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Why not do ENT?
- Thread starter nacholibre
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Meh I don't really like anatomy. I like surgery though obviously. Anatomy is just what you have to know to do surgery.
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epistaxis, and not the Johnny picks his nose and it bleeds type. The kind that starts and stops and keeps torturing you on and on.
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i would not be sad if the following consults never happened again:
-- "oropharyngeal bleeding" consult (or gift) from the transplant ICU
-- rule out invasive fungal sinusitis
-- my patient has ear pain (translation for: "i can't find an otoscope" or "i don't know how to use an otoscope")
-- rule out vocal cord dysfunction (... in this totally batsh*t crazy patient)
-- can you change this trach? because, i'm just not comfortable doing it (even though it's 5 years old and the patient can change it himself at home without a mirror)
-- anything mentioning the words vertigo or disequilibrium (just use the word "cerebellar" in your note and it usually goes away pretty quickly, though)
-- "oropharyngeal bleeding" consult (or gift) from the transplant ICU
-- rule out invasive fungal sinusitis
-- my patient has ear pain (translation for: "i can't find an otoscope" or "i don't know how to use an otoscope")
-- rule out vocal cord dysfunction (... in this totally batsh*t crazy patient)
-- can you change this trach? because, i'm just not comfortable doing it (even though it's 5 years old and the patient can change it himself at home without a mirror)
-- anything mentioning the words vertigo or disequilibrium (just use the word "cerebellar" in your note and it usually goes away pretty quickly, though)
Seconded.
Two other things I could do with out: dizziness and headaches.
Everything else is fine.
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Got a consult for "olfactory hallucination" in a schizophrenic...
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Atypical facial pain, TMJ, Trach care for ICU/GS placed trachs, chronic cough, speech delay in a 2 year old with normal hearing, snoring in obese patients, etc, etc.
While these things make me cringe - there are far more interesting things we see in clinic, and it is hard to beat the fact that we are the medical and surgical experts for our anatomical region. A bit like ophthalmology in that regard, but with a much more varied anatomy and surgical scope.
While these things make me cringe - there are far more interesting things we see in clinic, and it is hard to beat the fact that we are the medical and surgical experts for our anatomical region. A bit like ophthalmology in that regard, but with a much more varied anatomy and surgical scope.
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Vertigo has a strong association with CWLS (crazy white lady syndrome) and in the pre-gomer population. Straightforward vertigo like BPPV, menieres, vest neuronitis is easy and rewarding to treat, but they grey areas can be frustrating.
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Yep. True vertigo (which is a specific term meaning the sensation of spinning or moving) is generally pretty easy to figure out and treat. I'd say the majority of consults I see for "vertigo" are vague lightheadedness or other complaints, usually with a dose of craziness as well. I've also had a run of BPPV patients lately who are either morbidly obese, old/fragile, or otherwise a giant pain in the ass to do an Epley on...
I don't find any vertigo interesting.
I see tons of vertigo.
A patient with vertigo generally is someone I don't want to treat. Rarely I'll get that sac decompression or nerve section out of it, but the rest of it is migraine, BPPV, neurotic housewives/CWLS/whatever, and people poorly managed on their antihypertensives and diabetics.
dealing with H&N personalities.
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Hey. Go eff yourself!!
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Cleaning up another surgical specialty's mess when they go into the neck "because they need to know the anatomy"
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it's my experience that a lot of private practice ENT's like to see patients for snoring. They do a good job of addressing nasal/sinus issues (sometimes before, sometimes after a polysomnogram) and send them on to sleep specialists for further care in most cases.
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hmmm, odd coming from a sleep doctor. As an ENT who sees and treats a ton of OSA, I agree with Leforte. I do a lot, not because it's fun, but because it's needed. I always tell people CPAP is by far and away their best option. CPAP can cure, surgery can reasonable hope to get 50% improvement short of a trach. That's including doing 3 level surgery and possibly even maxillomandibular advancements.
The surgery is brutal, reasonably risky from potential complications, with a miserable recovery and little chance for cure in anyone with an AHI over 40-50.
Worse is that the surgical options have a 90 day global and have only ok reimbursement for the stuff that's really helpful. The nasal work pays well but alone is almost useless for OSA.
Most ENT's recognize lower reward, higher risk and while they take care of it, don't particularly look forward to it.
The surgery is brutal, reasonably risky from potential complications, with a miserable recovery and little chance for cure in anyone with an AHI over 40-50.
Worse is that the surgical options have a 90 day global and have only ok reimbursement for the stuff that's really helpful. The nasal work pays well but alone is almost useless for OSA.
Most ENT's recognize lower reward, higher risk and while they take care of it, don't particularly look forward to it.
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1. CPAP. Then...
2. I'll do the occasional UPPP in the right patient. Occasional Septoplasty to help you tolerate the mask if you septum is terrible. Otherwise refer back to 1.
We did GBATs in residency but I was never sold on their risk/reward profile and they weren't without complications. Our oral surgeon did orthagnathic surgery but not for OSA. We had a handful of patients with Montgomery trachs they could cap by day and uncork by night. But they seemed to cough them out a lot. But it fixed the OSA.
Generally it's patients who really are best treated at least with our current surgical options with CPAP.
Snoring pts without OSA can be a good cash business in the right patient population, I'm told, but I haven't encountered many cash customers in my area.
2. I'll do the occasional UPPP in the right patient. Occasional Septoplasty to help you tolerate the mask if you septum is terrible. Otherwise refer back to 1.
We did GBATs in residency but I was never sold on their risk/reward profile and they weren't without complications. Our oral surgeon did orthagnathic surgery but not for OSA. We had a handful of patients with Montgomery trachs they could cap by day and uncork by night. But they seemed to cough them out a lot. But it fixed the OSA.
Generally it's patients who really are best treated at least with our current surgical options with CPAP.
Snoring pts without OSA can be a good cash business in the right patient population, I'm told, but I haven't encountered many cash customers in my area.
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