Commonly Asked Questions

General

To make the most out of my visit with my ENT, what questions should I always remember to ask?

A lot goes into a visit with an ENT specialist so you want to make the most of the time for questions. The best questions are the ones that follow naturally from the assessment your ENT gives you at the time of your visit. These are questions like:

• What possible diagnoses would explain my symptoms?
• What tests do we need to evaluate my symptoms?
• What are my treatment options?
• What do you recommend?

It is best to try to avoid asking if your symptoms are a specific disorder you’ve read or heard about. It is natural to have done your own research and occasionally a patient might pick the right diagnosis; but quite often these questions waste valuable time while the doctor has to explain why that condition doesn’t really fit the symptoms and other findings.

Do I need a referral to see an ENT?

Most of the time, no. That said, certain managed-care insurance plans may require a referral from your primary care physician. It’s always best to check your insurance first or check with your primary care physician’s office to see if a referral may be needed.

Can my dentist refer me to an ENT?

Absolutely. If your dentist has concerns about something in your mouth, an ENT is the best provider to evaluate this further. This could just be an examination, but could also involve a biopsy (taking a small sample) or other tests such as imaging. ENT physicians are also the specialists who diagnose and treat growths (tumors) and other lesions of the mouth and throat.

Do ENT doctors see you for screening tests or only if you have a problem?

ENT physicians don’t do much in the way of routine screening as they are specialists. Usually, someone sees an ENT for evaluation of symptoms. Screening for hearing loss is sometimes performed such as in children with speech delay or older adults suspected of developing Alzheimer’s disease. Throat cancer is on the rise due to human papilloma virus (HPV) but there is currently no screening protocol for throat cancer.

I sneeze after I eat – should I see an ENT?

This is not a concern unless other symptoms of allergy are present such as runny nose, nasal congestion and frequent nasal and eye (ocular) itching. If other allergy symptoms are present, evaluation for possible allergies would be reasonable.

Will trimming the hair in my nose make me more susceptible to germs?

No. The hairs just inside the nose (called vibrissae) are there to help filter large particles such as blowing debris. They do not stop germs like viruses and bacteria from entering the nasal passages. Trimming them poses no risks. It is actually preferable to trim the hairs rather than pulling them out as pulling these hairs occasionally results in infections of the hair follicles.

Can spicy food give me ENT problems?

No. Spicy foods can make the nose run and the eyes water due to activation of a part of the nervous system called the parasympathetic nervous system. This resolves once you’re done with the spicy meal and there is no lasting effect. If your nose often runs with other (non-spicy) foods, you may have a condition called vasomotor rhinitis (VMR for short). This can be treated with a prescription nasal spray if it is bothersome.

If you are hyper-sensitive to smells, should you see an ENT?

No, this isn’t necessary as hypersensitivity to smells is just a character trait not a disorder. There is no particular evaluation or treatment for this.

Does Parkinson's disease cause you to lose your sense of smell?

No. Parkinson’s is what is called a movement disorder. This means that it effects control of muscles and movements by the body.

Allergy

How can I tell if I have an allergy or a cold?

This is a very common question and an important one. There are some major differences that usually make this easy to figure out. The first is time and duration. Allergy symptoms tend to continue for long periods of time. For some people, this can be throughout the year. For others, it may be certain seasons. For a head cold, from the start of your symptoms to complete resolution, we are talking about 2 weeks total duration. The next important difference is symptoms. Often times, the initial symptom of a head cold is a sore throat which is not a symptom of allergies and would be a tip-off you have a cold, not allergies. The most common sequence of head cold symptoms start with mild malaise (not feeling well) followed by sore, scratchy throat. Your sore throat gradually gets better after a few days but now your nose begins to run. Very thin and watery at first but becoming thicker, cloudy and minimally off-color by the end of the cold 10 days later. The nose, which is open initially, becomes more and more congested (blocked up) towards the end of the cold before becoming normal after about 10-14 days. Some colds prominently feature a cough, others don’t but allergies, especially with asthma, can also include a cough so this would not help you tell between a cold and allergies.

I hate needles. Is there an alternative to allergy shots?

