Shining a light on ENT in the Balkans, Metin Önerci explains the population and challenges in this part of the world.
There is no universal agreement on what constitutes the Balkans. However, the following countries are usually included: Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Kosovo, Moldova, Montenegro, North Macedonia, Romania, Serbia, Slovenia, Turkey and Ukraine.
The Balkan Society of Otorhinolaryngology, Head and Neck Surgery (ORL-HNS) was established in 1930 in Bucharest, Romania, and its first congress took place in Sofia, Bulgaria, in September 1931. The president of the congress and of the society was Prof Stoyan Belinov. There were two further meetings before the outbreak of World War II. After a long gap, new bylaws prepared by Prof Dr Metin Önerci were introduced at the 7th National Bulgarian Congress of Otorhinolaryngology in October 2001 in Plovdiv. At this meeting in Bulgaria, Prof Todor Karchev became the first president after the second world war. Further congresses have been held every two years since 2004. Venues have included Sunny Beach in Bulgaria and Edirne in Türkiye. Twelve Balkan ORL-HNS congresses have been held up to now. The 13th meeting was held in İstanbul in June 2024 under the presidency of Prof Dr Metin Önerci together with the Central and West Asian ORL Association.
ALBANIA
Population: 2.8 million
Number of ENT doctors: 140
President of ENT society: Jetmira Fejza Bulaj
Email: jetmirafejza@gmail.com
www.orlalbania.org
BOSNIA HERZOGOVINA
Population: estimation of around 3 million
Number of ENT doctors: 80
President of ENT society: Melika Arnautovic
Email: melikaarnautovic@yahoo.com
www.orl.ba/orl
BULGARIA
Population: 6.878 million
Number of ENT doctors: 611
President of ENT society: Karen Dzhambazov
Email: dzhambazov@gmail.com
Society email: otorhinolaryngology@abv.bg
http://orl.bg/?page_id=1045&lang=en
CROATIA
Population: 4 million
Number of ENT doctors: 260 active specialists and
78 residents, i.e. one specialist per 15,300 population. The oldest ENT department in Croatia was founded in 1894 in the Sisters of Charity Hospital, Zagreb.
President of ENT society: Tomislav Baudoin
Email: tomislav.baudoin@gmail.com
www.hdorl.hr
GREECE
Population: 10.3 million
Number of ENT doctors: 1000. This is the highest ratio of ENT specialists to inhabitants (one per 10,000) in the Balkans.
Universal Neonatal Hearing Loss Screening programmes and centres work with the appropriate associated cochlear implant centres. Following the advancement of otorhinolaryngology, the specialty is highly sought after by residents, especially among female colleagues. This increase in demand has inevitably led to prolonged waiting lists, which has driven a significant percentage of candidates to seek international training programmess in other countries.
President of ENT society: Pavlos B Maragkoudakis
Email: pmarag@hotmail.com
https://hellasorl.gr
KOSOVO
Population: 1.59 million
Number of ENT doctors: 82 active specialists and 34 residents
President of the ENT society: Qazim Hysenaj
Email: qazim.hysenaj@uni-pr.edu
The challenges have been clear since Kosovo came out with damaged infrastructure. After joining the Balkan ENT Association, Kosovo managed to join IFOS as well.
MOLDOVA
Population: 2.6 million
Number of ENT doctors: 160 active ENT specialists
(one specialist per 15.625 inhabitants) and 25 residents
President of ENT society: Ion Ababii
Email: mihail.maniuc@usmf.md
The oldest ENT department in Moldova was founded in 1945 in the Institute of Medicine in Chisinau. There is one university department now and five clinical departments in the cities of Moldova.
MONTENEGRO
Population: 600,000
In Montenegro, there were a total of 49 ENT surgeons
(one per 12,245 inhabintants), and among them, four audiologists, one facial plastic surgeon, and one speech therapist who served about 620 individuals in 2023.
President of ENT Society: Elvir Zvrko
Email: elvir@zvrko.me
www.orlcg.me
NORTH MACEDONIA
Population: 2 million
Number of ENT doctors: 200
President of ENT society: Nikola Nikolovski
Email: drnikolanikolovski@yahoo.com
Society email: orlasocijacija@yahoo.com
Every four years, a Macedonian ENT Congress is organised with international participation. The last was the 12th Balkan Congress of Otorhinolaryngology – Head and Neck Surgery and 1st Joint Meeting of American Academy of Otorhinolaryngology, organised in June 2022 in Ohrid, North Macedonia.
