Why Otolaryngology-Head and Neck Surgery?
Henry Ou, MD
Otolaryngology-Head and Neck Surgery
Children's Hospital and Regional Medical Center
University of Washington
What’s in a name
To some, the name otolaryngology-head and neck surgery might seem unnecessarily long and full of self-importance. It was chosen however to encompass the incredible breadth of the field. We operate on everything above the shoulders… but not the eye… and not the spine… and usually not the brain… but sometimes we harvest free flaps from the limbs, abdomen, or back to reconstruct parts of the head and neck!
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. 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. It seems unlikely, but there is some truth to the statement, and mastery of this complicated part of the body is daunting, rewarding, and probably impossible.
Variety of cases and practices
Many “jealous” (and unhappy) colleagues will call otolaryngologists “nose pickers” or “snot docs” without a real understanding of the scope of the field. Otolaryngology offers cases ranging from the 2 minute ear tube (for those with short attention spans and small bladders), to the 12 hour composite resection and free flap reconstruction (for the sadistic head and neck surgeons). Within otolaryngology are multiple subspecialties which include head and neck oncology, facial plastics, laryngology, neurotology, pediatric otolaryngology, rhinology, and even allergy. A significant portion of an otolaryngologist's practice involves clinic. It is thus a field that is often praised for its mix of medical and surgical practice. This unique perspective has led many prominent otolaryngologists to assume positions of leaderships within their insitution. Below is a breakdown of some of the subspecialties within OTO-HNS:
Head and neck – Resection and reconstruction of tumors of 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. Reconstruction can be through any number of options in the reconstructive ladder, ranging from skin grafts to microvascular free flaps.
Facial plastics – cosmetic and reconstructive procedures of the head and neck, including, but not limited to, rhinoplasty, facelifts, browlifts, blepharoplasties, and Mohs reconstructions.
Laryngology – evaluation and medical/surgical management of the larynx, including, but not limited to, phonosurgery, endoscopic treatment of laryngeal tumors, and even management of the professional voice.
Otology/Neurotology – 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 acoustic neuromas (vestibular schwannomas).
Pediatric – management of otolaryngology disorders in children including but not limited to endoscopic sinus surgery, airway endoscopy, middle ear disease, cochlear implantation, microtia and aural atresia, cleft lip and palate (at some institutions), laryngotracheal reconstruction, vascular malformations, head and neck tumors, and of course, lots of tubes and tonsils.
Rhinology – management of disorders of the nasal cavity and paranasal sinuses, including endoscopic sinus surgery, endoscopic management of paranasal and anterior skull base tumors, CSF leaks, orbital tumors, etc.
The best toys
Otolaryngology is a field that uses many cutting edge technologies. As a field that works in holes (ears, nose, throat), innovative techniques are necessary to operate in small places. These include lasers to excise lesions in the airway, drills for the mastoids, titanium prostheses to reconstruct the middle ear ossicles, cochlear implants, bone-anchored hearing aids, endoscopes to examine and operate on the aerodigestive tract and sinuses/skull base, microdebriders to chew up polyps, plates and screws for reconstruction of the facial skeleton, and an emerging use of robotics. For those with an engineering background, and for those who don’t, there are many gadgets to apply creatively.
Otolaryngology is sometimes referred to as “Early Nights and Tennis” (ENT). While this is hardly true (particularly during residency), one can certainly tailor one’s practice to have a very manageable lifestyle, despite being in a surgical field. In addition, since there are relatively few otolaryngology residents finishing training each year, the job market is generally good both in academics and in private practice.
While there are obviously exceptions and diverse personalities within the field, for whatever reason, otolaryngology has traditionally attracted “nice people”. Even within the medical literature, the otolaryngologist has been referred to as “the mild mannered otolaryngologist”, while in some programs they are known as the “gentlemen (or gentlewomen) surgeons.” One urologist colleague (RS) I trained with 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, and if you’re a nice person and enjoy surgery and working hard, then the profession of otolaryngology wants you!
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. Most residency programs provide at least one 4 month research block, while others offer 1 or even 2 years of research. 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 death and regeneration may be your niche. And for those who despise anything involving a protein, mouse, circuit, or computer programming, there are boundless clinical research opportunities, with some residency programs offering an MPH during residency training.
Otolaryngology-head and neck surgery is a great field with pleasant people doing interesting and diverse surgeries in the context of a manageable lifestyle. As a surgical resident, you will definitely work hard, but hard work is infinitely more tolerable when you enjoy your work, and like the people you work with.
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