Volume 3, Issue 1 / Summer 2006

Heads Up! Otolaryngology — Head and Neck Surgery Newsletter

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An Incredible Five Years Chairman’s Address

You Oto Know News and Events

In the Summer 2006 edition of Heads Up!, we continue to feature several of our programs including Facial Plastic and Reconstructive Surgery, and clinical services at both SFGH and the SFVAMC. In addition, we have included a fea-ture on Nanoparticles Re-search. Dr. Andrew Murr, our Clinical Vice Chairman, also pro-vides us with an update on clinical developments. Having the honor to serve as Department Chairman for the past five years, I would like to highlight a few of the Department’s key accomplishments during that time period. We have introduced several new clinical divisions and research centers including Pediatric Otolar-yngology, Head and Neck Endo-crine Surgery, the UCSF Voice Center, the UCSF Swallowing Center, a Laboratory for Auditory Hair Cell Physiology, and a new Temporal Bone Laboratory.

We have strengthened the depth of our programs in Laryngology, Otology/Neurotology and Skull Base Surgery, Facial Plastic and Reconstructive Surgery, and Head and Neck Surgery.

The Department has seen an

increase in endowments and charitable giving over the past five years with the generosity of a $2.1 million gift from Warren Buf-fett, a $2.5 million distinguished professorship from the late Robert K. Werbe, and the Lewis Francis Morrison Endowed Lectureship in Head and Neck Surgery, in addi-tion to many other gifts from alumni, faculty, foundations and private industry. UCSF OHNS continues to seek new ways to expand our clinical and research objectives through new programs, expanded educa-tional offerings and increased endowments to support our ef-forts. We look forward to seeing you at the Inaugural Roger Boles, MD Lectureship in Head and Neck Surgery on September 7, 2006. Dr. Charles W. Cummings of Johns Hopkins University will deliver the first Boles Lecture entitled “Demons of the Past and Demons of the Present.”

Sincerely,

David W. Eisele, MD Professor and Chairman

Andrew N. Goldberg, MD, MSCE has been promoted to Professor of Clinical Otolaryngology Kristina W. Rosbe, MD has been promoted to Associate Professor of Clinical Otolaryngology In May 2006, Andrew H. Murr, MD was inducted as an Active Fellow into the Triological Society Resident Awards: 2006 Triological Society, Western Sec-tion Meeting Resident Travel Awards: Theresa Kim, MD Andrea Yeung, MD

2006 AAOA Resident Travel Award

Andrea Yeung, MD 1st Place, Best Clinical Study, BARRS meeting

Kristin Egan, MD

UCSF Resident Research Award 1st Place, Andrea Yeung, MD 2nd Place, Ted Mau, MD 3rd Place, Amol Bhatki, MD Kelvin C. Lee Resident Award

Amol Bhatki, MD

Appointments: Steven Pletcher, MD, Assistant Profes-sor of Clinical Otolaryngology joins the Division of Rhinology in August 2006.

Vivek V. Gurudutt, MD, Clinical Instructor and Head and Neck Surgery Hemming Fellow, 06/07 Clinical Update

Vice Chairman’s Address We have just finished another interview season and the quality of the applicants to our program is absolutely amazing. Due to the extreme popularity of the Depart-ment of Otolaryngology – Head and Neck Surgery at UCSF we receive about 250 applications for 3 positions. This year, like with all Otolaryngology programs, our Department moved to the general NRMP match in March, which is a change from the long standing “early match” in January.

We have recently overhauled and improved our total curriculum un-der the oversight of our Education Committee. All of our residents attend the basic AAOA Allergy course, attend the UCSF Otolaryn-gology Update, the UCSF Ad-vanced Sinus Dissection Course, receive a $500 book fund per year, and are able to partake in a gener-ous travel grant program. In addi-tion, Dr. Mark S. Courey’s UCSF Voice Conference and the upcom-ing UCSF Endocrine Surgery Course run by Drs. Lisa A. Orloff

and David W. Eisele are excellent educational opportunities that are unique nationally. In addition, Dr. David W. Kim now offers a Soft Tissue Surgical Technique course and Dr. Susan E. Langmore offers several courses pertaining to en-doscopic swallowing evaluation (FEES) designed for speech lan-guage pathologists. The Depart-ment currently has four “named” lectures per year including the Sooy Graduation Lecture,

