A Day in the Life of an Academic Neurotologist

Session 148

Have you heard of the specialty Neurotology? Today, we have Dr. Walter Kutz, an ENT trained physician who subspecializes in Neurotology.

Dr. Kutz is currently the Director of the Neurotology Fellowship and Associate Director of the Otolaryngology Residency Program at UT Southwestern Medical Center. Today, he talks about his specialty, what he does day-in-and-day-out, what he doesn’t like about it, why he chose to be in an academic setting, and more!

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Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[01:55] What Got Him Interested in Otolaryngology

In medical school, Walter enjoyed anatomy, but especially when they got to the head-neck section of anatomy. He found it fascinating to dissect the neck, all the intricate structures, and just a small compact area. They spent maybe a half a day or less probably on the ear anatomy.

As a musician, Walter found ear anatomy pretty interesting. He stumbled upon this in the anatomy lab and thinking of how nice it would be to operate on the ear.

“A lot of medical students do not get exposure to learn otolaryngology, and if they do, a lot of times it's pretty late in their training.”Click To Tweet

Otolaryngology is not really part of the rotations so not many students get exposure to this. It’s a competitive specialty so you want to have had done some research and things outside of just a normal classroom. Walter initially thought otolaryngology was this general practice with a little more slant on allergies and nasal problems.

Neurotology is a very broad field that combines surgery with medicine and they’re a specialist on the head and neck. Fortunately for Walter, he was able to learn early about this into his second year of training that this specialty existed. And with that interest in head and neck anatomy, and his interest in music, he thought it would be a perfect specialty for him.

[03:46] Traits That Lead to Becoming a Good Otolaryngologist

You definitely have to enjoy surgery. You have to enjoy work with your hands, and be able to deal with the stresses of surgery such as times when things don’t heal properly or complications.

Obviously, you have to have an interest in medicine. A lot of what they do is clinical, not necessarily surgical. But it’s a very nice mix of surgery and medicine.

“For the field of neurotology, most of the surgeries are with a microscope, fine pics, and drills so you have to enjoy detailed work.”Click To Tweet

Especially for neurotology, you have to be able to look under the microscope for 7-8 hours a day, which is pretty taxing for most people. Yeah. So if you have those sorts of interests and skills, it’s a good specialty to consider.

[04:48] Types of Patients

Walter’s interest in music really allowed him to pick a field where he could help people hear better.

In neurotology, the majority of the work is to improve people’s hearing. They also treat things skull-based disorders such as tumors, most commonly in acoustic neuroma. They also address facial nerve disorders and tumors of the facial nerve. Because balance is part of the inner warm we are also specialists of balance. Looking at his interest in music and communication, it was a good specialty for Walter.

About 30% of Walter’s practice is pediatric and 70% are adults. From a hearing standpoint, a significant part of what they do is cochlear implants. They implant young kids, even as young as one year of age or even younger as well as older patients. They really take care of patients from birth all the way until even 100 years old.

For the deaf community, a lot of the patients are self-selected. But a child born to deaf parents, they won’t seek a cochlear implant or really won’t seek help. The vast majority of his patients are going to be especially pediatric – kids that are born deaf to hearing parents. Most causes of congenital hearing loss are going to be an autosomal recessive disorder. So it is almost self-select. He has rarely seen deaf children that are born to deaf parents, probably for that very reason that they wouldn’t be as interested in a cochlear implant.

[08:12] Surgical Procedures

Walter reveals that general otolaryngology is a very broad field. A lot of general otolaryngologists will do ear surgery which are similar surgeries that he does. Depending on their training and their comfort level, they may do more advanced or less advanced surgery.

A general otolaryngologist also does a lot of sinus surgery – head/neck surgery like thyroidectomy parotidectomy. They’re actually trained to do facial plastics so about a quarter of their training is faciall plastics so they may do skin lesions. Depending on their training, they may do blepharoplasty and rhinoplasty.

If you go to a good training program, which most training programs are excellent, you can come out and really practice whatever interest you have, whatever comfort level you have.

“General otolaryngology is a very broad field from a surgical standpoint.”Click To Tweet

[09:02] Typical Day

Walter has two days of clinic and two days of operating room. His clinic days start around 730 or eight, usually done by four. By the time he does all his charting, he’s done by five.

Walter sees I’ll see about 8-10 new patients. He also sees about 20 follow-up patients with maybe post-operative or patients with Meniere’s disease which is a recurrent cause of vertigo or other medical problems.

Typically, he’ll do three to four surgeries and that could range from a cochlear implant, repairing a tympanic membrane perforation, removing a cholesteatoma, which is a skin cyst that can migrate in the middle ear.

They do surgeries such as removing facial nerve tumors that are less common. They also do a fair amount of acoustic neuroma surgery. These are longer cases that they work with neurosurgery. They average about two days a week.

Then fifth day could be their operating or they could have their academic administrative time, not vacation time. So they still have to work five days a week.

[10:10] Taking Calls

Walter is in a big academic practice. There’s over 30 of them so he takes about three weeks a year, typically for calls on the weekend for the entire service. Then if any emergency comes in and the needs of the operating room were available, that could be an urgent airway, it could be neck abscess, and those are the sort of typical emergencies you see in otolaryngology.

In neurotology, they don’t really have too many emergencies per se. But for the calls that he takes for their entire group is about three weeks a year.

[10:54] Academic vs Community Setting

Walter chose the academic route because he really enjoys working with residents and medical students teaching. He enjoys being involved in clinical research. And as the program director for their fellowship and the Associate Program Director for their residency, he enjoys organizing and building things which is what the academics give you

“If you enjoy administrative, research, clinical, or teaching, you can figure out whatever works best for you and pursue to make that work.”Click To Tweet

[11:50] Life Outside of the Hospital

Walter admits that sometimes it gets somewhat exhausting. It’s more stress, trying to get everything done. But he gets home by 5-530. Most evenings, he’s able to coach his girls’ softball teams which he has done for about eight years now. He has watched most of his son’s golf tournaments on the weekends.

