Volume 2, Issue 2 / Fall 2005

Heads Up! Otolaryngology — Head and Neck Surgery Newsletter

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Building International Relationships Chairman’s Address

You Oto Know News and Events

Welcome to the Fall 2005 edition of Heads Up!, the UCSF Otolaryn-gology – Head and Neck Surgery Newsletter. In this edition, we highlight several of our clinical and research programs. These include Pediatric Otolaryngology — Head and Neck Surgery, the Division of Sleep Surgery, the Division of Rhi-nology and Sinus Surgery, the Douglas Grant Cochlear Implant Program, the UCSF Salivary Gland Center, and Audiology. In addition, Vice Chairman Chris-toph Schreiner, MD, PhD, provides an update on the department’s research programs, with an over-view on our funding, and current projects of our researchers. New educational developments in the department include the estab-lishment of a fellowship in Pediatric Otolaryngology – Head and Neck

Surgery under the directorship of Kristina Rosbe, MD. In addition, the internship year for the resi-dency program is now under the supervision of the Department of Otolaryngology – Head and Neck Surgery. We can now better influ-ence our interns’ transition into our residency program, as well as improve oversight of their perform-ance and well-being during that year. One of our department’s goals is to cultivate relationships with oto-laryngologist - head and neck sur-geons from around the world and particularly from the Pacific Basin. This Spring, I was invited to be a Visiting Professor in the Depart-ment of Otolaryngology of the Tra-ditional Chinese Medicine (TCM) University of Hunan in Changsha, China. My gracious host Daofa Tian, MD, PhD, provided me with great insight into the clinical and research programs of our col-leagues in China. We will continue to expand our international out-reach and exchange in the future. Sincerely,

David W. Eisele, MD Professor and Chairman

Andrew N. Goldberg, MD, MSCE received the 2005 Excellence in Direct Teaching Award from the UCSF Haile T. Debas Academy of Medical Educators, and an Honor Award from the American Academy of Otolaryngology. Herbert H. Dedo, MD is the 2005 recipient of the American Laryngological Award. Congratulations to David W. Eisele, MD, Andrew N. Goldberg, MD, MSCE and Mark I. Singer, MD who were named in the 2005 America’s Top Doctors List. Good-bye, Young Oh, MD: Best wishes to Dr. Oh who re-cently completed his UCSF Head and Neck Oncology Fel-lowship, as our first Bryan Hem-ming Fellow. In July 2005, Dr. Oh joined Kaiser Permanente in Los Angeles, CA, where in addi-tion to his clinical duties, he trains UCSD residents on a visiting rotation. New Appointments: D.J. Trigg, MD, Clinical Instruc-tor and Pediatric Otolaryngology Fellow, 2005/2006. Miriam van Mersbergen, CCC- SLP, PhD, Assistant Clinical Professor at the UCSF Voice Center, joined the department in June 2005.

Research Update Vice Chairman’s Address Outstanding basic, translational, and clinical research programs complement superb patient care services in the Department of Oto-laryngology-Head and Neck Sur-gery. The Department’s collabora-tive culture encourages research and clinical faculty to exchange ideas freely, and the synergies derived from joint efforts among faculty have long been an impor-tant driving force behind our tradi-tion of exceptional success in both scientific inquiry and health care delivery. A brief overview of the

Department’s scope of research areas and funding sources ap-pears below. Currently, 31 re-search projects receive extra-departmental funding. The pro-jects are lead by 17 principal in-vestigators that have their main appointments in the Department. Of those, 9 have predominantly clinical appointments with the re-maining 8 investigators in research positions.

Basic science studies range from explorations of auditory hair

cell function to the development of auditory brainstem connectivity, to explorations of function and plas-ticity of auditory cortex and speech-motor control.

Translational research includes projects such as auditory prosthe-sis function and the development of strategies for neural plasticity - based rehabilitation of brain disor-ders.

