Fellowships

Otology/Neurotology

It is the goal of the Department of Otolaryngology-Head and Neck Surgery to contribute to the training of academic otolaryngologists by offering a fellowship in Otology - Neurotology. The fellowship was the first of its kind to be accredited by the American Council on Graduate Medical Education. It is specifically designed to prepare board-eligible or board-certified otolaryngologists for the practice of otology-neurotology in academic otolaryngology. Fellowship Application (PDF)

Faculty

The Department of Otolaryngology-Head and Neck Surgery at the University of Michigan is under the chairmanship of Gregory T. Wolf, M.D. The fellowship director is H. Alexander Arts, M.D. The Division includes three other otologists: Steven A. Telian, M.D.; Hussam K. El-Kashlan, M.D.; and Syed Rizvi, M.D. The division enjoys a close collaborative relationship with Gregory Thompson, M.D., of the Department of Neurosurgery, who provides neurosurgical care for the acoustic neuroma operations and other skull base procedures.

The department is associated with an outstanding Division of Clinical Audiology and Neurodiagnostic Electrophysiology under the direction of Paul R. Kileny, Ph.D., an internationally recognized authority in his field. Teresa Zwolan, Ph.D., is the director of the Cochlear Implant Program, one of the largest implant programs in the United States. More than 1,000 patients have received implants. Our state-of-the-art vestibular testing facility is directed by Michael King, Ph.D., who also has a basic science research program in vestibular neurophysiology. In addition, the department is affiliated with the Kresge Hearing Research Institute under the direction of Thomas Carey, Ph.D. This institute houses laboratories staffed by approximately l5 Ph.D.-level scientists engaged in research concerned with the morphology, physiology, biochemistry, molecular biology, genetics and psychoacoustics of the ear.

Fellowship Design

The fellowship in Otology, Neurotology and Skull Base Surgery involves two years of training. During this time, the department intends to fully equip the fellow to function effectively in an academic department of otolaryngology. Candidates with a demonstrated prior commitment to academic medicine will be given highest priority in the selection process. However, those candidates who lack scientific experience because of clinical responsibilities during their medical education are not discouraged from applying if they earnestly desire to pursue an academic career.

The first year of training is clinically oriented, with approximately 20 percent of fellow's time protected so that he or she may pursue academic projects and develop a research interest. A formal research proposal will be designed, defended and submitted for extramural funding during the first year of training. During the first two months of training, a structured preceptorship in audiologic and vestibular diagnosis with related assigned readings will be completed. The next 12 months are spent involved in active care of neurotologic patients. Significant investment in laboratory temporal bone dissection is anticipated. Surgical opportunities in the operating room are graduated and commensurate with demonstrated competence in temporal bone surgery.

Typical first year schedule:

Six months of the second year of training is designed to permit the fellow to pursue the basic research project designed during the first year, under the supervision of clinical and research faculty. Clinical commitments are limited in order to facilitate this activity. Elective rotations in neuroradiology, neurology, neurosurgery and related disciplines are available during the final four months of training. The fellow will continue to assist with the more sophisticated neurotologic skull base procedures during these elective rotations. The trainee can expect to function independently as a neurotologist after completion of the fellowship.

Specific Duties of the Fellow

Operating Room Experience:
The fellow may participate in caring for all otologic surgical patients. The fellow's hands-on operative experience will be focused toward inner ear procedures, facial nerve disorders and neurotologic skull base surgery. The majority of the cases consist of acoustic neuroma operations (25-40 per year), cochlear implants (80-100 per year), vestibular nerve sections and labyrinthectomy (about 20 per year), and an assortment of complex facial nerve and lateral skull base surgery procedures (l0-20 per year). Translabyrinthine approaches are used in approximately half of the acoustic neuroma procedures, while the other half are performed with the goal of hearing preservation using the middle fossa approach. The retrosigmoid approach is occasionally used to attempt hearing conservation for larger or more medial tumors unsuitable for access through the middle fossa. These advanced otologic procedures, as well as surgery for otosclerosis, are performed by fellows and clinical faculty. On the other hand, middle ear and mastoid surgery primarily will be performed by residents on the Otology Service under the supervision of clinical faculty.

Clinical Patient Care:
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 on-call activities. The fellow will undertake the following duties related to clinical patient care:

Temporal Bone Laboratory:
The Temporal Bone Dissection Laboratory has l3 stations with otologic drills, binocular operating microscopes and closed circuit TV 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 other advanced techniques required for neurotologic surgery. These efforts will both precede and complement responsibilities in the operating room. In addition, fellows will participate in supervising otolaryngology residents during weekly drilling sessions and will circulate as instructors in temporal bone dissection courses offered four times a year.

Teaching:
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 periodically lecture during the Otology Conference and in continuing medical education courses, as deemed appropriate.

Research:
A major research project is completed by the fellow as the primary focus of the second year of training. This project may be the continuation of a prior research interest, a major clinical research undertaking, or an area of investigation that interfaces with the ongoing activities of the scientists at the Kresge Hearing Research Institute.

At least 20 percent of the weekly schedule will be available in the first year of training for research and academic pursuits. This should include development of a research plan leading to preparation of a formal NIH-style proposal. The fellow will have the opportunity to defend this proposal before the departmental Research Committee. The fellow will be expected to pursue extramural funding, although start-up support may be sought from the Otology Division and/or the department's Research Committee. In addition, the fellows are encouraged to initiate prospective or retrospective clinical studies leading to publication.

Travel:
The department will provide a travel stipend of $500 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.

Reimbursement and Benefits:
The otology fellow will be compensated at a salary level commensurate with other University of Michigan house officers at the same level of postgraduate training. The department provides malpractice insurance. Health care coverage for the trainee and family members is available through HMO or traditional insurance plans. Some health care options require additional payment by the subscriber.