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Heads Up!

Otolaryngology — Head and Neck Surgery Newsletter Volume 3, Issue 1 / Summer 2006

University of California, San Francisco / Department of Otolaryngology — Head and Neck Surgery

An Incredible Five Years Chairman’s Address

David W. Eisele, MD Professor and Chairman Grand Rounds Resume Sept. 11, 2006

Upcoming Lectures and CME Courses

Head & Neck Tumor Conference Wednesdays 7:30-9am H3805, Mt. Zion Challenges in Facial Plastic Surgery Conference 2nd Friday of every month 8-9am, 2330 Post St, 5th Floor Inaugural Roger Boles Endowed Lectureship September 7, 2006 Susan E. Langmore, PhD Foundation FEES Course July 13-14, 2006 October 5-6, 2006 Advanced FEES Course October 7, 2006 2006 UCSF Voice Conference October 26-28, 2006 Grand Hyatt UCSF Head & Neck Endocrine Surgery Course October 27-28, 2006 Westin St. Francis Western Society of Pediatric Otolaryngology December 2, 2006 Crowne Plaza Hotel

Andrew H. Murr, MD Prof. and Clinical Vice Chairman

In the Summer 2006 edition of Heads Up!, we continue to feature several of our programs including Facial Plastic and Reconstructive Surgery, and clinical services at both SFGH and the SFVAMC. In addition, we have included a feature on Nanoparticles Research. Dr. Andrew Murr, our Clinical Vice Chairman, also provides us with an update on clinical developments.

News and Events increase in endowments and charitable giving over the past five years with the generosity of a $2.1 million gift from Warren Buffett, a $2.5 million distinguished professorship from the late Robert K. Werbe, and the Lewis Francis Morrison Endowed Lectureship in Head and Neck Surgery, in addition to many other gifts from alumni, faculty, foundations and private industry.

Having the honor to serve as Department Chairman for the past five years, I would like to highlight a few of the Department’s key accomplishments during that time period.

UCSF OHNS continues to seek new ways to expand our clinical and research objectives through new programs, expanded educational offerings and increased endowments to support our efforts. We look forward to seeing We have introduced several new you at the Inaugural Roger Boles, clinical divisions and research MD Lectureship in Head and centers including Pediatric Otolar- Neck Surgery on September 7, yngology, Head and Neck Endo2006. Dr. Charles W. Cummings crine Surgery, the UCSF Voice of Johns Hopkins University will Center, the UCSF Swallowing deliver the first Boles Lecture Center, a Laboratory for Auditory entitled “Demons of the Past and Hair Cell Physiology, and a new Demons of the Present.” Temporal Bone Laboratory. Sincerely, We have strengthened the depth of our programs in Laryngology, Otology/Neurotology and Skull Base Surgery, Facial Plastic and Reconstructive Surgery, and Head and Neck Surgery. The Department has seen an

You Oto Know

David W. Eisele, MD Professor and Chairman

Andrew N. Goldberg, MD, MSCE has been promoted to Professor of Clinical Otolaryngology Kristina W. Rosbe, MD has been promoted to Associate Professor of Clinical Otolaryngology In May 2006, Andrew H. Murr, MD was inducted as an Active Fellow into the Triological Society Resident Awards: 2006 Triological Society, Western Section Meeting Resident Travel Awards: Theresa Kim, MD Andrea Yeung, MD 2006 AAOA Resident Travel Award Andrea Yeung, MD 1st Place, Best Clinical Study, BARRS meeting Kristin Egan, MD UCSF Resident Research Award 1st Place, Andrea Yeung, MD 2nd Place, Ted Mau, MD 3rd Place, Amol Bhatki, MD Kelvin C. Lee Resident Award Amol Bhatki, MD Appointments: Steven Pletcher, MD, Assistant Professor of Clinical Otolaryngology joins the Division of Rhinology in August 2006. Vivek V. Gurudutt, MD, Clinical Instructor and Head and Neck Surgery Hemming Fellow, 06/07

Clinical Update Vice Chairman’s Address We have just finished another interview season and the quality of the applicants to our program is absolutely amazing. Due to the extreme popularity of the Department of Otolaryngology – Head and Neck Surgery at UCSF we receive about 250 applications for 3 positions. This year, like with all Otolaryngology programs, our Department moved to the general NRMP match in March, which is a change from the long standing “early match” in January.

