You like the idea of working on the ears, nose, and throat.

你喜歡在耳朵、鼻子和喉嚨上工作的想法。

Overall the head just really gets you going.

總的來說，這顆頭顱真的能讓你興奮起來。

Let's debunk the public perception myths, and give it to you straight.

讓我們揭穿公眾認知的神話，並直接告訴你。

This is the reality of otolaryngology.

這就是耳鼻喉科的現實。

Dr. Jubbal, MedSchoolInsiders.com.

Jubbal博士，MedSchoolInsiders.com。

Welcome to our next installment in So You Want to Be.

歡迎來到《你想成為什麼樣的人》的下一篇文章。

In this series, we highlight a specific specialty within medicine, such as ENT, and help you

在這個系列中，我們強調醫學中的一個特定專業，如耳鼻喉科，並幫助你

decide if it's a good fit for you.

決定它是否適合你。

You can find the other specialties on our So You Want to Be playlist.

你可以在我們的 "你想成為的人 "播放列表中找到其他專業。

If you want to vote in upcoming polls to decide what future specialties we cover, make sure

如果你想在即將舉行的投票中投票，以決定我們未來涵蓋的專業，請確保

you're subscribed.

你已經訂閱了。

If you'd like to see what being an ENT looks like, check out my second channel, Kevin Jubbal,

如果你想看看作為一個耳鼻喉科醫生是什麼樣子的，請查看我的第二個頻道，凱文-朱巴爾。

M.D., where we'll be covering a day in the life of an otolaryngologist in the future.

醫學博士，我們將在未來報道一位耳鼻喉科醫生的一天。

ENT is a surgical subspecialty focusing on diseases of the head and neck region, including

耳鼻喉科是一個專注於頭頸部疾病的外科亞專業，包括

laryngology, meaning the vocal cords and larynx, rhinology, referring to the nose and sinuses,

喉科，指聲帶和喉部，鼻科，指鼻子和鼻竇。

ears, including not only the external ear but also inner ear, and endocrinology, including

耳朵，不僅包括外耳，還包括內耳，以及內分泌學，包括

the thyroid and parathyroid.

甲狀腺和甲狀旁腺。

ENT also deals with head and neck cancers and facial plastics.

耳鼻喉科還負責處理頭頸部癌症和麵部整形。

Delineating what exactly ENT does requires identifying the areas of overlap with other

界定耳鼻喉科的具體工作，需要確定與其他領域的重合之處。

specialties.

專長。

ENT will handle cancers of the head and neck region as far down as the esophageal inlet.

耳鼻喉科將處理頭頸部的癌症，最遠至食道入口。

Anything distal to that, meaning further down the GI tract, is handled by gastroenterologists

任何遠端，也就是說在消化道更遠的地方，都由胃腸病學家處理。

or general surgeons.

或普通外科醫生。

Plastic surgeons work all around the body and pioneered many aesthetic and reconstructive

整形外科醫生在身體各處工作，並開創了許多審美和重建工作。

techniques from head to toe.

從頭到腳的技術。

Otolaryngologists that specialize in facial plastics do cosmetic procedures of the head

專注於面部整形的耳鼻喉科醫生做的是頭部美容手術。

and neck only.

僅限頸部。

In terms of reconstruction, until recently plastic surgeons would harvest local or free

在重建方面，直到最近，整形外科醫生才會收穫當地或自由的

flaps to help otolaryngologists with reconstructive cases.

瓣，以幫助耳鼻喉科醫生處理重建病例。

However, ENT is moving in the direction of now doing their own local and free flaps without

然而，耳鼻喉科的發展方向是，現在做他們自己的在地和免費的襟翼，沒有

plastic surgery assistance.

整形手術援助。

These are most commonly used with oral cancers, specifically laryngeal.

這些最常用於口腔癌，特別是喉癌。

This includes the almost science fiction work of harvesting tissues from one part of the

這包括從一個部位採集組織的近乎科幻的工作。

body, like the radial forearm flap or fibular flap, and moving it to a new part of the body

像橈骨前臂皮瓣或腓骨皮瓣一樣，將其移到身體的一個新部位。

for coverage after trauma or cancer resection.

