You Get Into This Business For The Ear And The Nose, But The Throat Grows On You

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You Get Into This Business For The Ear And The Nose, But The Throat Grows On You

I’m often asked by acquaintances and patients about how I decided on my medical specialty, and, as much as I’m reluctant to admit it now with all the perspective I’ve gained after more than 20 years in the field, I can tell you that it certainly wasn’t because I loved every aspect of this line of work—not even close. As anyone in my profession will admit, you get into this business for two reasons and two reasons only: the ear and the nose.

The throat? Well, that’s a different story altogether. But here’s the thing: Over time, bit by bit, the throat really grows on you.

Back in med school, I couldn’t have been less interested in the throat—it just seemed like this big, boring tube. Let’s face it, after you get past the epiglottis and the tonsils, it’s nothing but esophagus until you hit the stomach. Naturally, my attitude was, “Who cares?” At the time, it was all about that perfect amalgam of bones and cartilage that make up the nose and the incredibly intricate inner and outer structures of the ear. When it came to the ho-hum throat, I made it a point to plow through those tedious textbook chapters as fast as possible so I could get back to noses and ears.

The throat may not be as flashy as its more notable counterparts, but over time, it wins you over with its subtle beauty and humble, workmanlike mechanics. In fact, I find myself more intrigued and beguiled by the throat each day.

In fact, while suffering through yet another seemingly endless throat-based lecture, I recall asking the instructor why we were spending so much time on painfully dull chronic pharyngitis when the amazing worlds of nasal polyps and external otitis of the ear awaited us. When he cryptically answered, “Ask me that same question 10 years from now,” and winked before continuing on with the class, I just brushed it off. And why wouldn’t I? I was a cocky kid fresh out of my family practice rotation who thought he had it all figured out.

But how right that instructor was! The throat may not be as flashy as its more notable counterparts, but over time, it wins you over with its subtle beauty and humble, workmanlike mechanics. In fact, I find myself more intrigued and beguiled by the throat each day.

It’s hard to say exactly when I started to turn a corner on the throat. I can tell you that I still feel the same excitement today when I’m prepping for a flexible fiberoptic nasolaryngoscopy as I did my very first time over two decades ago. And I’m not ashamed to admit that when I’m doing an ear exam, I’ll often pause between the left and the right, turn off my otoscope for a second, and thank my lucky stars that I’m able to make a living doing this.

But the throat—the throat really snuck up on me. Maybe 12 or 13 years ago, I began to notice instances when I stopped mindlessly going through the motions while assessing a run-of-the-mill thyroglossal abnormality, and instead found myself truly enjoying flagging it for removal and biopsy. Other moments, I would catch myself lingering a little too long on a vestibular fold here, an elegant hyoid bone there. And over the past few years, I can’t count the number of times I’ve caught myself staring rapt past the palatoglossal arch and into that dark, empty cavity, admiring the upper esophageal sphincter, the glint of the light on the stratified squamous epithelium, reveling in an entire world that I had for so many years looked right past.

So, I’ll say it, even though there was a time I never in a million years thought I would: I love the throat. In fact, I’d say it’s almost as good as the sinuses. And when I look at my calendar now and there isn’t at least a streptococcal infection or two sprinkled in throughout the day, I genuinely get a little disappointed.

Of course, let’s not go totally overboard here. No matter how many cases of candidiasis, papillomatosis, or laryngopharyngeal reflux I get to see, they’ll never top the glitzier diseases of the ear, or even the nose for that matter. I’m sorry, but as much as I’ve come to revere the anatomical structure, no throat, no matter how unique the malady affecting it, could ever live up to the overwhelming adrenaline rush of an ear with endolymphatic hydrops or a nose with a septal hematoma.

Maybe it’s not really productive to think about it in those terms, though; it’s like comparing apples and oranges, right? Because as much of a visceral thrill as you get from the ear and nose, the acquired taste that is the throat can fulfill you on an entirely different level. I guess you get out of the throat what you put into it.

But isn’t that true of most of the best things in life?