Texas Children’s Division of Otolaryngology recently hosted the 45th Annual Meeting of SENTAC (Society of Ear, Nose and Throat Advances in Children), one of the nation’s oldest and most respected ENT societies. It was the largest SENTAC conference ever, with nearly 300 national and international otolaryngology experts in attendance, including the largest ever turnout of allied health professionals.
“Multidisciplinary collaboration is one of the hallmarks of SENTAC,” said Dr. Deepak Mehta, Director of Texas Children’s Pediatric Aerodigestive Center and 2018 SENTAC president. “This event is not only for physicians, but also for audiologists, speech and language pathologists and therapists, advance practice providers, pediatricians, nurses and students. This experience is unique in that it brings us all together for a common purpose.”
The four-day event covered the entire spectrum of pediatric ENT topics, including sleep disorders, swallowing disorders, tracheostomy care and hearing loss. During the conference, over 60 presentations were given, including eight by experts from Texas Children’s – two of which won awards. Jessie Marcet-Gonzalez, CPNP, won first place for best podium presentation for her paper, “Effect of Inpatient Multidisciplinary Tracheostomy Team Rounds on Timely Outpatient Follow.” Texas Children’s audiologist Dr. Barbara Novak won second place for her paper, “Improving Loss to Follow-up: A Collaborative Citywide Initiation,” a project on newborn hearing screening in collaboration with Texas Children’s audiology clinical and cochlear implant specialist Dr. Samantha Lemelle, AuD.
Other event highlights included a banquet with live music and holiday lights at the Houston Zoo, and the first annual SENTAC Pediatric Otolaryngology Academic Bowl, presented by the Young Providers Committee. Texas Children’s took home the trophy, defeating teams from Rady Children’s Hospital in San Diego and Children’s Hospital of Wisconsin. Throughout the weekend, many said this was one of the best SENTAC conferences yet, both in terms of content and host venue.
“I feel pride in being part of Texas Children’s and all of us working together to put together such a fantastic meeting,” Mehta said. “The amazing support from Texas Children’s leadership and all the staff involved truly made it a success.”
December 3, 2018
Texas Children’s Hospital is excited to welcome Dr. Anna Messner as the new chief of the Division of Otolaryngology.
“Dr. Messner has a strong, clear vision for moving the Division of Otolaryngology to the next level,” said Surgeon-in-Chief Dr. Larry Hollier. “She is prepared to position Texas Children’s Otolaryngology clinics as a premier destination for subspecialty care.”
As chief of Otolaryngology, Messner will helm the largest group of pediatric otolaryngologists in the nation. She brings with her a collaborative, patient-focused approach to care, as well as a strong interest in training the next generation of ENT subspecialists. One of her main areas of focus will be working with each surgeon to help them develop their talents and grow in their professional career.
“Texas Children’s is a world leader in pediatric health care and I am delighted to be joining the team,” said Messner. “My goal for the Division of Otolaryngology is to be the leader in high-quality, efficient care for children with otolaryngology conditions and the premier training program for pediatric ENTs.”
Messner also plans to leverage Texas Children’s high clinical volume to develop and execute innovative new research studies around the care of children with common ENT disorders.
“The dramatic expansion of Texas Children’s Otolaryngology program in recent years creates an opportunity not only to improve patient care, but also to conduct groundbreaking research that can’t be done elsewhere,” Messner said. “We have the potential to become a national research hub that drives how children with these conditions are cared for, both now and in the future.”
Messner comes to Texas Children’s from Stanford University Medical Center, where she served as professor of Otolaryngology and Pediatrics and vice chair of the Department of Otolaryngology. She was also previously the Chief of Pediatric Otolaryngology at Lucile Packard Children’s Hospital Stanford and program director for the Otolaryngology Residency at Stanford University Medical School.
A nationally recognized leader in Pediatric Otolaryngology, Messner is president-elect of the American Society of Pediatric Otolaryngology (ASPO). She is also a member of the ACGME Otolaryngology Residency Review Committee and has been a guest examiner for the American Board of Otolaryngology Oral Exams.
Messner is a graduate of Wake Forest University School of Medicine, where she also completed her residency and internship. She completed an otolaryngology fellowship at the Hospital for Sick Children in Toronto.
