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To Boldly Go:
Maryland's Department of Otorhinolaryngology-Head and Neck Surgery
It's only fitting for Scott E. Strome, MD, to boldly go where no one has gone before at the medical school. The professor and chair of the department of otorhinolaryngology-head and neck surgery is an avid Star Trek fan who has been known to showcase his department's research with a powerpoint presentation that features an exploding Klingon starship. And some might mistake the department's name for a futuristic kind of science.
Otorhinolaryngology-head and neck surgery (Oto-HNS) doesn’t exactly roll off the tongue. But the full name is important, because it describes the expanding scope of a specialty once known as ear, nose and throat (ENT). Today, the care provided by Oto-HNS doctors goes far beyond standard treatments for ear infections, sinusitis and tonsillitis. From cochlear implants to treat hearing loss to rhinoplasty and experimental therapies for head and neck cancers, the department is leading the way in a field that is constantly evolving. In fact, under the leadership of Strome, the department has been a study in positive growth and change. Only two years ago, Oto-HNS was the division of ENT within the department of surgery.
But as a division with a limited number of faculty members, it was becoming more difficult for physicians to simultaneously provide a wide range of cutting-edge care, conduct research and meet a growing student interest in the specialty. It was also becoming more difficult for the division to garner research funding and attract collaborators, especially when competing against medical schools with the resources that a full, autonomous otorhinolaryngology department could provide. Recognizing the need for growth, former dean Donald E. Wilson, MD, MACP, put plans in motion to expand the ENT division into a separate department.
To captain the transformation from division to department, Wilson recruited Strome from the Mayo Clinic College of Medicine, where Strome ran a large translational research program. From the outset, it was clear that Strome would chart his own course. In the spirit of the famous Star Trek mission statement, he would “boldly go where no one has gone before.” Rather than follow a trail someone else had already blazed, Strome created the Oto-HNS department to his specifications. “I developed a leadership team in the three areas on which I wanted to focus—research, education and clinical practice,” he explains. “I then empowered those people to make decisions and simply supported them.”
Strome and his colleagues have moved at warp speed to meet the ambitious clinical and research goals he set for the newly created department. Under Strome’s leadership, the faculty has grown to 15 with more on the way. “I identified both our strengths and weaknesses and personally directed recruitment to fill those areas of need,” says Strome, who also serves as chief of otorhinolaryngology at the University of Maryland Medical Center (UMMC). That commitment has paid off with a significant increase in research funding and exponential growth of their patient base.
Administration has been a large part of Strome’s job during this important expansion. But first and foremost, Strome is a dedicated clinician and scientist. He has a special desire to help patients with head and neck cancers, particularly those who have run out of treatment options. That desire to help is reflected in his research on “Trojan peptide” vaccines to treat squamous cell carcinoma, a common type of head and neck cancer. The goal is to learn whether the vaccines, which target specific proteins made by tumors, can stimulate the body’s immune system to destroy the cancer.
Made from peptides, or fragments of proteins found in select tumor cells, the vaccines are designed to slip into cells with the help of a “chaperone” that carries the bulky protein molecules through dense cell membranes, much like a “Trojan horse” bringing soldiers behind enemy lines before a surprise attack.
“We hope that these vaccines will stimulate the patients’ T cells, or immune cells, to recognize the proteins as invaders and seek out and kill the cancer cells throughout the body that produce the same proteins,” says Strome, who helped develop the vaccines.
Cancers of the head and neck—including those of the throat, mouth, larynx, sinuses, salivary glands and skin—are often difficult to treat and have a high risk of recurrence. Treatments include surgery, chemotherapy and radiation therapy. More than 40,000 people in the United States are diagnosed each year with head and neck cancer, and about half will die of the disease. Smoking has been linked to some cancers, but physicians are seeing an increase in this type of cancer in people who do not smoke.
“We have used the latest scientific knowledge to design these vaccines,” Strome explains. “We hope that they will help patients, which is always our goal, but we also know that the knowledge we gain from this study may, in the end, help us to design even better vaccines.” Funded by the National Institutes of Health, the trial is being conducted at the University of Maryland Marlene and Stewart Greenebaum Cancer Center. It is the first to use large Trojan peptide vaccines to treat cancer patients. The peptides in these vaccines are comprised of approximately 40 to 50 amino acids, compared with much smaller numbers in other vaccines.
“While the clinical impact of our vaccine is too early to assess, it is gratifying to think that we have restored hope in some patients and given them the tools to fight back against their cancers,” says Strome.
Such boundary-breaking research—fostered by Strome’s leadership—has contributed to the department’s growing national reputation. But like any good captain, Strome also has a crew upon which he can rely, both at home and at work. “My family is truly the highlight of my life,” he says. “I have a wonderful wife, Kimberlee, who in addition to being a terrific mother is the director of the pilates program at Life Bridge Health and Fitness. Together we have three wonderful children: Arianna (12), Sophie (10) and Max (8).”
While Kimberlee is in command at home, many people fill that role on the job. “I view everyone in the department of Oto-HNS as a partner in this endeavor,” says Strome. “To single out an individual would be to lessen the impact of the contributions of the group.” To Star Trek fans, that sentiment will sound familiar. To quote a scene from Star Trek II: TheWrath of Khan, “The needs of the many outweigh the needs of the few—or the one.” There is no question that Strome’s inclusive management style has helped to ease the complex transition from division to department.
