Common ENT Conditions Cape Town | Dr Sharon Williams

Ear, nose and throat conditions sit in an awkward space in primary care. They are common, often uncomfortable but rarely urgent, and patients tend to manage them with over-the-counter medication, repeated GP visits and the hope that things will eventually settle on their own. Most of the time, things do settle. Some of the time, they do not, and what looked like a stubborn cold turns out to be a sinus condition that has been quietly progressing for years, or what felt like ear fullness turns out to be hearing loss that has been creeping in unnoticed.

This is a practical guide to the conditions that bring Cape Town adults to an ENT specialist, the signs that suggest the visit is worth booking, and what an initial consultation actually involves.

Why ENT conditions are easy to dismiss

The ear, nose and throat are interconnected. A blockage in one part affects the others. Postnasal drip from the sinuses irritates the throat. Allergies in the nasal passages cause ear fullness. Reflux from the stomach causes throat irritation and hoarseness. A patient often presents with what feels like one symptom while the underlying condition involves multiple structures.

Primary care medicine, by design, addresses the presenting symptom. Antihistamines for the runny nose. Decongestants for the sinus pressure. Throat lozenges for the hoarseness. The relief is real but often short-lived, because the underlying issue is structural or chronic rather than acute and self-limiting.

An ENT consultation is the point at which the whole system is assessed together, with the right equipment and the right anatomical knowledge to identify what is actually going on.

Conditions that bring patients in

Impacted earwax

Common, usually harmless, but capable of producing significant symptoms when it accumulates: muffled hearing, ear fullness, tinnitus, occasional pain, dizziness and irritation. Cotton buds make it worse by pushing wax deeper and damaging the canal.

An ENT removes impacted wax safely using microsuction or curettage under direct visualisation, with the canal protected throughout. The procedure is quick, performed in the consulting rooms, and produces immediate relief.

Hearing loss and tinnitus

Hearing loss is almost always gradual, which is why it goes unnoticed for years. The classic signs are turning up the television, asking people to repeat themselves, struggling in noisy restaurants, and a sense that people are mumbling more than they used to.

Tinnitus, the perception of sound (ringing, buzzing, humming) without an external source, often accompanies hearing loss. It can also occur on its own. Persistent tinnitus, especially in one ear, warrants ENT assessment.

Both conditions benefit from full audiological assessment, which evaluates the hearing across frequencies and the type of hearing loss (conductive, sensorineural, mixed). The assessment guides treatment, which may involve managing the underlying cause, hearing aids, sound therapy for tinnitus, or in some cases surgical intervention.

Allergies and sinusitis

Cape Town has a long pollen season, persistent wind, fluctuating humidity and a high prevalence of allergic rhinitis. Combined with anatomical factors (deviated nasal septum, nasal polyps, narrow sinus drainage pathways), the result is chronic sinusitis: ongoing nasal congestion, facial pressure, postnasal drip, headache, reduced sense of smell, and recurrent infections.

An ENT assessment for sinusitis typically includes:

Detailed symptom history including triggers and timing
Anterior rhinoscopy to examine the nasal passages
Nasal endoscopy where indicated, allowing direct visualisation of the sinus drainage pathways
Imaging (CT scan) for cases not responding to medical treatment
Allergy assessment where allergic rhinitis is suspected

Treatment moves through a defined sequence: avoidance and environmental measures, intranasal corticosteroids, antihistamines, saline irrigation, oral steroids for flares, and surgical intervention for cases that fail medical management.

Vertigo

Vertigo (the false sensation of movement) is a frightening symptom that can come from inner ear conditions, central nervous system causes, or cardiovascular factors. ENT involvement focuses on the inner ear contribution.