We have recently overhauled and improved our total curriculum under the oversight of our Education Committee. All of our residents attend the basic AAOA Allergy course, attend the UCSF Otolaryngology Update, the UCSF Advanced Sinus Dissection Course, receive a $500 book fund per year, and are able to partake in a generous travel grant program. In addition, Dr. Mark S. Courey’s UCSF Voice Conference and the upcoming UCSF Endocrine Surgery Course run by Drs. Lisa A. Orloff

and David W. Eisele are excellent educational opportunities that are unique nationally. In addition, Dr. David W. Kim now offers a Soft Tissue Surgical Technique course and Dr. Susan E. Langmore offers several courses pertaining to endoscopic swallowing evaluation (FEES) designed for speech language pathologists. The Department currently has four “named” lectures per year including the Sooy Graduation Lecture, Continued on back page

Facial Plastic Surgery Center The UCSF Facial Plastic Surgery Center may look like an elegant private San Francisco practice, but what the casual observer may not realize, is that the clinical center is just one focus of the Division of Facial Plastic and Reconstructive Surgery. Headed by Director Dr. David W. Kim, the division is comprised of two other key components: research and teaching. Dr. Kim is the principal investigator of a prospective multi-center outcomes study funded by a grant from the American Academy of Facial Plastic and Reconstructive Surgery. This study for the first time attempts to measure quality of life after functional rhinoplasty in patients suffering from obstruction to nasal breathing. The division’s research also includes studies of the biomechanics and oxygen perfusion of local flap reconstruction for defects of the face following cancer surgery and structural analysis of the nose following various nasal surgeries. Other ongoing studies are

working towards the creation of objective, measurable metrics for diagnosis and outcomes for various reconstructive and cosmetic procedures of the face.

These research and teaching endeavors, in addition to its clinical activity, allow the division to operate at the cutting edge of the field. Please visit the website at

Although resident teaching in the division is a daily occurrence, several special events offer additional educational opportunities. On April 30th, with the help of facial plastic surgeons from UC Davis, University of Washington, Stanford, and Johns Hopkins, Dr. Kim conducted the second Bay Area Facial Plastic Surgery Cadaver Dissection course for all OHNS residents in the region. In collaboration with UCSF Dermatologic Surgery and Oculoplastic Surgery, Dr. Kim will co-chair the May 2007 UCSF Minimally Invasive Aesthetic Surgery Course in San Francisco. He will also serve as co-chair of the National Fall Meeting for the American Academy of Facial Plastic and Reconstructive Surgery in Washington DC held in September 2007.

Dr. David W. Kim, Director of the Division of Facial Plastic and Reconstructive Surgery

Going For Gold Dr. Ivan H. El-Sayed, Assistant Professor and Skull Base Surgeon in the UCSF Department of Otolaryngology - Head and Neck Surgery, has teamed up with researchers from Georgia Institute of Technology to explore the biomedical applications of gold nanoparticles for diagnosis and therapy of head and neck cancer. The gold particles measure less than 200nm in size and have very useful optical properties. The gold scatters light much brighter than current analogous chemical agents and their color can be changed by changing the size or shape of the particle.

onstrated the potential for laboratory based investigations and in vivo diagnostic applications.

The researchers have found that if the particles are coated with antibodies targeted to oral cancer cells, they can specifically stick the particles to the cancer cells and measure the binding of the antibody to the cell receptor by a change in the color of the particle. By monitoring the light scattered and absorbed by the particles as they travel through live cells, the investigators dem-

Dr. El-Sayed and his co-investigators have published their results in several journals over the past year including Cancer Letters, Nanoletters and the Journal of the American Chemical Society. The team is currently planning the next phase of animal studies to determine the utility of the particles in vivo.

For more information about Dr. Ivan El-Sayed or to contact him, please visit our website at

In addition, the particles absorb light quite efficiently and convert the energy to heat. Dr. ElSayed and his group exploited this fact to selectively deliver the particles to cancer cells and then heat them with an infrared laser to kill the cancer cells at half the energy needed to kill the benign control cells. The gold particles require much less energy than currently available photodynamic therapy agents, and have the potential for much more selective tumor targeting.