Continued on back page Andrew H. Murr, MD Prof. and Clinical Vice Chairman

David W. Eisele, MD Professor and Chairman

Grand Rounds Resume Sept. 11, 2006 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 St, 5th Floor Inaugural Roger Boles Endowed Lectureship September 7, 2006 Susan E. Langmore, PhD Foundation FEES Course July 13-14, 2006 October 5-6, 2006 Advanced FEES Course October 7, 2006 2006 UCSF Voice Conference October 26-28, 2006 Grand Hyatt UCSF Head & Neck Endocrine Surgery Course October 27-28, 2006 Westin St. Francis Western Society of Pediatric Otolaryngology December 2, 2006 Crowne Plaza Hotel

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

Going For Gold

Speaking is perhaps the most critical motor skill people use, yet it is also one of the most compli-cated and least well understood. Recently, how-ever, exciting progress has been made in under-standing how people speak. On April 7th, 2006 the Department of Otolaryngology – Head and Neck Surgery hosted an all-day symposium on basic research related to speech production. The symposium was organized by John F. Houde, PhD, an Assistant Adjunct Professor in the department who studies speech motor con-trol. This symposium was a satellite event of the 2006 meeting of the Cognitive Neuroscience Society which took place in San Francisco April 8-11, 2006. The symposium was titled “Efference Copy, Auditory Feedback, and Speech Production”, covered a range of topics related to how auditory feedback is used in speech production, and consisted of presenta-tions from eight different researchers from UCSF and universities around the country, including three presentations from members of OHNS.

Dr. Houde gave a talk on his work using magne-toencephalography to examine cortical re-sponses to auditory feedback perturbations dur-ing speaking. Steven W. Cheung, MD discussed his investigations of how altered vocal produc-tion affects auditory cortex, and Dr. Theda Heinks-Maldonado, a postdoctoral fellow in Dr. Houde’s lab, spoke about her work comparing speech feedback processing in schizophrenic patients and healthy controls. These lectures, along with those of the other researchers, un-derscored how convergent work from a broad range of neuroscience fields is needed to under-stand this most important of human motor skills. The discussions also highlighted the unique opportunity that UCSF OHNS has to lead in this endeavour, especially given how many of the areas relevant to speech production are being studied right here at UCSF. For more informa-tion, please visit the symposium webpage at http://www.keck.ucsf.edu/~houde/CNS2006Symposium.htm.

Dr. Ivan H. El-Sayed, Assistant Professor and Skull Base Surgeon in the UCSF Department of Otolaryngology - Head and Neck Surgery, has teamed up with researchers from Georgia Insti-tute of Technology to explore the biomedical applications of gold nanoparticles for diagnosis and therapy of head and neck cancer. The gold particles measure less than 200nm in size and have very useful optical properties. The gold scatters light much brighter than current analo-gous chemical agents and their color can be changed by changing the size or shape of the particle. The researchers have found that if the particles are coated with antibodies targeted to oral can-cer cells, they can specifically stick the particles to the cancer cells and measure the binding of the antibody to the cell receptor by a change in the color of the particle. By monitoring the light scattered and absorbed by the particles as they travel through live cells, the investigators dem-

onstrated the potential for laboratory based in-vestigations and in vivo diagnostic applications. In addition, the particles absorb light quite effi-ciently and convert the energy to heat. Dr. El-Sayed and his group exploited this fact to selec-tively deliver the particles to cancer cells and then heat them with an infrared laser to kill the cancer cells at half the energy needed to kill the benign control cells. The gold particles require much less energy than currently available photo-dynamic therapy agents, and have the potential for much more selective tumor targeting. Dr. El-Sayed and his co-investigators have pub-lished their results in several journals over the past year including Cancer Letters, Nanoletters and the Journal of the American Chemical Soci-ety. The team is currently planning the next phase of animal studies to determine the utility of the particles in vivo.

