Should I See an ENT Doctor For A Broken Nose? And Can I Without a Referral from a Family Doctor?

Question

My nose recently changed shape (huge dorsal hump) in grade 9 after playing tons of sports and being hit in the face with volleyballs (spiked) and basketballs. Today, I feel as if i have trouble getting maximum airflow, especially when I sleep. However, i visited my family doctor and she said nothing is wrong with my nose. Despite this, while I was taking x-rays the x-ray doctor and many other people who have seen me think that I have broken it. In the x-ray the top nasal bone was also crooked.

Babak Larian, MD · Answer

Yes you should see an ENT.  Your insurence dictates if you are required to see a primary care doctor before a specialist, that is usually the difference between an HMO and PPO.

Aaron Stone, MD · Answer

I am curious why you and your family doctor have such a different assessment of the situation. To be fully evaluated you will need to see an ENT or plastic surgeon. One of these is not inherently better than the other. I have had to do revisions of some ENT nasal surgery & I am sure some ENTs have done revisions of plastic surgeons' patients. That is the nature of nasal surgery.

	The question then is what type of health insurance do you have and is your family doctor financially de-incentivized from making referrals to specialists. If that is the case and you make an end run around your family doctor your insurance may not cover the consultation with the specialist or the surgery. In that case your best bet is to change your insurance first-get a different policy with a different company.

	My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Anita Mandal, MD · Answer

What is most important is that you see a plastic surgeon or ENT specialist who performs a high volume of rhinoplasty procedures that include treatment of the function of the nose. Many facial plastic surgeons as well as ENT specialists may qualify but be sure they will treat the inside functionality of your nose as well. I would recommend viewing lots of before and after photos of your plastic surgeon to be sure you like their work before making a final decision as every surgeon has their own preferences.

Joseph Shvidler, MD · Answer

Evaluation by an Otolaryngologist or an ear, nose, throat specialist (ENT) would be most beneficial. Most facial plastic surgeons also dedicate 5-6 years of training in the area of the nose in addition to other areas in head and neck. They have a profound understanding of the function and aesthetics of the nose. In addition you may have signs and symptoms of obstructive sleep apnea and ENT doctors are well trained in evaluation and management of this condition. You may have more serious injury to the underlying cartilages than you think, which can cause nighttime as well as daytime symptoms. Evaluation by an experienced rhinoplasty surgeon is advised.

Michael G. Brandt, MD · Answer

If you're having trouble breathing you should certainly see an ENT or a Facial Plastic Surgeon.  Facial Plastic Surgeons are Otolaryngologists/ENTs who have done extra training in Facial Plastic Surgery.

	Without examining you, it's difficult to comment on whether you have had any previous fractures nor give you definite recommendations.  If you have some findings that could be improved through surgery then this could be done by an Otolaryngologist or a Facial Plastic Surgeon.  In Ontario, if you'd like your nose treated under OHIP then you'll need to have a referral from your family doctor.  This referral can be made to the provider of your choice. If your doctor suggests a septorhinoplasty (nose job) would give you the most benefit, then its up to OHIP to decide if they will approve (pay for) your procedure.  This is based on a report your doctor sends to them and typically requires photographs and a nasal airflow study proving that you have a functional nasal problem that could be improved through nasal surgery.  If OHIP does approve of your surgery, this typically would not include any cosmetic changes to your nose.  That being said, some providers can work with you to include some cosmetic changes (while they are there) for an aesthetic fee.

	If the aesthetic appearance of your nose is what you are really hoping to have corrected, you can make your own referral with the provider of your choice.  Typically, cosmetic referrals have an associated cost - but this is up to the individual provider.  You can then work with your provider to come up with a surgical goal (for both the breathing and the aesthetic changes) that is attainable and will make you happy.

	All the best.

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