2016 Annual Message From The Chair
A Golden Era for Stanford OHNS
Stanford Otolaryngology—Head & Neck Surgery (OHNS) is special. We are blessed with a warm and collegial culture among our community of 268 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. Stanford OHNS is a clinical, educational, and scientific powerhouse – we are truly in the midst of a Golden Era.
The core strength of Stanford OHNS is its outstanding faculty. In 2003, the year we became a department, we had 5 faculty. We began 2016 with 47 faculty (18 Professors, 6 Associate Professors, 15 Assistant Professors, 8 Instructors). In addition, we have 4 affiliated faculty at Santa Clara Valley Medical Center.
Over the last academic year we have welcomed 8 new faculty: Eben Rosenthal (Head & Neck Surgery), Zara Patel (Rhinology), Uche Megwalu (Comprehensive ENT), Mai Thy Truong (Pediatrics), Douglas Sidell (Pediatrics), Robert Riley (Sleep Surgery), George Shorago (Medical Otology), and Beth DiRenzo (Laryngology).
In 2016 we expect to add 5 additional new faculty in Pediatric OHNS, Laryngology, Otology-Neurotology, Research (molecular imaging), and Comprehensive ENT.
OHNS Faculty in Leadership Roles
Stanford OHNS is well represented among the school and medical center and school leadership. Lloyd Minor is the School of Medicine Dean. Eben Rosenthal, who joined the department in 2015, is the John and Ann Doerr Medical Director of the Stanford Cancer Center. Peter Koltai is a past Chief of Staff at Stanford Children’s and Ed Damrose has been elected the Stanford Health Care Vice Chief of Staff leading to a three year term as Chief of Staff.
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 $8.4 million (2015) projected to rise to $9.1 million (2016). 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 Research, Grant, and CCSR buildings. All will coalesce into the new Biomedical Innovations Building currently undergoing architectural planning.
Departmental faculty have more than 51 competitive extramural grants and are principal investigator on 11 NIH R-01s, U01, 3 DoDs and a CIRM award. Our basic science research community consists of 107 faculty, post-docs, researchers, students and other trainees.
PUBMED lists 161 peer reviewed publications for Stanford otolaryngology in 2015, which does not include books, chapters, abstracts, or editorials. At our 6th 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 graduations 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. (Heller, Ricci, Oghalai, Cheng, Mustapha, Chang, Grillet, Blevins, Fitzgerald, Jackler, and Minor). Important laboratory research is also being conducted in cancer immunology/cancer stem cells (Sunwoo), nasal mucosal development and regeneration (Nayak), and vocal fold mucosal biology (DiRenzo). Recently, we initiated an effort in molecular imaging of cancer (Rosenthal).
Using philanthropic and departmental funds, we are investing in further strengthening our core facilities with the addition of a Fluidigm system (single cell analysis with microfluidics) and an additional state-of-the-art confocal microscope (early 2016). Our imaging and inner ear physiology core facilities include dedicated equipment to study inner ear cells ranging from specialized microscopes and image analysis systems to apparatus for testing hearing and balance in laboratory animals.
Precision Health Initiatives for 2016
Stanford medicine has made enhancing the precision of health a priority. We have commissioned each clinical division to undertake research project(s) intended to enhance the precision of health care. These projects will be completed by summer 2016 and for the basis of an annual report on our progress in this important field of endeavor.
- Anna Messner: Cadupia (iPhone app) for Peds OHNS
- Robson Capasso: Stanford Sleep Surgery - Precision Outcomes Database
- Sam Most: DVT prophylaxis and rhinoplasty
- Zara Patel: Surgical versus Continued Medical Management for Medically Refractory Chronic Rhinosinusitis
- Beth DiRenzo: Comprehensive Instrumental Voice Assessment Protocols (IVAP) for Dysphonic Patients in the Stanford Voice and Swallowing Center
- Vasu Divi: Reducing Cost of Care in Head and Neck Cancer Patients
- Chris Holsinger: Improving AJCC Staging in H&N Surgery using Structured Data Fields in EPIC; Transforming H&N Tumor Boards: Implementing a Multidisciplinary Care Clinic; Reducing Variation of Care through Clinical Pathways in H&N Endocrine and Reconstructive Surgery
- David Sirjani: Telemedicine
- Matt Fitzgerald: Adaptation and perceptual learning in recipients of cochlear implants; Tinnitus rehabilitation; Testing hearing in noise
- John Oghalai: Optical Coherence Tomography of the Inner Ear
- Nik Blevins: Patient Specific Surgical Rehearsal
- Jennifer Lee: Developing algorithm for new patient referrals for Eustachian Tube Dysfunction
Our immensely talented trainee population includes 20 OHNS residents and 2 ACGME accredited fellowships (pediatrics, neurotology). 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 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/fellows programs obtain excellent faculty positions. 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 plan to add additional subspecialty atlases in 2016.
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.
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. 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 Jennifer Lee this 72 chapter project has taken a couple of years to produce and has several hundred original illustrations by Christine Gralapp. As a funded pilot project, we will augment the written material with a series of 10-minute topical videos (the concept is “Khan Academy” for 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. In June/July, 2014 Jennifer Lee, one of our recently-hired comprehensive otolaryngologists, trained in designing surgical simulation training, led all OHNS residents through simulations on “Carotid blowout” and “Angioedema.” She will be conducting another set of new simulations in January 2015. For student use, we purchased two otoscopy simulators; one for the department and the other was donated to the medical school’s simulation facility.