Continued on back page Christoph E. Schreiner, PhD, MD Vice Chairman of Research

David W. Eisele, MD Professor and Chairman

Grand Rounds 1st Monday of the Month 5-7pm Following Mondays 5-6pm S214, Parnassus Skull Base Conference 3rd Wednesday of every Month 7-8am A723, Parnassus 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 Street 5th Floor Conference Room Schindler Endowed Lecture Thursday, November 3, 2005, Toland Hall, U-142, 1st floor, UC Hall, 4pm Otolaryngology Update November 10-12, 2005 Morrison Endowed Lecture March 23, 2006 For More Information, please call or visit (415) 476-4952 http://ohns.ucsf.edu/events

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

Dr. David W. Eisele, invited speaker at the TCM University of Hunan, China

Pediatric Otolaryngology — Head and Neck Surgery

The UCSF Audiology Clinic sees approximately 8,000 patients per year and works with a variety of medical departments to provide state of the art diagnostic and electrophysiologic testing for individuals of all ages with any degree of hear-ing loss or communicative impairment. A full service hearing aid dispensing program is of-fered, utilizing a vast array of the most modern hearing aids and assistive listening devices. Rehabilitative services are also provided for patients with tinnitus and balance disorders.

Audiology maintains a very active research pro-gram that has pioneered many innovative ap-proaches to dealing with hearing loss. For ex-ample, Robert Sweetow, PhD, Director of Audi-ology, and his research group, including Jennifer Henderson-Sabes, MS and Monica Miller, re-cently introduced an interactive computerized training program called LACE (Listening and Communication Enhancement). LACE is de-signed for home use in training the brain to util-

ize skills that may diminish with deficiencies in hearing. While hearing aids can help a person detect softer sounds, they don’t provide good listening skills, which are essential for effective communication. Even people with normal hear-ing can be poor listeners. These abilities can be damaged both by hearing loss and by the natu-ral aging process. Just as physical therapy can help rebuild muscles and adjust movements to compensate for physical weakness or injury, LACE can develop skills and strategies that help compensate for situations when hearing is in-adequate. Another major area of research for Audiology is hearing aids. Despite technological advances in hearing aids, only 20% of people with hearing loss actually own and wear hearing aids. Part of the reason is related to stigma. In the past year, a new design of hearing aids has been devel-oped that is barely visible and leaves the ear canal open. This improves both comfort and

sound quality. These devices are not right for everyone, but the Audiology Division is examin-ing which patients they will benefit and how to best program them. If you have questions, please contact the Audiology Division at 415-

Dr. Kristina W. Rosbe joined the department in April of 2002 as Director of the Division of Pedi-atric Otolaryngology. Her areas of special inter-est include sinus disease in patients with cystic

fibrosis, pediatric airway reconstruction for such problems as choanal atresia and subglottic stenosis, and congenital masses of the neck such as lymphatic malformations. Dr. Rosbe has developed a Pediatric Otolaryn-gology Program incorporating state-of-the-art equipment for diagnosis and treatment of pediat-ric upper airway abnormalities. She works closely with pediatric anesthesiologists, pediatric intensivists, and other pediatric sub-specialists to provide comprehensive multi-specialty care to children who often have complex medical condi-tions. In addition, she is a consultant for the UCSF Craniofacial Clinic and UCSF Vascular Anomalies Clinic, both nationally recognized for their expertise and care. Her current research involves collaborations with the Department of Pediatric Pulmonology, examining airway mucociliary clearance in pa-tients. She also does research with the Division

of Pediatric Hematology/Oncology examining airway disease in patients with mucopolysac-charidoses who undergo bone marrow trans-plantation. Dr. Rosbe has developed a Pediatric Otolaryn-gology Fellowship for advanced training in the following pediatric areas: ear disease, sinus surgery, upper airway evaluation and manage-ment, and diagnosis and management of con-genital and acquired neck masses. Dr. D.J. Trigg recently joined us as our first Pediatric Otolaryngology Fellow. Dr. Trigg received his medical degree and completed his otolaryngol-ogy residency at the University of Chicago at Illinois. If you would like more information about pediat-ric otolaryngology, or to schedule an appoint-ment, please call 415-353-2757. For more infor-mation, or to apply for the pediatric otolaryngol-ogy fellowship, please call 415-885-7471.

