Otolaryngology: Amazing Scope Of Modern Surgery

ENT doctors, also known as otolaryngologists, perform a wide range of surgeries involving the ear, nose, throat, and related structures. According to a clinic, otolaryngologists collaborate with other specialists to provide comprehensive care for patients with conditions affecting these areas.

ENT specialists diagnose and treat various conditions, including ear infections, sinusitis, and head and neck cancers. Their role is crucial in managing these conditions, and they often work with other healthcare professionals to ensure the best possible outcomes.

Key Takeaways

• ENT doctors perform surgeries on the ear, nose, throat, and related structures.
• Otolaryngologists collaborate with other specialists for comprehensive care.
• ENT specialists treat conditions like ear infections, sinusitis, and head and neck cancers.
• Their role is crucial in diagnosing and managing these conditions.
• ENT doctors work with other healthcare professionals for the best outcomes.

The Field of Otolaryngology: Understanding ENT Specialties

The field of otolaryngology, also known as ENT (Ear, Nose, and Throat) medicine, is a complex specialty that requires extensive training and expertise. Otolaryngologists, or ENT specialists, are medical doctors who diagnose and treat conditions related to the ear, nose, throat, and related structures of the head and neck.

Scope and Definition of Otolaryngology

Otolaryngology encompasses a broad range of medical and surgical treatments for various conditions, including hearing loss, sinus infections, throat disorders, and facial plastic surgery. The scope of otolaryngology is vast, covering both common conditions like tonsillitis and complex issues such as head and neck cancers. As noted by a clinic, “Otolaryngologists are surgeons who treat a wide range of conditions, from common ailments to complex diseases.”

Otolaryngologists are trained to handle both medical and surgical treatments, making them versatile specialists. Their expertise extends to managing disorders that affect not just the ear, nose, and throat but also related areas of the head and neck.

Training and Certification of ENT Specialists

The journey to becoming an ENT specialist is rigorous. According to a clinic, otolaryngologists must complete undergraduate education, medical school, and five years of residency training. This extensive training equips them with the necessary skills to perform complex surgeries and manage a wide range of ENT conditions.

“The training involves not just theoretical knowledge but also practical, hands-on experience in diagnosing and treating various ENT disorders,” emphasizes the importance of comprehensive training in otolaryngology. After completing their residency, many otolaryngologists pursue additional specialized training through fellowship programs.

Certification for ENT specialists in the United States is provided by the American Board of Otolaryngology (ABO). To become certified, otolaryngologists must pass a rigorous examination that tests their knowledge and skills in managing ENT conditions and performing surgeries.

Common Ear Surgeries Performed by ENT Doctors

Common ear surgeries are performed by ENT specialists to treat a range of conditions, from hearing loss to chronic infections. These surgical interventions are crucial for restoring patients’ hearing and improving their overall quality of life.

Ear Tube Placement (Tympanostomy)

Ear tube placement, or tympanostomy, is a surgical procedure where a small tube is inserted into the eardrum to drain fluid or air from the middle ear. This surgery is often performed on children to alleviate recurrent ear infections and reduce the risk of hearing loss.

Benefits of Ear Tube Placement:

• Reduces the frequency and severity of ear infections
• Improves hearing by draining fluid from the middle ear
• Decreases the need for antibiotics

Tympanoplasty and Myringoplasty

Tympanoplasty and myringoplasty are surgical procedures aimed at repairing the eardrum and, in some cases, the middle ear bones. Tympanoplasty involves repairing the eardrum, while myringoplasty focuses on closing perforations in the eardrum.

Procedure	Purpose	Benefits
Tympanoplasty	Repairs eardrum and middle ear bones	Improves hearing, reduces risk of infection
Myringoplasty	Closes perforations in the eardrum	Prevents infection, improves hearing

Mastoidectomy Procedures

A mastoidectomy is a surgical procedure that removes infected mastoid bone air cells. This surgery is typically performed to treat mastoiditis, a complication of untreated or inadequately treated otitis media.

“Mastoidectomy is a critical procedure for addressing mastoiditis and preventing further complications such as meningitis or brain abscess.” -American Academy of Otolaryngology

These common ear surgeries highlight the importance of ENT specialists in treating a variety of ear-related conditions. By understanding the different procedures available, patients can better navigate their treatment options and make informed decisions about their care.

