2020 Annual Chair's Message

A much beloved member of our departmental community, Dick Goode, passed away peacefully on October 30th at the age of 84. Dick joined Stanford OHNS as a resident in 1962, shortly after the school moved to Palo Alto from San Francisco, and the faculty four years later. He improved the lives of countless thousands of Stanford patients and was a revered surgeon, educator, innovator, and leader. Widely beloved by generations of members of the department family, while we will miss him, but his memory and legacy will live on for generations.

Dick was a native Californian who went to the University of California, Santa Barbara where he was class president. At the University of Southern California Medical School he was both a member of the Alpha Omega Alpha honor society and also the “Skull and Dagger” society famous for its pranks.

When Dick entered the field otolaryngology was widely viewed to be was a dying field being killed by antibiotics. He had major roles in defining entire fields within OHNS. Dick was a founder of facial plastic surgery, renowned in sleep surgery, for decades did cancer surgery at our VA, and did leading edge middle ear mechanics research. As one measure of his extraordinary longevity at Stanford Dick worked under 7 Stanford Deans and 11 US Presidents.

Dick was an innovator contributing a number of patents and helping to start a number of companies. He is known world over for the invention of the “Goode” t-tube and he made important contribution to implantable hearing aids, among other inventions. Dick published over 170 scholarly papers and contributed a sleep surgery textbook while well into his 70s.

Dick was a splendid educator shaping the careers of many hundreds of trainees over his long faculty tenure. At his retirement in 2013, after an impressive 51 years of caring for Stanford patients, a huge turnout of his former trainees attended a gala in his honor. A photo from this wonderful gathering is on the top floor of 801 Welch Road.

Among other roles, Dick served as President of both the American Academy of Otolaryngology — Head & Neck Surgery and the American Academy of Facial Plastic and Reconstructive Surgery. Dick was a most capable interim leader of the Division of OHNS at Stanford from 2000-2003.

Dick was not only a renaissance surgeon, he had many, many talents outside of medicine. Dick’s hobby was magic – or more precisely mentalistism - he a was a mind reader – a seer. His hobby also defined his career. He was always gazing into his proverbial crystal ball – seeing advances before other do. Together with his wife Lynn, Dick loved theater and was a patron of the theater arts.

In September, in Dick’s honor the department launched the inaugural Richard L. Goode endowed lectureship. Dick was in attendance in fine form and was his sharp and witty self. We shall miss Dick’s exquisite, wry sense of humor which contributed to his enormous popularity among his colleagues, trainees, and staff. The family has requested that memorial donations be made to his eponymous lecture fund.

We plan to hold a celebration of his life at Stanford on Saturday, January 11, 2020 from 4-6 PM at the Traitel Building at the Hoover Institution – all are welcome. As Dick would have wanted it, this will be a lively time of story telling and reminiscing about the life and times of this most extraordinary man.

Stanford News Services did a nice memorial article about Dick.

I have let Dean Minor know that it would be an auspicious time for me to transition out of the departmental chair role in summer 2020. By then I will have completed my 17th year as the department’s inaugural chair (founded 2003). I have no plans to retire, merely to recalibrate my professional focus by reducing my administrative role to become more focused upon my research, education, and patient care. The search is well under way and I am pleased by the enthusiastic interest by an immensely talented applicant pool.

Our immensely talented trainee population includes 23 OHNS residents, and 10 instructor/fellows: 4 ACGME accredited fellows (pediatrics, neurotology (2), sleep surgery), and 6 instructors (head & neck surgery, sinus surgery (2), facial plastics surgery, laryngology. 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.

The department has two residency tracks: a five-year “clinical track” (CT) and a seven-year “clinician scientist training program” (CSTP), which integrates two years of dedicated research following the second year of clinical training. The CSTP is a National Institute of Child Health and Human Development (NICHD) funded training program. As the NIDCD supports and conducts research in the areas of hearing, balance, taste, smell, voice, speech, and language, the grant covers studies addressing the prevention, screening, diagnosing, and treatment of disorders of human communication.

More than 75% of our graduates complete fellowship training. Recent residency graduates have taken positions as attendings at the medical schools of Stanford, University of Chicago, University of Colorado; as affiliated Stanford faculty at Santa Clara Valley Medical Center; and in private practice settings such as Kaiser.

At the heart of the department’s education programs, the residency provides a rigorous foundation of clinical training with a broad range of experiences in head and neck surgery, otology, rhinology, laryngology, facial plastic surgery, sleep surgery, audiology, allergy and pediatric Otolaryngology — Head and Neck Surgery 8 otolaryngology. Further, residents are exposed to diverse patient populations in various clinical settings. Besides Stanford Health Care (SHC Palo Alto), the primary site in which residents spend approximately 35 months, residents rotate at the Veterans Affairs Palo Alto Health Care System (VA), Santa Clara Valley Medical Center (SCVMC), and Lucile Packard Children’s Hospital Stanford (LPCH). They also spend time in SHC sites in East Palo Alto (Stanford Ear Institute) and Redwood City (sleep surgery).