Yes. Sublingual (under the tongue) allergy drops may be an alternative to traditional allergy shots for some patients. However, this treatment is limited in terms of what allergies it can treat compared with traditional shots. Also, most insurance plans do not cover this therapy making it an out-of-pocket expense and there is much less data on this type of allergy treatment compared with shots.

If I start allergy shots, will I need them my whole life?

No. Typical allergy shots (called immunotherapy) are performed for several years. Once the body becomes “immune” to the allergies being treated, the shots can be stopped. The benefits then can last for many years after that.

How can I medically prevent allergy problems?

This is not necessarily possible. Sometimes, the tendency to develop allergies is genetically predetermined. However, there are ways to deal with allergies that can help your treatment. This can include staying indoors on windy days, keeping windows in the car and home closed, bare floors in the home rather than carpets and keeping pets out of the bedroom if you are allergic to them. In children at risk for the development of peanut allergy, supervised early exposure to peanuts may prevent peanut allergy later on. This may also be true for pet allergy but it is recommended any exposure strategy be undertaken with the guidance of an allergist and in some cases, the exposure may be done in the doctor’s office.

Can I be permanently cured on an allergy?

This is possible with allergy shots. Typical allergy shots (called immunotherapy) are performed for several years. Once the body becomes “immune” to the allergies being treated, the shots can be stopped. The immunity to those allergies should last for years.

Can you take shots instead of daily allergy medications?

Yes. However, for patients with severe allergies, the best strategy will likely be to take both the allergy shots and medications. Eventually, the medications may be stopped once the allergies are well-controlled with the shots.

Ears

How can I deeply clean out my ears with the least damage?

Most of the time, the ears are “self-cleaning” in that the wax and dead skin produced in the ear canal gradually works its way out on its own. Periodically, small amounts of wax just fall out. Therefore, most people really don’t need to clean or do anything in particular with their ears. However, if a buildup of wax occurs and hearing becomes muffled, there are commercial products available at most drug stores to safely flush out the wax. Brand names include Debrox and Murine. Usually, an oily substance is dripped into the ear canal to soften the wax and then it is flushed out with water. Make sure the water is at about body temperature to avoid getting very dizzy while irrigating the ear. Instruments sold to manually remove the wax are not recommended as you cannot see in your ear and blindly inserting an instrument can cause harm. If flushing out the wax doesn’t work or hearing remains diminished, it is best to schedule an appointment with an ENT physician who can evaluate the situation and remove the wax if necessary.

Is it dangerous to "pop" your ears?

No, not at all. In fact “popping” the ears by blowing against a closed or partially closed nose is helpful in certain situations when barometric pressure (air pressure) is rising quickly. This typically occurs when descending in an airplane or driving down from a mountainous area. Popping alleviates the pressure in the ear and can actually prevent problems including fluid buildup in the middle ear (part of the ear behind the ear drum). A frequent need to “pop” the ears can signal that there is a problem in the ear and professional evaluation with an ENT specialist is a good idea. In addition to checking your hearing, a test called a tympanogram checks the movement of the ear drum and measures the pressure in the middle ear. This can help determine if the Eustachian tubes (which connect the middle ear to the throat) are working properly.

Hearing aids/Hearing loss

What are the common early signs and symptoms of hearing loss?

Perhaps surprisingly, most people with early hearing loss don’t complain of difficulty hearing. More often, they complain that people are not speaking clearly (“mumbling”). They find themselves asking other people to repeat themselves. Often this is not perceived as a problem. Background noise makes the problem worse such as when eating in a noisy restaurant. If a patient or their family have concerns about possible hearing loss, it is best to come in for evaluation. Hearing impairment can contribute to social isolation and in older individuals is considered a risk factor for cognitive decline (trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life).

Is ringing in the ears normal as you get older?

No. Ringing is not considered normal. However, it is very common especially as people get older. The most common reason for ringing in the ears (called tinnitus) is hearing loss and naturally, most people lose hearing as they get older so tinnitus becomes more frequent as people age. When your ENT evaluates someone with ringing in the ears, a hearing test called an audiogram is almost always performed to look for the underlying cause and to determine if additional evaluation, such as with an MRI, may be needed.

Could my child benefit from a hearing aid?

