Department of Otorhinolaryngology

Otorhinolaryngology

Resident Rotations

The first year (PGY-1) is currently spent on general surgical rotations at the Hospital of the University of Pennsylvania (HUP). Rotations are chosen which will be beneficial to the resident's subsequent career in otorhinolaryngology: head and neck surgery. The four years of clinical otolaryngology training consist of 14 three-month clinical rotations and one six-month research rotation at the PGY-4 level. The rotation schedule is designed to offer each resident an equivalent experience.

Further, all aspects of adult and pediatric otolaryngology-head and neck surgery are taught and practiced so as to provide for a well-rounded program. Experience throughout the otolaryngology portion of the training program is progressive with increasing clinical and surgical responsibility. Each resident within the program has his or her final rotation at each institution in the capacity of chief, culminating as chief administrative resident at the Hospital of the University of Pennsylvania.

Clinical Subspecialties

 

Otology-Neurotology

The Department has an extremely active program in clinical otology-neurotology and has a close working relationship with the Division of Neurosurgery. In collaboration with Neurosurgery and other interested specialties, the Department has developed a multidisciplinary Skull Base Center. A significant number of skull base and posterior fossa cases are performed each month, in addition to more routine otologic operations such as middle ear and mastoid procedures.

The Department opened a multidisciplinary Balance Center in 1995. The Center provides both the most sophisticated diagnostic and rehabilitative equipment and the opportunity for exciting clinical research. There is an ongoing and active adult and pediatric cochlear implant program, which has performed implantation and rehabilitation for more patients than any other Center in the area. Resident education in otology/neurotology is based on clinical experience in ambulatory and inpatient care with emphasis on operative techniques of the temporal bone in the Sargent Temporal Bone Laboratory. Didactic lectures in temporal bone anatomy and histopathology supplement this experience providing the resident with a comprehensive understanding of this anatomic region.

Opportunities exist for research in vestibular diagnosis and rehabilitation, tinnitus, cochlear implantation, and disorders of the facial nerve. Residents and faculty have strong research support for otologicneurotologic research as provided by the Hearing Sciences Center as well as the Division of Audiology and Speech-Language Pathology.

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Rhinology and Endoscopic Sinus Surgery

The University of Pennsylvania Medical Center attracts patients with rhinologic disease from all parts of the world and these patients, combined with patients who are self referred or regionally referred provide an unparalleled opportunity for resident exposure and training in this growing and increasingly important field.

Resident training in rhinology and endoscopic sinus surgery begins with a full understanding of nasal and paranasal sinus anatomy and pathophysiology. This is achieved through formal didactic sessions (both lectures and videotapes), anatomic fresh cadaver dissection, and routine office nasal endoscopy.

Residents work closely with our attending staff while using the world's most advanced technology. Quality video and photodocumentation systems are used for teaching in both the operating room and outpatient clinics and a variety of computer assisted surgical navigation systems are available in the operating room.


The technology and expertise available within the field of Rhinology provide an excellent opportunity for resident training and attract both patients and observers from all over the world.

Research opportunities include ongoing work on the pathogenesis of chronic sinus disease, mucociliary clearance of the paranasal sinuses, rhinomanometry and acoustic rhinometry, fungal sinusitis and staging systems for sinusitis. Several research projects are also ongoing with collaboration of the Smell and Taste Center.

Upon successful completion of the didactic/clinical training program, residents should have the background training necessary to become leaders in this area.

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Head and Neck Oncology

Resident training in head and neck oncologic surgery is a major aspect of our clinical experience. The Department administers a multidisciplinary Head and Neck Cancer Center in conjunction with the Cancer Center of the University of Pennsylvania Medical Center. The Center has been an outstanding success and currently sees over 600 new head and neck cancer patients annually.

