Member Spotlight Interview | David E. Tunkel, MD

David E. Tunkel, MD, Director of Pediatric Otolaryngology, Johns Hopkins Children’s Center, Baltimore, Maryland

David E. Tunkel, MD
Director Pediatric Otolaryngology, Johns Hopkins Children’s Center, Baltimore, MarylandShare a little about yourself and your journey to otolaryngology.

I have been at Johns Hopkins in Baltimore, Maryland, as a student, a resident, and now as a faculty member for over 40 years combined. My journey to otolaryngology started in medical school at Johns Hopkins in 1983, when great mentors like Bernard R. Marsh, MD, and David W. Kennedy, MD, first showed me the range of ear, nose, and throat conditions that are treated medically and surgically.  As a resident several years later, I was introduced to innovative patient care by skilled clinician scientists like Haskins K. Kashima, whose landmark discoveries about recurrent respiratory papillomatosis and cutting-edge treatments for airway obstruction from vocal fold paralysis are still front and center. 

My path to pediatric otolaryngology was guided by the vision of Michael Johns, MD, my chair, who saw the need to structure tertiary pediatric otolaryngologic care at Hopkins.  I was fortunate to complete pediatric otolaryngology fellowship training with Kenneth M. Grundfast, MD, and George H. Zalzal, MD, who are still my mentors and friends,at the Children’s National Medical Center in Washington, DC.  I returned to Hopkins to practice this subspecialty in 1991, at an exciting time when Charles W. Cummings MD, renowned for developing academic leaders in otolaryngology, had become chairperson of our department.

Each of the aforementioned individuals, as well as many others, demonstrated clinical excellence, and each emphasized the importance of scientific discovery and teaching as part of academic otolaryngology. I was eager to begin participation in AAO-HNS activities—attending or teaching instructional courses, developing education materials, and serving on constituent committees—early in my career.

Can you share some information about your practice and the community of patients you serve?

As a pediatric otolaryngologist at an academic pediatric center, I do the usual mix of the usual (otitis media and sleep apnea) and the unusual (EXIT procedures and other stressful things!).  I have great partners, both surgeons and advanced practice providers, who provide a cohesive team approach to patient care.  We provide pediatric ENT care for a referral population from the suburbs and beyond, some who travel to Baltimore from outside the United States.  We also have the privilege and responsibility to provide care to the children of urban Baltimore, trying to improve the disparate access to medical care that has become all too apparent.  While primarily a clinician, I live the tripartite mission of my institution on a daily basis—as we educate our students, residents, fellows and others, and as we search for more effective ways to treat the diseases that sometimes humble us.

Has your community of patients changed at all in the last few years?

The pandemic has resulted in the greatest change in pediatric otolaryngology, altering my practice and daily routine.  We have seen the good and the bad—decreases in respiratory disease, ear infections, sinus disease in children associated with lockdowns and avoidance of in-person school and group daycare settings, and we have also seen late presentation of chronic diseases of childhood and hearing loss because of restrictions in access and avoidance of the healthcare settings associated with the pandemic. 

The parents and caretakers of the children I evaluate are, in general, better informed than ever, and this often allows real shared decision making.  Of course, the information available to parents is not always accurate or evidence-based, and I try to help parents and guardians assess the relevance and accuracy of information they may find on the internet and similar sources.

What are your guiding principles for practice and patient care? 

My principles that guide my patient care have not changed over time, but with experience I hope that I now follow them more consistently.  I emphasize to my patients and to my staff that I want to be accessible—the initial appointment time may seem short, but we should follow-up with phone calls, telemed access, and follow-up appointments.  I also want to deliver evidence-based care—we have all seen variability in surgical indications as we practice otolaryngology, and I have used resources like our Academy’s Clinical Practice Guidelines to provide a foundation for individualized decisions modified by patient level factors.  Our advice to patients and families requires two-way communication between parents/patients/guardians and me.  Lastly, as a pediatric specialist, I recognize the team approach to the care for children with complex medical needs, a team that included the pediatric primary care providers, other pediatric specialists, non-physician pediatric clinical staff, and of course families.

What lies ahead for the specialty?

Otolaryngology-head and neck surgery faces challenges that are common to healthcare in general as well as some unique to our specialty.  As we become more specialized within otolaryngology, we need to preserve the common bonds that allow our Academy to represent our entire specialty to optimize the health of our patients.  My spouse, Theda C. Kontis, MD, is a facial plastic surgeon leader, and she helps me understand the shared issues of our two otolaryngology subspecialties. 

In a way our opportunities and challenges for the future of otolaryngology are the same—we have rapidly advanced the science and practice of otolaryngology in so many areas, diagnostic, medical and surgical, yet how to broadly deliver these advances to our patients in a cost-effective way is a daunting task.

Describe how your volunteer service to the Academy and any related outside organizations help further outreach and advance the specialty?

I have served the Academy in several ways during my career—as a presenter of research at our Annual Meetings, as a participant in mini seminars and symposia, as a member of a variety of committees, as the Chair of the Pediatric Otolaryngology Committee, as a member and leader of several guideline development groups, and now as the Chair of the Guideline Taskforce.  While these efforts are often time-consuming and effortful, these groups of talented “volunteers” creates a synergy that advances the science and clinical practice of otolaryngology for all our members.  I am particularly proud of the quality products created by the AAO-HNSF, some of which involved my own efforts to assemble the contributions of experienced and wise stakeholder representatives—as guideline chair, co-chair, and methodologist.  The value of these guidelines, when published, is apparent when we look at the number of downloads, citations, and even original research centered around the adoption of the recommendations that are contained in these documents.

How does your work impact you and the communities you serve?

I must admit I am not always sure how my work impacts the communities I serve.  The microscopic view is that I have shared a lot of joy with patients and families over my 31 years of practices, some who have experienced significant illnesses where I have participated in their return to good health.  I have seen children, from time to time, who are brought to see me by parents who I treated years ago as children—even better than a favorable online review!

The broader view is that I hope I have contributed to quality care in otolaryngology through my participation and leadership in Academy endeavors, such as the practice guidelines.  It is especially gratifying when I see the fellows and residents I trained provide expert care and contribute to the knowledge base in otolaryngology.

What would you say to encourage others considering volunteer opportunities with the Academy/What are you most proud of during your volunteer service to the Academy?

The Academy the one organization that bring all otolaryngologists together—generalists and subspecialists, those practicing in the communities, hospitals, and academic settings.  The ability to work with Academy leaders and members has been a core part of my career development and satisfaction.  Through this participation I have been given the opportunity to shape the present and future of otolaryngology in ways that exceed the gratifying impact of patient care in the clinic and the operating room.  It is particularly satisfying to work with the dedicated and knowledgeable staff of our Academy, alongside otolaryngology colleagues with shared and diverse interests and experiences.

I encourage all otolaryngologists to participate in Academy meetings, committees, and other opportunities—to lend their knowledge and perspective to advance our knowledge base and optimize the management and delivery of otolaryngologic care.