BackTable ENT

Ep. 271 The OR Surgical Tech in Pediatric ENT with Jose Flores

Tue, 28 Apr 2026 07:00:00 -0000

Behind every smooth surgery is a team member you may not see in the spotlight—but without them, the operation doesn’t run. In this episode of the BackTable ENT podcast, Jose Flores, a surgical technologist at Rady Children’s Hospital in San Diego and ENT service coordinator, joins host Dr. Gopi Shah to discuss the importance of the surgical technologist’s role in the OR and how it directly impacts patient care.

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SYNPOSIS

Jose discusses his journey from being a medical assistant to finding his calling in the operating room, specifically in ENT. They explore the critical yet often overlooked role of OR scrub techs, the necessity of proper preparation and organization, and the importance of good communication and teamwork within the surgical team. Jose also shares personal experiences and advice for both new surgical techs and medical students, emphasizing the rewarding nature of working in pediatric ENT.

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TIMESTAMPS

00:00 - Introduction
01:29 - Jose Flores’s Journey to Becoming a Surgical Tech
05:41 - Daily Responsibilities and Preparation
10:11 - Communication and Teamwork in the OR
15:30 - Building Strong Surgical Tech Relationships
18:51 - Advice for New Surgical Techs
21:25 - The Role of Techs in Quality and Safety
23:15 - Giving and Receiving Feedback
27:02 - Fostering Respect and Recognition
30:40 - Final Thoughts and Contact Information

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RESOURCES

Jose Flores’s Story:
https://vimeo.com/1096085041

Ep. 270 Management of Sinonasal Tumors with Skull Base Involvement: Part 2 with Dr. Zara Patel, Dr. JP Almeida and Dr. Garret Choby

Tue, 21 Apr 2026 07:00:00 -0000

Could that routine epistaxis actually be the first sign of a challenging skull base tumor? This week’s episode of the BackTable ENT Podcast is part two of the sinonasal tumor and skull base involvement discussion. Host Dr. Satyan Sreenath is joined again by Dr. Joao Paulo Almeida, Dr. Zara Patel, and Dr. Garret Choby for a case-based deep dive into the multidisciplinary management of complex sinonasal tumors.

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https://www.backtable.com/app

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Timestamps

00:00 - Introduction
01:20 - Case 1: Juvenile Nasopharyngeal Angiofibroma
05:03 - Considerations for Pre-Operative Embolization
08:10 - Disaster Scenario: High Volume Loss
09:21 - Operative Approach
18:10 - Post-Op Imaging Considerations
21:00 - Case 2: Invasive Keratinizing Squamous Cell Carcinoma
24:40 - Operative Approach vs. Neoadjuvant Treatment Strategies
28:30 - Importance of Diagnostic Nasal Endoscopy
30:15 - Operative Approach
32:37 - Lumbar Drain Considerations
40:35 - Closing Thoughts

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More about this episode

The panel works through advanced cases presenting with epistaxis, using them to highlight key principles in evaluation, imaging, staging, and operative planning. They first discuss a 16-year-old male with a large juvenile nasopharyngeal angiofibroma extending to the skull base and middle cranial fossa, focusing on vascular supply, preoperative embolization, surgical strategy near the carotid, and planning for intraoperative hemorrhage and postoperative surveillance. They also emphasize the importance of thorough endoscopic evaluation and early referral to experienced centers.

They then review a 72-year-old female with invasive, HPV-negative keratinizing squamous cell carcinoma involving the anterior cranial fossa and dura. The conversation addresses tumor board decision-making, neoadjuvant considerations, endoscopic craniofacial resection, reconstruction strategies, and management of delayed positive margins. It highlights how accurate histopathology and coordinated multidisciplinary care guide outcomes in these complex cases.

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Resources

Joao Paulo Almeida, MD, PhD
https://medicine.iu.edu/faculty/68351/almeida-joao-paulo

Satyan B. Sreenath, MD
https://medicine.iu.edu/faculty/60724/sreenath-satyan

Zara M. Patel, MD
https://med.stanford.edu/profiles/zara-patel

Garret W. Choby, MD
https://providers.upmc.com/provider/garret-w-choby/2592344

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BackTable ENT & Allergy is the go-to podcast for otolaryngologists, allergists, and head and neck surgeons.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Ep. 269 Management of Sinonasal Tumors with Skull Base Involvement: Part 1 with Dr. Zara Patel, Dr. JP Almeida, & Dr. Garret Choby

Tue, 14 Apr 2026 07:00:00 -0000

Pathology, anatomy, and staging: how do these three pillars come together to guide sinonasal tumor management? In this episode of the BackTable ENT Podcast, host Dr. Satyan Sreenath is joined by Dr. Joao Paulo Almeida, Dr. Zara Patel, and Dr. Garret Choby to discuss a multidisciplinary approach to sinonasal tumors, emphasizing the triad of pathology, anatomy, and staging to guide treatment.

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Get the BackTable app
https://www.backtable.com/app

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Timestamps

00:00 - Introduction
02:04 - First Principles of Workup
05:23 - Case 1: Maxillary Sinus Mass
06:23 - Imaging and Biopsy Strategy
08:11 - Inverted Papilloma Pathology and Surgical Planning
20:28 - Case 2: Unilateral Disease Red Flags
24:34 - MRI Clues for Malignancy
31:47 - Video Walkthrough of Endonasal Resection
38:51 - Surveillance
41:41 - Key Papers
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More about this episode

The panel reviews key workup considerations, including in-office biopsy and the use of CT and MRI to distinguish tumor from retained secretions and guide operative planning. They walk through two illustrative cases of inverted papilloma. The first involves a left maxillary sinus mass treated with an endoscopic medial maxillectomy using a Denker-type approach, with emphasis on complete attachment-site eradication. The second case highlights an elderly patient with frontal and anterior ethmoid disease abutting the orbit and skull base, requiring meticulous endoscopic technique, careful management of the anterior ethmoid artery, and thoughtful handling of bone and periorbita.

