Ear, nose and throat (ENT) specialists, formally known as otorhinolaryngologists, are specialists who diagnose and treat medical and surgical conditions that affect the ears, nose and throat. These doctors may be involved in surgically managing problems that affect the head, neck and base of the skull, and they may also be referred to as head and neck surgeons.
ENT specialists need to first complete their undergraduate degrees, to become doctors, in order to further specialise in this discipline. This involves completing 5-6 years of training, depending on the country you live in, which is followed by internship training of 1-2 years before becoming eligible to specialise further.
If a post is available at an academic institution, and there are consultants available to train and mentor specialist candidates, a doctor can then apply for such post. If the application is successful, the candidate will be invited for an interview. If the interview is successful, then the job post will be made available to the candidate.
The doctors will then have to complete a 5 year residency training to become an ENT specialist. Following this residency training, some ENT specialists choose to specialise further by completing a sub-specialty fellowship. This training can take a further 1-2 years in duration. The fellowship disciplines that are available include the following, together with the medical conditions that these specialists will focus on:
Sinus diseases and the anterior skull base.
- Acute or chronic sinusitis
- Severe or recurrent epistaxis
- Empty nose syndrome
- Pituitary tumour
Head and neck oncologic surgery
- Oral cancer
- Squamous cell carcinoma of the mouth, pharynx and the larynx
- Skin cancer of the head and neck
- Thyroid cancer
- Skull base surgery
- Free flap reconstruction
- Parotid gland cancer
- Hoarseness caused by laryngitis, Reinke's edema, vocal cord nodules and polyps
- Spasmodic dysphonia
- Cancer of the larynx
Otology and neurotology
- Hearing loss
- Otitis media (inflammation or infection of the middle ear)
- Otitis externa (inflammation or infection of the outer ear or ear canal)
- Labyrinthitis/Vestibular neuronitis
- BPPV – benign paroxysmal positional vertigo
- Ear surgery
- Perforated eardrum (a hole in the eardrum caused by trauma, infection or a loud noise)
- Perilymphatic fistula
- Ménière's disease/Endolymphatic hydrops
- Acoustic neuroma
- Tonsillectomy and/or adenoidectomy
- Myringotomy and tubes
- Cricotracheal resection
- Caustic ingestion
- Laryngotracheal reconstruction
- Obstructive sleep apnoea – paediatric
Facial plastic and reconstructive surgery
Facial plastic and reconstructive surgery is a 1 year fellowship available to ENT specialists and plastic surgeons who wish to specialize in reconstructive and aesthetic surgery of the face, head and neck.
- Rhinoplasty and septoplasty
- Facelift (rhytidectomy)
- Soft tissue damage
- Complicated lacerations
- Trauma to the face including frontal sinus, orbital, mandible and nasal bone fractures
- Injectable cosmetic treatments
- Skin cancers such as basal cell carcinomas
The Daily Schedule Of An ENT Specialist
A note should be made that ENT specialists will see their hospital patients, that they have operated on, on a daily basis. Treatment orders are given to the nursing staff until the patient is discharged. Over the weekends, specialists who are on call for the hospital will be responsible for their patients, as well as patients managed by other ENT specialists.
ENT specialists will divide the week to be on call for the hospital depending on how many doctors are available. These specialists may end up being on call 2-3 times a week and they can be consulted frequently. Very seldom are there emergency cases that need immediate surgical intervention, but there can be such cases such as an obstructed airway due to enlarged tonsils or adenoids or an emergency tracheostomy that needs to be done.
If an on call evening was particularly busy, then the following day may start a bit later in order for the specialist to get some rest. A colleague could possibly cover seeing patients for 1-2 hours or an elective surgery list could start a bit later.
The ENT specialist will use a Monday to organise their week in terms of patient consultations, making sure about their surgical lists, making time available for emergency consultations and sorting out other administrative issues such as meetings with reps and hospital management.
The specialist will also consult with patients on this day, managing patients conservatively in their rooms or booking patients for surgery if they need to be treated via surgical intervention. These specialists will perform procedures such as laryngoscopies where they use instruments to be able to visualise an area, such as the vocal cords, if the patients complain of any issues involving this part of the throat.
Tuesdays are surgical days and the ENT specialist will try and focus on specific types of surgeries to be performed on specific days. Tuesday may include focusing on performing ear, nose and throat procedures such as tonsillectomies and adenoidectomies on children and adults, inserting Grommets in the tympanic membrane of the ear, rinsing of sinus cavities and tympanoplasties (where the ear-drum is repaired).
Wednesdays can also be surgical days where the specialist may want to focus on more complex operations such as head and neck surgeries that include removing oral cavity and throat tumours. These specialists can also perform procedures such as removing superficial tumours that involve the areas of the head and neck.
The specialist will consult and manage patients on this day, in the same way as has been mentioned above, and will perform any necessary procedures in their rooms or book the patient for the following week's surgical list.
The doctor may also use this day to offer training to under- and post-graduates if they are involved with the academic programme of the ENT department of the local medical school. The specialist may also choose to perform their own research or brush up on their academic knowledge.
Mornings are used to either consult with patients again or to perform minor surgical procedures. The afternoon is then used to finalise any unresolved or pending administrative issues or duties so that the work week ends. The surgical list for the following week in then printed and confirmed, as well.