Name:	Narajos Nena B
Grade:	1st year, Doctoral Course (D-1)
Affiliation:	Department of Otolaryngology – Head and Neck Surgery Graduate School of Medical Sciences, Kumamoto University Kumamoto Japan
Department Supervisor:	Yumoto Eiji, MD, PhD, Professor and Chair
Travel period:	September 22 – October 12, 2010
Facilities Visited:	MGH Center for Laryngeal Surgery and Voice Rehabilitation Harvard – MIT Health Sciences and Technology Boston, MA, USA

The main objective of the author for participating in this clinical observership program was to gain a strong clinical experience as well as a basic overview of the medical and surgical management that covers all aspects of laryngeal and voice disorders in both the pediatric and adult populace. Moreover, the Voice Center’s long history of conducting research has provided the author a view of the current state-of-the-art researches and prospective collaboration opportunities, while the Laryngology and Voice Surgery Course has reinforced learning through advanced updates as well as presentations on basic aspects in the field of Laryngology.

MGH Center for Laryngeal Surgery and Voice Rehab-ilitation, One Bowdoin Sq. The Massachusetts General Hospital (MGH) Center for Laryngeal Surgery and Voice Rehabilitation enjoys an outstanding international reputation as a leader in the development of innovative approaches for improving the diagnosis and treatment of voice disorders. The Center was established by the Department of Surgery to integrate pioneering research with state-of-the-art medical, surgical and behavioral management of throat disorders that affect the larynx and voice. Clinical care is integrated with an expansive ongoing program of researches headed by Dr. Steven M.

Harvard-MIT, Cambridge Zeitels, the Voice Center’s Director and creator of the Zeitel’s Universal Modular (UM) Glottiscope System™.

Working alongside Dr. Zeitels is a multidisciplinary team of renowned surgeons, speech-language pathologists and research scientists. The Center is affiliated with leading academic institutions that include Harvard Medical School (HMS), Massachusetts Institute of Technology (MIT) and the MGH Institute of Health Professions.

Alongside Dr. Steven M. Zeitels, Director of the MGH-Voice Center A wide range of experience was gained in the entire duration of the exposure. The two-day comprehensive course had a healthy gathering from 25 countries and a panelist of speakers who are highly regarded in their fields of specialty. The atmosphere charged with wide anticipation from day one of the first speaker until the conclusion of the course. The attendees shared in personal and professional experiences, asked about and discussed current trends of medical and surgical care in the areas of neurolaryngology, phonomicrosurgery, novel operating room and office-based light procedures, as well as up and coming research innovations.

Together with Senior Technical Assistant Sonny Cruz and visiting MDs from Germany and Brazil Of particular interest is the lecture by Marsha Moses, PhD on Molecular Regulation of Angiogenesis: From the Angiogenic Switch Through Tumor Progression, Implications for Therapy, Diagnosis and Prognosis.

Unilateral vocal fold immobility (UVFI) almost always results in significant problems with dysphonia and dysphagia.

What is potentially more harmful to patients with UVFI is that significant dysphagia could result to aspiration pneumonia that causes high morbidity to these patients. There are different etiologies of UVFI including surgical, malignancy, trauma and/or idiopathic. In this research, we did videofluoroscopic study (VFS) recordings of patients diagnosed with UVFI with recurrent laryngeal nerve paralysis (RLNP) as the primary cause and retrospectively analyzed them using the penetration-aspiration scale (PAS) and pharyngeal transport function measures. Results revealed that there was no difference in the likelihood of penetration or aspiration based on side of vocal fold immobility or etiologic factor. As for the pharyngeal transport function measures, four factors were found to be significantly associated with aspiration: swallow delay, reduced residue in the valleculae, pyriform sinus and reduced laryngeal elevation.

Fall is indeed the best time to visit Boston!

Dubbed as the “walking city” Boston lives up to its name as one sees multiple crosswalks and innovative pedestrian safety signs at busy locations such as downtown Boston. Culturally diversified, the city boasts of having “nations within a nation.” A clear example of this is its wide selection of culinary delights from its famous Boston baked beans and “chowdah” to French and Italian to Asian and Mediterranean.

The capital and largest city in Massachusetts, Boston is one of the nation’s oldest cities being founded in 1630. It owns the country’s first public library and houses museums with gorgeous indoor courtyard like the Isabella Stuart Gardner Museum.

Rich in cultural history, Boston has maintained much of its cultural heritage as seen in the historic neighborhoods of Beacon Hill, Back Bay and Charlestown.

Back Bay’s Victorian townhouses Boston Public Library	Overlooking Charles River
Back Bay’s Victorian townhouses

This international collaboration has bridged the gap in communication and knowledge. It has provided a venue for exchanging views and information, for developing and maintaining relationships with colleagues from around the world.

The support from Kumamoto University Program for Enhancing Systemic Education in Graduate Schools proved to be invaluable for graduate students like myself as this program promotes motivation among researchers and physician-scientists, alike to enhance knowledge through higher learning and to continuously upgrade their researches through global exposure.