Today was a clinic day I worked with a 2nd year resident and a 5th year resident. We saw 90 patients today. I saw 34 patients myself. ENT clinic mostly deals with patients who have had ear problems, neck masses, mouth cancers, sinus problems, vocal cord issues, swallowing problems and nasal problems that can't be resolved by their primary care physician. Thus by the time the patient ends up in the ENT clinic they have a real issue which is often serious. Today I diagnosed and or informed 4 patients that they had cancer. Most of these were mouth cancers which tend to be very aggressive. We had to set these patients up for surgery to remove the cancers.
I did several nasoscopes today. This involves taking a scope with a camera on it and feeding it through the patient's nose to visualize the sinuses and ultimately the larynx and vocal chords. I like doing procedures. Procedures also pay very well, specialties that do procedures tend to make more money. For example if a patient comes to the doctor with a chief complaint of congestion and the physician diagnosis acute sinusitis and prescribes an antibiotic the reimbursement will be somewhere around $150.00. If the doctor performs a nasoscope procedure on the same patient to rule out other pathology the reimbursement would be around $600.00 and would not take much more time. For the most part ENT surgeons are the doctors who do nasoscope procedures. Nasoscopes are very helpful for finding nasal polyps or cancers and throat nodules / cancers. Also they help diagnosis sinusitis.
Today we had a 52 year old african american female who had an onset of bilateral ear pain that started 2 months ago. She had visited the ER 6 times and visited 4 different doctors at clinics over the last 4 months complaining of ear pain. Each time her ears were looked at with an otoscope and appeared normal. She had a 2 CT scans that were normal yet the pain continued. The last doctor she visited prescribed her antibiotics as a last ditch effort even though there did not appear to be an infection.
The patient took the antibiotic drops for 8 days but did not like the way the drops made her ear feel. She said that it made hers ears and face numb and drove her crazy. She discontinued the medication because of these side effects. She noticed that her ear pain had subsided for a couple of days but was coming back. She returned to the doctor who this time referred her to the ENT clinic. I performed a nasoscope procedure and found 2 nodules on her vocal chords. Everything else about the exam was normal. Her tympanic membranes were intact without any inflammation or signs of infection. I showed one of the residents the nodules on the vocal chords. He agreed with my assessment and we scheduled the the surgery to excise and biopsy the nodules. If the nodules are cancerous then more surgery and treatments will be required. If the nodules are benign then no further surgery or treatment will be needed. This patient is a great example of the kinds of patients that ENT doctors see.
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