Working with the Stanford Faculty Development Center (SFDC), we launched our surgical teaching course earlier this year. Anna Messner, an SFDC-trained facilitator, taught two of these courses in the spring and summer to a group of OHNS faculty and to our newly-minted fellows and chief residents. Kelly Skeff and Georgette Stratos, who travel around the globe to provide teacher trainings, also presented a 4-hour version of this course at the Society of University Otolaryngologists annual meeting to an audience of nearly 200 faculty.
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.
In 2016, we have 3 continuing medical education courses planned: the Stanford/MEEI TEP course (March 11-12), the Stanford Otology Update (November 3-5), and our annual resident Facial Plastic Surgery Course (October).
We have an exceptional group of residents. Among our residency graduating class of 2015, 3 graduates went on to sub-specialty fellowship, one joined a full-time faculty, and one a university-affiliated practice.
- David Chang, MD, PhD: Boston Children’s – Fellowship in Pediatric otolaryngology
- JoAnn Czechowicz, MD: University of Washington – Fellowship in Pediatric otolaryngology
- Stuart Ginn, MD: Assistant Professor. Wake Med Health & Hospitals. Raleigh, NC
- Duncan Meiklejohn, MD: Assistant Professor. University of New Mexico School of Medicine
- Arash Shahangian, MD, PhD: MUSC – Fellowship in Rhinology
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 is our pediatric clinics at the Mary Johnson Center. Otology/neurotology is 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 and 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. 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 as maxillomandibular advancement, to open severe constrained upper airways.
In our Pediatric Division, Chief Anna Messner is highly experienced in the management of a wide variant 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 aerodigestive tract disorders. Mai Thy Truong is a highly skilled pediatric ENT able to handle a wide spectrum of children’s otolaryngology problems. Dr. Truong and Dr. Kay Chang oversee a dedicated microtia clinic and together they are surgically creating superb ear reconstructions. Drs. Chang, Cheng, and Oghalai focus on pediatric otology (see below).
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, alleviation of facial paralysis, and rejuvenation of the aging face. 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, Chief Nikolas Blevins is a renaissance surgeon handling all aspects of ear care and microsurgery. He and I along with our two very capable medical otologists, Drs. John Shinn and George Shorago, see most adult patients. Matt Fitzgerald, Chief of Audiology, oversees a large group of audiologists who provide diagnostic and rehabilitative services. The Children’s Hearing Center, lead by Dr. John Oghalai, includes Drs. Kay Chang and Alan Cheng. Our very active cochlear implant center includes 4 surgeons (Drs. Blevins, Chang, Cheng, and Oghalai).
In our Comprehensive Otolaryngology Division faculty members Jennifer Lee and Uche Megwalu expertly manage a wide spectrum of otolaryngology medical and surgical diseases.
Facial Plastic Surgery Clinic Opens
The stylish new Stanford Facial Plastic Surgery Clinic opened in June of 2015. The new, state-of-the art amenities include an aesthetician’s space and three exam rooms with built-in photography and digital imaging systems. The office provides patients with modern, upscale amenities and the privacy of a small office.
New Sleep Surgery Facility Under Construction
Anticipated in early 2016 is our new Sleep Surgery clinic with 4 specialized exam rooms, a large procedure room, and a dental lab. This new facility will be located at our Redwood City satellite adjacent to the Sleep Medicine program and Sleep Labs.
Global Health Programs
We have an ongoing collaboration with the University of Zimbabwe. Peter Koltai is the most recent faculty member to visit (we have sent a total of 4 faculty members.) Our goal is to send 2 faculty members a year. The Chief of their division (Clemence Chidziva) visited here this summer and discussions are underway for their residents to visit our program on an ongoing basis. Current Chief Resident, Anais Rameau, and recent graduates, Paula Borges and Joann Czechowicz, each spent a month there.
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. The next trip is planned for June 2016.
US News and World Report Rankings (2015)
- Stanford School of Medicine in top 2 nationally
- Stanford Medical Center on Honor roll of top hospitals
- OHNS is consistently the highest ranked clinical department at Stanford
- Stanford OHNS ranked in top 10 and best in the West
Major Enhancements in our Web Presence
We hired a full-time web designer-developer, Crystal Chen, to help enhance our web presence. Each clinical division has implemented substantial enhancements to the amount and quality of disease-specific patient educational material. In addition, numerous patient information videos and maps have been created along with aesthetic enhancements and more intuitive and patient-friendly navigation. We engaged a professional photographer to improve the portraits of our faculty and staff. Artist Christine Gralapp produced substantial new artwork for this project. An entirely new website was created for the new Stanford Ear Institute.
A few examples from the OHNS Website (http://med.stanford.edu/ohns):
Head & Neck Center: http://med.stanford.edu/ohns/healthcare/headneckcenter.html
Sinus Center: https://med.stanford.edu/ohns/healthcare/sinuscenter
Sleep Surgery: https://med.stanford.edu/ohns/healthcare/sleepsurgery
Ear institute: https://med.stanford.edu/ohns/healthcare/earinstitute
Voice & Swallowing Center: http://med.stanford.edu/ohns/healthcare/voicecenter
Heller Lab: http://hellerlab.stanford.edu
Grillet Lab: https://grilletlab.stanford.edu
Mustapha Lab: https://mustaphalab.stanford.edu
Sunwoo Lab: https://sunwoolab.stanford.edu
Cheng Lab: https://achenglab.stanford.edu
Residency Program: https://med.stanford.edu/ohns/education/residency
Online Grand Rounds: https://med.stanford.edu/ohns/education/grand-rounds
For the first time, we moved our alumni event at the American Academy of Otolaryngology-Head & Neck Surgery from Tuesday to Sunday evening. This move lead to a much more convenient, elegant, and well-attended time for us to gather. We plan to continue the Sunday night tradition in San Diego in fall of 2016.
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 during 2016.
— Robert K. Jackler, MD (December 14, 2015)