ROMANIA
Population: 19 million
Number of ENT doctors: 1200
President of ENT society: Serban Bertesteanu
Email: vifor2001@yahoo.com
http://sorlccf.ro/en/21-societatea-de-orl-si-ccf
SERBIA
Population: 6.647 million
Number of ENT doctors: 400 specialists and 70 residents
President of ENT society: Jovica Milovanović
Email: jmtmilov@gmail.com
The Serbian Otorhinolaryngology Society continues with the promotion of knowledge and skills by organising numerous national symposia and courses with internationally recognised lecturers. Their main challenges remain the education of young ENT doctors and the acquisition of modern medical equipment which will provide them with better diagnostics and treatment of patients.
SLOVENIA
Population: 2.1
Number of ENT doctors: 90
President of ENT society: Bostjan Lanisnik
Email: bostjan.lanisnik@ukc-mb.si
Society email: info@szd.si
www.szd.si/en
TÜRKIYE
Population: 85 million
Number of ENT doctors: 3500 (four per 100,000 inhabitants).
Turkish ENT surgeons are well trained and have good skills, but the large number of patients limits diagnostic and treatment services. The high number of residents exceeds the capacity of education and impairs the quality of ENT education. One of the most important issues facing ENT professionals are rules which restrict the practice of profession, as well as the violence against doctors.
President of ENT society: Bülent Topuz
Email: btopuz@pau.edu.tr
Society email: kbb@kbb.org.tr
www.kbb.org.tr
UKRAINE
Population: 36 million
Number of ENT doctors: 3200
President of ENT Society: Dmytro Zabolotny
Email: 90kizim@gmail.com
Society email: amtc@kndio.kiev.ua
https://ents.com.ua
The main goal of the ENT society, founded in 1935, is to satisfy and protect the legitimate social, economic, creative, age-related and other common interests of its members and to promote the professional and scientific activities of otorhinolaryngological specialists.
Issues facing Balkan ENT societies
- Uneven distribution of ENT specialists: Most ENT doctors are concentrated in larger cities, leading to shortages in other areas.
- Discrepancy between private and public health services: There is a significant disparity between private and public healthcare, with over 70% of doctors practising in the private sector.
- Shortage of oncological centres: Given the high smoking rates in Balkan countries, there is a need for increased awareness of head and neck cancer, as well as more fully equipped cancer centres that offer the full range of multidisciplinary treatment options for patients across the region.
- Excessive number of residents: The high number of residents exceeds the educational capacity, negatively impacting the quality of ENT training.
- Rules which restrict the practice of profession, such as restrictions on professional titles: There is often overlap between different specialties treating the same condition, and this can cause legal difficulties, particularly if there is no formal recognition of the surgeon’s specialist training in that area. For example, head & neck conditions and maxillofacial fractures are often treated by ENT surgeons, but other specialists are ‘authorised’ to treat these conditions.
- Increasing violence against doctors: Violence against doctors is becoming increasingly common, and existing laws are not strong enough to act as a deterrent. Lawmakers need to introduce stricter legislation to protect healthcare professionals. The violence can be both physical and psychological, with patients often harassing doctors through constant complaints. Interestingly, the aggression usually comes from second-degree relatives rather than immediate family members, as these relatives may express their concern for the patient by targeting doctors, sometimes disregarding the actual care being provided. In some tragic cases, such assaults have been fatal, and physicians in various countries have lost their lives due to attacks from patients or their families. Unfortunately, doctors lack adequate protection against such threats.
- Oncological pathology concerns: Oncological diseases, largely driven by smoking and alcohol consumption, present a significant challenge. However, fewer doctors are choosing to specialise in tumour pathology, primarily due to the high levels of stress and burnout associated with the field.
- Shortage of ENT specialists: The insufficient number of ENT specialists poses a significant problem in staffing emergency hospitals for ENT-related duties.
- Unequal access to modern equipment: State healthcare facilities do not have equal access to modern otolaryngology equipment, creating disparities in care.
