Fellowships

This fellowship consists of 60% clinical and 40% research components.

The clinical component encompasses the whole of otology and neurotology, including middle ear disease and surgery, hearing reconstruction, skull base surgery, cochlear implants, implantable hearing devices, vestibular disorders and medical hearing disorders, in both adults and children.

The research component studies middle ear mechanics, vestibular testing, gait testing, hearing handicap measures, as well as clinical research.

Please note, that although we have a large skull base volume, including a large NF2 population, our philosophy of management is increasingly conservative management and stereotactic radiosurgery. We now perform only about 5-10 skull base surgeries per year specifically for acoustic neuroma. However, the Fellowship will equip the fellow to look at the full range of management options for skull base tumours.

Our current volumes of cochlear implants and BAHAs are approx 25 per year. We expect the fellow to work harmoniously with the residents. 

Vestibular Disorders
The objectives of this component are to develop a standardized approach to dizzy patients that will make the fellow comfortable, efficient and accurate in the diagnosis of vestibular disorders. You will participate in the Balance Clinics, which are run regularly. These clinics have a standardized approach to vertigo and balance disorders, with a data collection sheet, standard history and physical examination tools, and database of patients for research and audit. This is a teaching clinic to allow for discussion and teaching. We have access to rotation chair, posturography, gait analysis and other vestibular testing tools. You are expected to spend one week of your fellowship in hands-on training doing electronystagmography, rotation chair testing and posturography testing. The fellow will be involved in surgery for vestibular disorders such as Gentimicin ablation, vestibular nerve sections, labyrinthectomies, posterior canal occlusions, middle fossa approach to superior canal resurfacing and endolymphatic sac decompressions.

Middle Ear
The bulk of the clinical volume consists of middle ear pathology. Many, if not most, are tertiary referrals and revision cases. The fellow will participate in the evaluation of patients with middle ear disease in clinics. You will gain experience in the clinical evaluation, radiologic interpretation of CTs and MRIs of the temporal bone, and audiometric evaluation of these patients. Surgically, the fellow will be involved in complex middle ear surgeries such as ossiculoplasty, stapes surgery and some revision mastoidectomies. Less involved cases will involve the resident staff, and the fellow may act as a teaching resource for them. The principles and practice acquired in the middle ear mechanics laboratory will be applied in the operating room.

Skull Base
The fellow will be a part of the Lateral Skull Base clinic, directed by Dr. Morris with participants from Neurosurgery. This clinic sees pooled patients with lateral skull base tumors or pathology. Management is arrived at in a consensus fashion by discussion of each case. This is a teaching clinic. All patients are entered into a skull base database. Surgically, the fellow will be involved in all transtemporal surgical approaches to the brainstem and cerebellopontine angle, and in the intracranial surgery of acoustic neuromas. You may be involved in the supervision of residents in the earlier parts of these procedures.

Cochlear Implant
The fellow will be involved in the multidisciplinary team assessment clinics for cochlear implants in both adults and children. You will partake in the decision-making process and will be expected to attend several programming sessions for cochlear implant recipients. Surgically, the fellow will be involved in the insertion of cochlear implants, and will share this surgical opportunity with the residents. 

Bone Anchored Hearing Aids (BAHA)
The fellow will be involved in the selection, surgery and follow-up of BAHA patients, both adult and pediatric. You will be expected to attend the audiologic assessment with “bite bar” trials, and the teaching sessions on care and use of the BAHA Medical Otology. You will participate in general otologic clinics and be involved in the assessment and management of a wide variety of general otologic problems including noise-induced hearing loss, ototoxicity, congenital hearing loss, otalgia, eustachian tube problems, the draining ear and others.

Hearing rehabilitation
The fellow will attend sessions in hearing rehabilitation counseling with the audiology staff at the QEII Health Sciences Centre. In the clinic setting, you will be involved in discussions on hearing rehabilitation strategies.

Tinnitus 
The fellow will attend several tinnitus evaluation and treatment clinics through the year with Mark Gulliver, an audiologist at QEII HSC who has a focused interest in this area.

Temporal Bone Laboratory
The fellow will have an opportunity to practise surgical drilling and skull base approaches on cadaveric temporal bones in the temporal bone drilling station located at QEII HSC. 

Forty percent of the fellow's time would be devoted to research, usually structured as about 2 days per week of protected time.

Middle Ear Mechanics Laboratory
This will be a mandatory component of the fellowship research experience. Projects here will focus on hearing reconstruction issues in the middle ear.

Audiologic Projects
Projects focusing on auditory evoked potentials and sound-field hearing handicaps will be performed in conjuction with faculty in the School of Communication Disorders.

Audiology
MSc students will be involved in many of these projects.

Clinical Databases
Databases are kept in the Lateral Skull Base Clinic, the Balance Clinic, as well as a Meniere’s Disease Database. A surgical database of all middle ear reconstructions is also kept. These will form the basis of retrospective reviews and audits.

Clinical Projects
Several clinical projects are available for investigation, many of which are focused clinical projects that could be performed within a three- to six-month time frame.

Presentations and publication
You are expected to present at least two papers at meetings, and publish at least two research and two clinical papers during your fellowship. 

Teaching/learning component 
The fellow will be involved in teaching the core otology resident teaching program, with assistance of faculty—a great learning opportunity. You will also have opoortunities to teach during clinics and OR time. You will also attend divisional rounds and be involved with formal coursework. 

