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-Click here to go to Pediatric Otolaryngology Fellowship Program
Pediatric Otolaryngology Residency Goals and Objectives
(Reviewed and modified 1/2010; Reviewed and modified 5/2007; Reviewed and modified 8/2006; Reviewed and modified 4/2006; Reviewed and modified 2/2006; Reviewed 12/2005; Reviewed and modified 3/2005; Created 1/2004)
The educational, clinical and academic goals of the pediatric otolaryngology fellowship program are:
- To provide excellent training for pediatric otolaryngology fellows in an ACGME accredited pediatric otolaryngology fellowship.
- To incorporate clinical and/or basic science research training into the pediatric otolaryngology fellowship program.
- To provide an in-depth study of the embryology, developmental anatomy and physiology, microbiology, oncology, and psychology of the infant and child as related to the head and neck.
- To promote an understanding of the differences with regard to the medical management of infant, childhood, and adult diseases of the head and the neck.
- To provide a sufficient number and variety of pediatric otolaryngology surgical procedures in the scope of the specialty with emphasis on complex and uncommon procedures, which are infrequently encountered in the general practice of otolaryngology in keeping with the case load expectations detailed in the ASPO core curriculum guidelines.
- To provide an understanding of the medical and surgical treatment of neonates and children with significant co-morbidities.
- To provide an appreciation for the inherent complexities of interacting and counseling with children and their families compared with adult patients.
- To provide an opportunity to teach and mentor medical students, residents and fellows in other sub-specialties in subjects related to pediatric otolaryngology.
- To continually incorporate the Core Competencies (patient care, medical knowledge, practice-based learning and improvement, interpersonal & communication skills and professionalism and systems-based practice) into the daily clinical and educational activities of the fellow.
The clinical and academic responsibilities of the pediatric otolaryngology fellow include:
- Managing the inpatient pediatric otolaryngology service by:
- Seeing and evaluating pediatric otolaryngology consults in the Emergency Room and on the wards at the University of Iowa Hospitals and Clinics after consult patients have been initially evaluated by an otolaryngology resident physician.
- Twice daily rounding on inpatient active consults and primary patients being followed by the pediatric otolaryngology service. The fellow oversees rounds, acting in a teaching and advisory role to assist the residents rotating on the pediatric otolaryngology service.
- Participating in pediatric otolaryngology surgical procedures in both a teaching and trainee role depending on the complexity of the case and the fellow’s level of experience with the procedure. Fellows generally participate in operative procedures 2 ½ days per week.
- Participating in pediatric otolaryngology office hours under the guidance of three fellowship trained pediatric otolaryngologists & participating in cleft lip and cleft palate clinic under the guidance of a fellowship trained plastic surgeon. On days that fellows participate in cleft lip and palate clinic they also participate in cleft lip and palate multidisciplinary conference. Fellows generally participate in clinic a total of 2 days per week.
- Participating in pediatric otolaryngology call. The pediatric otolaryngology fellow acts in an advisory role and participates in on call operative cases related to pediatric abscesses, pediatric airway issues, post-tonsillectomy hemorrhage and complex pediatric otolaryngology issues not readily handled by the general otolaryngologist on staff call. The pediatric otolaryngology fellow is on call every weeknight and every other weekend in compliance with the ACGME guidelines.
- Preparing a monthly mock oral style review lecture on pertinent topics in pediatric otolaryngology that is presented to the residents and pediatric otolaryngology faculty on the third Friday of every month from 6:30-7:00am. This conference is attended by the pediatric otolaryngology faculty and residents rotating on the pediatric otolaryngology service.
- Participation in a monthly multidisciplinary airway conference in concert with pediatric surgery and pediatric pulmonology faculty and trainees. Pediatric airway conference meets on the 4th Tuesday of every month at 4pm. The pediatric otolaryngology fellow is expected to prepare and present cases, and review and present relevant journal articles.
- Participation in multidisciplinary vascular malformations conference with pediatric cardiology and pediatric ophthalmology faculty and trainees. Pediatric vascular malformation conference meets on the 4th Friday of every second month. The pediatric otolaryngology fellow is expected to prepare and present cases, and review and present relevant journal articles.
