Otorhinolaryngology

Otorhinolaryngology (/oʊtoʊˌraɪnoʊˌlærɪnˈɡɒlədʒi/ oh-toh-RY-noh-LARR-in-GOL-ə-jee, abbreviated ORL and also known as otolaryngology, otolaryngology – head and neck surgery (ORL–H&N or OHNS), or ear, nose, and throat (ENT) is a surgical subspeciality within medicine that deals with the surgical and medical management of conditions of the head and neck. Doctors who specialize in this area are called otorhinolaryngologists, otolaryngologists, head and neck surgeons, or ENT surgeons or physicians. Patients seek treatment from an otorhinolaryngologist for diseases of the ear, nose, throat, base of the skull, head, and neck. These commonly include functional diseases that affect the senses and activities of eating, drinking, speaking, breathing, swallowing, and hearing. In addition, ENT surgery encompasses the surgical management of cancers and benign tumors and reconstruction of the head and neck as well as plastic surgery of the face, scalp, and neck.

"Otolaryngology – head and neck surgery" redirects here. For the medical journal, see Otolaryngology–Head and Neck Surgery.

Otorhinolaryngology
Significant diseasesDizziness, Head and neck cancer, Sinusitis, Chronic ear disease, Hoarseness, Nasal obstruction
SpecialistOtorhinolaryngologist
GlossaryGlossary of medicine
Otolaryngologist
Occupation
Names
  • Physician
  • Surgeon
Occupation type
Specialty
Activity sectors
Medicine, Surgery
Description
Education required
Fields of
employment
Hospitals, Clinics
A 40-watt CO2 laser used in otorhinolaryngology
Royal National Throat, Nose and Ear Hospital founded in 1874, in London

Etymology

The term is a combination of Neo-Latin combining forms (oto- + rhino- + laryngo- + -logy) derived from four Ancient Greek words: οὖς ous (gen.: ὠτός otos), "ear", ῥίς rhis, "nose", λάρυγξ larynx, "larynx" and -λογία logia, "study"[1] (cf. Greek ωτορινολαρυγγολόγος, "otorhinolaryngologist").

Training

Otorhinolaryngologists are physicians (MD, DO, MBBS, MBChB, etc.) who complete both medical school and an average of 5–7 years of post-graduate surgical training in ORL-H&N. In the United States, trainees complete at least five years of surgical residency training.[2] This comprises three to six months of general surgical training and four and a half years in ORL-H&N specialist surgery. In Canada and the United States, practitioners complete a five-year residency training after medical school.

Following residency training, some otolaryngologist-head & neck surgeons complete an advanced sub-specialty fellowship, where training can be one to two years in duration. Fellowships include head and neck surgical oncology, facial plastic surgery, rhinology and sinus surgery, neuro-otology, pediatric otolaryngology, and laryngology. In the United States and Canada, otorhinolaryngology is one of the most competitive specialties in medicine in which to obtain a residency position following medical school.[3][4]

In the United Kingdom, entrance to higher surgical training is competitive and involves a rigorous national selection process.[5] The training programme consists of 6 years of higher surgical training after which trainees frequently undertake fellowships in a sub-speciality prior to becoming a consultant.

The typical total length of education, training and post-secondary school is 12–14 years. Otolaryngology is among the more highly compensated surgical specialties in the United States. In 2022, the average annual income was $469,000.[6]

Sub-specialties
Head and neck oncologic surgery Facial plastic and reconstructive surgery* Otology Neurotology* Rhinology/sinus/anterior skull base surgery Laryngology and voice disorders Pediatric otorhinolaryngology* Sleep medicine*
Surgical oncology Facial cosmetic surgery Ear Middle and inner ear Sinusitis Voice disorders Velopalatine insufficiency Sleep disorders
Microvascular

reconstruction

Maxillofacial surgery Hearing Temporal bone Allergy Phono-surgery Cleft lip and palate Sleep apnea surgery
Endocrine surgery Traumatic reconstruction Balance Skull base surgery Anterior skull base Swallowing disorders Airway Sleep investigations
Endoscopic surgery Craniofacial surgery Dizziness Apnea and snoring Vascular malformations
Cochlear implant/BAHA Cochlear implant/BAHA

(*Currently recognized by American Board of Medical Subspecialties)

