Mission and Philosophy

Our goal at Stanford Otolaryngology-Head and Neck Surgery is to provide
an enriching and inspirational environment for future physician leaders to

• Foster dedication to life-long learning and teaching
  
  
• Excel at state-of-the art medical care for patients with
  otolaryngological diseases
  
  
• Provide patient care with both expertise and compassion 
  
  
• Take an investigative approach to the scientific and
  policy questions in medicine
  
  
• Strive to invent new approaches to diagnosis and therapy
  
  
• Work to implement and optimize emerging technologies
  
  
• Be active world citizens in the provision of health care to
  those most in need

Resident Rotation Schedule

Key
SUH – Stanford University Hospital
PAVA – Palo Alto Veterans’ Administration
LPCH – Lucile Packard Children’s Hospital
NSU- Neurosurgery
ED – Emergency Department

We follow all ACGME guidelines for duty hours. 
All call for the PGY2 through PGY5 years is from home. 
Call for the PGY1 year varies by rotation.

SPECIALTIES

Head & Neck Surgery

Residents have an active role in the evaluation and management of head and neck cancers. The bulk of this experience occurs at the Stanford campus, and Palo Alto Veterans’ Administration Hospital where there are several hundred new head and neck cancer patient visits per year. In addition to formal grand rounds and teaching rounds relating to head and neck cancer, there is a multidisciplinary Tumor Board, consisting of surgeons, radiation therapists, oncologists, maxillofacial surgeons, speech therapists, neuroradiologists and pathologists which meet to discuss all new head and neck cancer patients. Besides allowing for careful clinical diagnosis and treatment planning, this Tumor Board affords an excellent opportunity for didactic teaching. Active involvement by medical students, residents, and faculty is solicited.

Facial Plastic & Reconstructive Surgery

The training program provides significant exposure to patients with congenital and acquired facial deformities. Under the guidance of three facial plastic surgeons, residents learn techniques of facial reanimation, scar revision, and facial reconstruction following trauma and cancer excision. There is also exposure to patients desiring facial rejuvenation, and residents learn the latest techniques of facial cosmetic surgery.  Special emphasis is placed on functional and aesthetic nasal analysis for rhinoplasty patients.

In addition to the regular Facial Plastic Surgery Conferences, there are two weekly clinics at Stanford dedicated solely to these services. A yearly Facial Plastic Surgery Course is held each Fall.  Facilities include computer facial imaging, and a procedure room for aesthetic facial surgery, including state-of-the-art laser and IPL treatments. Additional reconstructive experience is gained at the Santa Clara Valley Medical Center and Veterans Affairs-Palo Alto.

Otology, Neurotology and Skull Base Surgery

The centerpiece of the otology education program is at the Stanford campus. Residents are trained in the care of patients with otologic, neurotologic, vestibular, and skull base disorders, actively participating with teams of neurotologists, otologists, and audiologists in patient care. In addition to a programmed reading course, there are several educational conferences: Otology Grand Rounds, Weekly Chart Discussion, Journal Club, Audiology Rounds, Skull Base Grand Rounds, and Neuroradiology Grand Rounds.

Surgical skills are further honed through a comprehensive Temporal Bone Surgical Dissection Course. Additional otologic surgical experience is afforded at the Santa Clara Valley Medical Center and Kaiser Permanente.

Inner Ear Fluorescence Microendoscopy

Collaborators: 
| Mark Schnitzer PhD | Gerald Popelka PhD | Jeurgen Jung MS | Ashkan Monfared MD |

We are developing a method to visualize functional hair cells and other cellular elements of the inner ear within the intact mammalian cochlea using fluorescence microendoscopy. Our laboratory has begun work on this minimally invasive in vivo imaging technique to provide high-resolution images of deep tissues previously inaccessible in live subjects.  Using microendoscopes as small as 0.3 mm in diameter, we have successfully imaged individual red blood cells flowing within capillaries inside the mammalian cochlea.   We are extending this work by labeling functional neural elements with fluorescent dyes to concurrently reveal mechanotransduction and electrical stimulation, as well as microanatomy.

An imaging technology to observe functional hair cells and dendrites within live mammalian subjects will provide considerable benefit, and enable progress in a broad range of previously intractable hearing science questions.  The success of inner ear microendoscopy will provide a basis on which inner ear surgery can be established.  The development of non-destructive imaging techniques will enable diagnostic and therapeutic manipulations, including the optimal placement of cochlear implant arrays, or the specific delivery of stem cells or growth factors to enable hearing restoration.