Dr. Robert W. Sweetow and the LACE Program

Audiology and The LACE Program

Dr. Kristina W. Rosbe in the clinic consulting with Pediatric Otolaryngology Fellow Dr. Dean James Trigg Program

Division of Rhinology and Sinus Surgery Andrew N. Goldberg, MD, MSCE arrived in 2000 bringing with him skills in the endoscopic treat-ment of sinusitis and related disorders that were new to UCSF. He established the Division of Rhinology and Sinus Surgery and serves as its first Director. Dr. Goldberg’s areas of expertise include minimally invasive surgery for sinusitis, treatment of cerebrospinal fluid leaks and en-cephaloceles, orbital decompression in Graves’ disease, and endoscopic tumor resection involv-ing the nose and paranasal sinuses. Dr. Goldberg completed his training in Otolaryn-gology – Head and Neck Surgery at the Univer-sity of Pittsburgh in 1990 and served as faculty at Washington University in St. Louis and the University of Pennsylvania before coming to UCSF. During his 7 years at the University of Pennsylvania, he worked with Dr. David Ken-nedy and completed a fellowship in clinical epi-demiology, earning a Master’s degree in Epide-

miology and Biostatistics during that time. His research interests include defining the causes of chronic sinusitis, including biofilms and fungus, quality of life assessment, and the use of acu-puncture in treating the symptoms of chronic sinusitis. The establishment of the UCSF Sinus Center by Dr. Goldberg in 2004 has enabled UCSF to be-come a referral center for complex disorders of the sinuses, nose and related structures, receiv-ing referrals from the West coast, South Amer-ica, and Asia. The UCSF Sinus Center brings together experts from different specialties to consult and treat patients with sinusitis and re-lated disorders and provide the best regimen of treatment for individual patient needs. These experts include allergists, infectious disease ex-perts, neurosurgeons, ophthalmologists, radiolo-gists, and many others whose input can be criti-cal to proper management of a complex problem.

If you would like more information, please visit our website at http://ccro.ucsf.edu.

Dr. Andrew N. Goldberg uses endoscopic techniques whenever possible to improve visualization and minimize morbidity

UCSF Douglas Grant Cochlear Implant Program

Eric J. Kezirian, MD, MPH joined the Depart-ment in August 2004 as the Director of the Division of Sleep Surgery. His practice fo-cuses on the evaluation and surgical treat-ment of patients with sleep-disordered breath-ing, including snoring and obstructive sleep apnea. Dr. Kezirian provides a thorough and individu-alized consultation to individuals with snoring or obstructive sleep apnea considering sur-gery or for whom previous surgical treatment has not produced the expected outcomes. Dr. Kezirian’s goal is to produce a targeted, effective surgical treatment plan for his pa-tients. Working with other otolaryngologists and sleep specialists throughout the region, the Division of Sleep Surgery offers a com-prehensive approach with the full spectrum of surgical procedures and non-surgical options available to treat adults and children with sleep-disordered breathing.

Dr. Kezirian has received the prestigious American Academy of Otolaryngology—Head and Neck Surgery’s Earleen Elkins Research Training Award for his work in obstructive sleep apnea evaluation. Using the technique of sedated sleep endoscopy, Dr. Kezirian examines the airway of obstructive sleep ap-nea patients with a flexible endoscope as they sleep. By directly observing the airway collapse that occurs in this disorder, it may be possible to develop a precise, effective surgi-cal plan in patients undergoing surgery for the first time or in whom previous surgical treat-ment may not have achieved the desired re-sults. A research grant supports Dr. Kezirian’s study of the functional and health-related ef-fects of sleep-disordered breathing and the changes that occur with surgical treatment. Practitioners wishing to enroll patients in these studies or who would like to refer a

patient may do so by calling (415) 353-2757 or contacting us through the Division’s web-site: http://sleepsurgery.ucsf.edu.

