National Throat Nose and Ear Hospital London - geograph

Otorhinolaryngology ( , 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 A nose is a protuberance in vertebrates that houses the nostrils, or nares, which receive and expel air for respiration alongside the mouth. Behind the nose are the olfactory mucosa and the sinuses. Behind the nasal cavity, air next passe ...

throat In vertebrate anatomy, the throat is the front part of the neck, internally positioned in front of the vertebrae. It contains the pharynx and larynx. An important section of it is the epiglottis, separating the esophagus from the trachea (windpip ...

base of the skull The base of skull, also known as the cranial base or the cranial floor, is the most inferior area of the skull. It is composed of the endocranium and the lower parts of the calvaria. Structure Structures found at the base of the skull are for ...

, 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

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

s and

benign tumor A benign tumor is a mass of cells ( tumor) that does not invade neighboring tissue or metastasize (spread throughout the body). Compared to malignant (cancerous) tumors, benign tumors generally have a slower growth rate. Benign tumors have r ...

s and reconstruction of the head and neck as well as plastic surgery of the face and neck.

Etymology

The term is a combination of

New Latin New Latin (also called Neo-Latin or Modern Latin) is the revival of Literary Latin used in original, scholarly, and scientific works since about 1500. Modern scholarly and technical nomenclature, such as in zoological and botanical taxonomy ...

combining forms ('' oto-'' + '' rhino-'' + '' laryngo-'' + ''

-logy ''-logy'' is a suffix in the English language, used with words originally adapted from Ancient Greek ending in ('). The earliest English examples were anglicizations of the French '' -logie'', which was in turn inherited from the Latin ''-lo ...

'') derived from four

Ancient Greek Ancient Greek includes the forms of the Greek language used in ancient Greece and the ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Dark Ages (), the Archaic pe ...

words: οὖς ''ous'' (

gen. The Book of Genesis (from Greek ; Hebrew: בְּרֵאשִׁית ''Bəreʾšīt'', "In hebeginning") is the first book of the Hebrew Bible and the Christian Old Testament. Its Hebrew name is the same as its first word, ( "In the beginning"). ...

: ὠτός ''otos''), "ear", ῥίς ''rhis'', "nose", λάρυγξ ''larynx'', "larynx" and -λογία ''logia'', "study" (cf. Greek ωτορινολαρυγγολόγος, "otorhinolaryngologist").

Training

Otorhinolaryngologists are

physicians A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

( MD, DO,

MBBS Bachelor of Medicine, Bachelor of Surgery ( la, Medicinae Baccalaureus, Baccalaureus Chirurgiae; abbreviated most commonly MBBS), is the primary medical degree awarded by medical schools in countries that follow the tradition of the United Kin ...

MBChB Bachelor of Medicine, Bachelor of Surgery ( la, Medicinae Baccalaureus, Baccalaureus Chirurgiae; abbreviated most commonly MBBS), is the primary medical degree awarded by medical schools in countries that follow the tradition of the United Kin ...

, etc.) who complete medical school and then 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. 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. In the United Kingdom entrance to otorhinolaryngology higher surgical training is highly competitive and involves a rigorous national selection process. 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 and training, post-secondary school is 12–14 years. Otolaryngology is among the more highly compensated surgical specialties in the United States. In 2019, the average annual income was $461,000.

Sub-specialties

(* 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 Oral cancer, also known as mouth cancer, is cancer of the lining of the lips, mouth, or upper throat. In the mouth, it most commonly starts as a painless white patch, that thickens, develops red patches, an ulcer, and continues to grow. When on ...

(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 Skin cancers are cancers that arise from the skin. They are due to the development of abnormal cells that have the ability to invade or spread to other parts of the body. There are three main types of skin cancers: basal-cell skin cancer (BCC) ...

of the head & neck **

Thyroid cancer Thyroid cancer is cancer that develops from the tissues of the thyroid gland. It is a disease in which cells grow abnormally and have the potential to spread to other parts of the body. Symptoms can include swelling or a lump in the neck. Ca ...

** 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

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) * Outer ear diseases **

Otitis externa Otitis externa, also called swimmer's ear, is inflammation of the ear canal. It often presents with ear pain, swelling of the ear canal, and occasionally decreased hearing. Typically there is pain with movement of the outer ear. A high fever is ...

– *** outer ear or

ear canal The ear canal (external acoustic meatus, external auditory meatus, EAM) is a pathway running from the outer ear to the middle ear. The adult human ear canal extends from the pinna (anatomy), pinna to the eardrum and is about in length and in di ...

inflammation *Middle ear and mastoid diseases **

Otitis media Otitis media is a group of inflammatory diseases of the middle ear. One of the two main types is acute otitis media (AOM), an infection of rapid onset that usually presents with ear pain. In young children this may result in pulling at the ear, ...

– middle ear inflammation **Perforated

eardrum In the anatomy of humans and various other tetrapods, the eardrum, also called the tympanic membrane or myringa, is a thin, cone-shaped membrane that separates the external ear from the middle ear. Its function is to transmit sound from the ...

(hole in the eardrum due to infection, trauma, explosion or loud noise) ** Mastoiditis *Inner ear diseases ** BPPV – benign paroxysmal positional

vertigo Vertigo is a condition where a person has the sensation of movement or of surrounding objects moving when they are not. Often it feels like a spinning or swaying movement. This may be associated with nausea, vomiting, sweating, or difficulties w ...

** Labyrinthitis/

Vestibular neuronitis Labyrinthitis is inflammation of the labyrinth – a maze of fluid-filled channels in the inner ear. Vestibular neuritis is inflammation of the vestibular nerve – the nerve in the inner ear that sends messages related to motion and position t ...

