The leader of the voice care team is ordinarily a physician (otolaryngologist). Otolaryngologists are physicians (surgeons) who specialize in problems of the ears, nose, and throat (ENT). Laryngologists are otolaryngologists who specialize in care of disorders of the larynx (particularly voice problems) and, in some cases, related problems such as swallowing. To practice laryngology, one must first complete training as an otolaryngologist. To become an otolaryngologist, a person completes college, 4 years of medical school, and 5 or more years of residency in otolaryngology head and neck surgery. In the year following completion of residency, the physician takes a national, standardized board examination given in 2 parts (written and oral) to become a “board certified” otolaryngologist. Certification by the American Board of Otolaryngology, or the equivalent organization in other countries or for osteopathic otolaryngologists, is an important indicator of mastery of basic knowledge in otolaryngology and is considered a basic, minimum qualification. The only exception is “board eligibility” in the case of a physician who has finished residency but has not yet successfully passed the board examinations. Board certification is not granted until a physician has had about 1 year of clinical experience following residency and demonstrated competency on the oral and written board examinations.

Most otolaryngologists’ clinical practices include many or all components of the specialty, such as otology (disorders of the ear and related structures), laryngology (disorders of the voice and upper airway structures such as the throat and trachea), head and neck cancer, head and neck neoplasms (masses including benign or malignant lesions), facial plastic and reconstructive surgery, allergy and immunology, bronchoesophagology (lower airway and swallowing disorders), rhinology (nose, sinus, taste, and smell disorders), and pediatric otolaryngology (ear, nose, and throat disorders of children). Most otolaryngologists and laryngologists care for patients of all ages from early childhood through advanced years. Some otolaryngologists subspecialize, caring for disorders in just one or two areas of otolaryngology. This subspecialization can either be a keen interest in a specific area while still providing a broad range of ear, nose, and throat care, or the focused practice of only one or two of the subcomponents of otolaryngology. Laryngology is one such subspecialty.

Most of the senior physicians specializing in laryngology today did not receive laryngology fellowship training. That is always the case as a new field develops. Modern laryngology evolved out of an interest in caring for professional voice users, especially singers. The first comprehensive article guiding otolaryngologists on care of professional singers was published in 19811; the first major modern American otolaryngology textbook with a chapter on care of the professional voice was published in 19862; and the first comprehensive book on care of the professional voice was published in 1991.3 So, most of the senior laryngologists practicing at the turn of the 21st century were involved in the evolution of the field before fellowships were developed. Most fellowship training programs started in the 1990s, although a few informal fellowship programs existed in the 1980s and earlier. It is reasonable to expect most voice specialists who finished residency training in the 1990s or later to have completed a fellowship in laryngology. There are approximately 2 dozen laryngology fellowship-training positions in the United States, and they are highly competitive. At present, completion of a fellowship is a reasonably good indicator of superior knowledge and clinical training in laryngology. Most laryngology fellowships include training in the diagnosis and treatment of voice disorders in adults and children, neurolaryngology (neurological problems that affect the voice and larynx), swallowing disorders, airway reconstruction, and laryngeal cancer. The training includes both medical diagnosis and treatment, and sophisticated laryngeal surgery. Typically, laryngologists care for both routine and complex problems that affect the voice. Such problems include voice dysfunction associated with something as simple as a common cold, especially when it affects the voice of a professional singer or actor. However, laryngologists also are called on to diagnose and treat structural lesions such as nodules or polyps, prolonged infections of the vocal folds, cancer, traumatic injury from fracture or internal trauma (intubation injuries from anesthesia, vocal fold injuries from previous surgery), neurological disorders, and other voice problems. The laryngologist is responsible for establishing a medical diagnosis and implementing or coordinating treatment for the patient. The laryngologist may prescribe medication, inject botulinum toxin, perform delicate microsurgery on the vocal folds, or operate through the neck on the laryngeal skeleton. He or she is also usually responsible for initiating evaluation by other members of the voice team and for generating referrals to other specialists as needed.

Laryngologists may practice in university medical centers or private offices, and in major cities in the United States, they are usually affiliated with a voice team including at least a speech-language pathologist, a singing voice specialist, and sometimes an acting-voice specialist. Laryngologists also should have, or have access to, a clinical voice laboratory with equipment to analyze the voice objectively and a stroboscope to visualize the vocal folds in slow motion. They also should be familiar with physicians in other specialties who have an understanding of and interest in arts-medicine. Even for patients with a voice disorder who are not singers and actors, such knowledge and sensitivity are important. Just as nonathletes benefit from the orthopedic expertise of a sports-medicine specialist, voice patients receive more expert care from physicians trained to treat singers, the “Olympic” athletes of the voice world.

Currently, there is no official additional certification for those who have completed a laryngology fellowship. However, there are organizations (medical societies) with which many of the leading laryngologists are affiliated. Essentially all laryngologists in the United States are fellows of the American Academy of Otolaryngology-Head and Neck Surgery (http://www.entnet.org), and laryngologists in other countries are members of their nations’ analogous organizations. A few are also members of the American Laryngological Association (ALA), the most senior otolaryngology society in the United States (http://www.alahns.org). The ALA also accepts “associate members” from other countries. Some laryngologists belong to the American Bronchoesophagological Association (http://www.abea.net), and the Voice Foundation (http://www.voicefoundation.org). The Voice Foundation was founded in 1969 and is the oldest organization dedicated to voice education and research. It provides seed grants for research, sponsors an annual symposium on care of the professional voice that started in 1972, and fosters voice education through conferences, educational videotapes, books, and publications such as the Journal of Voice and the Voice Foundation Newsletter. In recent years, several countries have developed organizations similar to the Voice Foundation, such as the British, Canadian, and Australian Voice Foundations. Laryngologists in such countries are usually members of their national organization, and many are also members of the Voice Foundation (Philadelphia, Pennsylvania). Although membership in these organizations is not a guarantee of excellence in practice, it suggests interest and knowledge in laryngology, particularly voice disorders.