View source for Otorhinolaryngology

{{short description|Medical specialty of the head and neck}}
{{Redirect|Otolaryngology – head and neck surgery|the medical journal|Otolaryngology–Head and Neck Surgery{{!}}''Otolaryngology–Head and Neck Surgery''}}
{{more citations needed|date=April 2010}}
{{Use dmy dates|date=July 2021}}
{{infobox medical speciality
| title        = Otorhinolaryngology
| subdivisions =
| image        = 
| caption      = 
| system       = 
| diseases     = [[Dizziness]], [[head and neck cancer]], [[sinusitis]], [[Chronic ear disease (disambiguation)|chronic ear disease]], [[hoarseness]], [[nasal obstruction]]
| tests        = 
| specialist   = Otorhinolaryngologist
| glossary     = [[Glossary of medicine]]
}}
{{Infobox occupation
| name= Otolaryngologist 
| image= 
| caption=
| official_names=
* Physician
* Surgeon
| type= [[Specialty (medicine)|Specialty]]
| activity_sector= [[Medicine]], [[surgery]]
| competencies= 
| formation=
* [[Doctor of Medicine]] (M.D.) or [[Doctor of Osteopathic medicine]] (D.O.)
* [[Bachelor of Medicine, Bachelor of Surgery]] (M.B.B.S.)
* [[Bachelor of Medicine, Bachelor of Surgery]] (MBChB)
| employment_field= [[Hospital]]s, [[clinic]]s
| related_occupation= 
}}
[[File:Sharplan 40C.jpg|thumb|A 40-watt CO<sub>2</sub> laser used in otorhinolaryngology]]
[[File:National Throat Nose and Ear Hospital London - geograph.org.uk - 984640.jpg|thumb|[[Royal National Throat, Nose and Ear Hospital]] founded in 1874, in [[London]]]]

'''Otorhinolaryngology''' ({{IPAc-en|oʊ|t|oʊ|ˌ|r|aɪ|n|oʊ|ˌ|l|ær|ɪ|n|ˈ|g|ɒ|l|ə|dʒ|i}} {{respell|oh|toh|RY|noh|LARR|in|GOL|ə|jee}}, abbreviated '''ORL''' and also known as '''otolaryngology''', '''otolaryngology{{nbsp}}–{{nbsp}}head and neck surgery''' ('''ORL–H&N''' or '''OHNS'''), or '''ear, nose, and throat''' ('''ENT'''){{Hair space}}) 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]], [[Human nose|nose]], [[throat]], [[base of skull|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 [[cancer]]s and [[benign tumor]]s and reconstruction of the head and neck as well as [[plastic surgery]] of the face, scalp, and neck.

==Etymology==
The term is a combination of [[Neo-Latin]] [[classical compound|combining forms]] (''[[wikt:oto-#Prefix|oto-]]'' + ''[[wikt:rhino-#Prefix|rhino-]]'' + ''[[wikt:laryngo-#Prefix|laryngo-]]'' + ''[[wikt:-logy#Suffix|-logy]]'') derived from four [[Ancient Greek]] words:<ref>"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.</ref> ([[cf.]] Greek {{lang|el|ωτορινολαρυγγολόγος}} {{gloss|otorhinolaryngologist}}).

{{Ordered list
| list_style_type=decimal
| {{lang|grc|οὖς}} ({{Transliteration|grc|ous}}),  {{gloss|ear}}, whose [[Genitive case|genitive]] is {{lang|grc|ὠτός}} ({{Transliteration|grc|otos}})
| {{lang|grc|ῥίς}} ({{Transliteration|grc|rhis}}) {{gloss|nose}}
| {{lang|grc|λάρυγξ}} ({{Transliteration|grc|larynx}}) {{gloss|larynx}}
| {{lang|grc|-λογία}} ({{Transliteration|grc|logia}}) {{gloss|study}}
}}

