Residency Review Committee (RRC) to increase from 4 to 5 residents per year starting in 2017 for a total of 25 residents in our program by 2021. In late 2017, Vice Chair Anna Messner was been elected to the OHNS RRC.
Many of our residents and fellows take advantage of the rich educational environment of Stanford. The Stanford Society of Physician Scholars provides training and mentoring core academic skills through evening sessions throughout the year. The SPECTRUM 1 week intensive course in clinical research educates on study design and performance. A number of our trainees and faculty have participated in the renowned Stanford Biodesign program which teaches medical device innovation and entrepreneurship.
The exceptional quality of today’s trainees insures that the future of our specialty will be in the best of hands. Our residents are having great success in obtaining fellowship positions and the graduates of our instructor/fellow programs obtain excellent faculty positions. Among our residency graduating class of 2017, 3 graduates went on to sub-specialty fellowship (2 rhinology, 1 FPS) and one joined the affiliated Stanford faculty at the Santa Clara Valley Medical Center.
2017 OHNS Residency Graduates
- Misha Amoils: Stanford Faculty at SCVMC
- Dan Beswick: Rhinology Fellowship OHSU
- Hollin Calloway: Facial Plastics Fellowship UCI
- Amelia Clark: Rhinology Fellowship, Kaiser
We have undertaken a number of initiatives designed to enhance the educational value of our website. OHNS grand rounds and CME courses are available online on our departmental website and iTunes channel. Over 2000 original illustrations are online in our skull base, neurotology, and otology atlases. We are in the midst of expanding this resource to encompass all of OHNS.
Nik Blevins and a team of computer scientists and engineers have created a haptic reinforced sinus and temporal bone surgical simulator. Our Perkins Microsurgery Teaching Laboratory has newly installed LED based microscopes with high definition video displays. Kwang Sung utilized the microsurgery lab for performing a phonomicrosugical simulation study with the residents. Twice a year Dr. Jennifer Lee, who is trained in surgical simulation, leads all OHNS residents through varied simulations such as “anaphylaxis” and “angioedema.” For student use, we purchased two otoscopy simulators; one for the department and the other was donated to the medical school’s simulation facility.
We have completed our departmental introductory textbook, a multi-authored work created entirely by our faculty and trainees and are in the process of making it available online. It goes under the title SOITO: Stanford Online Interactive Textbook of Otolaryngology. (http://enttextbook.stanford.edu) The text is targeted primarily for medical students, beginning residents, and patients interested in a reliable source of sophisticated medical information. The concept is to make available a well-illustrated online text, continuously updated, and made freely available to trainees and patients worldwide. Under the editorial leadership of Dr. Jennifer Lee this 72-chapter project has taken a couple of years to produce and has several hundred original illustrations.
Working with the Stanford Faculty Development Center (SFDC), we launched our surgical teaching course in 2014. Anna Messner, an SFDC-trained facilitator, leads an annual teaching course oriented to teaching skills in the operating room to new OHNS faculty, fellows and the chief residents.
About twenty Stanford students rotate in our department as part of the general surgery core clerkship; and approximately 20 sub-interns come from other institutions. Our visiting sub-intern rotation has become very popular, highly competitive, draws high outstanding applicants from around the country.
Stanford OHNS Research Overview
Stanford is a research intensive school of medicine and we are a research intensive department. Our commitment to basic and translational research is well illustrated by the growth of our annual research budget from under $5,000 (2003) to over an estimated $10 million in 2017. In 2017, Stanford OHNS is ranked #4 nationally in NIH funding. We have some 12,000 sq. ft. of research space with our major laboratory in the Edwards building and additional facilities in Lokey Stem Cell, Grant, and CCSR buildings. Most will coalesce into the new Biomedical Innovations Building starting construction this year with anticipated occupancy in early 2020.
In late 2017, departmental faculty have more than 64 competitive extramural grants and are principal investigator on 11 NIH R-01s, U01, 2 DoDs, a CIRM award, and 18 industry grants. Our basic science research community consists of 110 faculty, post-docs, researchers, students and other trainees.
