By Diana Mirel
If you’ve had ongoing sinus pain and pressure, a sore throat, ear pain or another ear, nose or throat problem, it can be tough to figure out what kind of doctor can help. Should you start with your primary care provider? Or is it time to see an ear, nose and throat (ENT) specialist?
For many common concerns, primary care is a good place to start. But some symptoms, especially those that are persistent, sudden and aren’t improving with treatment, may need more specialized care from an ENT, also called otolaryngologists.
Here’s how to know where to turn for answers and relief.
Starting with primary care
Your primary care provider can evaluate and begin treatment for many common ear, nose and throat concerns, including:
- Sinus pressure
- Ear pain
- Sore throat
- Allergy-like symptoms, such as headaches, scratchy throat and post-nasal drip
- Respiratory issues like coughing and congestion
“There is a lot your primary care provider can do to get the ball rolling, such as offering treatments like allergy medications, nasal sprays or antibiotics,” says Kristal Brown, MD, an otolaryngologist (ENT) at Rush. “That way, if you end up needing to go to an ENT specialist, your first visit can be more productive because we’re able to see you’ve already tried X, Y and Z.”
Your primary care provider can also order tests or imaging when needed. For example, a CT scan of your sinuses can help determine whether sinus disease is causing ongoing facial pain and pressure. “If the imaging shows that there is no sinus disease, we can start exploring other causes,” Brown says.
If you have sudden, new symptoms like a sore throat, cough or congestion, primary care is usually the best first stop. Your provider may be able to test you for strep throat, flu, RSV or COVID-19 in the office.
“When people come to an ENT when they’re acutely ill with flu-like symptoms, they actually get less from us than they could have from primary care because we just don’t have point-of-care tests available in our clinics,” Brown says.
When should I see an ENT?
There are, of course, times when you should go directly to an ENT. Brown recommends making an ENT appointment if you have a new neck mass, a mass in your mouth, sudden hearing loss, persistent hoarseness or a chronic cough.
“Sometimes when people have these signs and symptoms, they wait a long time and we often wish they would have come in to see us sooner,” Brown says.
Consider seeing an ENT if:
- You have hoarseness that last more than two weeks and isn’t improving
- You have sinus symptoms like facial pain and pressure, nasal congestion and runny nose for 12 weeks or longer
- You notice a new neck mass or mass in your mouth
- You experience sudden hearing loss, particularly in one ear. Ideally, you should see a specialist within one to two days.
- You suddenly have trouble swallowing that doesn't improve over two-three weeks
- Medications like antibiotics, nasal sprays and steroids have not successfully helped improve your symptoms
Some symptoms may require emergency care instead. For example, Brown recommends going to the emergency department if you are experiencing sudden, severe vertigo so doctors can rule out serious causes like stroke.
What can I expect at an ENT?
ENTs are specialists trained to diagnose and treat conditions that affect your ears, nose, throat, head and neck. They provide nonsurgical treatments but are also trained surgeons who can perform specialized exams and procedures.
Your first ENT visit at Rush will typically begin with a consultation about your symptoms, health history and treatments that you’ve already tried.
“We focus on identifying the problem,” Brown says. “And sometimes part of identifying the issue at that first appointment is that you may undergo a minor procedure, like a scope of your throat or ear cleaning.”
Depending on your symptoms, your visit may also include a hearing test or orders for additional imaging or testing. In some cases, your ENT may recommend a biopsy. Your ENT will explain why you need the procedure or test and will review the risks and benefits with you before moving forward.
At the end of the appointment, you’ll discuss next steps, which may include medication, additional testing or imaging and follow-up appointments. Some Rush ENT locations can also coordinate additional tests or imaging on the same day as your appointment.
If you need more specialized care, your ENT can connect you with other Rush ENT experts who focus on areas such as head and neck cancer, skull base tumors, facial surgery, hearing and balance issues or voice, airway and swallowing disorders.
Do ENTs treat sleep and snoring problems?
While ENTs do treat sleep and snoring problems, where you start depends on your age.
“There’s a big difference between snoring and sleep problems in children vs. adults,” Brown shares.
For children who snore, particularly if you notice pauses or interruptions in their breathing during sleep, an ENT can be a good first stop.
“If you have a healthy kiddo who’s snoring and you’re hearing that their breathing is interrupted when they sleep, I definitely recommend starting with an ENT,” Brown says.
Your child’s ENT can review your child’s health history and do a physical exam. “Often, we can then determine whether a tonsillectomy and adenoidectomy would be helpful for your child without doing a sleep study,” Brown explains.
If your child has more complex medical needs, Brown will often collaborate with pediatric sleep medicine doctors to get a sleep study that can help get to the root cause of the snoring and sleep problems like sleep apnea.
For adults, Brown generally recommends starting with a sleep medicine specialist because you will likely need a sleep study before an ENT can determine whether surgery could help.
“When you start by seeing someone in sleep medicine, an ENT can be more helpful if or when you do get to us,” Brown says.
If surgery is an option for you, Rush has ENT providers who focus specifically on sleep-related procedures. “Our ENT sleep surgeon, Michael Hutz, MD, is amazing and offers all kinds of surgical options for sleep,” Brown says. “He’ll usually do a sleep endoscopy to identify the exact point of any obstruction that is causing sleep problems and snoring, and then he tailors a treatment plan based on your specific needs.”
Still not sure? Ask for guidance
There isn’t always a clear-cut answer about whether you should see an ENT or your primary care provider. Overall, though, if your symptoms aren’t improving, have lasted longer than expected or simply have you worrying, it’s worth asking for guidance rather than continuing to wait.
“I always encourage people to err on the side of caution,” Brown says. “If you’re not sure but you feel like you’ve been having symptoms for a while, talk to your primary care doctor and they can help guide you and expedite things. We are always happy to reassure, educate or intervene whenever it makes sense.”
Your primary care provider can help determine whether specialty care is the next step. And if you do need an ENT, Rush’s team can help connect you with the right specialist so you can get answers, appropriate testing and a treatment plan to help you start feeling better, sooner.
