ENT FAQs

An otolaryngologist — commonly referred to as an ENT surgeon — is a specialist surgeon trained in the diagnosis and surgical management of conditions affecting the ear, nose, throat, head, and neck. In Australia, specialist registration requires completion of medicine followed by six or more years of advanced surgical training through the Royal Australasian College of Surgeons, leading to the FRACS credential.

Otolaryngology is one of the broadest surgical specialties, covering everything from a child’s ear infection through to sinus surgery, hearing loss, nasal airway obstruction, and head and neck cancer. Many otolaryngologists further subspecialise in rhinology, otology, facial plastic surgery, or head and neck oncology.

Dr Roth sees both paediatric and adult patients with general ENT conditions alongside his subspecialty practice in rhinoplasty and facial plastic surgery. Conditions he treats include:

• Nose and sinuses: Deviated nasal septum, turbinate hypertrophy, nasal valve collapse, chronic sinusitis, nasal polyps, nasal obstruction
• Ear: Ear infections, glue ear, perforated eardrum, hearing loss, grommet insertion, myringoplasty
• Throat and tonsils: Recurrent tonsillitis, adenoid problems, obstructive sleep symptoms, pharyngeal pouch
• Paediatric ENT: Ear infections, glue ear, grommets, tonsils and adenoids, nasal obstruction in children
• Facial plastic surgery: Rhinoplasty, deep plane facelift, neck lift, blepharoplasty, brow lift

Dr Roth does not manage head and neck cancer, laryngeal disorders, or cochlear implantation — patients with these concerns should be directed to a specialist centre.

Yes. Dr Roth sees paediatric patients with general ENT conditions — including ear infections, glue ear, grommets, recurrent tonsillitis, and nasal obstruction — as well as adults. Complex paediatric cases or those requiring paediatric hospital facilities may require referral to a dedicated paediatric ENT centre.

A deviated nasal septum is one that deviates significantly to one side, and is one of the most common causes of nasal airway obstruction in adults. A mild deviation is essentially universal; only significant deviations that cause meaningful nasal obstruction warrant surgical consideration.

Surgery to straighten the septum is called a septoplasty. It is performed under general anaesthesia as a day procedure in most cases. Whether septoplasty is indicated depends on the degree of obstruction, the impact on quality of life, and whether conservative measures have provided adequate relief.

Functional endoscopic sinus surgery (FESS) is a minimally invasive surgical procedure performed through the nostrils using a telescope and fine instruments, with no external incisions. It is used to treat chronic sinusitis, recurrent acute sinusitis, and nasal polyps that have not responded adequately to medical treatment. FESS opens the natural drainage pathways of the sinuses and allows topical medications to reach the affected sinuses more effectively after surgery.

FESS is typically performed under general anaesthesia as a day procedure. Recovery involves a period of nasal congestion and discharge lasting one to two weeks, followed by regular post-operative endoscopic reviews to clear crusting and assess healing.

Nasal polyps are benign, non-cancerous swellings of the nasal and sinus mucous membrane that grow from areas of chronic inflammation. They are associated with chronic rhinosinusitis, allergic rhinitis, aspirin sensitivity, and asthma. They cause nasal obstruction, loss of smell, and post-nasal drip. They are not a sign of cancer.

First-line treatment is medical — typically oral corticosteroids to shrink the polyps, followed by ongoing intranasal corticosteroid sprays. When polyps recur despite adequate medical treatment, FESS is appropriate. Polyps have a tendency to recur after surgery, and ongoing medical management is required to maintain the surgical result.

Septoplasty is a purely functional procedure — it corrects the internal structure of the nasal septum to improve airflow, without altering the external appearance of the nose. It is performed entirely through the nostrils with no external incisions and no visible change to the nose’s shape. It is a Medicare-rebatable procedure when clinical criteria are met (item 45641).

Rhinoplasty is surgery to alter the shape, size, or structure of the nose — it may be cosmetic, functional, or both. When septoplasty is combined with cosmetic or structural changes to the external nose, the combined procedure is called a septorhinoplasty. The functional component may attract a Medicare rebate; the cosmetic component does not.

Yes — nasal obstruction surgery performed for functional indications is covered by Medicare when the appropriate clinical criteria are met. Relevant Medicare item numbers include item 45617 (turbinate reduction), item 45641 (septoplasty), and item numbers in the 45622–45651 range for FESS procedures depending on the extent of surgery. A GP referral to a Specialist Otolaryngologist is required for Medicare rebates to apply.

Grommets (ventilation tubes) are small tubes inserted through the eardrum under general anaesthesia to ventilate the middle ear, bypassing a Eustachian tube that is not functioning normally. They are the most commonly performed surgical procedure in children in Australia.

