The Complete Guide To Becoming An ENT Surgeon/Otolaryngologist

Published on: 5 Oct 2021

ENT Surgeon/Otolaryngologist

 

The Role Of An Otolaryngologist:

If you are a medical student or foundation doctor with excellent manual dexterity who longs for diversity in their working life, otolaryngology may be what you are looking for. This article aims to provide you with great insight into otolaryngology as a profession and guide you on your journey to becoming an ENT surgeon.

An otolaryngologist is a surgeon who specialises in managing patients with diseases affecting the senses such as hearing, balance, smell and taste, as well as problems with breathing, swallowing, and voice. They may also treat head and neck tumours, including skull base and interface with the brain. An ENT surgeon’s job involves treating patients of all ages and seeing more children than most other surgeons (1). 

You will come across a plethora of diseases as an otolaryngologist, including (1):

 

Ear conditions

  • Otosclerosis

  • Otitis media with effusion

  • Age-related hearing loss

  • Tinnitus

  • Dizziness and vertigo

  • Ear infections

  • Perforated ear drum and cholesteatoma

  • Protruding ears

 

Nose conditions

  • Sinus infection and rhino-sinusitis

  • Nasal injuries

  • Nasal polyps

  • Tumours of the nose

  • Nasal obstruction

  • Dysfunctional sense of smell

 

Throat conditions

  • Adenoid problems

  • Tonsillitis

  • Laryngitis

  • Swallowing problems

  • Upper airway breathing problems

  • Snoring and obstructive sleep apnoea

 

Head and neck conditions

  • Cancer affecting the oral cavity, pharynx, larynx, salivary glands, skull base, nose, and sinuses

  • Thyroid and parathyroid problems

  • Facial skin lesions including skin cancer

 

Facial cosmetic surgery

  • Rhinoplasty

  • Otoplasty

  • Blepharoplasty

  • Facial reconstruction following cancer or trauma

Otolaryngologists get to use the widest range of surgical procedures of any specialty, with the most common ones including (1):

  • Insertion of grommets for glue ear – this involves a very small incision in the eardrum and is typically carried out on children.

  • Tonsillectomy or adenoidectomy (most often in children)

  • Septoplasty

  • Microlaryngoscopy

  • Oesophagoscopy 

  • Endoscopic sinus surgery

  • Tympanomastoid surgery

  • Open operations to remove neck lumps and salivary gland tumours

  • Tracheostomy

Although a surgical specialty, the majority of ENT work involves attending outpatient clinics, and you may see eight to twelve patients in a morning or afternoon clinic. You will work within a diverse multidisciplinary team, both, within the operating theatre (e.g. plastic surgeons, maxillofacial surgeons, ophthalmologists, anaesthetists, theatre nurses) and outside (healthcare scientists working in audiology, dietitians, head and neck physiotherapists, speech and language therapists, administrative staff, other doctors). Once you become a consultant surgeon, you will be leading and managing your team (1).

Apart from the necessary skills employed by all doctors, aspiring otolaryngologists should demonstrate certain qualities and traits. Excellent listening and communication skills are of utmost importance as you may often have to work with patients with communication difficulties. team working skills and leadership ability are vital to effectively work in this specialty.

The surgical component also necessitates a high degree of manual dexterity and visuo-spatial awareness.

ENT surgery is an incredibly varied and exciting specialty which has been at the forefront of the latest medical technologies. This has allowed for minimally invasive procedures that greatly improve a patient’s life, thus making otolaryngology a highly rewarding field.

The use of robots, lasers and surgical navigation systems will enable the development of further minimally invasive surgical techniques (1). However, as with surgery in general, this specialty is male-dominated. The “Women in Surgery'' initiative, nonetheless, is dedicated to encouraging and enabling women to pursue their surgical career ambitions (2).

 

A Typical Week:

ENT surgeons spend a higher proportion of their time in various outpatient clinics, such as adult or paediatric clinics, rather than in the operating theatre. Surgery is usually elective and carried out during the day; an average half-day in theatre might comprise three operations, which may range from simple procedures that take 15 minutes to more complex surgeries lasting up to twelve hours. Compared to other surgical specialties, otolaryngology has a lower on-call demand, thus allowing a good work-life balance (1). 

While most days would involve direct clinical care, be it outpatient work or surgery, some time must be allocated to teaching, clinical governance, and departmental and multidisciplinary meetings. The EU Working Time Directive limits the working week to 48 hours (1).

 

The Route To Becoming An Otolaryngologist:

Interested undergraduate medical students can join the medical society at their university and attend conferences for an opportunity to explore the specialty and network with potential future colleagues.

You may also want to consider joining associated societies, institutes or professional bodies such as ENT UK, the Royal College of Surgeons of England (RCSEng), and the Royal College of Surgeons of Edinburgh (RCSEd) (1). 