If there is significant hearing loss, absolutely. It is very important to make sure that your child can hear you and the teacher during school. Hearing aids are strongly recommended for children with significant hearing loss.

What happens at an audiologist's appointment?

The audiologist will first look in each ear to make sure that there is nothing such as ear wax blocking the ear canal. If there is excessive wax or other problems seen in the ear canal (such as an infection), the hearing test won’t be performed until this is addressed by your ENT. After that, the audiologist will perform several tests. These tests include evaluation of the movement of the tympanic membrane (ear drum), how the ear responds to sound (called acoustic reflex) as well as performing the actual hearing test. In an ENT practice the audiologist works closely with an ENT physician. After the hearing evaluation is performed by the audiologist, the ENT will then also see the patient.

Is a cochlear implant an option for my child? Where can I get more information?

Yes. Cochlear implants are used in children who are born deaf or lose their hearing due to illness. This allows the child to grow up with hearing and typically attend regular school with children without hearing loss. Early identification of deafness is crucial. Otherwise, the part of the brain responsible for hearing never develops. Adults who were born deaf and have never had hearing do not benefit from cochlear implants. More information on cochlear implantation can be found at https://www.enthealth.org/be_ent_smart/cochlear-implant-health/

Is tinnitus hereditary?

No. However, tinnitus is a frequent symptom in people who have hearing loss and there are hereditary forms of hearing loss. Thus, someone with a hereditary form of hearing loss is more likely to also have tinnitus.

Does ear wax cause deafness?

Not really. The term deafness should really be for individuals with little to no hearing even without any wax in their ears. Ear wax (cerumen) can cause mild reduction in hearing until it is removed. Removal of impacted cerumen is a common procedure in an ENT practice. ENT doctors typically remove the wax without irrigation using a microscope and special instruments. This allows for safe removal even when other ear problems such as ruptured ear drum or previous surgery are present.

If I am young and have hearing issues, is a hearing aid an appropriate solution?

Yes, a hearing aid may be very appropriate. The first step will be to see an ENT doctor to determine the nature and cause of the hearing impairment. If there is no known effective treatment for the hearing loss and it is significant enough to interfere with normal communication, a hearing aid is a good option.

Are there different types of hearing aids or are they all pretty similar?

There are many different kinds of hearing aids. This includes many different brands, models and types of technology. While hearing aid advertisements often make similar claims, in reality, there are major differences. Selecting the right hearing aid and having that hearing aid properly programmed is vital for a good outcome. At Valley ENT, our audiologists work closely with our ENT providers to make sure that any hearing aid will be the right technology, fitted and programmed specifically for you.

Is there a surgical solution to hearing loss?

Yes for certain causes of hearing loss. Most hearing loss is not treatable with surgery. However, there are some causes of hearing loss that respond well to surgery. These include abnormalities of the ear drum (tympanic membrane), middle ear (including the tiny hearing bones called ossicles), as well as cochlear implantation for children and adults who are deaf or nearly deaf. Perforated tympanic membranes can be repaired and ossicles can be reconstructed. Cochlear implants may be a solution for some with severe hearing loss where even the best hearing aids don’t work well.

Do I need a hearing exam to purchase a hearing aid?

Yes. This is essential. Every patient with hearing loss should be evaluated by an ENT to first see if there is a treatable cause including possible surgery. If the hearing loss cannot be corrected with medical or surgical treatment, a hearing aid may be needed. However, the correct selection and programming of a hearing aid cannot be performed without a hearing test.

Are there any drawbacks to buying more affordable hearing aids online or from a big box store?

Unfortunately, there are many drawbacks to this approach. First, buying a hearing aid is not like buying a pair of headphones or a washing machine. The patient simply won’t know what kind of hearing aid is best for their kind of hearing loss. Hearing aids at most big box stores are typically handled by a technician. Hearing loss at any stage can be complicated and selection and guidance by a technician, while well intentioned, may not be sufficient. Great care should be taken in evaluation of hearing loss and in the selection and programming of the right hearing aid. That level of care is best provided by a qualified audiologist and is simply not available at a big box store or online. Furthermore, optimizing any hearing aid often calls for slight expert adjustments to be made once the patient has got used to it.

