Advances in Pediatric Otolaryngology Care

Podcast Transcript

Paul C. Bryson, MD, MBA: Thanks for joining us for another episode of Head and Neck Innovations. I'm your host, Paul Bryson, Director of the Cleveland Clinic Voice Center. You can follow me on X, formerly Twitter, @PaulCBryson, and you can get the latest updates from Cleveland Clinic Otolaryngology-Head and Neck Surgery by following us on LinkedIn at Cleveland Clinic Otolaryngology - Head and Neck Surgery, and Instagram at Cleveland Clinic Otolaryngology. 

Today I'm joined by Dr. Mark Fadel, pediatric otolaryngologist head and neck surgeon in the Cleveland Clinic's Head and Neck Department. He is a new hire to our group and we're really excited to have him. So welcome to Head and Neck Innovations.

Mark Fadel, MD: Thank you. I appreciate the time.

Paul C. Bryson, MD, MBA: I understand you're a native Clevelander?

Mark Fadel, MD: Yes. I grew up in Mayfield, right down the road, and I went to Mayfield High School. Swam for Mayfield for many years and loved, loved living there. So it's good to be home.

Paul C. Bryson, MD, MBA: Well, it's great to have you back. We live out that way. If you can share with the listener, after Mayfield, where did you train and how did you come back to Cleveland?

Mark Fadel, MD: Yeah. After Mayfield, I was recruited down to DePaul University, it's a small liberal arts school outside Indianapolis. I swam there for a year and then chose to prioritize some other things, but really loved my time at a small liberal arts school. That gave me a good education in biochem, but also gave me some time to study in Italy and enjoy that time, but I knew I wanted to go into medicine pretty early on, as many of us do.

So from there, I went to the University of Toledo, just a couple hours away, where I started in medicine. And in my first year, I was in a course called the Business of Medicine where an attorney was actually teaching it and discussed with us in one of the classes this MD-JD dual degree program. My brother's an attorney, I have a family of attorneys here in Cleveland, and I'd always been interested in health policy and how medical outcomes, or how law and policy can impact medical outcomes and that intersection.

So I ended up doing an externship in Chicago in their rehab institute, taking the LSAT that summer between first and second year and did well enough to get in, and it added two years to the normal four in medicine. So I did the MD-JD dual degree program at Toledo. It was phenomenal, I loved my time in it. Really, we go into medicine and even any grad school for learning how to think. We learn the subject material, but learning how to think was an extreme benefit in law school because it's so different than medicine. There's some similarities, but the way you make your arguments and discuss health policy really opened my eyes in that education.

And then how I chose ENT, I kind of separated that decision from my passion for healthcare administration and health policy because I wanted to be happy on a day-to-day basis doing what I loved. So I needed to love the specialty that I chose to be able to accomplish that goal and I loved otolaryngology. The surgeons I've met, the types of cases ranging from one minute to 18 hours potentially in free flap surgery. So I loved that variability in my day so I moved to Pittsburgh where I completed ENT residency at UPMC and had a phenomenal experience there. And then just finished my one-year pediatric ENT fellowship at Texas Children's in Houston. And I chose peds because I love the parent-patient-child dynamic and working with families to help improve their kids' health.

So during residency, I met the love of my life who lives in Chicago and we were very strategic on where we wanted to settle, near family. So it worked out to move home near my family and she obviously came with me. She's also working at the Cleveland Clinic and she's in medicine as well. So we were very fortunate in that series of events to end up where we wanted to be.

Paul C. Bryson, MD, MBA: Well, congratulations. It's a really great journey. Yeah, I think we're really excited for what you're going to bring here. The fellowship, you were down in Texas you said, at Texas Children's?

Mark Fadel, MD: Yes.

Paul C. Bryson, MD, MBA: Yeah, I think you got to work with a colleague of mine, Dr. Ongkasuwan.

Mark Fadel, MD: Brilliant. That's the first word that comes to my mind when I think of her.

Paul C. Bryson, MD, MBA: Yeah. So I do adult laryngology, as you know, but I also ... It'll be cool to see the skillset that you bring here. We really have a growing pediatric laryngology group and it's so nice to see it continue to expand with your expertise.

I wanted to ask you. What are some of the things within your sub-specialty, either recent advances, innovations, what are you excited about as you start your practice here?

Mark Fadel, MD: Yeah, I think there's a few things that I'm excited about. First and foremost, starting off my career in pediatric otolaryngology, I want to see everything. I'm not closing the doors on many things, particularly because I want to develop a very robust practice in all sub-specialties considering my fellowship really. Because at Texas Children's, it's one of the largest children's hospitals in the world. So their sub-specialization even within pediatric otolaryngology was phenomenal. So it gave me a really broad set of skills with focused attention on the most innovative ways to treat things because you have not just a pediatric otolaryngologist, but you could have a dual-boarded, like Dr. Ongkasuwan, in laryngology, or in head and neck surgery, or in skull-based rhinology. You have these specialists that I was able to train with directly within that niche and gain the skills from.

