The triological society and its research legacy

Research is an important part of the Triological Society. Since its inception in 1875, the Society has required scholarly contributions for membership, and since 1900 these investigative works have been in the form of a thesis—an original creation—usually of a clinical or basic science nature. It is understood that these theses are “comprehensive dissertations on clinical or research aspects of otolaryngology–head and neck surgery, presumably adding knowledge to our healthcare in otolaryngology.” Our vibrant membership and thoughtful leadership attests to the importance of the thesis and research in the Society. It is also expected that members who complete the requirement of a thesis will continue to provide significant contributions to the organization. There is evidence of this participation as seen in the regional and annual meetings, but if one looks closely, there is only a small proportion of members who carry on research activity after the thesis is accepted. In fact, in spite of generous research grants totaling $2.5 million since 1994, there were only a few recipients of awards who were members of the Triological Society. One should not expect research to be important and flourish because one says so. However, there are many reasons for us to support research. Probably the most important argument is that research provides for new methods of diagnosis and treatment. Let us take a look at some of those advances as a result of research that have occurred in the last few decades. In otology there was the development of modern otological microsurgery based on the understanding of the anatomy and physiology of the ear. There was also the development of cochlear and auditory implants and the sophisticated hearing aids that are now available. The understanding of the electromotility of the hair cell has led to tests of spontaneous otoacoustic emissions, providing major screening capabilities. Moreover, there have been great strides in the understanding of genetic deafness, setting the stage for a better understanding of risks, improved counseling, and the possibility of future intervention. In cancer there has been the development of biomarkers, although early in application but with great potential to determine the stage and predict outcomes of treatment. The [18F]-fluorodeoxyglucose–positronemission tomography scan has greatly affected our ability to diagnosis new and recurrent tumors. Chemotherapy in conjunction with radiotherapy has resulted in improved survival of several head and neck cancers allowing for organ preservation. The advent of the robot has affected changes in surgical procedures, providing access to anatomical areas that were difficult using traditional methods. Rhinology thrives now on new imagining techniques and an improved understanding of allergy and inflammation. The research on immunoglobulin E was critical in the development of in vitro testing. Studies of mucociliary clearance have been the basis for the development of functional sinus surgery. In laryngology, studies in physiology have been instrumental in the development of phonosurgical techniques. Research on biocompatible implants has resulted in improved methods of phonation and prevention of aspiration. Imaging has also played an important role in health care for our specialty. Image-guided procedures provide for access to head and neck areas previously off limits. Magnetic resonance imaging scans continue to improve and are now capable of revealing the functions of anatomical structures. In plastic and reconstructive surgery, improvements are seen in microvascular surgery, rigid plating, and implantation of materials now tolerated by human tissues. There is also much enthusiasm for the development of tissue engineering and even generation of organs. Yet we are still not accomplishing what is possible. According to recent repents on grants and grant funding, there appear to be few, if any, coming out of our specialty. According to some reports, many faculty are poorly trained for research, and in many training programs there are insufficient funds, inadequate training, and outdated facilities to support the research mission. Moreover, there are few grants being submitted by otolaryngologists. In 2006, there were 45 RO1 grants at the National Institute on Deafness and Other Communication Disorders (NIDCD), and only 5% were held by otolaryngologists. In 2005, there were 17 K grants approved by the NIDCD, and only eight were awarded to otolaryngologists. These reports have prompted a number of articles on the clinical investigator as an endangered species. What can be done to improve the numbers and quality of researchers in our specialty? Many experts have commented on the best way to stimulate and train researchers. Most agree that the initial exposure for research must be early and positive. Medical school or even earlier seems like a good place to start, and according to Neinstein and MacKenzie, the experience must be positive and continue throughout residency and fellowship. The length of training is somewhat controversial. Although there are a few examples of excellent researchers with limited training, most agree that a least 2 and preferably 3 years of dedicated training is important in developing the competitive clinical investigator.