The discussion also covers imaging features suggestive of malignant transformation, as well as emerging AI-based CT and MRI tools that show high accuracy in distinguishing benign inverted papillomas from those associated with squamous cell carcinoma. The episode concludes with postoperative surveillance strategies and key consensus and review publications.

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Resources
Joao Paulo Almeida, MD, PhD
https://medicine.iu.edu/faculty/68351/almeida-joao-paulo

Satyan B. Sreenath, MD
https://medicine.iu.edu/faculty/60724/sreenath-satyan

Zara M. Patel, MD
https://med.stanford.edu/profiles/zara-patel

Garret W. Choby, MD
https://providers.upmc.com/provider/garret-w-choby/2592344

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BackTable ENT & Allergy is the go-to podcast for otolaryngologists, allergists, and head and neck surgeons.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Ep. 268 Building a Skull Base Program in Private Practice with Dr. Kibwei McKinney

Tue, 07 Apr 2026 07:00:00 -0000

What if you could build a skull base practice outside academia, without sacrificing complexity, income, or fulfillment? On this episode of the BackTable ENT Podcast, Dr. Kibwei McKinney from SSM Health St. Anthony Hospital in Oklahoma City joins guest host Dr. Dennis Tang to discuss building a rhinology and skull base surgery practice outside academia.

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Get the BackTable app

https://www.backtable.com/app

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Timestamps

01:30 - Introduction and Career
04:55 - Private Practice vs. Academics
10:38 - Defining Skull Based Surgery
15:10 - Patient Pool and Logistics in Academics vs Private Practice
19:03 - Marketing and Referral Sources
24:58 - Case Management and the O.R. in Private Practice
29:30 - Balanced Workload and Intentional Care
32:10 - Billing and Coding
38:55 - Lifestyle Benefits of Private Practice
44:21 - Strategic Advice and Advantages or Disadvantages of Private Practice.
47:38 - Common Misconceptions
50:00 - Advice and Closing Thoughts

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More about this episode

Dr. McKinney walks through his training journey, from dedicated research years to time in private-practice rhinology and a skull base fellowship, before ultimately starting his academic career in Oklahoma. He shares how shifting family priorities and the growing push for clinical productivity led him to step away from academia and into an employed private-practice model focused exclusively on rhinology and skull base surgery, without ER call. Along the way, he dives into what that transition really looks like, including the autonomy he’s gained, the role of marketing support, how he builds referrals through direct communication, and the operational differences of working without residents. He also touches on postoperative care structure, billing and coding, insurance challenges, and the impact on his overall lifestyle.

Check out this episode to hear Dr. McKinney’s perspective on why skull base surgery in private practice can be not only technically feasible and financially viable, but also emotionally sustainable, creating space for truly patient-centered care and the ability to pursue the work with genuine passion.

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Resources

Dr. Kibwei McKinney
https://www.getcare.ssmhealth.com/find-a-doctor/doctor-details/kibwei-mckinney-md

Ep. 267 Clinical Hypnotherapy Applications in ENT Medicine with Dr. Sonia Gupte

Tue, 31 Mar 2026 07:00:00 -0000

Why do some patients recover faster, cope better, and experience less pain despite similar diagnoses? The answer may lie not in the pathology, but in perception. In this episode of the BackTable ENT & Allergy Podcast, Dr. Sonia Gupte, a former family physician and board-certified clinical hypnotherapist, joins host Dr. Gopi Shah to explore how hypnotherapy works and where it fits in modern medical care.

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Get the BackTable app

https://www.backtable.com/app

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Timestamps

00:00 - Introduction
05:13 - Understanding the Subconscious Mind
09:29 - The Hypnotherapy Process
15:43 - Patient Selection
18:58 - Anxiety, Stress, and Pain Perception
23:54 - Use in General ENT Population
28:14 - When to Refer
31:51 - History of Hypnotherapy in Cancer Care
32:56 - Awareness, Access, and Billing Insurance
38:59 - Setting Expectations, Visits Required, and Smoking Cessation
43:42 - Virtual Visits and Possible Limitations
46:57 - Techniques for ENTs
49:14 - Closing Thoughts

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More about this episode

Dr. Gupte shares how her mother’s cancer journey led her to recognize gaps in addressing the mind-body connection and ultimately transition into hypnotherapy. She clarifies the difference between hypnosis and clinical hypnotherapy, emphasizing the latter as a collaborative, goal-oriented process aimed at uncovering the “why” behind patient patterns and reshaping perceptions. The conversation covers the structure of a hypnotherapy session, relevant brainwave states, patient selection and contraindications, and clinical applications ranging from oncology support to ENT-related quality-of-life concerns. They also discuss use in pediatric patients, expected timelines for improvement, virtual care delivery, and practical communication strategies clinicians can use to reduce patient anxiety in everyday practice.

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Resources

Dr. Sonia Gupte

https://enso-nia.com/about-sonia/

Ep. 266 Clinical Steps for Efficient Anaphylaxis Diagnosis & Treatment with Dr. Payel Gupta

Tue, 24 Mar 2026 07:00:00 -0000

Anaphylaxis doesn’t always look like hives and swelling. In up to 20% of cases, the skin is completely clear, making the diagnosis easy to miss. On this episode of the BackTable ENT & Allergy Podcast, Dr. Basil Kahwash speaks with Dr. Payel Gupta, allergist and immunologist at Mount Sinai in New York City, about how to recognize and manage anaphylaxis.

