Otolaryngologists are physicians who specialize in the treatment and control of ear, nose , throat and associated body structure diseases and disorders.
Often people refer to otolaryngologists as doctors of the ear, nose , and throat (ENT). They provide both medical and surgical care.
Otolaryngology is the oldest medical specialty in the United States, according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). Otolaryngological disorders and diseases may occur in individuals of any age or gender.
In the United States, over the course of 2010 people made an estimated 20 million visits to non-federally employed otolaryngologists. The most common visitors to otolaryngology clinics were adults between the ages of 45 and 64, although people under the age of 15 made up of 20 percent of visitors.
The most common reasons for visits to otolaryngology were hearing issues, earache or ear infection and nasal congestion.
Many otolaryngological conditions can be diagnosed by physical examination, which ensures that patient care is taken by otolaryngologists with a hands-on approach.
What is otolaryngology?
Over the past 50 years, otolaryngology study has expanded and is now focussing on the head and neck.
Despite its length, the word is also 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 otolaryngology field focuses on seven different areas. Many otolaryngologists may conduct further research to specialize in one of them and limit their services to their speciality.
These include:
- 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
Qualifications
To obtain full American Board of Otolaryngology (ABOto) certification, applicants must complete 4 years of college, and then 4 years of medical school.
They then have to complete a 5 more years residency programme. A substantial amount of time will be spent on basic surgery, emergency medicine, critical care, and anesthesia training within the first year.
An ENT student will then have another 51 months of specialty graduate study. As a chief resident of an approved institution, they will spend the final year of the program.
After this training, a trainee otolaryngologist can take a board certification exam on the American Board of Otolaryngology (ABOto), consisting of both a written and oral examination.
Otolaryngologists can also choose to continue their studies and complete a fellowship. A fellowship is a one- or two-year, extensive training course focusing on one of eight sub-specialties.
Common conditions
Otolaryngologists treat their patients with a diverse range of conditions, using both medical and surgical skills.
They will have a strong understanding of medical science that is relevant to head and neck, upper respiratory and upper food systems, communications systems, and chemical senses.
The College of Surgeons of America (ACS) states:
“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 list below is a set of specific conditions falling under the remit of otolaryngologists.
1) Airway problems
Breathing difficulties can range from mild, like stridor, to life-threatening, such as severe obstructions to the airway. These problems can come with a variety of different underlying conditions.
2) Cancer
More than 55,000 people will develop head and neck cancer in the United States this year, according to the AAO-HNS, and nearly 13,000 of those people will die from the disease.
3) Chronic sinusitis
This condition involves chronic inflammation and swelling of the nasal passages, with mucus build-up and difficulty breathing through the nose. Infection, polyp growth inside the nose, or a deviated septum may all contribute to chronic sinusitis.
4) Cleft lip and cleft palate
This is a split in the mouth, where the lip, palate, or both during fetal growth do not fully develop. Clefts may 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 which separates the cavity of the nasal.
A deviated septum is one that has shifted drastically away from the midline, typically causing difficulty breathing and chronic sinusitis.
From birth there may be a deviated septum present. An injury to the nose may however cause the septum to deviate later in life.
6) Drooping eyelids
Excessive upper eyelid sagging may be part of the natural aging process but it may also be responsible for several different underlying conditions, such as diabetes mellitus, stroke, and tumors that affect nerves or muscle reactions.
Drooping eyelids might sometimes obstruct vision.
7) GERD
Gastroesophageal reflux disease ( GERD) is a condition in which the gastroesophageal acid and other digestive tract contents travel up into the esophagus.
A muscle ring known as the sphincter at the bottom of the esophagus usually prevents upward travel of the stomach contents. This sphincter can be dysfunctional in people with GERD, which can lead to heartburn, chest pain and difficulty swallowing.
8) Hearing loss
Hearing loss can happen in people of all ages and has a number of potential causes. Aging, exposure to loud noise, viruses, heart conditions, head injuries, stroke and tumors could all result in gradual loss of hearing.
9) Swallowing disorder
People of any age can struggle to move food, liquid, and saliva from mouth to stomach. This condition is known as dysphagia and can cause discomfort, impair nutrition, and cause coughing and shock.
10) Tinnitus
In the past year, approximately 1 in 10 adults in the U.S. experienced tinnitus that lasted for at least five minutes.
Tinnitus is the perception of sound when there really is no external source of that sound. Approximately 1 in 5 people with the condition experience annoying tinnitus, a more severe form that can cause distress and adversely affect the quality of life and the functional health.
11) Tonsil or adenoid infection
In the throat, tonsils and adenoids are a part of the immune system. Their role is to sample bacteria and viruses that pass through the nose and mouth into the body, but they may be prone to recurrent infections that may lead to surgery.
12) Vertigo and dizziness
Dizziness is a general term used to describe feelings of lightheadedness and imbalance. Vertigo is a specific type of dizziness that includes a feeling of spinning or a sensation of falling while there is no motion.