Didactic instruction in head and neck oncology is provided in a formal course for all residents. Clinical research opportunities for residents exist not only with regard to patient management and surgical techniques but also in related disciplines such as bronchoesophagology. Basic science research projects have involved magnetic resonance spectroscopy and imaging of head and neck tumors as well as work in tumor cell biology and tumor immunology in the Wistar Institute. The department's Tumor Biology Laboratory provides an established environment for residents who choose to spend their 6-month research block studying mechanisms of tumor progression.

Clinical research is also currently ongoing with regard to evaluation of the role of neurotropic peptides in perineural invasion in head and neck squamous cell carcinoma.The Department and the Medical Center are both committed to the field of outcomes research and cooperative programs and educational opportunities are available through the Department of Clinical Epidemiology and the Leonard Davis Institute. Quality of life of patients with head and neck cancer is one of the areas currently being studied.

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Facial Plastic / Reconstructive Surgery

Resident experience in facial cosmetic surgery is developed by interaction with the Departmental Cosmetic Surgery Program. Facial Trauma is a significant component of several rotations and faculty with special interest and expertise in this area provide subspecialty teaching. Residents may attend a microvascular laboratory course giving hands- on instruction in arterial and venous anastomosis in the rat. The full range of topics within the field of reconstructive surgery of the head and neck is covered clinically as well as in lecture format.

Surgical defects generated by head and neck oncologic activities provide considerable volume of experience in reconstructive surgery. This includes not only strong experience with pedicle composite flaps but also experience in the use of free flap reconstruction with microvascular anastomosis.

Additionally, the Department works closely with the Department of Dermatology in the flap closure of facial and head and neck defects resulting from Mohs' chemosurgery. The Department participates as a member of the University of Pennsylvania Center for Human Appearance.

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Laryngology

Significant advances have occurred in recent years in the diagnosis and surgery of laryngeal pathology. The department has a voice laboratory equipped with state-of-the-art, microprocessor-based, digital signal processing equipment, and laryngeal stroboscopy with video documentation. The entire range of phonosurgery is practiced.

Research in laryngology has included such topics as speech patterns in patients with multiple sclerosis. The laboratory provides rich research opportunities for the resident in training. Additionally, the Department now houses the Tucker Laryngeal Collection, a whole organ section collection which provides an excellent resource for clinical research.

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Audiology and Speech-Language Pathology

The Division of Audiology and Speech-Language Pathology is based in the Department of ORL:HNS. Physically, the clinical facilities of the Division of Audiology and Speech Language Pathology and the Balance Center are also housed within the Department, so as to ensure informal interaction between the staff and residents.

The disciplines of audiology, speech-language pathology, and balance are integrated into the curriculum for residents in ORL:HNS. Specifically, the faculty and staff in Audiology and Speech- Language Pathology provide introductory lectures in these disciplines during the first two months of the PGY-2 year. The purpose of these lectures is to provide basic understanding of the clinical measures conducted to evaluate patients (adults and children) with hearing, balance, speech, language and swallowing disorders. These lectures include interactive programs for learning which enable handson experience with some of the diagnostic procedures used to evaluate patients with communication, swallowing and balance disorders.

During three months of the PGY-3 year, each resident spends one day/week rotating through various sections of the Division of Audiology and Speech-Language Pathology. This rotation provides an in-depth experience with the diagnostic and therapeutic activities of audiologists and speech pathologists, and provides an opportunity for learning referral procedures, interpretation of test measures, and management strategies for patients with disorders of communication and balance. The didactic lecture series for residents in clinical and basic sciences includes the faculty and staff in audiology and speech-language pathology to insure the broadest exposure to the disciplines of hearing, speech, language, swallowing and balance throughout the years of residency in ORL:HNS.

Residents are involved with staff speech pathologists in the team-approach to the evaluation and management of patients with swallowing and voice disorders.

The faculty and staff in the Division encourage the development of clinical research projects by residents within the disciplines of Audiology, Balance, Speech-Language, and Swallowing. The Department requires every resident to have a broad exposure to these disciplines, and provides the opportunity for in-depth experiences for the resident whose clinical or research interests suggest the need for such exposure.