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Get the BackTable app
https://www.backtable.com/app

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Timestamps

00:00 - Introduction
02:02 - Defining Anaphylaxis and Key Signs
04:09 - Anaphylaxis Versus Shock
05:54 - Diagnostic Pitfalls
12:43 - Epi First Epi Fast
32:33 - ER Or Observe
42:31 - Allergy Testing Limits
47:16 - New Anaphylaxis Therapies
51:34 - Public Awareness and Advocacy
01:02:55 - Final Pearls and Wrap up

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More about this episode

Dr. Gupta and Dr. Kahwash first define anaphylaxis and review common diagnostic pitfalls, including absent skin findings, overlap with asthma, atypical presentations, delayed reactions, and the effects of beta-blockers. Dr. Gupta emphasizes the importance of early treatment with intramuscular epinephrine. Antihistamines and steroids are discussed as adjunctive therapies and the episode reviews the risk and management of biphasic reactions. The conversation also covers optimal timing for tryptase testing, post-reaction counseling, evolving guidance on emergency department referral, and appropriate timing for allergy testing after a reaction. Dr. Gupta discusses emerging options such as intranasal epinephrine and the use of omalizumab to increase reaction thresholds in food allergy. The episode concludes with a discussion of public misconceptions around the term “allergy,” barriers to appropriate care, and Dr. Gupta’s advocacy and educational work.

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Resources

Dr. Payel Gupta
https://www.zocdoc.com/doctor/payel-gupta-md-facaai-571583

Ep. 265 Pediatric Tympanoplasty: Butterfly Cartilage Technique with Dr. Sean Evans

Tue, 17 Mar 2026 07:00:00 -0000

What makes butterfly cartilage tympanoplasty such an elegant solution for pediatric eardrum perforations? In this episode of the BackTable ENT Podcast, Dr. Sean Evans of Children’s Healthcare of Atlanta joins hosts Dr. Ashley Agan and Dr. Gopi Shah to discuss the evaluation and management of pediatric tympanic membrane perforations, with a focus on the butterfly cartilage tympanoplasty technique

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SYNPOSIS

Dr. Evans describes his practice and reviews common etiologies of tympanic membrane perforations. He outlines his approach to the clinical workup and patient counseling, including the role of audiograms, careful otoscopic examination, and selective use of laboratory studies and CT imaging in patients with chronic otorrhea or suspected cholesteatoma. The discussion also addresses timing and age considerations for repair, as well as strategies for managing chronic drainage. Dr. Evans also discusses his evaluation of patient selection criteria and operative technique for butterfly cartilage tympanoplasty. He shares practical insights on surgical steps, technical pearls and pitfalls, postoperative care, recovery expectations, potential risks, coding considerations, and approaches to revision surgery.

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TIMESTAMPS

00:00 - Introduction
02:35 - When to Repair Perforations
10:36 - Physical Exam, Audiogram, & Treatment Decisions
18:06 - Butterfly Graft Candidacy
20:42 - Step by Step Butterfly Technique
25:52 - Butterfly Technique Pearls and Pitfalls
29:16 - Example Case Video and Indications
35:12 - Restrictions, Pain, & Recovery
37:10 - Risk Factors and Complications
40:09 - Revision Timing and Failure Modes
42:37 - Final Pearls and Wrap Up

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RESOURCES

Dr. Sean Evans
https://med.emory.edu/directory/profile/?u=SSEVAN3

Ep. 264 Exploring Augmented Reality for Surgical Applications: Insights for Facial Plastic Surgeons with Dr. David Chou

Tue, 10 Mar 2026 07:00:00 -0000

Ep. 263 Immunotherapy for Adults with RRP with Dr. Aaron Friedman

Tue, 03 Mar 2026 08:00:00 -0000

Recurrent respiratory papillomatosis (RRP) has long been managed with repeated surgical debulking, sometimes requiring dozens of procedures over a lifetime. In this episode of BackTable, Dr. Aaron Friedman and guest host Dr. Stephen Schoeff discuss a major shift in care: immune-directed therapy targeting HPV 6 and 11.

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SYNPOSIS

Dr. Friedman reviews the recent FDA approval of the Precigen product PAPZIMEOS (August 2025), a therapeutic vaccine designed to stimulate HPV-specific T-cell responses. Clinical trial data show that about half of treated adults required no additional surgeries over the following year, with many responders maintaining durable benefit for years. The conversation also covers traditional management strategies, adjuvant therapies like bevacizumab, HPV vaccination, and the evolving algorithm for adult RRP care.

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TIMESTAMPS

00:00 - Introduction
02:13 - RRP Patient Types and Symptoms
05:06 - Adult vs Juvenile Transmission
10:46 - When to Escalate Treatment
15:40 - Immunotherapy
18:55 - Trial Enrollment, Results and Dosing Rules
26:17 - Durable Long Term Response
30:47 - Who Should Get Treated
32:34 - Logistics And Public Perception
37:50 - Future Research And Prevention

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Recurrent Respiratory Papillomatosis Foundation Position Statement on the Management of Adults With RRP
https://pubmed.ncbi.nlm.nih.gov/41543033/

Dr. Stephen Schoeff
https://healthy.kaiserpermanente.org/washington/clinicians/stephen-schoeff-6848607

Dr. Aaron Friedman
https://www.uchealth.com/en/provider-profiles/friedman-aaron-d-1609057587

Ep. 262 Systematic Approach to Pediatric OSA Management with Dr. Tali Lando

Tue, 24 Feb 2026 08:00:00 -0000

Not every airway is a tonsil problem. Pediatric obstructive sleep apnea is often more nuanced than it appears, requiring thoughtful evaluation beyond routine surgery. In this episode of the BackTable ENT Podcast, pediatric otolaryngologist Dr. Tali Lando discusses managing pediatric obstructive sleep apnea (OSA) with hosts Dr. Gopi Shah and Dr. Ashley Agan.

