When to See an ENT: How to Know If You Need an Ear, Nose, and Throat Specialist

Many of us have experienced the frustration of booking a specialist appointment, which often takes weeks and sometimes longer, only to leave with a referral to someone else. This is especially common in otolaryngology, the medical specialty focused on the ears, nose, and throat (ENT).

“Our wait list can be long, and sometimes when a person finally gets in to see us, we have to say, ‘Oh, you didn’t really need to see me,’” says Douglas Hildrew, MD, medical director of Yale Medicine’s Hearing and Balance Program.

This often happens because patients don’t know when it’s appropriate to see an ear, nose, and throat specialist versus when their problem might be better suited to primary care or to a provider such as an audiologist or speech–language pathologist (SLP).

Before you make an appointment with an ENT specialist, it’s important to understand what they treat, and when another provider might be a better first step.

An otolaryngologist—also known simply as an ENT—treats conditions that affect the ears, nose, and throat. While ENTs often see common issues such as sinus and ear infections, their expertise lies in surgical treatments and complex or chronic conditions.

Some of the common conditions treated by ENTs include:

• Chronic ear or sinus infections
• Sudden, unexplained hearing loss
• Vertigo or balance disorders
• Ear trauma, such as a perforated eardrum
• Birth defects affecting the anatomy and function of the ear or sinuses
• Nasal polyps or other breathing obstructions
• Deviated septum
• Persistent or sudden loss of smell
• Frequent, unexplained nosebleeds
• Ongoing hoarseness or voice changes
• Sleep apnea
• Masses in the neck or throat
• Allergic rhinitis that does not respond to medication
• Head and neck cancers

Whether or not your issue is on this list, if you’re still wondering whether you need to see an otolaryngologist, ask yourself these questions:

1. Is the issue acute or chronic?

If you or your child have a sudden, or acute, ear infection or sinus infection, that’s usually a job for a primary care provider (PCP) or pediatrician.

“We typically don’t need to see someone unless they’ve had multiple infections in a short time,” says Michael Weinstock, MD, a pediatric ENT specialist and co-director of the pediatric cochlear implant team. “If someone gets three ear infections, one after another, then we might say it’s time to consider putting tubes in, which does require an ENT.”

Recurrent sinus infections, sore throats, and coughs do warrant a visit with an ENT. “If you have a lot of strep throats—seven in one year, five a year for two years, or three a year for three years—you may benefit from having your tonsils removed and that’s something you’d see an ENT for,” Dr. Weinstock says.

Bottom line: An isolated ear, nose, or throat problem is probably a case for primary care. A repeating problem might be a case for an ENT.

2. Have I tried other treatments?

If you haven’t tried prescription or over-the-counter medications yet, your primary care doctor may still be the best starting point. ENTs typically come into play when those treatments fail.

Bottom line: Recurrent problems may only need the help of an ENT specialist if you’ve tried treatments that haven't worked.

3. Does the condition require surgery or a procedure?

It may come as a surprise to many people, Dr. Hildrew says, “but ENT is a surgical specialty.” If you suspect your issue could be solved with a prescription medication, a PCP may be the best first stop.

Dr. Hildrew suggests patients ask themselves, “Is the problem bad enough that something surgical, like a tonsillectomy, is on the horizon? Or can I avoid a procedure by getting acute treatment?”

Besides a tonsillectomy, common procedures that otolaryngologists perform include:

• Myringotomy with or without ear tubes: A small incision in the ear drum to relieve pressure or drain fluid; tubes might be placed to prevent recurrent ear infections.
• Tympanoplasty: Repair of a perforated ear drum.
• Ossiculoplasty: Reconstruction of middle ear bones to improve hearing.
• Tracheostomy: Surgical creation of a breathing hole in the windpipe.
• Thyroidectomy: Removal of all or part of the thyroid gland.

Bottom line: Surgical solutions call for ENT expertise.

4. Is your hearing loss sudden and severe or slow and gradual?

If your hearing is gradually declining, especially with age, an audiologist should be your first stop. Audiologists perform hearing tests and fit hearing aids—not ENT doctors.

Of course, not all hearing loss is resolved by hearing aids. In that case, an audiologist might refer you to an otolaryngologist. However, sudden and severe hearing loss could signal a medical condition, such as a vestibular disorder or tumor, and needs immediate attention.

“Sudden deafness is a medical emergency,” Dr. Hildrew adds. “See an ENT right away.”

Bottom line: Sudden, severe hearing loss is considered a medical emergency, and you should see an ENT. If your hearing loss is due to aging, an audiologist is probably a better fit.

5. What’s my most bothersome symptom?

ENT-related problems often overlap. You might have nasal congestion, pressure in your ears, a chronic cough, and a sore throat—all at once. But at Yale Medicine, each ENT has different specialties. Some focus on the voice, others on the sinuses or ears.

“The great thing about Yale Medicine is there is an expert for everything,” Dr. Hildrew says. “But the frustrating thing about Yale Medicine is that there’s an expert for everything,”

Bottom line: When scheduling an appointment with an ENT, describe your main symptom. This helps ensure you’re seeing the right subspecialist.

6. Can a PA or NP help me?

You don’t always need to wait to see a physician. Unless you’ve already been referred to an ENT physician for your problem, chances are a physician assistant (PA) or nurse practitioner (NP) can evaluate your condition or accelerate the process to get you in to see a specialist.

“People often underestimate PAs and NPs,” Dr. Hildrew says, “but it's quite the opposite because they can start treatment, and if it is something major, you get to jump ahead in line.”

Bottom line: Typically, an appointment with a PA or an NP will be available sooner than one with an MD or DO. Accept the earliest available appointment—even if it’s not with a doctor.

At Yale Medicine, our ENT team doesn’t work in isolation. Our physicians excel at coordinating care across disciplines, which is often needed with complex issues that span the ears, nose, and throat.

A person with breathing and swallowing problems, for example, might need care from our aerodigestive clinic, which includes an ENT, a gastroenterologist, a pulmonologist, and an SLP. A person who has hearing loss may need the cochlear implant team that includes an audiologist, an ENT, and an SLP.

Even outside of multidisciplinary clinics, we collaborate closely to diagnose and manage difficult cases—so you get the right care, from the right expert, at the right time. “We all diagnose complex problems together and help patients navigate a challenging medical environment,” says Dr. Weinstock. “We work well together as a team.”