At our 8th annual research retreat in October, the entire department participated and each of our faculty presented their research plans for the coming year. Both extramural funding and philanthropy remain strong. Trainees present their research progress as part of our annual graduation ceremonies each June.
The central theme of Stanford OHNS basic and translational research is to seek a better understanding of diseases in our field and inventing new therapies. Our research group, which is a mixture of basic scientists and surgeon – scientists, enjoys numerous collaborations throughout Stanford bioscience and technology. A major thrust of our research is to overcome hearing loss through regenerative means. To achieve this goal we have created the Stanford Initiative to Cure Hearing Loss, which is a long term, goal oriented, multidisciplinary research effort.
Formed an OHNS specific Biodesign group (“Otoinnovation”) of faculty and trainees in collaboration with Stanford’s Biodesign program. Led by Robson Capasso and joined by our Biodesign trained faculty Drs. Sidell, Santa Maria, Sirjani, Alyono, and Vaisbuch. (http://otoinnovation.stanford.edu) The goal of Otoinnovation is to educate Stanford trainees, faculty, post-docs and visiting research scholars in the innovation process and provide opportunities for industry and other partners to engage in any of its steps. The OHNS department at Stanford has been involved in numerous activities in partnership with the Byers Center for Biodesign and the Stanford SPARK program since its inception. This includes hosting immersion processes, mentoring for domestic and international students and fellows, leading clinical studies and bridging the gap between academia and industry. Our department is likely to have the highest number of faculty and trainees with formal education on Biodesign methodology per capita in the School of Medicine and currently has several ongoing SPARK projects, including one taken through to license by a major pharmaceutical company.
Please see our annual Research Report for greater detail
In 2017, OHNS has received over 200 gifts from grateful patients and individuals who share our passion for research and innovation. We are supported by Dr. Clifford Harris of the Office of Medical Development, who works closely with both our faculty and our generous donors. New gifts and pledges in 2017 exceeded $6,000,000, representing a trend of increasing donor support of our preeminent research programs.
If you would like to learn how you can support us in coming years, please contact Dr. Harris at (650) 721-5659 or visit our website: med.stanford.edu/ohns
Perkins Microsurgical Laboratory
Our clinical services continue their traditional growth annually – a trend which has been sustained annually for over a decade. Our focus is on high quality tertiary care of complex diseases in the head and neck region. We have 8 clinical divisions: facial plastics, head & neck surgery, laryngology, otology/neurotology, pediatric, rhinology, sleep surgery, and comprehensive ENT. Space does not permit a full accounting of our areas of expertise, but I will highlight a few noteworthy examples.
Our clinical programs are housed in a number of locations. Laryngology, rhinology, facial plastic surgery, and comprehensive ENT are all housed in our departmental home building at 801 Welch Road on the Stanford campus. Our head and neck surgery program occupies most of the 3rd floor of the Blake-Wilbur building adjacent to our home building. Across the street are our pediatric clinics at the Mary Johnson Center with additional pediatric clinic space in Los Gatos. Otology/neurotology and pediatric otology are situated at the Stanford Ear Institute at Watson Court and sleep surgery at our Redwood City satellite.
In our Head & Neck Surgery Division Chief, Chris Holsinger, leads our innovative transoral robotic program in which he is joined by Drs. Damrose, Capasso, and Sirjani. Lisa Orloff heads our very active thyroid-parathyroid program and is internationally renowned for her expertise in ultrasound. She is joined in head and neck endocrine surgery by Drs. Sunwoo and Holsinger. Dr. Davud Sirjani focuses on salivary gland surgery while Dr. John Sunwoo has special expertise in melanoma. Vasu Divi and Eben Rosenthal expertly perform microvascular free flap reconstructions. Michael Kaplan is our highly versatile, extremely busy, senior head and neck cancer surgeon. Speech therapist Ann Kearny provides care for post-laryngectomy voice restoration patients and Heather Starmer supports patients with swallowing disorders.