Advanced Hearing Restoration Procedures

Advanced hearing restoration procedures have revolutionized the field of otolaryngology, offering new hope to individuals with severe hearing loss. These procedures are designed to improve hearing outcomes for patients with significant auditory impairments.

Cochlear Implant Surgery

Cochlear implant surgery is a highly effective treatment for severe to profound sensorineural hearing loss. According to a clinic, this surgery involves implanting a device that bypasses damaged portions of the ear and directly stimulates the auditory nerve, providing a sense of sound to the recipient.

The benefits of cochlear implant surgery include:

• Significant improvement in speech recognition
• Enhanced ability to engage in conversations
• Improved quality of life

Cochlear implants are particularly beneficial for individuals who receive limited benefit from traditional hearing aids. The surgery is typically performed under general anesthesia, and the recovery time is relatively short.

Stapedectomy for Otosclerosis

Otosclerosis is a condition characterized by abnormal bone growth in the middle ear, which can cause hearing loss. Stapedectomy is a surgical procedure that involves removing part or all of the fixed stapes bone and replacing it with a prosthetic device, thereby restoring sound conduction.

The key advantages of stapedectomy include:

1. Improved hearing outcomes
2. Minimally invasive procedure
3. Quick recovery time

As noted by experts, “Stapedectomy is a highly effective treatment for otosclerosis, offering significant hearing improvement for many patients.”

Nasal and Sinus Surgical Interventions

Surgical procedures for nasal and sinus conditions are a significant part of an ENT surgeon’s practice, aimed at improving patients’ quality of life. These interventions are designed to address a range of issues, from chronic sinusitis to nasal obstruction and cosmetic concerns.

Functional Endoscopic Sinus Surgery (FESS)

Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive procedure used to treat sinusitis and other sinus conditions, as explained by a clinic. This technique involves the use of an endoscope to visualize the sinuses, allowing the surgeon to remove blockages, infected tissue, or other obstructions. FESS is particularly beneficial for patients suffering from chronic sinusitis who have not responded to medical therapy.

Benefits of FESS:

• Reduced sinus pressure and pain
• Improved drainage and reduced risk of sinus infections
• Minimally invasive, resulting in less recovery time

Septoplasty and Turbinate Reduction

Septoplasty is a surgical procedure aimed at correcting a deviated nasal septum, which is a common cause of nasal obstruction. Turbinate reduction is often performed in conjunction with septoplasty to further improve airflow through the nasal passages. These procedures can significantly enhance a patient’s ability to breathe through their nose.

Key aspects of septoplasty and turbinate reduction:

Procedure	Purpose	Benefits
Septoplasty	Corrects deviated nasal septum	Improved nasal breathing, reduced nasal congestion
Turbinate Reduction	Reduces size of turbinate bones	Enhanced airflow, reduced nasal resistance

Rhinoplasty: Functional and Cosmetic Approaches

Rhinoplasty is a versatile surgical procedure that can be performed for both functional and cosmetic reasons. Functionally, rhinoplasty can address issues such as nasal obstruction, while cosmetically, it can reshape the nose to improve its appearance. Modern rhinoplasty techniques often combine both aspects to achieve comprehensive results.

Rhinoplasty outcomes:

• Improved nasal function and breathing
• Enhanced aesthetic appearance of the nose
• Personalized results based on individual needs and preferences

Throat Operations in Otolaryngology Practice

Otolaryngologists perform a range of surgical procedures on the throat to treat conditions such as sleep apnea and tonsillitis. These surgeries are critical in addressing various throat-related disorders that can significantly impact a patient’s quality of life.

Tonsillectomy: America’s Most Common ENT Surgery

Tonsillectomy, the surgical removal of the tonsils, is one of the most common ENT surgeries performed. As of 1983, there were approximately 478,000 tonsillectomies performed annually in the US. This procedure is often recommended for patients suffering from recurrent tonsillitis or obstructive sleep disorders caused by enlarged tonsils.

The tonsillectomy procedure involves the complete removal of the tonsillar tissue. It is typically performed under general anesthesia, and the recovery period can vary depending on the individual’s overall health and the specific surgical technique used.

