ENT or Allergist for Sinus and Breathing Problems

Blocked noses, sinus pressure and endless throat clearing are among the most common complaints in
the UAE, and among the most commonly mismanaged — usually because people cycle through
decongestants for years without anyone establishing what is actually causing the problem.

The two specialties

ENT, or otolaryngology, is a surgical specialty covering the ear, nose, throat and related structures
of the head and neck. ENT specialists assess anatomy directly, using endoscopy to look inside the nose
and throat, and they operate when structure is the problem — correcting a deviated septum, opening
obstructed sinuses, removing tonsils, addressing structural causes of hearing loss.

Allergy and clinical immunology is a medical specialty concerned with the immune system’s
inappropriate responses. Allergists identify triggers through testing, treat the resulting inflammation
medically, and manage immunotherapy — desensitising a patient to a trigger over time.

The fields overlap constantly, because allergic inflammation in the nose is both an immunological
problem and an ENT one. Which specialist you need depends less on the symptom than on what stage the
problem has reached.

MyLinks lists over 600 ENT specialists, with 360
in Dubai and 126 in Abu Dhabi — a reasonably deep field. Dedicated allergy practice is much
thinner as a distinct listing, and allergy work is frequently done within ENT, immunology, dermatology
or paediatrics rather than by separately listed allergists.

Why this matters especially in the UAE

Several regional factors converge to make nasal and sinus symptoms unusually common here.

Dust is the dominant one. Fine airborne particulate is a constant, and it rises sharply during
sandstorms. It irritates airways mechanically, independent of any allergic mechanism.

Air conditioning is close behind. Most people spend most of the day in cooled, dried, recirculated
air. Low humidity dries the nasal lining, impairing its ability to clear itself. Recirculation
concentrates whatever is already indoors.

The indoor-outdoor temperature swing is dramatic, particularly in summer, and repeated rapid
transitions provoke symptoms in many people.

There are also genuine regional allergens, and expatriates frequently develop sensitivities within a
few years of arriving to things they never reacted to at home. A patient who says “I never had
allergies until I moved here” is describing something real and common.

The practical consequence is that persistent nasal symptoms in the UAE are often multifactorial
— some allergy, some irritation, sometimes a structural component that was always there but only
became symptomatic once inflammation was added. Treating one component and ignoring the others explains
a lot of the frustration people report.

Go to ENT when

Symptoms are one-sided. A blockage or discharge affecting only one side is structural until proven
otherwise, and warrants direct examination.

You have recurrent sinus infections — several courses of antibiotics in a year suggests
something is preventing normal drainage.

There is hearing loss, persistent ear pain, discharge, or ringing in one ear.

You are hoarse for more than a few weeks. Persistent hoarseness needs the vocal cords looked at, and
this is not a symptom to leave.

Swallowing is difficult, or something feels stuck.

You snore heavily, stop breathing in your sleep, or wake unrefreshed. Sleep-disordered breathing has
real health consequences and often has an ENT component.

You have had a facial injury, or you know you have a deviated septum.

There is a lump in the neck. This warrants prompt assessment.

Go to allergy when

Symptoms are clearly seasonal or situational — worse outdoors, worse near animals, worse in
particular buildings.

Both sides of the nose are equally affected, with sneezing, itching and clear discharge, which is the
classic allergic pattern.

You also have eczema, asthma or food reactions, indicating a broader allergic tendency.

You want the trigger identified rather than the symptom suppressed indefinitely.

You are considering immunotherapy, which can meaningfully change the course of allergic disease
rather than merely masking it.

There has been a severe reaction to food, medication or a sting. This needs proper assessment and,
often, an adrenaline autoinjector.

The decongestant trap

One pattern deserves a warning of its own, because it is extremely common and entirely avoidable.

Decongestant nasal sprays work quickly and well. Used beyond a few consecutive days, they produce
rebound congestion: the nose becomes blocked because the spray is wearing off rather than because of the
original problem. The user responds by spraying more often, and a self-sustaining cycle establishes
itself that can persist for years.

