The Role of a Comprehensive Otolaryngologist in an Academic Medical Center

Podcast Transcript

Paul Bryson: Welcome to Head and Neck Innovations, a Cleveland Clinic podcast for medical professionals exploring the latest innovations, discoveries, and surgical advances in Otolaryngology, Head and Neck Surgery.  

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 Twitter @PaulCBryson, and you can get the latest updates from Cleveland Clinic Otolaryngology - Head and Neck Surgery by following @CleClinicHNI on Twitter, that's CleClinicHNI. And new this year, find us on LinkedIn at Cleveland Clinic Otolaryngology - Head and Neck Surgery, and Instagram at Cleveland Clinic Otolaryngology.

Today I'm looking forward to speaking with my colleague, Dr. Kyra Osborne, Section Head of Comprehensive Otolaryngology in our Head and Neck Institute. You can follow her on your favorite social media channels as well. Dr. Osborne, welcome to Head and Neck Innovations.

Kyra Osborne: Thanks for having me.

Paul Bryson: Well, it's great to have you here. We've enjoyed working together now for probably more than a decade, but let's start by having you share some of your background with our listeners, where you're from, where you trained, how you came to Cleveland Clinic.

Kyra Osborne: I'm originally from a small town in eastern Kentucky. I did all of my undergraduate and medical school in Kentucky. I did my intern year at Vanderbilt, and then I came here as a second-year resident and I kind of have been here ever since. That was in July of 2010. I graduated from residency in June of 2014 and then started on staff in September of that year.

Paul Bryson: Well, it's great. It's been great to see your career development and our careers developed sort of in parallel, and it's great to see. The group has certainly grown. As we both know, the clinic is a large academic medical institution and it's not uncommon to have people travel from outside our region and the world to receive care, but at the same time, we're also here to care for our community in northeast Ohio and the surrounding area and provide some of the more traditional care to our patients. Can you tell and explain a little bit about your comprehensive otolaryngology group, what types of procedures you and they perform, and not just how you work with some of the sub-specialists that are here at Cleveland Clinic, but maybe elaborate on some of the own interests within your group and how you deliver that care?

Kyra Osborne: Absolutely. We are lucky to work at a wonderful place like the Cleveland Clinic and to be able to give care to the community. That's what our group kind of wants to do. We want to take care of northeast Ohio and the surrounding area, and we have about 10 surgeons in our group. We also collaborate with many of our APPs that see patients and then refer to us for surgery or other kind of more complicated care, which is really nice to be able to collaborate with them. We see adult and pediatric patients. We really kind of span the breadth of otolaryngology, which is why most of us went into it. We decided not to do a fellowship because we wanted to do the many procedures that we can do in head and neck surgery. We do bread and butter, so tubes, tonsils for kids, septoplasty, sinus surgery, even some micro laryngoscopy surgeries and some in-office procedures, which are great to be able to provide to patients.

A few of us have little niches that we've kind of developed, so one of our newer hires has a niche in otology, and so he's worked and collaborated with our otology section to be able to do some of the cases that he wants to do with that, so tympanoplasty and other tympanic mastoids, things like that. I have kind of developed a niche in doing Eustachian tube dilation. It's been something I started probably about six or seven years ago, and that's really developed over the years, and to be able to provide that care for patients is great because for so long we had nothing to offer except essentially putting an ear tube in. For someone that has chronic serous otitis media that's had multiple sets of tubes, you kind of got to the point where it's just like, okay, we're going to put another tube in, but now we have this technology that we've been able to use to fix the other side of things with the Eustachian tube problem itself, and so that's really nice to be able to deliver that care.

Paul Bryson: It's so important to have this sort of, frankly, sub-specialized treatment options for people, and it really increases access. I think going back to your comments about taking care of northeast Ohio and the adjacent areas, we really want to be able to get people in a timely manner for some of these problems that can be quite tertiary in nature. It's great to hear about the otology access, the Eustachian tube access. As I recall, you've also developed a practice for salivary disease. Can you elaborate on that a little bit?

Kyra Osborne: Sure. Doing salivary endoscopy for certain patients either that have chronic salinities or salivary stones, having that technology also and being able to do those procedures has been really nice. They learned to do it in residency and kind of continued after, and I've worked closely with Dr. Prendes, who I believe was on not too long ago, trying to just brainstorm and make that part of our practice a little better also. But being able to do those types of procedures in my practice and not have to refer to my subspecialty colleagues is really nice because then they can do other more complicated things that they want to be able to do.

