Volume 2, Issue 1 / Spring 2005

Heads Up! Otolaryngology — Head and Neck Surgery Newsletter

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Exciting Developments Chairman’s Address

You Oto Know News and Events

Welcome to the Spring 2005 edi-tion of Heads Up!, the UCSF De-partment of Otolaryngology – Head and Neck Surgery Newslet-ter. Since our last edition, our Department has expanded fur-ther, resulting in enrichment of both our patient care services and educational offerings. This edi-tion of our newsletter presents some of the exciting new develop-ments. In this issue, we highlight three of our enhanced clinical programs: Head and Neck Endocrine Sur-gery, the UCSF Voice Center, and Facial Plastic and Recon-structive Surgery. These services are directed by three of our tal-ented faculty, Lisa Orloff, MD, Mark Courey, MD, and David Kim, MD, respectively. These specialists provide contemporary, state-of-the-art clinical expertise and educational leadership in these subspecialties. Resident education is a top prior-ity for our department. With the building of our new Robert A. Schindler, MD Temporal Bone Laboratory this year under the direction of Dr. Lawrence Lustig, Director of the Division of Otol-ogy, Neurotology and Skull Base Surgery, resident training in Otol-ogy and Skull Base Surgery will be greatly enhanced. Candler

Gibson, our department develop-ment officer, has initiated an am-bitious fundraising campaign in an effort to further advance the R. A. Schindler Temporal Bone Labora-tory. We gratefully acknowledge all of the generous donations that have made this effort possible. Endowed lectureships are an important way to bring our faculty, residents, alumni, and community surgeons together for enlighten-ing discourse on the advances in our specialty. The Lewis Francis Morrison, MD Lectureship in Head and Neck Surgery and the Robert A. Schindler, MD Lecture-ship in Otology, are two newly-established endowed lectureships in the department. We encourage all of you to join us at these an-nual educational events. I hope you find this edition of our newsletter interesting, and I wel-come your comments at Eisele’s Corner on our Department web-site at http://ohns.ucsf.edu/. Sincerely,

David W. Eisele, MD Professor and Chairman

Andrew H. Murr, MD has been promoted to Professor of Clinical Otolaryngology, UCSF Department of Otolaryngology — Head and Neck Surgery. Steven W. Cheung, MD has been awarded the Edmund Prince Fowler Award, given for excellence in Basic Research by The Triological Society. 2004 AAO-HNSF Annual Meeting Awards and Honors: David W. Kim, MD AAFPRS Leslie Bernstein Investigator Development Grant Eric J. Kezirian, MD Earleen Elkins Research Training Award David W. Eisele, MD Distinguished Service Award

UCSF Association of Clinical Faculty - department promotions: Sheldon S. Kabaker, MD Clinical Professor David J. Quenelle, MD Clinical Professor Brian E. Schindler, MD Clinical Professor Carol Dimeling, MD Associate Clinical Professor Jacob Johnson, MD Assistant Clinical Professor

The Head and Neck Surgery prac-tice scored an impressive 96.9% on the January 2005 Press Ganey Patient Satisfaction Survey question. A Lifetime of Service

Dr. Robert A. Schindler’s Retirement Dr. Robert A. Schindler’s world-renowned research career at UCSF was highlighted at the re-cent research symposium and retirement dinner held at the Westin St. Francis Hotel. Dr. Schindler’s research in co-chlear implants began with animal studies conducted in the Coleman Laboratory in the early 1970’s in collaboration with Michael Merzen-ich, Robin Michelson and others. In 1973 he received a Fogarty Fellowship to work with Drs. Jan

Wersall and Åke Flock at one of the world’s foremost inner ear biology research laboratories at the King Gustav V Karolinksa Insti-tute in Stockholm, Sweden. After his tenure in the Karolinska’s world-class facilities, Dr. Schindler developed his vision of a state-of-the-art morphology and electron microscopy laboratory to comple-ment the electrophysiological labo-ratories in the Coleman Laboratory and to provide facilities for multi-disciplinary approaches to re-search on cochlear implants and

other areas of investigation. Due to his initiative and fundraising efforts, the UC Board of Regents established the Epstein Laboratory in 1976. The mid-1970’s to the early 1980’s saw important developments in cochlear implant research. A clini-cal trial of the first true multichan-nel device - a 4-channel implant fabricated in the Coleman Lab - was initiated with Dr. Schindler as the surgeon.

