Modern ENT Surgery: What Every Patient Should Know

Leading ENT surgeon at the VIRTUS Institute, Dmytro Pylypiuk, discusses current approaches in otolaryngology and key aspects patients should know before consultation or treatment.

What is the difference between an ENT therapist and an ENT surgeon?

Both specialists treat diseases of the ear, throat, and nose, but their scope of practice differs. An ENT therapist primarily focuses on medical (conservative) treatment. An ENT surgeon, in addition to therapeutic knowledge, specializes in surgical treatment methods and can determine when surgery is the most effective option. The best outcomes are achieved when both specialists work as a team and follow modern clinical guidelines.

Does an ENT surgeon always recommend surgery?

The main goal of an ENT surgeon during a consultation is to determine whether surgery is truly necessary. The doctor evaluates the patient’s complaints, examination results, and, if needed, analyzes CT scans, reviews the medical history, and only then develops a treatment plan. In some cases, non-surgical (conservative) treatment options are available. If they can provide a good outcome, surgery is not required. At the same time, there are urgent conditions when a decision must be made immediately. In such situations, a surgical intervention may be crucial for the patient’s health or even life.

Why is surgery sometimes recommended too early and sometimes too late?

Medicine is constantly evolving. What was considered the correct approach a few years ago may be revised today due to new research. That is why a doctor must continuously update their knowledge, follow international guidelines, read current scientific literature, and participate in professional conferences.

Without this, two extremes may occur:

• performing surgery in cases where modern approaches already allow successful non-surgical treatment;
• prolonged medical treatment in situations where it is no longer effective and surgery is the only appropriate solution.

It is important to evaluate each patient’s situation individually.

Can nasal decongestant drops be used for years?

A fairly common situation is when a person uses nasal decongestant drops for years without even knowing the true cause of their breathing difficulty. The problem is that these medications do not address the underlying condition. Impaired nasal breathing may be caused by:

• a deviated nasal septum;
• chronic inflammation;
• polyps;
• allergies;
• tumors;
• other nasal cavity diseases.

In some cases, drops only provide temporary symptom relief but do not treat the disease itself. If the cause is anatomical, medication will not provide a lasting result. With long-term use of decongestants, a full medical evaluation is necessary.

Why can the same surgery produce different outcomes?

The name of a surgical procedure does not always reflect its quality. For example, in chronic polypoid rhinosinusitis, different surgeons may perform procedures with the same name. However, modern endoscopic surgery allows for much more precise work in hard-to-reach areas of the nose and paranasal sinuses, better control during the operation, and more effective outcomes. Therefore, it is important to consider not only the name of the procedure, but also the surgical technique, the clinic’s equipment, and the surgeon’s experience.

Is it true that adenoids can grow back after surgery?

The outcome largely depends on the surgical technique and the surgeon’s experience. If the adenoid tissue is completely removed, regrowth does not occur. That is why adenotomy performed according to modern standards effectively resolves the problem without recurrence of the condition.

How long does a consultation with an ENT surgeon last?

A consultation may last about 30 minutes, even if the diagnosis becomes clear at the beginning of the appointment. In reality, making a diagnosis is only part of the work. The doctor must:

• thoroughly evaluate examination results;
• explain the cause of the condition;
• describe all possible treatment options;
• discuss different possible scenarios;
• explain the details of surgery, if it is needed;
• describe the postoperative period;
• explain potential risks and complications;
• answer all patient questions.

Sometimes even half an hour is not enough, especially in cases involving complex surgical procedures. Modern medicine is increasingly based on a partnership model between doctor and patient. A person should understand what exactly will happen, why a particular treatment method is proposed, and what possible outcomes may be.

What is a complex surgery in ENT (otolaryngology)?

Complex ENT surgeries, such as endoscopic interventions at the skull base or a transsphenoidal approach to the pituitary gland, consist of multiple sequential steps. Certain stages are specific to skull base surgery — for example, opening the skull base, creating a vascularized mucosal flap, and subsequent reconstruction of the defect. If a standard procedure may include only a few main steps, complex surgeries involve many more, often significantly increasing the level of precision and coordination required.

What qualities should a modern ENT surgeon have?

Modern medicine is developing so rapidly that a good doctor must be in a constant process of learning. The most important qualities include:

• English language proficiency — most modern scientific research, clinical guidelines, and international treatment protocols are published in English;
• Continuous professional development — a doctor must regularly update knowledge and learn new technologies and treatment methods;
• Critical thinking — it is not enough to read new information; it must be analyzed, its scientific quality assessed, and applied only when it truly benefits the patient.

A good otolaryngologist does not aim to operate at any cost. Their task is to determine the most effective treatment method for each individual case, honestly explain all available options, discuss benefits and risks, and help the patient make an informed decision.