Published on December 5, 2 016

Pleased to post an interview with Dr. Avraham (Abie) Mendelsohn, laryngeal surgeon. Please credit The Voice Forum when you share our content. #fellowshipofthelarynx #laryngology #laryngealsurgery #voice #voicerehab #frysade

TVF: Where do you currently practice?
AM: UCLA Voice Center for Medicine and the Arts, Department of Head & Neck Surgery, David Geffen School of Medicine at UCLA.

TVF: Where did you complete your medical training? Laryngology?
AM: Medical degree was completed at UCLA School of Medicine. Following which, fellowships were completed in laryngology with Dr. Gerald Berke at UCLA, as well as oncologic laryngology with Pr. Marc Remacle and Pr. Georges Lawson at the Université catholique de Louvain, Belgium.

TVF: How/Why did you come to choose laryngology?
AM: Good fortune and luck. As a young medical student I was convinced that I would grow up to be a pediatric cardiologist. In fact, I wasn't aware that otolaryngology was even a surgical subspecialty. As fate would have it, after my first day of otolaryngology I was hooked for life. Once I found otolaryngology, I needed to learn more about this incredibly complex specialty. I sought out the advice and mentorship of Dr. Gerald Berke. His advice was fairly straightforward: take a sabbatical from medical school and spend a year engaged in research. And so, after my 3rd year of medical school, I spent that sabbatical year assisting in the operating rooms, shadowing in the clinics, and investigating outcomes of adductor spasmodic dysphonia patients. During this year I gained a glimpse into the voice production and voice disorders. I read Titze's and Hiram’s textbooks, understanding about 10% of what they wrote. I learned how to write manuscripts and reviewed high speed images of mucosal waves until my eyes were red. It was in this year that it became clear to me that I could spend my entire career engaged in voice production and the treatment of voice disorders. This never-ending journey propelled me down the road towards becoming an academic laryngologist.

TVF: What comes to mind as one of the most pressing issues in contemporary voice disorders?
AM: There is an issue that I truly believe is currently holding back excellent clinical care of voice disorder patients. The issue is the practical and logistic divide between laryngologist and speech pathologist. Even in the most collaborative voice centers, one in which I am fortunate to participate, there is still room for better integration of clinical diagnoses and treatments of laryngologists along with the clinical diagnoses and treatments of SLPs. Notwithstanding, there are many other centers within the U.S. and within Western Europe that I have personally seen who are not able to offer much clinical collaboration between the two fields. Many factors contribute to this problem apart from a simple lack of interest, including concerns of scheduling, space availability, and billing. However, in my opinion, the best chance for helping our patients is when laryngologists and SLPs evaluate the patients in tandem. In this way, lines of communication are open in all directions, clinical suspicions can be discussed, treatment options can be weighed together, and the plan initiated immediately. As our specialty continues to grow and advance, I believe increased collaboration will be a necessity as a standard of care.

TVF: What are your research interests?
AM: My research interests? Everything. There's hardly a paper I read or presentation I hear which does not make me wish I was researching that topic as well. But being too scattered limits productivity. In order to organize my efforts, I divide my research into two major components, clinical and basic science. From a clinical aspect, amongst several smaller clinical projects, my main interest is improving the voice outcomes for early vocal fold cancer. Researching vocal fold cancer includes investigating which treatment option is best and how to improve surgical techniques to optimize post-surgical voicing. From a basic science standpoint, I am investigating the physiology of voice production of the human vocal folds. Traditionally, research of normal and abnormal voice production was performed in one of several methods (such as using computational modeling, physical constructs, animal surgery, or human cadaver tissue). Under the leadership and guidance of Dr. Berke, we have developed a model in which human larynges can be maintained "alive” with a blood supply outside of a human body. Using this model, human voice production can be directly studied and many of the uncertainties of current phonation knowledge.

TVF: In your opinion, what are some the most important advances made in the field of laryngology in the recent years?
AM: Another difficult question, as there are really so many possible answers, along with the fact that the true test of recent advancements can really only be measured years from now. However, I would give three possibilities and say that our field's move away from a steeply exaggerated rate of laryngopharyngeal reflux (LPR) diagnosis as the underlying cause of everything laryngology is an important step towards identifying true causes of dysphonia and throat discomfort. I would also point towards Titze's semi-occluded tract therapy as a methodology which seems to benefit an uncountable number of dysphonia patients. Finally, the recent stress placed on the stroboscopic subtleties of unilateral vocal fold paresis will continue to be very important. Not to the point where every patient who used to have LPR now has a paresis (because just like you can fit most stroboscopic exams to fit an LPR diagnosis, you can do the same for paresis), but it gives laryngologists a more specific intrinsic pathology to possibly apply a targeted therapy.