Continued on back page Alfred E. Mann and Dr. Schindler

David W. Eisele, MD Professor and Chairman

Grand Rounds Mondays 4:30-6:30pm N225, Parnassus Skull Base Conference 3rd Wednesday of every Month 7-8am A723, Parnassus Head & Neck Tumor Board 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 OHNS Resident Research Symposium Friday, June 17, 1pm N225, Parnassus Francis Sooy Lectureship Saturday, June 18, 7:30am N225, Parnassus Otolaryngology Update November 10-12 Ritz Carlton Hotel, SF For More Information, please contact Rachelle Venegas: (415) 476-4952

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

The Lewis Francis Morrison Endowed Lectureship in Head and Neck Surgery The Inaugural Lewis Francis Morrison, M.D. En-dowed Lectureship in Head and Neck Surgery was held on March 24, 2005.

Dr. Lewis Francis Morrison at-tended UC Berkeley, receiving his BA in May 1920, his MS in bacteriology in December 1920 and his MD in 1926. He then entered into private practice in otorhinolaryngology with Wallace B. Smith, MD, and was ap-pointed Instructor in the depart-ment of Otorhinolaryngology at

UCSF, beginning a 30-year association with the university. He rose in the department from Instruc-tor in 1928 to Clinical Professor and Chairman of the Division in 1944. He became a Director of the American Board of Otolaryngology in 1952. As a testament to his success at teaching, Dr. Morrison was presented with a silver laryngoscope at a tes-timonial dinner in 1952 by the doctors he had trained. At the time of his death in 1958, he was president-elect of the Triological Society. Dr. Morrison is best known for his monumental contributions in laryngology. He clarified our understanding of anatomy of the recurrent laryngeal nerves, the paralyzed larynx and cancer therapy. He origi-nated the reverse King operation, and pioneered the use of radioactive cobalt in otolaryngology and the application of Papanicolau smear technique for malignancies of the nasopharynx. The Morrison Endowed Lectureship was estab-lished by a generous gift from Dr. Morrison's daughter Helen M. Elkus and her husband, Rich-ard J. Elkus, Jr. The first Morrison Lecturer was Herbert H. Dedo, MD, Professor, Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco. Dr. Dedo has been associated with UCSF since 1951. He earned his BA at UC Berkeley in 1954 and his MD from UCSF in 1958. He joined the Department of Otolaryngology, UCSF, as an Assistant Professor in 1966. He served as Vice Chair in Otolaryngology from 1974 to 1991, becoming a Professor in 1982. He has received, for his research on laryngeal paralysis, the prestigious Harris P. Mosher Award of the Triological Society in 1970. Dr. Dedo is renowned for inventing the Dedo-Pilling Laryngoscope and for developing recurrent laryngeal nerve resection for treatment of spas-modic dysphonia. Dr. Dedo is a world-famous laryngologist who trained in Otolaryngology during the time when Dr. Morrison was Chairman of the Division of Otolaryngology at UCSF.

Head and Neck Endocrine Surgery

UCSF Voice Center

The Department is pleased to welcome its newest faculty member, Lisa A. Orloff, MD, a specialist in the surgical care of patients with thyroid and parathyroid diseases. Dr. Orloff has joined the Division of Head and Neck Surgery at UCSF Medical Center and the UCSF Comprehensive Cancer Center as Professor of Clinical Otolaryngology – Head and Neck Surgery. In addition to her expertise in head and neck endocrine surgery, Dr. Orloff brings a new dimension to the clinical practice in the form of real-time, office-based ultrasono-graphy. Not only is this non-invasive and painless imaging modality dynamic, sensi-tive, interactive, and convenient for pa-tients, but also it has proven to be an ex-tremely useful tool for operative planning and anatomic teaching. State-of-the-art management of patients with thyroid cancer involves ultrasonographic surveillance for thyroid bed and lymph node metastases, which Dr. Orloff incorporates into her perioperative care. Additionally, ultrasound is valuable in the staging and monitoring of primary tumors and lymph node metasta-ses in patients with benign and malignant head and neck and salivary gland tumors. Dr. Orloff has additional expertise in laryn-gology, microvascular surgery, and head and neck surgical oncology. She performs endoscopic, minimally invasive, open and

microscopic head and neck surgery. A graduate of Stanford University and UCLA School of Medicine, Dr. Orloff completed her residency training at the University of Washington, and a visiting fellowship in microvascular and reconstructive surgery at Mount Sinai Medical Center in New York. She has enhanced her ultrasonography experience through a recent Fulbright scholarship and visiting professorship at the Universities of Mainz and Regensburg in Germany. Prior to joining the faculty at UCSF, Dr. Orloff was a member of the fac-ulty and Co-Director of the Multidisciplinary Thyroid/Parathyroid Clinic at the University of California, San Diego.

