Scott Webb (Host): When most of us think of ENT doctors, we probably stop after the E, you know, ears. But most ENTs are really surgical subspecialists. And joining me today is Dr. Mark Brown. He's an ENT with Mass Eye and Ear part of Mass General Brigham, but he also performs surgeries at Emerson.

 This is the Health Works Here Podcast from Emerson Health. I'm Scott Webb.

Dr. Brown, thanks so much for your time today. We're going to learn about you, what ENTs do, who you see, how you help them, all that good stuff. So let's just start there. What is an ENT?

Mark Brown, MD: Well, that's a question a lot of people ask, because I don't think too many people know what we really do. Ear, nose and throat sort of covers it. Obviously do ears, hearing loss, ear infections. Some of our super subspecialists will operate on brain tumors that affect the ear along with neurosurgeons.

So it's kind of a wide range of ear things. Kids have tubes in their ears for repeated, you know, ear infections. So ears are a big, big part of what we do. But I think a lot of people think of ENTs as ear doctors, but nasal surgery, it has a lot of different things going on. We have nasal airway issues that we treat with surgical and non-surgical approaches. People who have chronic sinus infections that can't get cleared with medications end up having surgical intervention to help the sinuses drain. There are tumors in the nose and the sinuses, in the back of the nose that sometimes require surgery. And then you get around to the T part, throat, which actually encompasses a whole lot more than just throat.

Obviously, we see people with tonsil problems, adenoid issues with tonsils in kids. But we also see people with oral cancers in the tonsils, vocal cord problems, cancers of a voice box, swallowing issues, acid reflux problems that affect the throat. And then we get into the entire rest of the title of the specialty, which is head and neck surgery, which a lot of people don't recognize that we do. But most ENTs, all ENTs are trained and most do surgery on salivary glands and the thyroid gland. And we operate on people's necks when they have metastases from oral and throat cancers or other sorts of neck masses.

So it's a very broad surgical specialty. We do a lot of medical care for things that don't require surgery. Like, you know, before you operate on someone's sinuses, you try to treat them medically. We do a lot of medical ear care. We do a lot of medical care for vocal issues and swallowing issues, but at its heart, ENT is really a surgical subspecialty.

Host: Yeah, I appreciate that. I think you're right. Most of us, when we think of ENT, we kind of stop after the E. But we need to consider, it's the E, it's the N, it's the T. So ENTs, and I'm assuming you see people of all ages. You mentioned kids with tubes, but do you see all ages?

Mark Brown, MD: Well, in our practice here at the Mass Eye and Ear Concord, we have Dr. Jen Settler, who is a pediatric trained specialist for ENT. So I do see some kids and my whole career I've seen children. So I'm very comfortable with that. I don't see children that a pediatric fellowship trained person would see, so I'm very grateful Dr. Settler is here. So I see mainly adults, but in the office we cover all ages.

Host: Yeah, that's awesome. Basically, ENT is a surgical subspecialty, so there's a lot of surgery involved, which again, may not jive with what most of us think of when we think of ENTs. But let's talk about that, maybe some specific diseases or problems or just things that you treat that you know might be a little out of the ordinary that kind of get you excited a little bit.

Mark Brown, MD: Well, I think one of the things that we see almost exclusively, there's some overlap with other specialties. Like there's some general surgeons who do thyroid surgery and things like that. But when it comes to the salivary glands, they're pretty much ENT specific. There's a big salivary gland in front of your ear called the parotid gland, and that is a challenging place to go surgically.

We have a fairly frequent occurrence of tumors, mainly benign in that gland and they need to come out. And for the surgeon and the thing that makes the patient nervous is the nerve that moves the face runs right through the middle of that gland. So it's a challenging surgery technically, because you have to find the nerve. And then dissect the gland and the tumor off of the nerve to preserve the facial motion. So it's got a little high tension at some points in that case. We also do, I mentioned earlier, neck dissections. When someone has a cancer in their mouth or throat or down in the voice box area, sometimes they have lymph nodes that have metastases from that cancer.

And so we have to go in and remove the lymph node containing tissue from the neck, which is a four to five hour operation, and we are exposing the jugular vein and the carotid artery and all of the main nerves in the neck. And so it again, has a lot of technical issues with it, but it's something that's fairly mainstream for most ENT head and neck surgeons.

Host: Yeah, of course. I'm here shaking my head thinking, well that sounds really complicated and challenging. Right? And you're like, yeah. You know, it's uh, just something we do. Right?

Mark Brown, MD: Those are the kind of cases that actually attracted me ENT. The soft tissue neck operations and those things, they are difficult, and technically challenging, and it takes a lot of training to be able to feel comfortable doing those. But for me, that's the exciting part of the field.

Host: Yeah. And wondering if you could share maybe a particularly like meaningful experience with a patient, one that really sticks out to you, that you're kind of, maybe pat yourself on the back a little bit.

Mark Brown, MD: A couple people pop to mind. I trained at the Mass Eye and Ear and I did a fellowship in head and neck reconstructive surgery, which was mainly learning how to do free tissue transfer, which means you take tissue with skin, muscle, and or bone from one part of the body, and you revascularize it to reconstruct a defect in the head and neck.

