Otolaryngologists are physicians that specialize in the treatment and management of diseases and disorders of the ear, nose, throat, and related bodily structures.
Otolaryngologists are commonly referred to as ENT (ear, nose, and throat) physicians and provide both medical and surgical care.1
According to the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS), otolaryngology is the oldest medical specialty in the US.2 Otolaryngological diseases and disorders can affect anyone, regardless of age or gender.
In the US in 2010, an estimated 20 million visits were made to non-federally employed otolaryngologists. Most visits were made by adults aged 45-64 (32%), although 20% of visits were made by people aged under 15.3
The most common reasons for patients to visit an otolaryngologist were problems with their hearing, earache or ear infection, or nasal congestion. Most otolaryngological conditions can be diagnosed through physical examination, meaning that otolaryngologists have a hands-on approach to patient care.2
What is otolaryngology?1,4
Otolaryngology is actually an abbreviation; the full term is otorhinolaryngology, derived from the Greek words for ear (oto), nose (rhino) and throat (laryn). The study of otolaryngology has expanded over the past 50 years and now comprises a regional specialty of the head and neck.
Otolaryngologists specialize in treating conditions of the ears, nose, throat, head, and neck.
- Ears - Around 15% of adults in America (37.5 million people) reports some degree of hearing loss. The treatment of hearing disorders is unique to otolaryngologists. Men are more likely than women to report hearing loss.34
- Nose - chronic sinusitis is one of the most common medical complaints in the US, with around 28.5 million adults diagnosed with the illness (around 12.1% of adults in the US).35 Management of the nasal cavity also includes allergies and sense of smell.
- Throat - the diagnosis and treatment of diseases of the larynx and esophagus are the responsibility of otolaryngologists and include voice and swallowing.
- Head and neck - diseases and disorders affecting the face, head and neck can also be treated by otolaryngologists, including infectious diseases, traumas, deformities and cancers. There may be some crossover in this area with other specialists, such as dermatologists and oral and maxillofacial surgeons.
There are seven areas of expertise within the field of otolaryngology. Some otolaryngologists will undertake additional study to specialize in one of them and subsequently limit their services solely to the management of their chosen specialty:1
- Allergy - treatment of the condition by medication, immunotherapy or avoidance of triggers
- Facial plastic and reconstructive surgery - performing surgery on the face, neck or ear for cosmetic, functional or reconstructive purposes
- Head and neck - treatment or removal of (cancerous or noncancerous) tumors of the head and neck, including the nose and throat
- Laryngology - management of disorders of the throat
- Otology/neurotology - management of disorders of the ear, including nerve pathway disorders affecting hearing and balance
- Pediatric otolaryngology - treatment of ENT diseases in children, including birth defects and developmental delays
- Rhinology - management of 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. At least 9 months of this will be comprised of basic surgical, emergency medicine, critical care, and anesthesia training within the first year; including at least 48 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, ABOto examinations can then be taken, consisting of a written exam and an oral exam. Otolaryngologists can also opt to continue their studies and complete a fellowship - a 1 or 2 year course of extensive training focused on one of the seven subspecialties detailed above.
Common conditions treated by otolaryngologists
Otolaryngologists provide care for a diverse range of conditions, utilizing both medical and surgical skills to treat their patients. They will have a firm understanding of the medical science of relevance to the head and neck, the respiratory and upper alimentary systems, communication sciences and the chemical senses.
Specifically, the American College of Surgeons (ACS) state that otolaryngologists understand the clinical aspects of the medical and surgical methods to treat or prevent "diseases, neoplasms, deformities, disorders and/or injuries of the ears, the respiratory and upper alimentary systems, the face, jaws, and the other head and neck systems."2
The following list is a selection of common conditions that are treated by otolaryngologists, hopefully conveying a sense of the diversity of conditions treated by these physicians:
1) Airway problems
Breathing difficulties can range from the mild (for example, stridor) to the life-threatening, such as airway obstructions. These problems can be caused by a variety of different underlying conditions.5,6
According to the AAO-HNS, more than 55,000 Americans will develop cancer of the head and neck 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.7
3) Chronic sinusitis
This condition involves inflammation and swelling of the nasal passages, with a build-up of mucus and possible difficulty breathing through the nose. Chronic sinusitis can be caused by infection, the growth of polyps within the nose or a deviated septum (see below).8
4) Cleft lip and cleft palate
Cleft lips and palates are congenital disorders and can vary in severity.