Surgical Simulation

Collaborators:
| Kenneth Salisbury PhD | Federico Barbagli PhD | Sumit Agrawal MD |

We have developed a virtual surgery environment for skull base surgery to augment surgical education and provide for preoperative rehearsal of procedures.  In order to be safe and effective, the skull base surgeon must have a complete understanding of the intricate anatomy involved.  Such an understanding is difficult to acquire from traditional two-dimensional media.  Similarly, the surgical technique of working within this confined space in close proximity to vital neurovascular structures is difficult to convey within the setting of actual surgery.  For these reasons, the application of an immersive computer simulation environment is a natural fit for providing education in this surgical subspecialty.

In collaboration with the Biorobotics group, we now have a working system for virtual skull base dissection, incorporating anatomically accurate stereoscopic models,  and a touch-feedback (haptic) interface.  Innovative simulation techniques have been incorporated to maximize its realism and educational utility.  Such features include systems for innovative high resolution volumetric graphic rendering, a custom-developed simulation environment and user interface, and the potential for networked haptics – allowing multiple user s to manipulate and “feel” the same anatomic simulation.  The system also incorporates a scripting language through which an instructor can establish the expected flow of the surgical procedure.  Through the application of empirically determined metrics that define safe and effective surgery, the user can receive timely feedback regarding performance.  Currently, we are incorporating preoperative patient-specific data to allow for rehearsal of planned procedures.

Mathematical Modeling of Cochlear Biomechanics

Collaborators: 
| Sunil Puria PhD | Charles Steele PhD |

We are designing a computational model of inner ear mechanics to understand the mechanisms that support the highly sensitivity, dynamic, and non-linear properties of normal hearing.  This understanding will allow the functional characterization of alterations arising from a variety of cochlear disorders and from therapeutic interventions.  We will develop an anatomically based three-dimensional computational model for the cochlea that incorporates the details of the micro-mechanics of the hair cells, neurons, supporting structures, membranes, and surrounding fluid environment. The model is based on previous work by Dr. Steele.

A systematic and comprehensive computational model of inner ear mechanics will provide the basis for addressing a number of clinically important issues.  For example, we will be able to predict the mechanical effect of cochlear implant array placement, and how it may influence residual acoustic hearing in the implanted ear.  Such data may help us to develop more effective acoustic-electric hybrid prostheses for individuals with high frequency hearing loss.  Similarly, we will explore the mechanical sequellae of endolymphatic hydrops, and the degree to which this could contribute to hearing loss in Meniere’s disease.  With the anticipated  advent of micro-robotics, otologists will develop technology to manipulate the organ of Corti in an attempt to improve hearing. The benefit of this exciting future technology can only be fully realized if therapy is grounded a clear understanding of cochlear mechanics as will be provided by our project.  Another important future technology for hearing restoration is the regeneration of cochlear sub structures through the introduction and differentiation of stem cells. The yet unknown mechanical consequences on hearing of these regenerative efforts can be explored in the proposed biomechanical framework.

Rhinology

The Division of Rhinology offers a broad clinical experience in endoscopic sinus surgery, endoscopic skull base surgery and allergy. Residents rotate on the service during their R2, R4, and R5 years. The surgical case load includes primary sinus surgery, revision sinus surgery, frontal sinus surgery, endoscopic benign and malignant tumor resection, endoscopic pituitary surgery, and extended skull base approaches. Surgical navigation technology is used extensively. The operative experience is hands-on within a structured teaching environment. Residents also participate in preoperative and postoperative care in the outpatient rhinology clinic. A separate allergy clinic offers training in testing and treatment of inhalant allergy. Research opportunities are abundant and include the following topics: electrophysiologic characteristics of chronic sinusitis epithelium; ciliary regeneration in a rabbit model of sinus surgery; adaptive immunity in chronic sinusitis; clinical outcomes of sinus surgery; and novel models of surgical simulation.

Allergy

Over recent years, there has been an increase in allergic disorders to epidemic proportions in children and adults. Many studies have determined that the immune system in patients with allergies (also called atopy), such as asthma, atopic dermatitis, food allergies, allergic rhinitis, allergic conjunctivitis and other atopic disorders, is overactive and skewed toward a certain subtype of immune cell called the Th2 cell. So far, there is a lack of understanding on how cells turn off this abnormal proliferation and activation of the Th2 cell.  The Nadeau laboratory has found that a type of cell called the natural regulatory T cells (nTreg) can decrease Th2 cell overactivation in allergies and this leads to reversal or improvement of the allergic condition.  

By understanding how Treg work, we hope to establish new diagnostic and therapeutic approached to prevent and treat allergic conditions. The Nadeau laboratory maintains a database and sample/tissue bank of healthy controls and patients treated at LPCH/Stanford Medical Center with allergic disorders. There are three main foci of the laboratory 1) since most allergic conditions start in childhood, we are examining the role of Th2 and Treg in different age groups with and without atopy, 2) since the activity of Th2 and Treg is determined by their interactions with other cell types, such as epithelial cells and dendritic cells, we are studying their effects on Th2/Treg interactions, and 3) since improvement of Treg function is associated with improvement of allergic conditions, we are designing new treatments (for example, sublingual immunotherapy, small molecule chemokines) that enhance Treg function.

