Why should disorders of the ear, nose and throat be treated by the same specialty? Can this situation persist?

Abstract

The surgical specialty of otorhinolaryngology has its origins in the nineteenth century. Subsequently, the specialty also incorporated allied disciplines such as plastics and head and neck surgery. Following World War II, the survival of the specialty was threatened by the advent of antibiotics and the rise of the general surgeon. Despite this, the specialty of ENT was strengthened by strong post-war leadership and robust training.Today, with ENT knowledge ever increasing, the subspecialties have again begun to subdivide. Specialisation brings improved efficiency and outcomes; however, there remains a great need for the ENT generalist. Not all cases require subspecialist attention, and the generalist remains the basis of competent emergency cover. The natural development of otorhinolaryngology has brought the invaluable synergistic knowledge required to comprehensively treat disorders of the ear, nose and throat, knowledge that must not be overlooked when shaping the future of the specialty.

Regarding ‘The impact of new evidence on regional variation in paediatric tonsillectomy and adenoidectomy: a historical review’ by van Munster et al

“…Furthermore, it was during this period that otorhinolaryngology was formalised as a specialty, and this surgical procedure on the tonsilswhere the ears, nose and throat meet would anatomically represent this evolving discipline. 7 As I have argued elsewhere, the focal theory played an important role in the popularity of tonsillectomy; however, there were also important structural, financial and political incentives for the growth of the procedure. 8 Attention to the UK's historical experience allows us to gain an understanding of the factors implicated in the geographical variance of tonsillectomy rates, and helps explain why variance persists despite stricter indications and guidelines.…”

In the face of increasing subspecialisation, how does the specialty ensure that the management of ENT emergencies is timely, appropriate and safe?

“…It is difficult to extrapolate these results to ENT surgery, as it is relatively uncommon for emergencies to be neatly divisible or assignable to exact specialties. One strategy, however, to minimise the potential adverse effects of subspecialisation on emergency care could be to encourage generalists in the formation of a distinct ‘general ENT’ subspecialty or indeed an acute ENT care subspecialty, as suggested by Yalamanchili 33 . This approach has been trialled in the USA, mainly in the field of general surgery, 34 with encouraging results shown for acute appendicitis 35 …”

Sinonasal Inverted Papilloma Extirpation by Endoscopic Approach: a Case Report

“…The triad of main clinical manifestations of tumor are tendency to relapse, ability to destruct surrounding structures, and tendency to be malignant. 6,7 Histologically, papilloma can be divided into three forms including papillary or fungiform showing epithelium proliferation with the surrounding fibrous tissue as the central part without inverted epithelium, classic inverted papilloma characterized by dominant epithelial growth below the stroma, and columnar cell papilloma which is a papilloma variant in the nasal cavity characterized by columnar cell. The recurrence and malignancy rate of columnar cell papilloma is higher than other types.…”