Specialty Series: ENT Surgery



My name is Joe Manjaly. I’m a Consultant Otologist, Auditory Implant & ENT Surgeon, specialising in ear and hearing problems for adults and children. I’m based at the Royal National ENT Hospital in Central London, part of University College Hospitals NHS Trust.

My own career journey started at Bristol University. After graduating I did my foundation years in Bristol and moved to Wessex deanery for Core surgical training. National selection resulted in a higher ENT training position in London. After completing this I undertook an advanced fellowship in otology and cochlear implant surgery at Cambridge University Hospitals. I’m the editor of two trainee textbooks ‘ENT OSCEs’ and ‘Advanced ENT Training’. Outside medicine I’m a husband & dad, a keen Aston Villa supporter and also play in a function band at weddings and conferences around the UK.

I was always aware of ENT as a potential career option, but it was not a subject that was covered very much at medical school. Furthermore I was repeatedly warned that it was very competitive. However you soon realise that what sets you apart at medical school is different to what sets you apart as a surgical trainee. Working hard, going the extra mile, being a team player and accepting advice are key ingredients to succeeding. After an elective in ENT and a taster week during F1 I decided to just go for it and set about ticking all the boxes for selection, which are nowadays published online.

What do ENT surgeons do?

There are a number of subspecialties within ENT:

  • Head & Neck Cancer surgery
  • Benign Head & Neck & Endocrine surgery
  • Paediatric ENT
  • Otology
  • Neurotology
  • Skull base surgery
  • Rhinology
  • Facial Plastics
  • Laryngology & Voice
  • Sleep surgery

Many of these domains deal with the vital senses, and as such ENT surgeons have the ability to have a huge impact on people’s quality of life, whether it’s restoring hearing, voice or smell. It’s a significant balance of medicine and surgery, with many problems being solved with clinic procedures and only 15% of patients seen in clinic needing surgery. The surgery itself is very varied, ranging from major neck resections to microscopic middle ear surgery to endoscopic sinus surgery and much more.

The typical week of an ENT surgeon includes clinics, operating sessions and MDT meetings. You will also be on-call out of hours from home by registrar level and beyond, often covering multiple sites.

The Training Pathway

After Foundation years, there are currently 8 years of specialty training in ENT (ST1-8). In recent years this has meant applying for a 2-year core surgical training programme during or after F2. This would then be followed by national selection for registrar training where you would compete for a ‘national training number’ to take you from ST3 through to ST8. There are typically between 30-50 posts in the country each year at this stage and you need to have passed the MRCS (ENT) exam by the time of interview. There is currently a ‘run-through’ ST1-8 system being piloted which may or may not be adopted fully in the coming. years. You tend to focus on a sub-specialist area during the last 18-24 months of training. You also need to pass the FRCS (ORL-HNS) exam before being awarded a completion of training certificates. Some trainees choose to undertake advanced fellowships after ST8 if for instance there is a prospect of undertaking specialist work in a bigger unit as a consultant.

Here are my 7 top reasons for choosing ENT

  1. Patients New-borns to centenarians – we operate on more children than any other specialty, from very new-born babies to toddlers and teenagers. Working with children keeps you young and I think this has an influence on the characters that tend to go into ENT. Yet one day I can be looking after a child and their parents, the next I can be looking after someone at the other end of the spectrum – we can restore hearing with a cochlear implant to someone in their 100s who has lost their hearing and struggling with isolation.
  2. Wide variety of cases – ear, nose & throat. That means every day is different during your training.
  3. It’s a surgical specialty but you can make people better even without surgery! – at SHO level you can fix problems using practical clinic-based skills and procedures you’ve learnt, and discharge happy sorted patients often the same day.
  4. Emotive work – restoring people’s senses can have a hugely emotional impact on their life – whether its restoring voice, sense of smell or in my case helping people who have been deaf to hear again, it’s hugely rewarding work.
  5. Gadgets – scopes, microscopes, practical skills! ENT is hands-on right from the start meaning you’re making a practical difference and able to offer highly valued skills that aren’t easily available everywhere.
  6. Cool Surgery – cochlear implant surgery, robotic throat surgery, image-guided sinus surgery – it’s varied and cutting edge.
  7. The people – ENT surgeons have a reputation for being happy & personable. This is undoubtedly due to a somewhat healthier work-life balance when compared to some other specialties. Amongst surgical specialties it probably has the most balanced mix of men and women in the specialty. The emergency work can be dramatic and heroic when you’re called, but also less frequent than other surgical specialties which means more regular time for a home life from registrar level onwards.

Downsides to ENT (There are very few and I had to think hard to list any)

  • – Many trainees love the medical side of ENT but don’t want to be surgeons. ENT is a surgical specialty however, especially at a senior level. There are allied specialties such as audiovestibular medicine, allergy and endocrinology for those who don’t want to pursue a surgical career.
  • – ENT has always been competitive and that means making financial and life sacrifices in the early years to build an application that will see you through the bottlenecks.
  • – Because ENT is a smaller specialty, it may not come with the kudos and acclaim around the hospital that other specialties might bring.

Resources I would Recommend for Learning ENT





Oxford Handbook of ENT

ENT OSCEs – A Guide to Passing

Advanced ENT Training

Further Advice

If you’re interested in ENT and want to start preparing, I’ve written more tips and advice on my Instagram page @earsurgeonjoe. You’ll also find lots of helpful advice on the SFOENTUK website – https://sfo.entuk.org

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