Otolaryngologists are also known as ear, nose, and throat (ENT) doctors and provide both medical and surgical care.
According to the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS), otolaryngology is the oldest medical specialty in the United States. Otolaryngological diseases and disorders can affect anyone, regardless of age or gender.
In the U.S., people made an estimated 20 million visits to non-federally employed otolaryngologists over the course of 2010. Most visits appointments were made by adults aged between 45 and 64 years old, although 20 percent of visits were made by people under the age of 15 years.
The most common reasons for patients to visit an otolaryngologist were problems with their hearing, earache or ear infection, and nasal congestion.
Most otolaryngological conditions can be diagnosed through physical examination, meaning that otolaryngologists take a hands-on approach to patient care.
What is otolaryngology?
Otolaryngologists treat disorders of the ears, nose, throat, head, and neck.
The study of otolaryngology has expanded over the past 50 years and now comprises a regional specialty of the head and neck.
The word, despite its length, is actually an abbreviation of otorhinolaryngology.
- Ears: The treatment of hearing disorders is unique to otolaryngologists. Men are more likely than women to have hearing loss in adults between 20 and 69 years of age.
- Nose: Chronic sinusitis is one of the most common medical complaints in the U.S., with around 35 million adults people having been diagnosed with the developing this illness each year. Management of the nasal cavity also includes treating allergies and problems with sense of smell.
- Throat: The diagnosis and treatment of laryngeal and upper esophageal diseases are the responsibility of otolaryngologists. These include vocal difficulties and swallowing.
- Head and neck: Otolaryngologists can also treat diseases and disorders affecting the face, head, and neck. These include infectious diseases, traumas, deformities, and cancers. There may be some crossover in this area with other specialties, such as dermatologists and oral surgeons.
There are seven focuses within the field of otolaryngology. Some otolaryngologists will undertake additional study to specialize in one of them and limit their services to their specialty.
- treatment of allergy using medication, immunotherapy, or avoidance of triggers
- performing surgery on the face, neck or ear for cosmetic, functional, or reconstructive purposes
- treating or removing tumors of the head and neck, including the nose and throat
- managing disorders of the throat
- treating ear problems, including infections, tumors, and nerve pathway disorders affecting hearing and balance
- attending to ENT diseases in children, including congenital abnormalities and developmental delays
- managing disorders of the nose and sinuses
To become certified by the American Board of Otolaryngology (ABOto), applicants must complete 4 years of college and then 4 years of medical school.
A residency program of 5 further years must then be completed. A substantial amount of time will be spent training in basic surgery, emergency medicine, critical care, and anesthesia within the first year. The ENT resident will then have an additional 51 months of progressive education in the specialty. The final year of the program must be spent as a chief resident within an approved institution.
After this training, a trainee otolaryngologist can take the American Board of Otolaryngology (ABOto) examination to become board-certified. This consists of both a written and oral exam.
Otolaryngologists can also choose to continue their studies and complete a fellowship. A fellowship is a 1-or-2-year course of extensive training focused on one of eight subspecialties.
ENT surgeons will often treat chronic sinusitis with surgery.
Otolaryngologists provide care for a diverse range of conditions, using both medical and surgical skills to treat their patients.
They will have a firm understanding of the medical science that is relevant to the head and neck, the upper respiratory and upper alimentary systems, communications systems, and chemical senses.
Specifically, the American College of Surgeons (ACS) states that:
"An otolaryngologist-head and neck surgeon is a physician who has been prepared by an accredited residency program to provide comprehensive medical and surgical care of patients with diseases and disorders that affect the ears, the respiratory and upper alimentary systems, and related structures of the head and neck."
The following list is a selection of common conditions that are treated by otolaryngologists.
1) Airway problems
Breathing difficulties can range from mild, such as stridor, to life-threatening, such as severe airway obstructions. These problems can be caused by a variety of different underlying conditions.
According to the AAO-HNS, more than 55,000 people will develop cancer of the head and neck in the U.S. this year.
The majority of cases are considered preventable, and it is estimated that nearly 13,000 of these people will die from the disease.
3) Chronic sinusitis
This condition involves chronic inflammation and swelling of the nasal passages, with a build-up of mucus and breathing difficulties through the nose. Chronic sinusitis can be associated with infection, the growth of polyps within the nose, or a deviated septum.
4) Cleft lip and cleft palate
This is a split in the mouth in which the lip, palate, or both do not fully develop during fetal development. Clefts can vary in size, ranging from those that cause minor problems to those that seriously interfere with eating, speaking, and breathing.
5) Deviated nasal septum
The nasal septum is the wall that divides the nasal cavity. A deviated septum is one that has drastically shifted away from the midline, typically resulting in breathing difficulties and chronic sinusitis. A deviated septum can be present from birth or might be caused by injury to the nose later on.
6) Drooping eyelids
Excessive sagging of the upper eyelid can be part of the natural aging process but can also be caused by several different underlying conditions, such as diabetes mellitus, stroke, and tumors that affect nerves or muscle reactions. Drooping eyelids can sometimes obstruct vision.
Gastroesophageal reflux disease (GERD) is a condition in which stomach acid and other contents from the digestive tract travel up into the esophagus.
A ring of muscle known as the sphincter at the bottom of the esophagus usually prevents the contents of the stomach traveling upwards. In people with GERD, this sphincter may be dysfunctional, which can lead to heartburn, chest pains, and difficulty swallowing.