In April 2004, Mark Courey, MD joined the Department as Director, Division of Laryn-gology. Previously he was an Associate Professor at Vanderbilt University and Medi-cal Director of the Vanderbilt Voice Cen-ter. Dr. Courey’s practice focuses on pa-tients with hoarseness, breathing difficulties, swallowing disorders, and early laryngeal cancers. He works extensively with profes-sional voice users including teachers, attor-neys, commercial and classically trained singers and broadcasters. Through his research on benign laryngeal diseases, effects of laryngeal injection on vocal fold physiology and electrical stimulation of the paralyzed vocal fold, Dr. Courey gained experience in the management of laryngeal diseases. At UCSF, Dr. Courey’s goal has been to establish a multidisciplinary center for pa-tients’ with voice and swallowing disorders. Building on work begun by Mark Singer, MD and Susan Langmore, PhD, Dr. Courey designed a comprehensive Voice and Swal-lowing Center which offers patients com-plete diagnostic testing for voice disorders, including laryngeal stroboscopy, laryngeal electromyography and acoustic analysis; Dr. Langmore provides fluoroscopic and fiberoptic evaluations of swallowing. Specialized clinics are held weekly for pa-tients with spasmodic dysphonia and other neurolaryngeal disorders including those

related to tremor, Parkinson’s disease and ALS. Patients with voice disorders such as hoarseness, early laryngeal cancer, recur-rent respiratory papilloma and vocal fold paralysis are evaluated by the team of pro-fessionals daily. Miriam van Mersbergen, PhD is the Director of Singing Arts and Sciences for the Center. Dr. van Mersbergen has experience in both commercial and classical singing tech-niques. With her expertise in the behavioral aspects of treatment of professional voice problems, the center will clinically manage patients with all types of dysphonia. This exciting, technologically-advanced program is the first multidisciplinary center for pa-tients with voice and swallowing disorders in the Northern California/Bay area.

Dr. Lisa Orloff performing a neck examination in the Head and Neck Surgery Clinic using a high-resolution ultrasound unit

Dr. Mark Courey performing a video-stroboscopic examination in the Voice Center

Dr. Morrison's daughter Helen M. Elkus (center) with her husband, Rich-ard J. Elkus, Jr. (left) and Dr. Herbert H. Dedo

The Francis A. Sooy, MD End of the Year Lectureship and Program

The Francis A. Sooy Lectureship will be held on June 18, 2005. The 2005 Sooy Lecturer will be Ellen M. Friedman, MD, FAAP, FACS, Chief of Service, Department of Oto-laryngology, Texas Children's Hospi-

tal, Houston, TX, and Professor, Baylor College of Medicine. Dr. Friedman is also a Director of the American Board of Otolaryngology. Her primary clinical interests are pediatric otolaryngology, air-way problems, and congenital malformations of the head and neck. Dr. Francis A. Sooy was associated with the Uni-versity of California for 50 years, beginning with his undergraduate years at Berkeley in 1933 to his graduation from medical school at UCSF in 1941. Dr. Sooy joined the Division of Otolaryngology and transformed the enterprise to a department, serv-ing as Chairman from 1967 to 1972. He then went on to serve as Chancellor of UCSF from 1972 - 1982. During his tenure as Chancellor, UCSF gained recognition as a premier health sciences campus, and Dr. Sooy oversaw the completion of the new School of Dentistry building, the new mod-ernized Moffitt-Long Hospital. Dr. Sooy recruited many outstanding physicians and scientists, in-cluding three new deans. The Sooy Lectureship was established in his mem-ory by gifts from his family, colleagues, friends and former patients.

