Winter 2022 Newsletter
Stanford Otolaryngology — Head & Neck Surgery
With another holiday season upon us, it is time to express profound gratitude and celebrate all who have helped us care for our patients, advance research frontiers, and teach our exceptional students and trainees. The trials and tribulations of the pandemic and all the disturbances in our workflow and personal lives have brought us together as a department.
One source of our strength is our decision to keep our patients’ well-being at the very center of everything we do. Our inner core is buttressed by our commitment to equity and diversity to fulfill our tripartite mission of patient care, education, and research. In wise words attributed to Gandhi, we strive to be the change we want to see in the world.
As we are getting ready for another turbulent year with COVID, influenza, and RSV, as well as some economic clouds on the horizon, I have confidence that we’ll continue to excel in fulfilling our duties to all our constituencies. We should also remember to take care of our families and ourselves.
I wish you and your loved ones happy, healthy, and restorative holidays!
This newsletter intends to reach all friends of the OHNS community and Stanford alumni/ alumnae to share the latest developments. Thus, if you have updates, please get in touch with email@example.com
Our Head & Neck Division is Growing!
Michelle Chen, MD, MHS is a graduate of the Stanford Otolaryngology — Head & Neck Surgery Residency Program and completed both a head and neck oncology and microvascular reconstructive fellowship as well as an NIH-funded research fellowship in health services research at the University of Michigan. Her practice focuses on the treatment of cancers that affect the head and neck. She has received additional training in microvascular reconstruction and transoral robotic surgery. Her research interests center around using a mixed-methods approach to optimize head and neck cancer survivorship and surveillance. She is particularly interested in developing interventions to address psychosocial and financial hardship in cancer care. Dr. Chen has an active lab involved in head and neck cancer health services research and her work has appeared in numerous journals, including The Journal of the American Medical Association, Cancer, Journal of the National Cancer Institute, and Journal of Clinical Oncology. She has also authored chapters in textbooks on head and neck cancer treatment.
Andrey Finegersh, MD, PhD is staying at Stanford after completing a fellowship in head and neck surgical oncology and microvascular reconstruction with us in 2022. In addition to clinical expertise, he is bringing significant experience in both clinical and basic research. Dr. Finegersh obtained his MD and PhD in Molecular Pharmacology at the University of Pittsburgh School of Medicine's combined Medical Scientist Training Program, where he was elected to the AOA and Gold Humanism honors societies. He went on to complete residency in otolaryngology – head and neck surgery at the University of California San Diego (UCSD) before joining us for his fellowship. He has performed post-doctoral work at the University of Pittsburgh and UCSD, where he studied the role of DNA methylation and extrachromosomal DNA in the development of head and neck cancers. Dr. Finegersh has previously received funding form the NIH and the American Academy of Otolaryngology and currently runs a research lab studying how epigenetic pathways contribute to carcinogenesis and treatment response. He has additional clinical interests in studying the role of minimally invasive surgery to improve outcomes for head and neck cancer patients.
Guolan Lu, PhD is a new Instructor in our department. She is a Stanford Translational Research and Applied Medicine Scholar and a recipient of an NIH K99/R00 Pathway to Independence Award. Dr. Lu is a biomedical engineer who conducts translational research at the interface of artificial intelligence, biomedical imaging, and spatial omics to advance precision oncology. She was previously a fellow of the Stanford Molecular Imaging Scholars Program (NIH T32) and received the Stanford Cancer Institute Cancer Innovation Award. Her postdoctoral research focused on integrating single-cell drug imaging and cutting-edge spatial omics to elucidate the mechanisms of drug resistance in solid tumors and translate molecular imaging for cancer surgical navigation through first-in-human clinical trials. Dr. Lu received her Ph.D. from the joint Biomedical Engineering Department of Georgia Tech and Emory University. During her Ph.D. study, she received the Outstanding Translational Research Award and was named a Rising Star in Biomedical Engineering and Science by MIT. She has published 48 research articles (>3000 citations), including in Nature Communication, Nature Biomedical Engineering, Clinical Cancer Research, and Lancet Gastroenterology and Hematology.
