Otolaryngology—Head and Neck Surgery focuses on diagnosing and treating conditions affecting the ears, nose, throat, and related structures of the head and neck. These physicians, commonly referred to as ENTs, are trained in both medical and surgical management. The scope of practice covers a broad anatomical region, extending from the skull base down to the upper chest, excluding the eyes and brain. This allows the otolaryngologist to manage complex and interconnected systems, such as those governing hearing, balance, breathing, and swallowing.
Diagnoses Related to the Ear and Hearing
The auditory and vestibular systems are a primary focus for the otolaryngologist, who diagnoses a wide range of disorders impacting hearing and balance. Hearing loss is classified into three main types: conductive, sensorineural, and mixed. Conductive loss involves a problem in the outer or middle ear that prevents sound waves from reaching the inner ear, often caused by chronic ear infections, a ruptured eardrum, or abnormal bone growth like otosclerosis.
Sensorineural hearing loss involves damage to the inner ear, specifically the cochlea or the auditory nerve pathways. Mixed hearing loss occurs when both conductive and sensorineural components are present. Specialized tests, such as audiograms, measure the degree and type of hearing impairment, allowing the ENT to determine the underlying anatomical or neurological cause.
Balance disorders are diagnosed by examining the vestibular system, which is housed within the inner ear. Conditions like Meniere’s Disease, characterized by episodes of vertigo, fluctuating hearing loss, and tinnitus, are diagnosed in this domain. The ENT also investigates persistent dizziness and vertigo, which are often linked to inner ear dysfunction. Tinnitus, the perception of sound like ringing or buzzing without an external source, is diagnosed to determine if it stems from hearing loss, noise exposure, or an underlying medical condition.
Diagnoses Related to the Nose and Sinuses
Diagnosis of conditions affecting the nasal cavity and paranasal sinuses is a primary area of ENT practice. Chronic rhinosinusitis, or chronic sinusitis, is a frequent diagnosis, defined by inflammation and symptoms lasting twelve weeks or longer. This condition involves the swelling of the mucous lining, which blocks the channels that drain the sinuses, leading to a buildup of mucus, facial pressure, and nasal congestion.
ENTs differentiate between acute sinusitis, which lasts less than four weeks, and chronic forms, often relying on imaging like a CT scan or nasal endoscopy for diagnosis. Recurrent acute sinusitis, defined as four or more episodes per year, is also diagnosed, prompting investigation into underlying factors like allergies or structural issues. Allergic rhinitis is diagnosed when environmental triggers cause chronic inflammation of the nasal lining.
Structural abnormalities that impede airflow are another diagnostic area, such as a deviated septum. This occurs when the wall dividing the nasal passages is significantly shifted, causing obstruction and recurrent infections. Nasal polyps, which are non-cancerous growths arising from the sinus lining, are diagnosed via nasal endoscopy and are often associated with chronic inflammation. The ENT also diagnoses anosmia, the loss of the sense of smell, which can result from chronic sinus disease, trauma, or viral infection.
Diagnoses Related to the Throat and Voice
Disorders affecting the throat, voice box (larynx), and upper esophagus are diagnosed by the ENT. Persistent hoarseness, or dysphonia, is a common reason for consultation, leading to the diagnosis of various vocal cord pathologies. These pathologies include benign growths such as vocal nodules and polyps, which often result from vocal overuse or misuse.
Vocal cord paralysis is diagnosed when one or both vocal cords do not move properly, frequently caused by nerve damage from injury, surgery, or neurological conditions. Specialized diagnostic tools like videostroboscopy are used, which uses a flashing light to visualize the vocal cord vibration cycle in slow motion, allowing for precise identification of lesions or movement abnormalities. Swallowing difficulties, or dysphagia, are also diagnosed, often using procedures like a videofluoroscopic swallow study to visualize the passage of food through the throat and esophagus.
Otolaryngologists diagnose the effects of severe acid reflux on the upper airway, termed Laryngopharyngeal Reflux (LPR). Unlike classic heartburn, LPR presents as a persistent need to clear the throat, chronic cough, or hoarseness due to irritation of the delicate laryngeal tissues by stomach acid. Chronic tonsillitis and adenoiditis, characterized by recurring infections or persistent swelling of the tonsils and adenoids, are common diagnoses that can affect breathing and swallowing in both children and adults.
Diagnoses of the Head, Neck, and Facial Structures
The ENT diagnoses conditions across the entire head and neck region. A significant part of this practice involves investigating masses and lumps in the neck, including thyroid nodules, enlarged lymph nodes, and salivary gland masses. Specialists diagnose both benign and malignant (cancerous) tumors affecting the mouth, throat, voice box, and neck structures, often using biopsies and imaging studies for definitive diagnosis.
Obstructive sleep apnea (OSA) is a complex diagnosis managed by the ENT, involving the identification of anatomical blockages in the upper airway that cause breathing to repeatedly stop during sleep. Diagnosis relies on interpreting a sleep study and physically examining the nose, palate, and tongue for sites of collapse. Facial trauma, such as fractures of the nose, jaw, or orbital bones, is also diagnosed and managed by the otolaryngologist, who has expertise in complex anatomy and necessary reconstructive techniques.
The ENT also diagnoses various pediatric-specific conditions, including congenital hearing loss and issues related to cleft lip and palate. They diagnose disorders of the facial nerve, which can lead to facial paralysis, and manage conditions requiring cosmetic or reconstructive surgery due to trauma, cancer removal, or congenital deformities. This broad range of diagnoses highlights the otolaryngologist’s role in managing structures that govern communication, respiration, and sensory function in the upper body.