What is an Ear, Nose and Throat Doctor?

An ear, nose and throat doctor is also known as and ENT or an otolaryngologist.  These physicians diagnose and manage diseases or disorders of the ears, nose, throat, sinuses, larynx (voice box), mouth and throat, as well as structures of the neck and face (AAO, 2017).  ENT’s make diagnoses, prescribe treatments and perform surgeries in the ear, nose, throat, head and neck regions.


An otolaryngologist utilizes medical and surgical skills to treat their patients. They receive extensive education and training in the respiratory and upper alimentary systems, communication sciences and chemical senses.  

Ears- Hearing loss affects one in ten people in the United States. Ear, nose and throat doctors are trained on the medical and surgical treatment of hearing loss, ear infections, balance disorders, ear noise (tinnitus), and some cranial nerve disorders, in addition to congenital (birth) disorders of the outer and inner ear (AAO, 2017).

Nose - Chronic sinusitis is one of the most common health complaints in the United States, with almost 35 million cases reported every year. Otolaryngologists specialize in care of the nasal cavity and sinuses, including in problems such as allergies, smell disorders, polyps and nasal obstruction due to a deviated septum (AAO, 2017). 

Throat- The throat is vital for communicating (speech) and eating.  Ear, nose and throat doctors have expertise in managing diseases of the throat, larynx and upper digestive tract (esophagus), including voice and swallowing disorders (AAO, 2017).    

Head and neck- Sight, smell, hearing and appearance of the face are all aspects of the head and neck region.  Otolaryngologists treat infections of this area as well as benign (non-cancerous) and malignant (cancerous) tumors, facial trauma and deformities of the face, including plastic and reconstructive surgery (AAO, 2017). 

How to become an Ear, Nose and Throat Doctor

Approximately 15 years of education and training is required to become a licensed otolaryngologist.  The American Board of Otolaryngology (ABO) is the certifying organization for ear, nose and throat physicians.  A medical degree and a license are required to practice otolaryngology.  An otolaryngologist receives education in general medicine and specializes in the ear, nose and throat region. 

An undergraduate degree is the first step in becoming an ear, nose and throat doctor.  Typical majors include pre-medical, biology, anatomy, chemistry or biochemistry, although there is no specific requirement for undergraduate major.  Toward the end of the undergraduate program, the student will need to take and pass the Medical College Admission Test (MCAT) in order to apply for medical school.  Future otolaryngologists must apply for and be accepted into an accredited medical school.

Coursework in medical school includes biological, physiological, and biochemical sciences, in addition to laboratory training and experience.  Internships in clinical settings allow the future ear, nose and throat doctor to obtain education and training in the field by observing procedures such as tonsillectomies, ear tube insertions, sinus surgeries, thyroid-related surgeries or surgeries of the head or neck due to cancer (Tucker, 2017). 

Following medical school, a residency program must be completed at a hospital or other medical facility. During residency, aspiring ENT’s receive hands-on experience with patients under direct supervision of licensed physicians.  The residency program is specialized to focus on ear, nose and throat conditions, treatments and surgeries, and has a range of duration from 3 to 8 years.  Once the residency is completed, an application for a license can be submitted to the relevant state body.   

Some otolaryngologists choose to complete a fellowship after completing the residency program.  A fellowship program allows the ear, nose and throat doctor to focus on a sub-specialty area of otolaryngology.  There are eight sub-specialties for otolaryngology: allergy, facial plastic and reconstructive surgery, head and back, laryngology (throat), otology/neurotology (ears, balance, tinnitus), pediatric otolaryngology (children), rhinology (nose) and sleep disorders (AAO, 2017).

Specialized Areas

Allergists provide treatment by medication, immunotherapy (allergy shots) and/or avoidance of pollen, dust, mold, food, and other sensitivities that affect the ear, nose, and throat. ENT’s specialized in allergy will treat hay fever, seasonal and perennial rhinitis, chronic sinusitis, laryngitis, sore throat, otitis media, and dizziness.

Facial Plastic and Reconstructive Surgery – The otolaryngologist performs cosmetic, functional, and reconstructive surgical treatment of abnormalities of the face and neck and ear to treat conditions such as deviated septum, rhinoplasty (nose), face lift, cleft palate, drooping eyelids, hair loss and other ear deformities.

Head and Neck specialists evaluate, diagnose and treat cancerous and noncancerous tumors in the head and neck (nose/sinuses, mouth, throat, voice box and upper esophagus), including the thyroid and parathyroid. Additional patients may include those with a lump in the neck or thyroid, or cancer of the voice box.