Nathan Reticker-Flynn, PhD is an Instructor in the Department of Pathology who will be appointed Assistant Professor in the Department of Otolaryngology — Head & Neck Surgery in March 2023. He is a biomedical engineer and tumor immunologist working at the interfaces of cancer metastasis, tumor evolution, adaptive immunity, and immuno-oncology. Dr. Reticker-Flynn received his undergraduate degree in mechanical engineering from Tufts. He received a master’s degree in mechanical engineering at MIT and a PhD in biomedical engineering from the Harvard-MIT Division of Health Sciences and Technology (HST). For his PhD dissertation, he generated an extracellular matrix screening platform to analyze changes in cell-ECM interactions during cancer metastasis. This work led to first-author papers in Nature Communications and Cancer Discovery and revealed a critical role for altered carbohydrate interactions in the promotion of metastasis. His postdoctoral work at Stanford involved investigating the role of lymph node metastasis in the generation of systemic immune tolerance and subsequent distant organ dissemination. This work led to a first-author paper in Cell published this year. Other work led to a co-first author paper in Cell describing the importance of systemic immune responses to immunotherapy and co-author papers in Immunity, Journal of Clinical Investigation, Cancer Research, and Nature Methods.
In this trial, Dr. Divi, Associate Professor and Director of the Head & Neck Surgery Fellowship, used 4 cycles of the immunotherapy cemiplimab prior to surgical resection and demonstrated that over 60% of patients’ tumors had a complete or major response to therapy. The results of which were recently published in the New England Journal of Medicine(https://pubmed.ncbi.nlm.nih.gov/36094839/). The outstanding response to therapy in this trial has allowed us to rethink the optimal treatment paradigm for this disease. Importantly, these findings introduce new strategies to decrease the toxicity of therapy while improving overall patient outcomes. Dr. Divi has followed up this work with an investigator-initiated trial at Stanford that he is leading. This trial, Neoadjuvant Atezolizumab in Surgically Resectable Advanced Cutaneous Squamous Cell Carcinoma, similarly uses pre-surgical immunotherapy to decrease tumor size and potentially improve disease-free survival. The specimens from this trial are being evaluated in multiple laboratory correlative studies, led by Dr. Divi, for biological markers that could predict response to therapy and help identify potential mechanisms of resistance.
Dr. Reticker-Flynn has demonstrated that lymph node metastases are not simply a mechanical spread phenomenon – as has traditionally been thought – but rather they play a critical role in modulating the systemic immune response through the induction of Tregs, making it more permissive for distant metastases. This work was recently published in Cell (https://pubmed.ncbi.nlm.nih.gov/35525247/). This finding has significant implications for therapeutic strategies and on how the cancer research community now thinks about metastatic spread. In particular, the findings highlight the critical roles that tumor-draining lymph nodes play in facilitating the balance between pro- and anti-tumor systemic immune responses and may provide insights into the appropriateness and timing of lymphadenectomy as a means of preventing disease progression. While early lymphadenectomy may prevent the generation of tumor-specific immune tolerance, it may also limit the patient's ability to mount a productive anti-tumor immune response. Thus, strategies aimed at reprogramming tumor-specific immune responses within lymph nodes may prove more advantageous than nodal resection for patients exhibiting significant nodal involvement and induction of tumor-specific Tregs.
The Vice President has several key responsibilities including chairing the Policy Committee, Bylaws Committee, and Finance Committee. Additionally, the Vice President is a member of LPCH Medical Executive Committee (MEC). The MEC, which reports to the Hospital Board of Directors, represents the members of the medical staff, including faculty and community, and physicians who practice at the hospital and its clinics.