Image of cancer cell illuminated by gold nanorods bound to anti-EFGR

OHNS Hosts Symposium on Progress in Speech Production Research Speaking is perhaps the most critical motor skill people use, yet it is also one of the most complicated and least well understood. Recently, however, exciting progress has been made in understanding how people speak. On April 7th, 2006 the Department of Otolaryngology – Head and Neck Surgery hosted an all-day symposium on basic research related to speech production. The symposium was organized by John F. Houde, PhD, an Assistant Adjunct Professor in the department who studies speech motor control. This symposium was a satellite event of the 2006 meeting of the Cognitive Neuroscience Society which took place in San Francisco April 8-11, 2006. The symposium was titled “Efference Copy, Auditory Feedback, and Speech Production”, covered a range of topics related to how auditory feedback is used in speech production, and consisted of presentations from eight different researchers from UCSF and universities around the country, including three presentations from members of OHNS.

Dr. Houde gave a talk on his work using magnetoencephalography to examine cortical responses to auditory feedback perturbations during speaking. Steven W. Cheung, MD discussed his investigations of how altered vocal production affects auditory cortex, and Dr. Theda Heinks-Maldonado, a postdoctoral fellow in Dr. Houde’s lab, spoke about her work comparing speech feedback processing in schizophrenic patients and healthy controls. These lectures, along with those of the other researchers, underscored how convergent work from a broad range of neuroscience fields is needed to understand this most important of human motor skills. The discussions also highlighted the unique opportunity that UCSF OHNS has to lead in this endeavour, especially given how many of the areas relevant to speech production are being studied right here at UCSF. For more information, please visit the symposium webpage at CNS2006Symposium.htm.

The UCSF Department of Otolaryngology – Head and Neck Surgery hosts an all-day symposium on basic research related to speech production

San Francisco General Hospital San Francisco General Hospital has a very active Department of Otolaryngology – Head and Neck Surgery. The rotation at SFGH is staffed by 3 residents: a PGY-4(Chief), a PGY-3, and a PGY-2. It is a very busy surgical practice with about 6,000 patient visits and 650 surgical cases per year. These include all types of trauma cases as the department is on call for the Level 1 Trauma System every third night. We have excellent team coverage with Otology/Neurotology covered by Dr. Lawrence R. Lustig, Facial Plastic and Reconstructive Surgery covered by Dr. David W. Kim, and all general otolaryngology, rhinology and sinus surgery, and head and neck oncology covered by Drs. Andrew H. Murr, Andrew N. Goldberg, Eric J. Kezirian, and Jacob Johnson. Dr. James Pletcher helps us with clinic coverage two afternoons per week to provide efficient attending oversight in our busy clinics. SFGH has state of the art image guidance, a brand new electro-

magnetic microscope, modern CO2 laser equipment, and updated airway instrumentation. Dr. Goldberg’s Otolaryngology Outcomes Research Center is headquartered in Building 100 at SFGH and is staffed by Jenny Lee, M.H.S. Our mission is to care for the underserved population of San Francisco, to teach, and to accomplish clinical research. SFGH is often rated as the most popular rotation among our residents. New challenges face the faculty and staff at SFGH. After the recent problems in New Orleans in the aftermath of hurricane Katrina, it is even more obvious to visualize SFGH’s role as the only Level 1 Trauma Center in the City and County of San Francisco. SFGH is diligently working on its disaster response mechanism and is actively practicing for disaster emergencies on the scale of what was faced in New Orleans. It is not far fetched to consider that SFGH will one day be the main health care facil-

ity in the aftermath of a significant earthquake. From an Otolaryngology – Head and Neck Surgery perspective, inclusion in the general trauma triage process is anticipated with regards to facial trauma and otologic injuries.

