Otolaryngology: Treating the Head and Neck


Medicine is full of long, difficult words but otolaryngology may be one of the hardest; however when you consider that a doctor of otolaryngology diagnoses and treats diseases of the ear, nose, mouth, throat, head, and neck, the word may not seem long enough.

Doctors of otolaryngology are an interesting hybrid of country doctor and surgeon specialist. They are in the clinic about as much as they are in the operating room, treating surgical and nonsurgical diseases equally. Some of the instruments that doctors of otolaryngology use in the clinic look like something that should be carried around in a little black medicine bag on a house call. Many of their tools and instruments were designed in the early part of the last century and have remained the same, well, because they work. On the other hand, doctors of otolaryngology are on the forefront of technology as well. For example, otolaryngology as a field has seen the development of cochlear implants to treat the deaf. Doctors of otolaryngology place these devices in the middle and inner ear through a small incision behind the ear itself and provide sound to people that would otherwise hear none.

According to the American Academy of Otolaryngology, otolaryngology is the oldest medical professional in the United States.

Doctors who wish to practice otolaryngology need to finish medical school near the top of their class and distinguish themselves academically because acceptance to train in the field is highly competitive. The field is steeped in tradition from its tools to its practices. While most surgical subspecialties begin with general surgery residency after medical school, otolaryngology is somewhat unique in that doctors begin to train for the subspecialty right after medical school graduation. Training in the field of otolaryngology requires that the physician be adept at medical treatments along with surgical interventions.

There are several subspecialties within otolaryngology that doctors may pursue as part of their training. Otology and Neurotology encompasses diseases of the ear and the nerves that participate in hearing and balance. Pediatric Otolaryngology covers diseases of the head and neck that occur in children, such as birth defects. Head and Neck is another subspecialty that may seem to overlap with general otolaryngology, except that doctors that choose to subspecialize in this discipline focus almost exclusively on head and neck surgery. Head and Neck surgeons remove cancerous and non-cancerous tumors and perform operations on the thyroid gland. Doctors of otolaryngology can go on to specialize in plastic and reconstructive surgery of the face and neck. Because of their extensive knowledge of the anatomy of the region, these otolaryngologists can perform rather tricky and aggressive facial reconstructions. Rhinologists concern themselves with diseases of the nose and sinuses. Doctors that specialize in Laryngology treat disorders of the throat and vocal cords as well as problems that people may have with swallowing. Finally, doctors of otolaryngology may choose to leave the operating room behind and become allergists. This specialization uses advanced diagnostic and treatment techniques to combat the growing and serious problem of allergy and allergic reactions.

No matter the subspecialty, the field of otolaryngology is filled with some of the brightest doctors and surgeons that medicine has to offer. Their training may be rigorous and traditional, but their dedication to the field is unparalleled.

Otolaryngology and Cochlear Implants

With all of otolaryngology’s many traditions, the field is pioneering work on one of the most advanced neuroprosthetic devices ever devised. Cochlear implants promise to bring the gift hearing to those who are deaf or profoundly hard-of-hearing. Otolaryngology, especially the subspecialty of neuro-otology, is bringing sound to those previous destined to be deaf throughout their lives.

In contrast to a hearing aid which simply amplifies sound waves, a cochlear implant is a complex medical device that collects sound waves, converts the information, and presents it to the central nervous system in a form that it can understand. The cochlear implant is comprised of a microphone, a speech processor, a receiver/transmitter, and an electrode array. The speech processor takes the sound collected by the microphone and organizes it. The information is then converted into electric impulses which are sent through the electrode array directly to the auditory nerve. While current versions of the device do not provide perfect hearing, they do provide patients with useable sound information and can allow them to understand speech.

Children and adults can be implanted with cochlear implants, often by a doctor of otolaryngology. These doctors of the ear, nose, and throat are ideally suited to place these sophisticated devices. Doctors of otolaryngology train in both the medical and surgical aspects of diseases of the ear and related brain structures. Not all otolaryngologists place these cochlear devices so patients seriously considering the surgery should find a specialist that is skilled at evaluating patients for placement, placing the device, and providing training and management of the device. This generally requires the services of a specialist within the field of otolaryngology, such as a neuro-otologist, a pediatric otolaryngologist, or one that specializes in audiology.

It is important to remember that for individuals that have never heard sound, training after cochlear implant patient can be extensive. Not only must the person be taught the verbal version of their respective language, but the sounds that are transmitted by the neuroprosthetic device need to deciphered and interpreted. This can take a great deal of time and effort on the part of the patient, the patient’s family and medical professional providing care. Most of this therapy will be provided by an audiologist or speech therapist however, the long term care of the patient should be directed by a doctor of otolaryngology, preferably the one that did the initial evaluation and implant.

In the future, research in otolaryngology may make the use of cochlear implants obsolete. Current research efforts are aimed at restoring or replacing damaged hair cells, the sensory structures that harness sounds waves and transmit them to the brain in the normal ear. If otolaryngologist and neuroscientists can develop this treatment, the need for cochlear implants may become a thing of the past because it will provide normal hearing. Until that technology is clearly established, cochlear implants remain a powerful tool for doctors of otolaryngology to restore a form of hearing to the deaf and profoundly hard-of hearing.

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