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Otolaryngology

VOL. 13, NO. 2 FALL 2016

HARVARD NEWS FROM THE DEPARTMENT OF OTOLARYNGOLOGY AT HARVARD MEDICAL SCHOOL

The Need for Worldwide

Access to Surgery (page 12)

Otolaryngology


HARVARD Otolaryngology

Contents

News from the Department of Otolaryngology at Harvard Medical School Fall 2016 Vol. 13, No. 2 Published twice per year. Please send comments, requests for additional copies, and other inquiries regarding this issue to: Mary Yaeger Communications Specialist Department of Otolaryngology Massachusetts Eye and Ear 243 Charles Street, Boston, MA 02114 Ph: 617-573-3656 | mary_yaeger@meei.harvard.edu

Contributors Editor-in-Chief D. Bradley Welling, MD, PhD, FACS Walter Augustus LeCompte Professor and Chair Department of Otolaryngology Harvard Medical School

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Letter from the Chair D. Bradley Welling, MD, PhD, FACS 2 14th Triennial International Otopathology Society Meeting Held at Massachusetts Eye and Ear 4 Protein-Based Genome Editing Scientists develop in vivo protein delivery method that may restore hearing 8 Understanding XDP Researchers and clinicians team up to help X-linked dystonia-parkinsonism patients 12 The Need for Worldwide Access to Surgery Researchers investigate the economics of global surgery

Chief of Otolaryngology Massachusetts Eye and Ear Massachusetts General Hospital

16 Graduation and Annual Meeting

Managing Editor/Writer Mary Yaeger

20 Alumni Profiles Theodoros N. Teknos, MD, Class of 1996 Zachary M. Smith, PhD, Class of 2006

Design/Layout/Photography Garyfallia Pagonis On the cover: Dr. Mark G. Shrime and Dr. Blake C. Alkire Photo by Garyfallia Pagonis.

19 New Trainees

22 Alumni Giving Society 23 Highlights 26 Research Advances

Otolaryngology Massachusetts Eye and Ear Beth Israel Deaconess Medical Center Boston Children’s Hospital Brigham and Women’s Hospital Massachusetts General Hospital

©2016, Massachusetts Eye and Ear


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s fall creeps into New England and the leaves begin to turn, we are grateful for the beauties of nature and for the joy of our associations with each of you. It was wonderful to see many of you at the Academy meeting in San Diego this September. As we move forward in our basic, translational, and clinical research, we continue to strive for new discoveries and better therapies to help otolaryngology patients worldwide. For us, the impact of our research has recently gone beyond traditional science and is helping patients who do not have access to safe, affordable, and timely surgery. A group of physicians from the Harvard Medical School Department of Otolaryngology are using research to help inform surgical policies in developing nations across the globe. The power of their research has the potential to encourage economic development and growth as well as save many lives. In our cover story starting on page 12, we delve into the work of these physicians and discuss how their research has already led to the formation of world development indicators. By gathering surgical data in low- and middle-income countries, they show how important the development of global surgery is and the impact it will have on countries if ignored.

Letter from the Chair

Dear colleagues and friends,

In this issue, we’re excited to highlight the progress that is being made in the development of surgical infrastructure globally, as well as some of the important research advances our faculty have recently made in the field. As you read through the pages of our Fall Issue, I hope you connect with the many ways that the otolaryngology physicians and researchers at Harvard Medical School are contributing to our shared success through exceptional clinical care, research, and teaching advancements. Thank you for your interest in and support of the Department’s activities. Sincerely,

D. Bradley Welling, MD, PhD, FACS Walter Augustus LeCompte Professor and Chair Department of Otolaryngology Harvard Medical School Chief of Otolaryngology Massachusetts Eye and Ear Massachusetts General Hospital

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NEWS

14th

TRIENNIAL International Otopathology Society Meeting Held at Massachusetts Eye and Ear

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his past June, otologists from around the globe gathered in Boston for the 2016 International Otopathology Society meeting. Sponsored in part by the NIDCD National Temporal Bone, Hearing, and Balance Pathology Resource Registry and held at Massachusetts Eye and Ear, members of the Society meet for a scientific session every three years to discuss the latest in otopathology.

“This meeting is a wonderful tradition, one that continues to grow mainly through word-of-mouth from our former research fellows. I think this is a true testament to how faithful our fellows are.” —Dr. Nadol Dr. Joseph Nadol, Jr., with Linda Merchant, wife of the late Dr. Saumil Merchant, at the International Otopathology Society welcoming reception.

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Established in 1973 by former Chair of the Harvard Medical School Department of Otolaryngology and world-renowned clinician-scientist in the otology field, Harold F. Schuknecht, MD, the Society was created as a way for former research fellows of the Otopathology Laboratory at Mass. Eye and Ear to remain connected to the Department. Since this lab is known for having international trainees, the Society, which was originally called the “Schuknecht Society,” quickly became an outlet for former fellows to share interesting cases and observations related to the pathology of the inner ear.

Over the years, the Society and its meetings have grown in popularity, now attracting not only former research fellows, but also their students and those with a serious interest in human otopathology. As of June 2016, the Society has more than 150 members from more than 35 countries. “This meeting is a wonderful tradition, one that continues to grow mainly through word-ofmouth from our former research fellows,” said Joseph B. Nadol, Jr., MD, former Chair of the Harvard Medical School Department of Otolaryngology and current Director of the Otopathology Laboratory at Mass. Eye and Ear. “I think this is a true testament to how faithful our fellows are.”


This year, the three-day meeting began with a reception for all attendees, followed by two full days of presentations. According to Michael J. McKenna, MD, Professor of Otolaryngology at Harvard Medical School and the Society’s Secretary-Treasurer, this was “one of the best meetings the Society has had in the past 30 years in terms of scientific content and presentations.” The presentations covered topics such as cochlear synaptopathy in the aging or noise-exposed human ear, specific genetic mutations that led to neonatal or congenital profound hearing impairment, and the importance of correlating histopathology in animal models for hereditary hearing loss, among many others. During the second night of the meeting, the participants attended a banquet dinner, where Aaron K. Remenschneider, MD, MPH, Investigator at Mass. Eye and Ear/Harvard Medical School, gave a presentation on the life and work of Julius Lempert, MD, who is known as the “Father of Modern Otology.”

Top left: Dr. Michael McKenna with Dr. Yuko Suzuka and Barbara Burgess. Top right: Drs. Aaron Remenschneider, David Jung, and Elliott Kozin Bottom left: Dr. Brad Welling giving the welcoming address.

The meeting concluded with the official induction of 19 new members into the Society and the presentation of the Schuknecht and Merchant Travel Awards. Both awards recognize trainees for their research presentations and provide them with an award intended to help defray travel costs. This year, Shreya Narasimhan, MS, and Ariel Edward Hight, MS, researchers in the Eaton-Peabody Laboratories at Mass. Eye and Ear, were presented with the Merchant Travel Award and Masato Fujioka, MD, PhD, from Keio University School of Medicine in Tokyo, Japan, was the recipient of the Schuknecht Travel Award. “This conference is truly remarkable in terms of the attendees we get,” said D. Bradley Welling, MD, PhD, FACS, the Walter Augustus LeCompte Chair of Otolaryngology at Harvard Medical School. “Physicians and researchers from all over, many of whom have trained with Dr. Nadol at some point, attend and it is great to see the reach we have throughout the world.” The next conference is scheduled for June 16–18, 2019.

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PROTEIN-BASED

Genome Editing Scientists develop in vivo protein delivery method that may restore hearing

Drs. Zheng-Yi Chen and Yong Tao in the Chen Laboratory at Mass. Eye and Ear.

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Generally, proteins are neutral and do not carry an enetically-engineered proteins are a fast growelectric charge, which is thought to prevent them from ing treatment class, with potential for broad crossing cell membranes. Dr. Chen, working with his application to many conditions, including research fellows Yilai Shu, MD, PhD, and Yong Tao, hearing loss. While these proteins have been proven MD, PhD, as well as David R. Liu, PhD, Professor of to effectively treat extracellular targets, the use of Chemistry and Chemical Biology at Harvard University, proteins for intracellular targets has not been as whose lab engineered the proteins, explored this notion progressive because of a protein’s inability to naturally and hypothesized that supercharged proteins may be cross mammalian cell membranes. It is thought to be able to go into inner ear cells. Using an engineered, a protein’s neutral charge that inhibits it from entering super-negatively charged green fluorescent protein cells, which has resulted in major barriers to discovering (GFP) linked with the genome editing protein, Cre the full potential of protein-based therapies. recombinase, they injected the protein into the mouse For hearing loss, genetically-engineered proteins inner ear in vivo. They found that mouse inner ear hair could be important in developing new research tools and cells efficiently took up the protein with the expression treatments, specifically therapies using genome editing of a reporter gene, an indication that the protein was technology, by inserting, deleting, or repairing DNA in functional inside hair cells. the genetic material of an organism. If proteins were able With this method, the researchers have also shown to cross cell membranes, then the protein could carry that it can be used to deliver another genome editing and transfer the desired DNA into the cell and effectively protein, Cas-9 (CRISPR associated protein 9). CRISPR repair gene mutations. (Clustered regularly interspaced short palindromic Motivated by the implications proteins have on repeats)-mediated genome editing has become one of hearing restoration, a team of researchers includthe most powerful technologies in biomedical research ing Zheng-Yi Chen, DPhil, Associate Professor of and is a promising technology for treating genetic Otolaryngology at Harvard Medical School and Associate hearing loss. Scientist at Massachusetts Eye and Ear, have set their Using the same concept as the Cre recombinase sights on developing an approach to effectively insert protein, native Cas-9 protein can be packaged with proteins into cells. Through their research, they have found that when using a protein that is modified to carry an electric charge, “In a short amount of time, we have not also known as a “supercharged” only gotten the approach to work for protein, the protein can be multiple proteins but our recent work has successfully delivered into shown it is possible to use protein delivery inner ear cells in vivo. This for genome editing to restore a significant work, which was published portion of hearing in animal models with in Nature Biotechnology and genetic hearing loss.” the Journal of the American —Dr. Chen Chemical Society, was tested on animal models using two negatively-charged RNA molecules and be delivered into supercharged proteins that are capable of genome inner ear cells. This approach has led to efficient genome editing. Both proteins were delivered into inner ear hair editing (20 percent), whereas genome editing in vivo by cells and led to genome editing effects. other approaches generally has an efficiency of one “Our work in establishing that protein delivery is percent to five percent. a viable approach to in vivo genome editing is “In a short amount of time, we have not only gotten encouraging,” said Dr. Chen. “Protein-based delivery the approach to work for multiple proteins but our recent methods have not really been used for hearing loss, work has shown it is possible to use protein delivery for and our findings have potential for understanding genome editing to restore a significant portion of hearing the pathology of genetic hearing loss and, eventually, continued on page 7 exploring new treatment options.” HARVARD Otolaryngology

