PHOENIX-Laryngology is enjoying a resurgence in the world of endoscopy and the future of the field is promising, outgoing American Laryngological Association (ALA) President Roger L. Crumley, MD, MBA, said in his presidential address at the 130th annual meeting of the association, an address that touched on the discipline’s past as well as challenges it is facing.
Explore This Issue
August 2009Our endoscopic future is, in my view, evolving and growing before our eyes, and it is as bright as the brilliant light sources in these new scopes, Dr. Crumley said. Indeed, our specialty is once again assuming its proper leadership role in these venues.
Even as laryngology is improving its ability to attract new doctors interested in endoscopy, though, Dr. Crumley called on the association members to help improve the bottom line of the organization in unveiling a Sustainers’ Fund capital campaign.
Dr. Crumley’s lecture came just before his tenure ended and the reins were passed on to new President Marvin Fried, MD.
Laryngology’s Role in Endoscopy
Dr. Crumley traced the arc of laryngology’s role in the realm of endoscopy, which has gone from a prominent role, to a less prominent one, to a role he said is now on the rebound.
I find it very interesting to think of the hard-core otolaryngic time when we owned esophagology and bronchoscopy-in the era when otolaryngology clearly dominated airway endoscopy, he said. And even later, when I trained in the early ’70s, otolaryngology did virtually all the bronchoscopies and esophagoscopies in many, if not most, university centers in those days. However, our colleagues in the pulmonary and gastrointestinal subspecialties of internal medicine were astute and keen to perform endoscopy.
The role began to wane from the late 1970s through the early 1990s, he said.
Esophagoscopy evolved in some centers to be more frequently performed by non-otolaryngic physicians, Dr. Crumley said. In fact, by approximately 1990, it was noted that there were some ENT residents who would sit for their board exams who finished their residency training with very few, or no, bronchoscopies or esophagoscopies.
The times are changing, he said.
Maybe, as some have asserted, we as laryngologists were asleep at the switch, but the good news is that that has changed and continues to change. In the past year, for example, I have spoken with many younger otolaryngologists and laryngologists, all of whom devote a rather large percentage of their time to doing many transnasal esophagoscopies, TNE bronchoscopies, percutaneous gastroscopy, and some truly gastric procedures through today’s advanced endoscopes.
Sustainers’ Fund
Dr. Crumley also discussed the Sustainers’ Fund, a campaign to raise $500,000 in unrestricted money-available for meetings and general use-by the Combined Otolaryngology Spring Meeting in 2011.
Like other organizations in this tight economy, the ALA has had a drop in reserves. It has cut expenses by holding its winter council meeting by teleconference and eliminating the banquet from the recently held annual spring meeting.
In the Sustainers’ Fund campaign, any fellow, corresponding fellow, or emeritus member who makes a donation of $100,000 or more will have his or her name attached to the Sustainers’ Fund, Dr. Crumley said.
This will go a long way toward defraying costs at the annual meeting and other annual costs, he said.
Dr. Crumley revisited the roots of the field as well, tipping his cap to Dr. Horace Green, the Father of Laryngology, who was expert enough to even remove a laryngeal growth without the aid of a laryngoscope, operating mostly by feel, which to me is flabbergasting.
And he gave a nod to the group, organized by Dr. Frank H. Davis, who met in Buffalo in 1878-considered the founding meeting of the ALA. In those days, specialization was frowned upon by most of organized medicine, and people who split themselves into small groups as we have done were not highly thought of, Dr. Crumley said. Accordingly, these were courageous individuals.
Dr. Crumley said the field will keep evolving at a fast pace. As lasers and endoscopes become more advanced and useful to the laryngologists, so do clinically useful techniques from the worlds of gene therapy, stem-cell reseach, optical coherence tomography, and many other disciplines, he said. I am no futurist, but because of where we are technologically today, I think it would be very doubtful that a clinical day in the life of a laryngologist in the year 2019 would in any way resemble a clinical day that we experience in this year of 2009.
A Look to the Future
Dr. Fried, in his capacity as the new President, said he will continue to try to draw new talent into the field. He is attempting to broaden publication abilities and open up as many slots as possible for podium presentations at the annual meeting.
He said that he hopes the ALA can continue to shed its image as an organization for older doctors. We were considered a group of senior otolaryngologists and we’re trying to dispel that notion, he said.
Andrew Blitzer, an otolaryngologist at the New York Head and Neck Institute and a member of the ALA council, agreed that the status of laryngology is on the rise-a sharp turn from the days when he finished his residency in the late 1970s. At the time, he met with his mentor about what he wanted to do next, and told the mentor about his growing affection for laryngology.
He said, ‘Why?’ Dr. Blitzer recalled. Everything you need to know was written by [laryngology pioneer] Chevalier Jackson in his classic textbook in 1935. He drew beautiful pictures, he shows you all the diseases. There’s nothing else to say about it, except maybe reconstruction in patients with cancer of the larynx.’ And I said, ‘You know, the trouble with that book is it didn’t move,’ a reference to the subtleties of movement of the vocal folds.
The field has evolved, Dr. Blitzer said. We now have new tools and we now have new understanding. It’s not lumps and bumps anymore. But it’s the whole physiology and pathphysiology of the vocal cord that has evolved, by a lot of very smart people getting involved in laryngology because there were a lot of unanswered questions.
Dr. Blitzer said the renewed interest in the field also has to do with the simple need for a good job. If you want to go to a reasonable-sized city and find a job, and you have a fellowship in laryngology, you’ll find it, the jobs are there, he said. Why? They’re coming out with these technologies. They know how to do these things that these guys in practice don’t know how to do, and if they’re going to compete against the people in town, they have to have the latest technologies in their groups.
He added, It’s a very exciting time for us, because we’re getting some of the brightest residents applying for fellowships.
©2009 The Triological Society
Leave a Reply