The most common ENT-related causes are:

Benign paroxysmal positional vertigo (BPPV): short episodes triggered by head position changes, caused by displaced inner ear crystals
Vestibular neuritis: sudden severe vertigo lasting days, caused by inflammation of the vestibular nerve
Meniere's disease: episodes of vertigo with hearing loss, tinnitus and ear fullness
Vestibular migraine: vertigo episodes linked to migraine pattern

Diagnosis involves a careful history, physical examination including positional testing, and audiological assessment. Treatment depends on the cause, ranging from simple repositioning manoeuvres for BPPV to medication and lifestyle modification for Meniere's.

Nasal polyposis

Nasal polyps are soft, painless growths in the nasal passages or sinuses, often associated with chronic inflammation, asthma and aspirin sensitivity. They cause nasal blockage, reduced sense of smell, postnasal drip and recurrent infections.

Management typically involves intranasal corticosteroids, oral steroids for flares, and surgical removal in cases that do not respond. Newer biologic medications have changed the landscape for severe recurrent polyposis. An ENT consultation is the right starting point for any persistent nasal blockage.

Burning tongue syndrome

An uncomfortable condition where the tongue and other parts of the mouth feel persistently burnt or scalded without any visible cause. It is more common in middle-aged and older adults, particularly women, and may be linked to nutritional deficiencies, hormonal changes, oral conditions or nerve-related factors.

ENT assessment looks for treatable causes (oral candidiasis, reflux, dry mouth, allergies) and rules out structural conditions. Management is individualised and often involves managing contributing factors rather than a single intervention.

Voice-related issues

Persistent hoarseness, voice changes, loss of vocal range, voice fatigue and recurrent loss of voice all justify ENT review. Causes range from simple vocal cord swelling and reflux to nodules, polyps, paralysis and (rarely) malignancy.

The examination uses laryngoscopy to visualise the vocal cords directly, often with stroboscopy to assess the vibration pattern. Voice professionals, teachers, lawyers and call centre workers benefit particularly from early assessment of voice changes.

When to book a consultation

The following patterns suggest that ENT referral is appropriate rather than further GP management:

Symptoms persisting beyond three months despite primary care management
One-sided ear or nasal symptoms (unilateral changes always warrant assessment)
Hearing loss in one or both ears, with or without tinnitus
Recurrent sinus infections (more than three per year)
Persistent hoarseness lasting longer than four weeks
Recurrent vertigo episodes
Any nasal blockage lasting more than three months
Sudden hearing loss (urgent referral indicated)
Persistent or progressive tinnitus, especially in one ear

What an initial consultation involves

A typical first consultation runs 30 to 45 minutes. The session includes:

Detailed history of the presenting complaint, related symptoms and previous treatment
General ENT examination including otoscopy (ears), anterior rhinoscopy (nose), and oropharyngeal examination (throat)
Where indicated, nasal endoscopy or laryngoscopy for direct visualisation
Audiological assessment where hearing is a concern
Discussion of findings, working diagnosis and management options
Onward investigations (imaging, blood tests, allergy assessment) if indicated
Treatment plan with clear next steps

The emphasis is on patient understanding. Treatment decisions are best made with the patient fully informed about the condition, the options, the expected outcomes and any risks involved. ENT care is as much about education and partnership as it is about procedures.

Practice information

Dr Sharon Williams consults at two Cape Town locations: the Foreshore in the city centre, and Hout Bay close to Constantia Nek. Foreshore consulting hours are 7:00 to 13:30 on weekdays. Hout Bay consulting hours are 15:30 to 17:30 on weekdays. The office is open Monday to Friday from 7:00 to 15:30, and weekend appointments can be arranged for urgent cases.

Booking is straightforward through WhatsApp on +27 711 605 020, which is also the easiest way to ask routine questions about referral, medical aid and consultation specifics. The full practice information and online booking link are on the Dr Sharon Williams ENT Specialist website.

ENT conditions tend to be patient and persistent. Most respond well to the right assessment and treatment, but the longer they go untreated the more they affect daily life. A consultation is worth booking early when the symptoms become a pattern rather than an event.