The Vice President will serve for two years beginning in September 2022 and then automatically ascend to the position of President of the Medical Staff in September of 2024, also for a term of two years. After completing the term as President, the nominee will serve two more years as the Immediate Past President. Previously, Peter Koltai served in these roles 2010-2016.
Drs Cheng and Stankovic aim to build a molecular and optical cell atlas of the human inner ear as a resource for the scientific community to accelerate progress in discovering effective therapies for auditory and vestibular disorders. To achieve this objective, they will apply the latest molecular and optical imaging tools to live human inner ear tissues from organ donors, vestibular schwannoma patients, and rapid autopsy participants.
Dr. Alyono received funding from Cochlear Americas to study how cochlear implantation may help adults and children with single-sided deafness. Cochlear implants are surgically implanted devices that are placed inside the hearing part of the inner ear, known as the cochlea. They directly stimulate the hearing nerve to restore hearing in patients with hearing loss significant enough that hearing aids are no longer helpful. The first multichannel device was approved for adults in 1985, and for children in 1990 for those with profound hearing loss in both ears. More recently, cochlear implants have been approved by the FDA for patients with single-sided deafness. The study will look at multiple factors including hearing performance in background noise, quality of life, tinnitus, and spatial hearing. Patients with single-sided deafness share many struggles, which can include difficulty accessing sound from the deaf side, difficulty localizing where sound is coming from, difficulty understanding speech in background noise, tinnitus, and increased fatigue and listening effort. We invite interested patients and referring MDs to reach out to us. Contact the Stanford study team at firstname.lastname@example.org or read more at https://clinicaltrials.gov/ct2/show/NCT05318417
The Santa Maria Lab, together with the Cegelski Lab (Chemistry at Stanford) have been awarded a collaborative grant from Stanford's Maternal and Child Health Research Institute titled “Investigating the potential of quorum sensing molecules, produced by Pseudomonas aeruginosa, to produce sensory hearing loss in chronic suppurative otitis media.” This is part of the research to understand why we lose sensory hearing during chronic ear infections. Chronic ear infections are the greatest causes of permanent hearing loss in children of the developing world. Bacteria use messaging systems, called quorum sensing, that dictate their behavior in biofilms. This grant will explore the potential for ototoxicity with the aim of identifying a way to prevent hearing loss.
Dr. Heller received a grant from the Hearing Health Foundation to study cross-species epigenetics. In collaboration with other labs, Heller’s lab will complete the collection of transcriptomic and epigenetic data from systems that regenerate (neonatal mouse, zebrafish, chick) and those that do not (mature mouse and human). In addition, they will begin to perform cross-species comparisons of the behavior of a shared set of hair cell loci across species.
Dr. Elizabeth DiRenzo is a clinician scientist with a subspecialty interest in the behavioral assessment and treatment of laryngological disorders. She completed her undergraduate and clinical graduate degrees at Purdue University in West Lafayette, Indiana specializing in speech-language pathology. Following her clinical degrees, she remained at Purdue and earned a PhD in laryngeal physiology. She then completed postdoctoral training in the Department of Surgery, Division of Otolaryngology – Head & Neck Surgery at the University of Wisconsin-Madison studying vocal fold biology.
Clinically, Dr. DiRenzo is a practicing speech-language pathologist in the Stanford Voice and Swallowing Center. Her specific interests include the behavioral evaluation and treatment of patients with voice, resonance, upper airway, and swallowing disorders. In conjunction with her physician colleagues, Dr. DiRenzo implemented a team-based patient assessment approach between laryngologists and speech-language pathologists and standardized multidimensional evaluation procedures to characterize normal and pathological voices for clinical and research purposes.
Dr. DiRenzo's research goal is to advance patient care and improve treatment outcomes through study of both normal laryngeal function and the pathophysiology of voice disorders. To achieve this overarching objective, Dr. DiRenzo’s laboratory utilizes a highly collaborative, multifaceted approach consisting of basic science and clinical research techniques. Outside of work, she prioritizes spending time outdoors enjoying the beautiful California terrain with her husband Dan and their children Lucas and Clara.