One nice part about academics is, if you do clinical research and you get to know people, you’re invited to meetings. Some of these meetings are international, so he gets to travel which he really enjoys. Ultimately, Walter thinks it’s a very good balance between a fulfilling career and then a really nice outside life.

[12:46] The Training Path

You have to complete a five-year Otolaryngology residency. And then at around your fourth year, you determine what subspecialty if you’re going to do a subspecialty. About half of their residents do a fellowship. Neurotology is another two years of training.

“In otolaryngology, there are two sub-specialties recognized by the American Board of Otolaryngology – Neurotology and Pediatric Otolaryngology.” Click To Tweet

To get their certificate of additional qualification, you have to do a two-year fellowship. So it is an additional two years ends up being seven years total.

Facial plastics isn’t really recognized by their board. So if you’re going to primarily practice Facial Plastic Surgery, you can do a facial plastic fellowship, which is cost-share between plastic surgeons and otolaryngologists and other specialties but it depends on your subspecialty.

Otolaryngology is a competitive field. It waxes and wanes but it’s is probably the top three to five most competitive specialties. This year, for instance, they had about 450 applications and out of those, they only match four. So it’s a competitive specialty.

[14:44] Thoughts on Going Pass/Fail and How It Affects the Interview Process

Realistically, they would not really want to use a step one score. Some medical students will have more time to study than others, depending on the medical school.

“The fact of the matter is the applicants are very competitive, which is great for medicine, but it's difficult if you're an applicant.”Click To Tweet

So they wouldn’t particularly place a lot of weight to the score, but they would take that into some consideration, just because you have to have some objective finding to differentiate applicants.

With the pass-fail, they’ll just have to work around that. They will still be able to choose applicants that’d be a good fit for their program, but it’s going to present some challenges.

[15:42] How to Be Competitive for Matching

“If you're going to match in a competitive specialty like otolaryngology, you really need to be involved with research.”Click To Tweet

You need to show that you have an academic interest. Walter recommends finding a mentor as early as you can. You don’t necessarily have to publish or have a lot of papers published, but you do need to have some papers pending.

You need to show that you’ve done some clinical research or even basic science research, which is more difficult in training.

Any opportunity to present even as a local meeting is great and important. Otherwise, it would be difficult to match in otolaryngology if they had no research or no presentation experience. So that’s the number one thing he would recommend.

[16:31] Message to Osteopathic Students

For DO students interested in this field, again, you may have to do a little extra research. One of the challenges is your institution may not have an otolaryngology department.

That’s okay if you do research in any specialty as long as it’s high-level, high-quality research. Then they know that you understand, you’re curious, and that you understand how to perform research. It really doesn’t have to be otolaryngology.

The other thing that would be important is to do some away rotations. Maybe choose two or three programs you’re interested in. In most of the programs including theirs, you can do a four-week away rotation. That’s really a time for you to have a four-week interview, to basically shine and show them that you’re going to be a good resident there.

“An away rotation can be very helpful to make you more competitive.”Click To Tweet

[18:19] The Most Important Part About an Away Rotation

If you want to rotate, you want to have read all the cases and read about all the inpatients. You’re not going to get every question that the faculty had asked but you want the resident to know that you’re reading and you’re very engaged.

The other component is that you want to be curious. You want to ask questions. You want to be engaged, but you don’t want to do that too much. You don’t want to be saying things just to get attention. There’s definitely an art form to that.

[19:23] Message to Future Primary Care Physicians

Primary care physicians need to understand that otolaryngologists are here to help with conditions they may not be as comfortable with.

So just feel free to reach out to an otolaryngologist and ask them what sort of patients are appropriate from an otolaryngology/neurotology standpoint.

A lot of primary care doctors, and most of the population, are not aware that cochlear implants are available. And that patients that have significant hearing loss can still struggle with hearing aids. At this point, they’re able to place a cochlear implant even in those patients where they can be helped tremendously above even just a hearing aid.

“The awareness of the possibility of cochlear implants is something that the medical community and patients don't understand.”Click To Tweet

[20:46] The Most and Least Liked Things About the Specialty

Walter enjoys seeing how his patient’s quality of life has improved. He’s really most excited about the future of the specialty especially with cochlear implants and implantable hearing aids. And in treating tumors such as acoustic neuroma, instead of having to do these large surgeries, they could treat these with radiation therapy, which he’s also involved with.

So with their specialty having a lot of future growth and the technology, it’s going to really progress along, improving quality of life.

There’s nothing more satisfying than a four-year-old that you place a cochlear implant when they’re one year of age and now they’re talking.

“When you pick a specialty, you need to determine what is a common symptom or complaint that you're going to see that may be challenging.”Click To Tweet

Walter explain that of course, they want their patients to get better but it’s difficult to treat these patients sometimes. A lot of times, it may be a neurological problem or anxiety and things like that. Hence, one of the challenging things about neurotology is treating people with these chronic medical conditions that don’t have an easy fix.

[24:10] Final Words of Wisdom

If Walter had to do it all over again, he would still choose the same specialty.

Finally, Walter wishes to tell students who might be interested in this field that although it’s competitive, that’s no reason to get discouraged.

Just make sure that you’re early in your medical school training and you’ve done well with your grades. Focus on your research. Maybe do some away rotations and you need to get into that otolaryngology program.

Fortunately, the vast majority of otolaryngology training programs are excellent. Many of them will give you the opportunities to pursue fellowships such as neurotology and laryngology. The main thing is to get into otolaryngology residency then see what is most interesting.