Clinical duties
The fellow is treated as a semi-staff role, and there is usually a very friendly and informal relationship between the fellow and your supervisors. We expect the fellow to challenge us, and to blossom as an otologist during your time here.

Candidates will have a medical degree from an accredited university. You must have completed at least three years of an approved residency program in otolaryngology. You must also have demonstrated evidence of academic interest in neurotology through publications, presentations, and references from research or clinical faculty at sponsoring universities.

For information on how to apply for the Fellowship in Otology, Neurotology & Skull Base Surgery, please contact:

Dr. David P. Morris, Fellowship Director
Email: dp.morris@dal.ca 
Phone: 902-473-1986 

Mailing Address: 
Room 3037, 3rd Floor Dickson Building
5820 University Avenue
Halifax, Nova Scotia, Canada B3H 1V7 

The objectives of the Fellowship in Head & Neck Oncology/Reconstructive Microsurgery are:

• to provide expertise in the multidisciplinary management of head and neck cancer patients
• to practise effectively in a multidisciplinary tertiary care environment
• to develop competence in microvascular head and neck reconstructive surgery
• to develop skills in transoral laser microsurgery for head and neck cancer
• to develop an expertise in endocrine surgery of the head and neck, namely thyroid and parathyroid surgery
• to obtain broad-base knowledge and comprehensive principles in the management of head and neck cancer, including exposure to radiation oncology, medical oncology, maxillofacial prosthetics, oncologic nutrition, speech rehabilitation and diagnostic radiology
• to achieve competency in the management of head and neck skin cancer as well as the reconstructive options for various defects of the face, head and neck
• to develop expertise in the management of patients with facial paralysis
• to participate in the education of residents and medical students and to develop expertise in medical education

The fellow will spend one day per week in the Head and Neck Oncology Clinic under the guidance of the three preceptors. You will also be expected to be present for Tuesday ward rounds for various head and neck oncology inpatients where case management is discussed in detail. The fellow will also be expected to attend Head and Neck Oncology Tumour Board, which is a multidisciplinary team approach to new head and neck cancer patients seen at our institution.  

From a surgical standpoint, the fellow will have at least three to four days per week in the operating room. You will be expected to supervise both residents and medical students with basic head and neck oncologic procedures as well as endocrine surgery of the head and neck. You will be incorporated into the call schedule at the discretion of the Fellowship Director and of the attending staff in head and neck surgery.

The research goals of the fellowship are extensive. The fellow will be expected to present and publish two articles in a peer-reviewed journal in our specialty. You will also have the opportunity to develop your research skills in basic science. Currently we have a molecular biology lab that we operate in conjunction with the National Research Council of Canada.

There will be an opportunity to pursue detailed research in the area of transoral laser microsurgery.  The fellow will also have the opportunity to work with residents and medical students in our training program on various clinical research projects. Research goals will be set on a yearly basis by the Fellowship Director. 

The head and neck oncology fellowship runs parallel to our residency training program. The fellow will be designated to all free flap reconstructions of the head and neck. The fellow will be expected to harvest, inset and to perform microvascular anastomosis on all reconstructive microsurgery cases. Head and neck ablative surgery will be done in combination with one of the senior residents on the service and the attending head and neck oncologic staff. The fellow will be involved in oncologic ablations if it is felt to be at a level that is above that of the designated senior resident. The fellow will also be involved in various skull base resections of the head and neck given if this is felt to be, once again, outside the normal training realm for a senior resident in Otolaryngology-Head and Neck Surgery.

On the ward the fellow should function independent from the resident staff. The residents do not round in conjunction with the fellow. The fellow, however, will be responsible for all advanced head and neck oncology reconstructive cases and will report directly to the staff regarding patient progress and plans for discharge.

The fellow will be invited to participate in various academic affiliated programs in the Division, will attend weekly grand rounds and any educational seminars on head and neck surgery and facial plastic & reconstructive surgery. The fellow may be given the task of teaching the residents based on their previous experience. 

Fellows will be paid at the PGY6 level and will be offered financial support to present at a minimum of one scientific meeting during the course of the year. Financial support might also be arranged for one course during the one-year term of the fellowship. (A course dedicated to reconstructive microsurgery of the head and neck currently is recommended.) The fellow will also receive administrative support from the Fellowship Director and from the other staff members involved in the head and neck oncology program.

Dr. Jonathan Trites, Dr. Matthew Rigby, Dr. Mark Taylor and Dr. Martin Corsten are involved in the day-to-day activity of the fellowship program. 

Please forward applications and inquiries to:

Dr. Matthew Rigby – Fellowship Director
Suite 3044
3^rd Floor Dickson Building
5820 University Avenue
Halifax, NS  B3H 1V7

mhrigby@dal.ca

• Applicants are required to submit a current Curriculum Vitae and three letters of reference to the Fellowship Director.
• Three to five applicants will be selected for interviews. The interview process is a team effort involving the three academic head and neck surgeons and the current head and neck oncology fellow.
• Successful candidates will have Royal College of Canada certification in Otolaryngology-Head and Neck Surgery or its equivalent. 
• To date, we have had fellows from North America, Australasia, and Europe. 
• A solid grounding in head and neck surgery is a prerequisite for successful application for this fellowship.