Ear-Nose-Throat (ENT, or Otorhinolaryngology)
January 23, 1999
Saturday
Hi all I This journal deals with natural holes in the head, as opposed to those created by surgeons. I just finished a 2-week rotation in ENT (ear-nose-throat), formally known as otorhinolaryngology – wonder why the specialty is not called ORL?
ENT used to be EENT (eye-ear-nose-throat) until some people decided that the eye was too specialized an organ to be combined with the contiguous ear-nose-throat. These three are intimately related since there are a lot of tubes/tunnels connecting them. In the unlikely event that the ENT specialty will break up, it’s probably the ear that will split off from the other two (sort of like Mike Tyson biting it off). ENT used to be one of my medical specialties of interest until I decided I didn’t like poking instruments into ears, noses and throats. It was fun for a while, but not for the rest of my life. I didn’t mind all the earwax and mucus, but it was the (sometimes blind) instrumentation that got to me. I discovered this last year during my 4-week elective with the department (in addition to our 2 weeks required stay there) It was a self-directed elective, meaning I could do anything I wanted during the elective. The only requirements were that I attend conferences and rounds. So for the first 2 weeks of my elective I was at the outpatient department (OPD) seeing patients, or in the operating room observing procedures (as I was preparing for the end-of-rotation exam), but for the following 2 weeks I self-directed myself to Christmas shopping and other holiday preparations. That was the most fun 2 weeks of clerkship I had.
Back to ENT in internship. Most of our time is spent in the OPD, seeing new patients. I like ear cases best, as they are easily seen with an otoscope (sort of a magnifying lens with a light source). Noses and throats are rather difficult to examine as they require the patient’s extreme cooperation and depend on his willpower: breathe through your mouth… breath through your nose… relax your tongue… open wide… say (high-pitched) “eeeeee”… More often than not, the gag reflex takes over. The gag reflex happens when an instrument touches the back part of the tongue and thereabouts, making the patient want to vomit (to induce yourself to vomit, place your finger at the back part of your tongue – bulimics do this all the time). This is the frustrating part of the ENT physical examination, which is probably one reason I’m not going into this specialty. I guess it takes lots of practice before you get it right all the time.
ENT is also entwined with head and neck surgery (the full name of the department is Department of Otorhinolaryngology and Head and Neck Surgery) Which means ENT specialists also do thyroid excisions (goiters) and all sorts of masses in the head and neck aside from the usual tonsillectomy. The nice thing with ENT is that it is both medical and surgical, as you can treat some diseases with medicines alone, and then if the disease progresses, you can operate on the involved organ.
We see emergency cases at the ER [emergency room], where we go on 24-hour duties (and where it is so humid!). These include airway obstructions (such as if a thyroid gets really, really big – maybe as big as the person’s head – and presses down on the windpipe/trachea, the patient can’t breathe; or if his vocal cords do not move enough to let adequate air get into the lungs), all sorts of abscesses (collection of pus under the skin, making it swollen and reddish, not to mention painful) and my favorite, foreign bodies. Most patients with foreign bodies are kids. Pellet gun pellets, nuts, trinkets and (yucky) insects. If it’s an insect, you have to drown it first in baby oil before picking it out with forceps (hopefully not piecemeal, which is how I took out a cockroach in a patient’s ear… yuck). For inanimate objects, you could use a (sufficiently small) spoon, hook or the forceps also. The challenge here is not to push the thing further back into the ear or nose. Very difficult if you have a squirming, crying and sometimes swearing kid, who is wrapped in a blanket (“lumpia”… like the spring roll) to keep him from moving too much. Yeah, right. Kids have to be held down by several people to immobilize them, aside from the lumpia. I dread my Pediatrics rotation already.
So that’s it for ENT I’m now into a 2-week Ophthalmology rotation, which is not supposed to be too bad. Operative word is “supposed”. Since the emergency room set-up changed, the whole place has been in chaos and Ophthalmology hasn’t been as light as it was supposed to be. More on this in the next issue.
JOINT is the Journal of INTernship, a series of email messages to family and friends (“journal subscribers”) written during my yearlong medical internship from May 1, 1998 to April 30, 1999. Internship is one of the requirements before taking the Philippine Physician Licensure Examination (also known as the Medical Boards). Journal entries were edited for clarity in January, 2020. Read more about it in the first blog post, Introducing JOINT.