So I think what interests me most within the field is not necessarily skull-based rhinology, but allergy immunology, how we handle pediatric allergic rhinitis or sinonasal conditions. And with the advent of Dupixent in the past couple years, that's really, really improved our care of some of these kids, as well as Trikafta within the cystic fibrosis community. And while as a surgeon, I want to operate, the development of medical, medicinal treatments to avoid surgery has actually been fascinating over the past couple years because we've seen a big decrease in kids needing surgery on these medications, which has been great. But I enjoy that multidisciplinary work with the sub-specialists that would prescribe them and I would co-manage.

But beyond that, I think within pediatric ENT, all of these little sub-specialty areas are blossoming. You're seeing more and more, these dual-boarded pediatric ENTs. So other developments are within the sleep medicine community, big advances. Just two years ago, they approved the Inspire hypoglossal nerve stimulator for kids with Downs Syndrome in the 12-and-up or 13-and-up populations. So there's a ton of research right now coming out nationwide and worldwide on how best to manage those kids from mild sleep apnea or just sleep disordered breathing, to severe sleep apnea. So I could go on and on within each of these sub-specialties about advance within theirs. But pediatric ENT, while we've been around for decades, the innovation within each of these areas is really blossoming.

Paul C. Bryson, MD, MBA: You talked a little bit about your enjoyment of working with the parents and collaborating with our colleagues. What's your approach to shared decision making with families? Especially when you're talking about some of the things you were just mentioning can be complex decisions, medicinal or surgical.

Mark Fadel, MD: Yeah. When I'm faced with a patient that I do want to offer surgery for, as a pediatric, specifically a pediatric ENT or anyone within pediatrics in general, you have to understand the dynamic of shared decision making very well because you're not directly discussing with the patient, you're discussing with a surrogate making the decision on behalf of your immediate patient. So that dynamic in itself complicates things a little, and I would argue it requires you to have a deeper trust with the parent, with the guardian, versus just with the patient alone. There needs to be a foundational level of trust, but adding that little component, now the parent needs to be making a decision on someone else's body, on their kid's body. I value that relationship first and foremost, so I start that as soon as I walk in the door. I'm trying to gain that physician-parent-patient, those three, relationship in a very direct and friendly manner.

So when discussing when it gets to the point of surgery, it's my job to lay out all of the options with a recommendation on why I would like to offer surgery. So it's hard to describe, but you're trying to, in nonverbal and in verbal manner, gain the trust of that parent in whatever way. In the kindness that you're showing the kid, in the kindness that you're showing the family or whoever's with them, their guardian, and in the knowledge that you're providing them. So I like to use guidelines and research to advise my practice, and having just come out of fellowship training, I think that's one of the values of my practice right now. That I know the hot topics, and the innovative techniques, and what sub-specialists are doing now, and where the research going. So I use that to guide my clinical decision making.

While I've only been here a month-and-a-half, I've gotten good feedback from parents when I can tell them, "In the research, it shows there's a 1% chance of this." Or, "In the research, they show that this is an innovative technique, it might be a little newer, but there's really good data behind doing it now versus waiting later." So it's those types of knowledge base conversations that I try to gain their try on more, and then it's just being me. Being all of us as friendly providers hopefully.

Paul C. Bryson, MD, MBA: Well, I think you're going to do great. It's great to have you back. I think it's extra special when you're back in a community where you spent a lot of formative years. It's so, so cool to see you maybe be able to give back to the community where you're from. Congratulations on that.

Mark Fadel, MD: Thank you.

Paul C. Bryson, MD, MBA: As we wrap up today, any take home messages? My hope is we'll have you back on and we'll talk about even more specific topics, but I think it's important for people to know that you're here and the services that you're providing. Any final take homes?

Mark Fadel, MD: Yeah. I appreciate the time to meet and to meet everyone else in the Cleveland Clinic Otolaryngology Department. I think my sign-off message would be I grew up here, I know that Cleveland is a small town with a few degrees of separation between anyone you meet, and I look forward to meeting even more people than when I grew up. Particularly what my focus will be in, hopefully in future, I'm fascinated with where allergy and immunology is going and treating allergies and sinonasal conditions in kids, but you am fascinated in everything to do with pediatric ENT. So if you want someone homegrown, sign up to see me in clinic. But no, again, I appreciate the time and I look forward to talking with you further.

Paul C. Bryson, MD, MBA: Sounds great. Well, for more information on pediatric otolaryngology, please visit clevelandclinic.org/pediatrics/services/otolaryngologycare. And to connect directly with a specialist or to submit a referral, call 216-444-8500. That's 216-444-8500.

Dr. Fadel, thanks for joining Head and Neck Innovations and welcome home.

Mark Fadel, MD: Thank you. Paul C. Bryson, MD, MBA: Thanks for listening to Head and Neck Innovations. You can find additional podcast episodes on our website clevelandclinic.org/podcasts. Or you can subscribe to the podcast on iTunes, Google Play, Spotify, BuzzSprout, or wherever you listen to podcasts. Don't forget, you can access realtime updates from Cleveland Clinic experts in otolaryngology – head and neck surgery on our Consult QD website at consultqd.clevelandclinic.org/headandneck. Thank you for listening and join us again next time.