“Tonsillectomy is a common procedure that can significantly improve the quality of life for patients with recurrent tonsillitis or sleep disorders related to tonsillar hypertrophy.”- Expert in Otolaryngology

Adenoidectomy Procedures

Adenoidectomy involves the removal of the adenoid tissue, which is located behind the nasal passages. This surgery is often performed in conjunction with tonsillectomy, especially in pediatric patients, as adenoid hypertrophy can contribute to breathing difficulties and recurrent infections.

Procedure	Indications	Typical Patient Group
Tonsillectomy	Recurrent tonsillitis, obstructive sleep disorder	Pediatric and adult patients
Adenoidectomy	Adenoid hypertrophy, recurrent infections	Primarily pediatric patients

Uvulopalatopharyngoplasty (UPPP) for Sleep Apnea

Uvulopalatopharyngoplasty (UPPP) is a surgical procedure aimed at treating obstructive sleep apnea by removing excess tissue in the throat. This operation can help to widen the airway, reducing the severity of sleep apnea symptoms.

UPPP is considered when other treatments for sleep apnea have failed, and the patient has been diagnosed with significant obstruction in the upper airway. The procedure involves modifying the uvula, soft palate, and pharynx to improve airflow during sleep.

In conclusion, throat operations such as tonsillectomy, adenoidectomy, and UPPP are vital components of otolaryngology practice, offering relief and improved quality of life for patients suffering from various throat-related conditions.

Voice and Swallowing Disorder Surgeries

Voice and swallowing disorders can significantly impact an individual’s quality of life, and ENT specialists offer surgical solutions to address these issues. Otolaryngologists, or ENT specialists, are trained to diagnose and treat a wide range of conditions affecting the voice and swallowing mechanisms.

Vocal Cord Procedures

Vocal cord disorders, such as nodules, polyps, or paralysis, can severely affect an individual’s ability to speak or sing. ENT specialists perform various surgical procedures to correct these issues.

• Vocal Cord Injection: A procedure where a substance is injected into the vocal cord to improve voice quality.
• Vocal Cord Surgery: Surgical removal of lesions or growths on the vocal cords.
• Laryngoplasty: A surgery that involves modifying the larynx to improve voice or breathing.

Procedure	Purpose	Benefits
Vocal Cord Injection	Improve voice quality	Minimally invasive, quick recovery
Vocal Cord Surgery	Remove lesions or growths	Effective in treating voice disorders
Laryngoplasty	Modify larynx for voice or breathing	Can significantly improve voice or breathing function

Surgical Management of Dysphagia

Dysphagia, or difficulty swallowing, can result from various conditions, including neurological disorders or anatomical abnormalities. ENT specialists employ surgical techniques to manage dysphagia and improve swallowing function.

1. Dilation: A procedure to widen the esophagus or other narrowed areas.
2. Cricopharyngeal Myotomy: A surgery that involves cutting the cricopharyngeal muscle to facilitate swallowing.

Understanding what an ENT specialist does is crucial for individuals suffering from voice and swallowing disorders. These specialists provide comprehensive care, from diagnosis to surgical treatment, to restore normal function and improve quality of life.

Thyroid and Parathyroid Surgical Procedures

The thyroid and parathyroid glands are crucial for regulating metabolism and calcium levels, and surgical procedures on these glands can be lifesaving. Otolaryngologists, or ear nose and throat doctors, often play a significant role in performing these delicate surgeries.

Thyroidectomy: Partial and Total Approaches

Thyroidectomy is a surgical procedure that involves removing part or all of the thyroid gland. This surgery is typically performed to treat thyroid cancer, large goiters, or hyperthyroidism that doesn’t respond to other treatments. According to a clinic, thyroidectomy is a common treatment for thyroid cancer.

Types of Thyroidectomy:

• Partial Thyroidectomy: Removing a portion of the thyroid gland.
• Total Thyroidectomy: Removing the entire thyroid gland.

The choice between partial and total thyroidectomy depends on the underlying condition and its severity. For instance, in cases of thyroid cancer, a total thyroidectomy might be recommended.

Parathyroid Surgery for Hyperparathyroidism

Hyperparathyroidism is a condition where one or more parathyroid glands become overactive, leading to an imbalance in calcium levels. Surgery is often required to remove the affected gland(s).

Parathyroid Surgery Techniques:

Surgical Technique	Description	Benefits
Minimally Invasive Parathyroidectomy	A smaller incision is made to remove the affected gland.	Less scarring, quicker recovery.
Traditional Parathyroidectomy	A more extensive incision is made for better access.	Allows for more exploration and identification of glands.