She will begin her new role on January 14, 2019.
About Otolaryngology at Texas Children’s
Texas Children’s is home to largest pediatric otolaryngology program in the United States, providing advanced surgical and medical care for the entire spectrum of ear, nose, throat, and head and neck diseases and disorders. We are distinguished by wide range of clinical expertise across specialty areas including:
Cleft lip and palate
Complex airway surgery
Head and neck surgery
Microtia and atresia
Otology and neurotology
Our team of surgeons and advanced practice providers offers a comprehensive range of services at all three Texas Children’s Hospital locations, as well as five other Texas Children’s Specialty Care locations in the Houston metropolitan area. We see approximately 40,000 patients in clinic and perform more than 10,000 surgeries each year – and we’re still growing.
On November 10, nearly 100 people gathered at the Meyer Building for Texas Children’s first ever Microtia Awareness Day, sponsored by the Division of Otolaryngology’s Microtia Clinic.
The event featured educational talks and Q&A sessions offered by experts across numerous Texas Children’s specialties and subspecialties, including Pediatric Otolaryngology, Speech and Language Pathology, Audiology and Anaplastology. There was also a full slate of games and activities for children, such as face-painting, a bean bag toss, Hula-Hooping and mini bowling, as well as a step-and-repeat for photos.
For patients and families alike, it was a wonderful new opportunity to meet with members of the multidisciplinary care team in Texas Children’s Microtia and Atresia Program, and to interact with other families who have been affected by these rare conditions.
“The event was extremely well received,” said Allison Haggerty, senior speech-language pathologist at Texas Children’s Hospital The Woodlands. “It was incredible to hear families say how they no longer felt like the ‘only ones,’ as they met so many others in similar situations.”
Microtia is a rare congenital malformation of the ear, occurring in about one in 10,000 births. Typically, the condition affects only one ear and the severity of symptoms can vary widely. In less severe cases, the ear might be slightly smaller than normal. However, in the most severe cases, the ear may be completely absent. Because the external and internal structures of the ear are so developmentally linked, children with microtia may also experience atresia – an absence or underdevelopment of the ear canal and middle ear structures. Atresia can potentially cause hearing loss and speech difficulties, which can in turn contribute to poor academic performance.
The effects of these conditions on physical appearance and on speech, hearing and learning, especially during crucial early developmental years, could potentially have a lasting negative impact on self-esteem and overall quality of life.
To meet the complex needs of patients with microtia and atresia, Texas Children’s has built the only comprehensive program in the state that offers the full spectrum of care, from reconstruction of the outer ear, to complex repair of aural atresia, to hearing aids or implants for appropriate candidates.
“With our program, we have created a one-stop shop where families have access to care for children of all ages – and our demand is high,” said Dr. Rodrigo Silva, director of Texas Children’s Ear and Hearing Center. “These conditions may be rare, but because of Houston’s size and diversity we see a very large number of patients each year.”
The Microtia and Atresia Program offers families a multidisciplinary approach to care that includes audiology, with experts trained in age-appropriate hearing testing and solutions; speech and language pathology; and surgical interventions to address cosmetic needs and hearing loss. The event gave Texas Children’s caregivers an opportunity to share the many ways we can help.
“We wanted to highlight our capabilities and let families know that we offer individualized treatment paths for each child we see,” said Texas Children’s pediatric otolaryngologist Dr. Yi-Chun Liu. “Whether the child needs a reconstruction surgery of the ear or ear canal, a hearing aid or implant, speech and language therapy, or some combination of all of these, we’re committed to providing them with the best possible care.”
At the end of the event, parents were given survey cards that asked for suggestions about the kinds of information regarding microtia and atresia that families might find most helpful when starting their care journey. There was also a section for feedback and comments.
Judging by some of the responses …
“It was spectacular!”
“We absolutely loved the event.”
“It was so nice to meet other families with microtia.”
“I want to thank you all for everything. I learned a lot.”
… the event was a success.
“We’ve already had requests to make it an annual event,” said Jessie Marcet-Gonzalez, CPNP, with the Division of Otolaryngology. “We had so many volunteers who helped make this day special for our families and in letting them know that we really care.”
A world-class, multidisciplinary team at Texas Children’s is making huge strides in the care of children with extremely complex tumors.