The cochlear implant is a device that uses implant-able microcircuitry to restore hearing to severe and profoundly deaf individuals. The implant is differ-ent from a hearing aid, which sends amplified sound through the impaired auditory system. The cochlear implant works by bypassing damaged inner ear structures to directly trigger activity in the hearing nerve. This allows use of the device by individuals who are unable to understand speech with even the most powerful hearing aid. The UCSF Douglas Grant Cochlear Implant (CI) program has provided cochlear implants to pro-foundly deaf adults since the birth of this revolu-tionary technology in the 1970s. Under the direction of new Director, Lawrence R. Lustig, MD, the center is currently developing a model program of post-implant care for young children and rehabilitation for older children and adults. This innovative approach will employ a multidisciplinary team to comprehensively evalu-

ate candidates and to assess and deliver care based on individual patient needs. Our newest addition to the cochlear implant team is psychologist Peggy Kelly, PhD. Dr. Kelly is involved in the evaluation of patients preoperatively and assists patients in their transition to hearing with the cochlear implant. Dr. Kelly’s experience working with deaf and hearing-impaired individuals makes her uniquely qualified to fulfill this role. Amanda Scott, MS and Colleen Polite, AuD, comprise the audiology division of the program. We are currently recruiting a speech and language pa-thologist to join our implant team. With these changes, the UCSF CI program will enter the forefront of cochlear implant rehabilitation, be able to foster comprehensive patient care dur-ing all phases of the implant process, and en-able innovative research projects related to cochlear implant function and outcomes. Visit our website at http://cochlearimplant.ucsf.edu.

CI Team members: Colleen Polite, AuD, Amanda Scott, MS, Kristina Rosbe, MD, Lawrence Lustig, MD, Direc-tor, Peggy Kelly, PhD, Sarah Rankin, Administra-tive Assistant, Steven Cheung, MD (not pictured)

Dr. Eric J. Kezirian discussing treatment options for sleep disorders

Sleep Surgery

Sialendoscopy at the UCSF Salivary Gland Center The UCSF Salivary Gland Center provides a new minimally invasive technique for the treatment of salivary gland disorders. Sialendoscopy allows for the diagnosis and treatment of common salivary gland conditions, particularly stones of the subman-dibular and parotid glands. With this minimally inva-sive procedure, a miniature endoscope is inserted into the salivary gland duct. A video monitor linked to the endoscope allows optical visualization of intra-ductal problems. Small salivary gland stones can be extracted. Larger stones can be broken up using energy from a YAG laser delivered through a fiber cable, and the resultant stone fragments extracted. Although popular in other countries, sialendoscopy is new in the United States and has been performed at UCSF since 2004. The UCSF Salivary Gland Cen-ter Medical Director, Dr. David Eisele, trained with Dr. Francis Marchal, a major pioneer of this ap-proach, in Geneva, Switzerland. To make an ap-pointment for consultation at the UCSF Salivary

Gland Center, which offers comprehensive treat-ment of salivary gland disorders including stones, salivary gland enlargement, and neoplasms, please call the UCSF Head and Neck Surgery appointment

line at (415) 885-7528. To learn more about the UCSF Salivary Gland Center please visit http://ohns.ucsf.edu/, click on Patient Access/UCSF Sali-vary Gland Center.

A submandibular stone visualized by sialendoscopy

Drs. Eisele and Stoller with the YAG Laser used for salivary stone lithotripsy

Continued from front page

Clinical studies cover a broad range of topics including tinnitus suppression, sleep apnea, hear-ing loss, and molecular studies in head and neck cancer.

Several funded projects are related to the development and implementation of advanced teaching methods and tools. A more detailed description of individual research projects will follow in future issues of Heads Up! Annual extramural research funds have risen to approximately $4.0 million. However, supple-mental endowment funds, which support infrastructure and pilot studies, have continued to de-cline due to California budget cuts. Federal funding from the National Institutes of Health and National Science Foundation constitutes 80% of extramural research support. The Depart-ment’s continuing success in garnering highly competitive fed-eral grants and contracts is a strong indication of public recog-

nition for our excellent research programs. University-related funds contribute only 2% to the departmental research efforts. Private foundations and philan-thropic gifts fund the remaining 18%. While the Department has en-joyed expansion of research pro-grams in recent years, growth in the future may prove to be chal-lenging. Federal support for bio-medical research is expected to increase minimally, if at all, over the next decade. Despite loom-ing financial constraints, the De-partment is committed to growing its important research enterprise. For this, the Department will seek the support of friends, alumni, and philanthropic donors to offset reductions in federal funding. UCSF Otolaryngology-Head and Neck Surgery research is well positioned to develop the next generation of treatment protocols and products. Some rough wa-ters are ahead, but with the help of our supporters, we are confi-dent that we will succeed in this endeavor.

