What is an otolaryngologist? What do otolaryngologists do?

Otolaryngologists are physicians that specialize in the treatment and management of diseases and disorders of the ear, nose, throat, and related bodily structures. They 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 and 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 on physical examination, allowing otolaryngologists to 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 - 1 in 10 Americans is affected by hearing loss. The treatment of hearing disorders is unique to otolaryngologists.
• Nose - chronic sinusitis is one of the most common medical complaints in the US, with around 35 million people developing the illness each year. Management of the nasal cavity also includes allergies and sense of smell.
• Throat - the treatment of diseases of the larynx and esophagus are unique as a duty of otolaryngologists. These include voice and swallowing disorders.
• 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 of the face, neck or ear for cosmetic, functional or reconstructive purposes
• Head and neck - treatment or removal of tumors - cancerous or noncancerous - 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.

Otolaryngologist qualifications^1,2

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 science training, followed by 51 months of progressive education. 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

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 in the range of conditions treated by these physicians:

Cleft lips and palates are congenital disorders and can vary in severity.

• 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
• Cancer: 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
• Chronic sinusitis: inflammation and swelling of the nasal passages. Mucus builds up and breathing through the nose may become difficult. Chronic sinusitis can be caused by infection, the growth of polyps within the nose or a deviated septum (see below).⁸
• Cleft lip and cleft palate: 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 providing minimal problems to those that seriously interfere with eating, speaking and breathing.⁹
• 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 caused by injury to the nose or be present at birth.^10,11
• 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
• GERD: gastroesophageal reflux disease (GERD) is a condition whereby stomach acid and other contents of the digestive tract travel up to the esophagus. It is caused by a ring of muscle at the bottom of the esophagus not closing properly and can lead to heartburn, chest pains, and difficulty swallowing (dysphagia).^13,14
• 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
• Swallowing disorder: referred to as dysphagia, people among all age groups can have difficulty passing food, liquid, and saliva from the mouth to the stomach. Dysphagia can cause discomfort, impair nutrition, and lead to coughing and choking.¹⁶
• Tinnitus: the perception of sound when there is no external source present, tinnitus has been experienced by over 50 million Americans. 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
• 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
• Vertigo and dizziness: - dizziness is a general symptom that can describe sensations of lightheadedness and imbalance, depending on the cause. A specific form of dizziness involving a spinning sensation is called vertigo, and this can be caused by conditions in the central nervous system or the balance nerves and organs in the inner ear.¹⁹
• Voice disorders: voice disorders can be caused by many things, including injury to the vocal cords, viruses, cancer and acid reflux. Diseases can result in hoarseness, lower vocal pitch, vocal fatigue and complete loss of voice.²⁰

Common procedures performed

The otolaryngologist is required to perform a range of procedures that is as varied as the number of the conditions they must treat. These procedures also range in scale and complexity, from intricate microvascular reconstruction to surgery that incorporates the neck in its entirety.

Below is a list of procedures commonly performed by otolaryngologists that hopefully gives an idea of the scope of their work.

If tonsils become repeatedly infected, they may need to be surgically removed.

• Blepharoplasty: the removal of excess skin, muscle and fat can 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
• Endoscopic sinus surgery: typically performed for infectious and inflammatory sinus diseases such as chronic sinusitis. Otolaryngologists insert an instrument called an endoscope into the nose, which allows them to look at the sinuses. They can then insert surgical instruments - including lasers - in order to remove material blocking the sinuses or polyps. The procedure can be performed under local or general anesthetic.²²
• Excision and biopsy: suspicious lesions and tumors can develop anywhere on the body. Biopsies are performed so that otolaryngologists can identify precisely what they are and thus determine an appropriate course of treatment. The excision of small lesions and superficial skin cancers can often be done simply under local anesthetic in an outpatient setting.²³
• 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. Equally, they can also enhance the appearance of the facial structures, including the correction of wrinkles.²⁴
• 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 small incision is made in the ear drum.²⁵
• 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
• Septoplasty: 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
• Surgery for snoring or obstructive sleep apnea (OSA): otolaryngologists have a number of surgical solutions if cases of snoring or OSA necessitate them. 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
• 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
• Tonsillectomy and/or adenoidectomy: 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
• Tracheostomy: a procedure whereby an opening through the neck into the windpipe is created, through which a tube can be placed to provide an airway or remove secretions from the lungs. Tracheostomy can be required for several reasons, including cancer of the neck and paralysis of muscles used for swallowing.³²
• Tympanoplasty: the 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 otolaryngologist^1,4

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 should not need to refer patients on to other physicians for subsequent stages of treatment.

As a result, 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.

References:

1.        AAO-HNS What is an otolaryngologist?, accessed 15 December 2014.

2.        American College of Surgeons Otolaryngology - head and neck surgery, accessed 15 December 2014.

3.        Centers for Disease Control and Prevention (CDC) National ambulatory medical care survey factsheet - Otolaryngology, accessed 15 December 2014.

4.        Columbia University Department of Otolaryngology Otolaryngology, accessed 15 December 2014.

5.        University of Chicago Medicine Airway problems, accessed 16 December 2014.

6.        Chicago Otolaryngology Associates Airway problems, accessed 16 December 2014.

7.        AAO-HNS Head and neck cancer, accessed 16 December 2014.

8.        Mayo Clinic Chronic sinusitis - definition, accessed 16 December 2014.

9.        AAO-HNS Cleft lip and cleft palate, accessed 16 December 2014.

10.     AAO-HNS Deviated septum, accessed 16 December 2014.

11.     Mayo Clinic Deviated septum - causes, accessed 16 December 2014.

12.     MedlinePlus Eyelid drooping, accessed 16 December 2014.

13.     AAO-HNS GERD and LPR, accessed 17 December 2014.

14.     Mayo Clinic GERD - symptoms, accessed 17 December 2014.

15.     AAO-HNS Hearing loss, accessed 17 December 2014.

16.     AAO-HNS Swallowing trouble, accessed 17 December 2014.

17.     AAO-HNS Tinnitus, accessed 17 December 2014.

18.     AAO-HNS Tonsils and adenoids, accessed 17 December 2014.

19.     University of California, Irvine - School of Medicine Vertigo, accessed 17 December 2014.

20.     Washington University Physicians Otolaryngology: voice disorders, accessed 17 December 2014.

21.     Mayo Clinic Blepharoplasty - definition, accessed 17 December 2014.

22.     WebMD Endoscopic surgery for sinusitis, accessed 17 December 2014.

23.     South Texas ENT Consultants Surgery - introduction, accessed 17 December 2014.

24.     AAO-HNS Facial plastic surgery, accessed 17 December 2014.

25.     AAO-HNS Ear tubes, accessed 17 December 2014.

26.     MedlinePlus Neck dissection, accessed 17 December 2014.

27.     WebMD Repair of a deviated septum (septoplasty) - surgery overview, accessed 17 December 2014.

28.     AAO-HNS Snoring and sleep apnea, accessed 18 December 2014.

29.     AAO-HNS Thyroid disorders, accessed 18 December 2014.

30.     Mayo Clinic Tonsillectomy - definition, accessed 18 December 2014.

31.     Mayo Clinic Tonsillectomy - what you can expect, accessed 18 December 2014.

32.     MedlinePlus Tracheostomy, accessed 18 December 2014.

33.     Medscape Tympanoplasty, accessed 18 December 2014.