Theme 1: Supporting Hearing and Ear Function
As one of a few surgeons in the United States who completed fellowship training in advanced ear surgery and complex pediatric otolaryngology, my research team aims to better understand and treat conditions that cause loss of hearing in children as well as chronic ear disease (including cholesteatoma).

We are improving the treatment of hearing loss in three domains: improving diagnostic equity, advancing diagnostics, and innovating treatment. By linking the electronic health record with advanced geospatial and socioeconomic analytics (GeoMarker, SCALE, TriNetX, RUCA), we were the first to robustly examine diagnostic equity among children with sensorineural hearing loss as a measurable outcome. This formed the basis of data-driven strategies to guide intervention and quality improvement including development of an integrated consultation model clinically. In partnership with genomic answers for kids (GA4K), we are examining causes of sensorineural hearing loss that were undetectable by prior testing methods. In addition, our partnership is exploring polygenic hearing loss by combining advanced sequencing with population data. Finally, we are advancing the treatment of hearing loss by studying the delivery of intracochlear gene therapy to reverse genetic hearing loss. We are one of two groups in the United States applying the otopathologic techniques to better understand the compartmentalization of the inner ear and the safest way to deliver treatments to the cochlea. In addition, the Ear, Sinus and Skull Base Dissection Laboratory (a joint venture between otolaryngology and neurosurgery) links microscopic dissection capabilities with MicroCT scan images. This infrastructure in combination with a partnership with the University of Kansas Willed Body Program provides the tools needed to innovate and fine the delivery of treatments to the cochlea, including gene therapy.

Our work on comprehensive management of pediatric ear disease is among the first to focus on patient-centric outcomes and the methods used to deliver ideal care to pediatric patients with chronic ear conditions. This has led to inquiries about what constitutes complex pediatric otology as well as efforts to better understand the impact of chronic ear conditions on children. Clinically, our findings drove a partnership with Children's Mercy Kansas City Illuminate Program to treat the psychological impact of hearing loss and chronic ear disease.

Theme 2: Helping Babies Breathe
Craniofacial skeletal conditions (including small/absent jaw), head/neck mass, congenital high airway obstruction syndrome, thoracic/mediastinal mass, and multiple other conditions can prevent adequate breathing and cause brain injury from low oxygen or suffocation at birth. Fortunately, with in-utero diagnosis, we are able to make modifications during delivery that support more rapid onset of treatment or permit intervention on the fetus’s airway during a partial delivery, while oxygen and carbon dioxide exchange continue to occur through the placenta (ex-utero intrapartum treatment).

This potentially lifesaving and function-preserving treatment for newborns requires balancing concern for the infant’s well-being with the obligation to do no harm to those giving birth. It also requires us to consider just distribution of scarce resources. Due to the rarity of these interventions, there are limited data to guide treatment selection. I conducted a survey of fetal treatment centers, which found high variation in selection criteria as well as cases of over- or under-utilization of these techniques.

To address this gap, I led the first international consensus recommendations on the management of anticipated perinatal airway obstruction (27 authors, 8 countries), developed a novel methodology to assess the necessity and sufficiency of perinatal airway interventions, and developed and serve as one of two principal investigators in a 54-site North American Fetal Therapy Network (NAFTNet) endorsed prospective cohort study to improve patient selection for perinatal airway procedures.