Inner Ear Fluorescence Microendoscopy

Collaborators: 
| Mark Schnitzer PhD | Gerald Popelka PhD | Jeurgen Jung MS | Ashkan Monfared MD |

We are developing a method to visualize functional hair cells and other cellular elements of the inner ear within the intact mammalian cochlea using fluorescence microendoscopy. Our laboratory has begun work on this minimally invasive in vivo imaging technique to provide high-resolution images of deep tissues previously inaccessible in live subjects.  Using microendoscopes as small as 0.3 mm in diameter, we have successfully imaged individual red blood cells flowing within capillaries inside the mammalian cochlea.   We are extending this work by labeling functional neural elements with fluorescent dyes to concurrently reveal mechanotransduction and electrical stimulation, as well as microanatomy.

An imaging technology to observe functional hair cells and dendrites within live mammalian subjects will provide considerable benefit, and enable progress in a broad range of previously intractable hearing science questions.  The success of inner ear microendoscopy will provide a basis on which inner ear surgery can be established.  The development of non-destructive imaging techniques will enable diagnostic and therapeutic manipulations, including the optimal placement of cochlear implant arrays, or the specific delivery of stem cells or growth factors to enable hearing restoration.

Surgical Simulation

Collaborators:
| Kenneth Salisbury PhD | Federico Barbagli PhD | Sumit Agrawal MD |

We have developed a virtual surgery environment for skull base surgery to augment surgical education and provide for preoperative rehearsal of procedures.  In order to be safe and effective, the skull base surgeon must have a complete understanding of the intricate anatomy involved.  Such an understanding is difficult to acquire from traditional two-dimensional media.  Similarly, the surgical technique of working within this confined space in close proximity to vital neurovascular structures is difficult to convey within the setting of actual surgery.  For these reasons, the application of an immersive computer simulation environment is a natural fit for providing education in this surgical subspecialty.

In collaboration with the Biorobotics group, we now have a working system for virtual skull base dissection, incorporating anatomically accurate stereoscopic models,  and a touch-feedback (haptic) interface.  Innovative simulation techniques have been incorporated to maximize its realism and educational utility.  Such features include systems for innovative high resolution volumetric graphic rendering, a custom-developed simulation environment and user interface, and the potential for networked haptics – allowing multiple user s to manipulate and “feel” the same anatomic simulation.  The system also incorporates a scripting language through which an instructor can establish the expected flow of the surgical procedure.  Through the application of empirically determined metrics that define safe and effective surgery, the user can receive timely feedback regarding performance.  Currently, we are incorporating preoperative patient-specific data to allow for rehearsal of planned procedures.

Mathematical Modeling of Cochlear Biomechanics

Collaborators: 
| Sunil Puria PhD | Charles Steele PhD |

We are designing a computational model of inner ear mechanics to understand the mechanisms that support the highly sensitivity, dynamic, and non-linear properties of normal hearing.  This understanding will allow the functional characterization of alterations arising from a variety of cochlear disorders and from therapeutic interventions.  We will develop an anatomically based three-dimensional computational model for the cochlea that incorporates the details of the micro-mechanics of the hair cells, neurons, supporting structures, membranes, and surrounding fluid environment. The model is based on previous work by Dr. Steele.

A systematic and comprehensive computational model of inner ear mechanics will provide the basis for addressing a number of clinically important issues.  For example, we will be able to predict the mechanical effect of cochlear implant array placement, and how it may influence residual acoustic hearing in the implanted ear.  Such data may help us to develop more effective acoustic-electric hybrid prostheses for individuals with high frequency hearing loss.  Similarly, we will explore the mechanical sequellae of endolymphatic hydrops, and the degree to which this could contribute to hearing loss in Meniere’s disease.  With the anticipated  advent of micro-robotics, otologists will develop technology to manipulate the organ of Corti in an attempt to improve hearing. The benefit of this exciting future technology can only be fully realized if therapy is grounded a clear understanding of cochlear mechanics as will be provided by our project.  Another important future technology for hearing restoration is the regeneration of cochlear sub structures through the introduction and differentiation of stem cells. The yet unknown mechanical consequences on hearing of these regenerative efforts can be explored in the proposed biomechanical framework.

Pediatric Otolaryngology

The pediatric otolaryngology portion of the residency training is centered at Lucile Salter Packard Children's Hospital . A pediatric otolaryngology and audiology clinic is located at the children's hospital.