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| Protein-Based Genome Editing | continued

Protein delivery of DNA editing enzymes into mouse inner ear in vivo. (A) Delivery of Cre recombinase leads to expression of a reporter gene (red) in most outer hair cells (OHC). In the control (left panel), no such expression is detected. (B) Delivery of Cas-9 protein with a gRNA leads to genome editing that abolishes GFP expression in outer hair cells (right panel, boxes to show the edited hair cells). In the control, all outer hair cells are GFP positive (left panel). Adapted by permission from Macmillan Publishers Ltd: Nature Biotechnology. Zuris JA, Thompson DB, Shu Y, Guilinger JP, Bessen JL, Hu JH, Maeder ML, Joung JK, Chen Z-Y, Liu DR. Cationic lipid-mediated delivery of proteins enables efficient protein-based genome editing in vitro and in vivo. Nat Biotechnol. 2015;33(1):73–80, copyright 2015.

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in animal models with genetic hearing loss,” said Dr. Chen. “These findings are promising and, when thinking longterm, this technique might eventually have the capability of helping physicians treat hearing loss by correcting genetic mutations in a patient’s cells instead of using drugs or surgery.” Traditionally, gene therapy is the treatment choice for genetic disease by using an engineered virus to deliver the DNA into the cell. However, there are some potential advantages of protein delivery for genome editing that may make it preferable to gene therapy using engineered viruses, which are often difficult to control. Protein delivery allows for a more controlled delivery and may carry a reduced risk of long-term effects. This is because proteins degrade after a certain amount of time in the cell, removing the risk of what the protein may do. This is particularly important for genome editing as it carries the risk of potential off-target effects that could affect unrelated genes. With proteins, the researchers have shown a significantly lower off-target rate following protein delivery than DNA delivery. “When it comes to using a virus for gene therapy, the virus does not degrade,” said Dr. Chen. “With protein delivery for genome editing, however, the proteins enter the cell, perform their function, and then degrade, resulting in a permanent correction of mutations and

less long-term safety concerns. Other applications of protein delivery include the transcription factors to regenerate hair cells. Once the hair cells are regenerated, we will no longer need the transcription factors, again minimizing the long-term safety concerns.” As the researchers continue to explore the use of supercharged proteins and test their applications, they plan to assess several more models of genetic hearing loss that can be tested for hearing recovery in the near future. In addition, they are working on improving the approach and looking at refining components such as ease of use, safety, and overall performance. One of the more specific projects they are working on is determining a safe way to target different cell types at once. Eventually, the researchers believe that protein delivery has applications in other genetic disorders outside of the ear. But for now, their focus is on expanding their research with the hope of one day developing therapies to treat hearing loss. “We want to study the inner ear and find out what’s important for hearing and deafness,” said Dr. Chen. “Having this new technology helps with that and brings us closer to our ultimate goal of restoring hearing for those who may have been born without hearing or have experienced hearing loss throughout their lives.” l

Dr. Yong Tao observes a stained mouse cochlea under the guidance of Dr. Zheng-Yi Chen.

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FEATURE

Understanding

X

Researchers and clinicians team up to help

X-linked

dystoniaparkinsonism patients 8

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-linked dystoniaparkinsonism (XDP) is a debilitating disease that produces uncontrollable spasms of the mouth, tongue, jaw, neck, and throat, and presents unique challenges for both researchers and physicians. Also known as Lubag syndrome, XDP is a genetic movement disorder that predominantly affects males with a genetic tie to the island of Panay in the Philippines. Why it only affects those of Filipino decent is currently unknown because the exact genetic cause and the origin of the disease have yet to be determined. Between the complexity of the disease and its rareness, little is known about XDP, leaving thousands of patients without the proper care. First reported in 1976 by Lillian V. Lee, MD, MHA, XDP’s symptoms usually manifest in early to middle adulthood with speech changes and tremors. Early on, patients will develop dystonia symptoms such as involuntary muscle


contractions, which eventually evolve into parkinsonismrelated symptoms including slowness of movements and reflexes, shuffling gait, and rigidity. Over time, symptoms progressively worsen, affecting patients’ ability to swallow and breathe and leaving them significantly disabled. To understand XDP’s pathogenesis and help those affected by the disorder, a center dedicated to managing the disease was established at Massachusetts General Hospital. Led by Nutan Sharma, MD, PhD, Associate Professor of Neurology at Harvard Medical School, the Collaborative Center for X-linked Dystonia-Parkinsonism uses a multidisciplinary approach to study the disease and to expand the availability of clinical care options. “XDP is a terrible disease—rapid, painful, and affecting people in the prime of their lives,” said Phillip C. Song, MD, Assistant Professor of Otolaryngology at Harvard Medical School and a laryngologist at Massachusetts Eye and Ear who is on the Center’s clinical team. “Families are devastated as the primary breadwinner becomes disabled

and often living in disastrous conditions. The individual struggles that patients and their families experience is heartbreaking. The Center aims to support the physicians in the Philippines in clinical care and provide research expertise towards a cure to help those patients.”

Helping patients around the world Since its inception, the Collaborative Center for XDP has evolved into an international consortium of scientists, physicians, and advocates. Together, this team is working on discovering the causative mutation of XDP, characterizing the disease’s natural history, developing treatments, expanding clinical resources and training, and supporting patients and their families. To date, the team has helped hundreds of patients in the United States and in the Philippines, and has made promising advancements in their research. Most notably, although the exact mutation has not been identified, the research team has narrowed it down to a stretch of DNA on the X chromosome. continued on page 10

“Families are devastated as the primary breadwinner becomes disabled and often living in disastrous conditions. The individual struggles that patients and their families experience is heartbreaking. The Center aims to support the physicians in the Philippines in clinical care and provide research expertise towards a cure to help those patients.”

—Dr. Song

Dr. Phillip Song (center) with Dr. Nutan Sharma (left of Dr. Song), Dr. Lillian Lee (right of Dr. Song), and the XDP clinical team in the Philippines.

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FEATURE

| Understanding XDP | continued

Dr. Song’s involvement has been focused on characterizing the trouble XDP patients experience from an otolaryngology standpoint and how to treat those problems. The major causes of death for XDP patients are aspiration, malnutrition, and pneumonia because they often have trouble swallowing and breathing. The muscle contractions can be so severe that a patient’s ability to eat and drink might be limited; they might lose control of their limbs, necks, jaws, and tongues; and their larynx risks closing up during respiration. Dr. Song is working with the Center to determine ways for these patients to get better nutrition, to reduce the risk of aspiration, and to provide treatments that help relieve these symptoms. Earlier this year, Dr. Song took a medical trip to the Philippines to work with these patients. He performed endoscopic examinations to evaluate swallowing and to learn more about their laryngeal and pharyngeal function, hoping to develop therapies that will help these areas. He also administered botulinum toxin (Botox) injections to help ease the severity of the contractions. The Botox injections can be made into the voice cords, jaw, and neck to provide relief, stabilize the contractions, and help open up the larynx for better breathing. “Although there is currently no cure, treatments aimed at decreasing symptoms, such as Botox injections, have proven to be effective. So, on our trip to the Philippines, we focused a lot of our efforts on that,” said Dr. Song. “It’s important because these injections could mean a patient stays healthier and out of the hospital or even gives them a chance to actually eat a meal.” On the trip, Dr. Song also taught the neurologists in the Philippines how to administer the Botox injections in the head and neck. Training and learning collaborations are encouraged by the Center because it expands awareness and broadens the treatment options for local physicians. In the case of the Botox injections, Dr. Song has helped provide the opportunity for more treatments to be properly administered.

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“The more we study XDP, the more we are going to understand the basic organization of the human brain, which could have implications to other neurodegenerative disorders such as Parkinson’s disease, ALS, and Alzheimer’s disease.” —Dr. Song


Looking ahead While the Center’s main goal is to find a cure for XDP, the team has found the right balance between their research and clinical efforts and being a support system for patients. As the researchers continue studying the disease and clinicians continue providing care, the Center is also working with community advocates to understand a patient’s daily struggles, such as financial instability and social isolation, in order to offer more supportive services. By working with local organizations, the Center also hopes to expand its model of care to all provinces on Panay Island so more patients have access to care. For Dr. Song specifically, he is planning his next

medical trip to the Philippines, with the goal of bringing a larger swallowing team to be able to see more patients, administer more treatments, and look into whether or not there are therapeutic treatments, such as exercises or adaptive devices, that might be helpful to XDP patients. “The more we study XDP, the more we are going to understand the basic organization of the human brain, which could have implications to other neurodegenerative disorders such as Parkinson’s disease, ALS, and Alzheimer’s disease,” said Dr. Song. “It is an exciting line of work and I think with our multidisciplinary approach, we will see many advances in the coming years and be able to further help these patients live a longer, more comfortable life.” l

Drs. Phillip Song and Nutan Sharma discuss their work. HARVARD Otolaryngology

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FEATURE

Drs. Mark Shrime (left) and Blake Alkire (right) discuss their research.

