Some questions

[Grurik]

I have some questions that I hope can be answered. Been focusing on another surgical subspeciality but have come to enjoy ENT, however, some questions remains unanswered. Have had some exposure (my other field is close related to ENT surgery), mainly clinic and ER and some in the OR. Planning to get more exposure to the specialty, anyway, some questions that will be rather mixed;

1) How much is acute airway management in ENT? Is it a common problem in an adult population? This is for university hospitals.

2) What are some typical ENT patients/diagnoses in the ICU?

3) Which specialty deals with tracheal pathology? From articles on the subject, it seems to be both ENT and CT surgeons, or is there any general division for example distal = CT, proximal = ENT?

4) General turf wars; endocrine gland surgery, likely be increased volumes for ENT or general (/endocrine) surgeons; skull base surgery, NSG or ENT in the future?

5) What non-operative fields exists in ENT? I'm going into the specialty for the surgery, but have a father that has essential tremor (mild), I have no ET and don't know if I ever will get, but always nice to know.

Thanks in advance!

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[VisionaryTics]

I have some questions that I hope can be answered. Been focusing on another surgical subspeciality but have come to enjoy ENT, however, some questions remains unanswered. Have had some exposure (my other field is close related to ENT surgery), mainly clinic and ER and some in the OR. Planning to get more exposure to the specialty, anyway, some questions that will be rather mixed;

1) How much is acute airway management in ENT? Is it a common problem in an adult population? This is for university hospitals.

Relatively frequently, compared to other specialties. ENT is unique in that we are often the first person called for airway management (angioedema, deep space neck infections, stridor in the ER/NICU, obstructive H&N cancers, etc) but then need to work in a multidisciplinary team (anesthesia, ER, etc) to treat the patient.

2) What are some typical ENT patients/diagnoses in the ICU?

Adult ICU consults? Tracheostomies for ventilator-dependent respiratory failure. Otherwise consults for facial trauma in polytrauma ICU patients, bad infections (epiglottitis, Ludwig's, etc). Primary ICU patients tend to be H&N patients after microvascular reconstruction, skull base tumors (usually managed primarily by neurosurgery).

3) Which specialty deals with tracheal pathology? From articles on the subject, it seems to be both ENT and CT surgeons, or is there any general division for example distal = CT, proximal = ENT?
ENTs deal with subglottic and tracheal stenosis, tracheitis, other inflammatory conditions. Primary tracheal tumors are insanely rare; I've never seen one in residency but have done a few tracheal resections for locally invasive thyroid cancers. Pediatric cases were often multidisciplinary (ENT doing tracheal dilations/lasering/injections with CT doing vascular maneuvers for tracheomalacia or doing slide tracheoplasty).

4) General turf wars; endocrine gland surgery, likely be increased volumes for ENT or general (/endocrine) surgeons; skull base surgery, NSG or ENT in the future?
I think the trend for thyroid/parathyroid is swinging towards ENT, but still plenty of general surgeons out there doing plenty of endocrine. In addition, some hospitals are dominated by general surgery due to dedicated sections of endocrine surgery (staffed largely by endocrine-trained general surgeons). For skull base, it remains a multidisciplinary approach and I foresee it will remain so in the future. Most cases are co-scrubbed by both ENT (whether rhinologist/otologist) and neurosurgery.


5) What non-operative fields exists in ENT? I'm going into the specialty for the surgery, but have a father that has essential tremor (mild), I have no ET and don't know if I ever will get, but always nice to know.

Plenty of non-operative ENT. Many ENTs semi-retire to "medical ENT" practice, seeing dysphagia, dizziness, medical otology, laryngology, etc. That being said, don't worry too much about a tremor. Actually doesn't affect you too much as a surgeon. I have a slight tremor (we all do) and have no problems doing stapes surgery (probably finest work done in our field).

Thanks in advance!

As above. Overall, I'm a huge cheerleader for ENT. I think it's an amazing field with a ton of variety; you can create the career you want. Quality of life and reimbursement are good. We remain more autonomous than most other fields in medicine since we don't have any real competition for much of what we do. You do as much or as little surgery as you like and still be profitable and busy.

 

[HighPriest]

1 - Agree with the above. How much you get called is going to depend upon your hospital system. I very rarely get called for airway emergencies (which is fine by me) simply because they don't happen that often. But I don't work at a tertiary referral center.
2 - I would agree with the above and add "dysphagia" and "dysphonia" and "please scope this guy to see if he can be extubated (followed by me trying to do an NP scope at the bedside and seeing nothing but mucus and base of tongue)
3 - This is going to depend upon the site of the lesion. Most ENT-related tracheal problems are going to be invasive thyroid cancer (which is pretty rare, overall) or pediatric airway disorders. Some peds-ENT guys to a lot of tracheal work, and often solo. This is simply a factor of pediatric airways being more narrow and many of the problems being congenital. Some of this depends upon the type of pathology and the political situation at your institution.
4 - agree with 4 on all fronts. ATA guidelines recommend a neck dissection for metastatic thyroid disease, and I've not personally ever met a general surgeon who knows how to do one. A lot of them say that they're "basically" doing one, but they're just node plucking.
5 - ENT is one of the few (only?) surgical specialties where you could have a completely medical practice if you wanted to do that to yourself.

 

[Grurik]

Thanks a lot for your answers, really appreciate it. From these answers, it only touches upon then variety within the field. I will be interesting to keep on exploring it. Happy to learn that turf wars seems to be going well