The Division of Otolaryngology/Head and Neck Surgery at the University of Vermont/Fletcher Allen Health Care is a component of the Department of Surgery.  Besides providing general management of disorders of the head and neck, special services in otology, neurotology, and skull-base surgery are available.  Facial, plastic, and reconstructive surgery is performed by a fellowship trained facial, plastic, and reconstructive surgeon. Benign and malignant tumors of the head and neck are managed both surgically and with a multidisciplinary approach.  Endocrine disorders and tumors of the thyroid and parathyroid glands are treated with current surgical technology including diagnostic ultrasound. Diseases of the paranasal sinuses are managed medically with allergy testing and desensitization and surgical intervention with both open and functional endoscopic surgical techniques. A fellowship trained pediatric otolaryngologist provides a broad range of services to include the surgical management of the compromised upper airway.  A comprehensive voice and laryngology program provides videostroboscopy and all aspects of laryngeal surgery.  Patients with obstructive sleep apnea and snoring are evaluated and treated with a variety of medical and surgical options.  A comprehensive audiology and vestibular testing facility under the direction of three masters-trained audiologists provides complete diagnostic service and patient recommendations for effective amplification. Several multidisciplinary projects deserve special identification: 

• Head and Neck Oncology – in conjunction with the Departments of Radiation and Medical Oncology, patients with malignant head and neck tumors are reviewed in a multidisciplinary conference and co-managed.  A unique selective chemotherapy infusion program (RADPLAT) in the treatment of advanced head and neck tumors is fully operational and cooperatively structured through interventional radiology, medical oncology, and radiation oncology. This medical center is one of the few in the nation to offer this therapeutic modality.
  
  
• Endocrine Disorders and Tumors – in conjunction with the Division of Endocrinology/Department of Medicine, patients with thyroid malignancy are jointly managed to include provisions for adjunctive radioactive iodine and special followup considerations such as Thyrogen stimulation.  Focused parathyroid surgery utilizing intraoperative parathyroid hormone assay is a unique management option.
  
  
• Facial Reconstruction after MOHS Surgery -  This cooperative service exists in conjunction with the Division of Dermatology. Special reconstructive problems are discussed and shared between the MOHS chemosurgeon and the otolaryngologic facial plastic surgeon.
  
  
• Obstructive Sleep Apnea – Patients with these problems are considered jointly with the Department of Pulmonary Medicine and Neurology.  Patients unable to be managed with positive pressure ventilation (CPAP) are referred for management with a variety of surgical techniques to include nasal septoplasty, UVPP, and tongue advancement techniques.
  

• Laryngology and Voice Program – A laryngologist, speech and language pathologists, and consultants from the vocal arts provide a unique collaborative project for the management of dysphonia.  In addition, Botox injection into the vocalis muscle is performed in conjunction with EMG monitoring with a staff neurologist.
  
• Neurotology – Disorders of the skull base such as pituitary tumors, posterior fossa neoplasms, temporal bone lesions, and tumors of the anterior skull base are treated surgically through joint collaboration with the Division of Neurosurgery. A comprehensive Cochlear Implant Program in the management of profound sensorineural hearing loss utilizes the resources of surgical technology, audiology, deaf educators, and social services providers.

Finally, a fully approved five year training program attracts outstanding resident candidates from medical schools in many other parts of the United States.  Patients coming to the outpatient facility or in need of inpatient consultation can expect to be treated with state-of-the art assessment and comprehensive care.

William Brundage, M.D.
Associate Professor and Chief
Division of Otolaryngology
University of Vermont College of Medicine