With the decision to name the department's temporal bone and microvascular laboratory in honor of Dr. Robert Schindler (see article on his retirement, pg. 1), plans are rapidly emerging for the lab's design and its equip-ment needs. Dr. Lawrence Lustig, Director of Otology, Neurotology, and Skull Base Surgery, is heading up our effort to design and equip the Robert Schindler Temporal Bone Laboratory. Space has been secured in UCSF’s Mission Center Building at 15th and Folsom Streets for the department to build the laboratory and equip it with 12 surgical instrumentation stations and microscopes. The goal of the lab will be to train residents and visiting surgeons in all aspects of temporal bone anatomy and surgical technique. After directing renovation of the new space, Dr. Lustig will continue to work with his col-leagues to identify additional funding sources to outfit the lab. They will be looking for both corporate and private cash gifts or gifts-in-kind donations of equipment to use in the laboratory. It is estimated that the total cost of the project will approach $400,000. To date, the department has raised approximately $150,000 from our generous alumni as well as timely support from Hearing Research Inc., a private foun-

dation that has supported research in the department annually for over 16 years.

Robert A. Schindler, MD Temporal Bone Laboratory Established

Robert A. Schindler, MD Endowed Lectureship in Otology

The Inaugural Robert A. Schindler MD Endowed Lectureship in Otology was held on October 9, 2005 at the Westin St. Francis Hotel in San Francisco. The Inaugural Lecturer was Alfred E. Mann who presented "How Bob Schindler Helped the Deaf to Hear."

Al Mann is one of the world's most influential and well-respected medical technology entrepreneurs. Mr. Mann is Chairman and Co-Chief Executive Officer of Advanced Bionics Corporation, a global leader in implantable neurostimulation devices. The company was founded in 1993 to manufacture and distribute the CLARION ® cochlear implant to treat total deafness. This lectureship is named for Dr. Robert A. Schindler, who served as Chairman of the Depart-ment of Otolaryngology - Head and Neck Surgery from 1989-1999, and retired from UCSF in the fall of 2004. Dr. Schindler performed fundamental research documenting auditory nerve survival in chronically implanted experimental animals, which provided early impetus for the development of long-term intracochlear multichannel implants. It was this groundbreaking research that prompted Al Mann to develop the CLARION ® cochlear im-plant for commercial use by patients. The endowed lectureship was established by a generous gift from Dr. Robert A. Schindler and Mrs. Janet Feinberg Schindler.

Facial Plastic and Reconstructive Surgery Dr. David W. Kim joined us in July 2003 as Director of the Division of Facial Plastic and Reconstructive Surgery. His areas of spe-cial interest are rhinoplasty, functional na-sal airway surgery, facial reconstruction, and rejuvenation surgery of the aging face. Dr. Kim has developed a state-of-the-art UCSF Facial Plastic and Reconstructive Surgery Center. With aesthetic nurse spe-cialist Janet Tanaka, Dr. Kim receives pa-tient referrals with difficult or revision nasal deformities, deformities related to facial paralysis, and facial stigmata of the aging process. Equipped with the latest technology in pho-tographic and video imaging, computer imaging manipulation, and low-impact facial rejuvenation (intense pulse light therapy), Dr. Kim provides his patients with a thor-ough and individualized consultation. Pa-tients may receive surgical treatment and/or an assortment of minimally invasive in-office procedures such as botulinum toxin, intense pulse light therapy, or injectable fillers; his treatment plans reflect a conser-vative approach to surgery that minimizes risks and complications and emphasizes creating natural-appearing improvements. Dr. Kim has established a monthly multidis-ciplinary Challenges in Facial Surgery con-ference in which patients with especially

challenging problems are examined and discussed by a panel of UCSF experts in facial plastic surgery, dermatologic surgery, oculoplastic surgery, and otolaryngology. Dr. Kim received the prestigious Leslie Bern-stein Young Investigator Grant in 2003 for his study, “Functional Rhinoplasty: A Multicenter Prospective Outcomes Study.” He is the principal investigator of this 3-year project in which national leaders of rhinoplasty study patients undergoing nasal valve surgery within a protocol aimed toward determining the effectiveness of the various techniques used. Practitioners wishing to enroll patients into this protocol or who would like to refer a patient may do so by calling (415) 885-7700 or through the center’s web site: www.FacialPlasticSurgeryUCSF.com

Faculty managing the laboratory. Left to right: Drs. Cheung, Lustig, Wang and Murr

Dr. David Kim uses the Mirror System to provide post operative projections

Dr. Robert A. Schindler receiving a plaque from Chief Resident Dr. Steven Pletcher

