Scott Webb (Host): Otolaryngology is not an easy word to say. And though these specialists are sometimes referred to as ear, nose, and throat doctors, some are surgeons as well. So, it's good to have Dr. Paul Wilson here. He is an otolaryngologist and head and neck surgeon at Franciscan Health. And he's here to explain all of this to us.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Dr. Wilson, thanks so much for your time today. We're going to learn about what you do, you know, what an otolaryngologist does and what you treat and how you help folks. So, let's just start there. Nice, easy one for you, what is otolaryngology?

Dr. Paul Wilson: So, I know it especially is a bit of a mouthful. Otolaryngology, head and neck surgery is the full name. It's treatment of disorders of the ear, nose, and throat, and head and neck. So, there's both surgical and medical treatment of it. The more common name is ear, nose, and throat doctor, or ENT is how we're often referred to. But any disease in the ear, nose, and throat, both from a medical or surgical perspective.

Host: Yeah, that sounds right. For us lay people out here, ear, nose, and throat seems easier to say than otolaryngology, and that's how we kind of know you all. So, you mentioned there could be surgical, could be medical. What do you treat? What types of things do you treat?

Dr. Paul Wilson: Part of this is based upon also what you specialize in as an otolaryngologist. So, I'm a general otolaryngologist working in a community setting. So, example of common things that an otolaryngologist would treat would be ear-related complaints, be it hearing loss or ringing or ear infections, meaning for things like ear tubes or chronic ear infections, things like cochlear implants as well to rehabilitate hearing.

From a nose standpoint, we treat the sinuses with sinus surgery if needed, medications or antibiotics. We also medically treat allergies with medications, allergy testing, or even allergy shots or drops. From a throat standpoint, we do oropharyngeal surgery, things like chronic tonsil problems, tonsil infections. We also treat voice disorders, so problems with the vocal cords, either functional problems that we often work with speech pathologists to treat, or things like nodules.

For the head and neck, we treat head and neck cancers. That can include skin cancers. It can include throat cancers, thyroid, salivary tumors. And then, a lot of what we do is medical treatment in office. Again, medical treatment of allergies, helping people with hearing loss with hearing aids. So, kind of a full gamut of those and fitting it for the patient.

Host: Yeah. As you say, there is obviously some specialization there. Wondering, you're going through that whole host of things that otolaryngologists may treat, may see in the office, what types of training do you all get, especially the head and neck surgeons?

Dr. Paul Wilson: So, you go to medical school, so four years of medical school. Otolaryngology is a surgical residency, which is a five-year surgical residency. A decent number of otolaryngologists go on into practice after the five-year residency. But a little over half wind up doing a fellowship as well. So, subspecialty areas of otolaryngology can include neurotology or ear specialists, rhinology or sinus specialists, facial plastic and reconstructive surgery, which can be either for cosmetic purposes or also for reconstruction for things like traumas or cancers. Pediatric otolaryngologists would obviously specialize in the treatment of children with pediatric disorders. There's also a subspecialty in sleep, surgery and sleep medicine. You can subspecialize in laryngology or voice disorders. And then, head and neck cancer also has a different subspecialty, which can also include reconstruction for large cancer defects and resections.

Host: Yeah. So obviously, lots of training. As you say, possibly some fellowships. Lots of experience, obviously treating a whole host of patients. Wondering when is it time to see an otolaryngologist? When do we, you know, make that appointment directly if we can, or ask for a referral? You talked about everything that you guys do, that all of you would do and, you know, from ear to nose to throat and all of that. But when should we know that it's time to reach out to someone like yourself?

Dr. Paul Wilson: Obviously, there are emergency situations, so those would best be dealt with by going to the emergency room. We can often get called in there, for example, for like a really bad nosebleed or significant difficulty breathing if there's a narrowing of the airway. Outside of an emergency situation, a good starting point is often with your primary care doctor. They often are the frontline. So, for example, a routine sinus infection that clears readily with antibiotics is perfectly appropriate to be treated by your primary care doctor, and often doesn't need an otolaryngologist to weigh in.

We really help when things start to progress or aren't responding appropriately. So, that would be, you know, five or six sinus infections in a year. Or for example, in a pediatric patient, one or two rounds of an ear infection is within a normal expected limits, but when you're dealing with three or four or you're getting fluid that doesn't resolve. So, a lot of, again, the common ear, nose and throat disorders, the frontline treatment is often with the primary care. But if it becomes a persistent problem that it looks like we need to come up with a better long-term solution, then that's when a lot of those disorders will get referred to us. Patients can also, depending upon their insurance, directly request an appointment. And that can be appropriate as well, but that's more specific based upon their plan. Sometimes they require primary care to refer them.