用於外傷或癌症切除術後的覆蓋。

There are a few ways to categorize the specialty.

有幾種方法可以對專業進行分類。

ENT can be thought of as Ear, Nose, and Throat, plus facial plastics, sleep, allergy, and

耳鼻喉科可以被認為是耳、鼻、喉科，加上面部整形、睡眠、過敏和其他方面。

head & neck surgery.

頭和頸部手術。

For the ear, you have two primary functions: hearing and balance.

對於耳朵來說，你有兩個主要功能：聽力和平衡。

Otologists, dealing with the ears exclusively, work on cochlear implants, masses within the

耳科醫生專門處理耳朵問題，從事人工耳蝸的工作，其內部的腫塊。

ear, such as cholesteatomas, dizziness, infections, and trauma to the ear.

耳朵，如膽脂瘤、頭暈、感染和耳部外傷。

Experts of the nose, or rhinologists, deal with polyps in the nose, deviated septums,

鼻子的專家，即鼻科醫生，負責處理鼻子裡的息肉、鼻中隔偏曲的問題。

and other sinus surgeries, such as for resecting a tumor or mass.

和其他鼻竇手術，如切除腫瘤或腫塊。

They may also work in conjunction with neurosurgery in gaining access to various tumors, meaning

他們也可能與神經外科一起工作，以獲得對各種腫瘤的訪問，這意味著

making it easier for them to get to tumors at the skull base or in the pituitary.

使他們更容易到達顱底或垂體中的腫瘤。

Emergencies in this field include invasive fungal infections and difficult to control

該領域的緊急情況包括侵襲性真菌感染和難以控制的

epistaxis, such as if someone is on blood thinners.

鼻衄，如某人正在服用血液稀釋劑。

Experts of the throat, or laryngologists, deal with singers and celebrities who have

喉部專家，或稱喉科醫生，負責處理有以下情況的歌手和名人的問題

issues with their voice.

他們的聲音的問題。

They'll use a scope to visualize the vocal cords.

他們會用顯微鏡來觀察聲帶的情況。

Sometimes there are nodes or injuries to the recurrent laryngeal nerve requiring attention.

有時喉返神經有結節或損傷，需要注意。

They deal with swallowing issues, for which they may perform an esophageal dilation.

他們處理吞嚥問題，為此他們可能進行食管擴張。

If a patient has tracheal stenosis, meaning scarring and narrowing of the airway, they

如果病人有氣管狹窄，也就是氣道的瘢痕和狹窄，他們

may use lasers to remedy the problem.

可能使用脈衝光來補救這個問題。

Emergencies that happen in the airway are securing a surgical airway when anesthesiologists

發生在氣道中的緊急情況是確保手術氣道，當麻醉師

are unable to intubate in the traditional manner.

無法以傳統方式插管。

This is actually one of the most common emergent interventions otolaryngologists take care

這實際上是耳鼻喉科醫生最常採取的緊急干預措施之一。

of, and it's high acuity, meaning you have to drop everything and handle it immediately.

的，而且是高度敏銳的，這意味著你必須放下一切，立即處理它。

Other emergencies in this area include foreign bodies in the airway or upper esophagus, often

這一領域的其他緊急情況包括氣道或食道上部的異物，通常是

due to children swallowing random objects.

由於兒童吞下隨機物體。

Otolaryngologists specializing in facial plastics deal with botox, fillers, rhinoplasty, and

專門從事面部整形的耳鼻喉科醫生處理肉毒桿菌、填充物、隆鼻術和

facial trauma including jaw and mid-face fractures.

面部創傷，包括頜骨和中面部骨折。

They also help with facial transgender procedures, such as facial feminization whereby they make

他們還幫助進行面部變性手術，如面部女性化手術，從而使女性化。

changes to one's hairline, lips, cheekbones, jaw, and chin to appear more feminine.

改變一個人的髮際線、嘴脣、顴骨、下顎和下巴，使其看起來更有女人味。

They'll also handle facial traumas, which usually are not emergent, unless there is

他們也會處理面部創傷，這些創傷通常不是緊急的，除非有

uncontrolled bleeding or issues with vision.