Dr. Patel, Professor and Director of Endoscopic Skull Base Surgery, led an international consensus statement on olfaction, with an eye toward helping as many patients and providers as possible. This was published in the International Forum of Allergy and Rhinology (IFAR), the official journal of the American Rhinologic Society: https://pubmed.ncbi.nlm.nih.gov/35373533/
After investigating radiologic findings that can help otolaryngologists and radiologists predict malignant transformation of inverted papilloma https://pubmed.ncbi.nlm.nih.gov/30515841/ ,which occurs in 7-10% of these tumors, Dr. Patel collaborated with the rhinology division at University of Pennsylvania, and with computer science Stanford students to develop a neural network with predictive capabilities for this transformation: https://pubmed.ncbi.nlm.nih.gov/34989484/. Inspired by these results, she is now building an international collaborative network of rhinologists to increase the data input into this algorithm and continually improve its predictive capability. She hopes to one day open source this algorithm so that centers around the globe that are lacking in highly skilled neuroradiologists are still able to offer quality care to patients with this type of tumor.
Technology has the potential to influence healthcare in a variety of ways. Approximately 10 years ago, Professor Starmer initiated work on a mobile application to support patients with head and neck cancer undergoing radiation therapy. This application, called The Head and Neck Cancer Coach™, provides patients with access to video workouts to maintain the strength and mobility of their swallowing muscles, high-quality content about how to manage side effects during treatment, recipes and videos of foods that are well tolerated during treatment, and reminders to perform important therapy tasks. The impact of The Head and Neck Cancer Coach™ on patient outcomes and their experiences during treatment is currently under investigation at Stanford, Massachusetts Eye and Ear Infirmary, and the Fox Chase Cancer Center.
The VA telemedicine program uses objective data (PET-CT and pathologist-verified biopsies) to replace the preoperative visit for veterans with head and neck cancer. The veteran now makes only one trip to our hospital for an exam the day before the operation. As the director of telemedicine in Otolaryngology – Head and Neck Surgery for VISN 21, Dr. Sirjani continues to collaborate with other VAs to provide access to subspecialty care in areas that are understaffed or do not have the resources to perform complex head and neck cancer operations. This highly successful program started in 2013 and is now expanded to include Dr. Finegersh and several supporting staff members.
Founded by Dr. Paul Yock, the Stanford Biodesign Program began in 2001 with a mission of creating an ecosystem of training and support for Stanford University students, fellows, and faculty with the talent and ambition to become health technology innovators. Through the lens of multidisciplinary teams, the program focuses on a rigorous process of selecting and researching unmet clinical and business needs, before beginning the process of inventing and implementing a business strategy.
During his tenure as a Neurotology fellow in our department, Dr. Yona Vaisbuch not only excelled in his duties as an academic surgeon, but he pursued the Biodesign Innovation Course. This is a fast-paced, student-driven, two-quarter program offered to graduate and post-graduate students. Encouraged by what he learned about the process, Dr. Vaisbuch encouraged many fellow Israeli colleagues to take Biodesign teaching offerings and fellowships. He is currently the Founding Director of Biodesign Israel, with support from Rambam Medical Center, Hebrew University, and Technion.
Recently, Dr. Vaisbuch organized and led an intensive healthcare innovation course in Tel Aviv. Interdisciplinary Stanford Faculty with prior training in the Biodesign methodology (Robson Capasso from our department, Janene Huench from Pediatrics, and Robert Chang from Ophthalmology), interacted and engaged with local leaders in clinical care, business, product development, clinical research, regulatory expertise, and healthcare economics. The knowledge and insights generated through the course will no doubt foster the maturation of a thriving healthcare innovation ecosystem in Israel and allow venues for international academic collaboration with Stanford Medicine.