Host: Yeah. I have an HMO, so I am very familiar, unfortunately, with having to have my primary refer me for everything, every specialist that I see. And yeah, we probably wouldn't want folks just, as you say, one nasal infection, we don't need to come see you. But as you say, five or six in a year? Yeah, there may be something else going on. Maybe time for a specialist. That makes sense. And I want to ask you about sleep apnea. I know a lot of folks have sleep apnea. Is that something that otolaryngologists treat?

Dr. Paul Wilson: Yeah. So, we serve as part of the puzzle for treating sleep apnea. So, obstructive sleep apnea is an increasingly diagnosed and common disorder that affect up to 10% of the population. Most people are familiar with it as a disease and the initial treatment, the CPAP mask, which is a positive pressure mask that you wear when sleeping, that tends to work really well. And those patients are treated either by their primary or by a pulmonologist, or sleep specialists. But unfortunately, the mask for about half of patients, they just aren't able to use it very well. It's either uncomfortable, they get claustrophobic, they take it off. And for one reason or another, they just can't tolerate it and they get the benefit they want.

That's really where otolaryngologists play a role in the treatment of sleep apnea. And that would be coming up with different approaches. A lot of them medical and a lot of them surgical to try to improve the sleep apnea, either getting the mask more comfortable or providing another avenue of treatment. So for sleep apnea, if a patient is not using the mask or can't use the mask, we often will look at them, take a history, do an exam. Things like allergies can make the mask less comfortable. A lot of times nasal breathing issues with like a septal deviation or a sinus issue with polyps can make the mask less comfortable as well. And so, sometimes we treat nasal breathing or sinus allergy issues either with medications or surgery, and that improves people's mask tolerance.

Because the obstruction can occur anywhere in the throat, other surgeries we sometimes do are things like tonsillectomies. That's a very common surgery to do in children with sleep problems because children tend to have bigger tonsils. So, a lot of times children get better when you take out the tonsils from a sleep standpoint. Adult patients, it's a little more complex, so that type of surgery still will often play a role.

There's other varieties of surgery that are a potential. The newer one that I also wanted to highlight was something called the Inspire sleep apnea implant. This is a device that goes underneath kind of in the chest and senses when a patient breathes and then uses a stimulating electrode to push the tongue forward to open up the airway. So, that's a surgery that we're now offering for the right patient.

So, I think one takeaway is, for sleep apnea, there's not one perfect fit for everyone. It's really individualized for the patient, for their symptoms and for their anatomy. So if a mask works great for one patient, then we leave it there. Otherwise, we try to come up with another treatment or solution that might help them get treated.

Sleep apnea, in general, we want to treat for two reasons. Number one, if you have sleep apnea and it's not treated, you just don't feel great. You're tired, you don't get a good night's sleep. But number two, there's long-term health consequences, increased risk in car accidents, workplace accidents, long-term risks of cardiac and pulmonary complications and things like dementia. So, we want to treat it to get people feeling better, but also to avoid those long-term complications.

Host: Yeah, and good to understand sort of your role in all of this. As you say, if the mask works great, then you're good. And if it doesn't, there's lots of other things you can try, surgeries and otherwise. So, good stuff. Just want to finish up here talking about chronic ear infections, which I know is a thing, whether it be in kids or adults. How do you help folks who have those chronic ear problems?

Dr. Paul Wilson: It again depends on the problem. I will break it down into a couple more common scenarios we deal with. But like everything, it depends on the problem. In a lot of pediatric patients, young children tend to get a lot of what we call acute otitis media or middle ear infections as they're developing an immune system and just their anatomy predisposes them to it. After several ear infections like that, often we'll do a set of ear tubes. And those tubes work to equalize pressure, allow fluid to drain out, and do tend to decrease the frequency and severity of infections, and ensure that a child isn't having fluid or hearing issues related to that.

We'll also do ear tubes in adults, but both children and adults can have more complex infections where they get collections of infection that doesn't clear readily with antibiotics or other problems like collections of skin cells called the cholesteatoma that lead to persistent infections. So, not just an ear infection that gets treated with antibiotics, but an ear that is kind of always infected and draining. And those infections often require a little more aggressive surgery, removing that infection and kind of where it's trapped in the bone of the ear.

Host: Well, that sounds good, doctor. You know, as you say, a lot of these things are common. And frontline defense would be seeing our PCPs when possible, being referred if necessary. But, you know, in hosting a lot of these, it's always good to know that there are options, right? That there are specialists, that there are options, there are different things to try medical, surgical, and otherwise. So, thank you so much for your time today. You stay well.

Dr. Paul Wilson: Thank you.

Host: And for more information, visit franciscanhealth.org and search otolaryngology. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.