- The fellow selects articles and organizes pediatric otolaryngology journal club which meets on the second Friday of every month from 6:30-7:00am and is attended by the pediatric otolaryngology faculty and residents rotating on the pediatric otolaryngology service.
- The pediatric otolaryngology fellow gives a prepared 45 min. pediatric otolaryngology lecture to the medical students rotating on the otolaryngology service every second week during the year.
- The fellow gives a 2 hr. prepared lecture and clinical teaching session on nasal sinus anatomy and flexible endoscopy to the Allergy & Immunology Fellows at the University of Iowa Hospitals & Clinics once per year.
- The fellow gives two 1 hr. prepared lectures on topics of his/her choosing for the incoming 2nd year otolaryngology residents as part of the otolaryngology basic science course offered at the University of Iowa Hospitals and Clinics every July.
- The fellow gives a 1 hr. prepared lecture on the ‘Five Most Common Pediatric Otolaryngology Consults’ to the pediatric residents once per year.
- The fellow is given ½ day per week protected from clinical activities for the pursuit of academic interests and responsibilities.
- The pediatric otolaryngology fellow attends weekly didactic sessions on Monday morning at 7am where the residents review ‘Coclia’ questions from the American Academy of Otolaryngology, Head & Neck Surgery website. The fellow also attends weekly grand rounds lectures on Tuesday morning at 7am – grand round lectures include faculty, resident, attending and guest faculty lectures as well as monthly morbidity & mortality presentations.
The goals of the pediatric otolaryngology fellowship are achieved by participation in the above academic activities in concert with completion of the following rotations:
- Cleft/craniofacial service
- General pediatric otolaryngology service
- Otology/neurotology service
- Clinical and/or basic science research.
The goals and objectives of each of these rotations are described below.
| Rotation |
Goals and Objectives |
| Cleft-Craniofacial Service |
The Cleft-Craniofacial Service uses a multidisciplinary approach in the evaluation of the child with cleft lip/palate deformity. Pediatric otolaryngology, speech pathology and genetics are represented in the clinic to comprehensively evaluate each child so that the proper diagnosis of the problem can be obtained and optimal treatment strategies can be devised. It is expected that the pediatric otolaryngology fellow will be competent in all aspects of management of velo-pharyngeal incompetence at the completion of the one year of accredited pediatric otolaryngology fellowship. |
| General Pediatric Otolaryngology Training |
The general pediatric otolaryngology service cares for a wide variety of children with pediatric otolaryngology complaints. Included in this service are children with voice problems, genetic problems, vascular malformations, airway problems, congenital anomalies, infectious complications and otologic problems. Services provided in each of these areas. During the fellowship year, the pediatric otolaryngology fellow is expected to master the following:
- Voice disorders
- Provide a comprehensive evaluation and excellent voice care for children with pathology of the larynx effecting voice production.
- Advance the understanding of causes, treatment, and prevention of voice disorders.
- Provide optimal therapeutic paradigms to aid in vocal rehabilitation of voice impaired children
- Genetic Problems
- Understand the genetic causes of nonsyndromic deafness, especially the deafness genetic load caused by mutations in GJB2.
- Provide genetic counseling to families, including such concepts as recurrence chance, and anticipation, autosomal recessive inheritance and autosomal dominant inheritance
- Understand how advances in the genetics of deafness are changing the evaluation of a child with hearing loss.
- Vascular malformations
- Provide a comprehensive evaluation for children with vascular disorders considering both their cosmetic or functional impact.
- Understand the complex nature of these disorders and the numerous treatment modalities available.
- Understand the therapeutic paradigms based on diagnostic tests.
- Airway Management
- Provide a comprehensive evaluation and excellent care for children with breathing disorders.
- Advance the understanding of causes, treatment and prevention of airway disorders.
- Provide optimal therapeutic paradigms to aid in habilitation of airway disorders.
