What do otolaryngologists do?
People also refer to otolaryngologists as ear, nose, and throat (ENT) doctors. They 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 occur in people of any age or gender.
In the U.S., people made an estimated 20 million visits to non-federally employed otolaryngologists over the course of 2010. Adults aged between 45 and 64 years old were the most common visitors of otolaryngology clinics, although people under the age of 15 years made of 20 percent of visitors.
The most common reasons for otolaryngology visits were problems with 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?
ENT doctors focus on the ear, nose, and throat.
The study of otolaryngology has expanded over the past 50 years and now focuses on 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.
- Nose: Chronic sinusitis is one of the most common medical complaints in the U.S., with around 35 million adults receiving a diagnosis for 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 fall under the responsibility of otolaryngologists, including vocal difficulties and swallowing problems.
- Head and neck: Otolaryngologists can also treat diseases and disorders that affect the face, head, and neck, including infectious diseases, trauma, deformities, and cancers. In this area, otolaryngology might cross over with other specialties, such as dermatology and oral surgery.
The field of otolaryngology focuses on seven different areas. Some otolaryngologists will undertake additional study to specialize in one of them and limit their services to their specialty.
- treating allergies 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 in 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 anomalies and developmental delays
- managing disorders of the nose and sinuses
To receive full certification from the American Board of Otolaryngology (ABOto), applicants must complete 4 years of college and then 4 years of medical school.
They must then complete a residency program of 5 further years. A substantial amount of time within the first year will be spent training in basic surgery, emergency medicine, critical care, and anesthesia.
An ENT resident will then have an additional 51 months of progressive education in the specialty. They must spend the final year of the program as a chief resident within an approved institution.
After this training, a trainee otolaryngologist can take the American Board of Otolaryngology (ABOto) examination for board certification, consisting 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 that focuses on one of eight subspecialties.
Otolaryngologists test for and treat hearing loss among many other conditions.
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 medical science relevant to the head and neck, the upper respiratory and upper alimentary systems, communications systems, and chemical senses.
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 fall within the remit of otolaryngologists.
1) Airway problems
Breathing difficulties can range from mild, such as stridor, to life-threatening, such as severe airway obstructions. A variety of different underlying conditions can cause these problems.
According to the AAO-HNS, more than 55,000 people will develop cancer of the head and neck in the U.S. this year, and 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. Infection, the growth of polyps within the nose, or a deviated septum can all contribute to chronic sinusitis.
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 growth. 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. However, an injury to the nose can cause the septum to deviate later in life.
6) Drooping eyelids
Excessive sagging of the upper eyelid can be part of the natural aging process, but several different underlying conditions might also be responsible, such as diabetes mellitus, stroke, and tumors that affect nerves or muscle reactions.
Drooping eyelids might 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 occur in people of all ages and has a variety of possible causes. Aging, exposure to loud noise, viruses, heart conditions, head injuries, stroke, and tumors might all 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 may cause discomfort, impair nutrition, and lead to coughing and choking.
Tinnitus is the perception of sound when no external source of that sound is actually present. Roughly 1 in 5 people with the condition experience bothersome tinnitus, a more severe form that can cause distress and negatively impact on quality of life and functional health.
11) Tonsil or adenoid infection
The tonsils and adenoids in the throat are part of the immune system. 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 lead to surgery.
12) Vertigo and dizziness
Dizziness is a general term for describing 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.
Conditions affecting the central nervous system and organs in the inner ear can cause vertigo.
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.
Otolaryngologists must be able to perform a wide range of procedures to address the large number of medical problems within their specialty.
These procedures range in scale and complexity, from complex microvascular reconstruction to surgery that encompasses the entire neck.
The following list of procedures offers an overview of the vast 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 often occurs for cosmetic reasons and rarely requires a hospital stay.
2) Endoscopic sinus surgery
An otolaryngologist often performs this 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 occur 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.
They can often perform the removal of small lesions and superficial skin cancers 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 anomalies, 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
Otolaryngologists can perform a range of ear surgeries.
For people experiencing recurrent middle ear infections or hearing loss due to fluid in the ear, the surgeon can place tubes 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 the otolaryngologist makes a small incision in the eardrum to relieve pressure resulting from 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 take place 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 necessary.
8) Surgery for snoring or obstructive sleep apnea (OSA)
Otolaryngologists have a number of surgical solutions for snoring and OSA. They can remove excess soft palate tissue to open up the airway, such as with radiofrequency thermal ablation to reduce tissue bulk.
They can also make the palate stiffer with injections or by inserting stiffening rods to reduce vibration and the risk of collapse.
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 adenoids. They are commonly necessary for treating recurrent infections or breathing problems.
The procedure typically occurs 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. The otolaryngologist can insert a tube into this opening to provide an airway or remove secretions from the lungs.
Tracheostomy may be necessary to treat several health problems, 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 take place 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.
Otolaryngology is a wide-ranging medical specialty focusing on health problems in the ears, nose, throat, head, and neck.
An otolaryngologist must spend 4 years at college, a further 4 years at medical school, and then 5 years after that on a residency program specializing in this area. They will move on to 51 months of progressive education on the specialty, after which they take the ABOto board certification exam.
They will then treat a variety of medical problems, including airway difficulties, cancers of the head and neck, and chronic sinusitis. An otolaryngologist also helps with vertigo and dizziness, structural problems in the nose, and hearing loss, among many other medical issues.
Their training is extensive and covers a range of surgeries, including blepharoplasty, endoscopic sinus surgery, and tumor removal. They will also be able to perform plastic surgery of the face, myringotomy, and thyroid surgery, as well as removal of the adenoids and pancreas.