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 An ear is the organ that enables hearing and, in mammals, body balance using the vestibular system. In mammals, the ear is usually described as having three parts—the outer ear, the middle ear and the inner ear. The outer ear consists ...

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 passes th ...

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 (windpi ...

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 bl ...

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 re ...

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 a ...

combining forms ('' oto-'' + ''

rhino- This is a list of common affixes used when scientifically naming species, particularly extinct species for whom only their scientific names are used, along with their derivations. *a-, an-: ''Pronunciation'': /ə/, /a/, /ən/, /an/. ''Origin'' ...

'' + '' 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 ''-logi ...

'') derived from four Ancient Greek words: οὖς ''ous'' ( gen.: 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 King ...

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 King ...

, 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. Canc ...

Salivary gland cancer Salivary gland tumours, also known as mucous gland adenomas or neoplasms, are tumours that form in the tissues of salivary glands. The salivary glands are classified as major or minor. The major salivary glands consist of the parotid, submandi ...

**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 The outer ear, external ear, or auris externa is the external part of the ear, which consists of the auricle (also pinna) and the ear canal. It gathers sound energy and focuses it on the eardrum (tympanic membrane). Structure Auricle The ...

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 to the eardrum and is about in length and in diameter. Struct ...

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 The middle ear is the portion of the ear medial to the eardrum, and distal to the oval window of the cochlea (of the inner ear). The mammalian middle ear contains three ossicles, which transfer the vibrations of the eardrum into waves in the ...

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 ai ...

(hole in the eardrum due to infection, trauma, explosion or loud noise) **

Mastoiditis Mastoiditis is the result of an infection that extends to the air cells of the skull behind the ear. Specifically, it is an inflammation of the mucosal lining of the mastoid antrum and mastoid air cell system inside the mastoid process. The m ...

*Inner ear diseases **

BPPV Benign paroxysmal positional vertigo (BPPV) is a disorder arising from a problem in the inner ear. Symptoms are repeated, brief periods of vertigo with movement, characterized by a spinning sensation upon changes in the position of the head. * T ...

– 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 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 ...

/ Vestibular neuronitis **

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 initia ...

Endolymphatic hydrops Endolymphatic hydrops is a disorder of the inner ear. It consists of an excessive build-up of the endolymph fluid, which fills the hearing and balance structures of the inner ear. Endolymph fluid, which is partly regulated by the endolymph sac, ...

Perilymphatic fistula A labyrinthine fistula is an abnormal opening in the inner ear. This can result in leakage of the perilymph into the middle ear. This includes specifically a perilymph fistula (PLF), an abnormal connection between the fluid of the inner ear and the ...

Acoustic neuroma A vestibular schwannoma (VS), also called acoustic neuroma, is a benign tumor that develops on the vestibulocochlear nerve that passes from the inner ear to the brain. The tumor originates when Schwann cells that form the insulating myelin sheath ...

, vestibular schwannoma *Facial nerve disease **Idiopathic facial palsy (Bell's Palsy) **Facial nerve tumors **

Ramsay Hunt Syndrome Three different neurological syndromes carry the name of Ramsay Hunt syndrome. Their only connection is that they were all first documented by the famous neurologist James Ramsay Hunt (1872–1937). * Ramsay Hunt syndrome type 1, also called ''Ram ...

* 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 congestion is the blockage of nasal breathing usually due to membranes lining the nose becoming swollen from inflamed blood vessels. Background In about 85% of cases, nasal congestion leads to mouth breathing rather than nasal breathing ...

Nasal septum deviation Nasal septum deviation is a physical disorder of the nose, involving a displacement of the nasal septum. Some displacement is common, affecting 80% of people, mostly without their knowledge. Signs and symptoms The nasal septum is the bone and ...

Sinusitis Sinusitis, also known as rhinosinusitis, is inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain. Other signs and symptoms may include fever, hea ...

– acute, chronic * Environmental allergies *

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, irritant ...

Pituitary tumor Pituitary adenomas are tumors that occur in the pituitary gland. Most pituitary tumors are benign, approximately 35% are invasive and just 0.1% to 0.2% are carcinomas.Empty nose syndrome Empty may refer to: ‍ Music Albums * ''Empty'' (God Lives Underwater album) or the title song, 1995 * ''Empty'' (Nils Frahm album), 2020 * ''Empty'' (Tait album) or the title song, 2001 Songs * "Empty" (The Click Five song), 2007 * ...

* 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 Adenoidectomy is the surgical removal of the adenoid for reasons which include impaired breathing through the nose, chronic infections, or recurrent earaches. The effectiveness of removing the adenoids in children to improve recurrent nasal sympto ...

* Caustic ingestion * Cricotracheal resection * Decannulation * Laryngomalacia * Laryngotracheal reconstruction * 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 wi ...

Laryngology

Dysphonia A hoarse voice, also known as dysphonia or hoarseness, is when the voice involuntarily sounds breathy, raspy, or strained, or is softer in volume or lower in pitch. A hoarse voice, can be associated with a feeling of unease or scratchiness in the ...

/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 trouble swallowing. Typically, these last under two weeks. Laryngitis is categorised ...

Reinke's edema Reinke's edema is the swelling of the vocal cords due to fluid (edema) collected within the Reinke's space. First identified by the German anatomist Friedrich B. Reinke in 1895, the Reinke's space is a gelatinous layer of the vocal cord located un ...

** Vocal cord nodules and

polyps A polyp in zoology is one of two forms found in the phylum Cnidaria, the other being the medusa. Polyps are roughly cylindrical in shape and elongated at the axis of the vase-shaped body. In solitary polyps, the aboral (opposite to oral) e ...

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 pe ...

* Tracheostomy *

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 stagi ...

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 Rhinoplasty ( grc, ῥίς, rhī́s, nose + grc, πλάσσειν, plássein, to shape), commonly called nose job, medically called nasal reconstruction is a plastic surgery procedure for altering and reconstructing the nose. There are two typ ...

and

septoplasty Septoplasty �sɛp.toˌplæ.sti(Etymology: L, saeptum, septum; Gk, πλάσσειν plassein – to shape), or alternatively submucous septal resection and septal reconstruction, is a corrective surgical procedure done to straighten a deviated ...

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 mult ...

(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 t ...

Otoplasty Otoplasty ( el, Wikt:οὖς, οὖς, , "ear" + , , "to shape") denotes the plastic surgery, surgical and non-surgical procedures for correcting the deformities and defects of the Pinna (anatomy), pinna (Ear, external ear), and for reconstructing a ...

* Genioplasty * Injectable cosmetic treatments * Trauma 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 tooth, teeth in place. The mandible sits beneath the maxilla. It is the only movabl ...

fracture **

Orbital fracture Facial trauma, also called maxillofacial trauma, is any physical trauma to the face. Facial trauma can involve soft tissue injuries such as burns, lacerations and bruises, or fractures of the facial bones such as nasal fractures and fractures ...

** Frontal

sinus Sinus may refer to: Anatomy * Sinus (anatomy), a sac or cavity in any organ or tissue ** Paranasal sinuses, air cavities in the cranial bones, especially those near the nose, including: *** Maxillary sinus, is the largest of the paranasal sinuses, ...

fracture ** Complex lacerations and soft tissue damage * Skin cancer (e.g.

Basal Cell Carcinoma Basal-cell carcinoma (BCC), also known as basal-cell cancer, is the most common type of skin cancer. It often appears as a painless raised area of skin, which may be shiny with small blood vessels running over it. It may also present as a raise ...

)

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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