Office Based Rhinology
with Dr. Scott Fortune
BackTable, LLC (Producer). (2021, March 16). Ep. 18 – Office Based Rhinology [Audio podcast]. Retrieved from https://www.backtable.com/ent
Dr. Scott Fortune talks with us about how he built an Office Based Rhinology practice (now a Center of Excellence), including a how-to on safely performing procedures in the office.
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Dr. Scott Fortune
Dr. Scott Fortune is a practicing physician with Allergy & ENT Associates in Nashville, Tennesee.
Dr. Gopi Shah
Host Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.
Dr. Ashley Agan
Co-host Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.
In this episode, Dr. Scott Fortune joins Dr. Gopi Shah and Dr. Ashley Agan to discuss office-based rhinology procedures.
Dr. Fortune provides an overview of the procedures he performs in the office setting. He outlines the pre-procedure evaluation of patients including the use of validated clinical questionnaires (i.e. SNOT, NOSE scores etc..), a thorough history and physical exam, and necessary imaging studies. Once a full workup has been completed, the severity of disease is assessed as in-office procedures are tailored towards mild- to moderate-severity disease.
Dr. Fortune emphasizes that proper anesthesia is the most important factor in ensuring a successful in-office procedure. He goes into depth on the pre-, intra-, and post-operative anesthesia considerations for different procedures and patient comorbidities and reviews his own anesthesia protocol.
Lastly, Dr. Fortune discusses the logistical factors including equipment, procedure room set-up, staff training, and scheduling. He also describes the peer-to-peer training opportunities that he provides at his practice for other physicians interested in learning about in-office procedures.
Dr. Fortune’s Email Address: firstname.lastname@example.org
Dr. Fortune’s Twitter Handle: @DrScottFortune
American Academy of Otolaryngology Head and Neck Surgery FLEX Curriculum:
[Scott Fortune MD]
I would recommend considering your first step is treating those patients with chronic rhinitis. We all have the patient that walks into our office with the drippy nose that doesn't seem to respond to any medications and it's socially embarrassing. Their nose runs when they sit down to eat. They've always got the handkerchief. You know the type I'm talking about, I'm certain. There's a little relief you can provide for those folks with nasal sprays, especially ipratropium petroleum seems to be helpful. It's actually predictive of who might respond to treatment for chronic rhinitis.
If the patient has a positive response to the ipratropium and doesn't want to use medication for a long period of time, that they're probably a good candidate for treatment of chronic rhinitis. You've basically got two options there. They're the opposites of one another. You can cool it down or you can heat it up. You can offer cryotherapy or you can offer radiofrequency ablation. Both of those have been shown in studies to be safe and effective. The percentage responses in those studies are typically above 70%. A good rule of thumb for procedures for chronic rhinitis is that about four out of five are going to improve and improve, for some, means they don't need the nasal spray, but it's important to set a good expectation for patients.
Some will still need the nasal spray even though they don't need it as much and that's a nice subtle distinction to make for your patient, but let's just assume that you've done the workup, you've provided that prescription. They've come back and they've said, "Yeah, I improved a little bit on the ipratropium, but I don't want to use this medication for the next months, years, my life, whatever." Then you might offer to them a procedure to try to minimize that. Chronic rhinitis is a good starting point because there's not a lot of equipment needs and the procedures are fairly straightforward.
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