8) Hearing loss
Loss of hearing can affect people of all ages and is caused by a variety of different problems. Aging, exposure to loud noise, viruses, heart conditions, head injuries and trauma, stroke, and tumors have all been known to lead to gradual hearing loss.
9) Swallowing disorder
People of any age can have difficulty moving food, liquid, and saliva from the mouth to the stomach. This condition is called dysphagia and can cause discomfort, impair nutrition, and lead to coughing and choking.
Tinnitus is the perception of sound when there is no external source of that sound actually present. Roughly 1 in 5 people with the condition experience bothersome tinnitus, a more severe form that can cause distress and negatively affect the quality of life and functional health.
11) Tonsil or adenoid infection
Tonsils and adenoids are part of the immune system and are situated in the throat. Their role is to sample bacteria and viruses that enter the body through the nose and mouth, but they can be prone to recurrent infections, which might need surgery.
12) Vertigo and dizziness
Dizziness is a general term to describe sensations of light-headedness and imbalance. Vertigo is a specific form of dizziness involving a spinning sensation or a feeling of falling when there is no motion.
Vertigo can be caused by conditions affecting the central nervous system and organs in the inner ear.
13) Voice disorders
Many conditions, including injury to the vocal cords, viruses, cancer, and recurrent chronic acid reflux, can result in voice disorders. Diseases can result in hoarseness, lower vocal pitch, vocal fatigue, and complete loss of the voice.
An endoscope can help an otolaryngologist visualise the inside of the sinuses.
Otolaryngologists are required to perform a range of procedures as befitting the large number of conditions they treat.
These procedures also range in scale and complexity, from complex microvascular reconstruction to surgery that encompasses the entire neck.
The following list of procedures that are commonly performed by otolaryngologists offers an overview of the scope of their work:
This is the repair of droopy eyelids by removing excess skin, muscle, or fat that may be impairing vision. This procedure is frequently carried out for cosmetic reasons and often does not require a hospital stay.
2) Endoscopic sinus surgery
This is typically performed to treat infectious and inflammatory sinus diseases, such as chronic sinusitis or polyp growth. Otolaryngologists insert an instrument called an endoscope into the nose, which allows them to look at the sinuses.
They can then insert and use surgical instruments, including lasers, in order to remove material that is blocking the sinuses. The procedure can be performed under local or general anesthetic.
3) Excision and biopsy
A surgeon will perform a biopsy to identify suspicious lesions and tumors. These can develop anywhere in the body, and identification is essential for defining an effective course of treatment. The removal of small lesions and superficial skin cancers can often be performed under local anesthetic in an outpatient setting.
4) Facial plastic surgery
This type of surgery can be either reconstructive or cosmetic. Otolaryngologists can repair congenital deformities, such as cleft palates, or conditions that are the result of accidents, previous surgery, or skin cancer. They can also enhance the appearance of the facial structures, including the correction of wrinkles.
5) Myringotomy and pressure equalization (PE) tube placement
For people experiencing recurrent middle ear infections or hearing loss due to fluid in the ear, tubes can be placed through the eardrum to allow air into the middle ear. PE tubes can be short- or long-term.
A myringotomy is a procedure in which a small incision is made in the eardrum to relieve the pressure caused by the excessive build-up of fluid. They can also help to drain pus from the middle ear.
6) Neck dissection
This is a major form of surgery to remove cancerous lymph nodes from the neck, performed under general anesthetic. The extent of the surgery depends on the spread of the cancer.
Radical neck dissection requires the removal of all tissue from the jawbone to the collarbone on the side of the neck, along with the muscles, nerves, salivary glands, and major blood vessels from this area.
This is surgery to correct a deviated septum or to allow greater nasal access nose for the removal of polyps. The procedure can be performed under local or general anesthetic and involves the otolaryngologist separating the lining of the nasal passage from underlying cartilage.
They will then straighten the bent cartilage as required.
8) Surgery for snoring or obstructive sleep apnea (OSA)
Otolaryngologists have a number of surgical solutions for snoring and OSA. Excess soft palate tissue can be removed to open up the airway, such as with radiofrequency thermal ablation to reduce tissue bulk.
The palate can be made stiffer to reduce vibration and collapse with injections or by inserting stiffening rods.
9) Thyroid Surgery
The thyroid sits just below the larynx. Otolaryngologists can remove all or part or all of the thyroid gland in cases of thyroid cancer, suspicious lumps, obstruction of the windpipe or esophagus, or hyperthyroidism.
10) Tonsillectomy or adenoidectomy
Tonsillectomy is the surgical removal of tonsils, and adenoidectomy is surgical removal of the or adenoids. They are commonly needed to treat recurrent infections or breathing problems. The procedure is typically carried out under general anesthetic, but the patient will not usually need to stay in the hospital.
This is a procedure to create an opening through the neck into the windpipe. A tube can be inserted into this opening provide an airway or remove secretions from the lungs. Tracheostomy may be required for several reasons, including cancer of the neck and severe laryngeal disease.
This type of surgery can repair any defect in the eardrum with a graft or address middle-ear bone disease. Tympanoplasty serves to close perforations, improve hearing, and eradicate disease from the middle ear. The procedure can be performed in an outpatient setting.
When to see an otolaryngologist
The AAO-HNS states that otolaryngologists are the most appropriate physicians for treating disorders of the ears, nose, throat, and any structures related to the head and neck.
As they specialize in both medicine and surgery, they normally do not need to refer patients to other physicians for follow-up treatment.