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Hopkins Voices
| OTOLARYNGOLOGY-HEAD & NECK SURGERY |
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A Specialty with Continuity: Charles Cummings, M.D., on the Evolution of Otolaryngology
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| Charles Cummings, M.D., Professor and Director of Otolaryngology-Head & Neck Surgery. |
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Charles Cummings trained at the Harvard Medical School and the Massachusetts Eye and Ear Infirmary in Boston, and was chairman at the University of Washington in Seattle for 14 years before arriving at Hopkins on New Year’s Day, 1991. Cummings, a fan of baseball, America’s national sport, says coming to Hopkins and the otolaryngology department now considered the most comprehensive in the nation, was his chance to play in the big leagues, “at Yankee Stadium.”
He met recently with the editors of International Physician Update to discuss the evolution of otolaryngology over the past 35 years, and how he sees the specialty at Hopkins today and in the future.
Question: What attracted you to otolaryngology in the first place?
Dr. Cummings: I finally found a specialty that allowed a surgeon to have a continuity of practice with patients over time. People who have problems like bad head and neck malignancies are monitored frequently, so there’s mutual interaction, the establishment of true friendships.
Question: And from a head and neck surgeon’s perspective?
Dr. Cummings: It’s a very complicated and complex area in which to operate. The anatomy is compressed, there’s a tremendous number of vital structures in a small space. I like the challenge.
Question: So, how would you characterize otolaryngology practice?
Dr. Cummings: It was, and still is, a small player in medicine, not like ob/gyn or general surgery. Today, only about 2 percent of physicians are otolaryngologists. But the speciality has a tremendous impact on those who are afflicted with disorders of the head and neck.
Question: In what way?
Dr. Cummings: Well, the understanding of the causes of head and neck cancers, and the treatments, are profoundly better today. Through improvements in imaging and anesthesia, as well as in surgical reconstruction, patients’ survival and quality of life have improved dramatically. Also, through collaboration with medical oncologists and radiation therapists, and now geneticists and molecular biologists, the field is really making a difference.
Question: You mentioned molecular biology. What’s happening there?
Dr. Cummings: We’re blessed with wonderful resources within our Head and Neck Biological Research Laboratory, headed by Dave Sidransky, Joe Califano and Wayne Koch. These and other researchers are doing pioneering work on early detection of tumors and their potential for recurrence. They’ve also opened the door to potential gene modification for patients with a genetic predisposition to disease.
Question: Could you elaborate?
Dr. Cummings: They’ve determined from simple saliva, sputum and blood tests that patients may be able to protect themselves from genetic changes that occur along the pathway towards head and neck cancers. By screening and following these patients, we may be able to intervene very early before tumors become apparent. We may even be able to make their predisposition go away.
Question: And the implications?
Dr. Cummings: Huge, because physicians around the world would like to have such a test, which may very well become as accepted as PSA for prostate cancer. It has tremendous applicability, even for patients in underprivileged countries.
Question: Do you see any other significant advancements?
Dr. Cummings: Certainly, Lloyd Minor in a very elegant, classical fashion, defined the superior vestibular canal syndrome. He identified the problem–the loss of bone in the semicircular canal–and documented it. Since then he’s been operating on patients to restore that bone, and patients’ symptoms do go away. Another example is the cochlear prosthesis, which was in an embryonic stage when I was in training. Now it’s a very accepted modality for treating the profoundly deafened patient. We’re now seeing the miniaturization of surgical instruments, allowing us to use small cameras to see into areas that were heretofore inaccessible. These tiny devices have led to profound improvements in surgeries of the sinuses and voice box, among other areas. Otolaryngologists may even see a miniature vestibular prosthesis in the future.
Question: Any developments in the olfactory area?
Dr. Cummings: The loss of the sense of smell because of chronic sinusitis is a very common problem, and there’s been very little done to determine its etiology. But my sense is that Andy Lane, an accomplished surgeon and researcher in the field, has a real handle on this. I suspect we’ll soon come up with some very powerful observations and potential treatments.
Question: What gives you that confidence?
Dr. Cummings: This department is extraordinarily unique, filled with exquisitely talented individuals in all of the dimensions of the specialty. We could have a situation of warring cats, but it’s an extraordinarily collaborative environment. Part of my job is to recruit people who will contribute to that kind of an environment. We’re also training accomplished clinician scientists to become leaders in the speciality. In the past decade, over 50 percent of our residents have stayed in academic medicine, and eight faculty have become chairs at other medical centers.
Question: Does that collaboration go outside the department?
Dr. Cummings: Absolutely. Our Swallowing Center is a good example. From diagnosis to treatment, our faculty interface seamlessly with neurosurgeons, the orthopedists, radiologists and general surgeons. From the clinical and basic science levels, there’s a lot of collaborative activity, too. That helps to explain why the department ranks number one in National Institutes of Health research grants and why we’ve been named the nation’s top otolaryngology department for several years by U.S. News & World Report.
Question: So, what does the future hold?
Dr. Cummings: The next frontier for otolaryngology includes more of a focus on the management of vestibular, or dizziness, disorders. New treatments for olfactory disorders, some involving nerve growth factors, also loom on the horizon. Nerve growth factors will play a major role in the rehabilitation of patients with auditory, facial, laryngeal and vestibular disorders, too. We also see molecular biology playing an even greater role in the diagnosis and management of head and neck cancer. And one of our key goals continues to be establishing this department as the core for an attack on head and neck cancers throughout the world.
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