A collection of the most common questions about consultations, cochlear implants, tonsil and adenoid surgery with Coblation, septoplasty and pediatric ENT. Click any question below to jump straight to the answer.
Medically reviewed by Dr. Aline Gomes Bittencourt · CRM-MA 7562 · RQE 1832 · on
Appointments
Do I need a referral to book an appointment with an ENT?
No. You can book directly with Dr. Aline Bittencourt, without a referral from another doctor. Many patients come on their own after noticing a persistent symptom — nasal congestion, earache, ear discharge, hearing loss, tinnitus, runny nose, cough, hoarseness, snoring — while others are referred by pediatricians, neurologists, general practitioners or speech-language pathologists when a hearing or nasal problem is suspected and needs specialist assessment.
What helps reach a diagnosis faster is bringing, to the first appointment, any tests you have already done (audiometry, sinus CT scan, nasal endoscopy, relevant blood work) and a list of the medications you are taking or have been prescribed for the problem. Even without any previous tests, the appointment goes ahead normally: the investigation starts with a detailed medical history and physical examination, and further tests are requested from there, when needed.
The same applies if the appointment is for a child: there is no need to see another specialist first. Parents often come directly when they notice mouth breathing, snoring, recurrent ear infections or delayed speech.
Book your appointment via WhatsApp or through the website and bring any tests you already have — we will investigate the rest together.
What happens at the first ENT visit at Clínica Rhinus?
The first appointment begins with the medical history: a detailed conversation about the problem, how long it has been going on, what has already been tried and how it affects your daily life. This part matters as much as the physical examination — it is what guides which additional test actually makes sense to request, instead of ordering a generic battery of tests.
After the conversation comes the physical examination of the ears, nose and throat. When the clinical picture calls for it, nasal endoscopy, laryngoscopy or video otoscopy is performed during the same visit — so you don't have to come back another day just for a test that could have been done on the spot, and much of the diagnosis can already be established at the first visit.
To make the most of the appointment, bring previous tests (even old ones) and a list of the medications you currently take or have taken for the problem. If the appointment is for a child, the examination is carried out calmly, explaining each step beforehand — the pace of the appointment adapts to the patient's age.
Book your appointment and bring whatever medical history you have — the more information, the more direct the path to a diagnosis.
Consultations with Dr. Aline Bittencourt are private pay only. This is a deliberate choice: a good diagnosis in otolaryngology takes time — listening to the full history, examining carefully, reviewing previous tests and explaining each treatment option before deciding together with the patient. Keeping consultations private pay is the way to protect that time, rather than fitting each case into a tight health-plan schedule.
Tests performed at the clinic and surgery, when indicated — such as cochlear implant, septoplasty, and tonsil and adenoid surgery — can be done through the Brazilian health plans accepted at Clínica Rhinus, within each plan's rules (some tests are private pay only). Hearing implant surgery — cochlear implant and bone-anchored hearing device — has mandatory coverage and can also be done through plans the clinic does not accept. The assessment and the surgical indication take place at the private appointment; from there, the team explains the documentation needed to obtain authorization from the plan, when that is the route chosen.
If you are unsure whether your specific health plan is accepted for a given procedure, it is best to confirm directly with the clinic's front desk before the test or surgery.
Contact the Clínica Rhinus front desk via WhatsApp with any questions about health plans before booking.
Yes. Dr. Aline Bittencourt conducts her consultations in either Portuguese or English, which is especially helpful for foreigners living in São Luís, executives visiting the city or expatriate families who need specialist care without a language barrier. She is the only member of the Clínica Rhinus team who speaks English.
In English, the consultation follows the same structure as any other: a detailed medical history, examination of the ears, nose and throat and, when indicated, nasal endoscopy or laryngoscopy performed by Dr. Bittencourt during the visit. This applies both to routine appointments and to more complex assessments, such as investigating hearing loss or evaluating a patient for a cochlear implant.
Hearing tests, such as audiometry, are performed by the clinic's audiologists in Portuguese. Dr. Bittencourt then goes over the results with you in English.