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Need for Worldwide

Access to Surgery Researchers investigate the economics of global surgery 12

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pproximately 30 percent of the global burden of disease requires the involvement of a surgeon; yet, an estimated five billion people worldwide do not have access to surgery. Despite this apparent need, the development of surgical care systems has often been disregarded, and discussions concerning global health don’t often extend beyond infectious disease. The significance of this problem can be found in the estimated eight million people dying annually because they don’t have access to surgery. These lives are lost due to a systematic failure, and if the global health community wants to continue the advancement of universal health coverage, then increasing access to surgical services will be a vital step to achieving that. “For a long time people thought it was too expensive and not cost-effective enough to invest in surgery,” said Blake C. Alkire, MD, MPH, Instructor


in Otolaryngology at Harvard five key messages for health policy Medical School and Associate makers that laid out the importance Researcher for the Office of Global of measuring surgery and developing Surgery and Health (OGSH) at national surgical plans to help start Massachusetts Eye and Ear and the conversation. the Program in Global Surgery and “Our hope is that with our Social Change (PGSSC) at Harvard key messages, which have been Medical School. “Surgery has been accepted by the World Bank, and our viewed as a luxury instead of as a continued research efforts, countries necessity, and from a moral and Drs. Mark Shrime (left) and John Meara will start to make strides to building economic standpoint, it cannot (right) at the Program in Global Surgery more comprehensive health systems,” and Social Change weekly meeting. continue to be treated that way.” said Dr. Shrime, Assistant Professor Recently, a group of surgeons and other global surgery of Otolaryngology and of Global Health and Social advocates, including former Harvard otolaryngology Medicine at Harvard Medical School and Research resident John G. Meara, MD, DMD, MBA, Director of Director of Harvard Medical School’s PGSSC. Harvard Medical School’s PGSSC, decided it was time Redefining access to surgery to change the discussion. This group paired up with The Lancet to open a Commission on global surgery to To better understand surgical inequities, Dr. Alkire dedicate resources to collecting evidence on the state of and Dr. Shrime have led research at both the OGSH and surgery worldwide, to study the economics of surgical the PGSSC that runs the gamut from global modeling care, and to create strategies for improving access. This studies to country-specific work, particularly studying Commission is a far-reaching effort that includes three the economic impact of surgical conditions. One study, co-chairs and 22 commissioners from around the world. led by Dr. Alkire and Nakul Raykar, MD, MPH, a With help from Harvard Medical School Department general surgery resident and the Chief Paul Farmer of Otolaryngology faculty Mark G. Shrime, MD, MPH, Global Surgery fellow at Harvard Medical School, PhD, FACS, and Dr. Alkire, the Commission developed revealed that nearly five billion people do not continued on page 14

This graph shows the proportion of the population without access to surgery by country (selective tree with baseline assumptions). Alkire BC, Raykar NP, Shrime MG, Weiser TG, Bickler SW, Rose JA, Nutt CT, Greenberg SL, Kotagal M, Riesel JN, Esquivel M, Uribe-Leitz T, Molina G, Roy N, Meara JG, Farmer PE. Global access to surgical care: A modelling study. Lancet Glob Health. 2015 Jun;3(6):e316–23.

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| The Need for Worldwide Access to Surgery | continued

quantifying how much financial catastrophe patients are at risk of facing because of surgery. The study, which was published in the British Journal of Surgery, analyzed publicly available data from 186 countries and found that nearly half of the global population is at risk of financial catastrophe from the direct medical costs of surgery. Currently, a large percentage of people don’t get surgery because of the financial burden it could have, but if affordable surgical “We are not saying that we should options were created, then more people take on surgery at the expense of could consider surgery. other diseases, but we are saying that “If you build an operating room but a building out surgical systems has the patient can’t afford it, then you don’t have potential to improve overall economic actual access to surgery, you just have an welfare and development.” operating room sitting there unused,” said —Dr. Alkire Dr. Shrime. “We know that we need to scale up surgery because 70 percent of the world’s population doesn’t have access, but we cannot dimension—the availability of operating rooms. The do this at the expense of increasing financial destitution. notion of surgical access, however, is multidimensional Our hope is that these findings will help inform surgical and requires that all four domains be considered to be policies and ensure that financial protection is built in sufficient. For example, an abundance of surgeons and where needed.” hospitals means little if trauma patients cannot receive safe care in a timely fashion. When taken together, this Investment in surgical services multidimensional definition of access insists upon wide surgical coverage and positive outcomes; if even one Developing surgical infrastructure in low- and dimension was taken away, then a portion of the world’s middle-income countries will require a large, systematic population would still have no access to surgery and risk change as current surgical systems are often insufficient poor outcomes. (not achieving all four dimensions) or completely absent. One example proving this concept is the work In the past, this problem has been virtually ignored of Dr. Shrime. He has explored surgical affordability, on the larger global health agenda; however, countries have access to surgery. These findings, which were published in The Lancet Global Health, were determined by modeling access to surgical services in 196 countries with respect to four dimensions: timeliness, surgical capacity, safety, and affordability. Previous estimates reported that two billion people lacked surgical access, but this figure relied on only one

Dr. Mark Shrime giving a presentation at the Program in Global Surgery and Social Change weekly meeting.

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This graph shows the risk of catastrophic expenditure if surgical care is necessary. Shrime MG, Dare AJ, Alkire BC, O’Neill K, Meara JG. Catastrophic expenditure to pay for surgery worldwide: A modelling study. Lancet Glob Health. 2015 Apr 27;3 Suppl 2:S38–44.

that continue to neglect surgery may risk foregoing a significant proportion of their gross domestic product (GDP). A team of researchers, led by Dr. Alkire, modeled the global economic burden of surgical disease, looking specifically at how much money in GDP terms countries can expect to lose over the next 15 years from diseases that are surgically treatable. The findings, which were published in The Lancet Global Health, show that lowand middle-income countries risk losing $12.3 trillion U.S. dollars between 2015 and 2030 due to surgically treatable conditions. This loss, which can equate to up to two percent of their potential GDP, accounts for mainly the losses in Southeast Asia, East Asia, and Oceania. When including all income classifications, the loss could be upwards of $20.7 trillion U.S. dollars. “If nothing is done about the lack of access to surgery globally, surgical conditions could be responsible for massive financial losses, and more than half of those losses will occur in low- and middle-income countries,” said Dr. Alkire. “We are not saying that we should take on surgery at the expense of other diseases, but we are saying that building out surgical systems has the potential to improve overall economic welfare and development, and potentially offer huge economies of scope and scale given that the systems necessary to treat surgical diseases can also be used for non-surgical diseases.”

Global surgery moving forward The work toward developing sustainable healthcare infrastructure that includes surgical systems is still in its early stages. More support, both from a financial and work force perspective, is going to be important for progress to continue moving forward. More research, such as the work of Dr. Shrime and Dr. Alkire, will be needed for the development of surgical policies, and as countries begin to make changes, operational and training support will also be necessary. Making surgery available across the globe will take time and effort, especially when faced with challenges of making timely surgery safe and affordable. However, in the end, this work will be important in many ways—from the potential for economic growth to the lives that will be saved. “For Dr. Shrime and myself, we are going to continue to do research to build the evidence base to better understand where we are, where we need to be, and how we can get there with respect to surgical systems in low- and middle-income countries, with an ultimate goal of helping to inform policy. But we also hope the Commission’s work will encourage other surgeons, of any specialty, to join the cause,” said Dr. Alkire. “People are suffering and surgeons have enormous potential to help right that.” l

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OTOLARYNGOLO G Y E D U C AT IO N

Farewell Class of 2016 Harvard Medical School Department of Otolaryngology Celebrates 2016 Graduation and 4th Annual Meeting Faculty and staff from the Department of Otolaryngology at Harvard Medical School gathered in the Meltzer Auditorium at Massachusetts Eye and Ear on Friday, June 24, to celebrate the 2016 graduating class of residents and fellows. Four chief residents and 13 clinical fellows graduated from the program. These exceptional graduates were honored in a ceremony led by Harvard Medical School Otolaryngology Residency Director Stacey T. Gray, MD, Associate Residency Director Kevin S. Emerick, MD, and Walter Augustus LeCompte Professor and Chair of Otolaryngology at Harvard Medical School, D. Bradley Welling, MD, PhD, FACS, among others. “Graduation is a time to celebrate the endeavors of our residents and fellows,” said Dr. Gray. “Although we could not possibly capture how much they have accomplished over the last several years, it has been truly remarkable to watch them develop as clinicians, scientists, scholars, teachers, mentors, and leaders. We are so proud to have this group represent our program in their future careers as otolaryngologists.” Keynote speaker Paul E. Farmer, MD, PhD, Chair of the Department of Global Health and Social Medicine at Harvard Medical School and Co-Founder of Partners In Health, delivered this year’s graduation address, titled “Are the Ears, Nose, and Throat in the Head and Neck? What about the Eyes? Subspecialty Medicine and the Future of Global Health Equity.” Invited by the Office of Global Surgery and Health at Mass. Eye and Ear, which is directed by Mack L. Cheney, MD, Dr. Farmer’s speech stressed the importance of surgical specialties in global health and the need for surgery worldwide. Prior to the graduation ceremony, the day began with the Department’s fourth annual meeting, an event that brings together department faculty, residents, and fellows. The meeting featured Chief Resident Research talks on topics from hair cell regeneration to the role of simulation in otolaryngology training, followed by scientific presentations given by Stéphane F. Maison, PhD, MS; Mark G. Shrime, MD, MPH, PhD, FACS; and Dennis S. Poe, MD, PhD. Each year, the annual meeting provides a special opportunity for thoughtful discussion among faculty and staff across the different subspecialties and clinical venues that make up the Harvard Medical School otolaryngology department. Congratulations to all of our graduates, whom we are confident will make us proud in their successes for years to come.

