Every November 9th is National Microtia Awareness Day! With the Microtia and Atresia clinic being one of our centers for excellence at Vanderbilt University Medical Center, our clinic embraces November 9th in support of our patients every year! National Microtia Awareness Day is not just a national awareness day, but NMAD has become a recognized day of awareness around the world for the Microtia and Atresia community, including the medical professionals providing care to children and adults who have Microtia and Atresia.
National Microtia Awareness Day is a day to educate and promote awareness about Microtia and Atresia and the options for this rare cause. It is also a day for the community to come together and promote kindness and accept differences.
Here are some memories of National Microtia Awareness Day with our VUMC Microtia and Atresia clinic:
VUMC
Keeping Safe During COVID-19
Staying safe is essential. So is your health. We are also making things easier for all of our patients, including our D/HH patients and patients to the Microtia and Atresia clinic.
The Microtia and Atresia clinic and hearing center at Vanderbilt University Medical Center are making things easier for our D/HH patients. From our same day surgery program to our physicians wearing visible window masks and using tablets to help communicate well with our patients, we want to take every moment to make communicating with our D/HH patients as easy as possible. We realize that masks can get in the way of communicating, making it difficult to understand, causing muffled voices or preventing our patients from being able to read lips. We also realize that wearing a mask can be a challenge in general for patients who wear hearing devices or are missing ears. As a result, many of our physicians are wearing window masks and clear face shields. If you are still struggling with communication, just ask us to use a tablet and help make things better! We are also offering helpful suggestions on where to find masks that work best for you when you have Microtia and Atresia and also wear hearing devices or helpful resources on where to find masks may that work better for you.
The Vanderbilt University Medical Center’s audiology department has even taken on an extra hobby of making their own masks in order to help patients to see and hear them better with window masks. Kelsey Hatton, an audiologist at VUMC, realized her patients were having a difficult time hearing well when everyone was wearing a mask. At the start of the pandemic, she took it upon herself along with the help from some of her co-workers, to make masks that could help their patients hear their best and be able to see facial expressions and read lips. Dr. Hatton wanted to share her masks with everyone in hopes of making wearing a mask easier for both the hearing and D/HH community. You can see her make your own mask instructions below.
Making appointments: Your healthcare provider and you can decide together which is more comfortable for your. For your own safety, our facility is offering appointment care via telehealth services so you can still receive the care you need from your doctors. Our patients are of course still welcome to schedule for an in-person appointment when needing further testing or special care, but our facility will help guide you on what the safest steps to take are when coming in for a visit.
Below are some helpful tips and explanations on what Vanderbilt University Medical Center is doing to help keep you and everyone safe:
As we continue to manage the COVID-19 pandemic in our region and search for treatments and vaccines, we are here to provide vital care that goes beyond an illness caused by a single virus. We’re in this with you, to help you get the care you need, safely.
How Are You Keeping Me Safe?
- Everyone must wear a mask. This includes patients, visitors, and our staff.
- We take everyone’s temperature and ask questions about symptoms and exposure before anyone comes into our buildings.
- We’ve limited how many people who can accompany a patient or visit in the hospital.
- Our teams frequently clean and sanitize exam rooms and public areas.
- Waiting area chairs are spaced apart.
- Elevator capacity is restricted.
- Telehealth visits may be an option if you and your doctor agree.
Do I have to be tested for COVID-19?
Having COVID-19 can affect your recovery. People may be sick and infect others without appearing sick.
For your safety, we test everyone before admitting them to the hospital. This includes birthing mothers. We also test patients before scheduled surgery or procedures using general anesthesia.
A swab test is the best way to tell if someone has the virus that causes COVID-19. It detects genetic material from the virus. The test cannot tell if someone is immune to the illness or can make others sick.
We collect samples in 1 of 3 ways:
- A swab inside both nostrils
- A swab through one nostril to the palate above the roof of the mouth
- A swab through the mouth to the back of the throat
Inquire about our curb side assistance testing option.
The doctor and patient together will choose which method is used.