Laryngology - Disorders of the throat, including voice and swallowing problems are treated by an ear, nose and throat doctor specializing in laryngology.  This specialized field will treat sore throat, hoarseness, swallowing disorder, gastroesophageal reflux disease (GERD), infections and tumors.

Otology/Neurotology - Diseases of the ear, including trauma (injury), infection, benign tumors, and nerve pathway disorders, which affect hearing and balance are treated by an ENT specializing in otology and neurotology.  Issues presented to this field include ear infection; swimmer’s ear; hearing loss; ear, face, or neck pain; dizziness, ringing in the ears (tinnitus).

Pediatric Otolaryngology is a specialized field in treating diseases in children with special ENT problems including birth defects of the head and neck and developmental delays. Diseases or disorders may include ear infection (otitis media), tonsil and adenoid infection, airway problems, asthma and allergy/sinus disease, neck tumors.

Rhinology specializes in disorders of the nose and sinuses, which includes sinus disorder, nose bleed, stuffy nose, loss of smell, polyps, tumors.

Common Conditions Treated by an Ear, Nose and Throat Doctor

An otolaryngologist treats airway problems (breathing difficulties or obstructions), cancer, chronic sinusitis, cleft lip and cleft palate, deviated septum, drooping eyelids, gastrointestinal reflux, hearing loss, swallowing disorders, tinnitus, tonsil or adenoid infection, vertigo and dizziness and voice disorders, among many others. 

Tracheostomy is 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 (McIntosh, 2016). This may be used for emergency situations, neck cancer and neck muscle paralysis, among many other reasons.

An ear, nose and throat doctor performs biopsies and excisions on lesions and tumors to identify the presence of cancer and determine the correct treatment plan. Neck dissections are also performed to remove cancerous lymph nodes from the neck (McIntosh, 2016).  Depending on the severity of the condition, neck dissection may include removal of all tissues from the jawbone to the collarbone on one side of the body, in addition to removing muscles, nerves, salivary glands and major blood vessels from this area.

Cleft lip and palate is a congenital disorder where the lip or palate does not develop correctly.  A deviated septum occurs when the wall that divides the nasal cavity into two shifts to one side or the other, which typically results in breathing difficulty and chronic sinusitis. These conditions can be repaired during facial plastic or reconstructive surgery. A septoplasty is surgery that corrects deviated septum or to remove nasal polyps.

Excessive upper eyelid sagging is normal due to aging, but it can be caused by diabetes, stroke or tumors that affect nerve communication and muscle reactions.  An ENT removes the excess skin, muscle, or fat tissues, which is referred to as blepharoplasty.

Hearing loss due to the build-up of fluid in the middle ear can be alleviated via a myringotomy, which is a procedure using a small incision to relieve the pressure and/or drain the fluid. Pressure equalization (PE) tubes may also be surgically implanted to allow air into the middle ear. Tympanoplasty is a procedure used to repair defects in the eardrum to improve hearing or repair damaged tissue.

Vertigo is a specific type of dizziness that involves feelings of being in motion when no motion is present.  It can be caused by central nervous system disorders and inner-ear dysfunction or disease. Voice disorders may be caused by vocal cord injury, viral infections, cancer or persistent and recurring acid reflux.  Symptoms of voice disorders include hoarseness, lower vocal pitch, vocal fatigue and loss of voice.

 

Cholesteatoma

Cholesteatoma is a growth of skin or cyst that develops in the middle ear behind the eardrum due to repeated infections or poor Eustachian tube function.  This causes a build-up of skin which can cause severe damage to the bones and structures of the middle ear, including the eardrum.  Hearing loss, dizziness and paralysis of facial muscles can be caused by cholesteatoma. 

Symptoms of cholesteatomas include ear drainage, sometimes with a foul odor, hearing loss, ear pressure build-up, dizziness, and muscle weakness on one side of the face (the side of the infected ear).  Ear cholesteatomas can be extremely dangerous and in rare cases can lead to death.  As the middle ear bones erode, infection can spread into the inner ear and even the brain.  If the cholesteatoma is left untreated, it can cause deafness, brain abscess, and meningitis, which could lead to death.

Surgical treatment is required to drain the ear and remove the cyst or pouch of skin that has developed over the delicate bones of the middle ear. Depending on the severity of the condition, middle ear reconstruction may be necessary, which can involve multiple surgeries for complete repair.

