Department of Otolaryngology

 

One concern when contemplating the state of the department is the fear of nothing new to report over the past year.  Suffice to say that is not at all the case for the year that just passed, which was chock full of exciting improvements to our clinical and educational programs. It is always a joy and pleasure to pause annually and reflect on what a unique and special program we have.

The 2011-2012 academic year marked the 21st anniversary of the Department of Otolaryngology at SUNY Downstate Medical Center and affiliated hospitals.  Formed initially from existing services at Long Island College Hospital (LICH) and University Hospital of Brooklyn (UHB), the current academic structure for resident and medical student education includes affiliations with Kings County Hospital Center (KCHC), the Brooklyn Veterans Administration Medical Center (VAMC), and Maimonides Medical Center.  The department benefits from a thirteen full-time faculty, more than two dozen voluntary and part-time physicians, and from strong administrative support at all institutions.

As the only otolaryngology training program in a borough of 2.5 million (known) inhabitants we have the keys to a kingdom once called “the forty-ninth state.”  Indeed, if the borough were a state it would be the fourth most populous.  Brooklyn symbolizes American qualities of ambition, brashness, wiseguy humor, street smarts, and underneath the toughness, a soft touch.  This “soft touch” continues to be an undercurrent of our outstanding department, manifest daily in the warm, congenial, and respectful interactions between students, residents, and faculty.

Kings County Hospital (KCHC)

Last year I recounted the intriguing past of SUNY Downstate, from its origins in Brooklyn Heights in 1857, to its location in East Flatbush in 1954, and the historic merger with LICH in 2011.  The official link between Brooklyn Heights and East Flatbush, however, began in 1923, when LICH sent students to Kings County Hospital under an affiliation agreement with the New York City Department of Public Welfare.  The KCHC experience remains a cornerstone and highlight of residency training, one that deserves some historical perspective of its own.

In 1831 Kings County Hospital was founded as a one-room infirmary, becoming a complete hospital building in 1837. By 1939 it was the third largest hospital in the United States, a distinction retained into the mid-1990s. Kings County is the proud owner of many “firsts” in medicine: the first open-heart surgery in New York state, the world’s first hemodialysis machine, the first studies of HIV infection in women, and the first human images using magnetic resonance imaging (MRI).  Because of its role as the first Level 1 Trauma Center in the United States, police officers have been quoted as saying, “If I get shot…bring me to Kings County.”

If you ask any otolaryngology resident about Kings County they might respond: the best part of our program; the worst part of our program; the place where we learn the most; the most challenging rotation; the place where we become a real physician; a worm hole to the Caribbean; and a living Guinness Book for World Records for everything bizarre, incredible, and often unimaginable in medical practice. But all would agree that being an otolaryngology resident at Kings County leaves an indelible impression, invariably positive in hindsight, that prepares them for nearly any conceivable challenge in practice.

KCHC is located at roughly the geographic center of Brooklyn in East Flatbush, a dynamic neighborhood that has seen tremendous growth since the early 1980s.  As elegantly described in Neighborhoods of Brooklyn by Jackson and Manbeck:

“Sounds, sights, and flavors of the Caribbean tantalize visitors to East Flatbush. Tin awnings shade first- and second-floor porches of red-brick homes; lush flowers adorn tiny front yards; and the intoxicating aroma of jerk chicken, oxtail soup, plantains, pastries, fresh rotis, and codfish drifts out of restaurants, roti shops and bakeries. Street vendors tempt passersby with freshly cut sugarcane, coconuts, mangoes, ginger beer, and sorrel drinks. Local Haitian ska bands, warming up for performances in the neighborhood nightclubs, add their rhythms to the mix. And for desert, Taste of the Tropics shops (one of the oldest businesses in East Flatbush) offer homemade Caribbean fruit-flavored ice cream.”

Within walking distance of KCHC is New York City’s oldest home and first official landmark, the Wyckoff House, or Pieter Claesen Wyckoff House, built in 1652 on Clarendon Road and Ralph Avenue.  A short walk leads to another historic landmark at 5224 Tilden Avenue, the residence of legend Jackie Robinson, who pioneered the integration of baseball.  Although no longer present, the winter home of Barnum and Bailey Circus once resided in bungalows, on Remsen Avenue near East New York and Clarkson Avenues, built in the late 1930s by Fred Trump, father of Donald Trump.

