Author Topic: ENT or Neurosurgeon?  (Read 4111 times)

clr

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ENT or Neurosurgeon?
« on: August 12, 2009, 11:50:25 am »
Who did you see more of following your surgery? The ENT or neurosurgeon?  I find it a little bit strange that we always have an appointment with the neurosurgeon and very rarely do we have one with her ENT.

When we were first told about Betsy's (Bets, username here) AN, within a few hours we were at the ENT Institute in Pittsburgh. The ENT dr. that we met with had also called in a neurosurgeon to meet with us. So, we met with both the ENT and neurosurgeon at the same time to go over what they thought would be best, etc.

In between her surgeries 99% of the time we are meeting with the neurosurgeon.  When does the ENT come into play?  I do know though if she is to have the cyberknife done, it will be done by the ENT but we rarely even see him.

She has no hearing in her left ear, her eye bothers her, and she has facial paralysis. I find it odd that we never (almost never) have appointments with her ENT. 

Is this normal?

Thanks for your time!

I do not have an AN, my 23 yo daughter does. Her username here is Bets.
4.6cm x 3.6cm x 4.4cm  UPMC Retrosigmoid 12/29/2009, 01/19/2009, 06/22/2009 
CK Oct 2009, Dr. Hirsch
SSD before & after surgery
After 3 surgeries, some facial paralysis, but will come back

Sue

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Re: ENT or Neurosurgeon?
« Reply #1 on: August 12, 2009, 01:02:42 pm »
There are E-N-T's - Ear Nose and Throat specialists, who do a lot of things involving the ear, head, throat, etc...but, as  you know,  most do not do the microsurgery necessary to fixing an AN.  You would have to find an ENT that specializes in that kind of surgery.  Not all do.  My ENT never even diagnosed me.  He was much more interested in allergies and actually left the Vancouver clinic to go out on his own with an allergy clinic.  I was diagnosed by a neurologist, and then sent to the neurosurgeons and no ENT was ever involved in my treatment and I never saw the neurologist again either.  Surgery on AN's are done by neurosurgeons alone or together with an otolaryngologist, maybe, depending on the ENT I guess.    Even though  you may have seen the ENT first, s/he has now taken your case to a higher court, as it were, and the neurosurgeon, who is responsible for all of the surgical expertise now is the go-to guy.  I called up my ENT's office some time after all of my treatments and asked, "Am I supposed to come back to you guys again?  Are you interested in seeing me for anything?"  They kind of hemmed and hawed and said, "Sure, that would be okay to do a follow up - (which wasn't much).  Yeah, you are mostly deaf in one ear. Can you afford a $3000 hearing aid? No?  Okay, bye."

Your wife's cyberknife, would also be a team effort.  Usually a radiation oncologist has a lot to do with that too.  The term, "It takes a village..." can certainly apply to the treatment of AN's, among other serious diseases.  Just google Cyberknife Team...and you'll see all sorts of facilities and how many people would be involved.  It's interesting.

Best of luck,

Sue in Vancouver, USA

Sue in Vancouver, USA
 2 cm Left side
Diagnosed 3/13/06 GK 4-18-06
Gamma Knife Center of Oregon
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Jim Scott

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Re: ENT or Neurosurgeon?
« Reply #2 on: August 12, 2009, 02:27:23 pm »
Clr ~

Not every AN patient involves an ENT.  I was sent for an MRI by my Primary Care Physician and when an acoustic neuroma was discovered (he was looking for a sinus condition - there was none) I was referred to a neurosurgeon.  He seemed incompetent to me but my wife's neurosurgeon (she had spinal surgery) recommended another neurosurgeon in his practice that specialized in acoustic neuroma removals and had decades of experience.  I was favorably impressed with that neurosurgeon and he successfully performed my AN removal surgery.  I never saw an ENT.  I don't expect to see one, either.  My neurosurgeon does annual follow-ups (with an MRI scan) and that is all I really need at this point as I'm (thankfully) free of any real complications.   