不受控制的出血或視力問題。

Head and neck specialists are the ones who remove cancers of the head and neck and reconstruct

頭頸部專家是切除頭頸部癌症並重建的人。

the defects with free flaps.

有缺陷的自由瓣。

This can be as minor as a local excision to as massive as taking bone and muscle from

這可以是輕微的局部切除，也可以是大規模的取骨和肌肉。

the leg, or another part of the body, to reconstruct the face, jaw, and throat.

腿，或身體的另一部分，以重建面部、下頜和喉嚨。

Other general complications include necrotizing fasciitis, also known as flesh eating bacteria,

其他一般併發症包括壞死性筋膜炎，也被稱為食肉菌。

of the head or neck area, tonsil bed bleeding after tonsillectomy, some types of infections

頭部或頸部區域、扁桃體切除術後的扁桃床出血、某些類型的感染

and abscesses in the head and neck spaces, or angioedema, which is diffuse swelling of

頭部和頸部空間的膿腫，或血管性水腫，這是一種瀰漫性的腫脹。

the mouth and throat.

口腔和喉嚨。

Academic otolaryngologists work at teaching hospitals, where in addition to clinical responsibilities,

學術型耳鼻喉科醫生在教學醫院工作，除了臨床職責外。

they handle teaching and research as well.

他們也處理教學和研究。

At these academic centers, which are tertiary care centers, meaning they have specialists

在這些學術中心，它們是三級護理中心，意味著它們有專家

and more robust resources, you'll be seeing more complicated cases.

和更強大的資源，你將會看到更多複雜的案例。

That's because community ENT's don't have the resources to handle complicated cases

這是因為社區耳鼻喉科醫生沒有足夠的資源來處理複雜的病例。

requiring additional resources and interdisciplinary consults.

需要額外的資源和跨學科的諮詢。

Your hours will be dependent on your subspecialization within ENT, but you can expect regular 9 to

你的工作時間將取決於你在耳鼻喉科內的亞專業，但你可以期待正常的9至12小時。

5 hours on clinic days, but more variable hours when in the operating room.

在門診日為5小時，但在手術室時，時間更不固定。

For example, if you're doing flaps, some cases can take over 8 hours, but if you're doing

例如，如果你在做襟翼手術，有些病例可能需要超過8小時，但如果你在做

facial plastics, each case is much shorter in duration.

面部塑膠，每個案例的持續時間要短得多。

Community and private practice ENTs deal with more of the bread and butter of the field,

社區和私人診所的耳鼻喉科醫生更多的是處理該領域的麵包和黃油。

meaning simpler, more common, and more straightforward cases.

指更簡單、更常見、更直接的情況。

There's less research and less teaching, although some of these otolaryngologists get connected

研究和教學工作較少，儘管其中一些耳鼻喉科醫生得到了聯繫。

with local academic programs for some light duty mentorship and teaching opportunities.

與當地學術項目合作，提供一些輕度的指導和教學機會。

Overall, you'll see more emergent cases at academic and tertiary care centers over smaller

總的來說，在學術和三級護理中心，你會看到更多的急診病例，而不是小型醫院。

community practices.

社區實踐。

ENT is an often misunderstood field.

耳鼻喉科是一個經常被誤解的領域。

Many people don't realize that ENT is actually a surgical subspecialty, and isn't just clinical

許多人沒有意識到，耳鼻喉科實際上是一個外科亞專業，而不僅僅是臨床的。

in nature.

在自然界中。

And no, they're not glorified nose pickers, but rather handle everything from the simple

不，他們不是光榮的挖鼻孔者，而是處理從簡單的

straightforward issues of the head and neck to complex cancer resections and reconstructions.

從頭部和頸部的簡單問題到複雜的癌症切除和重建。

Also, otolaryngologists do not do hearing or vestibular tests – that's done by audiologists.

另外，耳鼻喉科醫生不做聽力或前庭測試--那是由聽力學家做的。

However, ENT's do interpret the results and prescribe treatment when necessary.

然而，耳鼻喉科醫生確實會解釋結果，並在必要時開出治療處方。

After medical school, ENT is a 5 year categorical residency, meaning you match straight into

醫學院畢業後，耳鼻喉科是一個為期5年的分類住院醫生，這意味著你可以直接匹配到

an ENT residency program.