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SYNPOSIS

Dr. Lando shares insights into her clinical practice, outlining a systematic approach to diagnosing and treating pediatric OSA, and emphasizing the value of sleep endoscopy. She explores the spectrum of interventions from adenoidectomy and tonsillectomy to complex airway evaluations and surgical management, while highlighting the roles of sleep studies, obesity, and emerging therapies such as hypoglossal nerve stimulation. Dr. Lando also reflects on balancing a busy clinical career with family life and discusses her two books, Hell & Back: Wife & Mother, Doctor & Patient, Dragon Slayer and Breathless: Surgical Tales from the Brink (and Back).

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TIMESTAMPS

00:00 - Introduction
06:21 - When Noisy Breathing Signals More Than Tonsils
10:01 - When to Add DISE: Combining T&A with Airway Evaluation
18:08 - Turbinates, Septum and Nasal Valve Matter
22:03 - Red Flags in Clinic
29:12 - When Surgery Helps and When It Doesn’t
41:33 - Sleep Studies
43:09 - Down Syndrome and OSA
55:19 - Finding Hidden Sites of Airway Collapse
01:06:13 - Hypoglossal Nerve Stimulation and Advanced Options

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RESOURCES

Dr. Tali Lando
https://www.wmchealth.org/physician-locator/tali-lando-1548383763?address_id=413
About Dr. Tali – Dr. Tali Lando

Ep. 261 Cochlear Implants in the Elderly - Challenges & Solutions with Dr. Cameron Wick

Tue, 17 Feb 2026 08:00:00 -0000

Only 7–10% of patients who qualify for cochlear implants actually receive one. Why are so many older adults missing out on life-changing hearing care? In this episode of the BackTable ENT Podcast, guest hosts Dr. Joe Walter Kutz and Dr. Brandon Isaacson are joined by Dr. Cameron Wick of University Hospitals Cleveland Medical Center to discuss cochlear implantation in the elderly population.

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SYNPOSIS

The doctors explore common barriers to cochlear implantation, persistently low referral rates, and the substantial benefits these devices can offer older adults. Dr. Wick shares insights from his recent study on patients in their 80s and 90s, highlighting meaningful improvements in speech perception and overall quality of life. The conversation also addresses surgical considerations, postoperative care, the importance of timely intervention, and updated Medicare guidelines.

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TIMESTAMPS

00:00 - Introduction
02:52 - Risks and Benefits of CI in Older Adults
11:57 - Handling Anticoagulation During CI Surgery
13:59 - Post-Surgery Expectations and Balance Issues
16:35 - Next Day Activation and Surgical Considerations
19:17 - Assessing Patient Suitability for Cochlear Implants
22:45 - Setting Patient Expectations for Cochlear Implants
23:39 - Barriers to Cochlear Implant Access
28:07 - Importance of Early Identification and Referral
31:47 - Postoperative Rehabilitation and Patient Support
39:30 - Concluding Thoughts and Acknowledgements

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RESOURCES

J. Walter Kutz, M.D.
https://utswmed.org/doctors/joe-kutz/

Brandon Isaacson, M.D.
https://utswmed.org/doctors/brandon-isaacson/

Cameron Wick, MD
https://www.uhhospitals.org/doctors/Wick-Cameron-1063737799

Ep. 260 Clinical Insights on Immunodeficiency & ENT Infections with Dr. Lauren Gunderman

Tue, 10 Feb 2026 08:00:00 -0000

At what point does a “routine” sinus or ear infection become a warning sign of immunodeficiency? In this episode of the BackTable ENT Podcast, board-certified allergist-immunologist Dr. Basil Kahwash explores the intersection of immunodeficiency and otolaryngology with Dr. Lauren Gunderman, a pediatric immunologist at Seattle Children’s Hospital. Learn why ENTs should remain vigilant for underlying immune disorders, and how to manage suspected immunodeficiency.

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SYNPOSIS

The conversation reviews common signs and symptoms of immunodeficiency, key elements of the diagnostic workup, and when ENT physicians should consider referral to immunology. Dr. Kahwash and Dr. Gunderman discuss the role of family history and genetics, as well as current management strategies, including antibiotic use, immunoglobulin replacement therapy, and lifestyle modifications. Throughout the episode, Dr. Gunderman emphasizes the importance of multidisciplinary collaboration between otolaryngologists and immunologists to improve outcomes for patients with recurrent or severe infections.

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TIMESTAMPS

00:00 - Introduction
02:45 - Understanding Immunodeficiency in ENT
08:20 - Common Immunodeficiencies and Indicators
11:02 - Basic Immunology Refresher
22:13 - Initial Diagnostic Workup
25:05 - Challenges in Allergy and Immunology Testing
27:57 - When to Refer to an Immunologist
34:01 - Antibiotic Stewardship in Immunodeficient Patients
46:07 - Advances in Diagnosing Immunodeficiency
50:31 - Final Thoughts and Takeaways

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RESOURCES

Lauren Michelle Gunderman, MD
https://www.seattlechildrens.org/directory/lauren-michelle-gunderman/

Ep. 259 Understanding Coblation Tonsillectomy: Benefits, Outcomes & Techniques with Dr. Stephen Chorney

Tue, 03 Feb 2026 08:00:00 -0000

Can one surgical approach reduce postoperative bleeding, shorten recovery, and save hundreds of dollars per case? In this episode of the BackTable ENT Podcast, Dr. Stephen Chorney, pediatric otolaryngologist at the University of Texas Southwestern Medical Center, joins hosts Dr. Ashley Agan and Dr. Gopi Shah to discuss the benefits and techniques of coblation intracapsular tonsillectomy. Drawing from his extensive clinical experience and findings from his recent Triological thesis, Dr. Chorney reviews the cost effectiveness of coblation intracapsular tonsillectomy compared to traditional extracapsular approaches.

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This podcast is supported by:

Smith+Nephew

https://www.smith-nephew.com/en-us/health-care-professionals/products/ear-nose-and-throat/coblation-technology-for-adenotonsillectomy#overview

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SYNPOSIS

The conversation highlights key advantages of coblation intracapsular tonsillectomy, including lower postoperative bleeding rates, reduced pain, faster recovery, and meaningful economic benefits. Dr. Chorney also shares practical pearls on surgical technique with coblation, equipment settings, and postoperative care, making this episode a valuable resource for surgeons considering or already performing intracapsular tonsillectomy.

