Portuguese Version

Year:  2003  Vol. 69   Ed. 2 - (1º)

Editorial

Pages: 146 to 147

PDF PT  

Behind the mountain

Author(s): Henrique Olival Costa

Keywords: -

In Brazil, the area of ENT is celebrating its 100 years of existence. We can see how our specialty has changed its practices since its first years. Initially operating together with Ophthalmology and Urology, its main focus was infectious-inflammatory diseases, and in the surgical arena, tonsillectomy was the main course if not the everyday dish for most.

However, based on a growing demand for professionals that could confidently act with neck and facial affections that were common in the daily practice of general practitioners, the specialty grew and started to encompass more comprehensive clinical and surgical practices. Otology grew with the advent of microscope and the same happened with Rhinology, supported by endoscopy and computed tomography, and laryngology, thanks to the help of nasofiberscope and telescope. Skull base surgery strengthened after an hesitating beginning, starting from resections of cerebello-pontine angle neuromas to reach the anterior and middle fossa effortlessly. Cosmetics has also become part of the routine of our specialists, following a strong program of facial cosmetic surgery training performed in all regions of Brazil. Similarly to surgical modalities, clinical practices have gained the spot in the specialty: immunology and infectology of the head and neck and face, with high prevalence of infectious disorders and inflammatory affections, started to be focused by ENT researchers, projecting the specialty towards the top of the world. Neurological disorders and dysfunctions are equally known and addressed by ENT physicians who are responsible for treating affections of all cranial nerves, requiring knowledge about the operating basis of functions such as hearing, balance, speech, swallowing, olfaction, mastication, taste and breathing. In Stomathology, the advances were felt in the accumulation of information about nosological infections and in our capacity to act in the diagnosis and treatment of diseases that used to be dealt by non-medical professionals. It comes to our mind dermatological, odontological and sleep disorders, which also have a major role in modern clinical practice. Facial traumatology has equally developed and the training centers are currently working hard to have a greater number of specialists ready to work with this emergency activities. There is still one last area that is essential for our professionals, which is oncology. How are we performing in this area? How will the future be?

In the other areas, we can perceive that the habilitation processes stem from the guiding principle that the head, neck and face segments could be recognized as a complete cohesive whole, and that the knowledge built or acquired for the area would serve as the basis for the development of new information about the discipline and that anatomy, physiology and semiology and therapeutic approaches would interconnect the specialized ENT services.

Within such context, areas such as ENT Immunology and Infectology, Stomathology, Facial Cosmetic Surgery, Facial Trauma, Neuro-otorhinolaryngology and Skull Base Surgery were created.

As a key part of such evolution, lies the scientific production of our peers in the various clinical settings aligned with ENT. There were plenty of scientific papers, courses and theses presented in the 100 years of the specialty that supported its safe expansion.

In order to know where we are heading to, we can analyze what has happened in the past years.
In 1998, 1999 and 2000, according to CAPES, there were 7,500 Master and Doctorate dissertation theses produced in Brazil. Among them, 450 were focused on ENT, meeting the issues that have been addressed by the textbooks of the specialty. That is, 6% of everything that has been written at graduate level in the health sciences in Brazil was related to ENT.

In order to know how the scientific production in the area of head, neck and facial oncology has developed, we can observe that out of this total, 15% were related to face and neck tumors. Most of the studies addressed diagnosis, prognosis and rehabilitation. Therapy is somewhat left aside, with the predominance of clinical trials. It may be explained by the relative immutability of the statistics of 5-year disease free survival, reached by surgical techniques. Ten years ago, we could not find promising news about surgical treatment for head and facial tumors. It seems that we have reached a therapeutic plateau and it has encouraged further studies in potential areas that interfere in prognosis: early diagnosis and clinical oncology.

Taking such information into account, we can define the future perspective of ENT in head, neck and facial oncology, since the guiding principle is related to our work, because at least the anatomy, physiology and semiology are closely related to us.

Accurate diagnosis, based on molecular biology and knowledge of natural progression of the disease, semiology supported by sophisticated devices and objective intervention such as nasofibroscopy, and the investigation of sentinel lymph node and rehabilitation of damage and harmful consequences in quality of life are, undoubtedly, the master lines of ENT activities in Oncology.

To that end, we have to be prepared and practice our professional future based on simple oncology concepts, its diagnostic apparatus and rehabilitation needs and techniques of what has been done and shall imply more and more "organ sparing" therapies and functions. In fact, our focus for many years now.

Let us start working now! There is so much to be done, but if we imitate the determination of our masters in the past, in no time Otorhinolaryngology shall take its place of right in one more area of activities.

Henrique Olival Costa

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