Vanderbilt Health currently only provides COVID-19 testing for our patients with symptoms or those without symptoms who are required to be tested before a scheduled surgery or procedure at VUMC. You may contact the Microtia and Atresia clinic at: MicrotiaAtresiaClinic@VUMC.org or call ph: 615-343-6166 for more information.
Here are some images of our Microtia and Atresia clinic staff masking up to help keep you safe!
Coronavirus (COVID-19) Information for Employees and Patients
This information is intended as a doorway to COVID-19 information for our workforce, our patients and visitors and our community.
Providing compassionate care for our patients, training the next generation of health professionals and advancing healthcare through research are important missions that must continue. Doing so safely is our highest priority.
Since before first case of COVID-19 in Tennessee was announced on March 5, Vanderbilt University Medical Center mobilized to help lead the response to the public health crisis. Our efforts include expert clinical care and testing, guidance on best practices to reduce the spread of the coronavirus, and research into treatments and vaccines.
On this site you’ll find:
- Latest news for our workforce, from changes in policies to inspiring stories about colleagues and messages from leaders. The “drop-down” list under the Latest News link at the top of the site takes you directly to other related content and articles.
- Information for patients and visitors, including a drop-down list of links to specifics including COVID-19 related billing, use of telehealth, and visitor policies. We also includes resources in Spanish and Arabic, the most common languages in addition to English spoken by our patients.
- Clinical guidance, where those taking care of patients can find the latest information about infection control and PPE, COVID-19 testing and treatment, and other clinical resources.
- Information for employees, including in the drop-down list resources for managers to help their teams. Here you’ll also find links to self care information and Shout Outs, our peer video messages of support.
- A link to resources for employers who are navigating the pandemic with their own employees.
Because this situation remains fluid, information is updated frequently. Members of the VUMC workforce should continue to watch MyVUMC emails and vumc2go for COVID-19 related news and notices.
Coronavirus (COVID-19) Resources
Hotline for Employees, Patients with Symptoms
If you are a Vanderbilt employee or patient with fever, cough or shortness of breath and are concerned about the coronavirus, call (888) 312-0847 to be assessed. This line is available daily, 8 a.m.-5 p.m.
General Resources
The Metro Nashville government, the Tennessee Department of Health (in collaboration with the Tennessee Poison Control Center), and the Centers for Disease Control and Prevention (CDC) offer resources for you to stay current. See the following for the latest status and recommendations.
- Metro Nashville’s COVID-19 Response Website
- Metro Nashville’s COVID-19 Hotline: (615) 862-7777, answered 7 a.m.-7 p.m. with information and assistance with assessment.
- Department of Health website
- COVID-19 Public Information Hotlines: (833) 556-2476 or (877) 857-2945, available daily, 10 a.m.-10 p.m.
CDC has launched coronavirus.gov, with information for the public. CDC also maintains a wealth of resources for health professionals.
Resources for Employers
The Employer Insights Blog offers information and resources to help employers keep their workforce safe and well during this unprecedented time.
Labadie, Rivas inducted into international otolaryngology collegium
Dec. 6, 2019, 11:05 AM
by Kelsey Herbers
Two Vanderbilt University Medical Center physicians were recently inducted into Collegium Oto-Rhino-Laryngologicum Amicitiae Sacrum (CORLAS), an international otolaryngology society created to facilitate collaboration and the open sharing of discoveries and ideas.
The society consists of members from 55 countries, each of which has a member quota on the number of clinicians that may be involved.
Robert Labadie, MD, PhD, professor of Otolaryngology-Head and Neck Surgery, was voted in last year as one of 20 total American representatives and was inducted during the 2019 annual meeting in Bern, Switzerland, in August.
Alejandro Rivas, MD, associate professor of Otolaryngology and associate service chief of Otology and Neurotology, was voted in this year as a representative of his birth country of Colombia. He will be inducted at the 2020 meeting in Santiago, Chile.
To become a member, nominees are presented by existing members from each country for final confirmation by the international membership committee. Membership lasts a lifetime.
“In my opinion, CORLAS is an ear, nose and throat (ENT) think tank where ego is checked at the door,” Labadie said. “The members are the thought leaders of ENT across the world, with most of the progress occurring during informal gatherings between and after scientific presentations.”
