Maggie McKay: When you have an earache or a sinus infection or strep throat, who do you see? Your ENT or ear, nose, throat doctor, officially known as an otolaryngologist. But what else do they treat? Today, we'll find out with Dr. Bhavishya Clark, ENT.

This is “Healthy Conversations,” a podcast presented by Adventist Health.

I'm Maggie McKay. Thank you, Dr. Clarke, for being here. I'm so interested to hear about all you do. Let's start with the basics. What is an ENT or otolaryngologist?

Dr. Bhavishya Clark: Good morning, Maggie. Thank you for having me. Otolaryngologists, which is quite the mouthful, treat a variety of functions of life relating to the head and neck and all the different things our head and necks do. So from everything from hearing to taste, to smell, to voice, there's a rich interplay of anatomy and function in this area. And ENTs are specialists of this set of qualities. So, some of the things I commonly treat include hearing and balance, swallowing and speech, breathing-related issues, sinus complaints, and then some more serious conditions such as head and neck cancer, skin cancers, reconstructive surgery for the head and neck area.

Maggie McKay: You mentioned skin cancer. I was so surprised at that one when I was reading up on this. And also TMJ, I thought you would go to the dentist for that and sleep apnea. There's so many things that you treat.

Dr. Bhavishya Clark: There is, and some of the challenge is actually coming up with the diagnosis because the symptoms can be very nuanced and may overlap with a lot of other specialists. So for example, I often am referred a patient for an earache that's not improving. They've tried many courses of antibiotics and it's a very subtle thing. And commonly with a good history and physical exam, the diagnosis of TMJ can be made. TMJ stands for temporomandibular joint disorder, or your jaw joint is effectively sore and arthritic, and that can be due to a variety of causes, but it's creating this referred pain to the ear, which is next to it. And so, sometimes the ear is not the problem at all. And so, it's a very tight area anatomically and so, there's a lot of things here that, you know, can sort of be a red herring for something else.

Maggie McKay: Same with skin cancer, I thought that you would go to a dermatologist for that. Where does that come in with ENTs?

Dr. Bhavishya Clark: It kind of depends. So, I think dermatologists are fantastic and they do manage skin cancers primarily. There are a variety of skin cancers. And in the central coast, we have a lot of wonderful sunny days, and so we have a high incidence of this cancer. Depending on the location in the head or neck area and the size of the skin cancer, the scale of the surgery to remove it is beyond the scope of a dermatologist. Really advanced skin cancers can also spread to deeper structures in the head or neck, such as lymph nodes or saliva glands. And then, the treatment for that is something more than just removing the tumor of the skin. And so, we work very closely with dermatologists to ensure that care is delivered in an interdisciplinary way. But this is another area that we share with another specialty..

Maggie McKay: And what are the signs or symptoms that it's time to see an ENT?

Dr. Bhavishya Clark: So, depending on the presentation of the symptoms. So commonly, if someone is having an earache that's not improving after multiple courses of antibiotics, that's a good time to see someone. So what looks simple but isn't getting better, that's a really good reason to go to the ENT. The converse, of course, is also something that looks complicated and not simple is beyond the scope of a primary care specialist, should also be sent to an ENT.

There's some certain conditions of the head and neck that in my world I treat as emergent in nature. One specific one is what I call or what we call sudden sensory neural hearing loss. It's rare, but commonly a person can, without warning, lose their hearing entirely, and almost overnight. So for example, if someone was to wake up suddenly blind in one eye, right? Most people would appreciate that that's an emergency and you need to go seek care right away. For whatever reason when we are suddenly deaf in one ear, it doesn't seem to trigger that same urgency of seeking care that one of our senses has suddenly gone offline. And I commonly see delays in care associated with this, which in turn does have a consequence in the prognosis and the treatment of the condition.

Maggie McKay: How does a typical office visit go when you see a patient for the first time?

Dr. Bhavishya Clark: So, I typically set aside somewhere between 30 to 45 minutes for new patients. Prepare in advance for the visit with all of the documentation that the referral included, including any imaging. I, as any other good physician, start by taking a very good history. One of the unique things about my specialty is I have a lot of diagnostic tools at my disposal that I can use in clinic to properly examine the area of concern. So, for example, if someone comes in with an earache, I have microscopes that allow me to use binocular vision to look at the middle ear and the ear canal. Similarly, if someone comes in with a throat ache or a change in voice, I have special endoscopes that are incredibly high definition that can give me a diagnostic ability that most other doctors don't have at their disposal.

And so the visit usually, like I said, takes between 30 to 45 minutes if it's a new patient. And I try very hard to collaborate with the patient to determine what might be the best treatment plan, mixing my expertise with their goals for care.

Maggie McKay: Dr. Clarke, do ENTs also take care of allergies? Because I was surprised, I went to an allergist for the first time and he was an ENT.

Dr. Bhavishya Clark: So within ENT, there is a very large wing of us who focus our efforts on allergy and sinus care. Some are fellowship trained to do this and allergy care can be delivered through an ENT's office, everything from skin testing to immunotherapy or what we commonly think of allergy shots. In the central coast, this is something that I think would be a wonderful addition to how we deliver ENT care, because accessibility to that care is a limitation in some ways.

The other thing that an allergist also manages besides allergies, which not all ENTs also touch on, is things such as asthma and other pro-inflammatory conditions. And so, we don't exactly replicate what an allergist does, but at least in relation to the head or neck, we do have some overlap with them.

Maggie McKay: And what's the most common reason people visit ENT specialists?

Dr. Bhavishya Clark: That's a good question. Usually, feeling a frog stuck in their throat seems to be the common thing, but it changes based on the season. You know, in the winter months, I get a lot of throat pain and colds and sinus complaints. And in the summertime, it tends to be, you know, things that people have put off until the holidays when they can take the time off. And so, there is a seasonality to my complaint.

Maggie McKay: Is there anything else you'd like to tell our listeners, take-away from this conversation?

Dr. Bhavishya Clark: Yeah, I'd like to encourage all of your listeners to seek care when they notice a new lump or bump in their head or neck area, especially as an adult. I also want to put it out there that I, as every other doctor, would encourage those who smoke and drink to work with their primary to cut back on these modifiable risk factors for head and neck cancer. And then, finally, to wear sunscreen, since we touched on the topic of skin cancer.

Maggie McKay: Thank you so much for sharing your knowledge, Dr. Clarke. It was so useful and educational. We really appreciate having, you know, this new information to go forward with.

Dr. Bhavishya Clark: Thank you. I appreciated being here and I appreciate the opportunity.

Maggie McKay: That was ENT, Dr. Bhavishya Clarke.

Dr. Bhavishya Clark: Thanks for checking out this episode of Healthy Conversations.

For more information and to listen to all of our podcasts, visit Adventist Health dot ORG . . . slash . . . Central  Coast  Podcast.

Disclaimer: This program is a community service and is not intended to be a substitute for medical advice. Listeners having questions about their health should make an appointment to see their personal physician. Any opinions or statements made during the program are those of the individuals or physicians making the statements and are not the opinions or statements of the hospital.