Ears, nose and throat: Why together?

What is Otolaryngology, or even more complex, what is Otorhinolaryngology? It is the medical discipline covering the ears (oto-), the nose (rhino-) and the throat (laryngo-). Of course, one could also include the sinuses (sino-), the mouth (oro-) and another part of the throat (pharyngo-). On occasion, the discipline may extend into the respiratory tract (broncho-) and the digestive tract (esophago-). So why do we cover all these areas together in one specialty? It’s because they are all connected, and they all interact with one another.

In the ENT world, we have a saying, “One airway, one disease.” What’s the difference between sinusitis and bronchitis? Location, location, location! Generally, the same bacteria cause infection in both places, and the same antibiotics can treat both infections.

What’s the difference between allergies and asthma? Not as much as you think! Most of the time, asthma is just allergies in the lungs. Why do tonsil infections and ear infections frequently occur together? Inflammation in the throat blocks the Eustachian tube, which in turn leads to inflammation in the middle ear.

As you can easily see, there is an interconnection among all areas of the ear, nose and throat. It starts with the nose and the mouth, as these are the areas where foreign invaders enter the upper airway. These invaders may include allergens, such as pollens, molds, dust and dander. They cause swelling in the nose and sinuses. This leads to mucus, which drains down the back of the throat, causing subsequent swelling in the pharynx and larynx. Other invaders include viruses and bacteria.

Eventually, inflammation can lead to infection, as bacteria proliferate due to the swelling and obstruction. Sinus infections, ear infections, tonsil and adenoid infections, bronchitis and pneumonia all have the same origin. Allergies and viruses lead to a local compromise of the immune system. Bacteria take advantage of the occupied immune system and cause infection, in the same way looters take advantage of occupied law enforcement in a natural disaster and steal from stores.

A comprehensive ear, nose and throat examination will include all of these areas. Don’t be surprised if you see your physician for ear pain and he examines your nose and throat with a scope. He is looking for potential problems in the nose and throat which may be causing your ear pain. Don’t be surprised if your child is getting ear tubes and he also needs his adenoids removed and allergy testing performed. The adenoids are blocking the Eustachian tube and causing nasal congestion. Removing the adenoids makes a second set of ear tubes far less likely. The allergies are what caused the adenoids to be enlarged in the first place. The allergies are also what further blocks the Eustachian tube. Treating the allergies also makes a second set of ear tubes far less likely.

It shouldn’t be a shock to learn that removing infected tonsils also improves asthma. Breathing cleaner air causes less airway disease. It shouldn’t be a shock to learn that treating allergies and sinusitis improves bronchitis and cough. Stopping post-nasal drip leads to less irritation in the throat and lungs. Keeping the nasal airway open leads to healthier breathing, less snoring, fewer headaches and better exercise tolerance.

The ears, the nose and the throat live and breathe together, so we treat them together.