In addition to learning about common pediatric otolaryngology problems such as ear infections, tonsillitis, and sinusitis, residents will learn how to evaluate children with voice disorders, airway obstruction, hearing loss, nasal and/or neck masses and other less common otolaryngology problems. In addition, residents will learn how to care for otolaryngology problems in children with multiple congenital anomalies, as well as those who have undergone organ transplants, and have inherited diseases such as cystic fibrosis.

FACILITIES

Stanford University Medical Center

Department of Veterans Affairs-Palo Alto Health Care System

Santa Clara Valley Medical Center

Kaiser Permanente at Santa Clara

Research

OHNS 801 Welch Road	Perkins Temporal Bone Lab

Fairchild	Beckman

Resident Research Forum

Every June, we host a resident research forum in which each resident (PGY2-5) gives a research presentation on a current or planned research project.  Prizes are awarded for the best presentation.

Education

Core
As part of their curriculum, residents attend routine conferences including weekly residency education sessions (Thursdays from 4-6PM), Grand Rounds (Thursdays, from 6PM), monthly temporal bone lab and journal club. Please see Conferences and Grand Rounds for a schedule.

Continuing Medical Education (CME)

Residents are invited to supplement their knowledge and core education with departmental CME events, including the biannual Otolaryngoloy/Neurotology Update, Pediatric Otolaryngology Update, Western States Rhinology Conference, as well as the annual Facial Plastics conference, and Resident Symposium.

Global Health Opportunities

Stanford OTO-HNS strongly encourages residents to engage in service work in areas of greatest need around the world.  Through various programs and pursuits, our residents have explored a number of such invaluable opportunities where they have participated in and observed the healthcare of diverse resource-deprived communities.

During the fall of 2007 Anna Messner M.D. and Vanessa Erickson M.D. had the opportunity to return to Quito, Ecuador to collaborate with the pediatric otolaryngology staff at the Hospital de Niños Baca Ortiz.  Dr. Anna Messner established a relationship with this group three years ago and has returned annually, most recently in October 2007.  This year Dr. Erickson, a resident in her fourth year of training, accompanied her.

Hospital de Niños Baca Ortiz is the only public pediatric hospital in the capital city of Quito.  Resources are limited and there are often long waiting lists for much-needed procedures.  Goals of the Stanford Department of Otolaryngology collaboration are to assist the hospital surgeons with complicated surgical procedures which are beyond their scope of practice while also training staff in these procedures, with the ultimate goal of future autonomy.  Additionally, surgical supplies and instruments for use in clinic and the operating room are donated.           

A broad scope of surgeries were scheduled and performed, including intricate airway reconstructions, endoscopic sinus surgeries and complicated middle ear surgeries.  Especially poignant were follow-up visits with patients that had been operated on during prior visits.  When viewed from the perspective of time elapsed, the positive impact is remarkably clear.

Who we are looking for: Stanford University and the Department of Otolaryngology are committed to an educational community of dedicated learners who are diverse in culture, ethnicity, life experiences, and talents. Individuals with exceptional qualifications, who aspire to thrive in the areas articulated by our mission and philosophy, are invited to apply. Stanford Otolaryngology especially encourages applications from women, African-Americans, Mexican-Americans, Native Americans, mainland Puerto Ricans, and other candidates from other under-represented backgrounds.  

Our program participates in The Electronic Residency Application Service (ERAS).  To submit an application to our program, please register on MyERAS.  After your application from ERAS has been received by the department, it will be evaluated by the Residency Selection Committee. Qualified candidates will be invited to interview.

Application Procedure: Our program accepts application materials exclusively through ERAS. Interested candidates should therefore submit their materials through ERAS by the application deadline.

Required Application Materials

· Common application form
· Personal statement
· Medical school transcript
· MSPE/Dean’s Letter (to be submitted as soon as it becomes available)

· No more than four letters of recommendation (minimum of three letters)
· Photograph
· USMLE transcripts

  Additional Requirements for international medical graduates:
· ECFMG Status Report (international medical graduates only)
· Status letter from California Medical License Board (international medical graduates only)
· Applicants will be reviewed after the application is complete

Application deadline: October 20, 2008

Interview dates: January 13th and 14th, 2009.

Q: Do you have a cut-off for USMLE scores?
A: We require that you have a passing USMLE score, but we do not have a minimum passing score cut-off.   However, most of our applicants’ scores are above-average.  

Q: Where can I get more information about the residency?
A: Our residency handbook describes the program and its policies in minute detail.   
If you would like to view our residency handbook please click here:
Residency Handbook

Q: I am a resident at another program. Where can I find details about visiting Stanford? 
A: We currently do not offer away rotations for residents from other OHNS programs. 

Q: I am a third/fourth year resident who is interested in clerkship or sub-internship opportunities.
A: Please see the MEDICAL CLERKSHIP PAGE