During your foundation years, get in touch with ENT surgeons at hospitals and try to help in any way possible, be it research or audits. Attend courses offered by the RCSEng and RCSEd (1).

After completion of your foundation programme, you are required to complete a two-year core surgical training (CT). During CT, you must obtain full Membership of the Royal College of Surgeons (MRCS ENT) prior to specialty training (ST3). Nevertheless, completion of CT and the MRCP does not guarantee an ST3 training post due to the level of competition (1); in 2019, there were 2.57 applications per place (3).

The CT programme usually contains some ENT themed or related surgical specialties. Although it is desirable to have 12 months’ experience in otolaryngology, six months suffice to qualify for MRCS ENT. Some candidates acquire relevant experience by working locum after completion of CT and before applying for ST3 (1). 

Starting this year, a run through pilot training programme is being introduced at some deaneries. This means training would commence at ST1 and run through to ST8, without the need to complete CT and further recruitment process (4).

Be ready to move to a different location as certain hospitals – such as Guy’s and St Thomas’ Hospital, King’s College London – are renowned for their excellence in this specialty and would prove beneficial to your career prospects (5).

Once you acquire a post, training will last six years (ST3-ST8). Academic-minded otolaryngologists may choose to pursue a research degree, usually an MD (2-3 years) or a PhD (3-4 years), before or during specialty training. You must pass the Intercollegiate Specialty Examination (FRCS) during specialty training, after which you will be awarded the certificate of completion of training (CCT) to go on to work as a consultant otolaryngologist (1).

 

Subspecialties:

Many ENT surgeons develop specific interests and complete post-CCT subspecialty training. Most subspecialties have societies/associations that ENT consultants are advised to join (4). The main subspecialties within otolaryngology include (1):

  • Otology – diagnosis and treatment of infection, disease and damage to the ear to improve hearing and balance. This includes cochlear implant surgery

  • Rhinology – treatment of all aspects of nose and sinus disorders including allergy, infection, inflammatory conditions and tumours, including those of the skull base e.g. pituitary tumours

  • Laryngology – treatment of diseases and disorders of the larynx and throat, such as vocal fold nodules, voice problems and cancer

  • Head and neck surgery – the treatment of benign and malignant diseases of the head and neck, including lymph, salivary, thyroid and parathyroid glands

  • Skull base surgery/neurotology – treatment of disorders of the skull base and acoustic neuromas (benign, non-cancerous growths on the vestibulocochlear nerve which controls hearing and balance)

  • Facial plastics – aesthetic procedures including rhinoplasty and pinnaplasty. The work also includes reconstruction of facial defects.

  • Thyroid and parathyroid surgery

  • Paediatrics

 

Earnings:

NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849.  

Consultant otolaryngologists may also wish to run private practices to supplement their salary; a “purely” private consultant is rare in the UK. On average, otolaryngologists can make a profit of an additional 98% of their NHS salary by working in the private sector.

In 2018, private otolaryngologists made a profit of £107,000; this is higher than most specialties, only behind orthopaedics (£128,000) and radiology (£117,000) (6).

For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.

 

Resources:

If you are interested in deepening your knowledge in otolaryngology, you may find it useful to consult relevant journals, such as the ones listed below:

  • The Journal of Laryngology & Otology

  • Clinical Otolaryngology

  • Journal of Otolaryngology – Head and Neck Surgery

  • Journal of Oral Pathology and Medicine

  • Acta Oto-Laryngologica

The following societies and institutes offer a wealth of information on conferences, podcasts, essay prizes, research, tutorials, courses, and learning resources relevant to otolaryngology:

 

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References 

1.     Otorhinolaryngology [Internet]. Healthcareer | NHS. [cited 2020 Sep 6]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/surgery/otorhinolaryngology-ear-nose-and-throat-surgery-ent

2.     Women in Surgery [Internet]. Royal College of Surgeons of England. [cited 2020 Jul 19]. Available from: https://www.rcseng.ac.uk/careers-in-surgery/women-in-surgery/

3.     Specialty Recruitment Competition Ratios [Internet]. Specialty Training | NHS. 2019. Available from: https://specialtytraining.hee.nhs.uk/Portals/1/Competition Ratios 2019_1.pdf

4.     Training Structure [Internet]. SFO ENT UK. [cited 2020 Sep 11]. Available from: http://sfo.entuk.org/training-structure

5.     ENT [Internet]. Guy’s and St Thomas’ NHS Foundation Trust. Available from: https://www.guysandstthomaseducation.com/project/ent/

6.     Morris S, Elliott B, Ma A, McConnachie A, Rice N, Skåtun D, et al. Analysis of consultants’ NHS and private incomes in England in 2003/4. J R Soc Med [Internet]. 2008 Jul;101(7):372–80. Available from: http://journals.sagepub.com/doi/10.1258/jrsm.2008.080004