Heads Up !

Otolaryngology - Head and Neck Surgery Newsletter

Volume 5, Issue 1 / Winter 2008 University of California, San Francisco / Department of Otolaryngology Head and Neck Surgery

Moving Forward
Chairmans Address
We are pleased to present the Winter 2008 edition of Heads Up!, the UCSF Otolaryngology Head and Neck Surgery Newsletter. This edition highlights the opening of the Robert A. Schindler Surgical Skills Classroom on November 29, 2007. This new classroom hosts 12 individual dissection stations in addition to state-of-the-art drilling and endoscopy capabilities. It will be the site of resident courses, in addition to national continuing medical education opportunities. We are also proud to announce the opening of our new Facial Plastic and Reconstructive Surgery practice in Marin County, under the direction of Division Director David Kim, MD. In the basic science arena, our Research Vice Chairman, Dr. Christoph Schreiner, provides us with an update on the clinical implications of faculty member, Dr. John Houdes work using magnetoencephalography (MEG) and functional MRI (fMRI) to look at brain activity during speech.

In addition, our newsletter features an overview of many exciting presentations at the 3rd annual Faculty Research Symposium held on October 5, 2007. It is our pleasure to introduce Dr. Osamu Tetsu who has been recently recruited to our basic science faculty to study novel therapeutic approaches to the treatment of solid tumors in the head and neck. We also wish to share with our readers pictures of the beautiful laryngoscope of Dr. Lewis F. Morrison (Otolaryngology Division Chairman, 1945-1956). The laryngoscope was graciously donated by Dr. Morrisons daughter, Mrs. Helen Elkus. Finally, our newsletter would not be complete without focusing on the accomplishments of our residents; this issues Resident Spotlight features 4th year resident Frederick Roediger, MD. Sincerely,

You Oto Know

News and Events
Congratulations! Professor, Lisa Orloff, MD was recently named Director of the Division of Head and Neck and Endocrine Surgery. Assistant Professor, Ivan El-Sayed, MD was recently named the Bryan Hemming Fellow in Head and Neck Oncologic Surgery. Graduate Student Researcher Matthew Schoenecker was recently awarded a highly competitive NIH F31 Fellowship to support his research in the departments Epstein Lab. Resident Travel Awards: Theresa Kim, MD and David Saito, MD Medical University, S. Carolina 4th Annual Sinus Masters Resident Course April 19 - 21, 2008 Frederick Roediger, MD Triological Association, Western Section Jan 31 Feb 3, 2008 Harry Hwang, MD and Krista Rodriguez-Bruno, MD Loma Linda Laryngeal / Sinus Surgery Course Nov 16 & 17, 2007 Betty Tsai, MD Loma Linda Skull Base Course Oct 6 - 8, 2007 Theresa Gurney, MD AAO-HNS/F Annual Meeting Sept 16 19, 2007

David W. Eisele, MD

Professor and Chairman

Upcoming Lectures and CME Courses

Lewis F. Morrison, MD Endowed Lectureship Guest Lecturer, Marc Remacle, MD, PhD Professor and Associate Head of the Department of Otorhinolaryngology, Louvain University Hospital at Mont - Godine, Belgium March 6, 2008, 5pm Toland Hall Francis A. Sooy, MD Endowed Lectureship Guest Lecturer, Donald A. Leopold, MD Professor and Chairman Department of Otolaryngology - Head and Neck Surgery University of Nebraska Medical Center June 28, 2008 Location TBA Challenges in Facial Plastic Surgery Conference 2nd Friday of every month 8-9am, 2330 Post St, 5th Floor Head and Neck Tumor Conference Every Wednesday 7:30-9am H3805, Mt. Zion For information about upcoming courses and lectures please contact Clair Dunne: (415) 476-4952

David W. Eisele, MD Professor and Chairman Assistant Professor, John Houde. When we hear speech, it is usually to understand what someone else is saying, but what happens when we hear ourselves talk? This has been the subject of Dr. Houdes research over the past several years. He and other researchers have found that when we speak, a system in our brain predicts what we will hear, compares this with what we actually hear, and takes corrective action if the two are different. Normally, we dont pay attention to this process, but its malfunction may be part of the cause of many debilitating speech problems, including spasmodic dysphonia, stuttering, the weak voice of patients with Parkinsons disease, and even the auditory hallucinations that afflict patients with schizophrenia.