- Prevent and treat intubation trauma
- Optimize post-operative tracheotomy care
- Interact with critical care and neonatal care services
- Otology
- Provide a comprehensive evaluation and excellent otologic care for children with chronic ear problems.
- Advance the understanding of causes of congenital aural atresia.
- Understand the treatment paradigms based on the evaluation of these children.
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| Pediatric Otology/Neurotology |
The otology/neurotology service cares for a wide range of adults and children with otology/neurotology complaints. Included in this service are children who are candidates for cochlear implants. The care of children who receive implants under the direction of Dr. Marlan Hansen will be managed by the pediatric otolaryngology fellow on the general pediatric otolaryngology service. It is expected that during this one-year period of time, the pediatric otolaryngology fellow will be responsible for the care of approximately 6-8 children who require cochlear implants.
- Understand the evaluation and management of children with congenital conductive hearing loss including ossicular malformations, fixed stapes and aural atresia.
- Understand the evaluation and management of children with severe to profound hearing loss.
- Understand the audiological criteria for cochlear implantation.
- Perform surgical approaches for cochlear implantation including management of chronic ear disease in the cochlear implant candidate.
- Understand the post-implantation rehabilitation strategies and performance expectations.
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| Clinical Research |
- A meaningful and productive research experience is offered during the pediatric otolaryngology fellowship training and is expected to provide the fellow with exposure to scientific methodologies and an opportunity to apply to these methodologies to specific clinical questions of interest that impact the care of pediatric otolaryngology patients. The program’s research focus is broad based and covers congenital hearing loss, vascular abnormalities, gastroesophageal and extraesophageal reflux disease, and airway management. The pediatric otolaryngology fellow is expected to study one of these areas in depth.
- Each fellow must publish a minimum of one manuscript in peer reviewed journal with staff as mentors and senior author.
- Presentation at National meeting is required.
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In achieving the goals and objectives of the rotations described above, it is expected that the pediatric otolaryngology fellow will have expertise in the areas described below.
| Subject |
Goals and Objectives |
| Developmental Anatomy |
It is expected that the pediatric otolaryngology fellow will be familiar with the developmental anatomy of the head and neck, specifically including the embryology of the branchial arches and pharyngeal pouches and their contribution to various masses in the neck. |
| Characteristics of Normal and Abnormal Postnatal Craniofacial Growth and Development |
It is expected that the pediatric otolaryngology fellow will have a good understanding of normal facial growth and development, including and understanding of the main theories of post-natal cranial facial growth and the characteristics with normal post-natal facial growth and development. |
| Hemangiomas and Vascular Malformations of the Head and Neck |
The pediatric otolaryngology fellow is expected to have an understanding of vascular anomalies. Included in this category are hemangiomas and malformations. Malformations include vascular malformations and lymphatic malformations. |
| Craniofacial Surgery for Congenital and Acquired Facial Deformities |
The pediatric otolaryngology fellow should develop expertise in the care of children with congenital and acquired facial abnormalities including but not limited to cleft lip and palate and congenital nasal deformities. |
| Functional Endoscopic Sinus Surgery |
The pediatric otolaryngology fellow should have a complete understanding of the treatment of pediatric acute and chronic sinusitis. This understanding should include methods of diagnosis, methods of medical management, and methods of surgical management. |
| Salivary Gland Diseases |
The pediatric otolaryngology fellow should be familiar with the treatment of salivary gland diseases in children. This includes common inflammatory processes such as cat scratch disease, atypical mycobacterial infections, and reactive hyperplasia of peri- or intra- parotid lymph nodes, neoplasms and excessive sialorrhea. |
| Velopharyngeal Incompetence |
The pediatric otolaryngology fellow should have a thorough understanding of velopharyngeal anatomy and function, including velopharyngeal closure patterns, causes of velopharyngeal insufficiency, techniques for diagnosis including nasopharyngoscopy, and management of velopharyngeal incompetence, including both medical and surgical management modalities. |
