Allergies are an extremely common medical problem, and it is estimated that one in four people suffer from this condition. More than 50 million Americans carry the diagnosis of “allergic rhinitis”. The cost of treatment for allergies exceeds $5 billion dollars annually.
An Ear, Nose, and Throat Specialist has a unique advantage in treating allergy. Approximately 1/4 of our training was devoted to understanding how to investigate and treat allergic disease. We have the ability to offer both medical and surgical options (or even a combination of the two) to our patients, and we can customize treatment according to each individual’s needs and condition.
The initial evaluation will include a thorough review of all symptoms and potential triggering factors, a detailed medical history, and a comprehensive head and neck exam. ENT surgeons are well-trained in the art of airway endoscopy, which gives us an unparalleled view of the problematic area. Combining the traditional exam techniques with magnified endoscopic viewing of the intranasal and sinus cavities allows us to better understand a patient’s disease.
Common presenting allergic symptoms include sneezing, runny eyes, itchy eyes, anterior and posterior nasal drip/discharge, congestion, dark circles under the eyes, fluctuating hearing loss, diminished or lost sense of smell, headaches, sinus pressure, sore throat, cough, and hoarseness, just to name a few. Many of our patients who present with chronic, recurrent sinus and ear infections oftentimes have some component of allergic disease at play. After our exam, we will often recommend additional, diagnostic testing either in the form of the gold-standard skin prick testing, which is a well-studied and trusted technique, or newer “in vitro” blood allergy tests. The skin prick testing is favored by most insurances because of lower cost and the high degree of accuracy. We utilize MQT testing, also known as Modified Quantitative Testing, for our skin prick analysis. This is done almost always on the forearm and upper arm, sparing the back. MQT is endorsed by the American Academy of Otolaryngic Allergy (AAOA), and it is the technique favored by most ENT surgeons. For those patients that cannot undergo skin testing (young age, non-favorable skin conditions, history of severe allergic reaction during skin testing, etc.), we sometimes employ a simple blood draw to check for allergy.
For patients who are found to have significant positives on allergy testing, we usually begin with aggressive medical therapy. Nasal steroids, antihistamines, and leukotriene inhibitors are some of the common medications prescribed to initially treat allergic disease. Avoidance therapy is also utilized, and we will review each individual positive with the patient and discuss easy ways to reduce exposure to the troublesome allergen. In some cases, immunotherapy is required to gain better control of the situation and reduce symptoms. The traditional method is subcutaneous immunotherapy (SCIT), a.k.a. “shots”. While we have many patients who choose this route, we also encourage patients to consider sublingual immunotherapy (SLIT), a.k.a. “drops under the tongue”. SLIT is a safe and effective alternative to shots, and they can be done in the comfort of one’s home.
Surgical therapy is sometimes needed in allergic patients. Altered anatomy will contribute to many of the common symptoms (nasal obstruction, congestion, pressure, etc). These defects are discussed in detail, and the various solutions to the problem will be highlighted by the ENT surgeon. The ability to look at issues from both a medical and surgical approach is a key advantage a patient gains by seeking care with us.