TVF: What is your vocal pet peeve and why?
AM: What gets me reeling is when vocal fold cancer patients are told that there is no reason to see a laryngologist before starting external beam radiation therapy. The general misunderstood nature of surgery for glottic cancer, particularly early staged cancer, is one which finds many patients frustrated having not received that treatment consultation ahead of time. I feel that one of the most important jobs we have is to educate our patients in complex medical issues from which they have no experience or education. Empowering patients with knowledge only improves the strength of their treatment decisions as well as strengthening the bond between clinician and patient. While there continues to be no consensus on the optimal treatment for early vocal fold cancer, we must continue to allow the patients to choose the course which best fits their needs.

TVF: Which vocal myth would you like to dispel?
AM: "Voice rest has a positive effect." While in very select situations voice rest is necessary, it is too commonly used as a treatment plan for just about any voice condition. Overall, voice rest can be a harmful recommendation for both phonatory physiology as well as patient emotional well-being and we need to rid it from our patients' lexicon.

TVF: Your most memorable voice case?
AM: A few years ago, my patient was taken to the operating room for the first evaluation and endoscopic treatment of what appeared to be early subglottic stenosis. During the endoscopic exam, the stenosis looked asymmetric and a biopsy revealed a malignant salivary gland cancer. Apart from the emotional challenges of that case, it was one of my most memorable experiences in which I came to understand that anything is possible, nothing is as expected, and the severe responsibility we hold as clinicians.

TVF: As a laryngologist/surgeon, what keeps you on your toes?
AM: Similar theme as the previous question. There is hardly a day which passes without some surprise or frustration. These constant humbling experiences of knowing so little and understanding so much less is what keeps me focused and on my toes.

TVF: What do you think the next steps are in growing the field of laryngology and voice rehabilitation?
AM: Lack of public awareness of the issues we face as voice clinicians is limiting our field's growth and advancement. Not only patients, but so many clinicians have very little appreciation for voice disorders until it is experienced, and even then, its significance can be overlooked. If our field can increase the general knowledge of the true impact of voice disorders, with public efforts like World Voice Day, then the public demand will necessitate continued innovation.

TVF: Who have been your most important/influential mentors?
AM: I should list about 50 people here, but I'll limit it to three for brevity's sake. First, my Dad who continues to show me that being a good person is a prerequisite for professional accomplishment. My Dad, leading by example, shows me that every person you see deserves a smile and a hello. Amongst so many other life lessons, these two are absolutes in all my patient interactions. Second, Dr. Gerald Berke, who with such a unassuming air demonstrates the qualities and attributes of a true expert laryngologist. Dr. Berke opened the world of laryngology to me. He has been the guide to lead me to this point in my career and I would be fortunate to have him continue leading the way for many years to come. Finally Pr. Marc Remacle, who similarly exemplifies the attributes of a first class laryngologist in such a understated manner, opened his doors to me so that I might break down my closed-in approach. Pr. Remacle has given me, and continues to give me, a glimpse at laryngology on a global scale and continues to show me the qualities of a leader of our field.

TVF: What is your advice in mentoring future laryngologists?
AM: Listen to the clichés, namely: read as much as possible, learn from everyone (senior and junior), and collect mentors.

TVF: What advice would you like to give to the general populace about voice care?
AM: Take your care of your voice, or perhaps better stated as the converse, don't ignore your voice. Do not wait longer than 3 weeks to seek out help for your hoarseness, discomfort, cough, and more (hopefully only 2 weeks). There have been some unfortunate guides misguiding patients to wait several months before seeking specialty evaluation and treatment. Get in, get treated, and understand that our lives should never be limited by what our voice can do.

TVF: Who are your favorite singers?
AM: While the musical genre I put on is generally motivated by my mood, the question to name a favorite singer is more challenging. If pressed for an answer, I simply would say whomever was in front of me. I have had the chance to experience a few of the greats in person: from Celine Dion to Bruce Springsteen to the cast of Wicked. Thinking after each time that what they do is so incredible that they must be my favorite... until I see the next!

TVF: What sparks "joy" for you as a person?
AM: We finish off with the easiest question of the day. My children. Each one shining brighter than the sun gives me the joy for life every minute of every day.