Dr. Chandler Marietta of Concord Hospital Otolaryngology-Laconia discusses the specialty and offers pearls, i.e. key information, for the general population.

What is otolaryngology? What do we do?

Otolaryngology is a surgical specialty commonly referred to as ear, nose and throat, or ENT. As the name suggests, otolaryngologists or ENTs operate and do procedures to solve issues with the ear, nose or throat; however, it is a little more complicated. In fact, we perform nearly all surgeries and procedures in the head and neck region with the exception of the brain, spine, eyes and teeth. We address diseases, disorders or injuries to the facial bones, oral cavity, lips, tongue, tonsils, sinuses, salivary glands, thyroid, lymph nodes and skin, among others. As a result, there is quite a bit of overlap with other specialties such as dermatology, plastic surgery, gastroenterology, allergy/immunology and oncology. This leads to interdisciplinary collaboration and robust care.

What is earwax? Should you
remove it?

Earwax, or cerumen, is good! That’s right, you didn’t misread that! There is a perception in our society that it is bad, dirty, and/or unhealthy, but that is far from the truth! Earwax is nature’s way of cleaning out and preventing infection of the ear canal. Made in the mid-portion of the ear canal, earwax is acidic, which prevents infection, and its stickiness allows it to trap debris. Skin migrates from the eardrum out and carries the wax with it, which can then just be wiped away when it reaches the opening of the canal. In addition to above, a pearl that most ENTs would like the general public to know and embrace is that cotton ear swabs are not recommended for the ears. Likewise, other methods marketed to remove wax are not recommended. Again, earwax has a very important function and generally should be left alone. Trying to remove it with cotton ear swabs tend to push more in than is removed on the swab. If this occurs, the packed-in wax can lead to complications including hearing loss, infection or erosion of the skin and bone of the ear canal. In the relatively infrequent times when earwax can cause symptoms and/or problems, it is best to see an ENT or a medical professional who can safely remove it.

When is hearing loss an emergency?

In the field of otolaryngology, sudden hearing loss is considered to be a semi-emergency. In most cases, the hearing loss can be attributed to easily remedied issues like wax blockage or fluid in the middle-ear space. However, if it is related to the inner ear, treatment sooner rather than later is paramount -- ideally within 72 hours. To help distinguish between a middle- and an inner-ear issue, you can scratch your scalp behind your ear -- if you cannot hear it on that side, then seek care medical care ASAP; if you can hear it, then it’s still advised to seek care, but it likely is not an inner ear loss.

Is there a problem with nasal steroid sprays?

If used correctly, no. Problems arise due to the lack of understanding of nasal anatomy. If you stick the applicator straight into your nose and spray up and in, like most people do, you will only be spraying the septum. The septum is the tissue structure separating the right and left nasal cavities, and if sprayed over and over again, it may become dry and bleed. Additionally, the medication is not getting where it needs to go and does little good. Therefore, another ENT pearl is to aim for where the nasal cavity is on the inside and also where the sinuses drain: out, up and slightly back. If you use the opposite hand and point towards the inner corner of your eye within your nose, the spray should be getting to the right spot to help symptoms and avoid bleeding. Another point is that although nasal steroid sprays are very effective, it can take up to a month to determine if the spray will be helpful, so stick with it!

What tools are used in this specialty?

There are numerous tools used in this surgical specialty, but one that is used often and revolutionized our specialty’s practice, as well as others, is the endoscope. An endoscope is a small telescope, can be either straight and rigid or long and flexible. They are sometimes angled to help look around corners and a camera is sometimes attached to help with visualization. We have many “holes” in the head and neck region -- endoscopes allow us to see into all of these “holes.” In some circumstances, it also allows us to forgo numerous or large incisions. Such a minimally invasive approach to diagnosis and treatment not only improves care through better visualization but also can result in shorter recovery times for patients.

Dr. Chandler Marietta of Concord Hospital Otolaryngology-Laconia spoke about the surgical specialty of otolaryngology, also known as ear, nose and throat (ENT) at the July Concord Hospital Trust “What’s Up Doc?” Donor Lecture Series. The monthly series, supported by the Walker Lecture Fund, features members of Concord Hospital’s medical staff speaking to Concord Hospital Trust donors about new and innovative medical treatments and services. You can watch Marietta’s presentation on Concord Hospital’s YouTube channel at: youtube.com/concordhospital.

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