Sore Throat

Sore throat is a symptom of many medical disorders, although infections cause the majority of sore throats and are contagious (CCENT, 2017).  Infections are caused by either a bacterium, which can be treated with antibiotics, or a virus, which does not respond to antibiotic treatment. Viral throat infections are typically associated with common cold and flu illnesses, and they are highly contagious.  The body attacks the virus and eventually destroys it in most cases.  Other viral infections that may cause a sore throat are measles, chicken pox, whooping cough and croup. 

One of the most common bacterial throat infections is strep throat.  In severe cases or when untreated, strep throat can lead to heart valve and kidney damage, as well as scarlet fever, tonsillitis, pneumonia, sinusitis and ear infections. Tonsillitis is a bacterial infection of the tissue at the back of the throat and typically presents in younger children.  Frequent sore throats can be a sign of an infected tonsil. 

Allergies, irritation, reflux and tumors can also cause soreness in the throat.  A sore throat that persists for more than a week or is accompanied by pain, rash, fever, or blood in the saliva is an indicator of a more serious issue. 

Swallowing Disorders

Dysphagia refers to the feeling of difficulty passing food or liquid from the mouth to the stomach, and it is common among all age groups, particularly the elderly.  Most swallowing disorders are minor and are easily treated, although it can be an indicator of a more serious issue, such as tumor growth. There are four steps in the process of swallowing: oral preparation, oral stage, pharyngeal stage and esophageal stage.

When food or liquid enters the mouth, it is chewed and/or manipulated in preparation for swallowing.  This is the oral preparation stage.  During the oral stage, the tongue begins the swallowing response by propelling the food or liquid to the back of the mouth, which leads to the pharyngeal stage, where the food or liquid passes from the mouth into the esophagus.  The esophageal stage refers to the passage of food or liquid through the esophagus into the stomach.

Swallowing disorders can be caused by a variety of factors including poor dental health, improper-fitting dentures or a common cold or flu.  Gastroesophageal reflux commonly leads to difficulties when swelling due to acid in the esophagus and pharynx occurs.  Other causes of dysphagia may be stroke, progressive neurological disorders, tracheostomy, damaged vocal cord, or tumors in the mouth, throat or esophagus. 

Although most conditions are treated with changes in diet, reducing weight and stress or with medications, some may require direct swallowing therapy.  Speech pathologists and occupational therapists provide special exercises to coordinate the muscles used for swallowing or re-stimulating the nerves to trigger the swallowing reflex (CCNET, 2017).  Some patients may also receive assistance with feeding themselves.

History of Otolaryngology

The specialty of otolaryngology is a product of the early 20th century, for it was then that the separate fields of otology and laryngology were joined together (Weir, 2000). Prior to joining together, otologists performed surgery and laryngologists did not, although they both treated diseases of the nose and chest.

The First Otolaryngologists

The first recorded ear, nose and throat surgery was in 1724, when a eustachian tube catheterization was performed, followed by myringotomy (piercing of eardrum) in 1801 and mastoidectomy in 1774 (Weir, 2000).  These remained the most common ear, nose and throat surgeries until medical advances in anesthetics and antisepsis were introduced. The inventions of incandescent light and electric light in the late 1800’s allowed otolaryngologists to view the hidden structures of the ear, nose and throat that were previously unseen via candlelight or daylight.

The origin of laryngology can be traced back to a day in September 1854 when Manuel Garcia (1805– 1906), a singing teacher, at last achieved his lifelong ambition to view his own larynx with a mirror (Weir, 2000).  Although Garcia may have thought he originated the concept of laryngology, Benjamin Babington (1794-1866) performed the first laryngoscopy at a London hospital in 1829.  The signi?cance of these observations of the larynx was applied clinically by Ludwig Türck (1810– 1868) and Johann Czermak (1828–1873), who effectively founded the discipline of laryngology (Weir, 2000). The first medical schools to specialize in both otology and laryngology were established in Vienna in the 1870’s.

The first total laryngectomy for cancer was performed in 1873 by a general surgeon, Professor Theodore Billroth (1829-1894) in Vienna.  It was successful, although there were complications with aspiration of food and drink post-surgery. In 1881, Themistokles Gluck (1853-1942) resolved this issue by severing the larynx from the trachea and suturing it to the skin (Weir, 2000).

