Otorhinolaryngology

Otorhinolaryngology
Significant diseasesDizziness, head and neck cancer, sinusitis, chronic ear disease, hoarseness, nasal obstruction
SpecialistOtorhinolaryngologist
GlossaryGlossary of medicine
Otolaryngologist
Occupation
Names
  • Physician
  • Surgeon
Occupation type
Specialty
Activity sectors
Medicine, surgery
Description
Education required
Fields of
employment
Hospitals, clinics
A 40-watt CO2 laser used in otorhinolaryngology
Royal National Throat, Nose and Ear Hospital founded in 1874, in London

Otorhinolaryngology (/oʊtoʊˌraɪnoʊˌlærɪnˈɡɒlədʒi/ oh-toh-RY-noh-LARR-in-GOL-ə-jee, abbreviated ORL), 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.

The ear, nose, and throat operate as an interconnected system, linked to each other via the Eustachian tube.

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, reconstruction of the head and neck, and plastic surgery of the face, scalp, and neck.

In modern otorhinolaryngology, laser-assisted surgical techniques are used for various indications. Depending on the laser system and clinical indication, these techniques can be used for tissue resection, coagulation, or vaporization. They may provide a minimally invasive and tissue-sparing approach to lesions and are often associated with good hemostasis.

Etymology

The term is a combination of Neo-Latin combining forms (oto- + rhino- + laryngo- + -logy) derived from four Ancient Greek words: (cf. Greek ωτορινολαρυγγολόγος 'otorhinolaryngologist').

  1. οὖς (ous), 'ear', whose genitive is ὠτός (otos)
  2. ῥίς (rhis) 'nose'
  3. λάρυγξ (larynx) 'larynx'
  4. -λογία (logia) 'study'

Training

Otorhinolaryngologists are physicians (MD, DO, MBBS, MBChB, etc.) who complete both medical school and an average of 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 last for one to two years. 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 among the most competitive medical specialties for residency positions following medical school.

In the United Kingdom, entrance to higher surgical training is competitive. It 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 before 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.

Sub-specialties

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*
Surgical oncology Facial cosmetic surgery Ear Middle and inner ear Sinusitis Voice disorders Velopalatine insufficiency Sleep disorders
Microvascular
reconstruction 		Maxillofacial surgery Hearing Temporal bone Allergy 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
Endoscopic surgery Craniofacial surgery Dizziness Apnea and snoring Vascular malformations
Cochlear implant / BAHA Cochlear implant/BAHA

(*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 (cancer of lips, gums, tongue, hard palate, cheek, floor of mouth)
      • Oropharyngeal cancer (cancer of the oropharynx, soft palate, tonsil, base of tongue)
      • Larynx cancer (voice box cancer)
      • Hypopharynx cancer (lower throat cancer)
      • Sinonasal cancer
      • Nasopharyngeal cancer
    • Skin cancer of the head & neck
    • Thyroid cancer
    • 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
  • Transoral laser microsurgery - used for selected laryngeal conditions, including early laryngeal cancers, premalignant lesions, recurrent respiratory papillomatosis, and laryngeal stenoses

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

Rhinology includes nasal dysfunction and sinus diseases.

Pediatric otorhinolaryngology

Laryngology

Facial plastic and reconstructive surgery

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

Sleep surgery encompasses any surgery that alleviates obstructive sleep apnea and can anatomically include any part of the upper airway.

Microvascular reconstruction repair

Microvascular reconstruction repairs are commonly performed on patients consulting an otorhinolaryngologist. It is a surgical procedure that involves moving a composite piece of tissue from the patient's body 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 most commonly moved during this procedure is from the arms, legs, and back, and can come from the skin, bone, fat, and/or muscle.

When performing this procedure, the reconstructive needs determine which is moved. 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 pieces of tissue are moved, they require their own blood supply to survive 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".

