Julina Ongkasuwan, MD
TVF: Where do you currently practice?
JO: I am currently faculty at Baylor College of Medicine and Texas Children’s Hospital in Houston, TX. I see both adults and children with voice, airway, and swallowing disorders.
TVF: Where did you complete your medical training? Laryngology?
JO: I attended medical school at the University of Maryland and followed by residency at Baylor College of Medicine. My first fellowship was in Pediatric Otolaryngology at Texas Children’s Hospital. My second fellowship was in Laryngology at the University of California San Francisco.
TVF: How/why did you come to choose laryngology?
JO: Like many laryngologists and speech pathologists I was a singer in a prior life (albeit not a particularly good one). In high school my vocal coach showed us a video of her singing during a laryngoscopy. I thought it was incredibly cool. With that experience percolating in the back of my mind during residency, I became increasingly fascinated by this incredibly tiny, yet vital, organ. So here I am.
TVF: What comes to your mind as one of the most pressing issues in contemporary voice disorders?
JO: When I encounter another medical professional who does not understand voice, airway, or swallowing anatomy and physiology my first instinctive response is to get annoyed. But then I have to pause, and realize it is our responsibility as a subspecialty to teach the importance of the larynx to physicians, mid-levels, and speech pathologists when they are students. Then, as fully fledged practitioners, they can think about prevention of laryngeal injury (such as during intubation or cardiothoracic surgery). In addition, they can recognize when to refer to us and not let patients suffer for years with potentially treatable laryngeal pathology.
TVF: What is your research interest?
JO: I have ongoing prospective research on the use of transcervical laryngeal ultrasound as a clinician’s tool to visualize vocal fold mobility and lesions. While ultrasound will never supplant stroboscopy, it can be another tool to use especially on unstable neonates or on children (or even some adults) who cannot tolerate laryngoscopy. I also have been looking at the impact and management of post-operative vocal fold paralysis in the inpatient setting.
TVF: In your opinion, what poses the greatest challenge in care of voice disorders?
JO: As mentioned previously, recognition of voice disorders with early referral on the part of other medical practitioners is important. Also a major challenge is the logistical availability of voice therapy especially outside of major cities and insurance coverage thereof.
TVF: In your opinion, what are some of the most important advances made in the field of laryngology in the recent years?
JO: The ability to record laryngeal exams at the bedside has been a huge help in the academic setting.
TVF: Which vocal myth would you like to dispel?
JO: Myth: All children will grow out of their voice problems. At the pediatric voice clinic we call them “not nodules.” Not every lump or bump on the pediatric vocal fold is a nodule!
TVF: What is your most memorable voice case?
JO: I had a little girl who was nearly aphonic due to vocal fold paralysis after a heart transplant. She was very self-conscious because no one could hear her and she could not drink thin liquids. She was frustrated and was starting to act out and withdraw socially. I performed an ansa to recurrent laryngeal nerve reinnervation and tracheostomy scar revision. A year later she was running around our clinic singing “Let it Go” (a perennial favorite in the pediatric voice clinic). Her mother was in tears because, at last, her daughter looked and sounded like every other child in her class.
TVF: As a laryngologist/surgeon, what keeps you on your toes?
JO: I love being part of a training program. The residents and fellows are always asking questions and pushing for explanations. “Because that is the way it has always been done” is never an adequate response.
TVF: What do you think the next steps are in growing the field of laryngology and voice rehabilitation?
JO: As stated above, we need to educate our colleagues and the public on the impact of laryngologic disorders and what we can do to help these patients. Also our understanding of the pediatric voice in terms of how it matures, heals, and functions lags behind the adult literature. There is so much to explore!
TVF: Who have been your most important mentors?
JO: I have been privileged to work with wonderful mentors throughout my career. I have learned so much from Drs. Courey, Donovan, Freidman, and Yung just to name a few.
TVF: What is your advice in mentoring future laryngologists?
JO: Like choosing any part of medicine, only do laryngology if you have a passion for it. Finding passion and meaning in your work makes all the other inevitable aggravating bits (the meetings, the paperwork, the late nights) manageable.
TVF: What advice would you like to give to the general populace about voice care? How about to the professional voice users?
JO: For both groups: education, education, education. I think science literacy, including basic anatomy and physiology, should be taught in all schools. Ideally, people should understand how their bodies work.
TVF: Who are your favorite singers?
JO: There are so many, but at this moment I have the Hamilton cast album on repeat.
TVF: What sparks “joy” for you as a person?
JO: Joy, for me, is exploring and learning. That means spending time with my family and watching my babies start to make sense of the world. It also means helping patients understand their bodies and helping us understand how to help them.