In our Rhinology Division, Chief Peter Hwang is constantly surrounded by international observation and our residents have begun calling it the “Hwangterage.” Peter has a busy practice of complex endoscopic sinus surgery, often taking on the most challenging cases. Both he, Drs. Jayakar Nayak and Zara Patel collaborate with neurosurgical colleagues on minimally invasive endoscopic skull base surgery including a substantial census of pituitary tumors. Dr. Nayak helped to develop a transnasal approach to the odontoid. The Stanford Sinus Center provides integrated care including cone beam CT imaging and allergic management by allergy specialists on site.
In our Laryngology Division, Chief Ed Damrose has special interests in rehabilitation of laryngeal paralysis and cancer of the larynx. His colleague Dr. Kwang Sung does a wide array of in office laryngeal procedures, including those requiring use of the laser. Kwang also has a strong interest in care of the professional voice, especially in entertainers. Dr. Karuna Dewan manages a wide spectrum of voice problems and has a special interest in swallowing disorders and chronic cough. Speech therapist Elizabeth DiRenzo provides care for a wide range of voice disorders.
In our Sleep Surgery Division, Chief Robson Capasso tackles a wide variety of procedures to alleviate obstructive sleep apnea and snoring. Dr. Capasso is especially sophisticated in management of sleep disorders as he is dual trained in sleep medicine and sleep surgery. His colleague Dr. Stanley Liu, an MD/DDS oral surgeon specializes in reconstruction of the facial skeleton, such a maxillomandibular advancement, to open severe constrained upper airways.
In our Pediatric Division, Chief Anna Messner is highly experienced in the management of a wide variety of ear, nose and throat disorders in children. She has a long-standing interest in velopharyngeal insufficiency. Peter Koltai focuses his interest on complex sleep disorders in children while Douglas Sidell tackles even the most challenging aerodigestive tract disorders. Mai Thy Truong is a highly skilled pediatric ENT able to handle a wide spectrum of children’s otolaryngology problems with a special interest in vascular malformations. Dr. Truong and Dr. Kay Chang oversee a dedicated microtia clinic and together they are surgically creating superb ear reconstructions. Tulio Valdez clinical interests include swallowing disorders and sinus problems in cystic fibrosis. Drs. Chang, Cheng, and Ahmad focus on pediatric otology (see below).
In our Facial Plastics Division, Chief Dr. Sam Most has built a highly successful aesthetic and reconstructive facial plastic surgery practice. Sam, who is known for his refined aesthetic sense and technical excellence, has special interests in rhinoplasty and rejuvenation of the aging face. Dr. JP Pepper also offers the full spectrum of aesthetic services and also leads of Multidisciplinary Facial Nerve Disorders Program. Oral surgeon Dr. Stanley Liu has a special interest in facial trauma and computer assisted, minimally invasive repair of facial fractures.
In our Otology-Neurotology Division located in the Stanford Ear institute (SEI), Chief Nikolas Blevins is a renaissance surgeon handling all aspects of ear care and microsurgery. Our surgical otologists (Drs. Blevins, Santa Maria, and Jackler) are joined by our two very capable medical otologists (Drs. Shinn and Shorago). Dr. Steenerson is a neurologist who specializes in care of vertigo, balance disorders, and tinnitus. Dr. Lloyd Minor, our Stanford Medical School Dean, also is a member of our Otology-Neurotology Division. Our SEI satellite office in San Jose houses the practice of Dr Sajjadi. Matt Fitzgerald, Chief of Audiology, oversees a large group of audiologists who provide diagnostic and rehabilitative services. The Children’s Hearing Center includes Drs. Kay Chang, Alan Cheng, and Iram Ahmad. Our very active cochlear implant center includes 5 surgeons (Drs. Blevins, Santa Maria, Chang, Cheng, and Ahmad).
