The fellow, under the directorship of Steven Telian, M.D., will have the opportunity to work with all faculty members within the Division of Otology/Neurotology, which actively collaborates with audiologists, hearing aid technicians, speech-language pathologists, physical therapists and a robust support staff. This dynamic team works together to detect, diagnose and rehabilitate hearing loss and related disorders. The division also enjoys a close collaborative relationship with B. Gregory Thompson, M.D., of the Department of Neurosurgery, who provides neurosurgical care for the vestibular schwannoma operations and other lateral skull base and posterior fossa procedures.
The fellowship is a two-year ACGME-accredited training appointment. During this time, the department intends to fully equip the fellow to function effectively in an academic department of otolaryngology.
The training is clinically oriented, though approximately 20 percent of the fellow's time is protected throughout the program so that he or she may pursue academic projects and develop a research interest. During the first two months of training, a structured preceptorship in audiologic and vestibular diagnosis with related assigned readings will be completed. The remainder of the training program is directed toward the active care of neurotologic patients, along with the mentored development of clinical expertise and surgical skills. Significant investment in laboratory temporal bone dissection is anticipated. Surgical opportunities in the operating room are graduated, with the degree of participation based upon personal preparation and demonstrated competence in temporal bone surgery. The typical weekly schedule of the fellow includes:
- Operating room - two days
- Outpatient clinic activities - 1.5 days
- Faculty mentored temporal bone dissection - half day
- Academic time - one day
The fellow may participate in caring for any otologic surgical patient. The fellow's hands-on operative experience will be focused on inner ear procedures, facial nerve disorders and neurotologic skull base surgery. Our team strongly emphasizes choosing the most suitable approach for vestibular schwannoma tumor resection, rather than surgeon preference or institutional tradition. We believe this to be one of the distinguishing characteristics of the University of Michigan Neurotology training program. We also tend not to recommend stereotactic radiation for healthy patients with unilateral benign tumors. The translabyrinthine approach is used most frequently, in over half of the vestibular schwannoma procedures. The other tumor resections are performed with the goal of hearing preservation using either the middle fossa approach or the retrosigmoid approach, the latter of which is also occasionally used for debulking of the largest tumors. Surgical case volumes for our most recent fellows are provided here:
These advanced neurotologic procedures are performed by fellows and clinical faculty. Though middle ear and mastoid surgery are primarily performed by residents on the Otology Service under the supervision of clinical faculty, with increasing faculty size the fellows have been involved in these operations more frequently than in the past.
Applicants must be eligible for the American Board of Otolaryngology examination or already board-certified. A training license to practice medicine in the state of Michigan is required for duties related to the training program, but an unrestricted license is needed if outside medical activities are planned. The fellow is appointed as a house officer due to ACGME regulations, and thus does not have independent clinical practice duties or routine on-call activities. The fellow will undertake the following duties related to clinical patient care:
- Assist division faculty in evaluation of outpatients with otologic complaints, generally 1.5 days per week.
- Be available to make rounds with the residents during weekdays and one weekend day if there are Neurotology patients in the hospital.
- Organize and present the clinical information regarding upcoming surgical cases at the weekly Otology Case Conference.
- Become sophisticated in vestibular diagnosis and multidisciplinary care of patients with vestibular disorders, including the interpretation of computerized videonystagmography, oculomotor testing, VEMP and electrocochleography, rotational chair testing and dynamic posturography.
- Respond to EMR inquiries regarding patient care during faculty absences.
- Perform triage and initial evaluation for neurotologic patients requiring urgent evaluation and presenting the case to the division faculty member on duty.
- Help clinical staff triage urgent and emergent otologic consultations.
- Help with resident call coverage during the annual Otolaryngology Training Exam (“In-service Exam”).
With satisfactory progress during this two-year program, the trainee can expect to function independently as a neurotologist upon completion of the fellowship.
Formal Teaching Activities
The division is actively involved in the otolaryngology residency teaching program at the University of Michigan. There are weekly Otology Case Conferences, as well as didactic sessions and supervised temporal bone dissection for residents and fellows on service. In addition to the teaching responsibilities in the Temporal Bone Laboratory, fellows will instruct during dissection sessions and periodically lecture during the Temporal Bone Course, Otology Didactic Conference and in other continuing medical education courses, as deemed appropriate.
Temporal Bone Laboratory
The Temporal Bone Dissection Laboratory has 14 stations with otologic drills, binocular operating microscopes and video monitors for instruction. Fellows are encouraged to spend extended blocks of time in the Temporal Bone Lab perfecting surgical skills, particularly those related to transtemporal approaches to the internal auditory canal and the other advanced techniques required for neurotologic surgery. These efforts will both precede and complement responsibilities in the operating room. In addition, fellows will circulate as instructors in temporal bone dissection courses offered four times a year. They will provide informal surgical mentoring for otolaryngology residents, and will occasionally participate in supervising during the weekly drilling sessions if the assigned faculty member is detained.
At least 20 percent of the weekly schedule is available during both years of training for research and academic pursuits. It is appropriate to participate in academic publications initiated by faculty members. In addition, it is expected that the fellow will complete one major clinical or basic science research project during the second year of training. This project may be the continuation of a prior research interest, a major clinical research undertaking, or a new area of investigation that interfaces with the ongoing activities of the scientists at the Kresge Hearing Research Institute. This should include development of a research plan supervised by a faculty member leading to preparation of a formal NIH-style proposal, which will be presented to the departmental Research Committee during the first year of training. The fellow will be expected to pursue extramural funding, although start-up support may be sought from the Division of Otology/Neurotology and/or from competitive funding available through the Research Committee. The fellows are also encouraged to initiate prospective or retrospective clinical studies suitable for publication.
The department will provide a travel stipend of $750 to assist the fellow with travel to one major otolaryngology meeting per year. Additional funding may be available at the discretion of the division director, particularly when a paper is to be presented.