Can hearing loss cause dementia?

No, hearing loss does not cause dementia. However, researchers at Johns Hopkins published a study in 2011 showing an association between hearing loss and the development of dementia. People with hearing loss were found to be at greater risk for developing dementia over time. The greater the hearing loss, the greater the risk of future dementia. However, the nature of the relationship between the hearing loss and dementia is not known. There could be a single cause for both rather than one causing the other. You can learn more at www.hopkinsmedicine.org .

Oncology and Surgery

Can ENT doctors diagnose and treat throat cancer?

Yes. In fact, ENT doctors are the physicians who do just that. Any time that there is concern that someone may have throat cancer, a consultation with an ENT doctor should take place. The examination that ENT doctors perform in the office will actually detect almost all cases of throat cancer. Sometimes, other tests such as CT or MRI will also be needed. A biopsy (small sample) would then be performed to make the actual diagnosis of cancer. After that, a treatment plan can be determined. This may include surgery, radiation therapy and/or chemotherapy. Radiation therapy and chemotherapy, when used, are administered by other cancer specialists called radiation and medical oncologists. This creates a care team of the ENT specialist plus the appropriate oncologist for a patient with throat cancer.

Pediatric

Are cotton swabs OK to clean my child's ear and nose?

Usually, cleaning the ears is unnecessary as the ears are usually “self-cleaning”. While cotton swabs usually cause no problems, they can push the wax deeper into the ear eventually blocking the ear canal. Therefore, most of the time, the best care of the ear is no care at all. If used at all cotton swabs should not be inserted very far into the ear canal or just used outside the opening. Cleaning the nose with the cotton swab is OK to help remove dried, crusty mucus from the nostrils. It can be helpful to wet the cotton swab first to soften the debris.

Can loud noises or strong smells hurt a baby?

In general, no. However, if the noise is loud enough to cause hearing loss in an adult, it is loud enough to cause hearing loss in the baby. Certainly, a baby should not be in very noisy environments. Examples would include a loud concert or near extremely loud power tools or motors. Anyone exposed to these types of sound can lose hearing and hearing protection is strongly advised. Strong smells would pose no problem.

Can crowd noise at sports games really damage a baby's hearing?

Yes, when it gets loud enough. Some sporting venues, particularly in closed arenas can get extremely loud. When sound levels exceed 105dB, this can cause permanent damage if there is repeated and prolonged exposure. This is probably not a significant risk for one sporting event but could be an issue with regular attendance.

Sinus

Are home remedies better than pharmaceuticals for building your body's own defenses to sinus conditions?

No. Unfortunately, there is much misinformation available when it comes to “home remedies” and “natural” cures for many medical conditions including various sinus conditions. Most of the time, remedies are recommended even though there is no scientific evidence that they work. What this means, is that the people suggesting these treatments haven’t done the necessary work to demonstrate to anyone, including themselves, that the treatment is safe or does anything at all. It really doesn’t seem very ethical to recommend medical treatment without any reliable supporting evidence but this is unfortunately quite common.

Should I skip my primary care provider and go to an ENT for my issues?

As a general rule, it makes sense to start with your regular doctor. This can be more cost-effective and occasionally what may seem like an ENT problem may be something else more appropriate for a primary care setting. However, in some cases it may be very obvious that an ENT specialist is needed in which case self-referral would be completely the right choice.

Why is balloon sinuplasty not done more often?

This is a very complex question within the ENT medical community. Balloon sinuplasty is a minimally invasive technique to open obstructed sinuses. In some situations, this may indeed be the best option. However, chronic sinusitis, which is a condition causing long-term sinus problems such as nasal blockage or frequent sinus infection, may not always be best managed with balloon sinuplasty compared with more traditional sinus surgery. Balloon sinuplasty has been shown to be both safe and effective but more clinical studies are being done to directly compare balloon sinuplasty with traditional (endoscopic) sinus surgery in cases of severe sinus disease. Such studies will show exactly where balloon sinuplasty fits as a treatment choice for chronic severe sinus problems.

Surgery

Do ENT doctors do surgery?

