Should I see an ENT or allergist?

If you’re experiencing seasonal allergies, you might consider seeing an otolaryngologist (ENT) for treatment. Or maybe you’re wondering if an allergist would be a better choice. Because there is some overlap in the conditions these two types of healthcare providers treat, deciding which one to visit can be confusing.

While allergists are trained in allergy diagnosis, treatment, and prevention, ENTs are trained to treat medical issues occurring in the head, throat, ear, nose, and neck—and may or may not have experience with allergies. Here’s how to determine if you should see an ENT or allergist and what to expect from your appointment.

What’s the difference between an allergist and an ENT?

Maybe you’re wondering, should I see an ENT or allergist? While there are a few similarities between allergists and ENTs—for example, both types of medical professionals diagnose and treat allergies—there are a few important differences. 

Maybe you have symptoms that could be allergies, like sneezing, runny nose, congestion, and watery eyes. Should you see an allergist first, or should you go with an ENT? “It is not wrong to start at either place,” says Inna Husain, MD, a board-certified otolaryngologist at Community Healthcare System in Indiana.

An ENT is a surgical sub-specialist who treats chronic medical conditions of the head, neck, ears, nose, and throat ranging from mild (like asthma and ear infections) to severe (such as head and neck cancer). ENTs perform surgical procedures, allergists do not. ENTs are better suited to identify and treat anatomical issues—such as nasal polyps or septal deviation—that could be causing your symptoms, says Dr. Husain.

An allergist, or immunologist, is a specialist who is trained to diagnose and manage asthma, allergies, and other problems with the immune system. If your symptoms are consistent with seasonal allergies, food allergies, recurrent hives or swelling (even in the mouth), it’s a good idea to start with an allergist, Dr. Husain says. That’s because they’re specifically trained to manage such immune system reactions. Both allergists and ENTs can perform allergy testing and administer immunotherapy, but not all ENT practices do so, says Dr. Husain.

What does an ENT do?

Otolaryngology (ENT) is the medical and surgical management of disorders related to the ear, nose, and throat, says Dr. Husain. You might see an ENT if you have chronic issues with these structures. 

According to the American Academy of Otolaryngology–Head and Neck Surgery, ENTs diagnose and treat conditions such as sinusitis, hearing loss, chronic ear disease, allergies, swallowing disorders, hoarseness, snoring, sleep apnea, nosebleeds, dizziness, and head and neck tumors. They are also able to perform surgeries of the head and neck. An ENT might also perform the following tests.

Hearing tests

• Tympanometry tests for pressure changes in the ear to determine how well your eardrum moves. It helps diagnose hearing loss related to the middle ear.
• Pure tone audiometry uses a series of tones and vibrations to test how well you can hear.
• Evoked potential (EP), or auditory brainstem response, helps diagnose hearing loss through the use of electrodes to record the brain’s response to sound.

Throat and voice tests

• Barium swallow tests are performed when patients have dysphagia, or difficulty swallowing, to help determine what is causing the issue.
• Biopsy involves taking a small sample of cells or tissue from the mouth, nose, larynx, throat, or other areas of the head and neck to determine whether an abnormal mass or growth is benign or cancerous.
• Laryngoscopy is a test that examines the back of your throat and voice box using a scope to diagnose conditions in these areas. A nasolaryngoscopy also examines the nasal passages as well.
• Laryngeal electromyography (EMG) identifies nerve problems by using electrodes to determine if the muscles in the vocal cords are functioning properly.
• Stroboscopy is performed on patients with a hoarse voice; it uses light and a camera to examine how the vocal cords vibrate during speech.

Nose and sinus tests

• Nasal endoscopy uses a thin, flexible tube called an endoscope to examine the nasal and sinus passages in order to diagnose and treat problems with these structures.
• Sinus computed tomography (CT) scans are performed to evaluate the sinus cavities.  

What does an allergist do?

Allergists are internal medicine physicians and/or pediatricians with additional training in  allergic and immunologic disorders of the entire body including nose, throat, lungs, skin, and gastrointestinal system, says Abeer Siddiqi, MD, an allergist and immunologist at Houston ENT & Allergy in Houston, Texas. Their specialty is to identify and treat asthma, allergies and allergic disorders, and primary immunodeficiency disorders. 

According to Dr. Siddiqi, allergists commonly treat allergic rhinitis, allergic sinusitis, allergic conjunctivitis, asthma, seasonal allergies, hay fever, food allergies and intolerances, drug allergies, and intolerances, immunodeficiencies, and recurrent infections. They provide medicine-based treatment options as well as immunotherapy and biologic medications (which target the immune system), she says. 

An allergist can conduct several types of allergy tests, including:

• Skin prick test: A thin needle is used to prick the skin on the forearm or back; each prick contains a different allergen (of which there can be 10-50). A reaction to triggers typically occurs within 15 minutes.
• Intradermal test: Small amounts of an allergen are injected into the outer layer of the skin, or epidermis to see if a reaction occurs.
• Patch test: An allergen is placed directly on the skin and covered with a bandage for 48-96 hours, after which a provider will check for a skin reaction.
• Blood (IgE) test: A blood sample is sent to a lab to measure levels of IgE antibodies, which are produced by the immune system in response to allergens.
• Challenge test: Performed under an allergist’s close supervision due to the risk of anaphylaxis, small amounts of suspected food or drug allergens are swallowed by the patient.

These tests identify triggers including environmental allergens including mites, pets, pollen, mold, or food allergens, medications, and other chemicals found in personal care products, and adhesives and metals, says Dr. Siddiqi. 

RELATED: Do allergy shots work? | Allergy testing for kids

What to expect from your ENT or allergist appointment

If your appointment is with an ENT, and you’re coming in with complaints related to the nose, your full exam may include a nasal endoscopy; if your issue is throat related, a laryngoscopy may be performed, says Dr. Husain, adding that imaging tests of the sinuses or throat may also be ordered. For issues related to the ear, hearing tests will likely be done, she says. And if allergies are suspected, you may undergo skin or blood tests—or receive a referral to an allergist.

At an allergist appointment, expect a thorough medical interview followed by a focused physical examination, says Dr. Siddiqi. If appropriate, allergy testing will be performed, and your provider will discuss an individualized treatment plan that includes various modalities such as immunotherapy or biologic agents. 

According to Dr. Husain, your provider may ask the following questions:

• How long have your symptoms been present? 
• Do your symptoms come and go or are they progressive? 
• Is there associated pain or bleeding? 
• Are you experiencing any facial weakness/numbness? 
• How is your sense of smell? 
• Do you have any history of nasal or head and neck surgery? 
• Do you have any history of smoking or vaping history (including marijuana)? 

Patients may consider asking their provider:

• What do you see on my exam?
• What do you think is causing my symptoms?
• Is this condition chronic or self-resolving?
• What are all my treatment options? 
• What will happen if I decide against treatment?

Allergists and ENTs work closely together to provide patients with the best care and outcomes for their condition, says Dr. Siddiqi. 

Cost of an ENT or allergist visit

The cost of your visit depends on your specific insurance coverage and location. And because both ENTs and allergists are specialists, you may be required to obtain a referral from your primary care provider, so be sure to check with your insurance provider before making an appointment.

If you are prescribed medications to manage your condition (such as Singulair, Flovent HFA, or prednisone), be sure to use a SingleCare coupon to save at the pharmacy.