“Being part of CORLAS is one of the most important recognitions of my career,” added Rivas. “It is an honor to be part of the organization where all of the major advances in otolaryngology are discussed in an open and free manner by its members without reservation and in a collegial manner in order to continue moving those advances forward.”
Labadie and Rivas are the second and third VUMC representatives inducted into CORLAS, preceded by George Wanna, MD, who was inducted representing his birth country of Lebanon. Wanna now serves as site chair of otolaryngology at New York Eye and Ear Infirmary of Mount Sinai.
“Induction into the international collegium — with an extremely limited total membership — is an extraordinarily prestigious honor in our otolaryngology community. I have not heard of any other center having three inductees — especially in such a short time span,” said Roland Eavey, MD, Guy M. Maness Professor and chair of Otolaryngology and director of the Vanderbilt Bill Wilkerson Center. “We are immensely proud that Vanderbilt has been the home to such illustrious individuals. We salute them for such a special achievement.”
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A “Pendulum Swing” in pHDPE Implantation for Microtia and Atresia
Breakthroughs in medical science and patient care from Vanderbilt University Medical Center
A “Pendulum Swing” in pHDPE Implantation for Microtia and Atresia
A “Pendulum Swing” in pHDPE Implantation for Microtia and Atresia
JANUARY 22, 2019
Today’s pHDPE implants open doors to earlier reconstruction, 3D customization and other advances.
Porous high-density polyethylene (pHDPE) implants offer an increasingly reliable, adaptable option for microtia and atresia reconstruction, says Scott Stephan, M.D., a facial and plastic reconstructive surgeon and director of the Microtia and Atresia Clinic at Vanderbilt University Medical Center. Stephan is pioneering several innovative uses of pHDPE implants at Vanderbilt. These include 3D-printed implants and advances in complex, combined atresia-microtia (CAM) surgery.
“The gold standard has been rib reconstruction for the last half-century, but the pendulum is swinging — quite rapidly,” Stephan said. “The recent advances in porous polyethylene have been a paradigm shift in terms of consistency and results.” First marketed as Medpor in 1983, pHDPE implants are now produced by multiple companies.
In the 2018 edition of Facial Plastic Surgery Clinics of North America, Stephan and co-author John Reinisch, M.D., outline a number of advantages of today’s pHDPE implants over autologous rib or other, non-pHDPE alloplasts. pHDPE implants can offer earlier reconstruction, fewer procedures, avoidance of donor site morbidity, shorter learning curves and improved size and contour match.
3D Printing
“A ‘perfect’ ear may not meet the needs or goals of our patients.”
Stephan and colleagues at the Microtia and Atresia Clinic have begun exploring use of 3D printing to augment standard model implants. “One exciting application of 3D printing is to customize standard pHDPE implants,” Stephan said. “Many microtia and atresia patients have associated craniofacial abnormalities, so that is a big issue.”
Perhaps counterintuitively, the goal of an augmentation is often “irregularization” of a standard implant. “Think about that: a ‘perfect’ ear may not meet the needs or goals of our patients,” Stephan said. “The 3D printing allows us to augment a standard implant so it truly fits that unique patient.” As a reconstruction material, pHDPE can be modified easily with a scalpel or by soldering on additional pieces.
3D printing can be used to create entirely custom implants. “In the past year, we’ve created custom implants for several patients based on CT data of their opposite ear,” Stephan said. “For those patients with unilateral microtia, it’s an exciting option that’s here right now. It’s happening.”
One advantage of a 3D-printed, custom implant may be added strength. Theoretically, a single structure not requiring fusion will be stronger than a fused two-piece implant.
Scott Stephan, M.D., discussing outer ear reconstruction with a family.
Combined Atresia-Microtia Reconstruction
Traditionally, patients with CAM requiring outside ear reconstruction with pHDPE and formation of a new ear canal will face two separate procedures. Canalplasty is typically followed by a later outside ear repair with pHDPE. In the past decade, however, a handful of specialized microtia and atresia clinics including Vanderbilt’s have begun to offer CAM surgeries using preformed pHDPE implants as a single, outpatient procedure.