To book, send us a WhatsApp message — messages in English are welcome. Our front desk team speaks Portuguese only, so written messages work better than phone calls.
Send us a WhatsApp message in English to book your appointment.
A teleconsultation is a video visit with Dr. Aline Bittencourt, and it can be conducted in English. It is booked through the same channels as an in-person visit: phone call or online booking.
It is useful for discussing your symptoms, reviewing tests you have already had, following up on ongoing treatment or asking questions about a surgical recommendation. To make the most of the time, have your previous test results and a list of your current medications at hand.
A teleconsultation does not replace the physical examination of the ears, nose and throat, or tests such as endoscopy and audiometry, which must be done in person. Depending on the case, Dr. Bittencourt may recommend an in-person visit in your city or at Clínica Rhinus, in São Luís, to complete the evaluation.
Teleconsultations follow the Brazilian Federal Council of Medicine (CFM) rules for telemedicine (Resolution CFM 2,314/2022): they require the patient's consent, are recorded in the medical record, and prescriptions and test orders can be issued with a digital signature.
There is no minimum age. Babies can and should be assessed whenever there is a reason — the most common is an abnormal newborn hearing screening result in the hospital after birth, which needs specialist follow-up within the first weeks of life. In addition, recurrent ear infections, persistent mouth breathing, snoring during sleep and noticeable speech delay are signs that justify an appointment, whatever the child's age.
A pediatric ENT appointment has its own pace. Each examination is explained before it is done, and the child is examined on the parent's lap, unhurriedly — the aim is to make the examination as stress-free as possible, which also improves the quality of the assessment. When needed, additional tests such as pediatric audiometry, auditory brainstem response (ABR/BERA) or nasal endoscopy are requested in an age-appropriate way.
Remember: speech delay is not only a speech-therapy issue. A mild hearing loss, even in one ear only, can go unnoticed in daily life and be the real cause of the delay — which is why a hearing assessment is usually one of the first steps before starting other treatments.
If you have noticed any of these signs in your child, book an assessment — the earlier, the simpler the solution tends to be.
My baby didn't pass the newborn hearing screening — what now?
First, some reassurance: not passing the newborn hearing screening does not necessarily mean the baby has hearing loss. It commonly happens because of vernix, residual fluid in the ear canal or even the baby being restless during the test in the hospital — factors that produce an abnormal result without there actually being a hearing problem.
Even so, it is a result that must be investigated as a priority, and cannot simply be left until the next well-child visit. The recommendation is to seek specialist reassessment within the first 15 days of life, with a repeat otoacoustic emissions (OAE) test and, when necessary, auditory brainstem response (ABR/BERA) testing — which assess the baby's hearing more precisely than the initial screening.
The urgency has a concrete reason: the first 12 months of life are the most sensitive window for language development. When there really is a hearing loss, the earlier it is identified and treated — with a hearing aid or, in cases of severe to profound loss, assessment for a cochlear implant — the better the child's speech and language development tends to be.
If your baby did not pass the newborn hearing screening, don't wait for the next well-child visit — book the reassessment as soon as possible.
Can speech delay be caused by hearing loss rather than a speech problem?
It can, and it is one of the most frequently overlooked causes before speech therapy is considered. A hearing loss — even a mild one, or in only one ear — can go completely unnoticed in daily life: the child reacts to sounds, turns when called, watches TV normally. What the child misses are the subtler details of speech, such as softer consonants, and it is precisely this loss of detail that hinders language development, even though at first glance the child does not seem to "not hear".
That is why, before starting speech therapy for speech delay, the child's hearing needs to be investigated with an ENT assessment and specific tests (pediatric audiometry, otoacoustic emissions (OAE), ABR/BERA, depending on age). If there is an unidentified hearing loss, treating it is what actually addresses the cause of the delay — speech therapy alone, without correcting the underlying hearing problem, tends to have limited results.
This does not mean every speech delay is hearing-related — there can be other causes. But hearing loss is simple and quick to rule out, and it is worth doing before, not after, months of therapy without the expected response.
If your child has speech delay, book a hearing assessment before (or alongside) starting speech therapy.
