Observation and Fellowships

Primary goals

1. Sound: Given that voice is “sound” and hoarseness is a “change in sound quality”, the fellow will learn to train their ear to hear and describe changes in sound. Those audible changes will be mapped to visual laryngeal endoscopic findings.
2. Three part model of laryngeal diagnosis: The fellow will learn Robert Bastian’s diagnostic model: how to elicit an appropriate vocal history; listen and record sound impairment and; operate and visualize laryngeal movement with endoscopy and combine these three approaches into a single, accurate diagnostic algorithm.
3. Experience: The fellowship’s goal is for participation in more than 100 hospital surgical procedures and be primary surgeon when skills allow. These will include feminization laryngoplasty, medialization laryngoplasty, microlaryngoscopies of benign and malignant lesions, denervation-reinnervation laryngeal surgery, surgical treatment of glottic stenosis and others.
4. Voice Laboratory: Learning details of video and audio recording, medical endoscopic equipment will prepare the fellow to establish a cost effective and highly functional voice laboratory after the fellowship.

Surgical office procedures should include office laser vocal cord tuning and ablation, injection augmentation, flexible endoscopic biopsy, medication injection (steroid, botulinum toxin), and others.

Overall, the fellowship will include exposure to the full range of laryngology, with emphasis on:

• Neurolaryngology
• Professional voice care
• Neoplastic and non-neoplastic diseases of the larynx
• Gender voice management
• Disorders of the upper airway
• Behavioral voice
• Diagnostic techniques
• Audible evaluation of hoarseness
  • Rigid, flexible & stroboscopic endoscopy
  • Operative techniques
  • audio and video technical methods for recording & storage
• Operative techniques
  • Microlaryngeal surgery
  • Medialization & augmentation techniques
  • Nerve reinnervation
    • for dystonia
    • for paresis
    • for laryngospasm
  • Pitch surgery
    • raise pitch — Feminization laryngoplasty
    • raise pitch — laser tuning
    • lower pitch — Masculinization
  • CO₂ Laser techniques
• Office surgical intervention
  • Blue Laser
  • injections — botulinum toxin in multiple locations
  • injections — augmentation
  • biopsies
  • neoplasms

New patients: Participate in approximately 300 new patient visits and 700 returning patient visits during the year.

Secondary goals:

1) Learn office management regarding billing, coding, working with employees.

Commitment:

One year (12 consecutive months)

Financial

• Salary - $81,000 annual
• Malpractice insurance - value ~$14,000
• Health Insurance

Location:

• office-based at 909 NW 18th AVE, Portland, OR, 97209

Surgical:

• Providence Portland Hospital, Portland, OR
• Legacy Emanuel Hospital, Portland, OR
• Wilshire Surgery Center, Portland, OR

Call Schedule:

• To be determined

License requirement:

• Full Oregon State Medical license

Accreditation Status:

• The Laryngology Fellowship is non-accredited.

Operating privileges:

• Hospital Full Time Staff

Description:

This is a comprehensive subspeciality training program in the field of laryngology. The office practice is limited to Laryngology. If the hospitals require a general ENT call for the fellow, then arrangements will be need to be made by the hospital to provide office space for any general otolaryngology patients that the fellow sees.

The fellow will be expected to participate 5 days per week plus any weekend call.

Office clinics & hospital surgery.

These typically alternate between four day and five day work weeks.

Vacation:

• 4 weeks (20 days)

Meetings:

• Presentations are encouraged at National meetings.
• Some meeting expenses will be covered when a presention is given.

Eligibility:

• Applicants must be American Board of Otolaryngology board-eligible or board-certified and satisfy the requirements for Oregon medical licensure.

Secondary learning - controversial topics:

• Compare approaches to tumor managment: frozen section vs wide excision vs tight excision with close follow up.
• Role of reflux in voice disorders.
• Visual neurolaryngology vs. electromyographic neurolaryngology.

Writing:

The fellow will be encouraged to write both research papers and textbook chapters. This should be considered a significant part of the fellowship goal. The ability to put into words what one learns solidifies the learning process. After fellowship, daily clinical and personal duties often preclude this type of experience.

Additional experience opportunity:

A close relationship is maintained with OMFS (Oral, Maxillo-facial Surgery) training program. The fellow may participate in both office and surgical procedures by OMFS colleagues where crossover is appropriate, including office endoscopy and head and neck tumor management, tumor board, neck trauma, & tracheostomy management.

James P. Thomas, M.D.