Yes. There are a great variety of surgeries that ENT doctors perform. Unlike some other medical specialties, ENT specialists provide both the medical and surgical treatment for the various conditions that they diagnose. For example, when a patient has a chronic sinus condition, the ENT specialist will first evaluate the patient to make the diagnosis and then treat the patient with medications. If the condition does not improve with treatment, surgery may then be performed. ENT specialists perform surgery on all areas of the head and neck region including the ears, nose and sinuses, throat, glands and lymph nodes as well as the skin. Some ENT doctors specialize in certain parts, limiting their practice to that area (such as just the ears, nose and sinuses, or throat.)

Throat

What kind of throat tests does an ENT do?

ENT doctors (called otolaryngologists) perform a comprehensive examination of the throat. While other physicians and providers can look into the throat, only an ENT specialist can examine the entire throat looking at all the different parts and surfaces. This is the single most important “test” done for the throat. Clues to most conditions can be seen by an ENT specialist. These clues may not be recognized by other providers. Sometimes, if all the different areas of the throat cannot be seen by direct inspection, the ENT doctor will pass a thin scope through the nostril to enter the throat. This allows for examination of the entire throat. Other tests may include CT scans, MRI, swallowing tests and ultrasound. The tests ordered depend on the nature of the problem but the evaluation always begins with that good physical examination.

Thyroid

Does an ENT treat thyroid problems?

Yes. The thyroid is a gland in the neck that produces a hormone called thyroid hormone. Evaluating a patient’s thyroid hormone levels and treating conditions of the thyroid that may result in too much or too little thyroid hormone levels is usually done by primary care physicians and specialists called endocrinologists rather than ENT doctors. However, if there is a lump or mass in the thyroid gland, ENT doctors become involved. This may include performing a biopsy (sample) of the lump as well as removing it if surgery is needed.

How easy is it to fix a bad nose job?

Of course, a lot depends on what didn’t turn out very well with the first nose job (rhinoplasty). If a small bump on the nose or visible irregularity is present, this could be a relatively minor procedure. However, if too much of the structural cartilage and/or bone was originally removed from the nose then correcting the problem can be more technically complicated and may require additional specialized measures such as bone or cartilage grafting.

Tonsillitis

When would I need to talk to my ENT specialist about getting my (or my child's) tonsils out?

There are several reasons (called indications) why tonsils should be removed. One is when the tonsils are so large that they cause obstructive symptoms in the throat. Obstructive symptoms include disruptive snoring and sleep apnea (pauses in breathing during sleep due to throat blockage) and occasionally difficulty eating solid foods in young children. Another common reason to remove tonsils is for frequent infections. This is called tonsillitis. Tonsillitis can be viral or bacterial. While Strep is the most common bacterial cause of tonsillitis, it is not the only bacteria that can cause tonsillitis. Thus, if you or your child is having frequent tonsillitis (more than 3 episodes per year), tonsillectomy can be a good idea. A third and less common reason to have the tonsils removed is for frequent debris accumulation in pockets in the tonsils. People often call this debris tonsil “stones”. It is really just chewed up food which lodges in the pockets (called crypts) of the tonsils. This can cause bad breath or a bad taste in the mouth. Rarely, a tonsil is removed due to cancer or a suspicion of cancer in the tonsil.

What is the earliest age they can remove my child's tonsils?

Most of the time, tonsillectomy is performed in children 3 years and older. However, for children with significantly enlarged tonsils and breathing problems at night due to the large tonsils, tonsillectomy may be performed at the age of 2. (Since this is considered a slightly higher risk procedure in 2 year olds, overnight observation at a hospital is usually recommended).

Do adults ever need their tonsils out or is that only common in children?

Tonsillectomy in adults is not unusual. Infections of the tonsils (tonsillitis) is most common between the ages of 15 and 25 but many young adults do have their tonsils removed just for frequent infections. Sometimes, the tonsils are removed for the treatment of obstructive sleep apnea. This may be done at any age. A common myth is that tonsillectomy is dangerous in adults when compared to children. This is not true. It is true that the risk of bleeding after surgery is slightly higher in adults compared to children (about 3% vs. 1% in young kids) this is treated with cauterization and is rarely a serious complication.