Massachusetts Ear and Eye Infirmary, 243 Charles Street, Boston, MA 02114, Massachusetts, United States.
Report by: Attila Dezso, Consultant Otologist ENT Surgeon
A two-week observership was offered to visit Boston Children’s Hospital (BCH) and Massachusetts Ear and Eye Infirmary (MEEI), with one week in each institution under the supervision of Professor Dennis Poe and Dr Daniel Lee respectively. The observership offered the chance to see clinical work in both hospitals and visit the associated research labs.
BCH has a well-structured observership programme. On my first day I joined Professor Dennis Poe on his all day outpatient department (OPD) session. The cases were rather complex, often syndromic patients coming for second or third opinion from all over the US. Dennis Poe is a world leader in the management of eustachian tube (ET) conditions. Half of the morning clinic was patulous ET cases and postoperative balloon dilatations. The remaining half was cholesteatoma, retraction pocket and cartilage tympanoplasty. The clinics run smoothly with the help of a physician’s assistant. Very little paper is used, and dictation is displayed real time, and imbedded in the letter immediately. Seven patients were seen am and pm, two new and five follow-ups on average.
In the operating theatre, I was lucky to see a bilateral ET tube obliteration procedure. The patient had had four unsuccessful cartilage implants for patulous eustachian tube. It was a highly complex transoral endoscopic procedure. The lumen was obliterated with allograft cartilage and the patient’s abdominal fat. I was eager to see some balloon dilatation cases. Unfortunately, the cases which were scheduled during my stay were cancelled by the insurance companies. Funding was withdrawn in the last minute.
BCH is affiliated with Harvard Medical School; Prof Poe’s chair is from Harvard. I had the privilege to join him visiting a 3D printing lab which is walking distance from the hospital. Among other preparations the lab can print full skull and temporal bones, based on CT.
At MEEI I attended two full-day operating sessions. The Infirmary has nine operating rooms, running five days a week. There was a great case mix in the operating theatre: endoscopic revision tympanoplasty with conchal cartilage graft; cholesteatoma removal and cochlear implant in one sitting with blind sac closure; endoscope assisted removal of acoustic neurinoma from retrosigmoid approach in a joint case with neurosurgery.
I would like to express my gratitude to the Matthew Yung and Chris Raine Fellowship for this opportunity, which improved my understanding of eustachian tube function and the management of patulous eustachian tube. I learned new surgical techniques and met two outstanding endoscopic ear surgeons. I hope these newly established links and friendships will lead to further collaboration.
Boston's Children Hospital 1
With Professor D Poe in the 3D printer lab