Residents are required to meet all ACGME and American Board of Otolaryngology standards and expected to master the cognitive, clinical, procedural and professional skills required to function as attending otolaryngologists. They are assessed according to the ACGME Milestones and core competencies rubrics.

The program’s educational curriculum is designed to help each resident achieve program aims while ensuring professional and personal growth in many possible directions: basic or translational science, patient-oriented research, bio-technological innovation, or clinical practice and medical education.

Until we reach a full complement of 27 residents in 2021-22, we will be accruing one additional resident per year to our total. In 2018-19, we had a total of 22 residents; in 2019-20 we have 23, and so on with two residents in the seven-year research track each year.

We are in the second year of our NIH funded program (T32- Funded Clinician-Scientist Training Program), intended to produce scientist-surgeons. 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 Otolaryngology — Head and Neck Surgery 9 per year starting in 2017 for a total of 25 residents in our program by 2021.

The T32- Funded Clinician-Scientist Training Program (CSTP) 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. This track includes current residents Grace Kim, Jason Qian, Tina Munjal, and Yu-Jin Lee. 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.

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 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/fellows programs obtain excellent faculty positions. Among our residency graduating class of 2018, all 4 graduates went on to sub-specialty fellowship.

Stanford OHNS has post-residency fellowship programs in all of the clinical subspecialties of the field: facial plastic surgery, head & neck surgery, laryngology, thyroid/parathyroid surgery, neurotology (2), pediatric OHNS 1 now, adding a 2nd), rhinology/sinus surgery, and sleep surgery. Selected from among the most talented residency graduates, these future academicians enrich both our education and research programs. Two of our current neurotology fellows, Taha Jan and Ksenia Aaron, are in the T32 clinician-scientist training program.

The Otoinnovation Lab is an accelerator of medical technology from discovery to patients. We collaborate with Stanford faculty, industry, and Stanford groups, including Biodesign and SPARK, to meet unmet medical needs in Otolaryngology. We provide coaching, mentorship, and technical resources to bring discoveries through the preclinical phase.We emphasize multidisciplinary, team-based approaches to problems and testing proof-ofconcept as rapidly as possible. We work together in our Otoinnovation Prototyping Lab as well as the Rodney Perkins Microsurgical Lab to test and realize ideas. Two examples of active otoinnovation projects are novel means of drug delivery to reduce the burden of oral mucositis post radiation (PI Dr.Santa Maria) and a wearable biometric device for diagnosis and rehabilitation of vestibular disorders. (PI Dr. Steenerson).

Molecular biologist Stefan Heller studies mechanisms of auditory development and strategies for inner ear regeneration. Auditory physiologist Tony Ricci is interested in unraveling the molecular mechanisms of audition and in so doing identifying sites of intervention for the protection, preservation and restoration of hearing. Geneticist Theresa Nicolson studies the molecular basis of the senses of hearing and balance in zebrafish. Her lab has identified more than nine genes that are specifically required for mechanotransduction, including components of the transduction machinery. Geneticist Nico Grillet studies genes required for hearing and head motion detection, and ultimately characterize the function of these genes at the molecular level. Theoretical physicist Daibhid Maoiléidigh employs mathematical and computational approaches to investigate auditory and vestibular systems. To be of use, a mathematical model must make experimentally testable predictions and it should be clear which features of the model are critical for correspondence with experiment.

Sinus surgeon and immunology PhD Jayakar Nayak studies nasal immune function and mucosal regeneration in response to injury from surgery, chemicals, and toxins in human and animal model systems.

Eben Rosenthal studies molecular imaging developing novel probes and agents for optical imaging, ultrasound, optoacoustic imaging, and Raman spectroscopy. John Sunwoo studies cancer immunology via a special subset of lymphocytes, called natural killer (NK) cells, which have been described to be critically important in the innate immune response to cells undergoing malignant transformation.

Alan Cheng studies the mechanisms underlying the development and regeneration of sensory hair cells via study of their progenitors. Tulio Valdez researches are at the interface of optics and medicine. He studies the optical properties of otitis media and cholesteatoma to enhance diagnosis and therapy.

JP Pepper studies facial nerve regeneration evaluating Hedgehog-responsive fibroblasts help restore the three dimensional architecture of the nerve after injury.

Beth DiRenzo studies laryngeal mucosal biology and also the laryngeal health effects of tobacco products.

