What Does A Typical Appointment With An ENT Specialist involve?

A visit to an ENT specialist or otolaryngologist is different from an average visit to your GP, as the specialist may use instrumentation to allow better visualization of difficult areas.

Outlined below is what to expect from a general ENT visit, however, the consultation and procedures performed will vary dependent on the symptoms and potential problems requiring investigation.

Typically, questions are asked about complaints, relevant past medical history and medication (always bring a current list with you). This is followed by a thorough examination to identify the problem and decide on further management.

Ears

The ears are examined by using an instrument called an otoscope, this allows for the identification of normal landmarks and abnormalities. This instrument is made with an illuminating handheld light source with a small amount of magnification attached to it.

Occasionally, the eardrum and canal need to be viewed under magnification and a microscope can be used to provide this. The microscope allows for a more precise view of the ear structures and the use of suction if necessary, to remove wax or debris from an ear canal.

Nose

To look at the front of the nose, a simple tool called a nasal speculum together with illumination from a headlight is used to visualize the anatomy and possible abnormalities. In many cases, a flexible instrument called a fiberoptic scope might be used to inspect the nose and throat more thoroughly.

Throat

An external examination of the neck is not uncommon to feel for any glands or pathology. This is undertaken manually feeling the different areas of the neck in a methodical fashion. The oral cavity is thoroughly examined often with a tongue depressor and good illumination to visualize the tongue and tonsillar area. It is not uncommon to visualize the back of the nose, pharynx, larynx (voice box) and the vocal cords with a flexible naso-laryngoscope.

Why Do I Need A Hearing Test?

A hearing test, or audiogram, is an important part of your visit. A hearing test helps answer three important questions:

1. Do you have hearing loss?
2. What is causing your hearing loss?
3. What is the best way to improve your hearing?

Along with the physical examination of your ears that will be performed during your visit, the hearing test provides important data to create a more thorough plan of care for you.

Disease or problem specific questions:

THE EAR

• Why do some children get mucus or “fluid” collection in the ear?
  Mucus is normally present in all ears but this drains by way of the eustachian tube to the back of the nose. This tube also maintains the air in the middle ears that give the sensation of a “pop” when you yawn, chew or try blow air into your ears.
  This tube is however the main problem in that it may become blocked and not allow air in or fluid to drain out, this would then result in fluid collecting in the ear. This causes hearing loss and pressure on the ears. In children this tube is also more horizontal and short which predisposes it to repeated fluid build up.
• Does mucus or fluid build up predispose to ear infections?
  Yes it can. Residual fluid provides an excellent growth medium for organisms that may creep up the Eustachian tube from the nose. The adenoids lie in close proximity to the opening of the Eustachian tube at the back of the nose and may obstruct the tube resulting in fluid build up along with organisms originating from the adenoids moving up the tube. It will obviously occur more often in winter with the frequent upper respiratory infections.
• Is there no medication which can open up the eustachian tube?
  Nothing is really guaranteed but a short dose of oral cortisone and/or nasal steroid spray which is absolutely safe is always worth a try.
• What are grommets?
  They are small ventilation tubes that allow ventilation of the middle ear and drainage of fluid. They’re inserted through the incision made in the eardrum after all the mucus has been sucked out and function as a surrogate of the eustachian tube.
• Swimming and Grommets
  This is a controversial question but recent evidence in the literature suggest that there is little difference in those children with grommets who avoided water and those who did not. This suggests that children be allowed to swim without restriction but if they fall into that small group where the ears are a problem with grommets then ear plugs or similar material are needed.
  Learning to swim is important and this outweighs any concern about a potential infection if exposed to water. One can handle a discharging ear but not a child who has drowned because of being told not to swim due to grommets. I would advise water precautions for 2- 3 weeks after the procedure only and thereafter water exposure would be fine.

THE NOSE:

NASAL ALLERGY: HAYFEVER

• Allergies are increasing Internationally by some 10% annually.
• Nasal allergies affect some 20% of South Africans. It’s much underrated as regards the negative effects it has on reducing one’s quality of life.
• The nose is the first part of the airway and access point to the chest, these together are called the United Airway. Many nasal allergy cases will either have an unstable chest or definite asthma of varying degrees and the two are intimately inter-related.
• Treatment of nasal allergy can help stabilise asthma.
• Environment and diet are important. They need to be assessed. Allergy tests are reasonably accurate and can suggest treatment profiles. Similarly food allergy can be an important factor…not only in children.

• Can allergy be cured?

  In many cases not. However, in certain cases with limited allergens, oral desensitising can be done. This is painless, lasts over roughly a 2 year period and needs to be performed by an allergologist. It is in fact the only way of trying to go for a cure.

  Treatment remains on an environmental and medical basis.

• Nasal cortisone sprays?
  

  These are safe and absolutely not dangerous as they have a local mode of action and almost none is absorbed systemically. Used correctly they’re an absolute life saver and will improve nasal congestion over a long time period. A common mistake is not to direct the spray in the correct direction - That is the side wall of the nose or toward the eye (but not into the eye!).

• What do antihistamines do?
  

  They reduce the amount of nasal mucus (i.e. to give you a more “dry” nose) along with addressing sneezing and itchy symptoms). Some of the new antihistamines will also improve the airway but not as much as the steroid cortisone sprays.

• Nasal steroid spray combined with antihistamine?
  

  These can and often are combined to appropraiately manage allergic disease and prevent progression of chest or lung disease.

Loss of smell?

• This requires evaluation as early as possible for potential causes as these are varied and further management is dependent on the cause.

THE THROAT:

Please remember that a “throat examination” requires the ability to examine the hidden parts behind the nose and the voice box area. This requires an endoscopic examination (or “scope”) which is easily performed in office as part of an ENT evaluation. Just looking in the mouth gives you some information about the tongue and tonsils but nothing else and then significant and sometimes dangerous diseases can be missed.

• Does throat cancer cause pain?

  Usually pain is a very late sign of cancer and early symptoms are persistent hoarseness or swallowing difficulty that does not resolve in 3 weeks. Referred ear pain may also be a warning sign and does require evaluation.

• Should every patient with hoarseness be comprehensively examined to exclude cancer?

  The answer is a definitive “yes”. However, in cases where it seems to be a viral laryngitis causing hoarseness then it would be quite appropriate to wait for a couple of weeks before seeing an ENT Specialist. Viral laryngitis is self-limiting.

• Can speech therapy and vocal training help people with hoarseness?

  Yes in many cases it certainly can. A lot of the vocal cord problems, especially in those using their voice a lot, are due to poor speech technique.

• Can hoarseness be caused by acid from the stomach?

  It certainly can. Reflux is a well-known cause and needs to be considered and if necessary excluded.

What can be done about my snoring?

Snoring is a common problem that may occur alone or in combination with obstructive sleep apnea.

Primary snoring:

Snoring typically is caused by vibration of tissues within the oral pharynx (the uvula and palate). Nasal obstruction can be another cause. In mild snoring, these measures may help: losing weight, sleeping on your side rather than your back, avoiding sedatives and alcohol. Surgery can reduce the size of the soft tissue of uvula and palate, and also relieve nasal obstruction.

Obstructive Sleep Apnea:

Obstructive apnea is a cessation of breathing that lasts ten seconds or more. Repeated episodes can significantly disrupt sleep. Manifestations of sleep apnea include snoring, restless sleep, and daytime fatigue. Many advances have been made in treatment of sleep apnea.