Are cochlear implants covered by Brazilian health plans?
Yes. In Brazil, both the cochlear implant and the bone-anchored hearing device must be covered by all health plans, under the ANS (National Supplementary Health Agency) Guidelines for Use, provided there is a documented medical indication. This means that once the indication is confirmed, the plan is required to authorize the procedure and the necessary materials (device, fixation components and other surgical supplies).
Typical candidates for a cochlear implant are: children with congenital hearing loss identified at newborn screening, adults with progressive hearing loss who no longer benefit enough from conventional hearing aids, and patients with severe to profound loss whose cochlea no longer responds to sound amplification. A bone-anchored hearing device, on the other hand, is usually indicated for conductive or mixed hearing loss, or when a conventional hearing aid is not well tolerated — including in cases of single-sided deafness.
Confirming the indication requires a clinical assessment and specific hearing tests (audiometry, and imaging when necessary). Once the indication is established, the Clínica Rhinus team prepares the technical documentation and the codes required by the plan to submit the authorization request.
If you or your child already use a conventional hearing aid and feel it is no longer helping enough, book an assessment to find out whether a cochlear implant is indicated.
There is no age limit. A cochlear implant can be indicated both for babies a few months old and for elderly patients — what changes across age groups is not whether surgery is possible, but the adaptation curve and the expected results in language and sound perception.
In general, the best language development outcomes occur in babies operated on before 1 year of age, when the brain is still in its most sensitive window for learning to process sound and speech. In adults, the most decisive factor is usually the duration of deafness: the shorter the time between hearing loss and surgery, the faster adaptation tends to be, because the brain has "forgotten less" about how to interpret sounds. This does not mean that patients with long-standing deafness or elderly patients do not benefit — it means that expected results and rehabilitation time are assessed individually.
The final decision always involves a complete assessment: cause of the hearing loss, how long it has progressed, imaging of the inner ear and specific sound perception tests.
If you are wondering whether there is "still time" for a cochlear implant — for yourself or a family member — book an assessment for an answer based on your specific case.
Cochlear implant or bone-anchored hearing device: what's the difference?
They are devices designed for different types of hearing loss, and the two are often confused. A bone-anchored hearing device is indicated for conductive or mixed hearing loss — when the problem lies in conducting sound to the cochlea, not in the cochlea itself — or when a conventional hearing aid is not well tolerated. The device picks up sound, amplifies it and conducts it through the bone directly to the cochlea, which keeps working normally. It may also be indicated for patients with single-sided deafness.
A cochlear implant, by contrast, is indicated when the cochlea itself no longer responds to sound amplification — that is, in severe to profound hearing loss. Instead of amplifying sound for a cochlea that can no longer process it, the implant directly stimulates the auditory nerve, bypassing the part of the cochlea that does not work.
In Brazil, both must be covered by health plans when indicated. Choosing between them is not a matter of preference — it depends on the type and degree of hearing loss, confirmed by audiometry and, when necessary, imaging.
If you already know you have hearing loss but are not sure which device applies to your case, book an appointment to find out.
It is not instantaneous, which often surprises those who expect to "hear normally" as soon as they leave surgery. After the procedure, there is a healing period of a few weeks before the device is first activated (usually 15 to 20 days after surgery). Activation is done by the audiologist who specializes in cochlear implant programming ("mapping"), adjusting the sound processor settings for that specific patient.
Activation is when the real adjustment process begins: the brain needs to learn to interpret a type of sound stimulus different from what it received before (or never received, in the case of congenital loss). This happens through programming sessions — progressive adjustments of the processor — combined, in most cases, with ongoing auditory and speech therapy.
Progress varies widely with age, duration of deafness and cause of the hearing loss. Young children implanted early tend to develop speech perception and language closer to what is expected for their age; postlingually deafened adults (who could hear before losing their hearing) tend to adapt faster, precisely because the brain already "knows" what sound and speech are.
If a cochlear implant has been recommended for you and you want to understand what to expect from recovery in your specific case, book an appointment.
