ENTs: Common Reasons for Referral


An ENT, or otolaryngologist, is a specialized doctor who focuses on the health and function of the ears, nose and throat. This includes everything from airway development to tongue-ties, chronic respiratory infections, vocal nodules, hearing loss, and enlarged tonsils and adenoids. ENTs are an integral part of interdisciplinary teams that support healthy speech, language, facial and airway development in children and adults.

“Red Flags” that often Warrant ENT Referral

  • enlarged tonsils and/or adenoids
  • chronic mouth breathing
  • chronic ear infections
  • chronic respiratory infections
  • signs and symptoms of asthma (if currently untreated)
  • persistent gravel vocal quality, strained vocal quality
  • history of vocal abuse
  • hypernasal and/or hyponasal vocal quality
  • symptoms of sleep-disordered breathing
  • symptoms of hearing impairment

Enlarged Tonsil and Adenoids

A child’s airway development is fundamental to a well-developed face and high-functioning speech mechanism. When a child’s tonsils and adenoids are enlarged, many problems arise. Enlarged tonsils and/or adenoids often result in an occluded airway that forces a child to mouth breathe versus nasal breathe. Studies have shown that mouth breathing is correlated with significant changes to the face and mouth, including a high and narrow palate, low oral rest tongue posture and a narrowing airway. Stanford Sleep Medicine research has shown correlations between these symptoms and sleep-disordered breathing problems, including pediatric obstructive sleep apnea.

Chronic Ear Infections, Wax Build Up and Hearing Loss

Hearing is essential to audibly learning and effectively speaking any language. In English, many speech sounds occur at a high frequency (/k/, /f/, “th,”/s/). If a child’s hearing is impaired, it can significantly impact the ability to identify and use speech sounds foundational to the English language. Hearing impairment has been correlated with delayed language acquisition and speech and language disorders. ENTs play a major role in identifying hearing impairment. Annual hearing exams and evaluations for chronic ear infections and wax build-up are essential, as these conditions result in hearing impairment. I have watched children make leaps and bounds in speech and language acquisition after remediation of chronic ear infections (whether tubes or pharmaceutical intervention) and wax removal intervention.

Interdisciplinary Teaming to Treat the Whole Patient

Thus, ENTs are a very important part of providing patients with effective care. For speech and language therapy and Orofacial Myofunctional Therapy to be effective, a child needs an open airway and the ability to hear speech sounds. All of the Myofunctional Therapy in the world will not resolve mouth breathing if a patient’s tonsils and adenoids are so swollen they cannot nasal breathe.  Similarly, intensive speech therapy will not resolve high frequency speech sound production errors if a child has chronic ear infections that are not treated. Interdisciplinary teaming is a huge part of my practice, as I am passionate about treating the whole patient. I am committed to making the proper referrals to effectively address a patient’s root issues and support patients in their journeys towards greater wellness.