At Richmond ENT, we take pride in performing a comprehensive history and specialty specific examination, so that we can provide an integrated approach to ear, nose and throat disorders. All new patients will be asked to provide a complete medical history on the first visit. After your first visit, you will receive an invitation to join our secure web portal, so that we have a way of securely contacting you with test results and follow-up appointments.
The most common services that we might provide on the first visit are:
Please be aware that your co-payment for an office visit applies to the ENT history and examination, but does not include any of the additional diagnostic tests listed above. These tests are billed separately to your insurance company and you may be responsible for a portion or all of these charges.
A complete ENT examination includes inspection of the face, ears, nose, throat and neck. We generally screen for hearing loss and we use pressure testing to examine the eardrum for fluid (pneumatic otoscopy or tympanometry). The specialty nasal examination is usually performed with a headlight or mirror and a handheld speculum that allows us to examine the nasal septum and turbinates closely. The nose will often be examined before and after application of a decongestant nose spray. The most unique part of the ENT visit is an examination of the voice box and the back of the nose using hand-held mirrors in the mouth. Examination of the neck is performed with care and includes the lymph nodes, salivary glands and thyroid gland. Examination of overall health and the cardiopulmonary system concludes the routine examination. The ear, nose and throat examination is not generally painful, although some patients find that examining the mouth makes them gag.
Audiometric testing is commonly performed for patients with complaints of hearing loss, ringing in the ears, or balance disorders. The otoacoustic emissions test (OAE) is a pass-fail screening test for normal hearing. This 5-second test requires a quiet room, but no response from the patient, and is routinely used for screening newborns in the nursery. Patients who are cooperative enough to follow instructions can be more precisely tested in our acoustically isolated testing booth. The audiologist records the quietest sounds you can hear at each frequency, in each ear. The resulting graph is called an audiogram. Tympanometry is a quick and painless way to measure the barometric pressure in the middle ear and to assess fluid behind the eardrum in small children.
Nasal endoscopy is the most commonly performed diagnostic procedure in patients with nasal, sinus, or allergy complaints. The nurse will spray your nose with a decongestant combined with lidocaine, a local anesthetic. The physician or nurse practitioner will then pass a small telescope into the nostril to obtain a magnified view. We can readily identify abnormal swelling, enlarged turbinates, nasal polyps, septal deformities, and sinus drainage. We are generally well equipped to culture abnormal secretions or to biopsy abnormal findings. If you have complaints in the throat, such as hoarseness or swallowing difficulty, we may use a flexible scope so that we can examine the back of the throat and voice box through the nose. This is especially helpful for patients who have difficulty sitting still for the mirror examination. We even have an endoscope long enough to pass all the way down the esophagus, into the stomach if necessary, the procedure called trans-nasal endoscopy. In most cases, we have the opportunity to display the endoscopic image on a television monitor, so that you can better understand your condition.
Allergy testing is most commonly recommended for patients who are not satisfied with medical management of their allergies, and those with asthma or nasal polyps. Superficial skin pricks and injections under the skin are performed with common airborne antigens and foods to determine your sensitivity to the environment and to calculate a safe starting dose for immunotherapy.
CT scans of the sinuses and middle ear can be performed in our office and immediately interpreted by your physician. Richmond ENT is the first medical practice in central Virginia to offer this service, as an alternative to scheduling a separate appointment at a radiology center and then returning several days later to discuss the results. The Xoran MiniCAT scanner exposes you to 80-90% less radiation than full-size scanners at a hospital, and results are available in 60 seconds.
Cultures, biopsies, and blood work are generally sent to a reference laboratory. Results may take up to 1 week to be returned to our office. It is our absolute policy to review every laboratory test result, and to contact you with your test results. Should you fail to hear from us within 7 days, please call the office at 804-622-3782.