Rhinology, Explained
What is a rhinologist?
A rhinologist is an otolaryngologist (ENT surgeon) who completed an additional fellowship in nose, sinus and anterior skull base surgery. All rhinologists are ENTs; not all ENTs are rhinologists. Dr. Justin Khetani trained in rhinology at the University of Alberta and limits his Burlington practice to the nose and sinuses, including rhinoplasty, septoplasty and endoscopic sinus surgery.
Written and reviewed by Dr. Justin Khetani, MD, FRCSC, Otolaryngology–Head and Neck Surgery · Last reviewed
Fellowship-trained rhinologist (University of Alberta, 2013) · Royal College-certified, Otolaryngology–Head & Neck Surgery · CPSO register (opens in a new tab)
The Word
A subspecialist of the nose, the sinuses and the base of the skull.
Rhinology is the corner of otolaryngology — ear, nose and throat surgery — that deals with the nose and the sinuses: the airway, the sinus drainage pathways, the sense of smell, and the thin plate of bone where the sinuses meet the base of the skull. A rhinologist is an ENT surgeon who, after completing the full specialty, spent further fellowship time operating only in that region.
The title worth checking is the certified one. In Canada, the Royal College certificate is in Otolaryngology – Head and Neck Surgery; rhinology is not a separate certificate but a fellowship — a year or more of additional training in endoscopic sinus and skull base surgery, taken on top of the five-year residency. So the honest description of a rhinologist has two parts, in this order: certified otolaryngologist first, fellowship-trained in rhinology second. That is exactly how the register on this site states it, with a public source for each line.
The Training
Step by step, a decade of it.
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Medical degree
Four years of medicine, before any surgical training begins.
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Residency: Otolaryngology – Head & Neck Surgery
Five years covering the full breadth of the specialty — ears, throat, neck, and nose — ending in the Royal College examinations and the FRCSC designation.
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Fellowship: rhinology
A further year or more spent only on the nose, sinuses and anterior skull base, operating daily with subspecialists on the harder end of the caseload.
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A concentrated practice
The training only means something if the daily work stays in the region it prepared for. This practice’s surgical work centres on the nose and sinuses on purpose.
Dr. Khetani's path, each line checkable
- MD — University of Toronto, 2007
- Otolaryngology – Head & Neck Surgery residency — McMaster University, completed 2012
- Royal College certification (FRCSC) — 30 June 2012
- Rhinology & Anterior Skull Base Surgery fellowship — University of Alberta, 2013
- Co-Director, Rhinology & Endoscopic Skull Base Surgery Fellowship, McMaster University
Sources for every line are on the affiliations register, starting with the CPSO public register (opens in a new tab).
The Distinction
Every rhinologist is an ENT. Not every ENT is a rhinologist.
This is a statement about concentration, not a ranking. General otolaryngologists carry the whole specialty deliberately — ears, tonsils, voice, neck, nose — and most nose and sinus problems are well looked after in a general practice. The difference is what the daily operating list holds: a rhinologist's stays inside the nose and sinuses.
Where the fellowship earns its keep is at the harder end of the region. Revision endoscopic sinus surgery, for instance, is usually done by fellowship-trained rhinologists, because scarring and altered anatomy raise the risks near the eye and the skull base. The same applies to extensive polyp disease, to surgery close to the skull base itself, and to the airway questions inside a rhinoplasty, where breathing and appearance have to be planned together.
The Territory
What a rhinologist assesses and treats.
The airway
Deviated septum, enlarged turbinates and nasal valve problems — treated from medication to septoplasty, and combined with rhinoplasty where appearance is addressed too.
The sinuses
Chronic sinusitis and nasal polyps: medical therapy first, then endoscopic sinus surgery or biologic treatment where indicated, including revision cases.
Smell & the skull base
Loss of smell, and disease reaching toward the anterior skull base — the region the fellowship is named for.
Getting Seen
When a referral to a rhinologist makes sense.
Sinus disease that has come back after surgery; nasal polyps confirmed on CT — which this practice, listed in the Canadian Rhinologic Society's directory of fellowship-trained rhinologists, commits to assessing within four months of referral; disease sitting close to the eye or the skull base on imaging; a lost sense of smell that needs proper assessment; or a blocked nose where surgery is on the table. An OHIP-insured assessment begins with a referral from your physician or nurse practitioner, faxed to (905) 639-2253. Current wait patterns are published here.
Common Questions
The term, answered plainly.
In Canada the Royal College certificate is in Otolaryngology – Head and Neck Surgery. Rhinology is fellowship training taken on top of that certificate rather than a separate one — which is why this site always states the certification first and the fellowship second, each with its public source.
An OHIP-insured assessment begins with a referral from your physician or nurse practitioner, faxed to (905) 639-2253. A cosmetic rhinoplasty consultation does not need one and can be requested directly through the office.
Some do, and this one does. Because a rhinologist operates inside the nose every week, appearance and breathing can be planned together at one consultation. Surgery to change the appearance of the nose is not insured by OHIP. Fees are quoted in writing after assessment.
Revision endoscopic sinus surgery is usually done by fellowship-trained rhinologists, because scarring and altered anatomy raise the risk to the eye and skull base. Here, revision cases are assessed with CT review, endoscopy and, where appropriate, image-guided surgery.
Assessment first. Then the options are yours.
An OHIP-insured assessment begins with a referral from your physician or nurse practitioner. The office contacts you once it is received.