Dr. Nesrine Benkafadar obtained her Pharm.D from the University of Constantine in Algeria. She then joined the Institute for Neurosciences of Montpellier in France, where she completed a master’s degree in Industrial Pharmacy and obtained her Ph.D in Biology and Health. She mainly worked on establishing a functional interaction between oxidative stress, DNA damage and cochlear cell aging. From there, she conducted postdoctoral research in Dr. Stefan Heller’s lab at Stanford University. Her current research is focused on studying the early regenerative triggers in damaged avian cochlea with the overarching goal to characterize the series of events that trigger and execute cochlear hair cell regeneration. Her ultimate goal is to investigate key trigger genes to induce adult mammalian supporting cells in damaged cochlea to reenter the cell cycle toward hair cell regeneration.
At the American Academy of Otolaryngology meeting that took place in Philadelphia, Stanford Sleep Surgery was well represented in sessions, invited lectures, poster presentations, and abstracts by Dr. Robson Capasso, Dr. Stanley Yung Liu, fellows, visiting scholars, and our residents. Our division has also demonstrated its international presence and prominence as distinguished speakers in meetings in Japan and Singapore.
We held a successful Stanford Otology Update in November. We had over 30 subspecialists from the Stanford faculty as well as internationally recognized leaders in otologic practice and education. Thank you to our special guest faculty member and distinguished alumnus, Ravi N. Samy, MD, for joining us this year!
Select Recent Publications + Podcasts + Videos
- Dr. Heather Starmer and her team discussed how “Head and Neck Virtual Coach”, a mobile health application, may provide benefits and serve as an adjunct to swallowing therapy for some patients undergoing head and neck radiation.
- The Sleep Surgery team has solidified their expertise and strategy for collaborative work on large database exploration to define clinically relevant outcomes, access, and perioperative strategy for sleep care.
- Dr. Stanley Liu has recently focused on an important unmet need: nasal outcomes post maxillomandibular advancement for obstructive sleep apnea.
- Dr. Ann Kearney discussed oral taping and the benefits of nasal breathing at the NYT.
- Dr. Valdez’s team describe a new method to deliver drug formulations across the tympanic membrane to the middle and inner ear without making an incision.
- Dr. Balakrishnan, Dr. Holsinger, and other contributors demonstrate single-port robotic surgery for thoracic trachea reconstruction.
- The Rhinology team discusses effects of the biological therapy on Eustachian tube dysfunction in patients with chronic rhinosinusitis with nasal polyposis.
- Dr. Patel reports on the management of inverted papilloma, aims to improve our ability to predict the conversion of this benign tumor to a malignancy, an unfortunate occurrence in 7-10% of these tumors.
- Dr. Mai Thy Truong, Dr. Jason Qian, and other contributors investigated machine learning in the evaluation of aesthetic outcomes for ear reconstructive surgery.
- Dr. Patrick Kiessling, Dr. Karthik Balakrishnan, Dr. Elizabeth Erickson-Direnzo, Dr. C. Kwang Sung, Dr. Brian Nuyen, and others described social perceptions of neck appearance to guide surgeons in providing gender-affirming care while maintaining the structural integrity of the larynx.
- In this 90 Seconds, Lisa Kim spoke with Dr. Robert Jackler about how menthol cigarettes ads have targeted certain audiences over the last century.
- Investigators in the Santa Maria Lab have discovered a way to eradicate sleeping bacteria which are the cause for chronic ear infections, the leading cause of hearing loss in children of the developing world.
- Researchers in the Santa Maria Lab have found that the macrophage, the cleaning up cell of the immune system is associated with hearing loss in chronic ear infections.
- Researchers in the Stankovic Lab demonstrate the feasibility of using a fluorescent photoimmunoconjugate to image cholesteatoma, a potentially serious complication of chronic ear infections.
- Dr. Stankovic co-led the study showing that magnetic stimulation allows focal activation of the mouse cochlea, paving the way for future magnetic micro-coil-based cochlear implants.
- Dr. Jason Qian reports on the association between social disadvantage and otitis media treatment in US children.