ENT Variety and Training

[Dr mann212]

A few questions out of curiosity about otolaryngology.

1. How much variety doe a general ENT see? What is the scope of a general ent? What about fellowship trained ENT guys?

2. Does one have to do a fellowship to do some of the advanced procedures? Like head and neck oncology with microvascular reconstruction? Or skull base surgery? What procedures would an ENT be unable to do without a fellowship

3. How does one get into skull base surgery? Is it through rhinology? Or with head and neck oncology?

4. How many different approaches are there in skull base surgery, and who does said approaches?

5. Can an ENT solo a skull base procedure? Or does a neurosurgeon always have to aid?

6. Would it be possible to do Neuro-otology, head and neck oncology, skull base and some general procedures, or some combination of those, and still be proficient in each?

7. Finally, do all head and neck surgeons do their own reconstructions, or does plastics cover that?

Any and all answers are greatly appreciated!

---

Members don't see this ad.

 

[Winged Scapula]

Moving to the ENT forum


Sent from my iPhone using SDN mobile app

 

[Dr mann212]

I've looked at many threads trying to find these answers. While I have found some, most are from 10+ years ago. I would just like some answers from today's ent guys in case anything has changed!

Thanks for any replies!

 

[Dr mann212]

Moving to the ENT forum


Sent from my iPhone using SDN mobile app

Don't mean to be a burden, but would it be possible to move this post to a higher traffic forum? I know cross posting is a no-no.

 

[Pir8DeacDoc]

Who do you think could provide more insight about what we do everyday? The surgery forum?
People read here, but your questions are generally well covered in other threads and not all that interesting. Tell us what is your situation and what you are trying to figure out.

 

[Winged Scapula]

Don't mean to be a burden, but would it be possible to move this post to a higher traffic forum? I know cross posting is a no-no.

If you're looking for responses from ENTs, this is the best forum. Posting in an irrelevant forum just because it's higher traffic is not allowed.


Sent from my iPhone using SDN mobile app

 

[Dr mann212]

I apologize for being a bit overbearing or obnoxious.

I'm a first year who's had an interest in otolaryngology for a while(my friends dad was one, though we do not speak anymore). I've done some shadowing, though the ents I shadowed were not very talkative and didn't answer many of my questions. This post was mostly out of curiosity, though answers to these questions would help me find out if ent would be for me. I will go into rotations with an open mind of course, I'm not trying to jump the gun.

I'm just fascinated with the field and many of the advanced procedures within it, which sparked all my questions. I've looked through the ent forum all the way back to 2005. While I have found some of the answers, most are answered vaguely and still leave me with unanswered questions. I did find some very informative posts, but they were from 2005 or before, which makes me wonder how much has changed. I may have also missed some threads that do answer my questions, a link would be greatly appreciated.

I figured it would be easiest to just make a thread with all my questions to see if I could finally put most, if not all of my inquiries to rest until rotations.

Again I apologize for being pushy. It was not my intent, these questions have just bugged me for a while.

I thank anyone who uses their time to help me.

 

[tvelocity514]

As an m2 who will be an m3 in 2 weeks, I also have a question regarding the variety of work. I'm trying to decide between Ent, ophtho, and urology for my elective (have to decide in a week). I'm honestly not sure which to choose. I really like how all 3 have a mix of clinic and surgery . Anatomically I'm more interested in ent and ophtho (like neuro type stuff and head and neck was awesome in anatomy). Love the pathology in urology, but I honestly like the pathology in all 3. I really like being specialized and knowing all I can about something , and would like a good mix of surgery as well (but not 24/7). I'm someone who loves medicine eg I would be happy working 6am- 11pm every day (prefer a field where I can get 6 hours of sleep if possible at night though... Obviously for residency I don't mind if I only get 3 or none etc in order to put in my time and get the best experience).

Can anyone offer any advice on the ENT side of things and why you liked it more than ophtho or urology if any of you were entertaining those options as well? The only things I don't like are GI and anything gynecological.

Sorry to hijack the thread Mann - but I'm also interested in a few of the questions you asked as well.

 

[OtoHNS]

1. How much variety doe a general ENT see? What is the scope of a general ent? What about fellowship trained ENT guys?

2. Does one have to do a fellowship to do some of the advanced procedures? Like head and neck oncology with microvascular reconstruction? Or skull base surgery? What procedures would an ENT be unable to do without a fellowship

6. Would it be possible to do Neuro-otology, head and neck oncology, skull base and some general procedures, or some combination of those, and still be proficient in each?

7. Finally, do all head and neck surgeons do their own reconstructions, or does plastics cover that?

Any and all answers are greatly appreciated!

I'll answer the above questions (I don't have good answers for the other ones you listed). I graduated residency in 2010 and am in solo private practice doing general ENT.

