JONATHAN BOCK, MD
TVF: Where do you currently practice?
JB: Associate Professor, Division of Laryngology & Professional Voice, Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI. Been on faculty at MCW since 2009. I practice at our main academic hospital, Froedtert Hospital, and also see patients at our Milwaukee VA hospital.
TVF: Where did you complete your medical training? Laryngology?
JB: After growing up in Appleton, WI, I attended college at Yale where I sang acapella with the Yale Whiffenpoofs. I went back home to Wisconsin for medical school at the Medical College of Wisconsin in Milwaukee. I then did a 7-year residency in Otolaryngology at University of Iowa including a 2-year NIH T32 research training fellowship in molecular oncology, followed by fellowship in Laryngology at Vanderbilt University.
TVF: How/why did you come to choose laryngology?
JB: I was initially going to be a head and neck cancer surgeon, as I got into Otolaryngology through cancer interests – my initial exposure to ENT was through a radiation oncologist at the University of Wisconsin who treated my father when he was dying from melanoma. I worked in his laboratory for 2 years between college and medical school and got very interested in cancer biology and oncology. As I began my research-track residency in Otolaryngology at Iowa, I was still thinking of doing head and neck fellowship. At that time laryngology fellowships were really beginning to flourish, and I realized that specializing in voice care made a ton of sense for me as I have a large background in music and stage performance. I also liked doing free flaps less and less as I progressed through my residency years, and realized that laryngology could allow me to have a busy clinical practice that synced my vocation and avocation. I’m so glad I made that decision!
TVF: What comes to your mind as one of the most pressing issues in contemporary voice disorders? Do you think this is an international problem or specific to your country?
JB: Over the last 2-3 years I have seen increasing challenges in my patient’s ability to afford care, with larger and larger co-pays and facility fees placed on the patient. This has been an ongoing struggle for my entire practice, but it seems to be getting markedly worse with time. So many of the performers and singers we care for have poor or no insurance, and we need to find ways to take the best possible care of our patients under these challenging financial conditions. This seems particularly true for coverage of speech therapy as many of our local insurance companies seem to be making it harder and harder to get any speech therapy covered.
TVF: What is/are your research interest(s)? Why?
JB: I’ve been involved in research actively throughout my career, and have transitioned from a basic science laboratory background to a more focused leadership role in translational research here at MCW. We have a longstanding research interest in the use of pepsin as a marker for laryngopharyngeal reflux (LPR) with my colleague Dr. Nikki Johnston, and we are currently studying ways to improve diagnosis of LPR using pepsin. We have an active protocol comparing the use of dual pH-multichannel intraluminal impedance to salivary pepsin testing for establishing a diagnosis of LPR. I’m also involved in a study here with Guillerme Garcia, PhD using computational fluid dynamic modeling to study laryngeal particle deposition of steroids and other medications as well as paradoxical vocal fold motion disorders. I’m finalizing my triological thesis right now on long-term patient outcomes following dysphagia interventions, which has been a long project that will hopefully add further insight into how we help our dysphagia patients with speech therapy and diet recommendations.
TVF: Who is your favorite singer?
JB: Wow, that’s a tough one. So many great singers. If I had to pick one, I’d probably say Al Green, because I’ve always loved soul music and my wife and I danced to “Let’s Stay Together” for our first dance at our wedding 16 years ago!
TVF: What is your vocal pet peeve?
JB: I wish I could get patients to understand that they can’t directly lubricate their vocal cords – they need to stay really hydrated and aware of their overall water intake to stay in good vocal health. I also think that caffeine likely doesn’t have as much effect on vocal health as we may have been taught over the years, and the data on caffeine consumption and overall body hydration so far doesn’t support any significant diuretic effect. I’m personally a caffeine-achiever, so perhaps I’m biased in my opinion on this, but I think perhaps our admonitions against caffeine consumption are a bit heavy-handed.
TVF: Which vocal myth would you like to dispel?
JB: Right now, I think a lot of people are putting too much emphasis on vocal fry and that it can be harmful. I just don’t see it causing many issues for people in my clinic, and I think perhaps we’re doing a disservice to a lot of patients by making them feel self-conscious about a functional vocal style that really may be harmless. It seems like a lot of the negative press and energy on this topic is also directed specifically at women, which makes me concerned.
TVF: Your most memorable voice case?
JB: Shortly after I started my practice here in Milwaukee, I was listening to the radio and heard a local broadcaster speaking that had some fairly significant hoarseness. I remember thinking to myself, “Wow, that person should really come into our clinic for an evaluation.” Little did I know that they had an appointment with me the next day! After removing a benign polyp and some directed voice therapy, their voice returned back to normal. Every time I hear that person on the radio now, it makes me proud to be a vocal cord surgeon.
TVF: As a laryngologist/surgeon, what keeps you on your toes?
JB: I really enjoy how technology continues to augment our skill set in laryngology. Smaller and higher resolution HD stroboscopy systems, improved manometry and impedance probes, expanding laser delivery systems, robotics – all of these things enable us to take better and better care of our patients. It’s a truly exciting field, and I am never bored at work!
TVF: What advice would you like to give to the general populace about voice care? How about to the professional voice users?
JB: Most of the issues that we see in clinic that really cause people problems with their livelihood and quality of life are due to vocal overuse and abuse, and I think that most people don’t understand this concept. This is particularly true for professional voice users – we spend so much time working with them to educate them on their “voice bank” and how many withdrawals they can take from it.
TVF: What sparks “joy” for you as a person?
JB: The best part of my job is the interpersonal connections I get to build with my patients. I so appreciate the trust that patients put in us to help them through their voice issues. This is particularly true for me with my singers and performers, as I continue to perform regularly myself with my band here in Milwaukee – it keeps me involved in the local music scene, and gives me that performance outlet that so many of our patients also need. I also get tons of joy from my family. Having four children at home is definitely chaotic, but there’s nothing quite like having your kids jump on you and hug you when you walk through the door at the end of a long day.