Giving Back: Donors Make It Happen! General Otolaryngology 415-353-2757 Pediatric Otolaryngology 415-353-2757 Otology and Neurotology 415-353-2757 Cochlear Implant Program 415-353-2464 UCSF Salivary Gland Center 415-885-7528 The Division of Rhinology and Sinus Surgery (415) 353-2757 Facial Plastic Surgery 415-885-7700 Voice and Swallowing Center 415-885-7700 Audiology 415-353-2101 Online http://ohns.ucsf.edu

Department Chairman, Editor in Chief: David W. Eisele, MD Executive Editor: Louisa T. Burgio, MA, MBA Managing Editor: Emerald Light Editors: Kathy Buchanan Candler Gibson Katherine Rollins-McLean Vivian Weigel Holly Wong, MA Artistic Design and Graphics: Bobby Penn, MBA Special thanks to photographic contributors.

Heads Up! Volume 2, Issue 2

Contact Us One of the most important ways that donors can reward excellence in our faculty is through the establishment of an endowed professorship. Endowed professorships are permanent assets of the department that recognize out-standing faculty achievements in re-search, teaching, or patient care. Endowments generate annual income that is used to support the chair holder’s activities, in keeping with the donor’s wishes in establishing the endowed gift. The gift’s principal can never be spent. Because endowments exist in perpe-tuity, donors and their families can enjoy the emotional rewards of these funds for generations. Endowed pro-fessorships forge an enduring, highly visible link between the donor and the continuing achievements of the chair holder. Our department is fortunate to have three endowed professorships,

which have been generously donated by grateful patients, alumni, and friends. Endowed chairs may be established with a gift or pledge of at least $500,000. Distinguished Professor-ships, UCSF’s highest faculty honor, require a gift commitment of $2.5 mil-lion. Endowed professorships provide vital ongoing support for our faculty. If you are interested in learning more about endowments at UCSF, please contact: Candler Gibson, Development Director Otolaryngology - Head and Neck Surgery (415) 476-3403 UCSF Box 0248 44 Montgomery St., Suite 2200 San Francisco, CA 94143-0248 cgibson@support.ucsf.edu

Calling Alumni Hurricane Update Dr. Peter Rigby checked in to say that he, his wife and children are safe, although he had to make multiple trips across the eastern US, rescuing two dogs in the process. He is helping to piece together the residency pro-gram at Louisiana State Univer-sity and reconnecting with pa-tients. He has high praise for the LSU residents, who provided basic medical care to evacuees

from the hurricanes and who stayed through the aftermath. Fortunately, with the completion of his fellowship at Tulane Univer-sity, Dr. Howard Stupak and his family moved out of New Orleans into a new home in Connecticut a few weeks before the hurricanes, so all are fine. Send us your news: vweigel@ohns.ucsf.edu, or Otolaryngology - Alumni News Attn: Vivian Weigel 400 Parnassus Ave, Box 0342 San Francisco, CA 94143-0342

Residents’ Spotlight: A Look Back Janelle A. Y. Engel, MD was the first woman resident in Otolaryngology at UCSF, from 1977 to 1980. After her resi-

dency, Dr. Engel moved to the Phoenix Arizona area where she practiced otolaryngology in a private solo practice for over 16 years. In 1998, Dr. Engel moved into a small group practice, which then merged into a 12 member otolaryngology practice in 2004. Dr. Engel is proud of having been the first woman to do sur-gery in the East Valley and the first female otolaryngologist in AZ. She was able to help people see women as competent sur-

geons and to build bridges be-tween women physicians, nurses and other health care profession-als. When looking at the pre-sent, Dr. Engel notes that she is happy to see woman surgeons today are receiving tremendous support, both personally and professionally as they pursue their medical careers. When Dr. Engel is not seeing patients, or spending time with her two grown children, she en-joys traveling abroad with her husband, Dr. Rodney Engel. Over the years, Dr. Engel has stayed in contact with the UCSF OHNS department through Dr. Boles, the Drs. Schindler, Vivian Weigel and the many others who attend our annual OHNS Alumni receptions that take place at the AAO – HNS meetings.