Awards and Honors Annual Poster Session Blake C. Alkire, MD, MPH 1st Place Poster Award “Global economic consequences of selected surgical diseases: A modeling study” Mentor: John G. Meara, MD, DMD, MBA Elliott D. Kozin, MD 2nd Place Poster Award “Design, fabrication, and testing of a 3-D printed biomimetic tympanic membrane graft” Co-Principal Investigator: Aaron K. Remenschneider, MD, MPH Collaborators: John J. Rosowski, PhD, Jennifer A. Lewis, ScD, Michael J. McKenna, MD, Daniel J. Lee, MD, FACS

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Jeffrey P. Harris, MD, PhD, Research Prize Presented to one of the graduating chiefs for his or her FOCUS research project. Dunia E. Abdul-Aziz, MD “Toward hair cell regeneration: Hic1 regulation of Atoh1” Mentor: Albert S. Edge, PhD

Fellow Teaching Award Tjoson Tjoa, MD

Chief Resident Teaching Award Blake C. Alkire, MD, MPH

William W. Montgomery, MD, Faculty Teaching Award Ralph B. Metson, MD

Dr. Dunia Abdul-Aziz (middle) receives the Jeffrey P. Harris, MD, PhD, Research Prize, presented by Dr. Stacey Gray (left) and Dr. Brad Welling (right)


Graduating Class of 2016 Residents Dunia E. Abdul-Aziz, MD, joined Mass. Eye and Ear/Harvard Medical School as a sevenyear research track resident and spent her two research years in the Eaton-Peabody Laboratories at Mass. Eye and Ear with Albert S. Edge, PhD, Professor of Otolaryngology at Harvard Medical School, investigating the role of epigenetic changes in guiding inner hair cell differentiation and regeneration. Through her research, she found a novel pathway to hair cell regeneration that will have a major impact on new treatments for sensorineural hearing loss. In addition to receiving an Academy CORE grant for this project, she was awarded the Jeffrey P. Harris, MD, PhD, Research Prize during the graduation ceremony. Throughout her residency, she was also involved in multiple publications and national presentations, all while being an incredibly thoughtful and insightful clinician. Dr. Abdul-Aziz is currently pursing fellowship training in neurotology at Mass. Eye and Ear/Harvard Medical School. Throughout his residency, Blake C. Alkire, MD, MPH, was known for his bright personality and his team player attitude. He was recognized by his fellow residents at graduation as the recipient of the Chief Resident Teaching Award. From a research perspective, he pursued his interests in global health for his FOCUS project, working with John G. Meara, MD, DMD, MBA, Professor of Global Health and Social Medicine at Harvard Medical School, on the economic burden of surgical disease in the developing world. He authored more than 20 publications and gave five oral presentations during his residency and was a key contributor to The Lancet publication on global surgery. Dr. Alkire recently joined Mass. Eye and Ear’s Longwood practice and is continuing his research work with the Office of Global Surgery and Health at Mass. Eye and Ear and the Program in Global Surgery and Social Change at Harvard Medical School. Faculty members of the program have described Regan W. J. Bergmark, MD, as someone with the “drive, personality, and intellect to truly make a difference.”

From left to right: Drs. Regan Bergmark, Matthew Dedmon, Dunia Abdul-Aziz, and Blake Alkire

Dr. Bergmark is passionate about public service and advocating for those in need. Because of this, she worked on surgical outcomes measures in Uganda for her FOCUS project as well as healthcare disparities in rhinosinusitis. As a clinician, Dr. Bergmark brings comfort to her patients with her contagious enthusiasm and her ability to connect with them on a personal level. Cumulatively, she was involved in 16 publications as well as multiple oral and poster presentations at national meetings during her residency. Dr. Bergmark is now pursuing fellowship training in rhinology at Mass. Eye and Ear/Harvard Medical School. During his residency, Matthew M. Dedmon, MD, PhD, was known for his dedication to his patients and his amiable sense of humor. Working with Phillip C. Song, MD, Assistant Professor of Otolaryngology at Harvard Medical School, Dr. Dedmon developed and validated a laryngeal surgical simulator for his FOCUS project. This simulator is now used as part of the residency-training curriculum. Given his interest in neurotology, he also worked on the development of a transcanal endoscopic ear surgery simulator, with both projects resulting in several national presentations and publications. In addition

to this work, Dr. Dedmon was involved in numerous publications and national and international oral and poster presentations. He is now pursuing a fellowship in neurotology at Vanderbilt University Medical Center.

Clinical Fellows, Mass. Eye and Ear Christopher D. Brook, MD Rhinology Fellowship Directors: Ralph B. Metson, MD, Stacey T. Gray, MD, Eric H. Holbrook, MD Future Plans: Assistant Professor, Department of Otolaryngology, Boston Medical Center Gillian R. Diercks, MD, MPH Pediatric Otolaryngology Fellowship Director: Christopher J. Hartnick, MD, MS Future Plans: Pediatric Otolaryngologist, Mass. Eye and Ear and suburban centers Newton-Wellesley and Wellesley Nathan Jowett, MD Facial Plastic and Reconstructive Surgery Fellowship Director: Tessa A. Hadlock, MD Future Plans: Clinical Associate, Division of Facial Plastic and Reconstructive Surgery, Mass. Eye and Ear continued on page 18

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Whitney E. Liddy, MD Thyroid and Parathyroid Surgery Fellowship Director: Gregory W. Randolph, MD, FACS, FACE Future Plans: Assistant Professor, Northwestern Memorial Hospital in Chicago Alice Z. Maxfield, MD Rhinology Fellowship Directors: Ralph B. Metson, MD, Stacey T. Gray, MD, Eric H. Holbrook, MD Future Plans: Otolaryngology Faculty, Brigham and Women’s Hospital/ Harvard Medical School Nikhila P. Raol, MD Pediatric Otolaryngology Fellowship Director: Christopher J. Hartnick, MD, MS Future Plans: Pediatric Otolaryngologist, Henrietta Egleston Hospital for Children; Assistant Professor of Otolaryngology, Emory University School of Medicine Aaron K. Remenschneider, MD, MPH Neurotology Fellowship Director: Daniel J. Lee, MD, FACS Future Plans: Otolaryngology Faculty, UMass Memorial Medical Center; Research Faculty, Mass. Eye and Ear/ Harvard Medical School Tjoson Tjoa, MD Head and Neck Oncology/ Microvascular Surgery Fellowship Directors: Daniel G. Deschler, MD, FACS, Derrick T. Lin, MD, FACS Future Plans: Otolaryngology Faculty, University of California, Irvine

Carissa J. Wentland, DO Pediatric Otolaryngology Fellowship Director: Christopher J. Hartnick, MD, MS Future Plans: Assistant Professor, Case Western Medical Center, Rainbow Babies and Children’s Hospital in Cleveland, Ohio

Clinical Fellows, Boston Children’s Hospital Pediatric Otolaryngology Fellowship Director: Reza Rahbar, DMD, MD, FACS David Tan-Wei Chang, MD, PhD Future Plans: Pediatric Otolaryngologist, Children’s Hospital of Orange County in California Jamie L. Funamura, MD Future Plans: Pediatric Otolaryngologist, University of California Davis Medical Center Lindsay Sobin, MD Future Plans: Pediatric Otolaryngologist, UMass Memorial Medical Center Ryan D. Walker, MD Future Plans: Pediatric Otolaryngologist, Advanced ENT in Voorhees, New Jersey

Back left to right: Drs. Tjoson Tjoa, Carissa Wentland, Nathan Jowett, Aaron Remenschneider, Christopher Brook; Front left to right: Drs. Nikhila Raol, Alice Maxfield, Gillian Diercks, Whitney Liddy

Top: Dr. Paul Farmer speaks about the need for surgery worldwide during his graduation address. Middle: (left to right) Dr. David Caradonna, Dr. Michael Cunningham, Dr. Stacey Gray, Dr. Jo Shapiro, guest speaker Dr. Paul Farmer, Dr. Mark Varvares Bottom: Drs. Ryan Walker, Jamie Funamura, Lindsay Sobin, and David Chang with Boston Children’s Hospital Otolaryngologist-in-Chief, Dr. Michael Cunningham.

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New Trainees The Otolaryngology Residency Program at Harvard Medical School The Department welcomes five new residents to Mass. Eye and Ear this year, including Alessandra Colaianni, MD, Allen L. Feng, MD, Natalie S. Justicz, MD, Suresh Mohan, MD, and Alisa Yamasaki, MD. We also welcome five new otolaryngology interns, Nicholas B. Abt, MD, Jenny X. Chen, MD, Shekhar K. Gadkaree, MD, Ashley L. Miller, MD, and Vinay K. Rathi, MD.

