| Otorhinolaryngology | |
| Diseases: | Dizziness, Head and neck cancer, Sinusitis, Chronic ear disease, Hoarseness, Nasal obstruction |
| Specialist: | Otorhinolaryngologist |
| Glossary: | Glossary of medicine |
| Otolaryngologist | |
| Official Names: |
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| Type: | Specialty |
| Activity Sector: | Medicine, Surgery |
| Formation: |
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| Employment Field: | Hospitals, Clinics |
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 subspecialty 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.
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").
Otorhinolaryngologists are physicians (MD, DO, MBBS, MBChB, etc.) who complete both medical school and an average of five–seven 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]
| 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* |
| Facial cosmetic surgery | Ear | Middle and inner ear | Velopalatine insufficiency | Sleep disorders | |||
| Microvascularreconstruction | Maxillofacial surgery | Hearing | Temporal bone | 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 |
| Craniofacial surgery | Vascular malformations | ||||||
| Cochlear implant/BAHA |
(*Currently recognized by American Board of Medical Subspecialties)
See main article: 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 includes nasal dysfunction and sinus diseases.
See main article: Laryngology.
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 encompasses any surgery that helps alleviate obstructive sleep apnea and can anatomically include any part of the upper airway.
Microvascular reconstruction repair is a common operation that is done on patients who see an otorhinolaryngologist. It is a surgical procedure that involves moving a composite piece of tissue from the patient's body and 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, and back, and can come from the skin, bone, fat, and/or muscle.[8] 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 that these connections need to be made with a microscope, which is why the procedure is called "microvascular surgery".