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Hearing Sciences Center

The Hearing Sciences Center is a multidisciplinary center developed by the Department to integrate the research activities of a number of scientists and laboratories on the Penn Campus working in the area of hearing research. The keystone of the Center is the Auditory Research Laboratory. The Hearing Sciences Center is under the direction of James C. Saunders Ph.D. who has received the University's highest award for his teaching in research methodology and in auditory neurobiology.

Research opportunities in the Auditory Research Laboratory are organized within three primary areas.These are: a) hair cell micro mechanics, b) hair cell regeneration, and c) signal processing at the auditory cortex.

Other faculty within the Auditory Sciences Center study such areas as inner ear homeostasis and the stria vasaillaris. The Department currently carries a funding grant for research within the hearing, balance and olfactory senses.

Other research opportunities in the Hearing Sciences Center include the Department's Developmental Auditory Biology laboratory. Research is underway to better understand the cellular mechanics underlying the development of hearing in mammals. The development of neural pathways between the ear and brain are being examined. An additional very interesting opportunity exists within the field of molecular biology to study the functioning of sound damaged, and regenerating hair cells. Co-operative research is currently being initiated between the Auditory Research Laboratory and several other laboratories in the Hearing Sciences Center to evaluate the molecular biology of the isolated hair cell in different phases of activity.

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Smell and Taste Center

The University of Pennsylvania Smell and Taste Center was established under the scientific leadership of Richard Doty Ph.D. in 1980 as the result of funding from the National Institute of Neurological Disorders and Stroke and other sources. This unique Center devoted to the senses of taste and smell-has achieved worldwide prominence for both its research and clinical activities, and is currently planning for the expansion of its clinical services, research programs and staff.

The Center focuses on three primary goals: first, to provide clinical evaluation, treatment and counseling for patients experiencing taste and smell disorders; second, to provide the facilities and an intellectual focus for research in both basic and applied aspects of chemoreception; and third, to provide training for the students and doctoral level scientists and other interested medical personnel in both basic and applied aspects of chemoreception science. Publications resulting from the Center's work number several hundred.

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Sleep Center

The Penn Sleep Center is one of the largest and most up-to-date sleep medicine departments in the country. The Sleep Center is under the direction of the Department of Medicine and is accredited by the American Academy of Sleep Medicine.

The relationship between the members of the Sleep Center and the Department of Otorhinolaryngology is unique with joint clinical sessions held at the Hospital of the University of Pennsylvania with the Department of Medicine Director of the Sleep Center and the Otolaryngology Surgical Director of the Sleep Center.

Otolaryngology residents have the opportunity to be involved in these sessions as well as the other activities of the Sleep Center. They are exposed to the most current advances in the treatment and evaluation of sleep disorders and have the opportunity to perform the latest surgical procedures in this field.

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Pediatric Otolaryngology

The Division of Pediatric Otorhinolaryngology is based at the Children's Hospital of Philadelphia (CHOP), under the direction of Dr.William Potsic. The division has one of the largest clinical faculties of any pediatric otolaryngology division and provides a superb, diverse pediatric otolaryngology experience. CHOP is located next door to the Hospital of the University of Pennsylvania.

Ambulatory care in pediatric otolaryngology is provided to children ranging in age from newborns to 18 years at the Richard D.Wood Ambulatory Care Center. Well over 23,000 outpatient visits are made each year with a referral area including southeastern Pennsylvania, southern New Jersey and Delaware.

All aspects of pediatric otolaryngology care are provided by the faculty and resident staff and include: otology, bronchoesophagology, head and neck surgery, treatment of nasal and sinus disease, and reconstructive surgery of the head and neck. Specifically, CHOP Pediatric Otolaryngology is operating a multidisciplinary airway clinic for children with all types of airway problems, including subglottic stenosis and chronic tracheotomies.

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