PGY-2 Residents Alessandra Colaianni, MD, is a graduate of Duke University, where she received degrees in biology and philosophy. She completed an MPhil in history and philosophy of science at the University of Cambridge as a Gates Cambridge Scholar and then completed medical school at Johns Hopkins School of Medicine. She completed her internship year at Massachusetts General Hospital. She has published several articles examining the influence of institutional culture on do-notresuscitate decision-making as well as moral distress regarding futile treatments at the end of life amongst medical trainees. Her research interests include medical/surgical ethics, the history and philosophy of science, and the concept of narrative medicine and how medical storytelling can be used to benefit physicians and patients. Hailing from Edmonton, Alberta, Canada, Allen L. Feng, MD, received his undergraduate degree in mechanical engineering from the University of Alberta. There, he was awarded the APEGA Past Presidents’ Medal in Mechanical Engineering for achieving the highest academic standing in the department. He went on to attend medical school at Johns Hopkins School of Medicine where he received the W. Barry Wood Jr. Research Scholar award for outstanding medical student research. He completed his internship year at Beth Israel Deaconess Medical Center. As a resident, Dr. Feng focuses his research efforts on medical device design, robotic surgery, and biomedical engineering with specific interests in applying finite element modeling to biomechanical problems within head and neck surgery.

Natalie S. Justicz, MD, grew up in Atlanta, Georgia, and attended Stanford University, where she graduated with a degree in human biology in 2009. Following graduation, she taught middle school science with Teach For America in New Orleans, Louisiana, for two years before returning to Atlanta to attend medical school at Emory University School of Medicine. During medical school she created and executed a clinical trial on the treatment options for patients with essential vocal tremor. She completed her internship year at Massachusetts General Hospital and is currently interested in continuing her research in the field of medical education. Originally from Ann Arbor, Michigan, Suresh Mohan, MD, graduated from the University of Michigan with dual concentrations in music and cell and molecular biology. He went on to complete his medical training at the Warren Alpert Medical School of Brown University and spent one year at the National Institute on Deafness and Other Communication Disorders (NIDCD) investigating novel targeted chemotherapeutics for head and neck squamous cell carcinoma. Dr. Mohan completed his internship year at Brigham and Women’s Hospital and is currently pursing the seven-year T32 resident research track. Alisa Yamasaki, MD, is a Dartmouth College and Harvard Medical School graduate. Prior to medical school, she worked as a healthcare consultant in the biotech, pharmaceutical, and medical device industries, which helped shape her approach to evidence-based clinical practice and research. Her prior research projects include international collaborations between academic hospitals in Tokyo, Japan, and Boston to analyze the discharge care coordination process for high-risk geriatric patient populations. Additionally, Dr. Yamasaki has a background in classical piano performance and has been involved in music and medicine research to explore the clinical applications of music in perioperative settings. She completed her internship year at Brigham and Women’s Hospital.

New Clinical Fellows Mass. Eye and Ear Facial Plastic and Reconstructive Surgery Callum K. Faris, MD

Head and Neck Oncology/ Microvascular Surgery Heather A. Osborn, MD

Laryngology Ozlem O. Celebi, MD

Neurotology Dunia E. Abdul-Aziz, MD

Pediatric Otolaryngology Sarah N. Bowe, MD

Rhinology Regan W. J. Bergmark, MD

Rhinology Adam P. Campbell, MD

Thyroid and Parathyroid Surgery Bradley R. Lawson, MD

Boston Children’s Hospital Pediatric Otolaryngology

Jeffrey C. Yeung, MD, Nikolaus E. Wolter, MD, Steven Rosenblatt, MD, and Colleen Heffernan, MD

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Alumni Profiles

Theodoros N.Teknos, MD, HMS Otolaryngology Resident, Class of 1996 From medical student to mentor

Dr. Teknos has built a career balancing research and clinical demands with the training of residents and fellows in addition to fulfilling his administrative leadership responsibilities. A Detroit native, Dr. Teknos earned his undergraduate degree from Wayne State University in 1987 prior to attending Harvard Medical School. During medical school, he spent a significant amount of time with the otolaryngology faculty, who eventually inspired him to stay in Boston to complete his otolaryngology residency at Massachusetts Eye and Ear/ Harvard Medical School.

T

ed Teknos, MD, started medical school with an open mind, ready to discover his interests. But soon enough, it took only one anatomic dissection of the head and neck to set his sights on otolaryngology. “It was the importance of otolaryngology and the complexity of the anatomy that grabbed my attention,” said Dr. Teknos, Professor and Chairman of the Department of Otolaryngology— Head and Neck Surgery and The David E. Schuller, MD, and Carole Schuller Chair in Otolaryngology at The Ohio State University College of Medicine (OSU COM). “Otolaryngology is how we relate to the outside world—we listen, we speak, we smell, we taste—and otolaryngologists strive to help all people experience that.” Now a fellowship-trained head and neck surgical oncologist, author of more than 150 scientific papers, and Department Chair at the OSU COM,

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“The otolaryngology faculty at Mass. Eye and Ear took a keen interest in my career,” said Dr. Teknos. “Many of them became important mentors to me and helped me better understand the field of otolaryngology. They showed me the best of what the field had to offer, and I chose to pursue this field because of them.” Following residency, Dr. Teknos went to Vanderbilt University Medical Center for a fellowship in head and neck oncology and microvascular reconstruction. He then returned to his home state in 1997 for a faculty position at the University of Michigan. There, he made his way up the academic ladder, becoming the Division Chief of Head and Neck Surgery in 2003. After five years of leadership, Dr. Teknos was recruited as a Professor to the OSU COM and as the Division Chief of Head and Neck Oncologic Surgery at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in 2008. Transitioning to Ohio with some of his research team from the University of

Michigan, he built upon his previous work of applying tumor angiogenesis to head and neck cancer, which eventually evolved into studying carcinogenesis, cell signaling, and novel therapeutics. His team’s discoveries culminated most recently with the licensing of a novel therapeutic agent that successfully eradicated Human papillomavirus (HPV)-related tumors by reactivating tumor protein p53. In 2014, Dr. Teknos was promoted to Chairman of the Department of Otolaryngology—Head and Neck Surgery at the OSU COM. Under his leadership, faculty recruitment has grown by more than 25 percent, national funding has increased, and the department is unwaveringly committed to its tripartite mission. “My career has really gone full circle,” said Dr. Teknos. “I’ve grown from a naïve medical student, to a young surgeon-scientist, to a department chair fostering the academic mission for others. I find it really interesting and satisfying to have seen my career evolve in this manner.” For Dr. Teknos, his proudest accomplishments are “those achieved by his mentees.” “Training at Mass. Eye and Ear was a huge privilege. My mentors not only put me on a path of clinical excellence and introduced me to head and neck cancer research, but they also taught me how to be an influential mentor myself,” said Dr. Teknos. “Mass. Eye and Ear has had a great impact on the field of otolaryngology across the world and being a part of that legacy is a great thing.” l


Zachary M. Smith, PhD, Eaton-Peabody Laboratories at Massachusetts Eye and Ear/ Harvard Medical School, 1999–2006 Finding the right balance between art and science

Z

achary Smith, PhD, grew up loving two things: playing music and building things. It was these two interests that eventually led him to become an auditory neuroscientist focused on restoring hearing through neural prostheses. “Growing up with musical and technical interests made deciding which direction to pursue difficult,” said Dr. Smith, Director of Coding Research at Cochlear Limited, a global biotechnology company specializing in implantable hearing solutions. “But realizing that I could combine these interests was a game changer for me.”

Photo by Stacie Smith

As an auditory neuroscientist who holds nine U.S. issued patents, Dr. Smith has built a career that balances his background in engineering with an interest in sound. At Cochlear Limited, he develops and investigates novel sound coding

strategies for cochlear implants, including a multi-center FDA clinical trial. Originally from Fresno, California, Dr. Smith double-majored in electrical engineering and music at Brigham Young University in Utah. After his sophomore year, he briefly worked on a research project that involved auditory models for hearing aids, sparking his interest in the perception of sound and the underlying neurophysiology of auditory pathways. When he graduated in 1999, he knew he wanted to pursue further education in engineering while continuing to study hearing and speech signal processing. “In college, my double major made me feel like I was living this double life,” said Dr. Smith. “So when the Health Sciences and Technology doctoral program at the Massachusetts Institute of Technology was presented to me, I immediately knew that it was exactly what I was looking for.” In the summer of 1999, Dr. Smith moved to Boston to begin his doctoral program, where he worked for the Eaton-Peabody Laboratories at Massachusetts Eye and Ear/Harvard Medical School under the guidance of Bertrand Delgutte, PhD, Professor of Otolaryngology at Harvard Medical School and Co-Director of the Speech and Hearing Bioscience and Technology doctoral program. During this time, Dr. Smith investigated binaural interactions in the auditory midbrain with bilateral cochlear prostheses, which is something he continues to expand upon today. Concurrently, he continued playing music as an oboist in the Longwood Symphony Orchestra, the nationally recognized orchestra of Boston’s medical community. After a brief postdoctoral position at Johns Hopkins University, Dr. Smith then

moved from academia into industry, joining Cochlear Limited in 2007. In this role, he directs perceptual studies of electric hearing and develops new sound coding strategies for auditory prostheses. Currently, two of his main focuses are on increasing the resolution of the electrode-neural interface of cochlear implants and improving bilateral devices so that they work better together and leverage the binaural circuits of the brain. “My team is interested in understanding the basic mechanisms of how electric hearing works and using those findings to develop new and better ways for treating deafness,” said Dr. Smith. “What’s great about this work is that we have the opportunity to interact closely with cochlear implant patients and see firsthand the importance of this intervention in their lives.” Dr. Smith has had the opportunity to see one of his early projects progress from initial concept to a clinical trial, which has allowed him to achieve many benchmarks within his career. Eventually, he hopes his work will lead to the introduction of new technologies for cochlear implants that will improve hearing performance, especially for music, to the commercial market. “Cochlear implants can completely transform people’s lives. They give deaf individuals the opportunity to fully connect with a whole world of people who use speech to communicate,” said Dr. Smith. “The work that I do is just a small piece of what cochlear implants are, but it is still an honor to be even a small part of something that is so impactful on so many lives.” l

