The Caruso Department of Otolaryngology – Head and Neck Surgery has the tenth largest National Institutes of Health (NIH) funding targeted to clinical otolaryngology departments in the nation, and our research is led by world experts in their fields with an unrelenting passion for discovery. Our clinical research is well positioned to be on the leading edge of understanding of pathologies and disorders affecting the head and neck.
Our clinical research goes hand-in-hand with our academic mission to train the next generation of leaders in international specialty medicine. Our research is designed to go from bench to bedside, so trainees experience a large volume case load with a spectrum of pathologies that can inform their research. Trainees have access to the latest technologies, particularly with respect to imaging, robotic surgery and diagnostic capabilities.
When a child is born, their ear is hard-wired for sound, but the brain has to learn how to perceive sound and speech from the information coming up the hearing pathway. Some children are born without a hearing nerve and cannot be helped by a hearing aid or a cochlear implant. If the ear is not providing sound information to the brain, the hearing part of the brain doesn’t develop properly.
A team of multidisciplinary researchers is currently leading a breakthrough (NIH)-funded clinical trial that attempts to prove that young children born without a hearing nerve can safely undergo an auditory brainstem implant (ABI) surgery. The study also allows our researchers to study how the brain develops over time and how it learns to hear sound and develop speech.
A separate NIH-funded study examines the effects of cochlear implantation on language, behavioral and societal outcomes in children.
Cancers of the Head and Neck
Squamous cell carcinomas of the head and neck represents the sixth most common cancer in the developed world. Treatment for cancers of the head and neck involve complex and delicate surgeries that can impact the patient’s ability to swallow or speak.
With a number of both clinical and scientific research studies currently underway, the physicians in the Caruso Department are working toward a goal that is two-fold:
- to measure patient outcomes, and adjust clinical practices to ensure we’re always offering the very best chances of curing a patient’s cancer
- to push the boundaries of medicine even closer to finding a cure
The latest collaborative research at Keck Medicine of USC is helping to determine molecular profiles in head and neck cancer that will allow physicians to target certain treatment modalities for better outcomes. For example, we’ll be able to identify drug regimens for particular patients that may allow a lower dose of radiation, which will have a major impact on their care experience and overall outcomes.
In an effort to pioneer technologies to detect oral cancer in treatable stages, Keck School researchers have developed a point-of-care diagnostic test that allows for earlier-than-ever detection of oral cancer by measuring biomarker levels in saliva. As a monitoring tool, the test has the potential to be an essential part of every patient’s annual general health or dental check-up. In addition to early detection, these biomarker levels can be monitored over time and used to predict prognosis and recurrence. In collaboration with the USC Viterbi School of Engineering, they are seeking FDA approval on the test as a diagnostic tool.
Facial Reconstruction & Facial Nerve Paralysis
In the instance of serious conditions such as facial paralysis or disfigurement, reconstructive surgery helps patients overcome physical limitations that drastically impact quality of life. Our team places great emphasis on research in order to design new approaches for treatment, especially when it comes to facial nerve and paralysis. They working to harness the power of induced stem cells to create nerve grafts generated from a patient’s skin. This opens the door to stem cell therapy and tissue engineering that does not rely on fetal or bone marrow tissue.
Hearing and Balance
Hearing loss is one of the most common birth defects. Approximately one in 500 newborns suffers from significant hearing impairment. In addition, once mechanosensory hair cells in the inner ear are damaged and lost by any of a variety of reasons, such as aging and loud noises, they never regenerate. A majority of sensorineural hearing loss is permanent and significantly affects the sufferer’s quality of life.
Researchers and clinicians in the Caruso Department are leading a unique interdisciplinary effort which uses the latest technology in genetics, stem cell medicine, neuroscience, and biomedical engineering to approach otology research. Their aim: trying to build on recent stem cell research that has offered the possibility of regeneration of hair cells in humans. The degradation of sensory hair cells in the inner ear is a leading cause of deafness.
By determining the mechanisms of cell regulation, scientists hope to develop a biological, curative approach that will trigger natural replacement of those hair cells in order to allow the inner ear to respond with substantive improvement in hearing.
A broad range of clinical and outcomes-based studies at Keck Medicine of USC is focused on the subspecialty of laryngology, including clinical research on reflux, cancer, immobility and more.
Much of the work involves collaboration between multi-disciplinary teams, including partnering with physicians in gastroenterology and esophageal surgery to further elucidate the diagnosis and treatment of extra-esophageal reflux disease.
They are also studying outcomes of early vocal fold medialization, both from a patient-centered and system-centered standpoint. By performing flexible examinations of swallowing in the early post-operative period, USC physicians can identify patients at high risk for aspiration and offer a medialization procedure. Investigation is also ongoing into the outcomes of endoscopic treatment of small stage laryngeal cancer in both the primary and salvage setting.
They continue to show that this type of treatment is safe, effective and can provide serviceable voice outcomes. Clinical research also continues to evaluate adjuvant treatment such as intralesional or inhaled steroids for subglottic and tracheal stenosis, and to investigate bio-compatible materials that can be injected into the vocal fold, both into the superficial layers to address vocal fold scarring and thinning of the superficial lamina propria, as well as for a long-lasting medialization product.
Michael Johns, III, MD