amanda hu, md
Published on September 3, 2016
Pleased to post an interview with Dr. Amanda Hu, laryngeal surgeon. Dr. Hu speaks fluent Mandarin and enjoys serving the Chinese-speaking population in Philadelphia. Dr. Hu is interested in medical education and computer simulation.
TVF: Where do you currently practice/teach?
AH: I currently practice in Philadelphia with Dr. Robert Sataloff at Drexel University College of Medicine. Four years ago, I had the privilege of joining this world class voice center led by a leader in the field of laryngology.
TVF: Where did you complete your medical training? Laryngology?
AH: I graduated from the University of Toronto medical school. I completed my Otolaryngology Residency at Western University in Canada. I further completed a Laryngology Fellowship at the University of Washington in Seattle with Drs. Al Merati, Al Hillel, and Tanya Meyer.
TVF: How/why did you come to choose laryngology?
AH: There are several reasons why I chose laryngology. First, I enjoy the patient population. I love interacting with professional voice users, like teachers, singers, and actors. Second, I love the surgeries. It is intricate, delicate, meticulous surgery. The finesse that is required for laryngeal surgery attracted me to the field. Finally, it is a surgical specialty with a reasonable lifestyle. As a female surgeon, I wanted to be able to balance my career with a family life.
TVF: What is your research interest?
AH: One of my research interests is in computer simulation and medical education. I have built a 3D educational computer model of the larynx and used it to teach laryngeal anatomy to medical students and residents. The time-honored tradition is to teach anatomy with human cadaver dissection; however, this tradition poses many challenges. There are decreasing availability of cadaver materials, increasing ethical concerns, decreasing time in medical school curricula, and trends in distributed medical education. Furthermore, medical students lack the technical skills to dissect a delicate organ like the larynx. Computer simulation is perfect for this need – it can magnify small, complex organs like the larynx, a computer model can be used outside of curriculum time, and it can be accessed anywhere with internet. I have used this 3D laryngeal model to study different aspects of medical education, i.e. how students learn anatomy. For example, I have studied long and short term retention, the effect of level of training, the effect of innate spatial ability, and student motivation.
TVF: How do you hope your research will be applied in the clinical field?
AH: My research work can be applied to clinical practice in several ways. First, training the next generation of physicians is always important in clinical practice. One of our jobs is to pass on the craft to the next generation. Second, I want to further refine my laryngeal model to teach technical skills, like botulinum toxin injections, vocal fold medializations, and thyroplasty. This advance in computer simulation will probably require haptic feedback technology.
TVF: In your opinion, what poses the greatest challenge in care of voice disorders?
AH: One of the greatest challenges in the care of voice disorders is access to voice therapy. I practice in urban, inner-city Philadelphia and I see patients from a wide variety of insurance backgrounds. Everyday, I see patients who would benefit from voice therapy. Their voice disorder cannot be treated with surgery or medications. Everyday, I have patients who tell me that they cannot afford the co-pay to see a speech language pathologist, or that their insurance does not cover it. It is frustrating to me as a laryngologist because I feel like I cannot help them.
TVF: In your opinion, what are some of the most important advances made in the field of laryngology in the recent years?
AH: There is active work on decreasing scar tissue in the vocal folds and bioengineering a material similar to the superficial lamina propria. Every laryngologist has faced difficult cases of patients with vocal fold scarring, most likely from previous surgery. It is a tough problem to fix and there is still no good solution. Many basic science research labs across the world are working on a solution.
Another important advance is laryngeal transplantation. The surgery is not only a technical challenge with the microvascular reconstruction and reinnervation, but the medical side of life-long immunosuppression is a hurdle. There are also ethical concerns with the transplantation of a “non-vital” organ. Currently, only a select population of patients with severe laryngeal trauma or benign laryngeal neoplasms necessitating laryngectomy are eligible candidates for this surgery. In the future, indications may expand to advanced laryngeal cancer.
TVF: What is your vocal pet peeve and why?
AH: Vocal nodules have such a bad reputation. So many singers and singing students come in with the fear that they have this diagnosis. The treatment is also misrepresented in the media. For example, a character in the movie, Pitch Perfect, had surgery for vocal nodules. The primary treatment is voice therapy. When I diagnose a singer with vocal nodules, they are often upset and then they ask me about surgery. I spend a lot of time educating them on proper vocal technique and the importance of seeing a speech therapist.
TVF: Which vocal myth would you like to dispel?
AH: Same as the previous question.
TVF: Your most memorable voice case?
AH: I had a patient who was a Broadway singer with a benign vocal fold polyp. I had to pull him out of a show to perform his surgery. He also needed a period of voice rest and rehabilitation with the voice therapy team. He healed very well and returned to singing on Broadway. I attended his first show back on Broadway and he greeted me with a hug. Since then, he has referred his singing colleagues to me and even his own mother. That is the highest compliment to pay to a physician.
TVF: As a laryngologist/surgeon, what keeps you on your toes?
AH: The ENT residents and laryngology fellow keeps me on my toes. Trainees approach everything with an open and inquiring mind. The novelty of the topics ignites an excitement in them. It’s contagious and I love working with them!
TVF: What do you think the next steps are in growing the field of laryngology and voice rehabilitation?
AH: Collaboration between voice centers across the country and the world is an important next step to growing the field of laryngology. Sharing our experiences with patients and pooling our resources for research are all important. The exchange of ideas at national and international conferences will help move the whole field forward in the future. For example, laryngologists may treat rare diseases, like subglottic stenosis. Meaningful research needs a large sample size to draw sound conclusions. There is currently a multi-institutional study on subglottic stenosis in the United States. Collaborations like this will help to grow the field.
TVF: Who have been your most important mentors?
AH: Dr. Kevin Fung at Western University was one of my early mentors during my residency. He was very dedicated to teaching and to his job. His enthusiasm for the sub specialty convinced me to pursue laryngology. Dr. Albert Merati, my fellowship director at the University of Washington, was also an important mentor. My approach to laryngology is based on him and I hear his voice in my head when I manage patients. Finally, my boss and current chairperson, Dr. Robert Sataloff, is a dear friend and mentor. I have learned so much from him and he has given me so many opportunities to grow in my career.
TVF: What is your advice in mentoring future laryngologists?
AH: Love your work. When you truly love your work, it never seems like work at all.
TVF: What advice would you like to give to the general populace about voice care? How about to the professional voice users?
AH: To the general populace: Don’t take your voice for granted! It is not until someone gets laryngitis that they appreciate their voice as a basic means of communication.
To the professional voice users: See a laryngologist to get a baseline examination. This will help the laryngologist know what is different when you come in for a vocal complaint. Just like how people go in for a “well woman” exam, professional voice users should do the same for their voice. I often see injured singers and it can be a challenge to differentiate what is baseline and what is due to the injury. For example, patients may have an asymptomatic sulcus vocalis (groove in the vocal fold), etc.
TVF: Who are your favorite singers?
AH: My favorite singer is Sarah Mclachlan. I grew up listening to her songs and my high school graduation’s song was “I will remember you”. Most Americans will know her song “Angel” that was featured on the American Society for the Prevention of Cruelty to Animals® (ASPCA) commercial. My current favorite singer is Adele. I love the sound of her voice. Her voice surgery also brought awareness to the general public on voice disorders.
TVF: What sparks “joy” for you as a person?
AH: Spending time with my family. My father was recently diagnosed with advanced cancer and is receiving palliative chemotherapy. This experience has reminded me of the priorities in life. Family comes first – and every day I get to spend with my father brings joy to me as a person.