The surgery is performed under general anesthesia, so there is no pain during the procedure. After surgery, discomfort is usually mild and managed with standard pain medication — it is not a surgery known for severe pain. Most patients are discharged from the hospital on the day of surgery or the following day.
In the first days after surgery, the main care points are keeping the compression dressing around the head in place and dry, not pressing on the operated area and avoiding physical exertion until cleared by the doctor. Some local tenderness or swelling in the first weeks is common and decreases gradually.
An important point: the implant is not activated on the day of surgery, nor soon after. Activation takes place a few weeks later (usually 15 to 20 days), once the surgical swelling has gone down and healing is adequate — this is when the actual hearing adaptation process begins, with follow-up by the audiologist responsible for programming.
If you have cochlear implant surgery scheduled or under evaluation, book an appointment to ask specific questions about your recovery.
When is tonsil and adenoid surgery truly necessary?
The decision is never automatic — it depends on how often symptoms occur and their real impact on quality of life, not only on the size of the tonsils or adenoids seen in a single examination. Even so, there are signs that commonly lead to a surgical indication:
Recurrent tonsillitis, with several episodes of infection over the year, is one of the most common indications. Enlarged adenoids causing nasal obstruction, persistent snoring or mouth breathing also warrant assessment, especially in children, because chronic mouth breathing can affect facial development, growth, attention and sleep quality. Obstructive sleep apnea, in both children and adults, is another relevant indication — and often underestimated, because snoring is dismissed as "just a habit". Peritonsillar abscess and very large tonsils that make swallowing difficult complete the list of the most frequent indications.
Confirmation requires a detailed physical examination and, when necessary, nasal endoscopy to assess the degree of obstruction caused by the adenoids — which, unlike the tonsils, cannot be seen with the naked eye.
If your child (or you) has repeated throat infections, frequent snoring or mouth breathing, book an assessment to find out whether surgery is indicated.
What is Coblation technology and why does it make a difference in surgery?
Coblation is a surgical technique that uses radiofrequency to reduce tissue at much lower temperatures than those reached by traditional electrocautery. This temperature difference explains practically all the benefits of the technique: less heat means less thermal injury to the tissue around the operated area.
In practice, this translates into minimal bleeding during surgery, less swelling in the throat (which helps the patient swallow and breathe more comfortably in the first days) and less discomfort while healing. Because the patient can eat and drink earlier and with less pain, the risk of dehydration after surgery is lower — one of the most common reasons for returning to the emergency room after this type of surgery with conventional techniques.
The practical result for the family's routine is a faster recovery: fewer days away from school or work, and a quicker return to a normal diet. Clínica Rhinus has its own Coblation equipment, which ensures this technology is available whenever surgery is indicated.
Discuss the surgical technique indicated for your case — book an assessment.
How long is recovery after tonsil and adenoid surgery?
With Coblation technology, most patients return to their routine — school or work — in about a week, typically sooner than with conventional electrocautery, which causes more thermal injury to the tissue.
In the first days after surgery, the essential care points are: a soft, cold diet (ice cream, popsicles, gelatin, mashed foods), frequent fluids even when swallowing is uncomfortable, and relative rest, avoiding physical exertion. Pain is usually managed with prescribed pain medication, and some throat dryness or discomfort when swallowing in the first days is normal and decreases gradually.
Post-operative follow-up takes place at return visits, usually once a week, to confirm that healing is progressing well and to clear a full return to activities, including physical exertion.
If your surgery is already scheduled, also book the follow-up appointment so recovery can be monitored closely.
Can the tonsils and adenoids be removed in the same surgery?
Yes, and this is in fact the most common situation in practice. When both the adenoids and the tonsils need to be removed, the two procedures — adenoidectomy and tonsillectomy — are performed in the same surgery, under the same anesthesia. This spares the patient, especially children, two anesthetics and two recovery periods weeks or months apart.