A cornerstone and highlight of our department, KCHC not only provides unparalleled opportunities for residency training, but also offers faculty incredible raw material for research, innovation, and professional development.  We look forward to many years of continued involvement with this historical gem and the vibrant Brooklyn neighborhood in which it resides.

Bringing Quality Care to Brooklyn

Of the three pillars that support academic medical departments – research, teaching, and patient care – it is often the ability of a department of serve the community with quality care that most affects the daily lives of the patients and families.  With this in mind, I will briefly summarize the current state of our varied clinical programs.

Facial plastic and reconstructive surgery has become a showpiece of the department, with continued growth and expansion through the leadership of Richard Westreich, Sydney Butts, and Steven Cannady, who cover all aspects of trauma, cosmetic, microvascular, and reconstructive surgery.  Our cleft and craniofacial initiative continues to expand and now includes a monthly multidisciplinary team meeting.

Head, neck, and skull-base surgery enjoy continued excellence under the leadership of Krishnamurthi Sundaram, Steven Cannady, and Michael Weiss, with additional expertise provided by Gady Har-el, Jessica Lim, Victor Lagmay, and voluntary faculty.  There has been significant growth in minimally invasive transoral laser microsurgery, because of better screening, earlier diagnosis, and improved chemoradiation.  Most importantly, our ability to operate on “unresectable” and advanced recurrent disease has improved dramatically with the enhanced microvascular reconstructive options available since Steven Cannady’s arrival.

Otology and neurotology remain vibrant through the leadership of Matthew Hanson, Neil Sperling, Abraham Shulman, and voluntary faculty.  Patients with cochlear implants have been well served by our partnership with the Auditory Oral School of New York, which provides state-of-the-art mapping, support services, and auditory training. We anticipate continued growth in audiology services at both UHB and LICH, and in speech services at LICH.

Pediatric Otolaryngology remains a highlight of the program with leadership by Nira Goldstein, Joshua Silverman, and Richard Rosenfeld, and additional contributions by Paul Vastola, Ari Goldsmith, Mauro Ruffy, and voluntary faculty.  We continue to offer a full spectrum of clinical services, including advanced airway reconstruction, voice restoration, and endoscopic surgery.

Laryngology and neurolaryngology are well covered under the leadership of Boris Bentsianov and Joshua Silverman, with substantial additional contributions from our pediatric otolaryngologists, head and neck surgeons, and voluntary faculty.

General otolaryngology, allergy, and rhinology continue to expand through the leadership of Marina Boruk who performs advanced endoscopic sinus surgery, complex image-guided procedures, and office balloon sinuplasty.  For the first time the department is offering in-office allergy testing and treatment.  Additional contributions come from Richard Westreich, Frank Lucente, and many of our superb voluntary faculty.

Research, Education, and Teaching

Our annual Frank E. Lucente Alumni and Resident Research Day was an unqualified success, featuring keynote speakers Harold (Rick) Pillsbury III and alumnus Jared Wasserman. For the first time we have required all PGY-2 through PGY-5 residents to give a research presentation, a practice that will continue for years to come.  Please review the full Research Day Agenda later in this report for a sampling of the incredible efforts of our residents and faculty.

We are fortunate to have Nira Goldstein continue as Director of Research, ably coordinating a rich palette of faculty, resident, and medical student projects.  She has been an incredible resource for navigating the intricacies of funding, IRB approval, and statistical analysis, resulting in superb resident presentations at national and international meetings.  Nira is assisted by Richard Kollmar, who serves as Director of Basic and Translational Research, and Richard Rosenfeld, who mentors residents in biostatistics, study design, and systematic review. By integrating research review into our Grand Rounds schedule we have significantly boosted awareness of research opportunities and enthusiasm for research among residents and faculty.

Our educational offerings to residents and medical students continue to expand, with the new 2-week and 4-week otolaryngology electives for third year students. Nicole Fraser, our educational coordinator, remains an invaluable resource as she completes her third year with the department. Krishnamurthi Sundaram, Vice Chairman, organized the 2nd Annual Multidisciplinary Head & Neck Symposium, which focused on the larynx and trachea with Marshall Strome as the guest of honor. The conference agenda is reproduced later in this report and we are particularly grateful for the kind support of Gady Har-el in sponsoring our keynote speaker.  We continue to embrace the philosophy of “residents as teachers” in our many interactions with medical students throughout their training.