Topics by subspecialty

Head and neck surgery
  • Head and neck surgical oncology (field of surgery treating cancer/malignancy of the head and neck)
    • Head and neck mucosal malignancy (cancer of the pink lining of the upper aerodigestive tract)
      • Oral cancer (cancer of lips, gums, tongue, hard palate, cheek, floor of mouth)
      • Oropharyngeal cancer (cancer of oropharynx, soft palate, tonsil, base of tongue)
      • Larynx cancer (voice box cancer)
      • Hypopharynx cancer (lower throat cancer)
      • Sinonasal cancer
      • Nasopharyngeal cancer
    • Skin cancer of the head & neck
    • Thyroid cancer
    • Salivary gland cancer
    • Head and neck sarcoma
  • Endocrine surgery of the head and neck
    • Thyroid surgery
    • Parathyroid surgery
  • Microvascular free flap reconstructive surgery
  • Skull base surgery

Otology and neurotology
Main articles: Otology and Neurotology

Study of diseases of the outer ear, middle ear and mastoid, and inner ear, and surrounding structures (such as the facial nerve and lateral skull base)

Rhinology

Rhinology includes nasal dysfunction and sinus diseases.

Pediatric otorhinolaryngology

Laryngology
Main article: Laryngology

Facial plastic and reconstructive surgery

Facial plastic and reconstructive surgery is a one-year fellowship open to otorhinolaryngologists who wish to begin learning the aesthetic and reconstructive surgical principles of the head, face, and neck pioneered by the specialty of Plastic and Reconstructive Surgery.

Sleep surgery

Sleep surgery encompasses any surgery that helps alleviate obstructive sleep apnea and can anatomically include any part of the upper airway.

  • Nasal cavity / nasopharynx
    • Septoplasty
    • Adenoidectomy (especially in pediatrics)
  • Oral cavity / oropharynx
    • Tonsillectomy (especially in pediatrics)
    • Uvulopalatopharyngoplasty
    • Transoral midline glossectomy
    • Genioglossus advancement
  • Other
    • Hyoid suspension
    • Maxillomandibular advancement
    • Hypoglossal nerve stimulator implant (Inspire)

Microvascular reconstruction repair

Microvascular reconstruction repair is a common operation that is done on patients who see an Otorhinolaryngologist. Microvascular reconstruction repair is a surgical procedure that involves moving a composite piece of tissue from the patient's body and moves it to the head and or neck. Microvascular head and neck reconstruction is used to treat head and neck cancers, including those of the larynx and pharynx, oral cavity, salivary glands, jaws, calvarium, sinuses, tongue and skin. The tissue that is most commonly moved during this procedure is from the arms, legs, back, and can come from the skin, bone, fat, and or muscle.[7] When doing this procedure, the decision on which is moved is determined on the reconstructive needs. Transfer of the tissue to the head and neck allows surgeons to rebuild the patient's jaw, optimize tongue function, and reconstruct the throat. When the pieces of tissue are moved, they require their own blood supply for a chance of survival in their new location. After the surgery is completed, the blood vessels that feed the tissue transplant are reconnected to new blood vessels in the neck. These blood vessels are typically no more than 1 to 3 millimeters in diameter which means these connections need to be made with a microscope which is why this procedure is called "microvascular surgery."

See also

References
  1. "otolaryngologist" entry in: Peter Harris, Sue Nagy, Nicholas Vardaxis, Mosby's Dictionary of Medicine, Nursing & Health Professions - Australian & New Zealand Edition, Elsevier Health Sciences, 2009.
  2. "Otolaryngology Specialty Description". American Medical Association.
  3. "Is There a Crisis in the Otolaryngology Match?". ENTtoday. Retrieved 16 April 2020.
  4. "National Residency Match Program 2020" (PDF). National Residency Match Program. Archived from the original (PDF) on 28 August 2021. Retrieved 2 April 2020.
  5. "Training and development (otorhinolaryngology)". Health Careers. 16 April 2015. Retrieved 16 April 2020.
  6. "Medscape, Otolaryngologist Compensation Report 2022".
  7. "Microvascular Head and Neck Reconstruction | Conditions & Treatments | UCSF Medical Center". ucsfhealth.org. Retrieved 6 December 2018.
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