Research News
Vice Chairmans Address
The departments research mission calls for two types of research; basic and clinical. Basic research often deals with uncovering normal mechanisms and processes of the human body. This research is necessary to devise strategies that help scientists to understand and potentially remedy pathological conditions. Clinical research is more directly related to the pathological conditions and their treatment in patients. To succeed, both branches of research have to come together and require close collaborations of basic and clinical researchers. An example of such highly collaborative work is that of

Christoph E. Schreiner, PhD, MD

In collaboration with Dr. Srikantan Nagarajan, a professor in the Department of Radiology, Dr. Houde has been using magnetoencephalography (MEG) and functional MRI (fMRI) to look at brain activity as speakers hear themselves speak. They have examined the responses in speakers Continued on back page

Professor and Research Vice Chairman

UCSF Robert A. Schindler Surgical Skills Classroom Grand Opening

After three years of planning by many individuals both inside and outside the department, the Robert A. Schindler Surgical Skills Classroom opened with great fanfare on November 29th. The state of the art classroom includes 12 individual dissection stations with microscopes, flat-panel displays, and full drilling and endoscopy capabilities. There is also a microvascular work station with a 2-headed microscope for training microvascular surgical techniques. Additionally, the classroom is fully equipped to incorporate three-dimensional navigation technology. The classroom is operated through a sophisticated, integrated computer system that links all stations, and provides us with the ability to broadcast any individual station over the entire network, as well as digitally capture audio and video stills or movies at each station. The department would like to formally acknowledge and thank all who oversaw the design and development of the classroom. The department committee included Dr. Steve Cheung,

As we go forward, we anticipate that this classroom will serve as an important teaching tool for medical students, residents, fellows, alumni, and community physicians. The classroom will be the site of our annual resident temporal bone dissection course, sinus endoscopy course, microvascular skills course, and head and neck anatomy course. We are also planning joint courses on skull base surgery with the UCSF Department of Neurosurgery. Additionally, we plan to hold annual continuing medical education courses in sinus anatomy and temporal bone anatomy. The classroom will also serve as a location where a variety of otolaryngologic anatomical studies and research can be performed. Robert Schindler MD, Professor Emeritus and former department Chairman, was an innovator and a leader. Most importantly, he was a fabulous teacher. This classroom will serve to honor his role as a mentor to generations of UCSF medical students and Otolaryngology - Head and Neck Surgery residents. We encourage all alumni and friends of the department to stop by and see our new classroom. variety of relatively new but underutilized tests to the standard audiometric battery. Current neurophysiological explanations for the distress associated with tinnitus focus on the hyperactivation of both the limbic system and auditory cortex. Robert Sweetow, PhD outlined an ongoing study comparing the use of white noise, hearing aid amplification, or amplification combined with music, fractal tones, and/or white noise to determine which are most acceptable to patients both in terms of relaxation and in terms of tinnitus habituation. David W. Eisele, MD discussed ongoing and potential projects in head and neck oncology. These include the successful recruitment of Osamu Tetsu, MD, PhD and the establishment of a new head and neck cancer laboratory with the goals of establishing head and neck cell lines, development of a head and neck tumor bank, creation of a head and neck cancer database, and investigations of head and neck cancer oncogenesis. Dr. Eisele also discussed clinical projects involving salivary gland and oropharyngeal neoplasms.

Robert A. Schindler Surgical Skills Classroom Dr. Andrew Murr, Dr. Steven Wang, and Dr. Lawrence Lustig. The architect, Hugh Cotter from Oculus, provided the needed artistic vision to create the beautiful and workable space. Patrick McGee from UCSFs Facility Management provided appropriate guidance and oversight during all aspects of the construction of the classroom. Dan Serpa provided all the necessary coordination of the sophisticated audiovisual system that is perhaps the most innovative feature of this classroom. The backing and encouragement of the department Chairman, Dr. David Eisele, was perhaps most integral for its successful completion because he