==Training==
Otorhinolaryngologists are [[physicians]] ([[Doctor of Medicine|MD]], [[Doctor of Osteopathic Medicine|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.<ref>{{cite web|title=Otolaryngology Specialty Description|publisher=American Medical Association|url=https://www.ama-assn.org/specialty/otolaryngology-specialty-description|access-date=2024-10-30}}</ref> This comprises three to six months of [[general surgery|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, [[neurotology|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.<ref>{{Cite web|url=https://www.enttoday.org/article/crisis-in-otolaryngology-match/|title=Is There a Crisis in the Otolaryngology Match?|first=Amy E.|last=Hamaker|date=11 June 2018|website=ENTtoday|language=en-US|access-date=2020-04-16}}</ref><ref>{{Cite web|url=https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2020/03/Advance-Data-Tables-2020.pdf|title=National Residency Match Program 2020|website=National Residency Match Program|access-date=2 April 2020|archive-date=28 August 2021|archive-url=https://web.archive.org/web/20210828123610/https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2020/03/Advance-Data-Tables-2020.pdf|url-status=dead}}</ref>

In the United Kingdom, entrance to higher surgical training is competitive and involves a rigorous national selection process.<ref>{{Cite web|url=https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/surgery/otorhinolaryngology-ear-nose-and-throat-surgery-ent/training-and-development|title=Training and development (otorhinolaryngology)|date=2015-04-16|website=Health Careers|language=en|access-date=2020-04-16}}</ref> 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.<ref>{{cite web|url=https://www.medscape.com/slideshow/2022-compensation-otolaryngologist-6015158#2|title=Medscape, Otolaryngologist Compensation Report 2022|website=Medscape|url-access=registration}}</ref>

==Sub-specialties==
{|class="wikitable"
|-  style="text-align:center; font-weight:bold; vertical-align:top;"
|  style="width:117px; height:12.75;"| Head and neck oncologic surgery
| style="width:100px;"| Facial plastic and reconstructive surgery*
| style="width:43.5;"| Otology
| style="width:117px;"| Neurotology*
| style="width:117px;"| Rhinology/sinus/anterior skull base surgery
| style="width:68.25;"| Laryngology and voice disorders
| style="width:140.25;"| Pediatric otorhinolaryngology*
| style="width:43.5;"| Sleep medicine*
|-  style="text-align:center; vertical-align:top;"
| style="height:12.75;"| [[Surgical oncology]]
 | Facial cosmetic surgery
 | Ear
 | Middle and inner ear
 | [[Sinusitis]]
 | [[Voice disorders]]
 | Velopalatine insufficiency
|[[Sleep disorders]]
|-  style="text-align:center; vertical-align:top;"
| style="height:12.75;"| Microvascular
reconstruction
 | Maxillofacial surgery
 | Hearing
 | Temporal bone
 | [[Allergy]] 
 | Phono-surgery
 | Cleft lip and palate
|Sleep apnea surgery
|-  style="text-align:center; vertical-align:top;"
| style="height:12.75;"| Endocrine surgery
 | Traumatic reconstruction
 | Balance

 | Skull base surgery
 | Anterior skull base
 | Swallowing disorders
 | Airway
|Sleep investigations
|-  style="text-align:center; vertical-align:top;"
| style="height:12.75;"| [[Endoscopic endonasal surgery|Endoscopic surgery]]
 | Craniofacial surgery
 |
 | [[Dizziness]]
 | Apnea and [[snoring]] 
 |
 | Vascular malformations
|-  style="text-align:center; vertical-align:top;"
| style="height:12.75;"|
 |
 |
 | [[Cochlear implant]] / [[Bone-anchored hearing aid|BAHA]]
 |
 |
 | Cochlear implant/BAHA
|}

(*Currently recognized by [[American Board of Medical Specialties|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 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
*[[Flap (surgery)|Microvascular free flap reconstructive surgery]]
*Skull base surgery