These sprays are widely available and the packaging warning is easy to miss. If you have been using
one daily for months, the blockage you are treating may now largely be caused by the treatment. Breaking
the cycle is uncomfortable and usually needs medical support, often with a steroid spray to cover the
transition.

Steroid nasal sprays are different and are not habit-forming in this way. They work slowly —
often two weeks before full effect — which leads many people to abandon them prematurely as
ineffective. Used correctly and consistently, and with proper technique, they are the mainstay of
treatment for allergic and inflammatory nasal symptoms.

Technique matters more than people realise. Spraying toward the septum, sniffing hard, and using it
irregularly all reduce effectiveness substantially. It is worth asking to be shown.

Allergy testing and what it proves

Allergy testing is useful and frequently over-interpreted, so it is worth understanding what a
result means.

Skin prick testing and specific blood tests both detect sensitisation — that your immune system
recognises a substance. Sensitisation is not the same as clinical allergy. Plenty of people test
positive to things that cause them no symptoms whatsoever.

A test result is therefore interpreted alongside your history, not instead of it. If you test
positive to cat dander and have no symptoms around cats, the test has not diagnosed a cat allergy. If
you test negative to something that reliably makes you unwell, the history may still be right.

This matters because broad panel testing generates long lists of positives that lead to unnecessary
avoidance. Testing is most valuable when it is targeted at a specific clinical question — is this
particular trigger responsible for these particular symptoms.

Be cautious of tests marketed directly to consumers claiming to identify food intolerances from a
blood sample. Several widely sold varieties have no accepted diagnostic basis, and acting on their
results commonly leads to unnecessarily restricted diets.

Children with recurrent ear and throat problems

Children present slightly differently and are worth mentioning separately.

Recurrent ear infections, persistent fluid behind the eardrum causing hearing difficulty, enlarged
tonsils or adenoids causing snoring and disturbed sleep, and repeated tonsillitis are common reasons for
paediatric ENT referral.

The threshold for intervention has shifted over recent decades, and surgery that was once routine is
now more selectively applied. That is appropriate, but it also means parents should expect a period of
watchful waiting rather than immediate action, and should understand what would trigger a change of
plan.

Where sleep is disturbed and a child is snoring heavily or pausing in their breathing, that deserves
more urgent attention than the symptom’s mundane appearance suggests. Disturbed sleep affects growth,
behaviour and school performance, and it is a legitimate reason to push for assessment.
Paediatrician or family doctor for your child? covers who to see first.

Getting the sequence right

A reasonable approach for persistent nasal and sinus symptoms in the UAE:

Start with a GP, who can assess the pattern, exclude infection, and start a properly used steroid
spray with a fair trial period of several weeks. Many people never need to go further.

If symptoms are one-sided, structural, or accompanied by any of the ENT flags above, go to
ENT for direct examination.

If symptoms are bilateral, itchy, sneezy and clearly triggered, pursue allergy assessment —
through an allergist where available, or through ENT or immunology where it is not.

If you have been treated for years without resolution, ask for reassessment of the diagnosis rather
than another prescription. Long-standing failure of treatment usually means the original diagnosis was
incomplete, and a second opinion is reasonable.

Alongside all of this, the environmental measures are genuinely worth doing: managing indoor
humidity, servicing air conditioning filters, reducing dust accumulation, and using nasal saline
irrigation, which is cheap, safe and more effective than its simplicity suggests.

When both specialties are needed

The most persistent cases are usually the ones where allergy and structure are both contributing, and
where treating either alone produces partial improvement that fades.

The mechanism is straightforward. Allergic inflammation swells the nasal lining. Persistent swelling
obstructs the sinus drainage pathways. Obstructed sinuses become infected. Repeated infection causes
tissue change, including polyps in some people, which obstructs further. By the time someone reaches
this stage, opening the sinuses surgically without controlling the underlying allergy tends to produce
temporary relief followed by recurrence.

Good management of these cases runs both tracks at once: medical control of the inflammation, and
surgical correction of whatever structural problem has developed. If you have had sinus surgery and
symptoms returned within a year or two, the allergic component is the first thing to revisit.

Ask directly whether both aspects have been assessed. It is a reasonable question and it frequently
identifies the missing half of a treatment plan.