And I had a patient when I was just out of training, I was on the faculty at Johns Hopkins who had half of his tongue removed because he had cancer and he had a neck dissection as well. And I was asked to do the reconstruction. And so we used skin from the forearm called a radial forearm free flap, and I revascularized it and I created half of the tongue out of that tissue and he was able to speak and swallow almost normally, which is really remarkable. It worked out beautifully for him. And I had another patient that I think of frequently. He is an artist and I was in practice in Austin for many years and he lives in Texas and he came to me with a tumor in the cheek sinus right below his eye.

And it's not infrequent that when those are large enough, we have to take the entire cheek, sinus, and the eye out. But fortunately, we were able to remove the tumor by leaving the eye intact except taking the bone under the eye. So that was the margin of the tumor. But he's still painting. He has a vision issue because one eye is kind of stuck, but he tilts his head way down and both eyes line up and he's still making beautiful, beautiful art. And when I left Austin, he gave me a study of one of his pieces and it's just a really beautiful picture of the baby Jesus in a hand, like a child's hand that's been sketched in preparation for his work. So those two people I've been very proud of in my career. There's been a lot of people that, that I feel like I've helped. But I think a lot of what we do as doctors is not just the technical part, but you help people feel comfortable with their diagnosis and you educate them.

Then you help them find a path to getting better. And a lot of people come to me and they have a great fear. You know, I'm having trouble swallowing. And in the back of their mind they're thinking, and I know I have throat cancer,

Host: Right.

Mark Brown, MD: And I can talk to them and I can examine them, and I can almost always reassure them that they are going to be okay. Occasionally I can't. And that's the hard part. But it's very valuable to help people understand that they are going to make it and that we can get some answers for them.

Host: I just love hearing just the transparency, the education, the optimism in your voice. And I want to talk to you a little bit about, you know, I know you, you mentioned Mass Eye and Ear, so you're a physician there, and that's a part of Mass General Brigham. So you see patients, you perform surgeries at Emerson. There must be a lot of benefits for patients to having you in multiple places.

Mark Brown, MD: Well, I do operate downtown at the main Mass Eye and Ear hospital on occasion. But most of my surgeries are done at Emerson and I've been very happy with the staff there. But being part of the bigger organization, the Mass General Brigham Mass Eye and Ear gives me access to people that are super subspecialists who quite honestly are some of the best people in the world.

And I don't say that to be self-serving. I'm honored to be part of the system. But if I have someone come in with a tumor like I did last week, I sent the email to one of the head and neck surgeons. He said, we'll see him tomorrow. And the guy had surgery this week. So and these are not people who are second rate surgeons, these are some of the best people you can find. So it's helpful for me. I like Emerson because it's a nice hospital and it's a good place for patients. And the people in Concord and the surrounding area have a great deal of affection for Emerson Hospital.

So I'm glad to be there. But when I have something that's big and needs a much more focused approach, I've got the Mass Eye and Ear downtown at my fingertips, which is really nice.

Host: Sounds like benefits for you, benefits for patients. Just a little bit of maybe a, sort of a fun one, hopefully, but what do you love most about being an ENT?

Mark Brown, MD: I love the surgery. But I think it's more about being a doctor than being an ENT. I like the relationships I have with the patients. I, enjoy, trying to set their minds at ease. I enjoy having conversations with them, learning more about them. I think it provides a richer experience for the patient. And I also really like when people feel like they've been listened to, because I think that makes them feel much better about the relationship they have with the doctor.

Host: Yeah, that's what I love most about my primary care physician is that, despite everything she has going on and busy days and all the distractions and all of the things hitting her inbox, when she comes in the room and she sits there, she just looks at me. And just listens to me. And she doesn't immediately start typing things into the computer. She just listens. And I think, yeah, from a patient's perspective, I just love that. And I've loved getting to know you today and learn more about ENTs and what you do and how you do it. As we wrap up here, Doctor, just final thoughts, takeaways. What do you maybe most want people to know about the work that you do? Or if they've had some things going on and they've been dragging their feet, maybe we could encourage them not to do that.

Mark Brown, MD: Sure, sure. Well, I have had a very interesting career. Obviously trained here in Boston. I was on the faculty in academic medicine at Johns Hopkins, I was in a large group practice. I had my own practice. I was in rural Ohio during the pandemic, which was an itching experience. I spent a year in New Zealand practicing in the national health system, and then I came back here.

So I've got a lot of experience with a lot of different types of people in places and systems, and I think that helps inform my approach to people because what I've found is through all those different experiences, they're all the same. All people at their hearts come to the doctor with a problem and they want help.

And I have tried my best during my career to do exactly what your primary care doctor says. I had a general surgery attending tell me once when I was an intern, if you listen to the patient long enough, they'll tell you what's wrong with them. And that really meant a lot to me. So I've tried to incorporate that.

So if people are worried about things, they should come in and get a look and have someone listen to what their problems are and find out if their fears are real and need to be addressed. And if they do, then you are in a good place to have it taken care of.

Host: Yeah, in a good place, in good hands, be it Mass Eye and Ear, Emerson, with Dr. Brown in the room. Yeah. So, thank you so much. I really appreciate this. You stay well.

Mark Brown, MD: Thank you. I've enjoyed it.

Host: And call 978-369-8780 or visit emersondocs.org to make an appointment with Dr. Brown or other Mass Eye and Ear ENTs who work at Emerson. And thanks for listening to Emerson's Health Works Here podcast. I'm Scott Webb. And make sure to catch the next episode by subscribing to the Health Works Here Podcast on Apple, Google, Spotify or wherever podcasts can be heard.