January 10, 1997

Otolaryngology leaps into second decade

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The founders of VUMC's Department of Otolaryngology include (from left) Dr. Robert Ossoff, David Zealear, Ph.D., Dr. James Duncavage and Dr. James Netterville

Otolaryngology leaps into second decade

Expanded and renovated clinic space is just one of the many positive changes occurring as the Department of Otolaryngology enters its second decade of service.

The clinic will gain expanded and renovated clinic space due to a $1 million gift from Dr. John S. Odess, a Birmingham otolaryngologist who graduated from Vanderbilt University School of Medicine 50 years ago.

The new clinic will be named the John S. Odess Otolaryngology Clinic.

"Because of the generosity of Dr. Odess we will be able to practice in space that is more suitable to our needs in the late 1990s and beyond," said Dr. Robert H. Ossoff, Guy M. Maness Professor of Otolaryngology and chairman of the department and Associate Vice-Chancellor for Health Affairs and chief of Staff for Vanderbilt University Hospital.

"Our current space in the TVC was designed for five faculty members. The department now has 12 full-time faculty members," he said.

The new clinic space comes at a good time – as the 10-year-old department begins its second decade at VUMC. The department was actually established in 1972, but operated for 14 years without a full-time chairman.

Also, next week the Vanderbilt Voice Center will celebrate its fifth anniversary with a benefit at the Loews Vanderbilt Plaza. The event, featuring a concert by country music stars Brooks and Dunn, will be held Jan. 17. Proceeds from the $350-per-person event will go to the Voice Center.

Ossoff joined the faculty at VUMC in 1986 as professor and chairman. He is also executive medical director of the Vanderbilt Voice Center, the department's nationally-known center for treating voice-related problems.

Joining Ossoff in 1986 were three other faculty members, contributing to the clinical, research, and education portions of the department's mission: Drs. James A. Duncavage and James L. Netterville, and David L. Zealear, Ph.D., associate professors of Otolaryngology.

"Our goal was to establish a department of clinical, research and educational excellence at Vanderbilt. I believe we have gone far beyond accomplishing that goal," Ossoff said.

Ossoff said the department has excelled in the following areas:

€ A first class residency program

Ossoff said that establishing an Otolaryngology residency program in July 1987 (the 106th in the country) was one of the department's first milestones. The residency program began with two residents each year in July 1987. There are three per year now, with the first group of three graduating last June.

"When we began our residency program the best thing going for us was the good name of VUMC, the reputation of folks on the faculty and our good and congenial relationship with other otolaryngologists in the Nashville community. Being 106th was certainly not satisfying, so we wanted to ascend to the top third of residency programs very quickly, and ideally into the top 10, becoming a consensus leader in the field. About three or four years ago we reached that goal," Ossoff said.

"Around the country our colleagues recognized very quickly that we were on a steep ascent and were world class in providing care, teaching, and making new discoveries that were important to the specialty."

€ The department's involvement with the Free Electron Laser

The department has been involved with the FEL since it was established in the late 1980s.

Ossoff, who came to Vanderbilt from Northwestern University School of Medicine, has been recognized internationally as an expert in lasers.

"The ability to participate in a program like the FEL for someone like me who has had a major interest in lasers was significant," Ossoff said.

Lasers have been an important technological advancement for the specialty of otolaryngology because of the deep, precise areas in which otolaryngologists work. Delicate areas such as the larynx and the ear can be damaged by post-operative scarring and swelling. Ossoff said that the FEL opens up a wealth of opportunities in areas such as tissue interaction, nerve repair and wound-healing.

"In the early going it was simply trying to leave a world where surgically we had used continuous lasers and to go to a world with pulse lasers. We have learned a lot in terms of favorable tissue interactions with less thermal trauma related to a combination of both wavelength and pulse versus continuous delivery," he said.

Recruited into the department to work with the FEL were Lou Reinisch, Ph.D., assistant professor of Otolaryngology and Physics, and Dr. C. Gaelyn Garrett, assistant professor of Otolaryngology.