一個耳鼻喉科住院醫師項目。

Some programs are up to 7 years with research years, but 5 years is the norm.

有些項目的研究年限長達7年，但5年是常規。

In your first year of residency, also called your intern year, you'll be required to

在住院醫師的第一年，也稱為實習生年，你將被要求

rotate on various services, just as you would with any other residency.

對各種服務進行輪換，就像你對任何其他居住地一樣。

You'll get exposure to ICU, anesthesiology, ophthalmology, plastic surgery, and general

你將接觸到ICU、麻醉科、眼科、整形外科和普通外科。

surgery among others.

其中包括外科手術。

You'll also get a few months exposure to ENT.

你還會接觸到幾個月的耳鼻喉科。

You'll be carrying the pager and learning how to deal with consults as an intern, with

你將帶著呼叫器，學習如何以實習生的身份處理問診，有

a few OR days mixed in.

摻雜了一些手術室的日子。

From your second year onward, you'll be exclusively on ENT rotations.

從第二年開始，你將專門進行耳鼻喉科的輪換。

During your 2nd and 3rd year, you gradually get more OR time as you will rotate through

在第二年和第三年，你會逐漸得到更多的手術室時間，因為你會在以下地方輪換

the various subspecialties of ENT.

耳鼻喉科的各個亞專業。

In your 4th and 5th years, you'll oversee your juniors, teach, and have greater autonomy

在第四年和第五年，你將監督你的學弟學妹，進行教學，並擁有更大的自主權。

in the OR as you prepare to graduate and be on your own as an attending.

在你準備畢業並作為主治醫生獨立工作時，你可以在手術室裡進行學習。

This is the fun part, as you'll do many surgeries on your own with little supervision,

這是有趣的部分，因為你將在很少的監督下自己做許多手術。

or assist the attendings with more complicated cases.

或協助主治醫生處理更復雜的病例。

ENT is a highly competitive specialty, consistently ranking at number 5 right after dermatology,

耳鼻喉科是一個競爭激烈的專業，一直排在皮膚科之後的第五位。

plastic surgery, neurosurgery, and orthopedic surgery.

整形外科、神經外科和矯形外科。

Most recently, ENT residents averaged 248 on USMLE Step 1 and 256 on USMLE Step 2CK,

最近，耳鼻喉科住院醫師在USMLE Step 1中的平均成績為248分，在USMLE Step 2CK中為256分。

with an average publication number of 13.7.

平均出版數量為13.7。

Medical students that pursue ENT are generally detail oriented, overachieving, and often

追求耳鼻喉科的醫學生一般都注重細節，成就感過強，而且經常

somewhat quirky.

有些怪異。

ENT's are the often considered the "nice surgeons" in the hospital.

耳鼻喉科醫生通常被認為是醫院裡的 "好外科醫生"。

Despite ENT already being a fairly narrow surgical subspecialty, there's a great deal

儘管耳鼻喉科已經是一個相當狹窄的外科亞專業，但仍有大量的工作要做。

of further subspecialization and fellowships to choose from.

的進一步亞專業性和研究金的選擇。

Laryngology is a 1 year fellowship focusing on the voice, swallowing, and airway related

喉科是一個為期一年的研究項目，側重於與嗓音、吞嚥和氣道有關的問題。

concerns.

關注。

This includes taking care of trachs, esophageal dilations for swallowing, and vocal cord procedures

這包括照顧拖把，為吞嚥進行食道擴張，以及聲帶手術。

such as injections, medializations, implants, reinnervations, or resections.

如注射、中軸化、植入、再灌注或切除等。

These are the ENTs that are interested in music, as many of them seem to play instruments.

這些是對音樂感興趣的耳鼻喉科醫生，因為他們中的許多人似乎會演奏樂器。

Rhinology is a 1 year fellowship with a primary focus on sinus surgery.

鼻科是一個為期一年的研究項目，主要側重於鼻竇手術。

They deal with simple stuff like deviated septums to more complicated issues, like removing

他們處理簡單的問題，如鼻中隔偏曲，也處理更復雜的問題，如切除鼻中隔。

diseased segments with micro-debridement, addressing invasive and noninvasive fungal

用微循環處理病變區段，解決侵入性和非侵入性真菌的問題。

sinus infections, and helping neurosurgeons with skull base tumors and pituitary approaches.