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Alumni Giving Society

Otolaryngology The Alumni Giving Society of the Department of Otolaryngology at Harvard Medical School The Department of Otolaryngology at Massachusetts Eye and Ear/Harvard Medical School established the Alumni Giving Society in 2015 to recognize faculty and alumni who make gifts of $1,000 or more during the fiscal year (October 1–September 30). Participation is a way to stay connected and to help deliver the finest teaching experience for today’s otolaryngology trainees. Our alumni know from firsthand experience that support of the vital work of our students and faculty in the Department of Otolaryngology helps drive continued achievement across all areas of education, research, and patient care. To date, we have 48 members whom we thank for their generosity and for partnering with us to achieve our department goals and institutional mission. If you are not a member, please consider joining your colleagues today by making a gift with the enclosed envelope. As a member, you may designate your gift in the way that is most meaningful to you. To learn more, please contact Julie Dutcher in the Development Office at 617-573-3350.

Alumni Leaders

Alumni Giving Society Leadership D. Bradley Welling, MD, PhD, FACS Walter Augustus LeCompte Professor and Chair of Otolaryngology, Harvard Medical School Chief of Otolaryngology, Massachusetts Eye and Ear/ Massachusetts General Hospital Michael B. Rho, MD, FACS, ’05 President, Harvard Otolaryngology Alumni Society Medical Director, Otolaryngology, Mass. Eye and Ear, Stoneham Stacey T. Gray, MD, ’04, ’05 Program Director, Residency in Otolaryngology–Head and Neck Surgery, Harvard Medical School Director, Sinus Center, Mass. Eye and Ear

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Daniel G. Deschler, MD, FACS Richard E. Gliklich, MD, ’93, ’94 Donald G. Keamy, Jr., MD, MPH Paul M. Konowitz, MD, FACS John B. Lazor, MD, MBA, FACS, ’95, ’96 Jon B. Liland, MD, ’72 Derrick T. Lin, MD, FACS, ’98, ’02 Leila A. Mankarious, MD William W. McClerkin, MD, ’73 Ralph B. Metson, MD, ’87 Michael M. Paparella, MD Herbert Silverstein, MD, FACS, ’66 Top: Drs. Daniel Fink, Linda Lee, and Michael Rho at the 2016 COSM meeting. Bottom: Former Harvard Medical School otolaryngology residents Drs. Joshua Silverman, Wade Chien, Shelby Leuin, and Andrew Scott.

Current Alumni Giving Society members for fiscal year 2016 from October 1, 2015 to September 30, 2016 are listed below. With your gift of $1,000 or more, you will be included in the 2017 Alumni Giving Society. CHAMPION: Gifts of $25,000 or more

KJ Lee, MD Ralph B. Metson, MD

VISIONARY: Gifts of $10,000 to $24,999

Anonymous Michael S. Cohen, MD Paul M. Konowitz, MD, FACS John B. Lazor, MD, MBA, FACS Derrick T. Lin, MD, FACS Leila A. Mankarious, MD Michael M. Paparella, MD Michael B. Rho, MD, FACS Herbert Silverstein, MD, FACS

INNOVATOR: Gifts of $5,000 to $9,999

Nicolas Y. BuSaba, MD, FACS Richard E. Gliklich, MD Eric H. Holbrook, MD Joseph B. Nadol, Jr., MD Oon Tian Tan, MD, PhD D. Bradley Welling, MD, PhD, FACS

PIONEER: Gifts of $2,500 to $4,999

Barry J. Benjamin, MD Samir M. Bhatt, MD Daniel G. Deschler, MD, FACS Christopher J. Hartnick, MD, MS Nathan Jowett, MD Jon B. Liland, MD Michael J. McKenna, MD Cliff A. Megerian, MD David E. Nash, MD H. Gregory Ota, MD Steven D. Rauch, MD Noah S. Siegel, MD Phillip C. Song, MD Eric H. Stein, MD

FRIEND: Gifts of $1,000 to $2,499

John F. Ansley, MD Benjamin S. Bleier, MD Daryl G. Colden, MD, FACS Ronald K. de Venecia, MD, PhD Ruth Anne Eatock, PhD Richard R. Gacek, MD Terry J. Garfinkle, MD, MBA Stacey T. Gray, MD Paul E. Hammerschlag, MD, FACS Jeffrey P. Harris, MD, PhD Matthew Jon Jackson, DMD Andrew A. McCall, MD William W. McClerkin, MD John J. Rosowski, PhD Mark F. Rounds, MD Feodor Ung, MD Mark A. Varvares, MD, FACS


HIGHLIGHTS

News from every corner of the Department of Otolaryngology at Harvard Medical School. New Faculty Nima Maftoon, PhD, has joined the EatonPeabody Laboratories (EPL) at Mass. Eye and Ear/Harvard Medical School and has been appointed Instructor in Otolaryngology. Dr. Maftoon received his doctorate in biomedical engineering from McGill University prior to completing his postdoctoral training in the EPL under the direction of John J. Rosowski, PhD. Dr. Maftoon’s research goal is to design and implement advanced devices and methods for detection, diagnosis, and treatment of hearing loss. Such work requires basic-science research to obtain a fundamental understanding of the biomechanical processes involved in hearing as well as applied research for developing devices and methods translatable to clinic. Alice Z. Maxfield, MD, has joined Brigham and Women’s Hospital as a general otolaryngologist and has been appointed Instructor in Otolaryngology at Harvard Medical School. Dr. Maxfield received her medical degree from Rutgers New Jersey Medical School prior to completing her otolaryngology residency at Albany Medical Center. She then completed fellowship training in rhinology at Mass. Eye and Ear/Harvard Medical School under the mentorship of Ralph B. Metson, MD, Stacey T. Gray, MD, Eric H. Holbrook, MD, Benjamin S. Bleier, MD, and Nicolas Y. BuSaba, MD. Her clinical interests include general otolaryngology with a focus in inflammatory sinus disease and skull base disorders. In her new role, she will continue her research on biomarkers of chronic rhinosinusitis.

Aaron K. Remenschneider, MD, MPH, has joined the Eaton-Peabody Laboratories at Mass. Eye and Ear/Harvard Medical School as an Investigator. He received his master’s degree from the Harvard T.H. Chan School of Public Health and his medical degree from Yale School of Medicine prior to completing his otolaryngology residency at Mass. Eye and Ear/Harvard Medical School, where he also completed a fellowship in otology and neurotology under the mentorship of Daniel J. Lee, MD, FACS, and Michael J. McKenna, MD. Dr. Remenschneider will devote his research time to exploring ways that additive manufacturing (3-D printing) can be applied to help solve long-standing problems in otologic disease. Dr. Remenschneider also serves as an otologist/neurotologist at the UMass Medical Center, where he is the Director of their Cochlear Implant Center and the Medical Director of Audiology. Jeremy D. Richmon, MD, recently joined the Mass. Eye and Ear Division of Head and Neck Cancer as a Clinical Associate and the Director of Head and Neck Robotic Surgery. Dr. Richmon received his medical degree from the University of Rochester School of Medicine prior to completing his residency in otolaryngology at the University of California, San Diego. He then completed additional fellowship training in head and neck oncology, microvascular reconstruction, and skull base surgery at Mass. Eye and Ear/Harvard Medical School. Dr. Richmon specializes in minimally-invasive robotic techniques in the head and neck and focuses his research on microvascular reconstructive techniques of head and neck defects and robotic surgery.

Ravindra Uppaluri, MD, PhD, FACS, has joined Brigham and Women’s Hospital/Harvard Medical School and the Dana-Farber Cancer Institute as the Director of Head and Neck Surgical Oncology. He received both his medical degree and PhD from the University of Minnesota prior to completing his otolaryngology residency at Barnes-Jewish Hospital and the Washington University School of Medicine, where he remained as faculty for the last 16 years. His clinical expertise is in multidisciplinary management of head and neck cancers, including minimally invasive transoral laser microsurgery and endoscopic and open approaches to anterior skull base pathologies. Dr. Uppaluri has been the principal investigator of clinical trials integrating small molecule and immunotherapeutics in the surgical management of head and neck cancers. He also leads an NIH-funded laboratory focused on basic and translational approaches to head and neck cancers.

New Leadership David M. Bowling, MD, has been named the Medical Director of Otolaryngology of Mass. Eye and Ear, Medford.

Peter N. Friedensohn, MD, has been named the Medical Director of the Mass. Eye and Ear South Suburban Center for Otolaryngology. continued on page 24

New textbook: The Recurrent and Superior Laryngeal Nerves Gregory W. Randolph, MD, FACS, FACE, recently celebrated the release of this textbook published by Springer International Publishing. The book delivers a comprehensive up-to-date review of all aspects of the recurrent laryngeal nerve and superior laryngeal nerve anatomy, written by world class U.S. and international experts in anatomy, surgery, and nerve monitoring.

