Ear, Nose & Throat (ENT)

Modern surgery has developed to such an extent that the body of knowledge and technical skills required have led to surgeons specialising in particular areas, usually an anatomical area of the body or occasionally in a particular technique or type of patient.

There are ten surgical specialties and this briefing covers otolaryngology, or ears, nose and throat (ENT) surgery.

What do ENT surgeons do?

Otolaryngologists (commonly referred to as ENT surgeons) deal with the diagnosis, evaluation and management of diseases of head and neck and principally the ears, nose and throat.

One of the key areas of concern for ENT surgeons are helping patients cope with or recover from diseases that impair the senses of hearing and balance. They will also be concerned with the functional aspects of breathing, eating and speech. ENT surgeons also deal with cancers in this region of the body. Many will undertake plastic and reconstructive work on the face.

There are around 1476 ENT surgeons working in the NHS, making them one of the biggest surgical specialty within the NHS and this is largely down to the very broad range of skills they cover. Unlike most other surgeons, ENT specialists also act as physicians spending a high proportion of their time running out patient clinics and managing conditions non-operatively through prescribing medicines rather than undertaking surgery. On average, only 15 per cent of the patients seen by ENT surgeons will go onto have an operation. Most ENT Surgeons will develop a special interest in a subspecialty.

ENT problems occur in all age groups but infective problems are particularly frequent in young people. Consequently, ENT surgeons see a much higher proportion of paediatric patients than any other branch of surgery, other than specialist paediatric surgeons.

Subspecialties

• Otology – Treatment of infection, disease and damage to the ear to improve hearing and balance. Neurotologists deal with conditions deep in the middle and inner ear where conditions are more closely linked to the brain.
• Rhinology – Treatment of sinus and nasal disorders, including allergy, to relieve pain, ease breathing and improve nasal function.
• Laryngology – Treatment of infections of the throat and larynx to ease speech and swallowing.
• Head and neck surgery – away from the main ENT systems, specializing in surgery on cysts, glands such as lymph, salivary, thyroid and parathyroid glands, and head and neck cancers.
• Facial plastics – this can include aesthetic procedures such as rhinoplasty (‘nose job’), pinnaplasty (bat ears), face lifts or reconstructive such as re-setting the jaw. There is a big cross-over here with the work of plastic and oral and maxillofacial surgeons.
• Paediatrics – there are many ENT conditions, often congenital, that require treatment at a very young age. These include airway problems, infections of adenoids or tonsils that require their removal, and grommets for ‘glue ear’.

Main operations:

• Insertion of grommets - to allow air to middle ear in cases of chronic middle ear infectionto assist hearing. This is typically carried out in children and removed when infection clears.
• (Adeno) - Tonsillectomy - removal of tonsils and/or adenoids to relieve a variety of conditions.
• Septoplasty - correction of nasal septum to enable clear breathing and prevent obstruction.
• Endoscopic sinus surgery - minimally invasive surgery for serious cases of inflamed, infected and blocked sinuses.
• Tracheostomy or “operations on the voice box (larynx)” - creation of an alternative airway in the throat for patients experiencing difficulty breathing.

Developments:

Cochlear Implants have been the biggest recent development enabling the profoundly deaf to gain a sense of hearing for the first time. Currently this procedure involves inserting an electrode into the inner ear (cochlea) and directly stimulating the auditory nerve. However, in the near future it will be possible to attach directly to the auditory brain stem, offering hope to a group of patients with no functioning auditory nerves for whom no treatment is currently possible.

Endoscopic sinus surgery. The development of lens technology has allowed unparalleled visibility inside the nose and sinuses, and a much improved understanding of their diseases. This has allowed for a much more focused and effective approach for surgery for sino-nasal problems.

Further Information

British Association of Otolaryngologists (ENT UK)