Reminiscing and Looking Ahead

Our Brief History from Those Interviewed in Chicago

—Keyu Liu

Some say that K. J. Lee’s Essential Otolaryngology—Head and Neck Surgery is a “bible,” a must read. In this 12th and the 45th anniversary edition, we are adding a historical perspective of our great specialty. Within the past 45 years, we have witnessed the explosive growth of ENT from being a less than desirable specialty among medical students to one that is very competitively sought after. Otolaryngology—Head and Neck Surgery is currently one of the most broadly encompassing specialty. Not only have our leaders pioneered and invented new diagnostic and treatment modalities, we have performed better in subspecialties that used to be in others’ purview through achieving better outcome for patients and offering great educational opportunities for young physicians. We are now the rightful “owner” of these subspecialties.

The story of how our specialty grew in the past half century to its current grandeur is hard work as well as a tale of hard-fought victory mixed with cheers and tears. With combined efforts of a group of exemplary individuals that Dr. Lee was honored to learn from and work with, Otolaryngology—Head and Neck Surgery climbed to a peak that spreads its influences across the fields of medicine.

“Head and Neck Surgery” was originally not part of the name of our specialty. An ENT doctor in the 1960s was not allowed to perform neck dissection, thyroid or parotid surgery. Dr. Stuart Strong, one of the esteemed practitioners of Head and Neck Surgery, recalled with a smile how “ENT was regarded a field of the dropout students.” He humorously recalled how ENT doctors needed to book a thyroid tumor case as an excision of “a lump in the neck.” Dr. Eugene Meyers, one of the major contributors to this subspecialty of Otolaryngology, recalled the “bittersweet battle” between the Society of Head and Neck Surgeons established by general surgeons in 1954 and the American Society for Head and Neck Surgery established in 1958 by ENT doctors.^* The former was not ready to share its “ownership” of Head and Neck practices with ENT surgeons. Through improvements in surgical trainings of ENT doctors, ENT doctors gradually improved in surgical expertise and gain the respect of general surgeons. Eventually the two associations merged and formed the American Head and Neck Society in 1998.

Plastic surgery procedures such as facelifts, rhinoplasty, otoplasty, mentoplasty, and blepharoplasty are the purview of general plastic surgeons. Giants like Jack Anderson, Irving Goodman, Bob Simmons, Howard Smith, Eugene Tardy among many other otolaryngologists branched out to perform these surgeries with great outcome and taught the procedures well. When Dr. Smith performed his first facelift in New Haven, the chief of general plastic surgery was furious. Dr. Smith and other leaders collaborated on developing the Facial Plastic Surgery Board Exam in the 70s, Dr. Lee was a mock candidate taking the exam and giving feedback. The resulting test was carefully structured to thoroughly examine the knowledge and skills of the testee. Today it is a respected Board Exam. Today, many general plastic surgeons take the American Academy of Facial Plastic Board Exam to gain prestige and respect. The diagnosis and treatment of allergic conditions were incorporated into the field of Otolaryngology due to the efforts of practitioners interested in this field such as Dr. Donald Nalebuff and Dr. Richard Fadal. Dr. Michael Setzen recounted the work of the American Rhinologic Society led by Dr. David Kennedy and many others to launch endoscopic sinus surgeries. Dr. Derald Brackmann recalled the development of cochlear implants by Dr. William House and many other cochlear implant surgeons. Dr. John Shea, Dr. Howard House, Dr. Schuknecht, and others introduced and refined stapedectomies. Dr. Brackmann recalled with fondness and excitement how Dr. William House pioneered acoustic neuroma and vestibular nerve surgeries which ultimately led to what is now known as skull base surgery. Dr. Brad Welling stressed the collaborations with basic scientists to cure tinnitus.

The fields of laryngology, pediatric otolaryngology, and sleep medicine have also witnessed an expansion of knowledge. Dr. Gavin Setzen, the 2017-2018 President of the Academy, remarked, “There has been an increase in collaboration among institutions and the public sectors. The sleep center project we are currently developing is a mutual effort with an orthopedic group and hospital. We aim to integrate ambulatory surgery center into our private practice model, with the true hope of offering efficient diagnostic services and robust patient network.”

The future of our specialty is guided toward a beacon of light, a scope of influence that spreads across the continents to reach an international scale. Dr. Pablo Stolovitzky remarked on how the Academy has grown in its enormous worldwide outreach. With the help of many leaders including but not limited to Drs. Eugene Meyers, K. J. Lee, Greg Randolph, and Dr. Pablo Stolovitzky, the American Academy of Otolaryngology—Head and Neck Surgery is well regarded worldwide.

The Academy of Ophthalmology and Otolaryngology was reorganized into two academies, the American Academy of Otolaryngology and the American Academy of Ophthalmology in 1979. Later the Academy was renamed to be the American Academy of Otolaryngology—Head and Neck Surgery. Currently departments in most universities and hospitals are called the Department of Otolaryngology—Head and Neck Surgery. After graduating from Columbia University College of Physicians & Surgeons, K.J. did his PGY I and PGY II in general surgery at St Luke’s Hospital, New York City, a teaching hospital of Columbia University. At the academic year end dinner, all graduating residents as well as departing PGY II residents leaving for specialized surgical residencies needed to announce where they were going in July. Some were going into Neurosurgery, some into Orthopedic Surgery, some into Cardiac-Chest Surgery, some into Urology. K.J. was too embarrassed to say ENT or Otolaryngology because in 1966, as Dr. Stuart Strong mentioned, ENT is a field for the “dropouts.” K.J. stood up and under his breath said “I’m going to Harvard to do Head and Neck Surgery” and sat down quickly. There was a rumbling among the dinner attendees “what specialty is that, there is no such residency.” Hence in June 1966 K.J. unknowingly coined the term Head and Neck Surgery for Otolaryngology—Head and Neck Surgery residency.

