Otolaryngology

ALSO KNOWN AS: Otolaryngology-head and neck surgery; otorhinolaryngology; ear, nose, and throat medicine

DEFINITION: Otolaryngology is the study, diagnosis, and treatment of disorders of the ear, nose, throat, and other structures of the head and neck. The American Academy of Otolaryngology voted to change the specialty’s name to otolaryngology-head and neck surgery in 1980 to emphasize the discipline's focus on surgery.

Subspecialties: Head and neck diseases, including treatment of tumors; facial plastic and reconstructive surgery; otology/neurotology (ear); rhinology (nose); laryngology (throat); allergy; pediatrics; sleep

Cancers treated: Any cancer occurring in the head or region of the neck above the collarbone (but not the brain or eye), including the thyroid, voice box, throat, mouth, tongue, lymph nodes, bones, nerves, and base of the skull

Training and certification: Otolaryngologists must complete at least five years of specialty training beyond medical school in an accredited residency program. Residency training involves one to two years of general surgery and four years of otolaryngology. After completing five years of residency training, doctors can become board-certified in otolaryngology-head and neck surgery by passing examinations administered by the American Board of Medical Specialties or the Royal College of Physicians and Surgeons of Canada. Many otolaryngologists complete one- or two-year fellowships after their residencies to become certified in an otolaryngology subspecialty. For example, some otolaryngologists may focus on head and neck surgery and treat patients with a variety of different kinds of cancers; others may focus entirely on diseases of the larynx.

During their training, otolaryngologists learn general surgical techniques and gain experience performing surgery, specifically on the head and neck. They also learn diagnostic techniques for the throat and airway such as laryngoscopy, bronchoscopy, and esophagoscopy, as well as how to interpret results of (MRI), computed (CT), and other scanning methods. Otolaryngologists must also be knowledgeable about radiotherapy and because these treatments may be used to treat cancer either in conjunction with or instead of surgery.

Depending on their subspecialties, otolaryngologists must renew their certifications every few years. Otolaryngologists may obtain additional certification in other specialties relevant to their particular area of expertise. For example, an otolaryngologist who focuses on treating cancer may also be board certified in pathology or radiation oncology.

Services and procedures performed: Otolaryngologists often receive referrals from other physicians if a patient is having ear, nose, throat, or airway symptoms. Therefore, otolaryngologists are often the ones who make the initial diagnosis of cancer. They will perform and interpret tests that stage the tumor and the extent of its spread. Because otolaryngologists are trained in medicine and surgery, patients with head or neck cancer do not need to be referred to another physician for treatment, as is often the case for other cancers.

The otolaryngologist's overall goal in treating cancer is to remove or control the cancer while also preserving a patient’s ability to swallow, breathe, eat, taste, smell, and hear to the extent possible. Because cancers of the head and neck may also involve the respiratory or digestive system, major nerves, the brain, or the eyes, otolaryngologists will often work with other specialists such as gastroenterologists, pulmonologists, ophthalmologists, radiation oncologists, and neurosurgeons in developing the best treatment plan for the patient.

Otolaryngologists can often treat early-stage cancers with radiotherapy or chemotherapy alone. Late-stage cancers typically require surgery, sometimes extensive, in addition to radiotherapy or chemotherapy. Because disfigurement due to tissue loss can occur with head and neck cancer treatments, many head and neck surgeons are also skilled in performing reconstructive or cosmetic plastic surgery. Otolaryngologists are also increasingly employing minimally invasive surgical techniques such as laser endoscopy to excise tumors. Targeted therapy is also used increasingly; this type of treatment goes after the genes, tissues, or proteins responsible for the cancer to prevent the cancer's spread. Minimally invasive methods preserve healthy tissue and lead to shorter hospital stays and less risk of post-surgery complications.

Related specialties and subspecialties: Otolaryngologists may employ advanced practice nurses to care for their patients. These are registered nurses who have obtained a master’s degree in nursing. Some nurses obtain board certification in otolaryngolic nursing by passing an examination administered by the Society of Otolaryngology-Head and Neck Nurses.

Because treating head and neck cancers can significantly impair a patient’s ability to breathe, speak, or swallow, a speech pathologist may also be involved in a patient’s care. In particular, speech pathologists work with patients who have lost their vocal cords to cancer and must learn alternative methods of voicing.

The significant effects head and neck cancer can have on a patient’s physical appearance and lifestyle can often cause anxiety and depression. A patient’s care team may also include a social worker or psychologist who can help the patient cope emotionally with the cancer and the effects of treatment.

Medical and scientific advances in cancer diagnosis and treatment continue to revolutionize otolaryngology and its role in cancer treatment. Artificial intelligence has enhanced imaging techniques, allowing for more accurate diagnoses. Robotic surgical techniques have allowed for an increase in minimally invasive procedures. The increased effectiveness of surgical procedures has decreased the amount of radiation used in oncological otolaryngology. Finally, gene therapies, targeted therapies, and immunotherapies continue to revolutionize otolaryngological treatments.

Bibliography

Corbridge, Roger, and Nicholas Steventon. Oxford Handbook of ENT and Head and Neck Surgery. New York: Oxford UP, 2006.

Fletcher, Aaron M. Comprehensive Otolaryngology Review: A Case-Based Approach. San Diego: Plural, 2014.

Lee, K. J. Essential Otolaryngology: Head and Neck Surgery. 10th ed., New York: McGraw, 2012.

Pasha, R., and Justin S. Golub. Otolaryngology: Head and Neck Surgery—Clinical Reference Guide. San Diego: Plural, 2011.

Spiegel, Jeffrey H., and Scharukh Jalisi, editors. “Contemporary Diagnosis and Management of Head and Neck Cancer.” Otolaryngolic Clinics of North America, vol. 30.1, 2005.

Ward, Elizabeth C., and Corina J. van As-Brooks. Head and Neck Cancer: Treatment, Rehabilitation, and Outcomes. 2nd ed., San Diego: Plural, 2014.

“Who We Certify.” American Board of Otolaryngology, www.abohns.org/about-our-certifications/who-we-certify. Accessed 28 June 2024.

Organizations and Professional Societies

American Academy of Otolaryngology-Head and Neck Surgery

, 1650 Diagonal Rd., Alexandria, VA 22314.

American Board of Otolaryngology

, 3900 Essex Ln., Suite 1110, Houston, TX 77027.

American Head and Neck Society

, 11300 West Olympic Boulevard, Suite 600, Los Angeles, CA 90064.

American Society of Head and Neck Radiology

, 820 Jorie Blvd, Suite 300, Oak Brook, IL 60523.