Published on August 20, 2016
Pleased to post an interview with Dr. Shigeru Hirano, a laryngeal surgeon from beautiful Kyoto, Japan. Apart from being a laryngologist and a voice scientist, he is also a classical singer!
TVF: Where do you currently practice/teach?
SH: I practice in the department of Otolaryngology, Kyoto Prefectural University in Kyoto, Japan. My practice includes laryngeal surgery and head and neck surgery. I teach students and residents at the same university.
TVF: Where did you complete your medical training?
SH: I completed my medical training and subspecialty training in laryngology at the department of Otolaryngology, Kyoto University (different one from the current place). I also learned phonosurgery and laryngeal research at University of Wisconsin-Madison from Prof. Charles Ford and Diane Bless from 2001 through 2003.
TVF: How did you come to choose laryngology?
SH: Because I was interested in phonosurgery, and I also like singing by myself. I had a rock band when I was young where I was the vocalist, and I am now practicing classical singing.
TVF: What comes to your mind as one of the most pressing issues in contemporary voice disorders?
SH: The biggest voice problem in my country as well as other developed countries should be vocal fold scar. Many vocal professionals suffer from scar caused by vocal abuse.
TVF: What is your research interest?
SH: My research is tissue engineering and regenerative medicine of voice which aims to restore irreversibly damaged vocal folds in cases of scar or aging voice. The restoration of vocal fold scar and atrophy is challenging, and I have researched how to restore them by using stem cells and growth factors. Stem cell is a powerful tool, but it is not usable for human now. Some types of growth factors, which stimulate growth of cells in the vocal fold and improve their function, has been proven to be very useful to recover the voice. Some growth factors are now usable for human, for example, fibroblast growth factor is commercially available in Japan, and revealed regenerative effects to some degree.
TVF: In your opinion, what poses the greatest challenge in care of voice disorders?
SH: The challenge includes vocal fold scar, papillomatosis, spasmodic dysphonia, and aging.
TVF: In your opinion, what are some of the most important advances made in the field of laryngology in the recent years?
SH: Tissue engineering, angiolytic laser, and holistic voice therapy approach.
TVF: What is your vocal pet peeve and why?
SH: This may not be a correct answer, but I am really frustrated with shortage of Speech-Language Pathologists (SLP) specializing in voice in my country. The level of voice therapy is not as high as the United States, and the few SLPs we have still work on pushing exercise for voice disorders, which I hate because it doesn’t work.
We have some excellent SLPs specializing voice at high level, but I feel that we have an urgent need to educate more SLPs in Japan.
TVF: Which laryngological or voice rehabilitation practices do you disagree with?
SH: Laser surgery for shallow vocal fold lesion such as leukoplakia, carcinoma in situ (CIS), papillomatosis. Laser causes heat damage to the mucosa, and is usually unnecessary and should be avoided for shallow cordectomy. The practice of pushing exercise for voice problems should be discarded.
TVF: Your most memorable voice case?
SH: A case with aged patient with vocal fold atrophy whom I treated for the first time by fibroblast growth factor. The results were excellent and encouraged me to proceed the research and trial.
I am also moved by most patients with scar, because they are always keen on any possible therapy to improve their voice, and they always keep track of any new strategies developed across the world. They never give up even after several procedures over several years. I respect them and am happy to work for them.
TVF: As a laryngologist/surgeon, what keeps you on your toes?
SH: Wound healing. It is very hard to predict wound healing although we do exactly the same procedure to different vocal folds. There are large individual variations in wound healing mechanism of the vocal fold, which really warrants me to think deeper to avoid bad wound healing (scarring).
TVF: What do you think the next steps are in growing the field of laryngology and voice rehabilitation?
SH: Tissue engineering is still growing, and I expect that cell therapy using appropriate cell such as adipose derived stem cell will become clinically available in the next decade.
Immune-therapy is also expected to grow for improvement of therapy for refractory papillomatosis or dysplastic lesions.
Anti-oxidant therapy may grow as a maintenance of voice.
TVF: Who have been your most important/influential mentors?
SH: Prof. Robert Sataloff in Drexel University, Prof. Charles Ford in University of Wisconsin-Madison, Prof. Michael Benninger in Cleveland Clinic
TVF: What is your advice in mentoring future laryngologists?
SH: It is important to improve surgical skill as a surgeon, but it is also important to be engaged in basic research, which widen the career and way of thinking on clinical commitment for laryngeal disorders.
TVF: What advice would you like to give to the general populace about voice care?
SH: Maintenance of voice includes vocal hygiene, hydration, anti-acid behavior, non-smoking. I also recommend taking anti-oxidant to prevent damage to the vocal fold from free radical which can easily be produced by inflammation or injury of the vocal fold.
TVF: What advice do you have for aspiring laryngologists?
SH: It is a privilege and responsibility of laryngologist is to see singers, and perform surgeries if needed. The laryngologists should know the mechanism of singing voice, and they should be able to sing themselves. I am learning classical singing in part to understand the singer’s problems. I also recommend SLPs to learn singing.
TVF: Who are your favorite singers?
SH: Julie Andrews, Jose Carreras
TVF: What sparks “joy” for you as a person?
SH: It is definitely a joy to listen to fabulous singing voice, and it is also fun for me to perform. Successful phonosurgery with post-op patients’ smile is another joy.