Rotations

During the fellowship year the following rotations will be required:

1) University Hospital NICU

a. The University Hospital NICU is of lower acuity than the PCMC NICU. During this rotation, the fellow will be required to assist in all consultations to develop expertise in flexible endoscopy of the neonate. Additionally, the fellow will develop judgment in the decisions for transfer to a more tertiary setting.

b. Children born at University Hospital who have an acute airway emergency will be seen by the fellow. The fellow will demonstrate mastery of the assessment and treatment of the newborn with acute respiratory distress.

2) Cleft and Craniofacial

a. The fellow will be required to attend the monthly craniofacial team meeting. The team focuses on feeding, speech, dental, and hearing as well as the functional and aesthetic and genetic aspects of the care of the child with a facial deformity.  The fellow will demonstrate understanding of the importance of team care by participating in the team’s health care decisions and activities.

b. The fellow will be required to attend an endoscopy clinic once a month to become competent at the endoscopic evaluation of velopharyngeal insufficiency as well as understanding nasalence testing.

c. The fellow will be participate in all cleft-related procedures, including palatoplasty, repair of the cleft lip, and speech surgeries to develop the skills needed to become a competent cleft surgeon.

3) Aerodigestive

a. The understanding of the complexities of the aerodigestive anatomy and physiology are important for a pediatric otolaryngologist. The fellow will be required to attend the monthly Aerodigestive conference and be responsible for presenting pediatric otolaryngology patients in that setting. The conference brings together pediatric otolaryngology, gastroenterology, pulmonary and speech specialists. The fellow will develop an understanding of how both pulmonary and GI issues affect the airway and the treatment decisions. The fellow will develop an understanding of the team approach to care.

b. The fellow will be required to participate in all airway reconstruction procedures. These will include but not be limited to laryngotracheoplasty, sleeve resection with primary anastomosis, slide tracheoplasty, endoscopic repair of laryngeal cleft and supraglottoplasty. The fellow will develop competence in each of these procedures.

c. Tracheotomy and ventilator management will be focused on in this rotation. These complex patients are cared for by a team that includes pulmonary, respiratory therapy, rehabilitation and pediatric otolaryngology. Additional consultations from social work, nutrition, GI, and wound care are obtained as needed. The fellow will participate to learn management of tracheostomy complications. Additionally, the fellow will be required to learn the basics of ventilator management.

d. The fellow learn the basic assessment of the child with sleep apnea. This will include understanding polysomnography, sleep endoscopy, and cine MRI evaluations of the airway. The fellow will learn the fundamentals of the medical management using CPAP. The fellow will be involved with and become proficient in the surgical management of the child with sleep apnea including adenotonsillectomy, expansion pharyngoplasty, tongue reduction surgery, supraglottoplasty, and mandibular distraction.

4) Head and Neck

a. Vascular malformations are common in the head and neck. The best approach to care is that of a team. The fellow will be required to attend and present patients at the monthly Vascular Anomalies Conference, attended by dermatology, pediatric otolaryngology, interventional radiology and other subspecialties as needed. The fellow will learn the evaluation and management strategies in these children. This will include medical management protocols with steroid and propranolol.  The fellow will participate in the decisions between sclerotherapy and surgical resection. The fellow will be participate in all major resections of vascular malformations.

b. The fellow demonstrate understanding of the anatomy and surgical treatment of branchial cleft and thyroglossal duct cysts and fistula and will gain experience in their excision.

c. The fellow will develop an understanding of infectious processes in the head and neck, including both common and rare diseases that present with head and neck masses. The fellow will develop an understanding of the approach to assessment and treatment including imaging, antibiotics, and surgical management including resection and drainage.

d. The fellow will develop an understanding of the more common cancers in the child that present in the head and neck. This will include the evaluation of abnormal lymph nodes, assessment with imaging, diagnosis with both excision and fine needle aspiration, and resection where appropriate.

e. The fellow will learn the pathology and assessment of thyroid disease in the pediatric population. This will include the assessment of the thyroid mass and the medical and surgical management of thyroid disease.

5) Pediatric Sinus Disease

a. The fellow will develop expertise in the assessment and medical management of the child with chronic rhinosinusitis.  In those children who are surgical candidates, the fellow will develop the skills of endoscopic sinus surgery in the pediatric population.

b. The fellow will develop the understanding of cystic fibrosis-related sinus disease and its surgical management.

c. The fellow will develop the understanding of image-guided sinus surgery and will demonstrate competency in operating the system.

d. The fellow will develop an understanding of the indications for surgical intervention in acute complicated sinus infections and the techniques needed to surgically treat these diseases.

e. The fellow will develop an understanding of the evaluation of the child with neutropenic fever and invasive fungal sinusitis. This will include the surgical assessment of the disease as well as the surgical management of the disease.

6) Otology

a. The fellow will be required to attend the multidisciplinary Hearing Assessment Clinic. This will focus on congenital hearing loss and understanding the etiology of deafness. The fellow will interact with genetics and audiology in assessing the patient and counseling families.

b. The fellow will be required to participate in the cochlear implant team. The fellow will develop expertise not only in the surgical aspects of cochlear implantation but also the selection process for candidates, postoperative mapping, and the integration of the child into the mainstream.

c. The fellow will become proficient in the surgical management of cholesteatoma including revision cholesteatoma surgery.

d. The fellow will become proficient in ossiculoplasty.

7) Research

a. The fellow will be required to complete at least one research project (basic science, translational or clinical). The fellow will be informed in January prior to the fellowship about ongoing projects but will also be encouraged to develop other projects of interest.

b. At least one publication-ready manuscript must be completed before the end of the fellowship year.