The two do not always need to be removed together, however. In some cases only the adenoids are causing the problem (for example, nasal obstruction and mouth breathing without recurrent tonsillitis), and in others only the tonsils justify surgery (recurrent tonsillitis without signs of enlarged adenoids). Which structures to operate on is decided at the appointment, with a physical examination of the throat and, when necessary, nasal endoscopy to assess the size and impact of the adenoids — which, unlike the tonsils, cannot be seen with the naked eye.
Book an assessment to find out whether, in your case or your child's, one procedure or both are indicated.
The most common signs that a deviated septum may need surgical correction are persistent nasal obstruction — usually more noticeable on one side of the nose than the other — difficulty breathing through the nose during sleep, recurrent sinusitis and, in some cases, frequent nosebleeds caused by dryness of the lining at the point of greatest deviation.
It is important to be clear: not every deviated septum needs surgery. Mild deviations that do not cause relevant symptoms in daily life often require no intervention — many people have some degree of deviation without ever noticing a difference. The surgical indication is made after a physical examination, nasal endoscopy and a sinus CT scan, which allow an accurate assessment of the degree of deviation and how much it actually restricts airflow through each nostril.
It is also worth bearing in mind that nasal obstruction may have other associated causes — allergic rhinitis, enlarged turbinates, polyps — that need to be investigated at the same time, because treating only the septum without addressing these causes may not fully resolve the symptom.
If you breathe poorly through one side of your nose or have recurrent sinusitis, book an assessment to investigate the cause.
Discomfort after septoplasty is usually managed with standard pain medication — it is not described as a surgery with severe pain. Most patients return to light daily activities in about a week.
In the first days, a blocked-nose sensation is common, even with the correction already done — this happens because the nasal lining develops temporary edema (swelling) after surgical handling, and the sensation eases gradually over the following weeks. Patients no longer have nasal packing, but they do use internal nasal splints (made of silicone) for a few days, removed at the first follow-up visit, 5–7 days after surgery.
More intense physical effort, exercise and activities that increase nasal pressure are usually cleared gradually, according to how healing progresses — generally between three and four weeks, but this varies from patient to patient. Follow-up visits are what set the actual pace of clearance for each case.
Ask your questions about the recovery specific to your case — book an appointment.
It can help a great deal, but the answer depends on the real cause of the snoring. When nasal obstruction caused by a deviated septum is the main reason for difficulty breathing during sleep, correcting the septum significantly improves airflow and, with it, the snoring.
The point to watch is that snoring and sleep apnea usually have combined causes, not a single isolated one. Enlarged adenoids or tonsils, obesity, jaw shape and collapse of the soft tissues of the throat during sleep also contribute, and more than one of these factors is often present at the same time. That is why a complete assessment — investigating not only the septum but the entire upper airway — is what really determines whether septoplasty alone will solve the problem, or whether other procedures (for example, adenoid and tonsil surgery, or orthognathic (jaw) surgery) are also needed.
Treating only the septum in a patient whose snoring comes mainly from another cause usually brings partial improvement, not the expected resolution — which is why a complete investigation avoids disappointment with the result.
If snoring or sleep apnea is affecting your sleep, book a complete airway assessment, not just of the septum.
It depends on the cause — and this is the most important thing to understand about tinnitus: it is a symptom, not a disease in itself. It may be linked to hearing loss (even a mild one), prolonged noise exposure, disorders of the temporomandibular joint (the jaw joint), vascular problems, the use of certain medications, among other possible causes.
When there is an identifiable and reversible cause — for example, hearing loss that can be treated with a hearing aid, or a temporomandibular joint problem that responds to specific treatment — treating that underlying cause usually improves or eliminates the tinnitus. In other cases, when the investigation finds no clear reversible cause (which is also common), the focus of treatment shifts to managing symptoms and quality of life — strategies to reduce the annoyance and the impact of tinnitus on sleep and concentration, since "eliminating" it may not be a realistic goal in these cases.
A complete investigation — detailed history, physical examination, audiometry and, when indicated, imaging — is always the first step. That is what distinguishes treatable tinnitus from tinnitus that needs long-term management, and it avoids promises of a cure that cannot be kept without first knowing the cause.
If tinnitus is disrupting your daily life or your sleep, book an assessment to investigate the cause before any treatment.