Ménière's disease Ménière's disease (MD) is a disease of the inner ear that is characterized by potentially severe and incapacitating episodes of vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear. Typically, only one ear is affected initi ...

/ Endolymphatic hydrops ** Perilymphatic fistula ** Acoustic neuroma, vestibular schwannoma *Facial nerve disease **Idiopathic facial palsy (Bell's Palsy) **Facial nerve tumors ** Ramsay Hunt Syndrome * Symptoms **Hearing loss **Tinnitus (subjective noise in the ear) **Aural fullness (sense of fullness in the ear) **Otalgia (pain referring to the ear) **Otorrhea (fluid draining from the ear) **Vertigo **Imbalance

Rhinology

Rhinology includes nasal dysfunction and sinus diseases. * Nasal obstruction * Nasal septum deviation * Sinusitis – acute, chronic * Environmental

allergies Allergies, also known as allergic diseases, refer a number of conditions caused by the hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic dermat ...

Rhinitis Rhinitis, also known as coryza, is irritation and inflammation of the mucous membrane inside the nose. Common symptoms are a stuffy nose, runny nose, sneezing, and post-nasal drip. The inflammation is caused by viruses, bacteria, irrita ...

* Pituitary tumor * Empty nose syndrome * Severe or recurrent

epistaxis A nosebleed, also known as epistaxis, is bleeding from the nose. Blood can flow down into the stomach, and cause nausea and vomiting. In more severe cases, blood may come out of both nostrils. Rarely, bleeding may be so significant that low bl ...

Pediatric otorhinolaryngology

* Adenoidectomy * Caustic ingestion * Cricotracheal resection *

Decannulation A cannula (; Latin meaning 'little reed'; plural or ) is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of samples. In simple terms, a cannula can surround the inner or outer surfaces ...

* Laryngomalacia *

Laryngotracheal reconstruction Laryngotracheal reconstruction is a surgical procedure that involves expanding or removing parts of the airway to widen a narrowing within it, called laryngotracheal stenosis or subglottic stenosis. Types Anterior graft - can be thyroid ala c ...

* Myringotomy and tubes *

Obstructive sleep apnea Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway leading to reduced or absent breathing during sleep. These episo ...

– pediatric *

Tonsillectomy Tonsillectomy is a surgical procedure in which both palatine tonsils are fully removed from the back of the throat. The procedure is mainly performed for recurrent tonsillitis, throat infections and obstructive sleep apnea (OSA). For those w ...

Laryngology

* Dysphonia/hoarseness **

Laryngitis Laryngitis is inflammation of the larynx (voice box). Symptoms often include a hoarse voice and may include fever, cough, pain in the front of the neck, and dysphagia, trouble swallowing. Typically, these last under two weeks. Laryngitis is c ...

** Reinke's edema **

Vocal cord nodules Vocal cord nodules are bilaterally symmetrical benign white masses that form at the midpoint of the vocal folds. Although diagnosis involves a physical examination of the head and neck, as well as perceptual voice measures, visualization of the ...

and polyps *

Spasmodic dysphonia Spasmodic dysphonia, also known as laryngeal dystonia, is a disorder in which the muscles that generate a person's voice go into periods of spasm. This results in breaks or interruptions in the voice, often every few sentences, which can make a p ...

Tracheostomy Tracheotomy (, ), or tracheostomy, is a surgical airway management procedure which consists of making an incision (cut) on the anterior aspect (front) of the neck and opening a direct airway through an incision in the trachea (windpipe). The r ...

Cancer of the larynx Laryngeal cancers are mostly squamous-cell carcinomas, reflecting their origin from the epithelium of the larynx. Cancer can develop in any part of the larynx. The prognosis is affected by the location of the tumour. For the purposes of staging ...

Vocology Vocology is the science and practice of vocal habilitation, or vocal training and therapy.Titze IR. (1996). What is vocology? Logopedics Phoniatrics Vocology, 21:5-6. Its concerns include the nature of speech and language pathology, the defects of ...

– science and practice of voice habilitation

Facial plastic and reconstructive surgery

Facial plastic and reconstructive surgery is a one-year fellowship open to otorhinolaryngologists and plastic surgeons who wish to specialize in the aesthetic and reconstructive surgery of the head, face, and neck. * Rhinoplasty and septoplasty *

Facelift A facelift, technically known as a rhytidectomy (from the Ancient Greek () "wrinkle", and () "excision", the surgical removal of wrinkles), is a type of cosmetic surgery procedure used to give a more youthful facial appearance. There are mul ...

(rhytidectomy) * Browlift *

Blepharoplasty Blepharoplasty ( Greek: ''blepharon'', "eyelid" + ''plassein'' "to form") is the plastic surgery operation for correcting defects, deformities, and disfigurations of the eyelids; and for aesthetically modifying the eye region of the face. With ...

* Otoplasty *

Genioplasty Chin augmentation using surgical implants can alter the underlying structure of the face, providing better balance to the facial features. The specific medical terms mentoplasty and genioplasty are used to refer to the reduction and addition of ma ...

* Injectable cosmetic treatments *

Trauma Trauma most often refers to: *Major trauma, in physical medicine, severe physical injury caused by an external source *Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic inju ...

to the face **

Nasal bone The nasal bones are two small oblong bones, varying in size and form in different individuals; they are placed side by side at the middle and upper part of the face and by their junction, form the bridge of the upper one third of the nose. Ea ...

fracture **

Mandible In anatomy, the mandible, lower jaw or jawbone is the largest, strongest and lowest bone in the human facial skeleton. It forms the lower jaw and holds the lower teeth in place. The mandible sits beneath the maxilla. It is the only movable bone ...

fracture ** Orbital fracture ** Frontal sinus fracture ** Complex lacerations and soft tissue damage * Skin cancer (e.g. Basal Cell Carcinoma)

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. 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."

References

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