AI scribe and clinic software for ear, nose and throat clinics

The ENT note, organised by site

An ENT note follows the anatomy. Ear, with symptoms by side, otoscopy, tuning fork tests, the pure tone audiogram and tympanometry. Nose, with obstruction, discharge, smell, nasendoscopy, septum, turbinates and polyps. Throat, with tonsils, swallowing and voice. Neck, with any lump described by site, size and character. wai's template holds those blocks in order, and the surgeon reads the same captured note as SOAP, problem-oriented, narrative or a bullet summary.

Hearing has its own standard. For the audiological assessment NICE asks for a full history, the person's hearing and communication needs at home, at work and in social situations, their expectations, otoscopy, pure tone audiometry and tympanometry if indicated.¹ It considers MRI of the internal auditory meati when sensorineural hearing loss shows an asymmetry of 15 dB or more at any 2 adjacent test frequencies, using 0.5, 1, 2, 4 and 8 kHz.¹ An ambient scribe records what is said, so thresholds enter the note when the surgeon reads them from the audiogram, side and frequency each time, and the surgeon checks them against the test before signing.

Tonsillectomy needs a count. Under the NHS Evidence-Based Interventions programme, surgery for recurrent tonsillitis is commissioned when the sore throats are due to acute tonsillitis, are disabling, and number seven or more documented, clinically significant, adequately treated episodes in the preceding year, five or more in each of the preceding two years, or three or more in each of the preceding three years.² The same page says a fixed number may not suit adults with severe symptoms or complications such as quinsy.² These are NHS commissioning criteria in England. A self-pay patient can choose otherwise, and an insurer may ask for the episode history before authorising surgery, so the template records each episode and how it was documented.

wai suggests ICD-10 and SNOMED CT codes from the note, each shown with the line it rests on, for the surgeon to confirm. In the WHO edition of ICD-10 used in the UK and the Gulf, typical codes are J35.0 for chronic tonsillitis, J03.9 for acute tonsillitis, unspecified, H90.3 for bilateral sensorineural hearing loss, H65.3 for chronic mucoid otitis media, J34.2 for deviated nasal septum and R49.0 for dysphonia. In US ICD-10-CM, chronic tonsillitis is J35.01 and acute recurrent tonsillitis J03.91. Procedure codes, OPCS-4 in the UK and CPT in the US, stay with the clinic's coder.

Letters to patients, parents, GPs and head and neck teams

The Academy of Medical Royal Colleges recommends that most outpatient letters are written to the patient with a copy to the GP, and that this should be the default for an AI scribe.⁴ For a child with glue ear, the letter goes to the parents in plain words, with the hearing result, what it means and the plan, and a copy to the GP.

Head and neck letters carry urgency. NICE NG12 considers a suspected cancer pathway referral for laryngeal cancer in people aged 45 and over with persistent unexplained hoarseness or an unexplained lump in the neck, and for oral cancer with unexplained ulceration in the mouth lasting more than 3 weeks or a persistent unexplained neck lump.³ A referral to the head and neck team states the duration, the site and side, the examination and endoscopy findings and the questions for the team, drafted from the whole record, as described in the referral letter.

Other letters follow from the same visit. An audiology referral carries the hearing needs and the question for the audiologist. Results letters explain a scan. After a tonsillectomy, where the Evidence-Based Interventions page notes that pain can be particularly severe in adults for up to two weeks,² a UK fit note covers the recovery period on the official form. Every document waits for the surgeon's signature and downloads as a PDF.

The patient's own language, written down

wai works in 60 languages, among them English, Arabic, Spanish, French, Portuguese, Italian, Russian, Polish, Turkish, Urdu and Mandarin. English can be mixed in one consultation with Spanish, French, Portuguese, Russian, Italian, Dutch, German, Hindi or Japanese, and the other languages are captured in that language. The signed note is written in English for the record, or in another language the clinic chooses.

ENT patients often struggle to hear the plan, which makes a written summary in their own language worth more. A parent who discussed a child's grommets in Urdu, or an adult with hearing loss who spoke in Arabic, gets the patient summary in that language beside the English letter, with crisis and emergency numbers kept exactly as written. Post-operative bleeding advice after tonsillectomy reads the same way. More is on the multilingual AI scribe page.