Over the past year we have critically reviewed, enhanced, and revised our processes for resident training, program assessment, and faculty evaluation.  We have worked hard to identify, and correct, issues that may detract from resident education, as identified by the annual resident survey and the prior RRC site visit. Nira Goldstein, Associate Program Director, and Richard Rosenfeld, Program Director, continue to refine the educational curriculum and grand rounds structure to better meet the needs of residents and faculty.

What a Year it Was

Since our last report there have been many notable accomplishments, which are fully described in the pages that follow.  Some events worthy of emphasis, however, are listed below.

 

Notable Faculty Accomplishments

• Boris Bentsianov was inducted into the New York Laryngological Society
• Sydney Butts was honored as a “40 Under Forty” dynamic achiever by Network Journal
• Steven Cannady joined the full-time faculty and soon after completed his 200th free flap
• Chris de Souza edited a six-volume otolaryngology textbook to be published by Thieme
• John Dodaro was the Voluntary Faculty Honoree at our Graduation Dinner
• Nira Goldstein was included in the Extraordinary Women of Downstate and was inducted into the Triological Society, receiving the prestigious Harris P. Mosher Award for her research thesis on pediatric sleep-disordered breathing
• Frank Lucente was appointed to the Board of the SUNY Downstate Foundation and became a Life Fellow of the NY Academy of Medicine and the AAO-HNS Foundation
• Richard Rosenfeld was appointed Senior Advisor for Guidelines and Quality at the American Academy of Otolaryngology – Head and Neck Surgery
• Abraham Shulman became Editor Emeritus for the International Tinnitus Journal
• Joshua Silverman was the Full-time Faculty Honoree at our Graduation Dinner and also received the Kings County Hospital Service Award
• Michael Weiss was the Faculty Honoree in Otolaryngology at the SUNY Resident and Fellows Graduation Dinner

 

Notable Resident, Study, and Other Accomplishments

• Dennis Lee made a generous donation to the ENT Legacy Fund
• Jonathan Cohen secured a fellowship in head & neck and microvascular surgery under the direction of Gregory Hartig at the University of Wisconsin
• Christopher Mascarinas was the Graduating Resident Honoree in Otolaryngology at the SUNY Resident and Fellows Graduation Dinner
• Paul Zolkind, a third year medical student, had a prize-winning poster at the Annual Research Day of the School of Graduate Studies for his research on the neuroprotective effects of leupeptin in zebrafish with Richard Kollmar
• Elizabeth Mia Floyd and Chelsea Ann Obourn received awards for Outstanding Medical Student Performance in Otolaryngology
• Tiffany Morgan was the Staff Honoree at our Graduation Dinner
• Marcel Menon Miyake and Davi Sousa Garcia, otolaryngology residents from São Paolo, Brazil, completed a clinical and scientific observership in pediatric otolaryngology

New Faces and a Bright Future

An update is also in order on outgoing resident physicians.  David Burstein begins a fellowship in facial plastic and reconstructive surgery with Russell Kridel in Houston, Texas; Sherry Fishkin joins a multispecialty group practice in Harvey, Illinois; and Christopher Mascarinas joins Kaiser Permanente in the Diablo Service Area of Northern California.  We are delighted to welcome our three new PGY-1 residents, Elizabeth Floyd from SUNY Downstate in Brooklyn, New York; Lyuba Gitman from Jefferson Medical College in Philadelphia, Pennsylvania; and Hamid Arjomandi from the Keck School of Medicine in Los Angeles, California.

Despite the many challenges of running a successful academic department in the current healthcare environment I enter the coming year with hope, confidence, and enthusiasm.  How can our department not succeed, prosper, and grow when supported by the best and brightest?  Many have already been acknowledged, but let me close by thanking two of our administrative miracle workers, Billy Tang at SUNY and Carole Facciponti at LICH.  Their efforts, along with all of our other talented support staff, help fulfill our mission of research, teaching, and patient care to the benefit of our community and all stakeholders.

Respectfully submitted,

Richard M. Rosenfeld, MD, MPH
July 2012

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