Nicolas Blevins leads the CardinalSim team which is an immersive simulation environment developed for the preoperative rehearsal of complex surgical procedures. The create interactive 3D reconstructions of patient-specific anatomy allow the surgeon to see and feel structures that can influence the course of a procedure. Peter Santa Maria studies tympanic membrane regeneration and the pathophysiology of chronic otitis media.

Our departmental faculty have more than 87 competitive extramural grants and are principal investigator on 12 NIH R-01s, 4 R-21s, 2 T-32s, 1 U-01, 1 U-54, 1 DoD, 1 K08, 2 CIRM award, and 27 industry grants. Our basic science research community consists of 118 faculty, postdocs, researchers, students and other trainees. At our 10th annual research retreat in October 28, 2019, 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. 2020 brings new excitement as we continue to grow and also to plan for a move into the new Biomedical Innovations building, a state-of-the-art facility that will enhance collaborative efforts. Over the next year we expect to hire at least one more basic science faculty member while also ensuring that our rapidly growing team has the resources and mentoring needed to be successful. Taking advantage of a newly acquired T32 training grant has allowed us to bring highly talented junior clinician scientists into the laboratory, adding yet another dimension to our research team. Through all of these exciting transitions we continue to generate high quality research and identify new targets and sites for intervention.

Stanford OHNS faculty and trainees contribute over 300 original, peer reviewed publications each year. Samples from the most recent complete calendar year are posted on two bulletin boards on the top floor of 801 Welch Road.

A number of generous donors support our research programs with over 200 gifts in 2019 with a total exceeding $8 million. While our Initiative to Cure Hearing Loss is the major recipient, substantial gifts have also been received by our laryngology, rhinology, head & neck, and facial plastic surgery divisions over the last year. As of late 2019, our departmentalendowments total $36.8 million ($25.8 in endowed professorships and $10.9 in various funds primarily for support of research. Gratitude goes to Clifford Harris, our peerless medical development professional who most ably supports our fund raising activities.

Our clinical services continue their traditional double-digit 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. Both adult and pediatric otology/neurotology are situated at the Stanford Ear Institute at Watson Court while sleep surgery is headquartered on our Redwood City campus.

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, Eben Rosenthal, and Fred Baik 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 observers 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 and is a leading expert in empty nose syndrome. The Stanford Sinus Center provides integrated care including cone beam CT imaging. 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 is a laryngologist with a special interest in swallowing disorders. 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. Dr. Robert Riley, one of the founders of the field of sleep surgery, collaborates with Dr. Liu on the facial skeletal surgery. Together, our sleep surgery team performs a large volume of hypoglossal nerve stimulator implants each year.

In our Pediatric Division, acting Chief Alan Cheng is a clinician-scientist with an expertise in children’s ear disease. Peter Koltai focuses his interest on complex sleep disorders in children while Douglas Sidell tackles 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. Drs. Truong and Kay Chang oversee a dedicated microtia clinic and together they are surgically creating superb ear reconstructions. Drs. Chang, Cheng, and Iram Ahmad focus on pediatric otology. Tulio Valdez has a special interest in swallowing disorders while Kara Meister has a focus on thyroid tumors in children

In our Facial Plastics Division, Chief 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. JP Pepper leads our facial nerve center and uses advanced reanimation techniques. Oral surgeon 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, Chief Nikolas Blevins is a renaissance surgeon handling all aspects of ear care and microsurgery. Drs. Peter Santa Maria, Jennifer Alyono, and I are broadly trained otologists-neurotologists with interests spanning chronic ear surgery, stapedotomy, acoustic neuroma, and cranial base tumor surgery.

Our two very capable medical otologists Drs. John Shinn and George Shorago see many adult patients. 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 performs over 130 implants per year in adults and children.

In our Comprehensive Otolaryngology Division faculty members Jennifer Lee and Uche Megwalu expertly manage a wide spectrum of otolaryngology medical and surgical diseases. Jennifer has a special interest disorders of the Eustachian tube and has now performed many endoscopies and balloon therapies of this structure.

Rhinology, Laryngology, Facial Plastics, and Comprehensive ENT Clinics at 801 Welch Road, Integrated Head and Neck Center at Blake Wilbur, Stanford Ear Institute at Watson Court, and Sleep Surgery at Redwood City Stanford North Campus. The Pediatric Clinics are located in the Mary Johnson Center.

Future home of Pediatric OHNS faculty offices and administrative support

Our Sunday night alumni event was held at the American Academy of Otolaryngology — Head & Neck Surgery in New Orleans. Gratitude to faculty member Mai Thy Truong and her husband Ken who hosted.

Friends and Alumni are always welcome to return to the Farm for a visit!

Please email me at jackler@stanford.edu and we can set up a time for a chat and a tour.