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HIGHLIGHTS

Awards, Grants, and Honors Pooja Balaram, PhD, postdoctoral fellow at Mass. Eye and Ear/Harvard Medical School, received a new F32 fellowship award for her project, “Structural and physiological plasticity in auditory cortex following cochlear denervation.” Benjamin S. Bleier, MD, was awarded the Best Basic Science Presentation from the American Rhinologic Society for his project, “P-glycoprotein is a secreted biomarker of CRS.” Francis “Pete” Creighton, MD, Chief Resident at Mass. Eye and Ear/Harvard Medical School, received the third prize poster award from the American Neurotology Society for his poster, “Investigation of piezoelectric sensors for implantable otologic microphones.” Darcy Frear, Speech and Hearing Bioscience and Technology PhD student at Harvard Medical School, received the Amelia-Peabody Scholarship award for her work on developing a prosthetic device to mechanically stimulate the round window and computational model of the middle and inner ear. She has also received the NIH F31 training award for her dissertation research at Mass. Eye and Ear.

HMS Promotions

Michael S. Cohen, MD, Assistant Professor of Otolaryngology

Donald G. Keamy, Jr., MD, MPH, Assistant Professor of Otolaryngology


Mark G. Shrime, MD, MPH, PhD, FACS, Assistant Professor of Otolaryngology and Assistant Professor of Global Health and Social Medicine

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Dr. Brian Lin at the American Academy of Otolaryngology—Head and Neck Surgery annual meeting, where he was awarded a top rated poster award.

Stacey T. Gray, MD, has been appointed Secretary/Treasurer of the Otolaryngology Program Directors Organization Council and is the 2016–2017 Chair Elect for the American Academy of Otolaryngology— Head and Neck Surgery Rhinology and Allergy Education Committee. Xiying Guan, PhD, postdoctoral fellow at Mass. Eye and Ear/Harvard Medical School, received the Emerging Research Grant from the Hearing Health Foundation for his research proposal on hyperacusis. Tessa A. Hadlock, MD, received an R01 resubmission grant award for her project titled, “Surgical and rehabilitative management of facial nerve injury.” David H. Jung, MD, PhD, won the 2016 American Neurotology Society/American Academy of Otolaryngology—Head and Neck Surgery Foundation Herbert Silverstein Otology and Neurotology Research Award. Margaret A. Kenna, MD, MPH, FACS, FAAP, was a visiting professor for the Department of Otolaryngology at the University of Nebraska. Paul M. Konowitz, MD, FACS, has earned the American Academy of Otolaryngology— Head and Neck Surgery Foundation Honors Award. Elliott D. Kozin, MD, Mass. Eye and Ear/ Harvard Medical School resident, has been selected as one of eleven 2016 Star

Reviewers for the journal Otolaryngology— Head and Neck Surgery by Editor-in-Chief, John H. Krouse, MD, PhD, MBA. He has also been selected to serve on the journal’s Editorial Board. Sharon G. Kujawa, PhD, was awarded a four-year grant from the Office of Naval Research, titled “Cochlear synaptopathy and neurodegeneration after noise.” Brian M. Lin, MD, Mass. Eye and Ear/ Harvard Medical School resident, received a Top Rated Poster award at the American Academy of Otolaryngology—Head and Neck Surgery annual meeting for his poster presentation, “Skin pigmentation and risk of hearing loss.” Jennifer R. Melcher, PhD, presented the 2016 Topics on Tinnitus Distinguished Lecture at the American Academy of Audiology annual meeting, AudiologyNOW!, and was the guest of honor at the 24th Annual Conference on the Management of the Tinnitus and Hyperacusis Patient. Ralph B. Metson, MD, has earned the American Academy of Otolaryngology— Head and Neck Surgery Foundation Distinguished Service Award. Dennis S. Poe, MD, PhD, successfully completed a 22 center FDA-mandated trial, which resulted in a new balloon dilator receiving FDA approval for the treatment of Eustachian tube dysfunction.


HIGHLIGHTS

Sunil Puria, PhD, has been appointed Conference Chair of the International Hearing Aid Research Conference (IHCON). The conference aims to advance knowledge and facilitate progress in hearing aid research and development through the exchange of current research findings and technical advances. Gregory W. Randolph, MD, FACS, FACE, is the President of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) and its Foundation. Elected by AAO-HNS members, Dr. Randolph is serving a one-year term leading the Academy’s nearly 12,000 members. Aaron K. Remenschneider, MD, MPH, received the Massachusetts General Hospital Research Fellow Poster Award for Excellence for his poster “3-Dimensionally printed tympanic membrane approximates sound induced motion patterns of human eardrum.” His poster also ranked third among 76 posters. Yin Ren, MD, PhD, Mass. Eye and Ear/ Harvard Medical School resident, received an Academy CORE grant award for his project, “Tumor-penetrating delivery of nanoparticles to human vestibular schwannomas.” He also received a Resident Research Grant Award from the New England Otolaryngological Society. Mark G. Shrime, MD, MPH, PhD, FACS, gave the Chris O’Brien Lecture at the 9th American Head and Neck Society International Conference on Head and Neck Cancer. Konstantina M. Stankovic, MD, PhD, FACS, received a new R01 award from the NIH for her project titled, “Mechanisms of sensorineural hearing loss: Secreted factors.” She was also the honorary lecturer at the VII International Otology and Neurotology Meeting in Medellín, Colombia, and the keynote speaker at the 4th Yonsei Acoustic Tumor Symposium at Yonsei University Hospital in South Korea. Ross Williamson, PhD, postdoctoral fellow at Mass. Eye and Ear/Harvard Medical School, received a new F32 fellowship award for his project titled, “In vivo dissection of auditory corticofugal circuits.”

Harvard CME Courses The Harvard Medical School (HMS) Department of Otolaryngology has a long history in providing continuing medical education (CME) opportunities to professionals in the field. This year, the Department hosted several courses offering CME credit, which attracted otolaryngologists representing all of the different subspecialties from across the globe. Directed by HMS otolaryngology faculty, courses offered focus on everything from endoscopic surgery techniques to a comprehensive review in the evaluation and management of sleep disorders. Using a mix of panel sessions, facilitated discussions, lectures, and live surgery demonstrations, these courses teach the latest in otolaryngology and for some courses, participants have the chance to practice their surgical skills through hands-on dissection sessions in the surgical skills laboratory at Massachusetts Eye and Ear. Heading into its fourth year in operation, the Joseph B. Nadol, Jr., MD, Otolaryngology Surgical Training Laboratory has become a popular venue for the CME courses. This state-of-the-art facility is equipped with video monitoring, surgical microscopes, drills, and other instruments to offer participants dynamic hands-on surgical skills instruction. A full, robust 2017 course schedule is being planned. Those interested in more information on upcoming Harvard CME courses can visit:

CMEcatalog.hms.harvard.edu/topics/otolaryngology

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RESEARCH ADVANCES

The following are select research advances from the Department of Otolaryngology at Harvard Medical School.

Basic Science Extracellular vesicles derived from human vestibular schwannomas associated with poor hearing damage cochlear cells Vestibular schwannoma (VS) is an intracranial tumor that arises from the balance nerve and causes hearing loss in 95 percent of patients. It has been assumed that the main mechanism of this hearing loss is direct compression of the auditory nerve by the tumor. A team of researchers from Mass. Eye and Ear/ Harvard Medical School, led by Konstantina M. Stankovic, MD, PhD, FACS, recently provided evidence for a new mechanism: tumor secretion of molecules that are toxic to the inner ear (Dilwali et al., Scientific Reports 2015). In their latest study, which was published in Neuro-Oncology, the team showed that tumor-secreted extracellular vesicles also contribute to damage of the auditory nerve. Extracellular vesicles (EVs) are cell-derived nanoparticles that contain the genetic profile of their cell of origin, including RNA and proteins, within a lipid bilayer. EVs are thought to be important mediators of cellcell communication by transferring their cargo between cells. The researchers isolated EVs from human vestibular schwannoma cells and these EVs were then applied to mouse organotypic cochlear cultures and dissociated cells from the auditory nerve grown in a dish. Human VS cells from patients with poor hearing produced EVs that could damage both cultured cochlear sensory cells and neurons. In contrast, EVs derived from VS cells from patients with good hearing did not damage the cultured cochlear cells. This is the first report on EVs derived from VS cells and on the capacity of EVs derived from vestibular schwannoma cells from patients with hearing loss to actively damage cochlear

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cells. The study identifies a potential novel mechanism of vestibular schwannomainduced hearing loss and the findings strongly motivate future work to identify the EV-derived cargo mediating cochlear damage, as this could provide insight into much needed prognostic and therapeutic targets for prevention and treatment of hearing loss due to vestibular schwannoma. Soares VY, Atai NA, Fujita T, Dilwali S, Sivaraman S, Landegger LD, Hochberg FH, Oliveira CA, Bahmad F, Breakefield XO, Stankovic KM. Extracellular vesicles derived from human vestibular schwannomas associated with poor hearing damage cochlear cells. Neuro Oncol. 2016 May 18.

Clinical Research Researchers find evidence of “hidden hearing loss” in college-age subjects A team of researchers from the EatonPeabody Laboratories (EPL) at Mass. Eye and Ear/Harvard Medical School, led by Stéphane F. Maison, PhD, MS, has, for the first time, linked in young people with

“Hidden hearing loss” refers to cochlear synaptopathy or damage to the connections between the auditory nerve fibers and the sensory cells, a type of damage that happens well before the loss of the sensory cells themselves. Loss of these connections is likely to contribute to difficulties understanding speech in challenging listening environments and may also be important in the generation of tinnitus and/or hyperacusis. Hidden hearing loss cannot be measured using the standard audiogram; thus, the Mass. Eye and Ear researchers set out to develop new clinical measures. Developing diagnostic measures for hidden hearing loss is key in the assessment of future therapies to repair the nerve damage in the inner ear. The EPL researchers have shown in animal models that, under some conditions, connections between the sensory cells and the auditory nerve can be successfully restored using growth factors, such as neurotrophins. Liberman MC, Epstein MJ, Cleveland SS, Wang H, Maison SF. Toward a differential diagnosis of hidden hearing loss in humans. PLOS ONE. 2016;11 (9):e0162726.