竇感染，並幫助神經外科醫生處理顱底腫瘤和垂體方法。

Facial plastics is a 1 year fellowship for the Instagram influencers of ENT surgeons

面部整形是為耳鼻喉科醫生的Instagram影響者提供的為期1年的獎學金

with dollar signs in their eyes.

他們的眼睛裡有美元符號。

They focus on aesthetic facial procedures, like botox, fillers, facial feminization,

他們專注於面部美容手術，如肉毒桿菌、填充物、面部女性化。

rhinoplasties, blepharoplasties, but also facial trauma.

鼻整形、眼瞼整形，但也包括面部創傷。

Neurotology is a 2 year fellowship for the nerdy and highly meticulous ENT surgeons,

神經病學是一項為期2年的研究，是為那些書呆子和高度細緻的耳鼻喉科醫生準備的。

as they are working in incredibly small structures.

因為他們是在令人難以置信的小結構中工作。

They work primarily on the middle and inner ear, dealing with cholesteatomas, tympanic

他們主要從事中耳和內耳的工作，處理膽脂瘤、鼓膜炎等。

membrane perforations, and working alongside neurosurgeons for schwannomas and approaching

醫學專家們還與神經外科醫生們一起工作，治療精神分裂症和接近。

brain tumors.

腦瘤。

Head and neck is a 1 year fellowship for the jocks of ENT that enjoy long and complicated

頭部和頸部是一個為期1年的研究項目，為喜歡長而複雜的耳鼻喉科醫生而設。

surgeries.

手術。

They're often resecting cancers and reconstructing the empty space, but also deal with thyroidectomies

他們通常要切除癌症，重建空隙，但也要處理甲狀腺切除術。

and less complicated procedures too.

而且程序也不那麼複雜。

Most commonly, they deal with squamous cell carcinoma of the throat, often related to

最常見的是，他們處理的是咽喉部的鱗狀細胞癌，通常與以下情況有關

smoking and drinking, and then use thigh or forearms flaps in reconstruction.

吸菸和喝酒，然後在重建中使用大腿或前臂皮瓣。

If bony structures require reconstruction too, they'll use a fibular flap from the leg.

如果骨質結構也需要重建，他們會使用腿上的腓骨瓣。

Sleep is a newer, 1 year fellowship, and academic centers see this as the hot new thing.

睡眠是一個較新的、為期1年的獎學金，學術中心將其視為熱門的新事物。

If a patient has obstructive sleep apnea and non-surgical management isn't working, the

如果病人患有阻塞性睡眠呼吸暫停，並且非手術治療沒有效果，那麼

ENTs specializing in sleep may operate on the tonsils or septum.

專門研究睡眠的耳鼻喉科醫生可能會對扁桃體或鼻中隔進行手術。

They also use hypoglossal nerve stimulators that cause the patient to protrude their tongue

他們還使用舌下神經刺激器，使病人的舌頭突出來。

while breathing to prevent snoring or breathing issues.

在呼吸時，以防止打鼾或呼吸問題。

Pediatrics is a 1 year fellowship for the ENTs that love kids.

兒科是為喜歡孩子的耳鼻喉科醫生提供的為期1年的獎學金。

You'll be dealing with lots of tonsillectomies, adenoidectomies, tubes in ears, mastoidectomies,

你將面對大量的扁桃體切除術、腺樣體切除術、耳內插管、乳突切除術。

and congenital abnormalities.

和先天性畸形。

For example, some babies are born without ears or their jaws may be underdeveloped,

例如，有些嬰兒出生時沒有耳朵，或者他們的下巴可能發育不全。

and these require surgical intervention.

而這些都需要手術干預。

There's a lot to love about ENT.

耳鼻喉科醫院有很多值得喜愛的地方。

The lifestyle is great, and you can make good money with a good work/life balance such that

生活方式很好，你可以賺到很好的錢，工作/生活平衡，這樣

it's family friendly.

