SCOPE OF PRACTICE
Otolaryngology offers a unique scope of practice compared with many other specialties, lending practitioners exceptional flexibility within the field - from 2 minute ear tubes to a 12 hour composite resection and microvascular free flap reconstruction, we do it all. Otolaryngology is one of the few surgical subspecialties without a true medical counterpart as compared with orthopedic surgery with sports medicine, neurosurgery with neurology, and so on. Not only does this increase the number of conditions the provider is comfortable managing, it also permits more career flexibility, allowing the otolaryngologist to tailor his or her practice toward either surgical or medical involvement. This unique mix has also led many prominent otolaryngologists to assume positions of leadership within their institutions.
Unlike other specialties, the purview of the otolaryngologist is not defined by a “body system,” as orthopedics is to the skeletal system or urology is to the urogenital system, for example, but instead is uniquely defined by an anatomic region. Because of this, the field boasts a range of subspecialty focus areas covering very different organ systems, each requiring a diverse surgical skill set including laser surgery, drilling, microsurgery, endoscopy, robotic surgery, and gross dissection. Below is a breakdown of the 7 main subspecialties within Otolaryngology-Head and Neck Surgery and procedures commonly performed by each:
Facial Plastics & Reconstructive Surgery– Cosmetic and reconstructive procedures of the head and neck, including, but not limited to, rhinoplasty, facelift, browlift, blepharoplasty, and Mohs reconstruction.
Head & Neck Oncology– Resection and reconstruction of tumors involving the head and neck, including, but not limited to, cervical lymphadenectomy (neck dissection) and resection of tumors of the skull base, aerodigestive tract, and thyroid. There are a number of options for reconstruction, ranging from skin grafts to microvascular free tissue transfer.
Laryngology– Evaluation and medical/surgical management of the larynx, including, but not limited to, phonosurgery, endoscopic treatment of laryngeal tumors, and management of the professional voice.
Otology, Neurotology & Skull Base Surgery– Management of disorders of the ear and lateral skull base including, but not limited to, middle ear and mastoid surgery, stapedotomy, tympanoplasty, labyrinthectomy, cochlear implantation, and vestibular schwannoma surgery.
Pediatric Otolaryngology– Management of otolaryngology disorders affecting children including, but not limited to, endoscopic sinus surgery, airway endoscopy, middle ear disease, cochlear implantation, microtia and aural atresia, cleft lip and palate, laryngotracheal reconstruction, vascular malformations, head and neck tumors, and of course, lots of tubes and tonsils.
Rhinology, Sinus & Anterior Endoscopic Skull Base Surgery– Management of disorders of the nasal cavity and paranasal sinuses, including functional endoscopic sinus surgery, endoscopic management of paranasal and anterior skull base tumors, CSF leaks, and orbital tumors.
Sleep Medicine & Surgery– Evaluation and surgical management of disorders related to snoring, nasal obstruction, upper airway obstruction, and sleep apnea.
PATIENT DIVERSITY
Depending on the area of specialty, otolaryngologists care for the entire spectrum of patient demographics, from the neonate with congenital airway disease to the nonagenarian with hearing loss. “No one is immune from seeing the otolaryngologist.”
THE ANATOMY
It has become cliché to say, but the head and neck does in fact offer some of the most beautiful and complex anatomy in the body. There is likely no other more surgically challenging area of the human body with respect to functional and aesthetic concerns than the head and neck. In countless personal statements for residency, medical students have described their first experience seeing the facial nerve or a neck dissection as the pivotal moment they became interested in otolaryngology.
THE BEST GADGETS
Otolaryngology is a field that uses many cutting edge technologies. As a field that operates on microscopic structures through tiny corridors (aka the ears, nose, throat), innovative techniques are paramount. These include lasers to excise lesions in the airway, drills to perform mastoid surgery, titanium prostheses to reconstruct the ossicles of the middle ear, cochlear implants and bone-anchored hearing aids to rehabilitate hearing loss, endoscopes to examine and operate within the aerodigestive tract and sinuses/skull base, microdebriders to reduce polyps, plates and screws to reconstruct the facial skeleton, and last, but not least, robots.
GREAT PEOPLE
There are countless jokes centered on the unique stereotypes labeled to physicians within various medical and surgical fields. And while these traits are often exaggerated and overly simplistic, it is true that people of similar personalities tend to find themselves gravitating toward certain specialties. While there are obviously diverse personalities within the field, for whatever reason, otolaryngology has traditionally attracted “nice people.” While running the risk of generalizing, otolaryngologists tend to break the “malignant surgeon” stereotype and, in general, are easy-going individuals who can just as easily talk about last night's baseball game or favorite television show as they can describe a radical neck dissection. One urologist colleague, with whom the founder of headmirror.com trained as an intern, would tell medical students that they should go into urology because “urologists were some of the happiest doctors, second only to otolaryngologists!” This may seem far-fetched and ridiculous, but like attracts like. If you’re a pleasant, hard-working person who enjoys surgery, then the profession of otolaryngology may be a good fit!
INTERESTING RESEARCH OPPORTUNITIES
Research has always been an important part of otolaryngology. As a field that deals with many of the body’s senses (taste, hearing, smell, touch, and sometimes vision), there are many interesting research avenues. All residency programs provide a research experience, but some will even offer 1 or 2 years of additional time. For those with a neuroscience background, the auditory system and nerve regeneration are excellent areas to research. For engineers, cochlear implants (and soon vestibular implants) are an excellent outlet for your skills. For those with a more molecular angle, head and neck cancer and hair cell regeneration may be your niche. For those who despise anything involving a protein, mouse, circuit, or computer programming, there are boundless clinical research opportunities. Some residency programs even offer an MPH or MS degrees during residency training.
LIFESTYLE CONSIDERATIONS
Lots of people have heard jokes regarding the ENT lifestyle: ENT stands for “early nights and tennis” or “easy not tough.” While these statements are clearly embellished, the field of otolaryngology does lend to a better lifestyle than many other surgical fields. Many of the procedures performed by the otolaryngologist can be completed on an outpatient basis, and with the exception of patients with advanced oncologic disease, the majority of patients who do get admitted to the hospital are generally healthy and have relatively short, uneventful hospital stays.
According to the 2019 Medscape Otolaryngologist Compensation Report, the average annual compensation for providers in the field is $461K, but can vary widely depending on fellowship training, geographic location, and practice setting (i.e., academic or private practice). As for annual work hours compared to other specialties, Otolaryngology was found to work just 24 hours per year more than Family Medicine, which is substantially less than the 888 hours per year more found for Vascular Surgery.
As previously mentioned, otolaryngologists are truly trained to be both medical and surgical specialists. Because the surgical portion tends to be more grueling with early mornings and less schedule predictability, it is not uncommon for some otolaryngologists later in their career to change to solely clinic-based practices, allowing for increased career longevity as desired.
EARWAX, SNOT, & PROJECTILE TRACHEAL SECRETIONS
Most people in the medical field would find this entry funny, but there are some people who absolutely cannot stand being around the various secretions of the head and neck – for these individuals, otolaryngology is probably not the best fit. Obviously, all surgical (and most medical) fields deal with some sort of bodily fluids. You just have to decide which ones you are most ok with.
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