Ear, Nose and Throat

July 1, 2010
John Kutchna

,
Renee de Gennaro
Renee de Gennaro

Renee de Gennaro is founder and president of Berwyn, PA-based Integrated Strategic Solutions, which offers customized solutions for any pharmaceutical training and development need, with an emphasis on the design of representative and management training. She holds multiple certifications in management and selling skill topic areas. Renee can be reached at integratedstrategicsolutions@gmail.com.

Pharmaceutical Representative

Otolaryngology or ENT (ear, nose and throat) is the branch of medicine that specializes in the diagnosis and treatment of ear, nose, throat and head and neck disorders. The full name of the specialty is otolaryngology-head and neck surgery. Practitioners are called otolaryngologists-head and neck surgeons, or sometimes otorhinolaryngologists (ORL).

Otolaryngology or ENT (ear, nose and throat) is the branch of medicine that specializes in the diagnosis and treatment of ear, nose, throat and head and neck disorders. The full name of the specialty is otolaryngology-head and neck surgery. Practitioners are called otolaryngologists-head and neck surgeons, or sometimes otorhinolaryngologists (ORL).

(DORLING KINDERSLEY, GETTY IMAGES)

According to the American Board of Medical Specialties, the otolaryngologist has special expertise in managing diseases of the ears, nose and nasal passage sinuses, larynx, oral cavity and upper pharynx (mouth and throat), as well as structures of the neck and face. Head and neck oncology, facial plastic and reconstructive surgery, and treatment of disorders of hearing and voice are fundamental areas of expertise. ENT is the oldest medical specialty in the United States. Management of disorders related to the eyes and brain are reserved for ophthalmology and neurology, respectively.

Education and Training

After earning a medical degree (M.D. or D.O.), the length of training for an ENT physician in the United States is generally five years. Residency in otolaryngology consists of one year of general surgery, emergency, critical care and anesthesia training followed by four years of otolaryngology training. To be certified, the physician must then pass the American Board of Otolaryngology examination. In addition, otolaryngologists can be subcertified in Sleep Medicine through additional training and examination.

ENT Specialties

Practice Environment

To better understand the practice of ENT physicians, it is important to take a closer look at the types of conditions treated common procedures utilized, as well as current plans of treatment.

The ENT practice consists of primarily office-based procedures and outpatient procedures. Occasionally, surgery requires a hospital stay.

Medical Conditions

ENT physicians commonly treat a number of conditions relevant to the ear, nose and throat locations in the body. Disorders related to the ear include tinnitus, ear-aches, hearing loss, dizziness, vertigo, swimmer's ear, otitis media, mastoiditis and tympanic membrane perforations.

Disorders related to the nose and paranasal include bacterial infections, foreign bodies, nasal polyps, rhinitis, sinusitis and nosebleeds.

Common Procedures

Disorders of or related to the throat include include hoarseness, tonsillitis, laryngitis, contact ulcers, benign tumors, pharyngitis and rhinorrhea.

A careful history and physical examination of the ears, nose, throat, head and neck is common during a patient's initial consultation with an ENT. Different instruments with light sources (otoscopes) enable ENT physicians to quickly visualize the ears, nose and throat.

The head and neck area is inspected and the neck/throat area is typically felt with the surgeon's hands (palpation). Nasal endoscopy allows visualization of the upper airway to detect anatomical problems related to sinuses. Videostroboscopy can be used to visualize the vocal cords and triple endoscopy (laryngoscopy, esophagoscopy and bronchoscopy) can diagnose head and neck cancers.

Plan of Treatment

The following list of medications are some (but not all) of the medications that may be prescribed by an ENT physician.

Some common medications that are FDA approved for the Otolaryngology category include Bactroban Nasal 2% (mupirocin calcium ointment), Cedax (ceftibuten), Depakote ER (divalproex sodium), Ethyol (amifostine), Floxin Otic (ofloxacin otc), Moxatag (amoxicillin), Omnicef (cefdinir), Patanase (olopatadine hydrochloride), Protonix (pantoprazole sodium), Rocephin (ceftriaxone), Tri-Nasal Spray (triamcinolone acetonide spray), Veramyst (fluticasone furoate) and Xyzal (levocetirizine dihydrochloride).

For ear disorders, it is common for ENTs to utilize acetaminophen (or, for adults, aspirin) and ear-drops that have antibacterial properties and steroid drugs for swimmer's ear.

Middle ear infection therapy includes antibiotics such as ampicillin, amoxicillin and clarithromycin. Acetaminophen is used to relieve pain as are pain-relieving eardrops.

Vertigo and tinnitus are results of an inner ear disorder called Meniere's disease and have been treated with the antibiotic gentamycin.

Sinusitis is a nasal disorder that is treated with antibiotics such as Amoxil, Bactrim or cephalosporin. Decongestants such as phenylephrine also can be used. Allergies can be treated with antihistamines, decongestants, immunotherapy and inhaled corticosteroids. In addition, nasal polyps can be treated with inhaled corticosteroids, antihistamines and decongestants, and antibiotics for infection.

Throat disorders, such as strep throat caused by the streptococcus bacteria, require penicillin or a broad-spectrum antibiotic. Acute tonsillitis is normally treated with aspirin or acetaminophen, rest and adequate fluid intake. However, if the infection is bacterially based, antibiotics such as erythromycin or penicillin are administered.

Connecting with ENTs

Ear, Nose and Throat physicians, like most other physicians, think in terms of patient cases. When connecting with ENT physicians in a selling situation, open a discussion by accurately describing a patient type and build your discussion around the characteristics of that specific patient.

Asking key questions about a case work-up can allow you to fully appreciate their differential diagnosis algorithm. Learning the physician's thoughts and approaches to treating specific patient cases can help you better understand how a product can be considered as the solution to a case. It will be important to also include clinical data, efficacy comparisons, side effects and titration/dosing schedules in your discussions.

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