The Head and Neck Tumor Program, begun in February 2016 as collaboration with partner institutions within the Texas Medical Center, has performed more than 20 major ablation free-flap multidisciplinary cases – a staggering number, considering the rarity and complexity of the tumors, which can be malignant or benign and can affect any combination of the sinuses, skull, jaw, mouth, neck and face. The ability to handle that volume of complex cases, combined with tremendous outcomes in the first two years, puts Texas Children’s Head and Neck Tumor Program among the best such programs in the country.
“Our institutional expertise is in taking care of these kinds of critically ill children, and Texas Children’s does it better than anyone,” said Dr. Daniel Chelius, attending surgeon in the Division of Otolaryngology and co-head of the program. “We’ve built a collaborative, coordinated program on that foundation of expertise in many different areas to provide the best care possible for the sickest children, while also reviewing and analyzing the care from every angle to see what went well and what processes could improve.”
Treatment of children with head and neck tumors around the country has historically been ad hoc, due to the varying functional issues or oncologic needs present from patient to patient and the extreme rarity of the tumors in any given city. Compound these complex physiological issues with the fact that most children these tumors have been treated in adult hospitals and the result has been a largely disjointed approach to care.
Texas Children’s Head and Neck Tumor Program, spearheaded by Chelius and Dr. Edward Buchanan, chief of Plastic Surgery, has developed a coordinated process around a multidisciplinary team approach that builds crucial experience in the treatment of these rare tumors and provides consistent, personalized care for patients – like 15-year-old Kami Wooten.
Last year, Kami began to notice swelling in her gums. Just months later, a benign tumor had covered half her face and threatened her vision. The team at Texas Children’s developed a specialized care plan that included removing the mass and reconstructing a portion of her face including the roof of her mouth and her orbit (eye socket). Additional procedures will be necessary in the future, but Kami and her family are grateful for the care Texas Children’s gave them.
The collaborative program comprises more than 10 Texas Children’s specialties and subspecialties, including Otolaryngology, Plastic Surgery, Neurosurgery, Oncology, Interventional Radiology and Anesthesiology, as well as a dedicated operating room team – led by Audra Rushing and Kelly Exezidis – that has been instrumental in building robust perioperative protocols. The additions of pediatric head and neck surgeon Dr. Amy Dimachkieh and microvascular reconstructive surgeons Dr. W. Chris Pederson and Dr. Marco Maricevich have increased the program’s abilities and improved the quality of its recommendations.
“It takes a lot of thought and planning to remove these complex tumors completely, while sparing as many nerves and other important structures as possible, and then to reconstruct those structures to provide both a good functional and cosmetic outcome,” Chelius said. “We tell our patients that the process might not be fast because they need the right surgery the first time. That requires recommendations from a team of experts, not just one surgeon. And that means carefully coordinating to make sure everything is as perfect as possible.”
The care required to treat these tumors, particularly if the patient is also undergoing cancer treatment, can also take a massive emotional and psychological toll. The Head and Neck Tumor Program provides additional care support through the department of Clinical Psychology and Child Life Services.
The team also uses technology to enhance the patient experience, from diagnosis to recovery. The program uses 3-D modeling to reconstruct children’s anatomy to help predict the extent of resection and to develop the surgical plan. The team also developed a data-driven protocol for pediatric tracheostomy removal, in close collaboration with Speech and Language Pathology, which uses a pressure monitoring device to signal when the trach is loose enough in the airway to be removed without adverse effects.
As a result of this innovative approach to care, 100 percent of patients treated have left the hospital breathing, eating and swallowing on their own. And the average stay in the hospital: just 14 days.
The program has been steadily building a referral base, drawing patients from across the region and from as far away as Mexico and the Middle East. In the near term, the team will continue to solidify the program, publish data and findings, and work to increase Texas Children’s reputation as the leading referral center for these complex cases. Long-term goals include building a basic science research infrastructure around understanding the underlying causes of these tumors, as well as collaborating with Texas Children’s Cancer Center and other research partners.
“We know that families are coming to us shocked and scared,” Chelius said. “We want them to know that we’re building our experience, we’ve walked families through this before, and we’re going to get them through this with the absolute best care available.”
