Introduction: Although often incidental, an empty sella turcica may correlate with idiopathic intracranial hypertension (IIH) and symptoms such as headache, visual or neurological disturbance. Imaging such as CT Brain, Petrous Temporal Bone and Facial Bones, frequently ordered by otolaryngologists, capture the sella, where this finding may be identified. However, published data on the incidence of incidental empty sella and referral pathways remain limited. This study aimed to determine its frequency and to assess symptom correlation and further investigations to inform ENT management and referral pathways. Methods: A retrospective review was performed of all adult CT scans capturing the sella turcica was conducted at Nepean Hospital (NSW, Australia) between 1 January and 1 July 2024. Scans performed for stroke or transient ischaemic attack and patients aged <18 years were excluded. Radiology images were manually reviewed by two consultant radiologists. Demographic, clinical, and referral data were extracted from medical records. Results: Of 3332 CT scans, 578 (17.3%) demonstrated an empty or partially empty sella. After exclusions, 358 (10.7%) cases were analysed (337 [94.1%] complete; 21 [5.9%] partial). Mean age was 70.8 years and mean BMI 28.6 kg/m². 3.1% identified as Aboriginal or Torres Strait Islander. No correlation was observed between BMI, weight, or Indigenous status. Thirty-six percent were symptomatic on presentation, with 71 patients (20%) demonstrating features consistent with empty sella syndrome. Referrals occurred in 16% of cases, most frequently to neurology, neurosurgery or ophthalmology. 52 patients underwent further imaging. Conclusion: Incidental empty sella is a frequent finding on CT imaging ordered within ENT practice. Symptomatic patients should be considered for further evaluation with MRI and specialist referral. Heightened awareness of this finding can assist ENT surgeons in identifying significant pathology and streamline follow-up pathways.