Surgical skills workstation secured the space and committed funds. We would like to thank Stryker for their extraordinarily generous gift of drills, endoscopes and endoscopy equipment, temporal bone dissection trays, as well as the commitment of threedimensional navigation to the classroom. Additionally, we would like to recognize the very generous gifts from Medtronic of drills and endoscopy equipment to the classroom. We would also like to acknowledge the generous financial support from Hearing Research Inc. Finally, we would like to thank the generous support from the alumni and friends of the department who contributed to the completion of the facility. Patricia Leake, PhD presented an update on the Epstein Laboratorys cochlear implant research program in, Factors Influencing Auditory Prosthesis Function: Insights from Animal Models. Dr. Leake discussed recent progress in her groups chronic animal studies evaluating the effects of deafness and the consequences of electrical stimulation from an implant and neurotrophic agents in several animal models. These models included congenital and earlyacquired profound hearing loss and long-term deafness resulting in severe peripheral and central pathology. Recent human temporal bone studies are correlating basal turn diameter with the depth of implant insertion required to reach an optimal frequency range along the spiral ganglion. The standard evaluation of hearing function has changed relatively little over the past two decades, and it does not provide information that may be critical to hearing loss rehabilitation. In Diagnostic Testing beyond the Audiogram, Jennifer HendersonSabes, MS described current investigations in the Division of Audiology considering the costs and effectiveness of adding a

Third Annual Faculty Research Symposium

On Friday, October 5, 2007 the Department of Otolaryngology Head and Neck Surgery held its third annual Faculty Research Symposium on the Parnassus campus. Seven research presentations highlighted the Departments diversity of scientific investigation to an audience that included otolaryngologist head and neck surgeons and researchers from UCSF and throughout the region. Lisa Orloff, MD delivered the first talk and described her ongoing research related to head and neck ultrasound, and focused specifically on projects that consider its role in evaluation of thyroid masses, surveillance in head and neck cancer patients, and guidance of fine needle aspiration, among other uses. Steven Cheung, MD used acoustic neuroma as an example for translating clinical outcome expectations to treatment decision models. This translational research approach requires constructing expectation models for specific outcome features and measuring tradeoff functions

Lisa A. Orloff, MD among outcomes using conjoint analytics. Research in the Division of Rhinology and Sinus Surgery includes projects in clinical and basic science and were described by Andrew Goldberg, MD, MSCE. These basic science projects are principally directed at understanding normal flora and pathogenic organisms though analysis of biofilms, PCR analysis of fungal organisms, and genetic microarray analysis of bacteria, fungi, and viruses. The breadth of clinical science projects is more varied and includes the use of omalizumab (Xolair) for chronic sinusitis, septal flap reconstruction of defects after skull base surgery, and the use of biomaterials to reduce scarring in sinus surgery.

UCSF Facial Plastic and Reconstructive Surgery Clinical Office Opens in Marin County
Dr. David W. Kim, Director of the Division of Facial Plastic and Reconstructive Surgery is now seeing patients in our North BayMarin office. Dr. Kim is double-Board certified in the American Board of Facial Plastic and Reconstructive Surgery and by the American Board of Otolaryngology. Dr. Kims main areas of focus are cosmetic and reconstructive problems of the face. He specializes in facial rejuvenation surgery and facial reconstruction following skin cancer resection. Dr. Kims practice offers a full range of minimally invasive treatments, including Botox, injectable fillers, skin resurfacing, and hair removal. Dr. Kim also specializes in nasal surgery for complex functional breathing problems, cosmetic concerns, and reconstruction. During his 4 years at UCSF, Dr. Kim has devoted his clinical research and teaching to various topics within rhinoplasty, having authored over 50 scientific articles, David W. Kim, MD, FACS chapters, and presentations on the topic. Dr. Kim is the principal investigator of the first prospective multi-center outcomes study on functional nasal airway surgery. Dr. Kims new office is located in scenic Marin County, approximately 10 miles north of the Golden Gate Bridge: UCSF Facial Plastic and Reconstructive Surgery 1300 South Eliseo Drive Suite 204 Greenbrae, CA 94904 For appointments and referrals please call (415) 885-7700 Or visit us on the web at: http://fprs.ucsf.edu

Resident Spotlight
It is our pleasure, to shine our spotlight on 4th year resident Frederick C. Roediger, MD. Dr. Roediger was born in San Francisco, California, and was raised in South Portland, Maine. He is the son of Mainebased Otolaryngologist John Roediger, MD, who completed his Otolaryngology residency training at the San Francisco VAMC/UCSF program. Dr. Roedigers main clinical interest is the treatment of sinonasal disorders and his favorite surgical procedure is endoscopic sinus surgery. Dr. Roediger earned his Bachelor of Science degree in Chemistry from Duke University in 1997. After college he worked in the Bay Area for three years, first at Parnell Pharmaceuticals and then as a research associate at UCSF. Dr. Roediger earned a medical degree from Cornell University in 2004, and then began his Otolaryngology - Head and Neck residency training at the University of California, San Francisco in 2004. Recently, Dr. Roediger spent a four month research rotation studying chronic rhinosinusitis with Andrew Goldberg, MD. Dr. Roediger designed a pilot study in which