===Otology and neurotology===
{{Main|Otology|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]] –
***[[outer ear]] or [[ear canal]] inflammation
**Exostoses or [[Surfer's ear]] are bony growths in the outer ear canal<ref>{{Cite web |title=Exostoses (Surfer's Ear) |url=https://stanfordhealthcare.org/medical-conditions/ear-nose-and-throat/exostoses.html |access-date=2024-07-21 |website=Stanford Medicine Healthcare}}</ref>
*Middle ear and mastoid diseases
**[[Otitis media]] – [[middle ear]] inflammation
**Perforated [[eardrum]] (hole in the eardrum due to infection, trauma, explosion or loud noise)
**[[Mastoiditis]]
*Inner ear diseases
**[[BPPV]] – benign paroxysmal positional [[vertigo]]
**[[Labyrinthitis]]/[[Vestibular neuronitis]]
**[[Ménière's disease]]/[[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]]
**Inferior turbinate hypertrophy
**[[Nasal septum deviation]]
**Chronic sinusitis with nasal polyps
*[[Sinusitis]] – acute, chronic
* Environmental [[allergies]]
*[[Rhinitis]]
*[[Pituitary tumor]]
*[[Empty nose syndrome]]
* Severe or recurrent [[epistaxis]]

===Pediatric otorhinolaryngology===

*[[Adenoidectomy]]
*[[Caustic ingestion]]
* Cricotracheal resection
*[[Decannulation]]
*[[Laryngomalacia]]
*[[Laryngotracheal reconstruction]]
*[[Myringotomy|Myringotomy and tubes]]
*[[Obstructive sleep apnea]] – pediatric
*[[Tonsillectomy]]

===Laryngology===
{{main|Laryngology}}
*[[Dysphonia]]/hoarseness
**[[Laryngitis]]
**[[Reinke's edema]]
**[[Vocal fold nodule|Vocal cord nodules]] and [[Vocal cord polyp|polyps]]
*[[Spasmodic dysphonia]]
*[[Tracheostomy]]
*[[Cancer of the larynx]]
*[[Vocology]] – science and practice of voice habilitation
*[[Muteness]] and [[Selective mutism|selective muteness]]

===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.

*[[Rhinoplasty]] and [[septoplasty]]
*[[Rhytidectomy|Facelift]] (rhytidectomy)
*[[Browlift]]
*[[Blepharoplasty]]
*[[Otoplasty]]
*[[Genioplasty]]
* Injectable cosmetic treatments
*[[Physical trauma|Trauma]] to the face
**[[Nasal bone]] fracture
**[[Human mandible|Mandible]] fracture
**[[Orbital fracture]]
** Frontal [[Sinus (anatomy)|sinus]] fracture
** Complex lacerations and soft tissue damage
* Skin cancer (e.g. [[Basal Cell Carcinoma]])

=== Sleep surgery ===
{{main|Sleep surgery}}
Sleep surgery encompasses any surgery that helps alleviate obstructive sleep apnea and can anatomically include any part of the upper airway.

* [[Nasal cavity]] / [[nasopharynx]]
** [[Septoplasty]]
** [[Adenoidectomy]] (especially in [[pediatrics]])
* [[Oral cavity]] / [[oropharynx]]
** [[Tonsillectomy]] (especially in [[pediatrics]])
** [[Uvulopalatopharyngoplasty]]
** Transoral midline [[glossectomy]]
** [[Genioglossus advancement]]
* Other
** [[Hyoid suspension]]
** [[Maxillomandibular advancement]]
** [[Hypoglossal nerve stimulation]]

=== Microvascular reconstruction repair ===
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.<ref>{{Cite web|url=https://www.ucsfhealth.org/treatments/microvascular_head_and_neck_reconstruction/|title=Microvascular Head and Neck Reconstruction - Conditions & Treatments|website=ucsfhealth.org|access-date=2018-12-06}}</ref>

When performing 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&nbsp;millimeters in diameter, which means that these connections need to be made with a microscope, which is why the procedure is called "microvascular surgery".{{citation needed|date=June 2022}}

==See also==
{{col div|colwidth=27em}}
* [[Audiology]]
* [[Head and neck anatomy]]
* [[Head and neck cancer]]
* [[Head mirror]]
* [[Oral and maxillofacial surgery]]
* [[Plastic and Reconstructive Surgery]]
* [[Speech–language pathology]]
* ''[[Otolaryngologic Clinics of North America]]''
{{colend}}

==References==
{{commons category}}
{{reflist}}

{{Cleft lip and palate}}
{{medicine}}
{{Authority control}}

{{DEFAULTSORT:Otolaryngology}}
[[Category:Auditory system]]
[[Category:Otorhinolaryngology| ]]
[[Category:Surgical specialties]]
[[Category:Medical specialties]]