A split in the oral structure whereby the lip and/or palate fails to fuse during fetal development. Clefts can vary in size, ranging from those causing minor problems to those that seriously interfere with eating, speaking and breathing.9
5) Deviated septum
The septum is the wall that divides the nasal cavity into two. A deviated septum is one that is drastically shifted away from the midline, typically resulting in breathing difficulties and chronic sinusitis. A deviated septum can be present at birth or may be caused by injury to the nose.10,11
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, stroke, and tumors that affect nerve or muscle reactions. Drooping eyelids can sometimes hinder vision.12
Gastroesophageal reflux disease (GERD) is a condition whereby stomach acid and other contents of the digestive tract travel up to the esophagus. A ring of muscle at the bottom of the esophagus usually prevents the stomach contents traveling upwards, but in people with GERD this sphincter may be dysfunctional, which can lead to heartburn, chest pains, and difficulty swallowing (dysphagia).13,14
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.15
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.16
Roughly 1 in 10 adults in America have experienced tinnitus lasting at least five minutes in the past year.36 Tinnitus is the perception of sound when there is no external source of that sound. Roughly 1 in 5 people with the condition experience bothersome tinnitus, a more severe form that can cause distress and negatively affect quality of life and functional health.17
11) Tonsil and/or adenoid infection
Tonsils and adenoids are part of the body's 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 infection, which may necessitate surgery.18
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 feeling of motion when there is no motion (such as a spinning sensation or sensation of falling). Vertigo can be caused by conditions affecting the central nervous system (including nerves controlling balance) and organs in the inner ear.19
13) Voice disorders
Voice disorders can be caused by many things, including injury to the vocal cords, viruses, cancer and recurrent acid reflux. Diseases can result in hoarseness, lower vocal pitch, vocal fatigue and complete loss of voice.20
Common procedures performed
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 intricate microvascular reconstruction to surgery that encompasses the entire neck.
The following list of procedures commonly performed by otolaryngologists offers an overview of the scope of their work:
The removal of excess skin, muscle and/or fat to repair droopy eyelids that may be impairing vision. This procedure is frequently carried out for cosmetic reasons and is often performed in an outpatient setting.21
2) Endoscopic sinus surgery
Typically performed for 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 blocking the sinuses. The procedure can be performed under local or general anesthetic.22
3) Excision and biopsy
Biopsies are performed so that otolaryngologists can identify suspicious lesions and tumors. These can develop anywhere in the body, and identification is essential in order to determine an appropriate course of treatment. The excision (removal) of small lesions and superficial skin cancers can often be done simply under local anesthetic in an outpatient setting.23
4) Facial plastic surgery
This type of surgery can be either reconstructive or cosmetic. Otolaryngologists can repair birth defects 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.24
5) Myringotomy and pressure equalization (PE) tube placement
For people experiencing middle ear infection or hearing loss due to middle ear fluid, tubes can be placed through the eardrum to allow air into the middle ear. PE tubes can be used in both the short and long term. A myringotomy is a procedure where a small incision is made in the ear drum to relieve pressure caused by excessive fluid build-up or to drain pus in the middle ear.25
6) Neck dissection
A major form of surgery performed under general anesthetic in order to remove cancerous lymph nodes from the neck. The extent of the surgery depends on how far the cancer has spread. 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.26
Surgery to correct a deviated septum or to allow greater access to the nose for the removal of nasal polyps. The procedure can be performed under local or general anesthetic and involves the otolaryngologist separating the nasal passage lining from underlying cartilage, then straightening the bent cartilage as required.27
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, or thermal ablation can be used to reduce tissue bulk. The palate can be made stiffer to reduce vibration, through injections or by inserting stiffening rods.28
9) Thyroid Surgery
Otolaryngologists can remove all or part of the thyroid gland - located just below the larynx - if required due to thyroid cancer, suspicious lumps, obstruction of the windpipe or esophagus, or hyperthyroidism.29
10) Tonsillectomy and/or adenoidectomy
If tonsils become repeatedly infected, they may need to be surgically removed.
The surgical removal of tonsils or adenoids, commonly due to recurrent infection or to treat breathing problems. The procedure is typically carried out as an outpatient procedure under general anesthetic.30,31
A procedure to create an opening through the neck into the windpipe, through which a tube can be placed to provide an airway or remove secretions from the lungs. Tracheostomy may be required for several reasons, including cancer of the neck and paralysis of muscles used for swallowing.32
12) Tympanoplastythe repair of any defect in the eardrum (tympanic membrane) with a graft. Tympanoplasty serves to close perforations, improve hearing and eradicate disease from the middle ear. The procedure can be performed in an outpatient setting.33
When to see an otolaryngologist1,4
The AAO-HNS state 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 subsequent stages of treatment.
Otolaryngologists can be seen for any health or cosmetic concerns regarding the face, ear, nose, sinuses, mouth, salivary glands, thyroid gland, neck, larynx, pharynx, bronchial tubes and esophagus.