Paul Bryson: No, and it's really complimentary, and I would certainly emphasize that there's not a ton that's always routine about sialendoscopy. It's pretty specialized equipment, as you know, and can be quite challenging.

Kyra Osborne: It is. They're not always easy cases, that's for sure. But when you're able to remove the stone that way and not have to either excise the gland or something like that, it's really rewarding, and the patients do well.

Paul Bryson: It's great to hear. In terms of the nuts and bolts of getting people into the practice, you mentioned our advanced practice providers. If we have listeners that want to refer to you and your group, what can they expect in terms of appointments and plan of care? Who might the patient meet with? How does the system sort of flow for those encounters?

Kyra Osborne: Most of the time when they get an appointment with us, depending on what they're coming for, it's nice because we are the ones that see them. If they need an audiogram, if they're coming in for hearing loss, we're able to try and coordinate those visits at the same day because we have audiology at most of our sites to be able to coordinate. I think the biggest thing to take home is that we can take care of most ENT problems, most head and neck problems, and kind of continue that care with the patient and not have to refer to someone else. It's not always the case, obviously, but most times we can be kind of the point person for them to be their otolaryngologist and kind of continue their care on, because a lot of these people need to be followed for sometimes years.

It depends on what they're coming in for, but being able to develop that relationship is awesome. What I love about what I do is being able to see entire families so I can take care of their kids, I can take care of parents, I can take care of grandparents, and I've done that in multiple families and it's so rewarding being able to take care of them all.

Paul Bryson: It's really fabulous and to see the growth that your group has undergone and is undergoing is really commendable. Getting back to the northeast Ohio element of our care, we've really, with your leadership and the leadership of others, had a real regionalization for this. For the listeners that have patients that say, well, I only want to come to the west side of the metro area. Okay, well, we have that. We have surgical sites, we have offices, and the same goes for the east side, and so we've really tried to facilitate patients getting the care they need in their own backyard without having to travel extra and into areas perhaps where they're less familiar.

Kyra Osborne: Oh, exactly. I think we kind of consider ourselves the community ENTs, and that's what our goal is, to take care of the community in northeast Ohio.

Paul Bryson: Well, Dr. Osborne, you mentioned some of the spectrum of procedures and conditions that you see and treat. You described the care for our pediatric patients with tonsillectomy, adenoidectomy, tube placement. I understand you actually do quite a bit more. Do you want to elaborate on some of the other conditions and surgical procedures that you and your group perform?

Kyra Osborne: Absolutely. Most of us do parotid surgery, so taking out kind of parotid masses and tumors. A lot of us do thyroid surgery as well, so either for multinodular goiter or thyroid nodules. We do that, which is really nice to be able to do in the community and not have to be here at the main campus for certain people. Some of us have sleep surgery as well, and that's something that we'll be working with Dr. Kominsky in his sleep section to sort of try and help that grow.

Paul Bryson: The sleep surgery seems like quite an opportunity. When we talk with him, we certainly understand that hypoglossal nerve stimulation isn't an exciting treatment, but there's often other opportunities for evaluating the airway. Looking at patients that perhaps are not tolerating their CPAP as well. I recall you have functional nasal surgery practice along with your partners that cannot just help nasal breathing, but perhaps facilitate more comfort with positive pressure devices.

Kyra Osborne: Yeah, that's important. I mean, there's a whole spectrum of sleep surgery. It's even just as simple as doing a tonsillectomy, but also doing other types of surgeries to help them tolerate CPAP better, which can be life changing for them and being able to offer that, but also the functional nasal valve surgery and things are really rewarding as well.

Paul Bryson: For more information on Cleveland Clinic's section of Comprehensive Otolaryngology, Head and Neck Surgery, please visit ClevelandClinic.org/ENT. That's ClevelandClinic.org/ENT. To speak with a specialist or submit a referral, please call 216.444.8500. It's 216.444.8500. Dr. Osborne, thanks for joining Head and Neck Innovations.

Kyra Osborne: Thank you for having me.

Paul Bryson: Thanks for listening to Head and Neck Innovations. You can find additional podcast episodes on our website at clevelandclinic.org\podcasts, or you can subscribe to the podcast on iTunes, Google Play, Spotify, SoundCloud, or wherever you listen to podcasts. Don't forget, you can access real-time 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.