Since mid-January this year, I’ve had the pleasure of shadowing Dr. VanKoevering, an otolaryngologist at The James Cancer Hospital, one of the best medical centers of its kind in the United States, as ranked by U.S. News & World Report. I’m thrilled by this new experience, for which I think writing about is very much worth it.
As a medical student, and later, as an international medical graduate, I’ve shadowed multiple surgeons in the past, in large hospitals in Vienna, Austria, Aarhus, Denmark, Samara, Russia, and, of course, the US. However, this rotation is different due to the fact that I am able to see patients in surgeries and medical rounds from the perspective of a biomedical engineer, something I’ve never experienced on past rotations.
As all engineers do, the biomedical engineer applies natural science and math to solve problems in our society and improve already-existing technologies, but, unlike the others, focuses on biological sciences and medicine in a unique manner that addresses human health and disease. As an IMG and future biomedical engineer and researcher, I want to acquire a round understanding of the human body, in order to provide better treatments and develop more efficient medical devices.
During this ENT surgery rotation, I’ve seen several types of craniofacial cancer, including sinonasal undifferentiated carcinoma, low grade sinonasal adenocarcinoma, sinonasal malignant mucosal melanoma, nasopharyngeal carcinoma. Often, these cancers are highly aggressive and have very poor prognosis. Also, many of these patients (a large portion of them heavy smokers) require partial removal of their larynx, including their vocal chords, which leaves them unable to speak.
One of the medical procedures I’ve seen thus far in this rotation is the tracheoesophageal puncture, TEP, which allows patients to speak again by connecting the esophagus with the trachea, causing vibrations in the esophagus that mimic the function of the vocal cords as air passes through them.
Another device I’ve seen during my rotation, which has called my attention, is the flexible nasopharyngoscope, which uses fiberoptic or digital chip-on-the-tip technology. Its scope diameter varies from 1.9 mm (pediatric model) to 6 mm (adult model). It is possible to attach a high-resolution camera to the scope’s viewing port, allowing the health provider to visualize the area of interest as seen from the tip lens of the device. The tip which carries the lens is flexible, providing a field of view of up to 90 degrees by maneuvering the angulation control knobs located in the control body of the device. It is primarily a diagnostic device (e.g. evaluation of sleep apnea, venopharyngeal insufficiency, fiber endoscopic evaluation of swallowing, FEES, done by a speech therapist) with assistive therapeutic applications (e.g. visual tool for excision and debridement of nasopharyngeal cancerous tumors and their biopsy, removal of easily accessible foreign bodies, tracheostomies, and vocal cord injections for vocal cord palsies). It is generally a safe device which doesn’t generate complications; however, it is not totally exempt from them. These include mucosal tearing, bleeding, sneezing, laryngospasm (in less than 1% of procedures), gagging, and damage to anatomical structures, which is extremely rare with the use of flexible scopes, as opposed to rigid ones. The two main contraindications for its use include acute epiglottitis and croup.
This is the first of four entries I intend to make on this subject. In doing so, I look forward to encouraging people to learn more about this exciting topic.