Frederick C. Roediger, MD, 4th Year Resident sinus samples are analyzed for the presence of fungi, viruses, and bacteria using DNA microarrays, a molecular method of identifying pathogens present in disease. When asked what drew him to study sinusitis, Dr. Roediger responded that chronic rhinosinusitis is one of the most common chronic diseases and is associated with a decreased quality of life, yet it is still poorly understood. Dr. Roediger plans to pursue a career in general otolaryngology with a focus on rhinology upon completion of his residency in 2009. on ambitious studies of adenoid cystic carcinoma (ACC), a malignant neoplasm that arises within the major and minor salivary glands of the head and neck. Dr. Tetsu suspects that a number of genes might be deregulated in ACC by recurrent genomic aberrations and/or somatic mutation in critical genes. Among these molecules, Dr. Tetsu is examining the Wnt signaling pathway, the implicated genetic changes in ACC, and how these mutations contribute to cancer development. Being able to determine the exact cancer mechanism will allow for progress towards improving treatment of ACC. Given the significant scope and importance of this research, Dr. Tetsu will be leading the expansion of our head and neck cancer basic science research program in the Department of Otolaryngology Head and Neck Surgery. His examination of key pathways central to radiosensitivity and chemosensitivity in head and neck and other cancers will provide clarity on the varying levels of patient sensitivity to therapeutic radiation and chemotherapy. We eagerly anticipate future discoveries and their benefit to the lives of cancer patients.

OHNS Welcomes New Research Faculty Member

We welcome the newest addition to our research faculty, Assistant Professor Osamu Tetsu, MD, PhD. Dr. Tetsu has 10 years of experience conducting cancer research at the UCSF Cancer Research Institute under the direction of Director Frank McCormick, PhD, FRS. Dr. Tetsu holds a medical degree and a PhD in Immunology from Chiba University in Japan. With the recruitment of Dr. Tetsu, the department will expand the scope of our basic science research programs to further integrate head and neck cancer. Goals for this program include the following: Establishment of head and neck cancer cell lines Development of a head and neck tumor bank Creation of a head and neck cancer database Exploration of head and neck cancer oncogenesis Development of targeting therapy for head and neck cancers Focused concentration on salivary gland cancers With expertise in cancer biology, and cell cycle regulation, as well as cell signaling pathways, Dr. Tetsu has investigated the

Osamu Tetsu, MD, PhD genes responsible for epithelial tumor initiation and cancer development. He has also worked with developmental cancer therapeutics. His research focus is to understand the mechanisms of cell signaling and growth deregulation in cancer and to identify novel therapeutic approaches to the treatment of solid tumors in the head and neck. Dr. Tetsu has several important projects currently underway including the study of the oncogene cyclin D1 as a therapeutic target for head and neck cancers. Depletion of cyclin D1 protects cells against cancers in the colorectum and breast and has been reported to enhance sensitivity of head and neck cancer cells to radiation and chemotherapy. Cyclin D1 is a promising therapeutic approach because amplification of the cyclin D1 gene is strongly correlated with poor prognosis in head and neck cancer. Dr. Tetsu is working on new methods targeting cyclin D1 proteolysis for these cancers. Loss of cyclin D1 expression in the nucleus may protect cells against cancers, and can increase radiosensitivity in head and neck cancers. In addition, Dr. Tetsu is working