Conditions affecting the central nervous system and organs in the inner ear can cause vertigo.
13) Voice disorders
Many conditions can result in voice disorders, including vocal cord injury, viruses, cancer, and recurrent chronic acid reflux. Diseases can lead in hoarseness, lower vocal pitch, vocal fatigue, and total loss of the voice.
Common procedures
Otolaryngologists must be able to perform a wide range of procedures within their specialty to address the large number of medical problems.
These considerable differences in scale and complexity, from complex microvascular reconstruction to surgery that covers the entire neck.
The following list of procedures provides an overview of their vast scope of work.
1) Blepharoplasty
This is how droopy eyelids are repaired by removing excess skin, muscle, or fat that may impair vision. This procedure often occurs for cosmetic reasons and rarely requires a stay in hospital.
2) Endoscopic sinus surgery
This is often done by an otolaryngologist to treat infectious and inflammatory diseases of the sinus, such as chronic sinusitis or growth in polyps. Otolaryngologists insert into the nose an instrument called an endoscope, which allows them to examine the sinuses.
Then they can insert and use surgical instruments, including lasers, to remove material which blocks the sinuses. The procedure can take place under local or general anesthesia.
3) Excision and biopsy
A surgeon conducts a biopsy to identify suspect lesions and tumors. These can develop anywhere in the body and identification is critical to defining an effective treatment course.
Often, they can remove small lesions and superficial skin cancers in an outpatient setting under local anesthetic.
5) Myringotomy and pressure equalization (PE) tube placement
For people with recurring infections of the middle ear or hearing loss due to fluid in the ear, the surgeon may place tubes through the eardrum to allow air into the middle ear.
PE can be short or long term tubes.
A myringotomy is a procedure in which the otolaryngologist makes a slight incision in the eardrum to reduce the discomfort created by the excessive fluid build up.
They also can help to drain pus from the middle ear.
6) Neck dissection
This is a major form of surgery performed under general anaesthetic to remove cancerous lymph nodes from the neck. The extent of the surgery will depend on the cancer spread.
Radical dissection of the neck requires the removal of all tissue from the jawbone to the collarbone on the neck side, together with the muscles , nerves, salivary glands and major blood vessels in this area.
7) Septoplasty
This is surgery to fix a deviated septum or to allow greater nasal access to the nose for polyp removal. The procedure may take place under local or general anesthetic and involves the otolaryngologist separating the lining from the underlying cartilage of the nasal passage.
They would then, if possible, straighten the bent cartilage.
8) Surgery for snoring or obstructive sleep apnea (OSA)
Otolaryngologists offer a number of surgical snoring and OSA solutions. We can remove excess soft palate tissue to open up the airways, such as thermal ablation with radiofrequency to reduce tissue bulk.
They can also make the palate stiffer by injecting or inserting stiffening rods to reduce vibration and collapse risk.
9) Thyroid Surgery
The thyroid sits just below the larynx. In cases of thyroid cancer, suspicious lumps, windpipe or esophagus obstruction, or hyperthyroidism, otolaryngologists may remove any or part or all of the thyroid gland.
10) Tonsillectomy or adenoidectomy
Tonsillectomy is the removal of tonsils by surgery and adenoidectomy is the removal of adenoids by surgery. These are usually used to treat recurrent infections or breathing problems.
The procedure typically takes place under general anesthetic, but usually the patient will not need to stay in the hospital.
11) Tracheostomy
This is a method of making an opening through the windpipe through the neck. The otolaryngologist may insert a tube into this opening to supply an airway or remove lung secretions.
Tracheostomy may be required to treat various health problems including neck cancer and severe laryngeal disease.
12) Tympanoplasty
This type of surgery has the potential to repair any defect in the eardrum with a middle-ear bone disease graft or address. Tympanoplastic drugs serve to close perforations, improve hearing and eradicate middle ear disease.
The procedure can take place in an outpatient setting.
When to see an otolaryngologist
The AAO-HNS states that otolaryngologists are the most suitable doctors for the treatment of ear, nose , throat and any head and neck related structures.
As they are specialized in both medicine and surgery, patients do not normally need to be referred to other doctors for follow-up treatment.
Summary
Otolaryngology is a broad medical specialty that focuses on health issues in the ears, nose , throat, head , and neck.
An otolaryngologist must spend 4 years at a college, another 4 years at a medical school, and then 5 years later on a specialized residency program in this area. They will move on to 51 months of graduate specialty education, after which they will take the ABOto board certification exam.
They will then treat a variety of medical issues including airway problems, head and neck cancers and chronic sinusitis. Also, an otolaryngologist helps with vertigo and dizziness, nose structural problems, and hearing loss, among many other medical problems.
Their training includes extensive surgery, including blepharoplasty, endoscopic sinus surgery, and tumor removal. They will also be able to perform facial plastic surgery, myringotomy and thyroid surgery, as well as adenoid and pancreatic removal.
