Your child’s ENT surgeon recommended ear surgery. He says he can do the surgery or he can send you on to an “otologist/neurotologist” for surgery. You also read about a “pediatric ENT”. Who should do my kid’s surgery and why are there so many options?
Ear surgery is performed by one of three types of surgeons: an otologist/neurotologist, a general ENT or a pediatric ENT. Each of these surgeons has undergone training in managing issues of the ear, nose and throat by completing ENT residency but each has a different primary area of focus.
Historical Perspective:
In general, there has been a trend in medical training over the last several decades to train doctors who are very specialized and treat only a few conditions instead of being more broad in their scopes of practice. This shift has been driven by several factors, including advances in medical technology, an increased understanding of diseases, and the growing complexity of patient care.
This shift towards sub-specialization has led to the development of many more fellowship programs which allow for further training after residency in a more narrow scope of practice. Once residency is complete, a surgeon can choose to practice general ENT or go on to become more specialized within a specific area of ENT. In the US, there are currently fellowship programs for each area within ENT surgery. These include fellowships in ear surgery (otology/neurotology), sinus surgery (rhinology), voice surgery (laryngology), cosmetic facial plastic surgery, sleep surgery, head and neck cancer surgery and pediatric ENT surgery.
As of 2021, an estimated 58% of ENT surgery graduates went on to complete fellowship training.1 Given the increased number of ENT residents completing fellowship training, it is becoming more common for a fellowship-trained surgeon to perform a given surgery rather than a surgeon without specialized training.
Ear surgery is the best example of this transition within the field of ENT surgery.
Ear surgery techniques are still considered a core competency for ENT residents. However, though the techniques are still taught in residency, it has become uncommon for general ENT surgeons to perform most types of ear surgeries after residency training is complete.2 Instead, these cases are more commonly referred to an otologist/neurotologist with more specialized training.
Key Differences Between General ENT Surgery, Pediatric ENT Surgery and Otology/Neurotology:
General ENT training is very rigorous in its own right. After medical school, ENT residents spend 5 years exclusively learning head and neck surgery. During residency, trainees are exposed to all areas of ENT and have different exposures depending on the specific residency program. Some programs focus more on head and neck cancer, while others may expose residents to more pediatric ENT management. General ENT surgeon spread their time managing all areas of the ear, nose and throat. In a given day, they may see patients for complaints pertaining to swallowing, voice, sinus, ear and sleep.
A pediatric ENT surgeon, or pediatric otolaryngologist, specializes in treating ear, nose, and throat conditions in children. After completing a general ENT residency, surgeons complete a one year program in pediatric otolaryngology. This additional training focuses on managing ENT disorders unique to infants, children, and adolescents. Pediatric ENT surgeons complete some ear surgery during fellowship but the focus is also on other areas of ENT including sleep disorders, complex airway issues, sinus problems, etc. Most pediatric ENT surgeons spend their time treating all areas of the ear, nose and throat but focus on infants, children, and adolescents instead of adults.
Otologist/neurotologists complete general ENT residency and then go on to complete two additional years exclusively performing ear surgery on both children and adults. During this time, fellows are immersed in the management of diseases affecting the ear and lateral skull base. This training equips them with in-depth knowledge and skills in managing complex ear conditions such as chronic ear infections, hearing loss, cholesteatoma, balance disorders, and tumors like acoustic neuromas. Most otologists/neurotologists exclusively treat ear issues.
Takeaways:
General ENT surgeons, pediatric ENT surgeons, and otologist/neurotologists each have very specialized training and play a crucial role in managing medical and surgical problems of the head and neck region. Some conditions of the ear, for both adults and children, may be managed by general or pediatric ENT surgeons. But it is the otologists/neurotologists who have the most comprehensive training and experience in caring for all ear conditions. As the complexity of you or your child’s ear problem increases, the more likely you will be referred to an otologist/neurotologist to take over that care.
At Dallas Ear Institute, all of our surgeons are board certified in otology/neurotology. Drs Peters, Hahn, Rodgers and Page practice exclusively within the scope of otology/neurotology for both pediatric and adult patients.
Sources:
- Miller RH, McCrary HC, Gurgel RK. Assessing Trends in Fellowship Training Among Otolaryngology Residents: A National Survey Study. Otolaryngol Head Neck Surg. 2021 Nov;165(5):655-661. doi: 10.1177/0194599821994477. Epub 2021 Feb 23. PMID: 33618575.
- Adams JK, Malka RE, Marinelli JP, Esquivel CR, Newberry TR, Spear SA, Erbele ID. The Case Against Stapedectomy as a Core Competency for General Practice: A Study of Care Patterns in the Department of Defense. Otol Neurotol. 2022 Oct 1;43(9):1011-1015. doi: 10.1097/MAO.0000000000003657. Epub 2022 Aug 26. PMID: 36006782.
Reviewed by the board-certified ENTs doctors at Dallas Ear
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