In our Comprehensive Otolaryngology Division faculty members Drs. Jennifer Lee and Uche Megwalu expertly manage a wide spectrum of otolaryngology medical and surgical diseases. Dr. Lee has a special interest disorders of the Eustachian tube and has now performed many endoscopies and balloon therapies of this structure. Dr. Megwalu is focused upon enhancing health literacy and addressing disparities of care.
Biomedical Innovations Building
Future home of OHNS Research Laboratories in early 2020
The New Stanford Health Care and Stanford Children's Hospitals
Stanford Medicine is very much looking forward to occupying two splendid, state-of-the-art new hospitals which are in advanced stages of construction. The spectacular new Lucille Packard Children’s Hospital opens in December 2017 with the state-of-the-art new surgical suites to follow in spring 2018. The new Stanford Hospital is anticipated to open in early 2019. This $3+ billion project will provide many more ICU beds and operating rooms and have private room for all patients.
Stanford OHNS scholars have remained highly productive this year. PUBMED lists 222 peer reviewed publications for Stanford OHNS in 2017, which does not include books, chapters, abstracts, or editorials. Working with our departmental web designer Crystal Chen, we have comprehensively modernized our websites. Our research community has been especially creative in using latest web design elements (https://med.stanford.edu/ohns/research/labs).
Global Health Programs
We have an ongoing collaboration between with the University of Zimbabwe. Peter Koltai and Lisa Orloff are the most recent faculty members to visit (we have sent a total of 5 faculty members.) Our goal is to send 1-2 faculty members a year. With local faculty and supported by an American donor, Dr Koltai has been creating the countries first pediatric OHNS center.
The Chief of OHNS at the University of Zimbabwe (Clemence Chidziva) visited Stanford in 2015 leading to two junior Zimbabwe faculty visiting Stanford OHNS in each of the last 2 summers (2016, 2017). These learning experiences have been funded by the Stanford Center for Innovation in Global Health, the OHNS department, and the physicians were hosted by Koltai family.
Sam Most organizes an annual humanitarian mission to Phnom Penh, Cambodia, in conjunction with Face-to-Face, an organization within the American Academy of Facial Plastic and Reconstructive Surgery. Patients treated include adults and children with congenital, post-traumatic and post-ablative defects. On his most recent trip Dr. Most was assisted by one of the Stanford OHNS residents and Elise, his daughter who is a Stanford student.
For the second time this year, we moved our alumni event at the American Academy of Otolaryngology-Head & Neck Surgery from Tuesday to Sunday evening. Gratitude to faculty member Mai Thy Truong who hosted in Chicago this fall and has generously offered to host again in 2018 at the AAO-HNS meeting in Atlanta.
Stanford Departmental OHNS History
I recently came across a 1962 Stanford Otolaryngology residency description for applicants. The program took 2 residents per year (5 today) and lasted 3 years. Our residency is now 5 years and most graduates take 1-2 years of fellowship after.
The brochure recommends that new residents “buy a 2-3 bedroom house in Palo Alto, usually around $17,000, or rent one for $150 - 200 per month.” That same house today would likely sell for $2,000,000+ and rent for over $5000. Keep in mind that at the time residents had minimal stipends, but the hospital washed their shirts for free.
Visiting professor Albert Mudry, who is probably the only otolaryngologist who also has earned a PhD in history, and I are writing a history of Stanford OHNS. This spans from the Stanford predecessor schools in the 19th century to the present and will be close to 50 pages long. We have compiled a list of discoveries and inventions introduced by department members and also a complete roster of Stanford OHNS residents since the program was founded in 1909. We expect to have a comprehensive history on our website in the near future.
Individuals or families interested in supporting our research programs are welcome to join us to meet our faculty and tour our laboratories.
Alumni are always welcome to return to “The Farm” for a visit!
Please email me at email@example.com and we can set up a time for a chat and a tour.
— Robert K. Jackler, MD Sewall Professor & Chair (December 1, 2017)