brent richardson, md
Published on September 17, 2016
Pleased to post an interview with Dr. Brent Richardson, laryngeal surgeon. Experiences as a singer in boychoirs, select collegiate ensembles, and musical theater (as both a singer and an actor) sparked Dr. Richardson’s interests in the unique problems affecting professional voice users.
TVF: Where do you currently practice/teach?
BR: I am in private practice with my colleague and mentor, Dr. Robert Bastian, at Bastian Voice Institute, centrally located in the suburban Chicago area, in Downers Grove, Illinois.
TVF: Where did you complete your medical training?
BR: I attended medical school at the University of Washington, and completed my residency in Otolaryngology/ Head and Neck Surgery at the University of Minnesota. My laryngology fellowship was with Dr. Robert Bastian at Loyola University Medical Center. I remained on the faculty there for 6 years, until we established Bastian Voice Institute in 2003.
TVF: How/why did you come to choose laryngology?
BR: I have been a musician since I attended what was then called “musical kindergarten.” I later began singing in a boy choir, and continued the pursuit of vocal music through college in highly-selective ensembles. In medical school, I was fascinated by head and neck anatomy and so this, combined with the opportunity to see both genders, all ages, and perform medical and surgical management of a wide variety of problems, some of which remain poorly understood, made Otolaryngology a good fit for me. I gravitated to laryngology in large part because of my interest in voice, but also because it was, and continues to be, one of the major frontiers in our field.
TVF: What are your research interests?
BR: We are currently either conducting or actively participating in research in several areas. One multi-site study investigates the genetics and mechanism of spasmodic dysphonia, a rare neurological voice disorder which is a form of focal dystonia. This voice problem has two main variations: one characterized by a strain-strangled voice, the other by irregular dropping out of the voice. Some patients also have breathing difficulty from this. Most patients get excellent, but temporary, relief of their symptoms through periodic Botox injections into the affected muscles. Through better understanding the disorder, we hope treatments that provide longer- lasting, or even benefits can be developed.
Another multisite study is enrolling patients with an uncommon, but recurring problem of airway narrowing within the cricoid cartilage, the lower part of the voice box (larynx), leading to trouble breathing. This condition is termed subglottic stenosis and is presently treated by dilation of the narrowing when breathing becomes problematic. The vast majority of such patients are female, and they often have other signs, symptoms, or diagnoses of autoimmune diseases. The aim of this study is to find the common features that might help explain how and why this narrowing happens and how we can better treat it.
We have ongoing research characterizing the nature of benign (recurrent respiratory papillomatosis or RRP) and also malignant (squamous cell carcinoma) HPV-related disease in the larynx. We have participated in novel approaches to treatment, and are investigating better means to monitor treatment results.
TVF: How can one bridge the gap between basic science and clinical application?
BR: There is a role for basic science research simply “for the sake of knowing.” This information is often useful later when we better understand what questions to ask. However, I think the key to bridging the gap between basic science and clinical application is ask basic science questions that are clinically relevant. It may seem obvious, but instead of trying to find a clinical application for the basic science questions we studied because we were curious, we should instead work to discover the basic science behind the clinical problems that afflict our patients.
TVF: In your opinion, what poses the greatest challenge in care of voice disorders?
BR: Perhaps not the greatest challenge, but the most important aspect of our treatment is education of the patient regarding the correct diagnosis and the cause of the problem. Patient uncertainty and fear is often what drives them to see us in the first place. We need recognize and address their unspoken questions and concerns, and then “deputize” them to be in charge of their own vocal health. Educated patients are key to both the treatment and the prevention of many voice problems. Dr. Bastian has created a tremendous, free resource for this at www.laryngopedia.com.
TVF: In your opinion, what are some of the most important advances made in the field of laryngology in the recent years?
BR: Office-based and minimally invasive procedures that enable us to secure diagnoses and perform treatment without the risk, inconvenience, and expense of general anesthesia have been the critical innovation. My colleague, Dr. Robert Bastian, pioneered the modern version of these advances and has truly led this revolution over the past 3 decades.
TVF: What is your most memorable voice case?
BR: There have been so many amazing stories that I can’t say that there is any one in particular. I think it is worth remembering that even though we may see diagnoses that are to us routine, each patient comes with their own set of circumstances and needs, so each encounter is unique, and we may never fully know how we affect our patients’ lives. Whether it is making it possible for a performer to go on for a critical show, reassuring a patient who is afraid they might have cancer, medializing a paralyzed vocal fold so that a man can communicate with his aging, nearly deaf father, or fixing a Zenker’s diverticulum so that an elderly woman can enjoy Thanksgiving dinner with her family, it is all memorable and important.
TVF: As a laryngologist/surgeon, what keeps you on your toes?
BR: Figuring out how to individualize the treatment plan to provide the best outcome for each patient, and making sure that their questions have been answered and their expectations addressed.
TVF: Who have been your most important/influential mentors?
BR: George “Shep” Goding introduced me to the field and served as my graduate research advisor during residency. Robert Bastian was the innovator of the tripartite approach to diagnosis that I use; I owe so much of what I understand about the voice, swallowing, and airway to his consummate teaching and collaboration over these past 20 years.
TVF: What is your advice in mentoring future laryngologists?
BR: Question everything that you have learned, especially dogma. Be detailed in elements of the history, vocal capability, and examination that are crucial to discerning between competing diagnoses, while taking care not to get lost in the forest of irrelevant information. Constantly reevaluate whether your treatment is effective, or if there might be a better way. If your treatment regimen is not working, revisit the history and the diagnostic process to see if a different explanation is a better fit for the patient’s problem.
TVF: The “voice” community is a very tight knit group of medical professionals, pedagogues, scientists, and vocal performers of many genres. What can we learn from each other?
BR: We have a great deal to learn from each other, because we each see a different facet and experience the vocal mechanism in a different way. That leads to varied descriptions and ways of understanding which can be confusing. It would be cliché to say that “we need to learn each other’s languages” but clearly identifying what we are all talking about in each situation is the key. Once we have effectively described the phenomenon, we can begin to compare our theories and observations about what is happening.
TVF: What advice do you have for aspiring laryngologists?
BR: Learn as much as you can about your own voice and how it works. You will be better able to understand your patients’ needs in this way. Study patient examinations that are unusual to glean fine points about the diagnosis.
TVF: Who are your favorite singers?
BR: That would be almost impossible to say. I don’t really have favorites, but I listen to a wide variety of music, from chant to opera, musical theater, hip-hop, early music, rock, R&B, etc.
TVF: What sparks “joy” for you as a person?
BR: There are lots of things. It may seem disingenuous to say that seeing that what I have done has truly benefited a patient sparks joy, but it’s true. Apart from my work, I enjoy gardening, working with bees, being with my family, fly fishing, performing, or any of a number of dilettante projects I may have going, not necessarily in that order.