As Sue noted, ENT's usually don't play that big a part in AN removal surgery, although some are in the OR for backup.  I would be confident dealing with the neurosurgeon but be aware that in many cases, once the AN is successfully removed, the neurosurgeon is not often too involved with any post-op issues not directed connected to his surgery.  If your daughter opts for radiation, a radiation oncologist will most likely be involved as well as an ENT.    Remember, these doctors are specialists and if Betsy has post-op/radiation problems, they may be sympathetic but often can't offer much help.  Then you'll need to seek out another doctor who specializes in whatever the problem may be.  Of course, we'll assume that your daughter will do just fine, minus any real post-op/radiation issues and that won't be necessary.  :)

Jim
4.5 cm AN diagnosed 5/06.  Retrosigmoid surgery 6/06.  Follow-up FSR completed 10/06.  Tumor shrinkage & necrosis noted on last MRI.  Life is good. 

Life is not the way it's supposed to be. It's the way it is.  The way we cope with it is what makes the difference.

clr

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Re: ENT or Neurosurgeon?
« Reply #3 on: August 12, 2009, 04:39:04 pm »
Thanks for explaining things to me, I/we really just didn't understand it.

Maybe I didn't explain myself too well, though.  Her ENT is an otolaryngologist and was in the operating room with the neurosurgeon for all 3 (12/29/08, 1/19/09, & 6/22/09) of her surgeries. For her first 2 surgeries he actually worked on her, for the last one he told us it was all the neurosurgeon, he was there but wasn't needed.

Her ENT is actually the one that will do the cyberknife if needed. When we went down in April for her 3 month MRI and met with her neurosurgeon, we asked, "Do we see her ENT today since he will be doing the cyberknife?" It was weird that we had to ask that, at least we thought it was weird.  Since it was her 3 month check up and they told us they will take care of the rest with the cyberknife, we thought we would be seeing both doctors. Well, as it turned out her neurosurgeon sent us over to see the ENT to see what he thought of her MRI because he thought it was still too big. When the ENT looked, he agreed with the neurosurgeon.

When she was in the hospital all 3 times, the ENT came in everyday, sometimes twice a day to see how she was doing. This is why I thought it strange that we never have follow-up appointments with him as we do with the neurosurgeon. But, I see now that that's the way it's done, thanks!

I do not have an AN, my 23 yo daughter does. Her username here is Bets.
4.6cm x 3.6cm x 4.4cm  UPMC Retrosigmoid 12/29/2009, 01/19/2009, 06/22/2009 
CK Oct 2009, Dr. Hirsch
SSD before & after surgery
After 3 surgeries, some facial paralysis, but will come back

carter

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Re: ENT or Neurosurgeon?
« Reply #4 on: August 13, 2009, 12:09:40 pm »
i can only explain my situtation to see if this helps....

i went to audiologist who ran tests and forwarded me to an ENT. i met with him the next day and he ordered the MRI.   a few days later, i got a  call from him stating that i had a growth.  He had called my PCP and he recommended that i talk to a CK dr.

i met with the first CK dr and later decided to go with her treatments.  teh ck dr said that she and her nurse were there for my care - they would take care of me unless a specialist was needed.  i learned later that she set up a follow up appointment with an ENT.  on the first treatment day, things were not a we had discussed so she decided to replan the treatment and set the next day to do it.  at the second day, she said tha tshe wanted me to see a neurosurgeon before proceeding.  i ran form her as i had lost confidence - but her plan was to be primary dr to take care of things.

i called ENT who referred me to 2nd CK center.  this CK dr had me to see a neurosurgeon before treatment.  Neuro dr said follow ups were to be done by CK dr. the neuro approved the CK treatment plan as well as CK dr.  on first treatment, neuro authorized the set up and told tech to proceed.  the next 2 treatments were started by the CK dr.  neither dr was availble to talk any day of the treatments.  i had failed to ask enough questiosn about how / who were to take care of me ....  i ended up asking questions to a PA.   2 months later the CK dr schedueld a follow up MRI, had me in and tried to say to see nuero dr from now on.  i told him that  neuro dr sdaid to follow up with CK dr.  he said no problem.

about 2 months later, i am having heaches, etc and call to CK dr --- i am told to see neuro dr.  i did.

at 6 months after CK, i am loosing hearing. i think my aid is bad... go to audiologist and find that it is hearing - not the aid.

 i call neuro dr and his office says to see him in a week and a half.  i explained the situation and got no return call after asking for one from dr or nurse.  i call ENT, he is booked for next 6 weeks - no exceptions. i call ck dr and am told to see neuro.  on the cyberknife support site - Dr Medely says to stir it up and get in to see a dr.  i get into see CK dr.  he orders MRI and tells me to come back in a about a week.  on return, he reads mri report and tells me to see neuro surgeon - plus starts me on steroids.   he says tumor is huge!

to neuro dr who says that the mri report is wrong.  just a few places where decimal point was off, etc.  he acted as if he wonders why i am there.  he just tells me how much better off  i am with CK rather than surgery.  he said tha tmy hearign is just gone - it will get worse - not better.