| Pharyngitis and Adeno-tonsillitis |
The pediatric otolaryngology fellow should be competent in the management of pharyngitis and adeno-tonsillitis including the recognition of post-operative complications associated with adenotonsillectomy such as velopharyngeal insufficiency, nasopharyngeal stenosis and bleeding. |
| Head and Neck Malignancies |
The pediatric otolaryngology fellow should be familiar with the most common pediatric head and neck malignancies including lymphomas, sarcomas, neuroblastomas, salivary gland malignancies and teratomas. The pediatric otolaryngology fellow should also be familiar with the sequelae of management of these tumors. |
| Congenital Disorders of the Larynx |
The pediatric otolaryngology fellow should have a complete understanding of laryngeal anatomy and physiology. Expertise should be obtained in the endoscopic management of the airway and the recognition of specific abnormalities including laryngomalacia, laryngeal cysts, vocal fold paralysis, laryngeal webs and atresias, posterior laryngeal clefts, laryngeal hemangiomas and inflammatory conditions. The pediatric otolaryngology fellow should be comfortable in the management of stridor and acute and emergent airway problems. |
| Glottic and Subglottic Stenosis |
The pediatric otolaryngology fellow should have expertise in the management of chronic laryngeal stenosis and chronic tracheal stenosis. There should be a complete understanding of the etiology and pathophysiology of these conditions, methods of diagnosis, methods of voice assessment, and methods of management, including anterior cricoid splits, combined laryngofissure with posterior cricoid division, autogenous costal cartilage reconstruction, and cricotracheal resection. |
| Gastroesophageal Reflux and Extraesophageal Reflux Disease |
The pediatric otolaryngology fellow should have a complete understanding of the pathophysiology of gastroesophageal reflux and extraesophageal reflux disease. |
| Voice Disorders |
The pediatric otolaryngology fellow should have an understanding of the underlying etiology of voice disorders, and be comfortable in the evaluation of a child with voice disorders. Familiarity should be obtained with organic voice disorders including resonance problems, vocal cord paralysis, and vocal cord pathology due to granulomas, polyps, and webs. |
| Disorders of the Trachea |
The pediatric otolaryngology fellow should be familiar with tracheal disorders, their diagnosis and management. Included would be deformities caused by vascular anomalies such as innominate artery compression, double aortic arch, right aortic arch, pulmonary sling, and an anomalous subclavian artery. The pediatric otolaryngology fellow should also be familiar with the diagnosis and management of tracheoesophageal clefts, tracheomalacia, tracheal stenosis, and tracheitis. |
| Caustic Ingestion |
The pediatric otolaryngology fellow should be familiar with the diagnosis and initial assessment of patients with caustic ingestion, including staging of therapy. Management modalities should be understood including pharmacological therapy and mechanical therapy. |
| Foreign Bodies of the Airway and Esophagus |
The pediatric otolaryngology fellow should be able to handle all pediatric airway emergencies including foreign bodies. The pediatric otolaryngology fellow should understand the epidemiology, location, symptoms, radiographic evaluation, and management of these airway emergencies including equipment needs. In addition, the pediatric otolaryngology fellow should be familiar with the management of esophageal foreign bodies. |
| Audiology: Management of Hearing Loss |
The pediatric otolaryngology fellow should have a good understanding of the causes of congenital and late onset hearing loss, including acquired varieties and inherited varieties. The pediatric otolaryngology fellow should also be familiar with the tests available to diagnose various forms of hereditary hearing loss. |
| Congenital Malformations of the Ear |
The pediatric otolaryngology fellow should have a good understanding of the inner ear development, the incidence of congenital anomalies of the inner ear, and their classification. In addition, the pediatric otolaryngology fellow should also be familiar with the reconstruction of microtia and the indications for cochlear implantation. |
| Acute Otitis Media and Otitis Media with Effusion |
The pediatric otolaryngology fellow should be familiar with the epidemiology, pathophysiology and sequelae of acute otitis media and chronic otitis media with effusion. The pediatric otolaryngology fellows should also be familiar with the diagnosis and treatment of these entities. This includes indications for tympanostomy tubes, perioperative considerations for tube placement, and an understanding of the complications associated with tympanostomy tubes. |
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