Reinisch developed the Computer Assisted Surgical Techniques system (CAST) to help surgeons work with the FEL, a very rapidly pulsed laser.

"My hand/eye coordination as a surgeon is not fast enough to achieve maximum benefit from the way the laser is delivered, in terms of achieving minimal thermal damage to the tissues and taking advantage of the unique characteristics of the FEL," Ossoff explained. "What we needed was a way to have the actual tissue interactions controlled by something that could do it faster than my hand/eye coordination, hence the computer."

Ossoff said he believes the department is "on the threshold" of developing FEL animal models further so they will soon have the ability to perform some of the operations on humans.

"It is possible that a patient won't be treated with the FEL. It's possible that a laser company will come in, come up with an XYZ laser that mimics the FEL with a paradigm that looks exciting. But I think the reality is that's doubtful, given that the FEL is here. My gut feeling is that since we have operating rooms over there, we will probably do the first patients with the FEL and the technology transfer will occur after that."

€ The Vanderbilt Voice Center

When Ossoff, Duncavage, Zealear and Netterville got together in 1986 and looked at the road ahead, they decided that the Vanderbilt department of Otolaryngology should be recognized as a leader in an area in which there was a tremendous opportunity in Nashville – the larynx, voice and professional voice. Thus the Vanderbilt Voice Center was established in 1991.

"We were going to work in all of the areas. We were not going to neglect cancer, ear disease, children's otolaryngology diseases and other traditional problems. We believed that putting an emphasis on areas where not so many other people were working was a good idea.

Being in Music City USA was Ossoff's good fortune.

Since the Voice Center's inception, countless entertainers have been treated and operated on by Ossoff and other faculty members. In 1991, Ossoff's surgery on entertainer Larry Gatlin received worldwide attention as Gatlin went public talking about the surgery that saved his career.

"It gave us the kind of publicity that $1 million wouldn't buy and all of a sudden we began getting patients from New York City, Los Angeles and Las Vegas, areas we normally wouldn't have attracted patients from."

"We've been able to establish surgical interventions for benign problems of the larynx that can end careers – cysts or scar tissue in the vocal fold which oftentimes is acquired by a combination of overuse, misuse or lack of training," Ossoff said. "We can correct these problems and restore careers."

The current faculty in the Voice Center are: Dr. Mark S. Courey, medical director; R.E. (Ed) Stone Jr., Ph.D., director of Vocology; and Thomas F. Cleveland, Ph.D., director of Singing Arts and Sciences. There are also two fellows in laryngology and the care of the professional voice.

€ Reputation in treating patients with head and neck cancer.

Dr. Terry A. Day, assistant professor of Otolaryngology, has joined the faculty with expertise in microvascular free flap reconstructive training. The department also has a fellow in head and neck surgery.

"Drs. Brian B. Burkey and Netterville provide Vanderbilt "with an excellent reputation in head and neck cancer and skull based surgery and are currently reviewing their first 100 free flap surgeries," Ossoff said.

Netterville is also a world leader in medialization laryngoplasty, Ossoff said.

€ A first-class Otolaryngology faculty

The Otolaryngology faculty has consistently been included in various national polls targeting top-notch departments and faculty, like those in U.S. News and World Report and Good Housekeeping's Best Doctors in America list.

Otolaryngology faculty members are consistently in positions of national leadership in their respective societies that make up Otolaryngology.

The faculty includes Drs. Jay A. Werkhaven, a pediatric otolaryngologist; James A. Duncavage, an expert in Rhinology/Sinus disorders; William Russell Ries, a facial plastic and reconstructive surgeon; and James W. Hall III, Ph.D., in the Balance and Hearing Center.

Last year, the department hired Dr. David S. Haynes, one of Vanderbilt's first Otolaryngology residents, to join the faculty, as well as Drs. Day and Timothy L. Smith, assistant professor of Otolaryngology.

"A department is only as good as its faculty," Ossoff said. "I feel very gratified that the world-class people in our department have been called upon to go around the world giving lectures and participating in training programs."