Prevalence, severity, exposures, and treatment patterns of tinnitus in the United States

normal hearing sensitivity, symptoms of difficulty understanding speech in noisy environments with evidence of cochlear synaptopathy, a condition known as “hidden hearing loss.” While audiometric thresholds and the ability to understand speech in quiet environments were the same across all subjects, Dr. Maison and colleagues recorded reduced responses from the auditory nerve in participants exposed to noise on a regular basis. That loss was matched with difficulties understanding speech in noisy and reverberating environments.

Researchers from Brigham and Women’s Hospital/Harvard Medical School, including Senior Author Neil Bhattacharyya, MD, FACS, in collaboration with researchers from the University of California, Irvine, including fellow Mass. Eye and Ear/ Harvard Medical School alumnus, Harrison W. Lin, MD, recently quantified the contemporary prevalence and severity of tinnitus in the U.S. Dr. Bhattacharyya and colleagues found that approximately 1 in 10 adults in the U.S. live with tinnitus by examining national governmental survey data that included more than 75,000 adults. This translates into 21.4 million Americans living with tinnitus. Interestingly, of those adults reporting


This contemporary data frame the epidemiology and symptom burden of tinnitus against the backdrop of recently published American Academy of Otolaryngology— Head and Neck Surgery guidelines on tinnitus and identify target risk factors and target populations to help those suffering from tinnitus. Bhatt JM, Lin HW, Bhattacharyya N. Prevalence, severity, exposures, and treatment patterns of tinnitus in the United States. JAMA Otolaryngol Head Neck Surg. 2016 Jul 21.

Contribution of intra-vestibular sensory conflict to motion sickness and dizziness in migraine disorders Researchers from Mass. Eye and Ear/ Harvard Medical School, including Richard F. Lewis, MD, studied how the brain processes conflicting motion and orientation information from the inner ear in normal subjects, people with migraine, and people with vestibular migraine (migraine that causes vertigo). The researchers found that in the normal and migraine subjects, the brain resolves this motion conflict in an optimal manner but that the vestibular migraine subjects do not. Additionally, the degree that these vestibular migraine patients fail to resolve this optimally correlates with their motion sickness sensitivity. Overall, the findings suggest that the part of the brain (the cerebellum) that normally integrates these signals and resolves their conflicts functions abnormally in vestibular migraine patients in a manner that explains both their episodes of dizziness and their enhanced motion sensitivity. Wang J, Lewis RF. Contribution of intra-vestibular sensory conflict to motion sickness and dizziness in migraine disorders. J Neurophysiol. 2016 Jul 6;jn.00345.2016.

Balloon dilation of the Eustachian tube with a novel approach through the ear

Corticosteroid use linked to worse outcomes for patients with Lyme disease-associated facial paralysis

A team of researchers from Boston Children’s Hospital/Harvard Medical School including Dennis S. Poe, MD, PhD, and the Vitruvio Institute for Medical Advancement, Dallas/ Louisiana State University, reported on developing a technique to perform balloon dilation of the Eustachian tube using an approach through the ear. Balloon dilation is a new treatment for Eustachian tube dilatory dysfunction (ETD), which is considered the leading cause of otitis media and the ear diseases that arise from its complications. Balloon dilation has emerged as a new technology that can reduce inflammation within the Eustachian tube as an alternative to the insertion of tympanostomy tubes (ear tubes). It is presently done as a minimally invasive endoscopic procedure through the nose, as the Eustachian tube lies in the back of the nasopharynx. However, there is a desire to be able to reach the Eustachian tube from the ear, as surgeons wish to treat it at the time that they may be doing surgery on the ear for removal of disease or reconstruction after chronic injury.

A team of researchers from Mass. Eye and Ear/Harvard Medical School, including Nathan Jowett, MD, and Tessa A. Hadlock, MD, has found that patients who were prescribed corticosteroids as part of treatment for Lyme disease-associated facial paralysis had worse long-term outcomes of regaining facial function than those who were prescribed antibiotic therapy alone. In the largest study of its kind, the researchers studied the long-term recovery (an average of 15 months) of 51 patients with Lyme disease-associated facial paralysis. Patients were grouped into those who were previously treated with triple therapy (antibiotics, antivirals, and corticosteroids), double therapy (antibiotics and corticosteroids), or antibiotics alone to determine whether differences in long-term facial function outcomes exist between groups. Comparison of facial function scores between groups demonstrated statistically worse outcomes for those who received corticosteroids as part of their initial treatment. Based on these retrospective findings, which were published in Laryngoscope, the researchers urge caution in prescribing corticosteroids to patients with confirmed acute Lyme disease-associated facial paralysis.

The researchers studied a prototype balloon that could be passed from the ear into the Eustachian tube to perform the dilation without having to approach it from the nose. In doing so, they developed a technique to safely navigate the balloon past the internal carotid artery, which provides the main blood supply to the brain. A study in cadavers demonstrated the reliability and safety of the prototype balloon and the techniques that were designed to protect the carotid artery. The results were assessed by anatomical study with endoscopes and by CT scans, and the success of the study lays the foundation to further develop the device for use in patients. It would be expected that the use of the proposed device would expand the ease and ability for surgeons to perform balloon dilation of the Eustachian tube. Dean M, Chao WC, Poe D. Eustachian tube dilation via a transtympanic approach in six cadaver heads: A feasibility study. Otolaryngol Head Neck Surg. 2016 Jun 14.

RESEARCH ADVANCES

tinnitus, 27 percent had symptoms for longer than 15 years and 36 percent reported that their symptoms were basically constant. While many adults consider the tinnitus to be a relatively small problem, 7.2 percent felt it was a big or very big problem. Perhaps most surprisingly, less than half (49.4 percent) had discussed their tinnitus symptoms with a physician and potential treatment options including hearing aids and masking devices were rarely discussed with caregivers.

Jowett N, Gaudin RA, Banks CA, Hadlock TA. Steroid use in Lyme disease-associated facial palsy is associated with worse long-term outcomes. Laryngoscope. 2016 Sep 6.

Acute exacerbations mediate quality of life impairment in chronic rhinosinusitis The classic paradigm for the pathophysiology of chronic rhinosinusitis (CRS) is that chronic sinonasal symptomatology, driven by inflammatory mechanisms, leads directly to decreased quality of life. However, CRS has other disease-defining characteristics, including acute exacerbations during which patients experience spikes in continued on page 28

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symptomatology that are sometimes associated with acute sinus infections. Whereas the chronic sinonasal symptomatology of CRS is treated with topical medications, acute exacerbations are often treated with systemic therapies, such as antibiotics and corticosteroids, which may have significant side effects and are thus, a source of significant morbidity in CRS. In a prospective study, researchers from Mass. Eye and Ear/Harvard Medical School and Beth Israel Deaconess Medical Center/Harvard Medical School, led by Ahmad R. Sedaghat, MD, PhD, showed, for the first time, that the frequency of acute exacerbations of CRS experienced by patients is a significant mechanism for decreased quality of life that is on par with the quality of life detriment caused by chronic sinonasal symptomatology. These findings have important clinical implications by highlighting the quality of life benefit that may be derived from tight therapeutic control of CRS. Phillips KM, Hoehle LP, Bergmark RW, Caradonna DS, Gray ST, Sedaghat AR. Acute exacerbations mediate quality of life impairment in chronic rhinosinusitis. J Allergy Clin Immunol Pract. In Press.

Innovations in Residency Training Measuring nontechnical aspects of surgical clinician development in an otolaryngology residency training program Surgical competency requires sound clinical judgment, a systematic diagnostic approach, and integration of a wide variety of nontechnical skills. Traditionally, these aspects of clinician development have been difficult to measure through standard assessment methods. Knowing this, faculty members of the Harvard Medical School Otolaryngology Residency Program, including Jennifer J. Shin, MD, Michael J. Cunningham, MD, FACS, Kevin S. Emerick, MD, and Stacey T. Gray, MD, have developed a measurement instrument for trainee assessment, called the Clinical Practice Instrument (CPI). The researchers used the CPI to measure nontechnical

diagnostic and management skills during otolaryngology residency training to determine whether there is demonstrable change in these skills between residents who are in postgraduate years (PGYs) 2, 4, and 5, and to evaluate whether results vary according to subspecialty topic or method of administration. They found that with the CPI, there was an improvement in qualitative diagnostic and management capabilities as PGY levels advance. Shin JJ, Cunningham MJ, Emerick KG, Gray ST. Measuring nontechnical aspects of surgical clinician development in an otolaryngology residency training program. JAMA Otolaryngol Head Neck Surg. 2016 May 1;142(5):423–8.

Errata: Harvard Otolaryngology Vol. 13, No. 1 In the Alumni Profiles section, the years Charles W. Cummings, MD, worked for the State University of New York Upstate Medical Center and the University of Washington were incorrectly identified. Dr. Cummings worked at the State University of New York Upstate Medical Center from 1976 to 1978 and at the University of Washington from 1978 to 1990.

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Harvard Otolaryngology Fall 2016  

Harvard Otolaryngology magazine is a semiannual update from the Department of Otolaryngology of Harvard Medical School.

Harvard Otolaryngology Fall 2016  

Harvard Otolaryngology magazine is a semiannual update from the Department of Otolaryngology of Harvard Medical School.