“It’s a long day,” said Stephan, who performs CAM surgeries in collaboration with Vanderbilt atresia and canalplasty specialist Alejandro Rivas, M.D. “However, it allows that child or adult to accomplish both their goals in one surgery. For pediatric patients, in particular, it means we can deliver the external ear reconstruction and the hearing restoration before they reach kindergarten or the first grade, ideally. There are a variety of psychosocial benefits to that earlier approach.”
Stephan notes that the CAM approach also offers less time in recovery, less exposure to anesthesia in total and a reduced care burden for patients and their families. “Our center has focused on improving the consistency and predictability of our results. For example, with CAM surgeries, we have developed new techniques for joining the neo-canal with the bowl of the external ear that heals faster and therefore prevents it from closing down — a problem that has plagued many in the past.”
Global Microtia-Atresia Patient Community
As microtia and atresia patients around the world gain more access to online research, images and videos, Stephan anticipates increasing interest in the options now available at specialty centers like Vanderbilt’s.
“With increased connectivity around the globe, patients are coming from farther to seek the best ear results,” he said. “So, with porous polyethylene reconstructions in particular, patients are coming from Europe because the European body has not yet universally embraced this approach. It’s just that the results we are attaining in microtia reconstruction are so tangible — can be seen so clearly in a photo or video—as opposed to some medical conditions.”
Availability of pHDPE implants internationally will grow, Stephan believes, as the technology and surgical expertise become more widely disseminated: “The conversation changes, but it will take time to reach locations across the country and around the world.”
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OTOLARYNGOLOGY Expanding Options for Children with Atresia
Breakthroughs in medical science and patient care from Vanderbilt University Medical Center
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MAY 08, 2019
Innovations in robotic canalplasty and active bone conduction implants.
One in 10,000 to 15,000 babies are born with aural atresia—an extremely narrow or absent external ear canal, often accompanied by microtia, a malformed auricle. Options for these children historically consisted of a bone conduction implant with a soft exterior band until age five, followed by either three to four reconstructive procedures to open the ear canal and rebuild the auricle, or a percutaneous implant for those who were not reconstructive surgery candidates.
Computer-assisted robotic canalplasty has the potential to optimize the complex surgical procedure, lowering the risk of damage to critical structures in the region and increasing odds that the ear canal will remain unobstructed. At Vanderbilt University Medical Center, Alejandro Rivas, M.D., director of endoscopic ear surgery, and Robert Labadie, M.D., vice chair of research, are developing a customizable drill technology for robotic canalplasty to refine this approach.
Rivas and Labadie are also working under an industry grant to investigate a transcutaneous active bone transmission device, the Bonebridge®, that received de novo FDA clearance in July 2018 for ages 12 and up. The implant requires only one procedure and resides under the skin—surgically attached to the mastoid bone. The Bonebridge® is magnetically bound to an external processor, and offers hearing outcomes comparable to those of percutaneous devices.
Making Atresia Repair Safer
Atresia is correctable by surgery in many, but not all, patients. “As long as the child has functional hearing ossicles, a middle ear space and inner ear, we can usually attempt the surgery,” Rivas said. The risk level hinges primarily on whether the patient already has a small channel that ends in a blind pouch, or no ear canal whatsoever. Other considerations include the position of the facial nerve and other soft tissues (e.g. blood vessels, brain) as well as the body’s attempt to close the channel as part of healing.
To lower surgical risks, Labadie and Rivas are developing a patient-customized drill template for use with robotic canalplasty. When used with CT imaging, the device is intended to provide a more precise guide for extending or creating an ear canal.
“Using CT guidance, the software maps the location of the facial nerve and other tissues to be avoided and charts the best path from the outside to the location of the new ear drum,” Labadie said. “We can then mount a drill on the customized drill guide to follow that path.”
Rivas and Labadie are testing this technology on cadavers and expect to compile the data for an FDA Investigational Device Exemption submission.