For more information about Dr. Ivan El-Sayed or to contact him, please visit our website at http://ohns.ucsf.edu

OHNS Hosts Symposium on Progress in Speech Production Research

Facial Plastic Surgery Center The UCSF Facial Plastic Surgery Center may look like an elegant private San Francisco practice, but what the casual observer may not realize, is that the clinical center is just one focus of the Division of Facial Plastic and Reconstructive Surgery. Headed by Director Dr. David W. Kim, the division is comprised of two other key components: re-search and teaching. Dr. Kim is the principal investigator of a prospec-tive multi-center outcomes study funded by a grant from the American Academy of Facial Plastic and Reconstructive Surgery. This study for the first time attempts to measure quality of life after func-tional rhinoplasty in patients suffering from ob-struction to nasal breathing. The division’s re-search also includes studies of the biomechanics and oxygen perfusion of local flap reconstruction for defects of the face following cancer surgery and structural analysis of the nose following vari-ous nasal surgeries. Other ongoing studies are

working towards the creation of objective, measur-able metrics for diagnosis and outcomes for vari-ous reconstructive and cosmetic procedures of the face. Although resident teaching in the division is a daily occurrence, several special events offer additional educational opportunities. On April 30th, with the help of facial plastic surgeons from UC Davis, University of Washington, Stanford, and Johns Hopkins, Dr. Kim conducted the second Bay Area Facial Plastic Surgery Cadaver Dissection course for all OHNS residents in the region. In collabora-tion with UCSF Dermatologic Surgery and Ocu-loplastic Surgery, Dr. Kim will co-chair the May 2007 UCSF Minimally Invasive Aesthetic Surgery Course in San Francisco. He will also serve as co-chair of the National Fall Meeting for the Ameri-can Academy of Facial Plastic and Reconstructive Surgery in Washington DC held in September 2007.

These research and teaching endeavors, in addi-tion to its clinical activity, allow the division to oper-ate at the cutting edge of the field. Please visit the website at www.facialplasticsurgeryucsf.com.

Dr. David W. Kim, Director of the Division of Facial Plastic and Reconstructive Surgery

Image of cancer cell illuminated by gold nanorods bound to anti-EFGR

The UCSF Department of Otolaryngology – Head and Neck Surgery hosts an all-day symposium on basic research related to speech production

San Francisco VA Medical Center The San Francisco Veterans Affairs Medical Center (SFVAMC) is a major tertiary referral medical center for eligible veterans throughout northern California and Nevada. The VA system leads the nation in providing high quality care, and was one of the first healthcare systems to fully implement the electronic medical record. The San Francisco VA is an integral part of the UCSF Department of Otolaryngology-Head and Neck Surgery, supporting its clinical mission, education, and research. It is one of a few VA medical centers in the United States to provide comprehensive otolaryngology care, including head and neck oncologic surgery and microvas-cular reconstruction, skull base surgery, image-guided endoscopic sinus surgery, and a unique program of auditory rehabilitation through im-plantable hearing devices (bone-anchored, mid-dle ear, and cochlear implantation). The San Francisco VA otolaryngology outpatient clinic sees approximately 3800 patients per year, and recently underwent a complete renovation.

The OHNS attending staff at the San Francisco VA includes Dr. Steven Wang (Section Chief), who has a special interest in head and neck oncologic and microvascular reconstructive surgery, and Dr. Steven Cheung, who has a special interest in neurotology and implantable hearing devices. As of August 2006, the divi-sion is pleased to announce the addition of Dr. Steve Pletcher to the staff. The clinical service is primarily run by a PGY-5 resident, assisted by a PGY-3 resident. Residents participate fully in all aspects of patient care and management. The VA also supports the research mission of the Department, and the San Francisco VA ranks #1 in the nation’s VA system for total re-search funding. Both Drs. Wang and Cheung conduct otolaryngology research through the San Francisco VA. Ongoing research projects include translational laboratory studies on CD44 signaling in head and neck cancer and auditory learning in the neocortex, as well as clinical

studies of the quality of life impact of head and neck cancer treatment.

