The leader of the voice care team is typically a surgeon who specializes in ear, nose, and throat medicine (otolaryngologist) or an otolaryngologist who has further subspecialized in the larynx, voice, and related problems such as swallowing (laryngologist).
Education and Training Track
Subspecialization in laryngology in the United States requires the series of educational and training programs outlined below.
- Undergraduate degree
- Medical degree
- 1-2 years of general surgery residency
- 4 years of otolaryngology-head and neck surgery (Board-eligiblity by the American Board of Otolaryngology or equivalent organization in other countries)
- 1 year clinical experience and competency on written and oral exam (Board certification)
Scope of Practice
Most otolaryngologists’ clinical practices include many or all components of the specialty, such as:
- Disorders of the ear and related structures (otology)
- Disorders of the voice and upper airway structures such as the throat and trachea (laryngology)
- Head and neck cancer, head and neck neoplasms (masses including benign or malignant lesions)
- Facial plastic and reconstructive surgery
- Allergy and immunology
- Bronchoesophagology (lower airway and swallowing disorders)
- Rhinology (nose, sinus, taste and smell disorders)
- Pediatric otolaryngology (ear, nose, and throat disorders of children)
Most otolaryngologists and laryngologists care for patients of all ages from early childhood through advanced years. Some otolaryngologists subspecialize in caring for disorders in just one or two of the areas of otolaryngology described above. This subspecalization can either be a keen interest in a specific area while still providing a broad range of ear, nose, and throat care, or focused practice of only one or two of the subcomponents of otolaryngology. Laryngology is one such subspecialty.
Brief History of Laryngology
At present, most of the physicians specializing in laryngology did not receive laryngology fellowship training. That is always the case as a new field develops. Modern laryngology evolved out of an interest in caring for professional voice users – teachers, clergy, singers, etc. So, most of the senior laryngologists practicing at the turn of the 21st century were involved in the evolution of the field before fellowships were developed. Most fellowship training programs started in the 1990’s, although a few informal fellowship programs existed in the 1980’s and earlier. It is reasonable to expect most voice specialists who finished residency training in the 1990’s or later to have completed a fellowship in laryngology.
Laryngology Training Programs
There are approximately a dozen laryngology fellowship training programs in the United States. At present, completion of a fellowship is a reasonably good indicator of superior knowledge and clinical training in laryngology. Most laryngology fellowships include training in the diagnosis and treatment of voice disorders in adults and children, neurolaryngology (neurological problems that affect the voice and larynx), swallowing disorders, airway reconstruction, laryngeal cancer, and laryngeal surgery.
Spectrum of Voice Disorders
Typically, laryngologists provide care (diagnosis and treatment) for both routine and complex problems that affect the voice.
- the common cold – especially when it affects the voice of a professional singer or actor
- structural lesions such as nodules or polyps
- prolonged infections of the vocal folds
- traumatic injury from fracture or internal trauma (intubation injuries from anesthesia, vocal fold injuries from previous surgery)
- neurological disorders and other voice problems.
Scope of Responsibilities
The laryngologist is responsible for establishing a medical diagnosis and implementing or coordinating treatment for the patient. The laryngologist may prescribe medication, inject botulinum toxin, perform delicate microsurgery on the vocal folds, or operate on the laryngeal skeleton.
The laryngologist is also usually responsible for initiating evaluation by other members of the voice team and for generating referrals to other specialists as needed.
Perspective on Practice
Laryngologists may practice in university medical centers or private offices; and in major cities in the United States they are usually affiliated with a voice team including at least a speech-language pathologist, a singing voice specialist and sometimes an acting voice specialist. Laryngologists should also have, or have access to, a clinical voice laboratory with equipment to analyze the voice objectively and a stroboscope to visualize the vocal folds in “slow motion”. They also should be familiar with physicians in other specialties who have an understanding and interest in arts medicine. Even for patients with a voice disorder who are not singers and actors, such knowledge and sensitivity is important. Just as non-athletes benefit from the orthopedic expertise of a sports-medicine specialist, voice patients receive specialized expert care from physicians trained to treat singers, the “Olympic athletes” of the voice world.
Medical Societies for Laryngologists
At present, there is no official additional certification for those who have completed a laryngology fellowship. However, there are organizations (medical societies) with which many of the leading laryngologists are affiliated, such as:
American Academy of Otolaryngology-Head and Neck Surgery (http://www.entnet.org/) or equivalent in other countries
American Laryngological Association (ALA), the most senior otolaryngology society in the United States (http://www.alahns.org/)
American Bronchoesophagological Association (http://www.abea.net/)
The Voice Foundation (http://www.voicefoundation.org/)
While membership in these organizations is not a guarantee of excellence in practice, it suggests interest and knowledge in laryngology, particularly voice disorders.