Otolaryngology

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About Otolaryngology

Otolaryngology is a medical specialty that remains focused on the ears, nose, and throat. It is also known as otolaryngology-head and neck surgery because specialists are trained in both medicine and surgery.  An otolaryngologist is often called an ear, nose, and throat doctor, or an ENT for short.

This medical specialty dates back to the 19th century, when doctors determined that the head and neck contained a range of interconnected systems. Doctors developed techniques and tools for examining and treating problems of the head and neck, eventually forming a medical specialty.

What is treated?

  • Ear: Otolaryngologists are experts in the medical and surgical treatment of hearing loss, ear infections, balance disorders, ear noise (tinnitus), nerve pain, and facial and cranial nerve disorders. They also manage congenital (birth) disorders of the outer and inner ear.
     
  • Nose: Nasal cavity and sinuses care is one of the primary skills of otolaryngologists. Otolaryngologists diagnose, manage and treat allergies, sinusitis, smell disorders, polyps, and nasal obstruction due to a deviated septum. They can also correct the looks of the nose (rhinoplasty surgery).
     
  • Throat: Otolaryngologists have expertise in managing diseases of the larynx (voice box) and the upper aero-digestive tract or oesophagus, including voice and swallowing disorders.
     
  • Head and Neck: In the head and neck area, otolaryngologists are trained to treat infectious diseases, both benign and malignant (cancerous) tumours, facial trauma, and deformities of the face. They perform both cosmetic plastic and reconstructive surgery.

There are seven areas of expertise within the domain of otolaryngology. Some otolaryngologists will start additional study to specialize in one of them and subsequently limit their services solely to the management of their chosen specialty:

  • Allergy - treatment of the condition by medication, immunotherapy or avoidance of triggers
     
  • Facial plastic and reconstructive surgery - performing surgery on the face, neck or ear for cosmetic, functional or reconstructive purposes
     
  • Head and neck - treatment or removal of (cancerous or noncancerous) tumors 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.

Otolaryngologists provide care for a wider range of conditions, using 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.

Common procedures performed

Otolaryngologists are required to perform a range of procedures as befitting the large number of conditions they treat. These procedures also range in scale and complexity, from intricate microvascular reconstruction to surgery that encompasses the entire neck.

The following list of procedures commonly performed by otolaryngologists offers an overview of the scope of their work:

  • Blepharoplasty: - The removal of excess skin, muscle and/or fat to 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.
     
  • Endoscopic sinus surgery: - Typically performed for 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 blocking the sinuses. The procedure can be performed under local or general anesthetic.
     
  • Excision and biopsy: - Biopsies are performed so that otolaryngologists can identify suspicious lesions and tumors. These can develop anywhere in the body, and identification is essential in order to determine an appropriate course of treatment. The excision (removal) of small lesions and superficial skin cancers can often be done simply under local anesthetic in an outpatient setting.
     
  • 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. They can also enhance the appearance of the facial structures, including the correction of wrinkles.
     
  • 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 procedure where a small incision is made in the ear drum to relieve pressure caused by excessive fluid build-up or to drain pus in the middle ear.
     
  • 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.
     
  • 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.
     
  • Surgery for snoring or obstructive sleep apnea (OSA): - Otolaryngologists have a number of surgical solutions for snoring and OSA. 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.
     
  • 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.
     
  • 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 anaesthetic.
     
  • Tracheostomy: - A procedure to create an opening through the neck into the windpipe, through which a tube can be placed to provide an airway or remove secretions from the lungs. Tracheostomy may be required for several reasons, including cancer of the neck and paralysis of muscles used for swallowing.
     
  • 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.

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