Director
of one of the leading Laryngology departments in the country, Dr. Ramon
Franco discusses his work at Mass Eye and Ear, Boston; his committment
to laryngological education in the community; and his
advice to singers on staying healthy.
In November I sat down with Dr. Ramon A. Franco, Jr., Acting Director
of the Laryngology Division at Mass Eye and Ear Institute (MEEI) to talk
about his interest in and advice for singers. Listening to him talk about
his work, his voice and his smile reveal someone who loves his job. Born
and raised in New York City, Dr. Franco is the grandson of a professional
singer and son of a professional clarinetist, turned ENT. He also brings
a musical background to his medical practice, having played the clarinet
and piano, which he still plays, albeit infrequently. After completing
medical school, a surgery internship and a residency in Otolaryngology,
he chose to pursue Laryngology because he saw it as an emerging field
where he could learn new procedures and break ground in both research
and clinical contributions.
Although it is early in his surgical career, he already has a lengthy
CV detailing an array of research, clinical and teaching credentials.
In his clinical practice at MEEI, he offers medical and surgical care
to all voice users for both benign and malignant diseases. As a surgeon
he performs reconstructive airway surgery, phonosurgery, pulsed dye laser
treatment and Botox injections for neurolaryngological diseases.
MEEI is well known to professional voice users. The voice lab, which
has existed for fifteen years, offers a staff of 4 full-time and 2 part-time
voice therapists, all with professional voice experience. Singers who
visit MEEI with a voice problem can expect to receive some of the best
care available in the country.Dr. Franco's research has addressed everything
from the use of pulsed dye lasers to treat laryngeal papillomatosis, to
examining laryngeal lesions for the presence of enzymes found only in
cancerous cells to predict possible recurrence of laryngeal cancer. He
is also serving as medical advisor for a computer modeling of tongue function
during phonation.
Several research studies he is involved in will have a direct impact on
care offered to professional voice users. One recent study focused exclusively
on singers and the treatment of laryngo-pharyngeal reflux (LPR). Because
current acoustic measures are unable to detect the subtle changes in the
voice before and after treatment for LPR, Dr. Franco implemented a quality
of life survey for singers to answer and indicate any perceived changes
in the voice. The preliminary results show that the singers perceived
an improvement of the singing voice. A long-term follow-up study is currently
being developed and will be expanded in scope.
Another study has addressed the issue of skin flaps created as a result
of phonosurgery. Following surgery, while a patient is on total voice
rest, these flaps can be disturbed and healing impeded by something as
simple as a sneeze or a cough. In the past, no efforts to hold the flaps
together have worked. In this study, done on cadaverous larynges, the
process of shining light on a chemical applied to the skin flaps formed
a bond between flaps. The bond was strong enough to resist the forces
of coughing and sneezing, keeping the flaps together. Additional studies
are planned but the long-term implications are exciting. If it proves
successful on live larynges, post-surgical total voice rest could be shortened
and healing time improved.
In another effort to improve voice care, Dr. Franco recently founded the
Boston Laryngological Society, open to Laryngologists practicing in the
greater-Boston area. He hopes the society will facilitate discussions
around clinical and research practices, helping each other with difficult
cases, resulting in improved care for all voice users. It is important
for singers to note that as compared to a field like Otology, that has
had standardized care practices for years, Laryngology is rapidly expanding.
There are currently only 8 places in the country to train to be a Laryngologist.
The field is moving away from the primitive procedures of the past, using
state of the art technology and recent research findings to offer revolutionary
treatment to professional voice users.
There is also movement towards a standardized method of training. The
Laryngology field in medical schools is currently un-accredited, meaning
it can be taught however the teacher sees fit. One of Dr Franco's long-term
goals is to work with others to establish criteria helping to create a
core curriculum, standardizing the training received by future Laryngologists.Outside
of his medical practice and research endeavors, Dr. Franco finds time
to write a column for Choral Singer (www.bluelanternpress.com) and give
presentations to teachers and singers through the National Association
of Teachers of Singing (NATS).
In the past year he has traveled to Chile, Cuba, Thailand and Turkey making
presentations to Otolaryngology departments, bringing the state of the
art procedures practiced at MEEI to the international community. He also
serves on the teaching faculty at Harvard Medical School in Otology and
Laryngology.
His advice to singers includes being as informed as possible about your
instrument. Getting a baseline exam of your vocal cords early in your
career, when your larynx is healthy, will allow for better care if a voice
problem arises. The baseline exam gives doctors something to compare against
ensuring treatment of the current problem. He points out that it is not
uncommon for a professional voice user to have some kind of voice pathology
that does not interfere with the singing voice. If the doctor doesn't
know that the voice pathology isn't new, he or she may treat that pathology,
resulting in a longer time for the singer to re-learn how to use his or
her instrument. He also points out that singers often find themselves
in vocal trouble as a result of their speaking voice. Developing an awareness
of how much voice use is reasonable for you as an individual is critical
to maintaining vocal health. In general, he recommends taking good care
of the body as a whole and staying rested and well hydrated as a way offending
off illness. The benefit of voice rest should not be underestimated as
the body needs down time to repair tissues and muscles.
Although Dr. Franco admits he hasn't ever taken a voice lesson, his knowledge
of the voice, recognition of the connection singers have to their instrument,
and commitment to work towards the best care possible for all voice users
from novice to professional, make him an important ally for the singing
community. If you have a voice problem and are interested in seeing Dr.
Franco, please see your primary care physician and get a referral.
Dr. Ramon A Franco, Jr.
Mass Eye and Ear Infirmary
243 Charles St
Boston, MA 02114
617-573-3958 ˆ for appointment