New Options
Many children with atresia who aren’t candidates for ear canal surgery can still attain near-natural hearing through implants. Percutaneous passive implants entail an abutment protruding through a permanent hole in the skin and a processor that snaps on and off. Transcutaneous passive devices are entirely under the skin and conduct acoustic signals through magnets on either side of the skin barrier.
While transcutaneous options avoid an external wound, thicker skin can impede hearing quality. The newly FDA-approved Bonebridge® (transcutaneous active) device solves this issue in a novel way. It retains the magnetic contact on either side of the skin, but adds an amplifier to the implant, compensating for amplitude lost in transit through the skin.
Vanderbilt is working with three other centers on a clinical trial of hearing outcomes in adults with the Bonebridge®. Because active bone conduction implants optimize both hearing and cosmetics, Rivas and Labadie are enthusiastic about their prospects for expanding patient benefits.
“Choice of treatment options is so important.”
“Choice of treatment options is so important because there are so many malformation variations and different options for them,” Rivas said. “A child who plays physical sports might need the percutaneous device that won’t slip off. Another child who loves to swim might do better with transcutaneous devices they can take off when they go in the pool.”
Rivas and Labadie are also planning a study investigating the Bonebridge® device for children as young as five years old. “If we can provide this procedure to a younger child, we may be able to avoid complications like skin infections from the percutaneous devices, while providing optimal hearing and good cosmetic results,” Rivas said.
Vanderbilt is one of three centers testing the BONEBRIDGE® implant for mixed or conductive hearing loss, currently being tested in adults. Image provided by MED-EL.
About Bill Wilkerson Center for Otolaryngology
Vanderbilt’s Bill Wilkerson Center for Otolaryngologyoffers all FDA-approved options available today for hearing rehabilitation and is unique among U.S. centers in offering comprehensive options for combined atresia and microtia repair.
Click here for the complete article.
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Dr. Scott Stephan travels to Guatemala to help children who have cleft palates and microtia
This February, Dr. Scott Stephan and a surgical team traveled to Guatemala for the 6th year in a row with the FINN Foundation, a organization in conjunction with the Face To Face Foundation — the humanitarian division of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS).
Every year, Dr. Stephan helps children on this mission trip who have cleft lip, palate, cleft rhinoplasty deformities and … microtia!
Vanderbilt’s Ron Eavey collaborates on genetic research for Microtia
Dr. Ron Eavey, Director of the Vanderbilt Bill Wilkerson Center for Otolaryngology and Communication Sciences and the Guy M. Maness Professor and Chair of the Department of Otolaryngology in collaboration with Dr. Jonathan Seidman of Harvard University’s genetics department, had a grant application that was selected through the Gabriella Miller Kids First Pediatric Research Program titled, “The Genetics of Microtia in Hispanic Populations” to go forward, as part of the 2018 sequencing pipeline. The program will support the genetic sequencing of approximately 400 samples. The grant awarded will provide sequencing done by the Broad Institute of MIT & Harvard. Drs. Eavey and Seidman hope to find a gene in common that may lead to causing Microtia.
Ear Community at the FDA
Ron Eavey, MD, Guy M. Maness Professor and chair of Otolaryngology and director of the Vanderbilt Bill Wilkerson Center, far right, testified recently at the Food and Drug Administration in Washington, D.C., along with members of Ear Community. They are, from left, Nathaniel Mendoza, Melanie Mendoza, Daniel Mendoza, Melissa Tumblin, Camilla Gilbert and John Savage. Ear Community is a nonprofit organization that supports children and adults who are born with microtia (underdeveloped ears) and atresia (absence of ear canals resulting in hearing loss).
Scott Stephan, M.D., honored to be editor for the 2018 edition of Facial Plastic Surgery Clinics of North America book
Dr. Scott Stephan of Vanderbilt University Medical Center, ENT, was honored to be asked to editor for the 2018 edition of Facial Plastic Surgery Clinics of North America book for “Cosmetic Reconstructive Surgery of Congenital Ear Deformities.” The book discusses reconstructive options for the outer ear along with the discussion of multiple surgical techniques. This book was published during February 2018.