Parathyroid surgery is highly effective in treating hyperparathyroidism, and the choice of technique depends on the individual case and the surgeon’s expertise.

Head and Neck Cancer Surgical Treatments

Otolaryngologists play a vital role in treating head and neck cancers through various surgical interventions. According to a clinic, otolaryngologists are crucial in the treatment of head and neck cancer, utilizing surgical techniques to remove tumors and reconstruct affected areas.

Tumor Removal Techniques

Tumor removal is a primary surgical approach in treating head and neck cancer. ENT specialists use advanced techniques to ensure the removal of cancerous cells while preserving surrounding tissue and function. The goal is to eliminate the cancer while maintaining the patient’s quality of life.

The precision in tumor removal has been enhanced by technological advancements, including image-guided surgery and laser surgery. These techniques allow for more accurate removal of tumors, reducing the risk of damage to nearby structures.

Neck Dissection Procedures

Neck dissection is often necessary when cancer has spread to the lymph nodes in the neck. Otolaryngologists perform neck dissections to remove affected lymph nodes, which is critical for staging the cancer and planning further treatment.

There are different types of neck dissections, ranging from selective removal of specific lymph node groups to more comprehensive dissections. The choice of procedure depends on the extent of cancer spread and the patient’s overall condition.

Reconstructive Options After Cancer Surgery

Reconstruction is a vital aspect of head and neck cancer surgery, aiming to restore function and appearance after tumor removal. Reconstructive surgery can involve local flaps, free flaps, or other techniques to repair defects and improve patient outcomes.

The choice of reconstructive technique depends on the extent of the surgery, the location of the tumor, and the patient’s overall health. Advanced reconstructive techniques have significantly improved the quality of life for patients undergoing head and neck cancer surgery.

Facial Plastic and Reconstructive Surgeries in ENT

Otolaryngologists, or ear, nose, and throat (ENT) doctors, perform facial plastic and reconstructive surgeries to correct congenital conditions and trauma-related injuries. These procedures are vital in restoring both the function and appearance of facial structures.

Facial Trauma Reconstruction

Facial trauma reconstruction is a critical aspect of otolaryngology, involving the repair of injuries to the face and surrounding areas. ENT specialists use advanced techniques to restore the original appearance and function of the affected areas.

Key aspects of facial trauma reconstruction include:

• Assessment of the injury to determine the extent of damage
• Surgical planning to restore facial aesthetics and function
• Use of advanced imaging techniques for precise reconstruction

Cosmetic Facial Procedures

Cosmetic facial procedures are another important facet of facial plastic surgery performed by otolaryngologists. These procedures aim to enhance the appearance of the face, addressing concerns such as aging, asymmetry, or other aesthetic issues.

Procedure	Description	Benefits
Rhinoplasty	Surgery to change the shape of the nose	Improves nasal aesthetics and can correct breathing difficulties
Facelift	Procedure to reduce signs of aging on the face	Restores a more youthful appearance, enhancing self-confidence
Otoplasty	Surgery to correct the shape or position of the ears	Improves the appearance of the ears, addressing protrusion or other deformities

Cleft Lip and Palate Repair

Cleft lip and palate repair are significant reconstructive surgeries performed by otolaryngologists. These congenital conditions affect the upper lip and the roof of the mouth, requiring surgical intervention to correct.

The repair process typically involves:

• Initial surgery to correct the cleft lip, usually within the first few months of life
• Follow-up surgery to repair the cleft palate, typically before the age of 2
• Ongoing care and potential additional surgeries to improve speech and appearance

In conclusion, facial plastic and reconstructive surgeries are essential components of otolaryngology, offering solutions for a range of conditions from trauma and congenital anomalies to cosmetic concerns. By understanding the scope and benefits of these procedures, patients can make informed decisions about their care.

Pediatric ENT Surgical Interventions

The field of pediatric ENT surgery encompasses a wide range of procedures, including those that correct congenital anomalies and improve the quality of life for young patients. Children often require specialized care for ear, nose, and throat conditions, and surgical interventions are sometimes necessary to address these issues effectively.