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TIMESTAMPS

00:00 - Introduction
03:34 - Intracapsular Tonsillectomy: Training and Adoption
08:46 - Patient Selection and Surgical Techniques
15:50 - Postoperative Care and Pain Management
37:26 - Understanding Post-Workout Pain and Recovery
38:13 - Comparing Surgical Tools: Microdebrider vs. Coblator
38:54 - Visual Cues and Techniques in Tonsillectomy
39:22 - Challenges and Solutions in Tonsillectomy Procedures
46:37 - Case Studies and Video Demonstrations
56:12 - Cost-Effectiveness of Intracapsular Tonsillectomy
01:07:19 - Conclusion and Final Thoughts

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RESOURCES

Dr. Stephen Chorney
https://utswmed.org/doctors/stephen-chorney/

Trio Thesis
https://onlinelibrary.wiley.com/doi/full/10.1002/lary.32448

Ep. 258 Understanding Sublingual vs. Subcutaneous Immunotherapy with Dr. Nikhila Schroeder

Tue, 27 Jan 2026 08:00:00 -0000

When allergy meds aren’t enough, how do you choose the form of immunotherapy that will work best for your patient? Board-certified allergist-immunologist Dr. Nikhila Schroeder and host Dr. Basil Kahwash answer that question and more in this episode of the BackTable ENT Podcast.

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SYNPOSIS

Dr. Schroeder shares her path from an engineering background to becoming a board-certified pediatric and adult allergist-immunologist, offering insight into how that perspective shapes her approach to patient care. The discussion focuses on the nuances of sublingual immunotherapy (SLIT) versus subcutaneous immunotherapy (SCIT), including administration, efficacy, safety, and patient adherence challenges. They also explore how immunotherapy can modulate the immune system and provide long-term symptom relief. Dr. Schroeder concludes by sharing her vision for the future of allergy immunotherapy, highlighting the accessibility and growing potential of SLIT. This episode offers ENT specialists a practical overview of why understanding and integrating allergy-immunotherapy can benefit both their practice and their patients.

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TIMESTAMPS

00:00 - Introduction
05:01 - History and Evolution of Immunotherapy
10:36 - Mechanisms of Immunotherapy
14:59 - Subcutaneous Immunotherapy: Process and Benefits
19:52 - Sublingual Immunotherapy: Process and Benefits
27:56 - Comparing Subcutaneous and Sublingual Immunotherapy
34:14 - Efficacy Comparison: Allergy Shots vs. SLIT
39:51 - Patient Adherence and Treatment Choices
41:58 - Contraindications for Allergy Immunotherapy
48:58 - Long-term Benefits of Immunotherapy
59:26 - Key Takeaways for ENT Professionals

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RESOURCES

Dr. Nikhila Schroeder
https://allergenuityhealth.com/about-us/

Ep. 257 Understanding Eosinophilic Esophagitis: Diagnosis & Treatment Strategies with Dr. John Leung

Tue, 20 Jan 2026 08:00:00 -0000

Think beyond the esophagus. Up to 75% of eosinophilic esophagitis (EoE) patients have ENT-relevant atopic disease that is often best managed with a multidisciplinary approach. Get caught up on best practices in EoE diagnosis and treatment with this episode of the BackTable ENT Podcast, featuring dual board-certified gastroenterologist and allergist-immunologist Dr. John Leung and host Dr. Basil Kahwash.

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SYNPOSIS

The discussion covers the definition, symptoms, and diagnosis of EoE, highlighting the role of food and environmental allergies. Dr. Leung and Dr. Kahwash cover diagnostic techniques like endoscopy and emerging non-invasive methods, as well as various treatment options including dietary modifications, pharmacology, and biologics. The doctors also emphasize the importance of multidisciplinary collaboration between gastroenterologists, allergists, and otolaryngologists to provide optimal care for patients with EoE.

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TIMESTAMPS

00:00 - Introduction
03:13 - Understanding Eosinophilic Esophagitis (EoE)
05:45 - EoE Symptoms and Diagnosis
08:41 - Role of ENT in EoE Diagnosis
11:32 - Diagnostic Criteria for EoE
16:34 - Treatment Options for EoE
20:55 - Role of Allergists and Environmental Allergies
23:24 - Pharmacological Management of EoE
29:38 - Complications and Risks of EoE
36:21 - Follow-Up Endoscopies and Surveillance
40:34 - Future Directions in EoE Management
45:21 - Conclusion and Final Thoughts

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RESOURCES

Dr. John Leung
https://www.bostonspecialists.org/dr-leung-full-profile

Ep. 256 Keys to FESS: Intra-Op Pearls for Optimizing Outcomes in Sinus Surgery with Dr. Dennis Tang

Tue, 13 Jan 2026 08:00:00 -0000

The best approach to sinus surgery is the one tailored to the patient in front of you. In this episode of the BackTable ENT podcast, guest host Dr. Satyan Sreenath, rhinologist and Assistant Professor at Indiana University, and Dr. Dennis Tang, rhinologist and Assistant Professor at Cedars-Sinai, discuss advanced surgical techniques and post-operative management strategies in Functional Endoscopic Sinus Surgery (FESS).

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SYNPOSIS

The conversation covers the latest practices in intraoperative maneuvers, the use of bioabsorbable materials, and the contentious topic of middle turbinate resections. They review patient cases, surgical approaches, and provide insights into optimizing patient outcomes. Additionally, they emphasize the importance of individualized care tailored to specific chronic sinusitis phenotypes and patient-specific factors.