1. I'll list things I see commonly and occasionally under each category:

Ears:
Common: Earwax, Eustachian tube dysfunction, Acute and chronic OM, TM perforations, Otitis externa, Hearing loss, Dizzy patients (~50% of which have inner ear etiology)
Occasional: Cholesteatomas, Ossicular chain problems (otosclerosis, etc)

Nose/Sinus:
Common: Allergic rhinitis, recurrent acute sinusitis, chronic sinusitis, minor nosebleeds, deviated septum, large turbinates, polyps, "sinusitis" which is actually migraine
Occasional: Smell disorders, nasal vestibulitis

Throat:
Common: Reflux, reflux, reflux, reflux
Occasional: Vocal cord lesions, vocal cord paralysis, malignancies

Pediatric:
Common: tubes, tonsils, allergic rhinitis, tongue ties, "mouthbreathers"
Occasional: foreign bodies in ears or nose, pedi sinusitis

Head and Neck:
Common: thyroid nodules, various lumps and bumps in the neck
Occasional: Oral, pharyngeal, or laryngeal cancers, parathyroid adenomas, parotid masses

Other:
Common: Sleep apnea

I don't do any cosmetic stuff, mainly because of personal choice. My patient population is fairly blue collar and would not be a great fit for a froo-froo cosmetic practice anyway.

Common surgeries and office procedures: Ear tubes, T+A, turbinate reduction, balloon sinuplasty, endoscopic sinus surgery, septoplasty, thyroids, parathyroids, parotidectomy, microlaryngoscopy, cancer biopsies, tympanoplasty, skin cancer excisions, sleep surgery, etc.

2. Depends somewhat on your exposure during residency. I doubt anywhere would hire you as a microvascular surgeon without a fellowship.

6. Possible, maybe. Practical, not so much.

7. I feel like there was a big transition between 2000-2010 from plastics doing a lot of reconstructions to the vast majority of ENT departments employing a microvascular surgeon or surgeons. When I applied to residency in 2004-05, there were still lots of ENT programs without micro surgeons. Now, there are very few if any.

 

[OtoHNS]

As an m2 who will be an m3 in 2 weeks, I also have a question regarding the variety of work. I'm trying to decide between Ent, ophtho, and urology for my elective (have to decide in a week). I'm honestly not sure which to choose. I really like how all 3 have a mix of clinic and surgery . Anatomically I'm more interested in ent and ophtho (like neuro type stuff and head and neck was awesome in anatomy). Love the pathology in urology, but I honestly like the pathology in all 3. I really like being specialized and knowing all I can about something , and would like a good mix of surgery as well (but not 24/7). I'm someone who loves medicine eg I would be happy working 6am- 11pm every day (prefer a field where I can get 6 hours of sleep if possible at night though... Obviously for residency I don't mind if I only get 3 or none etc in order to put in my time and get the best experience).

Can anyone offer any advice on the ENT side of things and why you liked it more than ophtho or urology if any of you were entertaining those options as well? The only things I don't like are GI and anything gynecological.

Sorry to hijack the thread Mann - but I'm also interested in a few of the questions you asked as well.

Caveat: I never did any rotations or had any real experience in either, other than occasionally covering the urology service while on call as an intern.

Ophtho just seems way too specialized and small to me. It's basically just the eyeball. Pathology in the orbit goes to ENT.

Urology: I never had much interested in penises, balls, or sticking my finger where the sun don't shine. If you don't like GI or GYN, there's quite a lot of overlap with urology for both of those...

But hey, there's something for everyone, right?

You can pretty easily spend enough time shadowing all 3 specialties during the next 6 months to figure things out. People are happy to have you come shadow, even if it's not an official elective rotation. Just email some attendings and set it up.

 

[tvelocity514]

Caveat: I never did any rotations or had any real experience in either, other than occasionally covering the urology service while on call as an intern.

Ophtho just seems way too specialized and small to me. It's basically just the eyeball. Pathology in the orbit goes to ENT.

Urology: I never had much interested in penises, balls, or sticking my finger where the sun don't shine. If you don't like GI or GYN, there's quite a lot of overlap with urology for both of those...

But hey, there's something for everyone, right?

You can pretty easily spend enough time shadowing all 3 specialties during the next 6 months to figure things out. People are happy to have you come shadow, even if it's not an official elective rotation. Just email some attendings and set it up.

Thanks for the advice! Unfortunately, it's against the rules to shadow as a Med student according to our faculty. I've still done it unofficially thought and might try again. I've ruled out ophtho Bc I emailed the director who said it was more primary care oriented. I would like something at least ~50% surgical so not going to do that. Now just to decide between uro and ENT. I didn't really think of the gi/gyn overlap. Thanks again.


Sent from my iPhone using SDN mobile app

 

[OtoHNS]

Thanks for the advice! Unfortunately, it's against the rules to shadow as a Med student according to our faculty. I've still done it unofficially thought and might try again. I've ruled out ophtho Bc I emailed the director who said it was more primary care oriented. I would like something at least ~50% surgical so not going to do that. Now just to decide between uro and ENT. I didn't really think of the gi/gyn overlap. Thanks again.