Continued from page 1 brains as they are speaking versus when they hear a playback of their speech. Drs. Houde and Nagarajan have found that the auditory cortex responds intensely to hearing the tape playback speech, but responds much more weakly when speakers hear their own speech while they are producing it. However, this suppression of brain activity disappears when speakers hear their speech altered in unexpected ways. For example, if speakers hear a high-pitch version of their speech while they are speaking, their brain activity is not suppressed. These results suggest that, during speaking, auditory cortex compares what is being heard with a prediction of what it expects to hear. Strong brain responses occur only if there is a mismatch with the prediction. Because the prediction is derived from motor cortex activity as the speaker speaks, it is not available during passive listening to tape playback. How does this relate to potential speech disorders? Currently, Dr. Houde is collaborating with other researchers at UCSF to investigate whether dysfunction of this feedback comparison process is associated with various disease states. Along with Dr. Mark Courey, Professor and Director of the Laryngology Division, Dr. Houde is investigating whether patients with spasmodic dysphonia have degraded representations of speech sounds in their auditory cortex that result in inappropriate corrective responses causing the laryngeal muscle spasms that give spasmodic dysphonia patients their strangled, breathy voices. Additionally, Dr. Houde has recently teamed with Dr. William Marks in the Department of Neurology at the San Francisco VAMC to examine whether dysfunction of auditory feedback processing leads to the hypophonia (weak voice) condition in Parkinsons disease. Furthermore, Dr. Houde will be continuing his existing collaboration with Dr. Judith Ford in the Department of Psychiatry, who has been investigating whether the dysfunction in the auditory feedback prediction process leads patients with schizophrenia to mislabel their own, internally generated speech as arising from an external, nonexistent speaker, such as in auditory hallucinations. These examples illustrate how basic science can inform clinicians about the mechanisms underlying disease processes and how collaborations are critical in forging a research environment that is of most benefit to our patients. As a result of our initiatives, UCSF OtolaryngologyHead and Neck Surgery research is well positioned to develop fundamental new insights into brain disorders and to generate new treatment protocols and products for our patients. With further help from our friends, alumni, and philanthropic donors, we are confident that we will continue to succeed in these endeavors.

Giving Back: Donors Make It Happen!

Dr. Lewis F. Morrison, former Chairman of the Division of Otolaryngology, made many contributions to the field as a scholar, teacher, and clinician that continue to this day. And now, thanks to Dr. Morrisons daughter, Helen Elkus, a reminder of Dr. Morrisons many contributions has a new home. A silver-plated laryngoscope was presented to Dr. Morrison in April 1952 by the former residents of the division on the occasion of his being elected President of the Pacific Coast Oto-Ophthalmological Society. The laryngoscope is inscribed with the names of all of the residents who had trained under Dr. Morrison until that time. the laryngoscope, Dr. Morrison was a great teacher. Things ran smoothly because he held a tight rein He was warm, helpful beyond expectations, and kindly, especially to the quaking residents.

Assistant Professor John F. Houde, PhD

Contact Us
General Otolaryngology Pediatric Otolaryngology Otology and Neurotology Rhinology and Sinus Surgery Sleep 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 UCSF Voice and Swallowing Center 415-885-7700 Audiology 415-353-2101 Online http://ohns.ucsf.edu

Heads Up!
Volume 5, Issue 1
Department Chairman, Editor in Chief: David W. Eisele, MD Executive Editor: Deborah Samii, MA, Ed Managing Editor: Emerald Light Editors: Matt Forbush Jonathan Hecht, MPA/HSA Catherine Lee, MPH Holly Wong, MA
Silver-Plated Laryngoscope, circa 1952 Best known for his work with the larynx, Dr. Morrison made significant contributions in the field of recurrent laryngeal paralysis, carcinoma of the larynx, and anatomy of the recurrent laryngeal nerves. He also developed the reverse King operation. According to Dr. Alex Weisskopf of Prescott, AZ, one of the residents whose name is inscribed on

Mrs. Helen Elkus and Mark S. Courey, MD Thanks to Mrs. Elkus and her husband, Richard, the laryngoscope has been encased in an airtight container and will be placed on display in the lobby of the UCSF Voice and Swallowing Center. Dr. Mark Courey, Director of the Division of Laryngology, accepted the laryngoscope on the Departments behalf.

If you would like to support the Department of Otolaryngology Head and Neck Surgery, or know someone who would, please contact Jeff Hauk, Director of Development at: UCSF Foundation 44 Montgomery Street Suite 2200 San Francisco, CA 94104-4709 415.502.6198 jhauk@support.ucsf.edu www.ucsf.edu/support/

Special thanks to faculty contributing writers: John F. Houde, PhD Eric J. Kezirian, MD Lawrence R. Lustig, MD Christoph E. Schreiner, PhD, MD Osamu Tetsu, MD, PhD