See also

References

  1. ↑ Landry, Vivianne; Sedillot-Daniel, Ève; Ayad, Tareck; Leclerc, Andrée-Anne (2024). "Strategies for CO2 Laser Use in Laryngeal Microsurgery: A Systematic Review". Otolaryngology–Head and Neck Surgery. 171 (2): 353–367. doi:10.1002/ohn.734. ISSN 1097-6817. PMID 38529664.
  2. ↑ Remacle, Marc; Arens, Christoph; Eldin, Mostafa Badr; Campos, Guillermo; Estomba, Carlos Chiesa; Dulguerov, Pavel; Fiz, Ivana; Hantzakos, Anastasios; Keghian, Jerôme; Mora, Francesco; Matar, Nayla; Peretti, Giorgio; Piazza, Cesare; Postma, Gregory N.; Prasad, Vyas (1 October 2017). "Laser-assisted surgery of the upper aero-digestive tract: a clarification of nomenclature. A consensus statement of the European Laryngological Society". European Archives of Oto-Rhino-Laryngology. 274 (10): 3723–3727. doi:10.1007/s00405-017-4708-3. ISSN 1434-4726. PMC 5758682. PMID 28819810.
  3. ↑ Lau, Kimberley; Stavrakas, Marios; Ray, Jaydip (1 February 2021). "Lasers in Rhinology—An Update". Ear, Nose & Throat Journal. 100 (1_suppl). SAGE Publications Inc: 77S–82S. doi:10.1177/0145561320940115. ISSN 0145-5613. PMID 32703032.
  4. ↑ Eckel, Hans Edmund; Simo, Ricard; Quer, Miquel; Odell, Edward; Paleri, Vinidh; Klussmann, Jens Peter; Remacle, Marc; Sjögren, Elisabeth; Piazza, Cesare (1 June 2021). "European Laryngological Society position paper on laryngeal dysplasia Part II: diagnosis, treatment, and follow-up". European Archives of Oto-Rhino-Laryngology. 278 (6): 1723–1732. doi:10.1007/s00405-020-06406-9. ISSN 1434-4726. PMC 8131286. PMID 33058010.
  5. ↑ "otolaryngologist" entry in: Peter Harris, Sue Nagy, Nicholas Vardaxis, Mosby's Dictionary of Medicine, Nursing & Health Professions - Australian & New Zealand Edition, Elsevier Health Sciences, 2009.
  6. ↑ "Otolaryngology Specialty Description". American Medical Association. Retrieved 30 October 2024.
  7. ↑ Hamaker, Amy E. (11 June 2018). "Is There a Crisis in the Otolaryngology Match?". ENTtoday. Retrieved 16 April 2020.
  8. ↑ "National Residency Match Program 2020" (PDF). National Residency Match Program. Archived from the original (PDF) on 28 August 2021. Retrieved 2 April 2020.
  9. ↑ "Training and development (otorhinolaryngology)". Health Careers. 16 April 2015. Retrieved 16 April 2020.
  10. ↑ "Medscape, Otolaryngologist Compensation Report 2022". Medscape.
  11. ↑ Eckel, Hans Edmund; Simo, Ricard; Quer, Miquel; Odell, Edward; Paleri, Vinidh; Klussmann, Jens Peter; Remacle, Marc; Sjögren, Elisabeth; Piazza, Cesare (1 June 2021). "European Laryngological Society position paper on laryngeal dysplasia Part II: diagnosis, treatment, and follow-up". European Archives of Oto-Rhino-Laryngology. 278 (6): 1723–1732. doi:10.1007/s00405-020-06406-9. ISSN 1434-4726. PMC 8131286. PMID 33058010.
  12. ↑ Remacle, Marc; Arens, Christoph; Eldin, Mostafa Badr; Campos, Guillermo; Estomba, Carlos Chiesa; Dulguerov, Pavel; Fiz, Ivana; Hantzakos, Anastasios; Keghian, Jerôme; Mora, Francesco; Matar, Nayla; Peretti, Giorgio; Piazza, Cesare; Postma, Gregory N.; Prasad, Vyas (1 October 2017). "Laser-assisted surgery of the upper aero-digestive tract: a clarification of nomenclature. A consensus statement of the European Laryngological Society". European Archives of Oto-Rhino-Laryngology. 274 (10): 3723–3727. doi:10.1007/s00405-017-4708-3. ISSN 1434-4726. PMC 5758682. PMID 28819810.
  13. ↑ Landry, Vivianne; Sedillot-Daniel, Ève; Ayad, Tareck; Leclerc, Andrée-Anne (2024). "Strategies for CO2 Laser Use in Laryngeal Microsurgery: A Systematic Review". Otolaryngology–Head and Neck Surgery. 171 (2): 353–367. doi:10.1002/ohn.734. ISSN 1097-6817. PMID 38529664.
  14. ↑ Bradley, P. J.; Mackenzie, K.; Wight, R.; Pracy, P.; Paleri, V.; ENT-UK Head & Neck Group (August 2009). "Consensus statement on management in the UK: transoral laser assisted microsurgical resection of early glottic cancer". Clinical Otolaryngology: Official Journal of ENT-UK ; Official Journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery. 34 (4): 367–373. doi:10.1111/j.1749-4486.2009.01944.x. ISSN 1749-4486. PMID 19673988.
  15. ↑ "Exostoses (Surfer's Ear)". Stanford Medicine Healthcare. Retrieved 21 July 2024.
  16. ↑ Lau, Kimberley; Stavrakas, Marios; Ray, Jaydip (2021). "Lasers in Rhinology—An Update". Ear, Nose & Throat Journal. 100 (1_suppl): 77S–82S. doi:10.1177/0145561320940115. PMID 32703032.
  17. ↑ Abiri, Arash; Goshtasbi, Khodayar; Maducdoc, Marlon; Sahyouni, Ronald; Wang, Marilene B.; Kuan, Edward C. (2020). "Laser-Assisted Control of Epistaxis in Hereditary Hemorrhagic Telangiectasia: A Systematic Review". Lasers in Surgery and Medicine. 52 (4): 293–300. doi:10.1002/lsm.23147. ISSN 1096-9101. PMC 7035186. PMID 31441079.
  18. ↑ "Table of Recommendations". CureHHT. 15 July 2026. Retrieved 31 August 2026.
  19. ↑ Ahmed, Jake; Arya, Arvind (1 February 2021). "Lasers in Tonsillectomy: Revisited With Systematic Review". Ear, Nose & Throat Journal. 100 (1_suppl). SAGE Publications Inc: 14S–18S. doi:10.1177/0145561320961747. ISSN 0145-5613. PMID 33048574.
  20. ↑ Eckel, Hans Edmund; Simo, Ricard; Quer, Miquel; Odell, Edward; Paleri, Vinidh; Klussmann, Jens Peter; Remacle, Marc; Sjögren, Elisabeth; Piazza, Cesare (1 June 2021). "European Laryngological Society position paper on laryngeal dysplasia Part II: diagnosis, treatment, and follow-up". European Archives of Oto-Rhino-Laryngology. 278 (6): 1723–1732. doi:10.1007/s00405-020-06406-9. ISSN 1434-4726. PMC 8131286. PMID 33058010.
  21. ↑ "Microvascular Head and Neck Reconstruction - Conditions & Treatments". ucsfhealth.org. Retrieved 6 December 2018.
  22. ↑ "Microvascular Reconstructive Surgery Head & Neck Surgery Stanford Otolaryngology — Head & Neck Surgery Stanford Medicine". Stanford Medicine. Retrieved 20 June 2026.