Pediatric otolaryngology was developed based on the understanding that children are not young adults, but a specialized group with specialized needs. It was first promoted as a specialized otolaryngology field by Daniel Owitz of Warsaw, Poland in 1938 (Weir, 2000). The most common surgery performed in this field at the time were tonsillectomy and adenoid removal in children. Perhaps the pediatric otolaryngologist’s most important contribution is in the management of congenital abnormalities of the ear, nose and throat where specialized facilities and expertise have markedly reduced the risks of treatment (Weir, 2000).

Modern History

The introduction of the first microscope occurred in 1921.  Thirty years later, the Zeiss Optical Company designed the first binocular operating microscope in 1953, which allowed for the first modern microsurgery of the ear. Fiber-optic light sources, developed by Hopkins in 1954, heralded a new era of endoscopy and ?exible ?berscopes used to examine the nose, nasopharynx, larynx and pharynx in out-patients have in many instances obviated the need for hospital admission (Weir, 2016).  The use of the microscope allowed for discoveries in the anatomy and pathology of the ear led to the reduction of radical surgeries.

The discovery of antibiotics in the 20th century led to unparalleled change in the medical field, including ear, nose and throat specialties. Antibiotic treatments led to a significant decrease in complications due to middle ear disease and infections, as well as a reduced number of tonsillectomies and adenoid removal. The technological advances made during the two world wars also led to significant advances in the field by way of developing surgical procedures and the use of anesthesia.

The first grommet or ventilation tube was introduced in 1960 by B.W. Armstrong.  The purpose of the grommet is to drain excess fluid and equalize pressure on either side of the eardrum and to allow resolution and absorption of the middle ear effusion (Weir, 2000).  Drainage of the ?uid and insertion of the grommet is now said to be the commonest operation performed under general anesthetic.   throughout the Western World (Weir, 2000).  These advancements led to more reconstruction as opposed to removal of ear structures or the ear canal.

Although many advancements in the ear, nose and throat medical field have been made, there is no cure for the loss of hearing due to age or for deafness, whether congenital or due to trauma or medication.  Technology continues to advance and provide surgical options for hearing loss repair. Endoscopy, microsurgery, the use of lasers, cytotoxic drugs, flap reconstruction and microchips are all technological advances that have allowed for significant improvement in an otolaryngologist’s ability to diagnose and treat diseases and disorders of the ear, nose and throat.

Job Prospects

Otolaryngology is a growing field that is expected to see significant increases in job opportunities, as over 50% of Americans suffer from ear, nose or throat issues, in addition to an increased aging population.  The Bureau of Labor Statistics reports an average income of $184,650 for all physicians and surgeons regardless of specialty, however, ear, nose and throat physicians typically earn more than the average income, with the median income around $296,000.

An ENT may work in a hospital, clinic, or group or private practice, and they have dual physician and surgeon responsibilities.  They work long, often irregular, work shifts and often have on-call schedules as well. An ear, nose and throat doctor interacts with a wide range of patients with a variety of disorders or diseases.  The profession of otolaryngology is extremely demanding, although it does have its rewards. Improving their patient’s quality of life is one of the most rewarding aspects of this occupation.

Due to the variety of symptoms and patients an ear, nose and throat patient will treat, ear, nose and throat doctors must have expansive knowledge of general medicine in addition to expertise in disease of the ear, nose, throat, head and neck.   This is a demanding yet rewarding profession with intensive education and training requirements, but it has a high beginning and median salary.

 

References

 

AAO - American Academy of Otolaryngology.  What is an Otolaryngologist? 2017.  Retrieved September 13, 2017 from: http://www.entnet.org/content/what-otolaryngologist

 

Tucker, Kristine.  What Degree Do You Need to Become an Ear, Nose, and Throat Doctor? Our Everyday Life, 2017. Retrieved September 14, 2017 from: http://oureverydaylife.com/degree-need-become-ear-nose-throat-doctor-20813.html

 

CCENT – Central California Ear Nose and Throat Doctors. Otolaryngology head and neck services, 2017. Retrieved September 13, 2017 from: http://www.ccent.com/ear-nose-throat-specialist-fresno.htm

 

McIntosh, James.  What do Otolaryngologists Do?  Medical News Today.  January 28, 2016.  Retrieved September 13, 2017 from: http://www.medicalnewstoday.com/articles/287230.php

 

Weir, Neil.  History of Medicine: Otorhinolaryngology.  Journal of Post-Graduate Medicine, 2000;76:65–69


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