With the current super-achievers in our midst and the pool of talented residents following us, Otolaryngology—Head and Neck Surgery will enable all to hear, smell, breathe, sing, swallow, free of imbalance, pain, and cancer.

(The above is an extemporaneous summary from the leaders whom Keyu (Katherine) Liu was able to interview in Chicago during the AAO-HNSF annual convention in September, 2017. We apologize for not mentioning the other great leaders and pioneers who helped transform our specialty to its current preeminent position.)

Keyu Liu

Department of Biomedical Engineering

Columbia University FU Foundation

School of Engineering Applied Sciences, New York, NY, USA

References

The following is an excerpt from American Head and Neck Society’s website:

Shaha Ashok, et al. “AHNS Society History.” American Head and Neck Society, www.ahns.info/about-ahns/history-ahns/.

AHNS Society History

On May 13, 1998, The American Head and Neck Society (AHNS) became the single largest organization in North America for the advancement of research and education in head and neck oncology. The merger of two societies, the American Society for Head and Neck Surgery and the Society of Head and Neck Surgeons, formed the American Head and Neck Society.

The contributions made by the two societies forming the AHNS are significant in the history of surgery in the United States. Dr. Hayes Martin conceived the Society of Head and Neck Surgeons in 1954, a surgeon considered by many to be the “father of modern head and neck tumor surgery.” The purpose of the society was to exchange and advance the scientific knowledge relevant to the surgery of head and neck tumors (exclusive of brain surgery) with an emphasis on cancer of the head and neck. Two years later, The American Society for Head and Neck Surgery was organized with the goal to “facilitate and advance knowledge relevant to surgical treatment of diseases of the head and neck, including reconstruction and rehabilitation; promote advancement of the highest professional and ethical standards as they pertain to the practice of major head and neck surgery; and to honor those who have made major contributions in the field of head and neck surgery, or have aided in its advancement.”

The new Society remains dedicated to the common goals of its parental organizations.

AHNS—Tenth Anniversary

The new American Head and Neck Society was founded as a merger of two head and neck societies, the Society of Head and Neck Surgeons (SHNS) and the American Society for Head and Neck Surgery (ASHNS), in 1998. The SHNS was founded under the leadership of Hayes Martin, William MacComb, Grant Ward, and others in 1954. It was initially dominated by general surgeons. A parallel society (ASHNS) was established by John Conley, George Sisson, and others in 1958. Even though there was considerable rivalry and animosity between the two societies initially, over a period of time, many cooperative activities were undertaken by the two societies. Several leading head and neck surgeons with an ENT background trained many young otolaryngologists with a special interest in head and neck surgery.

Over the years, both of the societies became well established, and ran parallel to each other. The SHNS membership consisted primarily of general surgeons, plastic surgeons and surgical oncologists interested in head and neck surgery, while membership in the ASHNS was comprised of otolaryngologists. Early on, significant hostility and disrespect was evident in members of both organizations who saw each society as being competitive, however, rational individuals from each group recognized that the two societies possessed similar goals and objectives. Several combined activities were undertaken, beginning first with the Advanced Training Council and occasional combined annual meetings of the two societies, and annual head and neck workshops. In 1984, under the leadership of Paul B. Chretien, MD (SHNS), the first combined International Conference on Head and Neck Cancer was planned by a committee representing leadership of both societies. This meeting followed a successful NCI Head and Neck Oncology Research Workshop initiated in 1980 to address the clinical and research advances in multidisciplinary care. The success of these collaborative activities brought head and neck surgeons from both societies closer together, bridging the gap. As the workshops and quadrennial International Conferences continued for a period of approximately 10 years, the members of both organizations came closer and closer.

The issues of merger, unification, and amalgamation were discussed as early as 1960. The formal first meeting was held in Atlanta on October 15, 1989. The discussions continued over a period of time, with several ups and downs. These issues were brought for discussion in each individual society, as well as the joint training council. After the 1996 International Conference on Head and Neck Cancer in Toronto, the leaders of SHNS seriously considered the merger of the two organizations, and the discussions began. After extensive discussions, the merger agreement was prepared, and a new society was born in 1998 – The American Head and Neck Society. The first two co-presidents were Ashok Shaha and K. Thomas Robbins.

It is now 50 years since the founding of the ASHNS and 10 years since the birth of the new society. Many young members may not be aware of the tumultuous history of the two societies. Clearly, the new society represents a stronger bond amongst head and neck surgeons and a broader representation of the multiple disciplines countrywide with a special interest in furthering the care of head and neck cancer patients. Happy Anniversary, American Head and Neck Society.

Ashok Shaha, MD

K. Thomas Robbins, MD

Gregory Wolf, MD