Some of the involved doctors had their doubts when they first heard of the division’s impending change in status. “I did not appreciate fully what a huge impact it would make,” says Rodney J. Taylor, MD, an assistant professor of Oto-HNS at the medical school. “I thought it would be more of an administrative or financial arrangement that would not impact my career and practice. But I was dead wrong,” says Taylor. “We have been able to grow new programs and attract talent in both the clinical and research arenas that we never were able to before.”
One of the biggest advantages of becoming a department has been the higher profile it’s given Maryland researchers, both in Maryland and around the world. “Being a department has literally created regional, national and international relationships and collaborations for our research,” says Taylor. “It is amazing.”
Strome is the first to admit that building those opportunities has been a team effort. “This transition was undertaken with support from the dean’s office and the department of surgery,” says Strome, “and I am indebted to Dr. Wilson and Dr. Stephen Bartlett (chair of the department of surgery) for their support in facilitating this endeavor.” That support continues today under Dean E. Albert Reece, MD, PhD, MBA.
While his hands-on style has been critical to the department’s success, faculty members agree that Strome also knows when to step back and let others take the helm.
“Dr. Strome has an open-door and open-discussion policy about departmental decisions,” explains Jeffrey Wolf, MD, a head and neck surgeon who has been an assistant professor at the school since 2001. “We now have the autonomy to advance our clinical care and research programs.”
Wolf is taking full advantage of his new clinical and research opportunities. He recently received FDA approval to conduct a vaccine trial, using dendritic cells to try to stimulate the immune systems of patients with head and neck cancers. He is also investigating the causes and treatment of sinusitis and overseeing a clinical trial correlating sinusitis with tobacco smoke exposure.
This cutting-edge research has garnered media attention and raised the department’s national profile, but to patients, publicity doesn’t matter half as much as whether the doctors can fix what ails them. Jane (not her real name) recently had a health scare involving her thyroid. Located in the neck, it is one of the larger endocrine glands in the body. As a bride-to-be, Jane was already under enormous stress when her medical issues emerged to complicate her life even further. She sought out Strome for help. “He immediately made me feel at ease,” Jane says. “He knows how to use comedy to take your mind off the situation.”
Strome and his team also impressed her with their knowledge. “They were able to figure out very quickly what was wrong,” Jane explains. Fortunately, malignancy was ruled out early on. “It was such a relief to get an answer right away about what was going on medically; so I could get back to focusing on everything else going on in my life.”
The department currently oversees eight treatment programs at the medical center: the center for skull-base surgery, facial plastic and reconstructive surgery, general otorhinolaryngology, which includes treatment and management of pediatric ear, nose and throat problems, head and neck oncology, head and neck surgery, the hearing and balance center, speech/language pathology, and professional voice, which provides medical, surgical and rehabilitation services for individuals with voice problems and other disorders of the larynx.
Department physicians never know from one day to the next what their next patient challenge might be. “We see all sorts of folks, with problems ranging from earaches to advanced skull-base tumors,” says Strome. “These individuals are from all socioeconomic groups and geographic locations. I have several out-of-state patients who have followed me from Mayo, and others who are interested in our unique clinical trials or our cancer care program.”
All department physicians remain active in research and patient care, while also training the next generation of otorhinolaryngology-head and neck specialists at the school and medical center. “Now that we have clearly defined the structure of our educational program, we plan to nurture its development,” Strome says. “This will be done by promoting our residents’ learning initiatives, as well as their interpersonal and career development. It is incredibly gratifying to me to see the joy in our residents’ eyes as they expand their knowledge base, clinical skills and surgical acumen. As we foster our program’s development, we intend to maintain this spirit and graduate Oto-HNS surgeons who not only have the expertise to provide outstanding care, but the humanity to address their patients’ fears and the inquisitiveness to advance new knowledge.”
Students and residents aren’t the only ones benefitting from the way the department continues to push the envelope. “This is an exciting time to be at the department,” says assistant professor Thomas Le, MD, a facial plastic and reconstructive surgeon. “The opportunities to conduct truly innovative state-of-the-art patient care, research and education are enormous. Looking to the future, I see only continued tremendous growth, and this means outstanding patient care for the state of Maryland, the region and the nation.”
Strome plans to pilot his crew to continued success through further expansion of the department’s research enterprise and a commitment to translational research; so that lessons learned in the laboratory lead to new treatments for patients. Pro-viding support and mentorship for clinician scientists is also key to the success of the expansion. A senior scientist has been appointed to mentor both junior faculty and post-doctoral fellows. And Strome is developing close ties with other senior scientists throughout the university. “This effort has already paid enormous dividends in terms of both academic productivity and grant support,” says Strome.
Clinical programs will also remain a priority. “From a clinical perspective, we plan to work in partnership with the medical system to expand our program into the community,” says Strome. “This will allow patients throughout the state to receive Oto-HNS care by physicians affiliated with the University of Maryland, regardless of their location. We are also developing specialized programs of excellence, including a center for voice and swallowing, a center for balance and falls, and a center for skull-base surgery. These centers will incorporate skilled providers in multiple disciplines to enhance the patient care experience, facilitate dissemination of knowledge, and advance our understanding of specific disease processes. Finally, we are working in partnership with private practitioners within the community to facilitate referrals and provide seamless patient care.”
There is no question that Strome has set the bar high for his department. But there is one more goal he’d like to reach—a goal that is a bit more personal than his department’s success. It’s an ambition that says much about Strome’s zest for life, his desire to “live long and prosper,” as the Vulcan greeting goes.
“I love to play pick-up basketball,” he says with a laugh. “Although I am without question the worst player on the court, I think I have the most fun! I just wish, once in my life, that I could dunk!” Now that would be a bold move.
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