3 weeks larter, i have the appointment with CK to talk about the steroids ----- i had stopped taking after calling the dr.  he asked questions and said that he never had to see me again - see the neuro dr.  i asked about the loss of hearing and he looks at me funny.  i finally say that i will find an ENT.  he just agrees.

to me the after care leaves much to be improved upon.   i have written to the  hospital that owns the Ck machine and that the neuro and CK dr work for. .... the neuro dr called to say that his staff failed to relay the message and this is why he did not call me back.  but i am still to find my own dr and find out about the hearing loss.  i find that i get no package of total care at St John's of Tulsa, OK!!!!  i have told them the same thing - including a letter to their CEO.

so you gave me teh opportunity to air my thoughts --- it appears taht there is no consitency?   but i do warn others that ask or that i have the opportunity ot tell .... ask a lot of questions about after care before deciding what to do and where!    i ddi not explore this well enough???? 


be your own advocate - once there - do whatever you have to ....


carter
Diagnosed in fall of 2008 with 1.6 * 2.9cm AN on left side. 

Scheduled CK at Oklahoma Cyber Knife in December, 2008 and decided not to proceede on 2nd date that CK was scheduled.  I fired them.

CK performed at St John's Hospital (Tulsa)Jan 2009

AMD

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Re: ENT or Neurosurgeon?
« Reply #5 on: August 23, 2009, 01:24:43 pm »
I see both each time i drive to Indy for my appts.  However, the neurosurgeon was the primary one.  He did most of the surgery and was the one making the calls. Both work as a team, it's just more of the neurosurgeon's territory (at least in my case)
Left side 1.7 cm AN diagnosed 7/30/08
Misdiagnosed for 8 + years
Surgery, Sub-occipital, 11/17/2008 at Indiana University Hospital
Left SSD
Tumor much larger than expected. Facial nerves intact, but had RARE swelling resulting in brachial plexus injury and tracheostomy after surgery.

CHD63

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Re: ENT or Neurosurgeon?
« Reply #6 on: August 23, 2009, 05:04:04 pm »
You are probably going to have answers all over the place on this, because each situation is unique and Betsy's certainly was even more unique!

In my case, my PCP sent me to an ENT, who ordered hearing tests and an MRI with contrast.  Upon the results, after several consultations, the ENT sent me to the neurosurgeon who removed my AN.  My follow-up MRIs have been ordered by my PCP, with copies of the report going to her and the ENT and a copy of the CD-ROM to the neurosurgeon (who is ultimately in charge of any follow-up treatment).  I will continue to have annual hearing tests (at the ENT's office) and annual MRIs, ordered by my PCP.

Clarice
Right MVD for trigeminal neuralgia, 1994, Pittsburgh, PA
Left retrosigmoid 2.6 cm AN removal, February, 2008, Duke U
Tumor regrew to 1.3 cm in February, 2011
Translab AN removal, May, 2011 at HEI, Friedman & Schwartz
Oticon Ponto Pro abutment implant at same time; processor added August, 2011

leapyrtwins

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Re: ENT or Neurosurgeon?
« Reply #7 on: August 23, 2009, 09:57:41 pm »
I haven't seen my ENT since he ordered my diagnostic MRI.  Once the results showed an AN, he promptly referred me to my neurotologist.

Post op my follow up appointments were with my neurotologist - I didn't see my neurosurgeon at all until just last weekend at the ANA Symposium (more than 2 years after my surgery).

Jan
Retrosig 5/31/07 Drs. Battista & Kazan (Hinsdale, Illinois)
Left AN 3.0 cm (1.5 cm @ diagnosis 6 wks prior) SSD. BAHA implant 3/4/08 (Dr. Battista) Divino 6/4/08  BP100 4/2010 BAHA 5 8/2015

I don't actually "make" trouble..just kind of attract it, fine tune it, and apply it in new and exciting ways