Congenital Anomaly Corrections

Congenital anomalies affecting the ear, nose, and throat are relatively common in children. These anomalies can range from mild to severe and may significantly impact a child’s health and development. ENT surgeons play a critical role in correcting these anomalies through surgical interventions.

Some common congenital anomalies that require surgical correction include:

• Cleft lip and palate
• Ear deformities
• Nasal passage abnormalities
• Tongue-tie (ankyloglossia)

Correcting these anomalies not only improves the child’s appearance but also enhances their ability to breathe, eat, and hear properly. For instance, repairing a cleft palate can significantly improve a child’s speech development.

Age-Specific Considerations in Pediatric ENT Surgery

When performing ENT surgery on children, surgeons must consider the unique aspects of pediatric anatomy and physiology. Children’s bodies are still developing, and this requires ENT surgeons to adapt their techniques accordingly.

Age Group	Considerations	Surgical Adaptations
Infants (0-1 year)	Delicate structures, small anatomy	Use of specialized pediatric instruments
Toddlers (1-3 years)	Cooperation challenges, anxiety	Pre-operative preparation, sedation techniques
School-age children (4+ years)	Better cooperation, understanding	Age-appropriate explanations, comfort measures

By understanding these age-specific considerations, ears, nose, and throat doctors can provide more effective and compassionate care to their young patients. This tailored approach helps minimize stress and promotes better outcomes for children undergoing ENT surgical interventions.

Minimally Invasive Techniques in Modern Otolaryngology

Minimally invasive techniques are revolutionizing the field of otolaryngology, offering patients safer and more effective treatment options. Otolaryngology, by definition, is the branch of medicine that deals with the diagnosis and treatment of ear, nose, and throat (ENT) disorders. Understanding what an ENT specialist does is crucial in appreciating the impact of these advancements.

Endoscopic Approaches

Endoscopic approaches have become a cornerstone in modern otolaryngology. These procedures involve using a flexible or rigid endoscope to visualize the surgical site, allowing for precise interventions with minimal disruption to surrounding tissues. Endoscopic sinus surgery, for example, is a common procedure used to treat sinusitis by removing blockages and improving sinus drainage.

The benefits of endoscopic approaches include reduced recovery time, less post-operative pain, and minimal scarring. According to a clinic, such minimally invasive techniques have significantly improved patient outcomes in various ENT procedures.

Laser Surgery Applications

Laser surgery has emerged as a valuable tool in otolaryngology, offering precision and control in delicate procedures. Laser-assisted surgeries are used in treatments ranging from vocal cord lesions to tonsillectomies. The precision of laser surgery minimizes damage to surrounding healthy tissue, promoting faster healing and reducing the risk of complications.

Robot-Assisted ENT Procedures

Robot-assisted surgery represents the latest advancement in minimally invasive otolaryngology. Robotic systems provide ENT surgeons with enhanced visualization, precision, and dexterity, enabling complex procedures to be performed with greater accuracy. Robot-assisted thyroidectomy and robotic sinus surgery are examples of procedures that benefit from this technology, offering patients less invasive options with potentially fewer complications.

The integration of robotic assistance in ENT surgery is expanding the possibilities for treating complex conditions while minimizing patient morbidity and improving outcomes.

Technological Advancements in ENT Surgical Practices

Technological innovations have transformed the landscape of ENT surgical procedures, enhancing the precision and effectiveness of treatments. The integration of advanced technologies has significantly improved patient outcomes and recovery times.

Image-Guided Surgical Navigation

Image-guided surgical navigation has revolutionized the field of otolaryngology by providing ENT doctors with real-time data during surgeries. This technology utilizes preoperative imaging to guide surgeons through complex anatomical structures, reducing the risk of complications.

According to LivHospital, the use of image-guided navigation systems has become increasingly prevalent in ENT surgeries, allowing for more precise interventions and improved patient safety.

3D Printing Applications

The application of 3D printing in ENT surgery has opened new avenues for preoperative planning and patient education. Custom-made models of patient anatomy can be created, enabling surgeons to better understand complex cases and plan their approach more effectively.

3D printing also facilitates the creation of custom implants and prosthetics, which can significantly improve the outcomes of reconstructive surgeries.

Artificial Intelligence in Surgical Planning

Artificial intelligence (AI) is increasingly being integrated into surgical planning for otolaryngologists. AI algorithms can analyze vast amounts of data, including imaging studies, to help predict outcomes and identify potential complications.

