Why Does my ENT perform a Nasal Endoscopy and request a CT scan? Are they both necessary?

An otolaryngologist has very special training in the detailed anatomy of the nasal cavity and the sinuses. They also have been trained to identify correctly what different diseases look like inside the nose and sinuses. All of this knowledge isn’t very useful without a technique to get a good exam of these areas. Most of us have had the experience of our primary care doctor shining the light at the entrance to our nose as part of their exam. In truth, very little except the obvious can be identified by this exam. Their nasal or sinus diagnoses is basically based on symptoms and unfortunately this is not very reliable. An otolaryngologist uses a nasal endoscope in the office to obtain a magnified detailed examination of the nasal anatomy and the sinus. This is frequently performed along with a sinus CAT scan which looks at the bony openings of the sinus cavities and the sinuses themselves. This is similar to a primary care doctor feeling your abdomen to identify what is causing intestinal complaints versus a gastroenterologist doing a colonoscopy and a barium enema. The use of these types of tools by a specialist greatly increases the ability of the physician to correctly identify the diagnoses and provide the relief the patient needs. Daniel Slaughter, MD

Does it seem like your sinus issues are getting worse every year?

This is a very common complaint for Austin’s sinus sufferers. The over the counter medicines just don’t seem to provide the relief they did just a few years ago and the prescription medicines may not be providing the relief you expected. There are several explanations for this common complaint. Allergies do actually worsen over time. Allergy is a strong immune response to the allergen. Subsequent exposure year after year can cause a progressively stronger immune response. Starting on effective allergy therapy prior to your bad season is much more effective than trying to catch up once you are already suffering. Immunotherapy can also be a big help to provide a reduced immune response. Anatomical problems in the nose also tend to worsen over time. Even a small nasal injury many years ago can result in progressive deviation of the septum inside the nose and progressive swelling of the turbinates as well. The space for air to pass freely can be reduced each year making the medicines feel less effective. An evaluation by an ENT doctor can answer whether the anatomy may be the main issue. Correction with minor surgical procedures is quick and easy with modern techniques. Your worsening sinus complaints can actually be an ongoing chronic sinus infection. It’s hard for the patient to tell the difference between chronic infection and allergies and the proper treatment plan is completely different. If allergy therapy that previously provided relief isn’t working, it is worthwhile to consider sinusitis as the possible diagnosis. A MiniCat xray can be performed in an office setting to rule out sinusitis. Anatomical issues would also be identified with this image. Therapy can be provided specific to the bacteria or mold infection based upon cultures performed in an office setting. Like my professor used to say..”if its hard you are doing it wrong”. If you aren’t getting the response you need from your sinus complaints, consider these possible causes to find your solution. Daniel Slaughter, MD