Drs. Pletcher, Egan, Roediger, and Murr in clinic at San Francisco General Hospital

San Francisco VA Medical Center The San Francisco Veterans Affairs Medical Center (SFVAMC) is a major tertiary referral medical center for eligible veterans throughout northern California and Nevada. The VA system leads the nation in providing high quality care, and was one of the first healthcare systems to fully implement the electronic medical record. The San Francisco VA is an integral part of the UCSF Department of Otolaryngology-Head and Neck Surgery, supporting its clinical mission, education, and research. It is one of a few VA medical centers in the United States to provide comprehensive otolaryngology care, including head and neck oncologic surgery and microvascular reconstruction, skull base surgery, imageguided endoscopic sinus surgery, and a unique program of auditory rehabilitation through implantable hearing devices (bone-anchored, middle ear, and cochlear implantation). The San Francisco VA otolaryngology outpatient clinic sees approximately 3800 patients per year, and recently underwent a complete renovation.

The OHNS attending staff at the San Francisco studies of the quality of life impact of head and VA includes Dr. Steven Wang (Section Chief), neck cancer treatment. who has a special interest in head and neck oncologic and microvascular reconstructive surgery, and Dr. Steven Cheung, who has a special interest in neurotology and implantable hearing devices. As of August 2006, the division is pleased to announce the addition of Dr. Steve Pletcher to the staff. The clinical service is primarily run by a PGY-5 resident, assisted by a PGY-3 resident. Residents participate fully in all aspects of patient care and management. The VA also supports the research mission of the Department, and the San Francisco VA ranks #1 in the nation’s VA system for total research funding. Both Drs. Wang and Cheung conduct otolaryngology research through the San Francisco VA. Ongoing research projects include translational laboratory studies on CD44 signaling in head and neck cancer and auditory learning in the neocortex, as well as clinical

Drs. Gurney and Wang in clinic at San Francisco Veterans Affairs Medical Center

Residents Spotlight:

The Schindler Vineyard

Congratulations to our graduating Chief residents who are joining exciting practices.

Robert Schindler, MD almost gave up medicine for life on a vineyard in 1968. Fortunately for us he stayed with Otolaryngology. Now in retirement, Robert and his wife, Janet, are realizing their dream of growing a “great American Pinot Noir” on their Oregon vineyard in the Willamette Valley. We were fortunate again, when they shared their wonderful wine with us at this year’s Resident Graduation Dinner.

Jason Biller, MD Santa Teresa Kaiser Permanente in San Jose, California

Michael Cho, MD Head and Neck Associates of Orange County Mission Viejo Office Doris Lin, MD Central Carolina ENT with Dr. William Leliever and Dr. Sam Davis

Continued from front page

and sinus surgery at the Massachusetts Eye and Ear Infirmary The Schindler Endowed Lecture in under Dr. Ralph Metson. With Otology, the Morrison Endowed Steve’s arrival, more efficient paLecture in Head and Neck Surgery, tient appointment opportunities are and we are pleased to announce anticipated along with improved the addition of the Roger Boles opportunities in clinical reEndowed Lecture in 2006. Please search. Please join us in welcomkeep an eye on our website, as the ing Steve to our faculty. department’s educational offerings have never been better and can be Finally, I want to mention that the an excellent source of convenient Department is increasingly taking and local CME credit. on an international presence. In March, the Director of the Division The department has recently com- of Rhinology, Andrew Goldberg, pleted its latest recruitment. A MD traveled on a medical mission national search was conducted for to Vietnam with Resource Exa fellowship-trained rhinologist and change International to teach sursinus surgeon. Significant interest geons there. In addition, the dewas generated by this new position partment has hosted numerous and the department is very pleased visiting scholars including, a PGY-4 to announce the appointment of Dr. resident from Turkey, and Dr. Alfio Steven Pletcher as an Assistant Ferlito from Italy, this year’s MorriProfessor in the Department. Steve son Lecturer. As new opportunities graduated from our residency pro- for international collaboration arise, gram in 2005 and subsequently the department is well positioned to completed a fellowship in rhinology participate.

Vivian Weigel A Lifetime of Service After over 30 years in the Department of Otolaryngology – Head and Neck Surgery, Vivian Weigel retired this year. She was a much loved and respected member of our UCSF OHNS family. During her tenure, Vivian provided administrative support to four Chairmen and years of friendship to both faculty and staff. Vivian’s June 1st farewell party was well attended by many current and former department members. Although it was sad to see her go, we wish her all the best in her new life in West Virginia. Thanks for everything, Viv!

