ENT Complaints#

Approach to common ear, nose, and throat complaints in primary care. Most ENT presentations are self-limited viral illnesses or benign conditions—the key is identifying who needs antibiotics, urgent evaluation, or ENT referral.

Key Principles#

• Viral vs bacterial: Most upper respiratory symptoms are viral; antibiotics rarely indicated
• Duration matters: Acute (<4 weeks) vs chronic (>12 weeks) sinus symptoms have different management
• Red flags: Unilateral symptoms, cranial nerve findings, neck mass, persistent hoarseness >3 weeks
• Medication review: ACE inhibitors (cough), antihistamines (drying), aspirin (epistaxis)

Topics#

Throat#

• Sore Throat — viral vs strep vs peritonsillar abscess; Centor criteria
• Hoarseness — acute laryngitis vs chronic dysphonia; when to scope

Nose and Sinuses#

• Sinus Symptoms — viral URI vs acute bacterial sinusitis vs chronic rhinosinusitis
• Epistaxis — anterior vs posterior; first aid vs ED referral

Ear#

• Otalgia — primary ear pathology vs referred pain; otitis externa vs media
• Hearing Loss — conductive vs sensorineural; sudden SNHL is an emergency

When to Refer to ENT#

• Peritonsillar abscess or deep space neck infection (urgent)
• Sudden sensorineural hearing loss (urgent—within 24-48 hours)
• Posterior epistaxis not controlled with anterior packing
• Hoarseness >3 weeks (laryngoscopy needed)
• Chronic rhinosinusitis failing medical management
• Unilateral nasal symptoms or mass
• Recurrent acute otitis media (>3 episodes in 6 months)
• Cholesteatoma or chronic otitis media with perforation