The Future of Laryngology

Abstract

Otorhinolaryngology has only been recognized as a single and distinct specialty since about 1920 (1). The specialty of otolayrngology is a product of the 20th century; otology and laryngology have quite different origins. The early otologists were surgeons used to the scalpel and trephine whilst the early laryngologists were physicians who combined their knowledge of the larynx with that of the chest. The link between the two, namely rhinology, was embraced by the laryngologists. The two separate disciplines had their own practitioners, departments and journals and only came together, with a few exceptions, in the middle of the Ž rst half of the 20th century (2). This technological era is fast-moving and rapidly changing. Medicine must be updated and go where the ‘‘world goes’’. In the beginning otolaryngology was a specialty created from a fusion of the disciplines of otology and laryngology (2) and concerned the study and treatment of otological, rhinological, laryngological and pediatric otolaryngological diseases. However, the increasing knowledge and complexity of the subject lead this specialty to subdivide again over the last few decades. Within 5 years of completion of residency training, it is no longer possible in most cases to consider a general otolaryngologist to be a well-prepared and updated specialist in all Ž elds of the specialty. We have seen increasing subspecialization in otolaryngology over the last few years. This has principally been into otology neurotology, rhinology, laryngology, head and neck surgery and pediatric otolaryngology . Within these areas some practitioners have developed further special expertise in the Ž elds of otological and oncological skull base surgery, hearing and balance, facial plastic and reconstructive surgery and voice disorders. There is also a trend towards subspecialization in some aspects of otology (3). There still remains a need for the general otolaryngologist but there is also a place for sufŽ cient subspecialists to serve a wider population’s needs (2). Subspecialization is a natural progression of the accumulation of increasing knowledge that improves the technology and surgical techniques, as well as focusing on a clinical practice that is of beneŽ t to both the specialty and the patient (4). The American Board of Otolaryngology (ABOto) has suggested that they would consider subspecialty certiŽ cation in those situations in which there is already a well-established subspecialty (4). A certiŽ cate that recognizes subspecialty training provides an obvious recognition of the additional training and expertise (4). The approval of a CertiŽ cate of Added QualiŽ cation (CAQ) in a subspecialty was granted by the ABOto in otology neurotology and pediatric otolaryngology . Approval has also been given for subspecialization in facial plastic surgery in conjunction with the American Board of Plastic Surgery (4). Specialization increases in the clinic as in the laboratory.