Learn more about Texas Children’s Head and Neck Tumor Program.
December 20, 2017
Five-year-old Marianne Franco failed every hearing test since she was born, causing her to move through life lip reading and hearing what she could with a hearing aid. All of that recently changed when doctors at Texas Children’s Hospital The Woodlands turned on the cochlear implant Marianne received weeks before.
As an audiologist rang a bell, the girl gave a grin. When they continued to ask her questions, trying to gauge how much she could hear, Marianne’s mom, Lizette, whispered behind her daughter’s head.
“I hear that,” Marianne said.
“What did you hear?” her mom asked.
Marianne is not sure yet how to discern exactly what she’s hearing. She’s grown up lip reading and has been able to pick up amplified sounds through a hearing aid. However, the sounds have never been crisp or at a safe volume. That’s why her family opted for Texas Children’s physicians in The Woodlands to surgically place a cochlear implant inside her head and give her the chance to hear.
“I think she’s going to do fantastic with the implant,” said Pediatric Otolaryngologist Dr. Jill Beck, explaining that the implant in Marianne’s head is sending a wireless signal to the outside processor. The nerve that’s being exercised for the first time is so fragile they have to send very soft sounds that will gradually build with time.
Meanwhile, she has to learn what sounds to associate with words in both English and Spanish. It will be exhausting, but Marianne is willing to work hard. To understand her motivation, you have to think like a child. Minutes after her implant was on, she asked to go underwater. She’s never heard the sound of water.
“You’ve been dreaming about this right?” Lizette asked.
Beck said Marianne is one of four children at Texas Children’s Hospital The Woodlands to get this kind of implant. As technology gets better, she said, there’s a lot of promise that this will become a more routine procedure.
For more information about Texas Children’s cochlear implant team and the Eat & Hearing Center at Texas Children’s click here.
To watch KPRC Channel 2’s story about Marianne’s cochlear implant and reaction to hearing the world like she never has before, click here. To read a story in the Houston Chronicle about her implant, click here.
December 12, 2017
On February 10 at Third Coast on Bertner Avenue in Houston, Texas Children’s Chief of Otolaryngology Dr. Ellis Arjmand and Dr. Oded Netzer, professor of business at Columbia Business School in New York City, will lead an interactive workshop focused on the psychology of decision making in medicine.
During the 8-hour course, attendees will learn about the psychology of decision making and how to make smarter decisions in the presence of uncertainty.
Building on the landmark research from two trailblazing psychologists, Drs. Daniel Kahneman and Amos Tversky, attendees will learn how to recognize cognitive bias and systematic errors in decision making. Topics discussed include:
Cognitive Bias and Decision Making
Systematic Forms of Error: Understanding Our Biases
System I and System II: Thinking Fast and Slow
Interrogating the Data
Understanding Error in Medical Decision Making
Syntheses vs. Summary
Reducing Bias in Medical Decision Making
To register for the Continuing Medical Education course or for more information about the event, click here.
January 4, 2017
Texas Children’s Otolaryngologist Dr. Deepak Mehta was recently named to two important positions in professional otolaryngology organizations.
In December, Mehta was elected president of the Society for Ear, Nose and Throat Advances in Children (SENTAC). The December 2018 meeting of SENTAC will be in Houston, giving Texas Children’s otolaryngologists the chance to introduce our city and hospital to more than 200 colleagues and members of the growing professional society.
Mehta also was named program chair for the 2017 American Society of Pediatric Otolaryngology (ASPO) meeting. One of the primary missions of the professional society is to share and disseminate advances and innovations in patient care through the annual meeting and other venues.
Mehta joined Texas Children’s in 2015 from the Children’s Hospital of Pittsburgh, Division of Pediatric Otolaryngology, where he was director of the Aerodigestive Program. He was also associate professor of Otolaryngology at the University of Pittsburgh School of Medicine. Mehta performed his residency at So. Trent Otolaryngology Programme at Nottingham, UK, and a pediatric otolaryngology fellowship at Cincinnati Children’s Hospital and Medical Center. Mehta will see patients at the main campus of Texas Children’s and at the Sugar Land Health Center. Mehta has also been appointed associate professor in the Department of Otolaryngology – Head and Neck Surgery at Baylor College of Medicine.