San Francisco General Hospital San Francisco General Hospital has a very ac-tive Department of Otolaryngology – Head and Neck Surgery. The rotation at SFGH is staffed by 3 residents: a PGY-4(Chief), a PGY-3, and a PGY-2. It is a very busy surgical practice with about 6,000 patient visits and 650 surgical cases per year. These include all types of trauma cases as the department is on call for the Level 1 Trauma System every third night. We have excellent team coverage with Otology/Neurotology covered by Dr. Lawrence R. Lustig, Facial Plastic and Reconstructive Surgery covered by Dr. David W. Kim, and all general otolaryngology, rhinology and sinus surgery, and head and neck oncology covered by Drs. Andrew H. Murr, Andrew N. Goldberg, Eric J. Kezirian, and Jacob Johnson. Dr. James Pletcher helps us with clinic coverage two after-noons per week to provide efficient attending oversight in our busy clinics. SFGH has state of the art image guidance, a brand new electro-

magnetic microscope, modern CO2 laser equip-ment, and updated airway instrumentation. Dr. Goldberg’s Otolaryngology Outcomes Research Center is headquartered in Building 100 at SFGH and is staffed by Jenny Lee, M.H.S. Our mission is to care for the underserved popula-tion of San Francisco, to teach, and to accom-plish clinical research. SFGH is often rated as the most popular rotation among our residents. New challenges face the faculty and staff at SFGH. After the recent problems in New Or-leans in the aftermath of hurricane Katrina, it is even more obvious to visualize SFGH’s role as the only Level 1 Trauma Center in the City and County of San Francisco. SFGH is diligently working on its disaster response mechanism and is actively practicing for disaster emergen-cies on the scale of what was faced in New Or-leans. It is not far fetched to consider that SFGH will one day be the main health care facil-

ity in the aftermath of a significant earth-quake. From an Otolaryngology – Head and Neck Surgery perspective, inclusion in the gen-eral trauma triage process is anticipated with regards to facial trauma and otologic injuries.

Drs. Pletcher, Egan, Roediger, and Murr in clinic at San Francisco General Hospital

Drs. Gurney and Wang in clinic at San Francisco Veterans Affairs Medical Center

Residents Spotlight:

Jason Biller, MD Santa Teresa Kaiser Permanente in San Jose, California

Michael Cho, MD Head and Neck Associates of Orange County Mission Viejo Office

Doris Lin, MD Central Carolina ENT with Dr. William Leliever and Dr. Sam Davis

Congratulations to our graduating Chief residents who are joining exciting practices.

Robert Schindler, MD almost gave up medicine for life on a vineyard in 1968. Fortunately for us he stayed with Otolaryngol-ogy. Now in retirement, Robert and his wife, Janet, are realizing their dream of growing a “great American Pinot Noir” on their Oregon vine-yard in the Willamette Valley. We were fortu-nate again, when they shared their wonderful wine with us at this year’s Resident Graduation Dinner.

The Schindler Vineyard

Continued from front page The Schindler Endowed Lecture in Otology, the Morrison Endowed Lecture in Head and Neck Surgery, and we are pleased to announce the addition of the Roger Boles Endowed Lecture in 2006. Please keep an eye on our website, as the department’s educational offerings have never been better and can be an excellent source of convenient and local CME credit. The department has recently com-pleted its latest recruitment. A national search was conducted for a fellowship-trained rhinologist and sinus surgeon. Significant interest was generated by this new position and the department is very pleased to announce the appointment of Dr. Steven Pletcher as an Assistant Professor in the Department. Steve graduated from our residency pro-gram in 2005 and subsequently completed a fellowship in rhinology

and sinus surgery at the Massa-chusetts Eye and Ear Infirmary under Dr. Ralph Metson. With Steve’s arrival, more efficient pa-tient appointment opportunities are anticipated along with improved opportunities in clinical re-search. Please join us in welcom-ing Steve to our faculty. Finally, I want to mention that the Department is increasingly taking on an international presence. In March, the Director of the Division of Rhinology, Andrew Goldberg, MD traveled on a medical mission to Vietnam with Resource Ex-change International to teach sur-geons there. In addition, the de-partment has hosted numerous visiting scholars including, a PGY-4 resident from Turkey, and Dr. Alfio Ferlito from Italy, this year’s Morri-son Lecturer. As new opportunities for international collaboration arise, the department is well positioned to participate.

