AN OVERVIEW OF THE SPECIALTY

Laryngology encompasses the defining skill set of an Otolaryngologist. It represents one of the first examples of surgical and medical specialization across any of the surgical disciplines. As a result of its age, Laryngology has an established cultural consciousness, and a host of technically demanding surgical procedures.

Surgical exposure and safe manipulation of the larynx has been the central element of the specialty’s origin and accelerated development over the last 150 years. Current fellowship training allows a specialized focus in the pathology and therapeutic approaches to disorders in communication, breathing and swallowing. There is wide variability in the type of practice across academic medical centers, but when examined in total, Laryngology focuses on diagnosis and management of disorders that impair breathing and communication (glottic stenosis, vocal fold immobility, tracheal stenosis). With its advanced skill set in diagnostic and surgical approaches to the glottis it also focuses on tissue pathology arising on the laryngeal epithelium (benign phonotraumatic lesions, recurrent respiratory papillomatosis, squamous cell carcinoma). Given the increasing understanding of the complex neurologic circuits mediating language, phonation, and articulation, Laryngology also has a central role in the diagnosis and management of neurologic based perturbations in laryngeal function (spasmodic dysphonia, Parkinson’s disease, ALS, muscle tension dysphonia). Additionally, over the past 25 years, the core competencies of laryngology have been increasingly applied to the process of swallowing. We play a central role in the diagnostic and surgical management of a range of swallowing disorders.

First and foremost, Laryngology interacts with patients suffering from deficits in the defining functions of the human condition (breathing, communication, and eating) and restores those lost functions. It is a rewarding and exciting opportunity to directly impact patients' lives on a massive scale. We have grateful patients who can quickly resume their normal lives. Additionally, the chronic nature of some of the diseases we treat facilitate forming deep relationships with our patients. The specialty also affords an opportunity to interact with Speech Pathologists, Physical Therapists, Pulmonologists, Gastroenterologists, Head and Neck surgeons, Neurotologists, Radiation Oncologists, Cardiac Surgeons, Rheumatologists, and Neurologists. This inherent multidisciplinary focus provides a nuanced opportunity to care for the whole patient.

Laryngology offers broad clinical exposure as well a mix of surgical cases. One of the most exciting aspects of Laryngology is its current growth. It is an accelerating, vital specialty with deep efforts to apply the newest tools in comparative effectiveness research, translational biology, immunology, and neuroscience to refine our understanding of airway, communication, and deglutitive disease and the effectiveness of our therapies. Like most subspecialties, the typical work week/month can have incredible variation depending on your personal life and type of practice you want to have. There are both private practice and academic surgeons that specialize in Laryngology. Most Laryngologists spend about 60-70% of their time in the clinic. This represents both outpatient clinic visits as well as an ever-expanding mix of in-office surgical procedures (laser based treatments for recurrent respiratory papillomatosis, leukoplakia, subglottic stenosis, and benign phonotraumatic lesions, botulinum injections, unilateral vocal fold medialization). Depending on a clinician’s interest and practice structure, the nature of the specialty (and its clinic volume) imparts a significant measure of structure to the daily routine. This controlled schedule is infrequently punctuated by the emergent opportunity to diagnose and ameliorate airway obstruction.

Those interested in finding a Laryngology Fellowship should begin exploring the process during the middle of their third year of residency (PGY-3). CVs and letters of recommendation are sent to potential programs during the fall of the fourth year of residency (PGY-4), and interviews are done in the late winter and early spring of that same year. Rank lists are then submitted in late spring of the fourth year. Laryngology is a NRMP match, but there is not a centralized application process (i.e. you have to contact each program you are interested in yourself to coordinate the application process). Participants then apply through the NRMP website to submit their rank lists.

Successful applicants come from a range of programs and demonstrate myriad life-experiences. One consistent trait is intellectual curiosity illustrated by a record of successful research projects culminating in publication (most candidates have 1-3 publication in their specialties' journals). Strong letters of recommendation are also critical.