ENT Disorders

We see more ENT (ear, nose, throat) disorders than any other specialty. That’s probably why we cannot get a refer to ENT in less than 2 weeks, and by then the problem has cleared.
The 2 main problems are sore throat and sinusitis. Both of these disorders are over treated with antibiotics.

Sore throat (pharyngitis)-the vast majority of sore throats are viral, and no treatment is effective. You can usually tell if it is viral by the symptoms-besides the sore throat, patients usually have other symptoms-runny nose, voice change or cough. Viral infections tend to infect multiple areas, so when more than the throat is envolved, it is usually viral. Antibiotics do not work for viral infections. We us pain medicine, warm water salt gargles, and time.

Strep throat (pharyngitis/tonsillitis)-this is a bacterial infection confined to the throat. Cough, runny nose and voice change are not usually associated with a strepto- coccal throat infection. To confirm a strep infection, we do a rapid strep test. However, if we suspect a strep infection, we treat with a 10 day course of penicillin, even if the rapid strep test is nagative. The tests are not infallible. The logic in treating the strep infection is to prevent the development of rheumatic fever. Almost no physicians in the USA have seen rheumatic fever-perhaps in cold areas. There are occasional outbreaks, but is is rare.

Sinusitis-this is so common. Again, most are viral. Sinusitis starts as a head cold that lasts 2 weeks, and progresses to pain over the face and purulent nasal discharge. If you start to treat the nose with decongestants (Sudafed, Advil Cold & Sinus) to stop the nasal membranes from swelling and obstructing the sinus drainage, you may prevent a sinus attack. Nasal irrigation with warm saline also helps get all the purulent mucous cleared. If this fails, you probably need antibiotics. Remember, antibiotics are not our first line drug in sinusitis-work on the nose first. We have an instructional sheet for sinusitis that will tell you as much as I know about the disease.

Ear pain-this can be from a variety of etiologies. Q tip trauma, swimming, and a head cold cause most of the problems. Examining the ear will show pathology if the problem is in the ear-redness, pus, painful exam. If the exam is normal, the pain is referred to the ear from another source-dental abscess, obstruction of the tube from the ear to the nose (occurs in a head cold), barotrauma from flying, TMJ dysfunction, or other pathology.
Middle ear infections are very rare in adults. Children have the market.

We limit our treatment of hearing problems to removing wax. Most hearing problems will need to have hearing tests-we refer.

We see many other ENT problems-wax, nose bleeds, fractures of the nose, nasal allergies, and vertigo but the above are the common ENT problems.

Read more about Ear Treatments at www.earsurgery.org
More info about sinusitis www.sinuscarecenter.com
Read more about other ENT at www.scuba-doc.com

Written & edited by Robert E. Dyer, MD