Dr. Rebecca Howell’s Circuitous, Yet Serendipitous, Path to Laryngology

Dr. Howell is a mother of three. Here she’s at a Cincinnati Reds game with her family, shown are her daughter Emma and husband John.

Dr. Rapoport: Laryngology sits at such a particular intersection of technical precision and deeply human outcomes. Is there a moment that crystallizes that for you?

Dr. Howell: I rarely extend people’s lives, but very often I extend their quality of life. I had a recurrent respiratory papillomatosis (RRP) patient—a physically strong man—who would close the door to my office and weep because his voice didn’t portray who he was. The unpredictability was devastating. My Parkinson’s patients are the same: When they can’t be heard, they stop trying. They slowly step back from social life. Similarly, with swallowing, nobody wants to sit at a table with a spit cup. If I can get someone to take a sip of coffee at a family dinner without feeling humiliated, that is a win. That is the work. It’s also why my clinic always runs late. I tell patients upfront, if timeliness matters to you, I am not your doctor. But when I’m in that room with you, you have my undivided attention.

Dr. Rapoport: You’ve built something remarkable in Cincinnati—three NIH-funded labs, a fellowship, a multidisciplinary team. How did that evolve?

Dr. Howell: I was very fortunate to join the late Dr. Khosla, who was the sole laryngologist here at the time, and had already started the laryngeal biomechanics lab. Sid and I used to joke that he was fantastic at hiring, and I was good at keeping the people he hired. Over time, Dr. Friedman joined as an amazing partner, then Dr. Dion came to continue the biomechanics work, and just before Sid passed, we hired Brittany Krekeler, a speech-language pathology PhD, who now runs our dysphagia lab. We now have three NIH-funded labs: airway, voice biomechanics, and swallowing. It wasn’t a master plan—it was always about asking, “What do we need next?” and then fighting to get it. I begged my first chair to let us be our own division. Then I begged for a fellowship. Each step opened the way to the next one.

Dr. Rapoport: Some of your most innovative work grew directly out of your speech pathologists. Can you talk about that dynamic?

Dr. Howell: When I arrived, the physician and speech pathologist saw patients separately. We changed that, creating true multidisciplinary clinics, everyone in the room together. And a lot of what I’ve done came from my speech pathologist saying, “Can’t you just inject there?” or “Can’t you stretch that?” And I’d think, actually, yes. My research scientists challenge me one way, my fellows challenge me another. It’s never adversarial. It’s always just, why do you do it that way?

Dr. Rapoport: Speaking of that, can you tell me about VAPER? I heard you talk about it at a laryngology conference last year. You called it “the dysphagia Whipple” at one point.

Dr. Howell: The name came from one of my residents, John Stafford, MD. He said, “This is everything you could possibly do to somebody at once, like a dysphagia Whipple.” Then Mike Yang, MD, the head of UT Health San Antonio Voice Center, and I were chatting at a conference and realized we’d each arrived at something similar independently, so we formalized it.