Clinic software for ENT clinics, from hearing test to follow-up

Calls, email, web forms and WhatsApp messages land in one thread per patient, and wai drafts each reply in the clinic's voice for a person to approve before it is sent. NICE asks that adults with sudden hearing loss developed within the past 30 days be seen within 24 hours,¹ so the clinic's replies to hearing enquiries ask when it started, and the person approving the reply decides on the slot.

Patients request appointments through booking links that read each surgeon's calendar in Google, Outlook or Apple, and the front desk lines up the hearing test before the ENT review. Cancellations are offered to the waitlist and reminders go out. Invoices, deposits and payment links run through the clinic's own Stripe account, and insured patients get insurer invoices. Each result reaches the patient with the surgeon's own comment and a plain explanation.

After the visit, the signed plan goes home in plain words, and the after-visit companion tracks each referral, prescription and follow-up until it is done, from the audiology fitting to the head and neck appointment. Proactive care sends the recall for the repeat hearing test or the review the surgeon set, each message approved by a person. Parents can be given access to a child's record with consent, and private prescriptions are issued and signed through SignatureRx in the UK. The full set is on the clinic management software page.

One recurrent tonsillitis consultation, start to finish

Take a 29-year-old primary school teacher with recurrent sore throats. She says she has had about eight episodes in the past year, each with fever and difficulty swallowing, and that she has missed eleven working days. Her GP's referral letter lists seven treated episodes of acute tonsillitis in the past twelve months, with dates and antibiotics. The surgeon examines her throat and neck, talks through continuing to manage episodes as they come against a tonsillectomy, and explains the recovery, including pain that can last up to two weeks in adults and the risk of bleeding after surgery. She chooses surgery.

The draft is ready as she leaves. It holds the history, the time off work, the examination, the options, the risks as the surgeon described them and her decision. The surgeon corrects the episode count. The draft recorded eight episodes from what she said, and the surgeon changes it to seven documented episodes from the GP letter, with her estimate of eight beside it, so the record shows which figure meets the criteria. ICD-10 J35.0 is suggested beside the line where he named recurrent tonsillitis, and he confirms it and signs.

The letter goes to her with a copy to her GP. The front desk sends the deposit link through the clinic's Stripe account and a booking link for pre-assessment, and the after-visit companion opens the follow-up after surgery. Her fit note for the recovery period is drafted once the operation date is set, for the surgeon to sign.

The evidence behind wai's method

The note is one part of the day the evidence measures. In a randomised trial of 238 outpatient physicians across 14 specialties at UCLA Health, the ambient scribe with a significant effect cut the time spent writing each note by about 41 seconds, against 18 seconds in usual care.⁵ wai is built on that finding, so it takes on the letters, the replies, the booking and the follow-up as well as the note.

ENT guidance turns on documentation. The tonsillectomy criteria count documented episodes,² and NICE sets out what an audiological assessment must include and record.¹ A template with a field for each episode and each audiogram finding keeps the count and the thresholds where the surgeon can check them.

A draft stays a draft until the surgeon signs it. wai holds every draft until the clinician signs it, and every reply until a person at the clinic sends it. In a systematic review of 33 studies, 76% found at least one outcome better when patient and physician shared a language other than English.⁶

Measured in a working clinic. At The Wellness in London, which runs on wai every day, every clinician has 15 hours a week back, as published in the customer story.⁷

Where to start

Start with one surgeon's general ENT clinic. In the first week, build the note template by site, with fields for side, audiogram thresholds by frequency, tympanometry and the episode count, and run it for every new patient. Measure the time from the end of clinic to signed letters, and count corrections to side and to figures.

In the second week, add the head and neck referral and the post-tonsillectomy fit note, and turn on booking links and recalls at the front desk. Children's clinics follow the approach in the paediatrics guide, and voice and swallowing referrals often go on to the speech and language therapy team. Other specialties are on the specialties page, and the scribe is described on the wai Clinicians page.

Frequently asked questions