What topics should an Ear, Nose, and Throat (ENT) doctor know?

Essential Topics for Ear, Nose, and Throat (ENT) Doctors

An ENT doctor (otolaryngologist) must have comprehensive knowledge of ear, nose, throat, head and neck disorders, including their diagnosis, medical management, and surgical interventions to effectively treat patients and minimize morbidity and mortality. 1

Core Knowledge Areas

Ear Disorders

• Otitis media (acute and with effusion) and its complications requiring proper diagnosis, medical management, and surgical intervention when necessary 1
• Hearing loss (conductive and sensorineural) assessment, diagnosis, and management 1
• Vestibular disorders including vertigo and balance disorders 1
• Congenital malformations of the ear requiring surgical correction 1
• Cerumen impaction management and complications 1
• Tympanic membrane perforation diagnosis and treatment 1
• Mastoiditis and other temporal bone infections 1, 2

Nasal and Sinus Disorders

• Chronic rhinosinusitis diagnosis and management, including endoscopic approaches 1
• Nasal obstruction causes and treatments 1
• Epistaxis (nosebleed) management - both anterior and posterior 2
• Nasal trauma and fractures 1
• Congenital nasal malformations 1
• Allergic rhinitis diagnosis and management 1
• Nasal polyps and their surgical management 1

Throat and Laryngeal Disorders

• Tonsillitis and adenoiditis - indications for medical treatment versus surgical intervention 1
• Pharyngitis - differential diagnosis and management 1
• Laryngitis and voice disorders 1
• Vocal cord pathologies including nodules, polyps, and paralysis 1
• Dysphagia evaluation and management 1
• Sleep-disordered breathing and obstructive sleep apnea 1
• Stridor evaluation and management in pediatric and adult patients 1

Head and Neck Disorders

• Head and neck cancers - diagnosis, staging, and multidisciplinary management 3
• Neck masses - differential diagnosis and appropriate workup 1
• Salivary gland disorders including sialadenitis, sialolithiasis, and tumors 3
• Thyroid and parathyroid disorders requiring surgical intervention 3
• Deep neck space infections including retropharyngeal and parapharyngeal abscesses 1, 2
• Facial trauma management 1
• Facial nerve disorders 1, 3

Emergency Management

• Airway emergencies including epiglottitis, foreign body aspiration, and angioedema 1, 4, 2
• Epistaxis management - anterior and posterior packing techniques 4, 2
• Complicated infections requiring urgent surgical intervention 1
• Post-operative complications and their management 4, 2
• Trauma to the head and neck region 4, 2

Pediatric Otolaryngology

• Congenital airway anomalies 1
• Pediatric hearing loss evaluation and management 1
• Recurrent respiratory papillomatosis 1
• Pediatric sleep-disordered breathing 1
• Congenital malformations requiring surgical correction 1
• Management of children with complex medical conditions requiring ENT procedures 1

Diagnostic and Therapeutic Skills

• Otoscopy (including pneumatic otoscopy) and microscopic ear examination 1
• Nasal endoscopy and sinus evaluation 1
• Laryngoscopy techniques (flexible and rigid) 1
• Audiologic testing interpretation 1
• Vestibular testing interpretation 1
• Imaging studies interpretation (CT, MRI, ultrasound) 5, 6
• Common surgical procedures including tonsillectomy, adenoidectomy, myringotomy with tube placement, septoplasty, sinus surgery, and neck dissection 1, 3

Multidisciplinary Collaboration

• Working with audiologists for hearing assessment and rehabilitation 1
• Collaboration with speech-language pathologists for voice and swallowing disorders 1
• Coordination with oncologists and radiation oncologists for head and neck cancer management 3
• Partnership with primary care providers for management of common ENT conditions 1, 5, 6
• Interaction with allergists for management of allergic rhinitis and related conditions 1

Professional Development

• Staying current with evidence-based practice guidelines from the American Academy of Otolaryngology-Head and Neck Surgery 1
• Understanding the limitations of primary care providers' ENT knowledge and providing appropriate education and support 1, 5, 6
• Recognizing when subspecialty referral is needed for complex cases 1

Common Pitfalls and Caveats

• Failure to recognize potentially life-threatening complications of common ENT infections can lead to increased morbidity and mortality 1, 2
• Inadequate assessment of hearing loss can delay appropriate intervention and affect quality of life, particularly in children 1
• Misdiagnosis of otitis media with effusion due to lack of pneumatic otoscopy skills leads to inappropriate antibiotic use and unnecessary referrals 1
• Overlooking extraesophageal manifestations of GERD that can present as ENT symptoms 1
• Delayed recognition of head and neck malignancies due to attribution of symptoms to more common benign conditions 3