Giving Back: Donors Make It Happen!

General Otolaryngology Pediatric Otolaryngology Otology and Neurotology The Division of Rhinology and Sinus Surgery 415-353-2757

Head and Neck Surgery Head and Neck Endocrine Surgery UCSF Salivary Gland Center 415-885-7528

Cochlear Implant Program 415-353-2464

Facial Plastic Surgery 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: Candler Gibson Kathryn Higgins Katherine Rollins-McLean Vivian Weigel Holly Wong, MA Special thanks to photographic and design contributors.

Heads Up! Volume 3, Issue 1

Contact Us

Individuals choose to support our Department in many ways, from funding current research and training programs to endowing academic positions and pro-grams. There are tremendous emotional benefits for donors who make lifetime gifts because they get to see for themselves the tangible benefits our faculty, resi-dents and patient-care programs receive through philanthropy. For donors interested in creating a “legacy” at UCSF, Planned Giv-ing might provide an attractive option to consider. So named because more planning goes into these types of gifts, planned gifts include Bequests, Trusts, and Charitable Gift Annuities. Each of these planned giving instruments provides significant tax benefits to individuals and often their estates, while promising the Department a major charitable contribution in the future. A planned gift offers an excellent way to “leave a legacy” that will benefit our Department, our peo-ple and our programs. Many

donors choose to support UCSF by means of a bequest, either in a will or revocable trust. A bequest may be a specific dollar amount, or a percentage of the estate. Individuals may designate a be-quest to the Department for a particular purpose, or to honor a loved one. Because there are many planned gift options, the type of gift plan a donor chooses will depend upon his or her particular situation, financial goals, and charitable objectives. It is recommended that planned giving donors also consult their legal or financial advisor. If you are interested in learning more about planned giv-ing opportunities 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

We would like to say goodbye and remember with fond-ness Dr. Kelvin C. Lee. Kelvin was a much admired and

highly regarded former resident and faculty member in our depart-ment, who died suddenly on November 20, 2005 at age 47. Kelvin was born in Pittsburgh, PA on July 12, 1958 to Dr. Winston and Margaret (nee Hsu) Lee. He was a graduate of Yale University and attended the University of California at San Francisco Medical School graduating in 1984. After training in the Gen-eral Surgery department at New York University, he returned to UCSF for his residency in Otolar-yngology-Head and Neck Surgery from 1986 to 1990. After resi-dency, Kelvin remained on faculty at UCSF for 9 years and served at various times as Residency Director, Chief of Service at San

Francisco General Hospital and as Vice Chairman. In 1999 he returned to NYU as Associate Professor of Otolaryngology and Associate Director of Otolaryngol-ogy at Bellevue Hospital. Dr. Lee's research interests included sleep surgery, sinus surgery, and instrument innovations for tonsil-lectomy. He was Chief of the Division of General Otolaryngol-ogy and Sleep Surgery at New York University Medical Center. Kelvin was an avid fly fisherman and an avid boater. He was loved and admired for his kindness and achievements. We will all miss him. He is survived by his wife Johanna (nee Benton) Lee. They were married in 1990 in San Francisco. He is also survived by his children, Samantha Lee and Benjamin Lee; parents, Dr. Winston and Margaret Lee; sib-lings, Ervin (wife Marla) Lee, Karen (husband Mark) Lynskey and the late Evan Lee. He was also son-in-law to Mrs. Guinivere and the late Dr. Walter Benton.

Lee Memorial A Tribute to Our Colleague

After over 30 years in the Department of Otolaryngology – Head and Neck Surgery, Vivian Weigel retired this year. She was a much loved and respected member of our UCSF OHNS family. During her tenure, Vivian provided administrative support to four Chairmen and years of friendship to both faculty and staff. Vivian’s June 1st farewell party was well attended by many current and former department members. Although it was sad to see her go, we wish her all the best in her new life in West Vir-ginia. Thanks for everything, Viv!

Vivian Weigel A Lifetime of Service