Sent from my iPhone using SDN mobile app

WTF, that is an absurd policy! I would still suggest contacting faculty- most docs enjoy having an interested student shadowing.

Outside of doing head+neck in academia where you can realistically be in the OR 2-2.5 days/week, you'll find that ENTs spend the majority of their time in the office rather than the OR (though there are a lot of in-office procedures to be done). I personally am 80% clinic, 20% OR.

And I would caution you against ruling out a whole specialty based on an email exchange. Spend some time with docs in those fields and keep an open mind during your M3 rotations. Most people don't decide until late M3 or M4 year.

 

[Dr mann212]

I'll answer the above questions (I don't have good answers for the other ones you listed). I graduated residency in 2010 and am in solo private practice doing general ENT.

1. I'll list things I see commonly and occasionally under each category:

Ears:
Common: Earwax, Eustachian tube dysfunction, Acute and chronic OM, TM perforations, Otitis externa, Hearing loss, Dizzy patients (~50% of which have inner ear etiology)
Occasional: Cholesteatomas, Ossicular chain problems (otosclerosis, etc)

Nose/Sinus:
Common: Allergic rhinitis, recurrent acute sinusitis, chronic sinusitis, minor nosebleeds, deviated septum, large turbinates, polyps, "sinusitis" which is actually migraine
Occasional: Smell disorders, nasal vestibulitis

Throat:
Common: Reflux, reflux, reflux, reflux
Occasional: Vocal cord lesions, vocal cord paralysis, malignancies

Pediatric:
Common: tubes, tonsils, allergic rhinitis, tongue ties, "mouthbreathers"
Occasional: foreign bodies in ears or nose, pedi sinusitis

Head and Neck:
Common: thyroid nodules, various lumps and bumps in the neck
Occasional: Oral, pharyngeal, or laryngeal cancers, parathyroid adenomas, parotid masses

Other:
Common: Sleep apnea

I don't do any cosmetic stuff, mainly because of personal choice. My patient population is fairly blue collar and would not be a great fit for a froo-froo cosmetic practice anyway.

Common surgeries and office procedures: Ear tubes, T+A, turbinate reduction, balloon sinuplasty, endoscopic sinus surgery, septoplasty, thyroids, parathyroids, parotidectomy, microlaryngoscopy, cancer biopsies, tympanoplasty, skin cancer excisions, sleep surgery, etc.

2. Depends somewhat on your exposure during residency. I doubt anywhere would hire you as a microvascular surgeon without a fellowship.

6. Possible, maybe. Practical, not so much.

7. I feel like there was a big transition between 2000-2010 from plastics doing a lot of reconstructions to the vast majority of ENT departments employing a microvascular surgeon or surgeons. When I applied to residency in 2004-05, there were still lots of ENT programs without micro surgeons. Now, there are very few if any.

Thank you so much for the input!

 

[Bbroush]

I'll answer the above questions (I don't have good answers for the other ones you listed). I graduated residency in 2010 and am in solo private practice doing general ENT.

1. I'll list things I see commonly and occasionally under each category:

Ears:
Common: Earwax, Eustachian tube dysfunction, Acute and chronic OM, TM perforations, Otitis externa, Hearing loss, Dizzy patients (~50% of which have inner ear etiology)
Occasional: Cholesteatomas, Ossicular chain problems (otosclerosis, etc)

Nose/Sinus:
Common: Allergic rhinitis, recurrent acute sinusitis, chronic sinusitis, minor nosebleeds, deviated septum, large turbinates, polyps, "sinusitis" which is actually migraine
Occasional: Smell disorders, nasal vestibulitis

Throat:
Common: Reflux, reflux, reflux, reflux
Occasional: Vocal cord lesions, vocal cord paralysis, malignancies

Pediatric:
Common: tubes, tonsils, allergic rhinitis, tongue ties, "mouthbreathers"
Occasional: foreign bodies in ears or nose, pedi sinusitis

Head and Neck:
Common: thyroid nodules, various lumps and bumps in the neck
Occasional: Oral, pharyngeal, or laryngeal cancers, parathyroid adenomas, parotid masses

Other:
Common: Sleep apnea

I don't do any cosmetic stuff, mainly because of personal choice. My patient population is fairly blue collar and would not be a great fit for a froo-froo cosmetic practice anyway.

Common surgeries and office procedures: Ear tubes, T+A, turbinate reduction, balloon sinuplasty, endoscopic sinus surgery, septoplasty, thyroids, parathyroids, parotidectomy, microlaryngoscopy, cancer biopsies, tympanoplasty, skin cancer excisions, sleep surgery, etc.

Thanks @OtoHNS for this! I have followed this forum for a long time but having a comprehensive list like this is helpful.