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TIMESTAMPS

00:00 - Introduction
03:28 - Case Study #1: CRSsNP with Nasal Congestion
04:59 - Factors Influencing Minimal vs. Maximal Surgery
14:23 - Case Study #2: Severe Nasal Polyposis
27:56 - Debating the Use of Packing in Sinus Surgery
40:24 - Scrutinizing Overhead Costs in Patient Care
42:45 - FESS Postoperative Care
43:54 - Evolving Biomaterials in Sinus Surgery
49:46 - The Debate on Middle Turbinectomy
50:46 - Middle Turbinate Management Strategies
01:13:17 - Concluding Thoughts on Surgical Practices

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RESOURCES

Dr. Satyan Sreenath
https://iuhealth.org/find-providers/provider/satyan-b-sreenath-md-1821999

Dr. Dennis Tang
https://www.cedars-sinai.org/provider/dennis-tang-3316614.html

Ep. 255 Antibiotic Allergy vs. Intolerance: Understanding Patient Risk with Dr. Cosby Stone

Tue, 06 Jan 2026 08:00:00 -0000

When should an antibiotic allergy actually be tested? In this episode of the BackTable ENT Podcast, guest host Dr. Basil Kahwash, an allergist and immunologist at Ohio ENT & Allergy, sits down with Dr. Cosby Stone, an allergist and immunologist at Vanderbilt University Medical Center, to discuss antibiotic allergies and how to distinguish true allergies from intolerances.

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SYNPOSIS

Dr. Stone breaks down common misconceptions around antibiotic allergies, with a focus on penicillin and cephalosporins. The conversation explores how these allergies are evaluated, including when skin testing is appropriate, why inaccurate allergy labels matter, and how confirmed allergies should be managed long term. They also dive into more advanced topics such as drug desensitization, current research in the field, and where the future of drug allergy evaluation is headed.

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TIMESTAMPS

00:00 - Introduction
01:03 - Understanding Antibiotic Allergies
07:28 - The Importance of Accurate Allergy Diagnosis
10:55 - Key Questions for Diagnosing Allergies
17:10 - Implementing Allergy Testing in Healthcare Settings
19:06 - Identifying Severe Allergic Reactions
26:31 - Interpreting Allergy Skin Testing Procedures
33:17 - Penicillin and Cephalosporin Cross-Reactivity
37:15 - Drug Desensitization: Indications and Process
40:30 - Prognosis and Long-Term Outcomes of Drug Allergies
47:22 - Conclusion and Final Thoughts

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RESOURCES

Dr. Basil Kahwash
https://www.ohioentandallergy.com/physicians/basil-kahwash-md/

Dr. Cosby Stone
https://www.vanderbilthealth.com/doctors/stone-cosby

Ep. 254 Modern ENT Private Practice: Insights and Innovations with Dr. Caleb Masterson

Tue, 30 Dec 2025 08:00:00 -0000

“This is the kind of conversation I wish I heard earlier in training.” If you’re thinking about private practice at all, you’ll want to hear this episode of the BackTable ENT Podcast. Private practice otolaryngologist Dr. Caleb Masterson joins host Dr. Ashley Agan for a conversation about what modern ENT private practice can look like when autonomy, leadership, and patient experience take priority.

---

SYNPOSIS

Dr. Masterson shares his journey from academic medicine to establishing his own private practice, highlighting his motivations for seeking autonomy and the challenges he faced. The discussion covers the importance of creating a patient-centered experience, innovating during the COVID-19 pandemic, and the significance of developing strong leadership within a practice. Dr. Masterson also shares his entrepreneurial ventures, including the creation of a coffee shop within his clinic and the development of an allergy engagement mobile app to enhance patient care.

---

TIMESTAMPS

00:00 - Introduction
01:40 - Journey to Private Practice
06:36 - COVID-19 Impact and Adaptation
09:37 - Building a Successful Team
16:37 - Financial Strategies in Private Practice
27:59 - Creating an Exceptional Patient Experience
30:05 - Community Involvement and Unexpected Outcomes
39:53 - The Importance of Autonomy in Healthcare
48:41 - Developing Resources for Healthcare Providers
51:17 - Innovations in Patient Experience

---

RESOURCES

Dr. Caleb Masterson
https://www.bnbsinusandallergy.com/team-members/caleb-masterson

Ep. 253 ENT Women in Industry: Research & Innovation with Dr. Karen Hoffmann

Tue, 23 Dec 2025 08:00:00 -0000

How can your clinical experience translate into industry leadership? In this episode of the BackTable ENT Podcast, otolaryngologist Dr. Karen Hoffmann at Piedmont ENT in Atlanta joins hosts Dr. Gopi Shah and Dr. Ashley Agan to discuss the many opportunities for industry involvement within otolaryngology.

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SYNPOSIS

Dr. Hoffmann shares her extensive experience in otology and rhinology, highlighting her involvement in clinical trials, public speaking, and industry collaborations. The discussion focuses on the vast opportunities available for ENTs in industry, addressing how clinical experience can translate into meaningful contributions beyond traditional practice. Dr. Hoffmann offers insights on balancing clinical practice with industry work, the importance of gender diversity in advancing medical tools and practices, and the potential for future innovations in ENT driven by women in the field.

---

TIMESTAMPS

00:00 - Introduction
02:31 - Opportunities for ENTs in Industry
08:43 - Balancing Career and Family
16:39 - Navigating Industry Partnerships
21:39 - Addressing Criticism in Medicine
25:09 - Getting Started with Clinical Trials in Private Practice
28:57 - The Role of Mentorship and Networking
36:13 - The Importance of Women in Medicine
42:10 - Future Opportunities for Women in ENT

---

RESOURCES

Dr. Karen Hoffmann
https://www.piedent.com/about-us/providers/karen-hoffmann

Ep. 252 The Wealthy Healer: Escaping the 7-year Slump with Robert Glazer, MPA

Tue, 16 Dec 2025 08:00:00 -0000

Ever wondered what a high-powered healthcare executive thinks physicians should know about money, leadership, and career longevity? This episode of BackTable ENT features an especially engaging conversation with Bob Glazer, a recently retired healthcare executive, who shares his wisdom on achieving financial and personal abundance with guest host Dr. Ayesha Khalid.

