Published on September 10, 2016
Pleased to post an interview with Dr. Joseph Spiegel, laryngeal surgeon. He is the Co-director of the Jefferson Voice and Swallowing Center in Philadelphia.
TVF: Where do you currently practice/teach?
JS: I currently am on faculty and practice at Thomas Jefferson University (Sidney Kimmel Medical College) in Philadelphia.
TVF: Where did you complete your medical training? Laryngology?
JS: I completed my residency in Otolaryngology – Head & Neck Surgery at the University of Michigan in 1985. When I finished residency, there was no formal fellowship in Laryngology. I spent the first half of my career in private practice (and volunteer faculty at Jefferson) with a partner specializing in care of the Professional Voice. As a result, my first year was considered as a fellowship as I learned that special work. As the years of practice progressed I also developed an interest in patients with swallowing disorders. As the subspecialty developed further and Jefferson became a Department separated by sub-specialty, I left my practice and came to Jefferson full time in 2003 to develop a Center for care of patients with voice and swallowing disorders. For me, it is fascinating that the sub-specialty of voice and swallowing disorders did not exist when I was training. I’ve watch the field develop rapidly and really progress with the advent of sub-specialty concentration and fellowship training.
TVF: What comes to your mind as one of the most pressing issues in contemporary voice disorders?
JS: I think the most “pressing” or growing issue is aging voice, in concert with our aging population. Older patients want to keep their “normal” voice as they remain active and social well into their eighties and nineties. Besides the effects of aging alone, other common ailments such as stroke and Parkinson’s disease often affect vocal quality.
TVF: What are your research interests?
JS: My most recent research involves comparing endoscopic and open techniques for hypopharyngeal surgery, cricopharyngeal myotomy and Zenker’s diverticulum. In layman’s terms, the push to do things endoscopically is driven to avoid incision and sometimes hospitalization. However, there are specific advantages to each approach and outcomes show that the best approach can be influenced by many nuances in the patients’ individual history and desires. I also have an ongoing interest in the subject of voice rest, both in primary treatment and post-operative care.
TVF: In your opinion, what poses the greatest challenge in care of voice disorders?
JS: The greatest ongoing challenges in voice (airway) care are bilateral vocal cord paralysis and vocal fold scar. In patients with bilateral paralysis we cannot restore “normal” function for both breathing and voice. There is active research with laryngeal pacemakers and new surgical techniques. Vocal fold scar is very difficult to treat successfully and frustrating as it is often iatrogenic. It is an exciting topic as new techniques with genetic alteration and biologic modifiers are being described both in animal models and recently in early human trials.
TVF: What is your vocal pet peeve?
JS: The vocal fry voice. It is very common in younger women and beginning to creep into young men’s voices as well.
TVF: Which vocal myth would you like to dispel?
JS: 1) GE reflux is a major cause of hoarseness. I am in the school of Laryngologists that think the diagnosis of laryngeal reflux is made too often, or after made is not appropriately dismissed after an adequate treatment trial or negative testing. Every throat complaint is not due to reflux and control of reflux will not necessarily fix everything, especially hoarseness.
JS: 2) Vocal fold nodules end a career.
TVF: Your most memorable voice case?
JS: Hard to pick a most memorable voice case, but early on I had an actor treated with radiation therapy for a T1N0 glottic cancer and helped him so he could open as a lead in show at a major theater 2 weeks after completing treatment. He maintained an active career for more than 20 more years and I still follow him.
TVF: As a laryngologist/surgeon, what keeps you on your toes?
JS: I keep on my toes by training residents, the willingness to see other physicians’ problems or patients whose problems they can’t figure out and by airway cases. I still routinely see things I’ve never seen before so practice remains exciting and interesting.
TVF: What do you think the next steps are in growing the field of laryngology and voice rehabilitation?
JS: In the near future, I think we will see laryngeal pacemakers for unilateral and bilateral vocal fold paralysis and robotic surgery in the larynx.
TVF: What is your advice in mentoring future laryngologists?
JS: My advice to future laryngologists:
1) It’s voice AND swallowing – interest in swallowing disorders expands practice and brings great opportunities for collaboration
2) Listen and learn from speech pathologists. Treat them as colleagues, not subordinates. Good therapy will make you a much better surgeon. Speech pathologists have become a major referral source, both in-patient and outpatient. I gained much of my knowledge and expertise in swallowing disorders by working with experienced SLP’s in nursing home and long-term care settings.
3) Laryngology “fits in” many places. It can be considered a part of “general” Otolaryngology or a narrow subspecialty unto itself. Training in Laryngology can be a necessary tool to an academic career or a value-added adjunct in private practice.
TVF: What advice would you like to give to the general populace about voice care?
JS: Advice to the general population: Stop screaming at each other. But, more (slightly) more seriously, don’t settle for a worsening voice with age. You can keep your voice in shape like the rest of your body if you know how.
TVF: Who are your favorite singers?
JS: I’m not big with “favorite” singers. I’ve always loved Barbara Streisand, Maria Callas, Andrea Bocelli. I am incredibly impressed with Tony Bennett still singing so great at 90.
TVF: What sparks “joy” for you as a person?
JS: My “joy” in life is my family…my wife of almost 38 years, our three children and one grandchild. My joy professionally still comes from individual patient care, hearing the result, seeing the smile as a patient throws away their tracheotomy or G-tube. It also remains very satisfying to watch the development of residents and be a part of their training to become the kind of doctor I would go to or send my family.