Contact Us General Otolaryngology Pediatric Otolaryngology Otology and Neurotology The Division of Rhinology and Sinus Surgery 415-353-2757

Heads Up! Volume 3, Issue 1 Department Chairman, Editor in Chief: David W. Eisele, MD

Head and Neck Surgery Head and Neck Endocrine Surgery UCSF Salivary Gland Center 415-885-7528

Executive Editor: Louisa T. Burgio, MA, MBA

Cochlear Implant Program 415-353-2464

Editors: Candler Gibson Kathryn Higgins Katherine Rollins-McLean Vivian Weigel Holly Wong, MA

Facial Plastic Surgery Voice and Swallowing Center 415-885-7700 Audiology 415-353-2101 Online

Managing Editor: Emerald Light

Special thanks to photographic and design contributors.

Lee Memorial A Tribute to Our Colleague We would like to say goodbye and remember with fondness Dr. Kelvin C. Lee. Kelvin was a much admired and highly regarded former resident and faculty member in our department, who died suddenly on November 20, 2005 at age 47. Kelvin was born in Pittsburgh, PA on July 12, 1958 to Dr. Winston and Margaret (nee Hsu) Lee. He was a graduate of Yale University and attended the University of California at San Francisco Medical School graduating in 1984. After training in the General Surgery department at New York University, he returned to UCSF for his residency in Otolaryngology-Head and Neck Surgery from 1986 to 1990. After residency, Kelvin remained on faculty at UCSF for 9 years and served at various times as Residency Director, Chief of Service at San

Francisco General Hospital and as Vice Chairman. In 1999 he returned to NYU as Associate Professor of Otolaryngology and Associate Director of Otolaryngology at Bellevue Hospital. Dr. Lee's research interests included sleep surgery, sinus surgery, and instrument innovations for tonsillectomy. He was Chief of the Division of General Otolaryngology and Sleep Surgery at New York University Medical Center. Kelvin was an avid fly fisherman and an avid boater. He was loved and admired for his kindness and achievements. We will all miss him. He is survived by his wife Johanna (nee Benton) Lee. They were married in 1990 in San Francisco. He is also survived by his children, Samantha Lee and Benjamin Lee; parents, Dr. Winston and Margaret Lee; siblings, Ervin (wife Marla) Lee, Karen (husband Mark) Lynskey and the late Evan Lee. He was also son-in-law to Mrs. Guinivere and the late Dr. Walter Benton.

Giving Back: Donors Make It Happen! Individuals choose to support our Department in many ways, from funding current research and training programs to endowing academic positions and programs. There are tremendous emotional benefits for donors who make lifetime gifts because they get to see for themselves the tangible benefits our faculty, residents and patient-care programs receive through philanthropy.

donors choose to support UCSF by means of a bequest, either in a will or revocable trust. A bequest may be a specific dollar amount, or a percentage of the estate. Individuals may designate a bequest to the Department for a particular purpose, or to honor a loved one.

Because there are many planned gift options, the type of gift plan a donor chooses will depend upon For donors interested in creating his or her particular situation, a “legacy” at UCSF, Planned Giv- financial goals, and charitable ing might provide an attractive objectives. It is recommended option to consider. So named that planned giving donors also because more planning goes into consult their legal or financial these types of gifts, planned gifts advisor. If you are interested in include Bequests, Trusts, and learning more about planned givCharitable Gift Annuities. Each of ing opportunities at UCSF, please these planned giving instruments contact: provides significant tax benefits to individuals and often their estates, Candler Gibson, while promising the Department a Development Director Otolaryngology major charitable contribution in Head and Neck Surgery the future. (415) 476-3403 A planned gift offers an excellent UCSF Box 0248 44 Montgomery St., Suite 2200 way to “leave a legacy” that will benefit our Department, our peo- San Francisco, CA 94143-0248 ple and our programs. Many


Amol Bhatki, MD Head & Neck Tumor Conference Wednesdays 7:30-9am H3805, Mt. Zion Grand Rounds Resume Sept. 11, 2006 Kristin Egan, MD 1...