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SYNPOSIS

The discussion covers Bob’s extensive career in healthcare administration to key financial strategies for otolaryngologists, including tax planning and long-term financial management. Mr. Glazer emphasizes the importance of balancing career ambitions with personal life, planning for different stages of one's professional journey, and exploring entrepreneurial ventures. With practical advice on leadership, maintaining work-life balance, and continuous self-improvement, Mr. Glazer offers invaluable guidance for both young practitioners and seasoned professionals in healthcare.

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TIMESTAMPS

00:00 - Introduction
02:53 - The Importance of Tax Planning for Physicians
06:50 - Navigating Early Career Financial Decisions
11:40 - Building a Strong Professional Reputation
14:51 - The Seven-Year Itch: Seeking New Challenges
23:59 - Understanding Risk Tolerance
26:25 - Balancing Work and Life as an Otolaryngologist
29:37 - Retirement and Rediscovering Hobbies
32:36 - Leading Yourself and Crafting Your Life
35:37 - Data-Driven Leadership and Career Advice
38:43 - Final Takeaways

---

RESOURCES

Robert Glazer
https://www.askascent.com/page/RobertGlazerbio

Ep. 251 Clinical Evaluation and Treatment of Tongue Tie in Pediatric OSA with Dr. Brennan Dodson and Allegra Bereszniewicz M.S., CCC-SLP, QOM

Tue, 09 Dec 2025 08:00:00 -0000

Does tongue tie impact pediatric sleep disordered breathing? In this episode of the Back Table ENT Podcast, otolaryngologist Dr. Brennan Dodson and speech language pathologist Allegra Bereszniewicz discuss tongue-tie and the pediatric airway with hosts Dr Ashley Agan and Dr. Gopi Shah.

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SYNPOSIS

The discussion covers the anatomy and pathophysiology of tongue tie, surgical techniques for its release, and the importance of pre- and post-operative myofunctional therapy. They delve into patient selection, the impact of tongue tie on sleep-disordered breathing, and contrasting surgical methodologies, including frenuloplasty. The episode also features an insightful case study with visuals, examining Dr. Dodson's surgical approach in detail. Additionally, they touch on insurance considerations and the challenges within current medical practice regarding tongue tie diagnosis and treatment. Check out detailed surgical techniques at the end with case presentations!

---

TIMESTAMPS

00:00 - Introduction
01:29 - Understanding Tongue Tie and Pediatric Airway
06:17 - The Role of Myofunctional Therapy
10:37 - Scientific Evidence and Research on Tongue Tie
15:52 - Clinical Approaches and Patient Evaluations
35:00 - Pre-Op and Post-Op Procedures
39:02 - Post-Surgery Recovery and Exercises
40:32 - Surgical Techniques and Tools
44:31 - Post-Operative Care and Pain Management
48:59 - Patient Selection and Considerations
01:02:41 - Sleep Studies and Outcome Measures
01:12:30 - Incision Techniques and Dissection Tools
01:17:24 - Closure and Post-Operative Care
01:23:51 - Innovations and Techniques in Surgery
01:28:09 - Final Thoughts

---

RESOURCES

Dr. Brennan Dodson
https://www.bridgerent.com/

Allegra Bereszniewicz MS, CCC-SLP
https://grospeech.com/about/

Ep. 250 Preauricular Pits: Workup & Surgical Management with Dr. Eric Berg and Dr. Eric Gantwerker

Tue, 02 Dec 2025 08:00:00 -0000

From asymptomatic dimples to chronic infections—here’s how experts navigate the spectrum of preauricular pits. In this episode of the Back Table ENT podcast, pediatric otolaryngologists Dr. Eric Gantwerker and Dr. Eric Berg discuss the surgical management of Preauricular Pits with host Dr. Gopi Shah.

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SYNPOSIS

The conversation covers the etiology of preauricular pits, their presentations, decision-making for excision, surgical techniques, post-operative management, recurrence, and valuable tips in preauricular pit management. The doctors also touch upon collaboration with facial plastics and the importance of communication with families.

---

TIMESTAMPS

00:00 - Introduction
03:11 - Common Presentations & Management of Preauricular Pits
06:17 - Differential Diagnoses and Imaging
13:56 - Surgical Considerations and Techniques
18:51 - Managing Recurrent Infections
19:07 - Skin Flap Techniques
19:55 - Excising Chronic Wounds
23:07 - Post-Op Management
24:46 - Revision Surgery Insights
29:08 - Final Tips and Pearls

---

RESOURCES

Dr. Eric Gantwerker https://www.northwell.edu/find-care/find-a-doctor/dr-eric-alan-gantwerker-md-ms-1144482662

Dr. Eric Berg
https://www.wellstar.org/physicians/eric-berg-md

Ep. 249 Maximizing Your ENT Away Rotation: Tips for Success with Dr. Viraj Shah

Tue, 25 Nov 2025 08:00:00 -0000

Are you a med student with an upcoming away rotation? Get a head start with this episode of the BackTable ENT Podcast. Dr. Viraj Shah, a PGY-4 ENT resident at UT Southwestern and guest host Dr. Quynh-Chi Dang, PGY-1 at UC Davis Medical Center, discuss how to succeed on away rotations.

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SYNPOSIS

They cover the basics of away rotations, factors to consider when applying, and effective strategies for excelling both in the operating room and within the residency team. Additionally, they delve into the importance of networking, securing recommendation letters, and making a positive impression through situational awareness and preparation. Personal anecdotes and practical tips make this a valuable listen for medical students gearing up for their rotations.