它是家庭友好的。

Compared to some other surgical subspecialties, there can be more clinic time, and you can

與其他一些外科亞專業相比，可以有更多的門診時間，而且你可以

split your time 50/50 between each.

將你的時間抽成50/50。

Clinical days will have regular 9 to 5 hours, and OR days can either be half days or full

臨床日將有正常的9至5小時，手術日可以是半天或全天。

12 hour days if you're dealing with more complicated cases.

如果你處理的是比較複雜的案件，每天要工作12小時。

In terms of compensation, it's up there with other surgical subspecialties, right under

在報酬方面，它與其他外科亞專業一樣，都是低於其他專業的。

orthopedic surgery or plastic surgery, averaging $455,000 per year.

矯形外科或整形外科，平均每年455,000美元。

In terms of your patient population, you'll be dealing with a wide range of ages, from

就你的病人群體而言，你將面對廣泛的年齡範圍，從

newborns to those at the end of their life, and it's quite rewarding to provide massive

從新生兒到生命末期的人，為他們提供大規模的醫療服務是相當有意義的。

quality of life improvements to all your patients.

為你的所有病人提供生活品質的改善。

Helping a deaf person hear is tremendously satisfying.

幫助聾啞人聽到聲音是非常令人滿意的。

There's also a good amount of variation in the surgery.

手術中也有很好的差異性。

Even as a general ENT surgeon, you can have a wide breadth from the E's, N's, and T's.

即使作為一名普通的耳鼻喉科醫生，你也可以從E、N、T三個方面有一個廣泛的範圍。

And if you want the adrenaline rush, there's acuity to get that fix.

如果你想獲得腎上腺素的刺激，可以通過敏銳度來解決這個問題。

And if you want to go the private practice option and have a cash-based practice, facial

如果你想選擇私人診所，有一個以現金為基礎的實踐，面部

plastics provides that route.

塑膠提供了這一途徑。

While ENT is great, it's not for everyone.

雖然耳鼻喉科醫院很好，但它並不適合每個人。

Compared to some other specialties, the anatomy is relatively limited – not only are you

與其他一些專業相比，解剖學是相對有限的--你不僅是

limited to one region of the body, but that region is also incredibly complex and even

雖說只限於身體的一個區域，但這個區域也是無比複雜的，甚至是

as a resident, you may find it difficult to understand and navigate.

作為一個居民，你可能會發現它難以理解和瀏覽。

Plus, getting access to various structures is also often tricky, as one structure is

另外，要進入各種結構也往往很棘手，因為一個結構是

often hidden behind multiple other delicate structures.

往往隱藏在多個其他精緻的結構後面。

There's also often many noises, fluids, and nastiness in the various crevices and compartments

在各種縫隙和隔間中也經常有許多噪音、液體和討厭的東西。

of the head and neck.

頭部和頸部的。

If you don't have a strong stomach and are easily grossed out, steer clear.

如果你沒有強壯的胃，而且很容易被噁心到，請避開。

Depending on the type of ENT you subspecialize in, you may also find yourself in the operating

根據你所擅長的耳鼻喉科類型，你也可能發現自己在手術中

room for the whole day.

整整一天的房間。

Complex reconstructions dealing with free flaps, such as in cancer resections and reconstructions,

處理遊離皮瓣的複雜重建，如癌症切除術和重建術。

can take 12 or even 14 hours.

可能需要12或甚至14個小時。

And while helping patients can be rewarding, it can also be incredibly frustrating when

雖然幫助病人可以得到回報，但也可能是令人難以置信的沮喪，因為

dealing with a non-adherent patient.

處理不依從的病人。

You'll find yourself feeling helpless as you watch their head or neck cancer grow.

當你看著他們的頭部或頸部癌症增長時，你會發現自己感到無助。

How can you decide if ENT is the right fit for you?

你如何決定耳鼻喉科是否適合你？

If you are detail oriented, don't mind working on just one region of the body, and aren't

如果你注重細節，不介意只在身體的一個區域工作，並且不

put off by complex anatomy or strange sounds and smells, ENT might be a good fit.

如果你對複雜的解剖結構或奇怪的聲音和氣味感到厭煩，耳鼻喉科可能是一個很好的選擇。

You should also enjoy the balance between both clinic and surgery.