Standard indications include: persistent bilateral glue ear with documented hearing loss lasting three months or more (particularly where there is impact on speech or learning); and recurrent acute otitis media (typically three or more episodes in six months). Most standard grommets extrude spontaneously within twelve to eighteen months.

Glue ear (otitis media with effusion) is thick non-infected fluid in the middle ear, causing a conductive hearing loss typically in the mild to moderate range. It is the most common cause of hearing loss in children. It is self-limiting in the majority of cases and resolves spontaneously within three months.

Persistent bilateral glue ear with documented hearing loss for three or more months, particularly when affecting speech development or learning, is the standard threshold for ENT referral and consideration of grommet insertion. When appropriately treated, glue ear does not typically cause permanent hearing loss.

ENT referral is appropriate when:

• Infections are recurrent — typically three or more in six months, or four or more in twelve months
• The child has persistent fluid behind the eardrum (glue ear) and associated hearing loss
• Concerns exist about speech development, language acquisition, or school performance
• Recurrent infections are causing significant antibiotic use or parental concern
• A complication of ear infection occurs — perforation, mastoiditis, or facial nerve weakness

A GP referral is recommended and enables a Medicare rebate on the specialist consultation fee.

The principal indications for tonsillectomy include:

• Recurrent tonsillitis — the standard threshold is seven or more episodes in one year, five or more per year for two consecutive years, or three or more per year for three consecutive years
• Obstructive symptoms — tonsillar hypertrophy causing significant obstruction to breathing or obstructive sleep apnoea in children
• Peritonsillar abscess — recurrent quinsy is a standard indication
• Suspected neoplasm

Tonsillectomy in adults carries a higher complication rate — particularly post-operative bleeding — than in children. This is discussed in full at consultation.

Yes, heavy snoring in a child warrants ENT assessment. Primary snoring without obstructive episodes is usually benign, but obstructive sleep apnoea — in which the airway partially or fully collapses during sleep — is significantly more serious. In children, the most common cause of obstructive sleep apnoea is tonsillar and adenoid hypertrophy, which is surgically treatable.

Signs that make ENT assessment more pressing include: witnessed breathing pauses during sleep; significant gasping or choking; restless sleep; daytime tiredness; behavioural changes or concentration difficulties; and bed-wetting in an older child who was previously dry.

Dr Roth consults from Suite 4205, Level 2, 834 Pittwater Road, Dee Why NSW 2099, on Sydney’s Northern Beaches. The practice telephone number is (02) 9982 3439.

Dr Roth performs surgery at the following accredited private hospitals and surgical facilities in Sydney:

• North Shore Private Hospital — rhinoplasty, facelift and neck lift, sinus surgery, and ENT procedures
• Castlecrag Private Hospital — rhinoplasty, facelift and neck lift, sinus surgery, and ENT procedures; Dr Roth serves as Head of the Otolaryngology Department
• Wyvern Private Hospital — rhinoplasty, facelift and neck lift, and ENT procedures
• Pittwater Day Surgery — day-case ENT procedures including grommets, tonsillectomy, adenoidectomy, and selected nasal procedures

A GP referral is strongly recommended. Dr Roth is a Specialist Otolaryngologist, and a referral from a GP or another specialist enables a Medicare rebate on the consultation fee. Without a referral, the full consultation fee applies without any Medicare offset.

A referral is straightforward to obtain from your GP for both general ENT problems and for rhinoplasty or facial plastic surgery consultations.

No. Dr Roth does not bulk bill. A consultation fee applies, and a Medicare rebate is available for patients who present with a valid GP or specialist referral. The out-of-pocket gap depends on the type and length of consultation. Fee information is available from the practice on (02) 9982 3439.

Yes. While Dr Roth’s practice is located in Dee Why on Sydney’s Northern Beaches, patients travel from across Sydney, interstate, and occasionally internationally — particularly for rhinoplasty, deep plane facelift, and complex ENT procedures. Patients from outside Sydney are welcome to contact the practice to discuss appointment logistics.

Yes. Patients seeking a second opinion on a previous ENT diagnosis, surgical recommendation, or treatment plan are welcome to consult with Dr Roth. A GP referral is recommended to enable the Medicare rebate. Copies of relevant investigations — CT scans, audiograms, previous surgical reports — are useful to bring to the appointment.

For urgent clinical concerns — such as sudden hearing loss, a suspected peritonsillar abscess, a rapidly enlarging neck lump, or significant nosebleed — telephone the practice on (02) 9982 3439 and advise the nature of the concern. Sudden sensorineural hearing loss in particular is a time-sensitive condition where prompt treatment significantly affects the chance of hearing recovery. For after-hours emergencies, attend the emergency department of your nearest hospital.