The use of AI in surgical planning is expected to continue growing, further enhancing the capabilities of ENT doctors to provide personalized and effective care.

Multidisciplinary Approaches in Complex ENT Cases

Complex ENT cases demand a comprehensive approach that involves various medical specialties. The ear, nose, and throat (ENT) field is intricate, with structures that are closely related and often interdependent. As such, ENT specialists must sometimes collaborate with other medical professionals to provide the best possible care for their patients.

Collaboration with Neurosurgery

One critical area of collaboration is with neurosurgery. ENT specialists work closely with neurosurgeons on cases involving the skull base, where intricate structures of the brain intersect with those of the ear, nose, and throat. Conditions such as tumors or other abnormalities in this region require a delicate and coordinated approach to surgery.

The integration of neurosurgery and ENT expertise ensures that patients receive comprehensive care. For instance, in cases of skull base tumors, the neurosurgeon and ENT specialist might work together to plan and execute a surgery that removes the tumor while preserving critical surrounding structures.

Integration with Maxillofacial Surgery

Another important collaboration is with maxillofacial surgery. ENT specialists and maxillofacial surgeons often work together on cases involving facial trauma, congenital anomalies, or cancers of the head and neck. This multidisciplinary approach is crucial for addressing the complex anatomy of the face and neck, ensuring that both functional and aesthetic considerations are taken into account.

For example, in cases of facial trauma, the ENT specialist and maxillofacial surgeon might collaborate on reconstructive surgery to repair damaged structures, restore function, and improve the patient’s appearance.

The benefits of such multidisciplinary approaches are numerous. By combining their expertise, ENT specialists, neurosurgeons, maxillofacial surgeons, and other healthcare professionals can provide more effective treatment plans, improve patient outcomes, and enhance the overall quality of care.

Recovery and Outcomes After ENT Surgical Procedures

Recovery from ENT surgical procedures is a multifaceted process that significantly impacts patient outcomes. Otolaryngologists, or ENT specialists, play a crucial role in guiding patients through this process.

Typical Recovery Timelines

The recovery timeline after ENT surgery varies depending on the procedure. For instance, after a tonsillectomy, patients may experience a recovery period of about 7 to 10 days, during which pain management is crucial. In contrast, recovery from sinus surgery might take a few weeks, with improvements in symptoms noticeable over time.

Post-Operative Care Considerations

Proper post-operative care is essential for optimal recovery. This includes following the surgeon’s instructions regarding wound care, medication, and follow-up appointments. For example, after ear tube placement, patients are advised on how to keep the ear dry and manage any discomfort.

Patients should also be aware of potential complications and when to seek medical attention. According to a clinic, monitoring for signs of infection or unexpected symptoms is crucial in the post-operative period.

Quality of Life Improvements

ENT surgical procedures can significantly improve a patient’s quality of life. For instance, cochlear implants can restore hearing in individuals with severe hearing loss, enhancing their ability to communicate. Similarly, surgeries like septoplasty can improve nasal breathing, reducing the risk of sinus infections and related complications.

By understanding the recovery process and adhering to post-operative care instructions, patients can maximize the benefits of their ENT surgery, leading to improved health outcomes and quality of life.

Conclusion: The Future of ENT Surgery

The field of otolaryngology, or ENT, is rapidly evolving, driven by advancements in technology and surgical techniques. As an otorhinolaryngologist, staying at the forefront of these developments is crucial for delivering the best possible care to patients.

LivHospital’s commitment to innovative and academic protocols in ENT surgeries reflects the growing importance of continued innovation and research in improving ENT surgical practices and patient outcomes. The definition of otolaryngology encompasses a broad range of surgical interventions, from ear tube placement to complex head and neck cancer surgeries.

As ENT surgery continues to advance, the integration of new technologies, such as image-guided surgical navigation and robot-assisted procedures, is expected to enhance precision and outcomes. The future of ENT surgery holds much promise, with ongoing research and development poised to address current challenges and improve the quality of life for patients undergoing ENT surgical procedures.

FAQ

Reference

American Board of Otolaryngology – Head and Neck Surgery (ABMS / ABOS)
Link:https://www.abms.org/board/american-board-of-otolaryngology-head-and-neck-surgery/ American Board of Medical Specialties