From Part-Time to Full-Time: The Rise of Otolaryngology in 20th-Century American Medicine

Despite early success, by 1950, “conventional wisdom said that otolaryngology was a dying specialty” (Otolaryngol Clin North Am. doi: 10.1016/j.otc.2007.07.001). In 1951, one in three otolaryngology residency positions remained unfilled (Laryngoscope. doi: 10.1097/00005537- 199610000-00001). Antibiotics could now cure infections such as tonsillitis and sinusitis that previously had been the focus of many otolaryngology departments.

While specialization in U.S. medicine initially created interdependence among physicians, boundaries between the different specialties often included a gray area where patient assignment remained unclear. This gray area ultimately created competition between specialties, including general surgery and otolaryngology, which both wanted inclusion of head and neck cancer in their respective specialties. According to Calhoun, Davis, and Templer, “[In 1950,] head and neck cancer and thyroid surgery were commonly the purview of general surgeons, and cosmetic surgery was generally performed by plastic surgeons.” This control over head and neck cancer became even more important as federal research funding played an increasingly important role in academic medical centers in the post-World War II era. While much otolaryngology funding comes from the National Institute on Deafness and Other Communication Disorders today, this institute was not founded until 1988. The National Cancer Institute, though, was established in 1937 and funded head and neck cancer research from its early years.

Competition between general surgeons and otolaryngologists over the field of head and neck surgery increased during the 1950s. In 1954, the Society of Head and Neck Surgeons (SHNS) was founded and consisted primarily of general surgeons, and several years later, in 1958, a group comprised mostly of otolaryngologists formed a “parallel society,” the American Society for Head and Neck Surgery (ASHNS) (American Head & Neck Society. http://www.ahns.info/history-ahns).

Ultimately, over the next four decades, otolaryngology gained dominance over the head and neck subspecialty, and in 1998, the SHNS and ASHNS merged to form the American Head & Neck Society. Elliot Strong, a renowned head and neck surgeon with general surgery training, later wrote, “When I first started, of course, the controversy between the disciplines of surgery and otolaryngology was on the minds of most people …. As time has gone on, the demands for specialty and sub-specialty surgical training have increased, and I think in all honesty have tended to favor the otolaryngologist and his training as opposed to that of general surgery. The opportunities for a general surgeon in otolaryngology and head and neck surgery have diminished, and probably rightfully so.” (American Head & Neck Society. http://www.headandneckcancer.org/history/strong/).