Continued from front page He developed an instrument for inserting spiral electrode arrays into the cochlea and contributed extensively to the remarkable improvements in devices that occurred over the ensuing years. In 1993, Dr. Schindler convinced Mr. Al Mann to undertake the commercial development of the UCSF multichannel cochlear im-plant through the establishment of Advanced Bionics Corporation. Contemporary cochlear implants have now exceeded the most optimistic early hopes that they would restore speech understand-ing to profoundly deaf individuals. The latest technology provides more channels, reverse telemetry for assessing neural responses and high rate/flexible speech processors, small enough to be worn behind the ear. Today, many of the 85,000 cochlear im-plant users enjoy 80-90% speech recognition and use the tele-phone. A few even appreciate music. Over the past three decades, the Epstein Lab has continued to grow. In 1980 Dr. Schindler be-came the first member of the UCSF faculty to be a recipient of the Triological Society Fowler Award for his research on the human endolymphatic sac. Dur-ing the next 20 years he collabo-rated with residents, fellows and visiting faculty to study and pub-lish articles on the ultrastructure and pathology of the endolym-phatic sac in Meniere’s disease,

response to ototoxic drugs, fluid/particle transport, hyaluronan synthesis and effects of endolym-phatic duct occlusion. In 1991 the Coleman Lab became part of the new Keck Center, and the Epstein Lab relocated into larger, better-equipped facilities that include an animal surgery and electrophysi-ology suite and new electron and light microscopy suites. The mul-tidisciplinary approach to complex research issues continues with projects focused in areas that include cochlear implant re-search, auditory system develop-ment and plasticity and critical periods. The laboratory has pro-vided training and collaboration to dozens of medical and graduate students, postdoctoral fellows, visiting scientists and faculty from around the world, and it will play a major role in the research mission of the department in the future. The Epstein Laboratory is Dr. Schindler’s important legacy to the department.

Giving Back: Donors General Otolaryngology 415-353-2757 Pediatric Otolaryngology 415-353-2757 Otology and Neurotology 415-353-2757 Cochlear Implant Program 415-353-2464 Head & Neck Surgery and Rehabilitation Center 415-885-7528 Facial Plastic Surgery 415-885-7700 Voice and Swallowing Center 415-885-7700 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

Contact Us Philanthropy has provided vi-tal support for our educational mission. The Robert A. Schindler, MD Temporal Bone Laboratory will offer a state-of-the-art facility for our residents to develop skills in surgery of the temporal bone and microvascular anatomy. This facility will be the first of its kind at UCSF and al-lows us to enhance our national reputation for outstanding resi-dency training. Philanthropy has strengthened our educational offerings. The Lewis Francis Morrison, MD En-dowed Lectureship in Head and Neck Surgery has been estab-lished by a generous gift from Helen M. and Richard J. Elkus, Jr. Dr. Robert Schindler and his wife Janet generously established the Robert A. Schindler, MD En-

dowed Lectureship in Otology, which was inaugurated last fall by medical device entrepreneur Al-fred E. Mann. It was at Dr. Schindler's retirement event that the Elkuses decided to make their generous commitment. All of us in the department thank our donors for helping us expand our educational opportunities and to support our commitment to excellence in patient care and research. 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

Residents’ Spotlight Congratulations to our Graduating Chief Residents:

Welcome to our new 2005 / 2006 Program Year 2 Residents:

Welcome to our new 2005 / 2006 Program Year 1 Residents:

Dov Bloch, MD Private practice Multi-Specialty Group in Danbury/ Ridgefield, CT

Karsten Munck, MD U.S. Air Force Travis Air Base Fairfield, CA

Steven Pletcher, MD Fellowship with Dr. Ralph Metson at the Massachusetts Eye and Ear Infirmary, Harvard University, Boston, MA

Theresa Kim, MD Frederick Roediger, MD David Saito, MD

Harry Hwang, MD

Calling Alumni News and Updates Congratulations to 1994 Resident Alumnus Dr. C.Y. Joseph Chang recently appointed Chairman, Department of Otolaryngology —

Head and Neck Surgery, Univer-sity of Texas at Houston. 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

Dr. Robert A. Schindler using an electron microscope to examine the inner ear in 1976

Krista Rodriguez - Bruno, MD

Betty Tsai, MD