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Otolaryngologist/Laryngologist
The leader of the voice care team is typically a surgeon who
specializes in ear, nose, and throat medicine (otolaryngologist)
or an otolaryngologist who has further subspecialized in the larynx,
voice, and related problems such as swallowing (laryngologist).
Education and Training Track
Subspecialization in laryngology in the United States requires
the series of educational and training programs outlined below.
- Undergraduate degree
- Medical degree
- 1-2 years of general surgery residency
- 4 years of otolaryngology-head and neck surgery
(Board-eligiblity by the American Board of Otolaryngology or
equivalent organization in other countries)
- 1 year clinical experience and competency on written and oral
exam (Board certification)
Most otolaryngologists' clinical practices include many or all
components of the specialty, such as:
- disorders of the ear and related structures (otology)
- Disorders of the voice and upper airway structures such as the
throat and trachea (laryngology)
- Head and neck cancer, head and neck neoplasms (masses
including benign or malignant lesions)
- Facial plastic and reconstructive surgery
- Allergy and immunology
- Bronchoesophagology (lower airway and swallowing disorders)
- Rhinology (nose, sinus, taste and smell disorders)
- Pediatric otolaryngology (ear, nose, and throat disorders of
children)
Most otolaryngologists and laryngologists care for patients of
all ages from early childhood through advanced years. Some
otolaryngologists subspecialize in caring for disorders in just one
or two of the areas of otolaryngology described above. This
subspecalization can either be a keen interest in a specific area
while still providing a broad range of ear, nose, and throat care,
or focused practice of only one or two of the subcomponents of
otolaryngology. Laryngology is one such subspecialty.
Brief History of Laryngology
At present, most of the physicians specializing in laryngology
did not receive laryngology fellowship training. That is always the
case as a new field develops. Modern laryngology evolved out of an
interest in caring for professional voice users – teachers, clergy,
singers, etc. So, most of the senior laryngologists practicing at
the turn of the 21st century were involved in the evolution of the
field before fellowships were developed. Most fellowship training
programs started in the 1990's, although a few informal fellowship
programs existed in the 1980's and earlier. It is reasonable to
expect most voice specialists who finished residency training in the
1990's or later to have completed a fellowship in laryngology.
Laryngology Training Programs
There are approximately a dozen laryngology fellowship training
programs in the United States. At present, completion of a
fellowship is a reasonably good indicator of superior knowledge and
clinical training in laryngology. Most laryngology fellowships
include training in the diagnosis and treatment of voice disorders
in adults and children, neurolaryngology (neurological problems that
affect the voice and larynx), swallowing disorders, airway
reconstruction, laryngeal cancer, and laryngeal surgery.
Spectrum of Voice Disorders
Typically, laryngologists provide care (diagnosis and treatment)
for both routine and complex problems that affect the voice.
- the common cold – especially when it affects the voice of a
professional singer or actor
- structural lesions such as nodules or polyps
- prolonged infections of the vocal folds
- cancer
- traumatic injury from fracture or internal trauma (intubation
injuries from anesthesia, vocal fold injuries from previous
surgery)
- neurological disorders and other voice problems.
Scope of Responsibilities
The laryngologist is responsible for establishing a medical
diagnosis and implementing or coordinating treatment for the
patient. The laryngologist may prescribe medication, inject
botulinum toxin, perform delicate microsurgery on the vocal folds,
or operate on the laryngeal skeleton.
The laryngologist is also usually responsible for initiating
evaluation by other members of the voice team and for generating
referrals to other specialists as needed.
Laryngologists may practice in university medical centers or
private offices; and in major cities in the United States they are
usually affiliated with a voice team including at least a
speech-language pathologist, a singing voice specialist and
sometimes an acting voice specialist. Laryngologists should also
have, or have access to, a clinical voice laboratory with equipment
to analyze the voice objectively and a stroboscope to visualize the
vocal folds in "slow motion". They also should be familiar with
physicians in other specialties who have an understanding and
interest in arts medicine. Even for patients with a voice disorder
who are not singers and actors, such knowledge and sensitivity is
important. Just as non-athletes benefit from the orthopedic
expertise of a sports-medicine specialist, voice patients receive
specialized expert care from physicians trained to treat singers,
the "Olympic athletes" of the voice world.
Medical Societies for Laryngologists
At present, there is no official additional certification for
those who have completed a laryngology fellowship. However, there
are organizations (medical societies) with which many of the leading
laryngologists are affiliated, such as:
While membership in these organizations is not a guarantee of
excellence in practice, it suggests interest and knowledge in
laryngology, particularly voice disorders.
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