---

TIMESTAMPS

00:00 Introduction
02:33 Diving into Away Rotations
05:20 Factors to Consider for Away Rotations
22:54 Handling Away Rotation Offers
28:33 Succeeding in the OR
34:30 Navigating OR Dynamics
40:49 Securing Recommendation Letters
46:11 Onsite Interviews: Preparation and Presentation
50:48 Housing for Away Rotations
56:03 Final Tips: Observing Team Dynamics and Being Proactive

---

RESOURCES

Chi Dang
https://health.ucdavis.edu/otolaryngology/our-team/residents.html

Viraj Shah
https://www.utsouthwestern.edu/departments/otolaryngology/education-training/residency-program/residents/

Ep. 248 Understanding Inducible Laryngeal Obstruction: Diagnosis & Management with Dr. Steven Sims

Tue, 18 Nov 2025 08:00:00 -0000

From misdiagnosed asthma to anxiety-related breathing issues, inducible laryngeal obstruction is often hiding in plain sight. In this episode of the BackTable ENT Podcast, Dr. Steven Sims from Rush University Medical Center discusses contemporary care for inducible laryngeal obstruction (ILO) with guest host Dr. Stephen Schoeff.

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SYNPOSIS

The discussion elaborates on the evolution of the nomenclature surrounding vocal cord dysfunction and the clinical challenges in diagnosing and managing ILO. Dr. Sims shares his approach to patient evaluation, various presentations, and targeted treatment strategies, including the use of neuromodulators, speech pathology, and nerve blocks. He also delves into trauma-informed care, particularly focusing on patients with adverse childhood events and their impact on laryngeal function. The episode highlights the importance of an interdisciplinary approach, especially the role of speech pathologists in treating this complex condition.

---

TIMESTAMPS

00:00 - Introduction
01:39 - Understanding Inducible Laryngeal Obstruction
04:53 - Patient Presentation and Evaluation
07:51 - Management Strategies and Patient Care
09:06 - Trauma and Mental Health Considerations
19:27 - Interdisciplinary Approach and Additional Testing
23:52 - Understanding Subglottic Stenosis and Asthma
27:08 - The Role of Botox in Treatment
31:49 - Biofeedback and Patient Empowerment
34:25 - Exercise-Induced Laryngeal Obstruction
39:05 - Advanced Treatment Approaches and Challenges
41:06 - Conclusion and Final Thoughts

---

RESOURCES

Dr. Stephen Schoeff
https://www.enthealth.org/find-ent/stephen-s-schoeff/

Dr. H, Steven Sims
https://doctors.rush.edu/details/22035

Ep. 247 Keynote 689: Implementation & Multidisciplinary Care for Immunotherapy in Head & Neck Cancer with Dr. Adam Luginbuhl, Dr. Jennifer Johnson, Dr. Mihir Patel and Dr. Siddharth Sheth

Tue, 11 Nov 2025 08:00:00 -0000

When treating head and neck cancer, how can you tell the difference between true disease progression and pseudoprogression? In this episode of the BackTable Podcast, we discuss the practical implementation of the KEYNOTE-689 trial published in the New England Journal of Medicine, which demonstrated the benefit of adding neoadjuvant and adjuvant immunotherapy to standard head and neck cancer care. Our tumor board panel includes Dr. Mihir Patel, a head and neck surgeon from UNC Chapel Hill, Dr. Siddharth Sheth, a head and neck medical oncologist from UNC, Dr. Jennifer Johnson, a professor of medical oncology and otolaryngology at Sidney Kimmel Comprehensive Cancer Center, and Dr. Adam Luginbuhl, a head and neck surgical oncologist at Thomas Jefferson University.

---

SYNPOSIS

The doctors address the trial's practical implications, patient selection, case management, dealing with tumor progression, and the integration of multidisciplinary care. They also emphasize the importance of communication, real-world application of trial protocols, and the potential benefits and challenges of such therapies.

---

TIMESTAMPS

00:00 - Introduction
03:18 - Discussing the New Indication for Immunotherapy
11:42 - Challenges and Practical Implementation
22:48 - Managing Tumor Progression: A Case Study
28:07 - Exploring Treatment Options: Surgery vs. Chemotherapy
36:46 - Operational Challenges and Future Directions
43:58 - Concluding Thoughts and Future Directions

---

RESOURCES

Keynote 689
https://www.nejm.org/doi/full/10.1056/NEJMoa2415434

Ep. 246 How Nasal Obstruction Impacts Sleep Apnea Treatment with Dr. Scott McCusker

Tue, 04 Nov 2025 08:00:00 -0000

If your patients still struggle with sleep apnea after other treatments, it might be time to look at the nose. In this episode of the BackTable ENT Podcast, otolaryngologist and facial plastic surgeon Dr. Scott McCusker joins hosts Dr. Gopi Shah and Dr. Ashley Agan to discuss the impact of nasal airway obstruction on obstructive sleep apnea (OSA).
---
This podcast is supported by:
Aerin Medical
https://aerinmedical.com/
---
SYNPOSIS
Dr. McCusker shares insights on his practice, evaluation techniques for nasal obstruction, and the use of minimally invasive procedures like VivAer. The conversation covers the importance of the septal swell bodies, the effectiveness of nasal treatments on OSA outcomes, and patient management strategies, including when to combine different surgical interventions. The episode also touches on post-operative care and the potential role of new technologies and treatments in enhancing patient outcomes.
---
RESOURCES
Dr. Scott McCusker
https://ambrdfcs.org/doctors/scott-mccusker-md/

Ep. 245 Understanding Keynote-689: Immunotherapy for Head & Neck Cancer with Dr. Dylan Roden, Dr. Ravi Uppaluri and Dr. Adam Luginbuhl

Tue, 28 Oct 2025 07:00:00 -0000

While the standard for adjuvant head and neck cancer treatment hasn't changed since 2004, a new trial using perioperative pembrolizumab is forcing clinicians to rethink their entire workflow, starting with diagnosis. In this episode of the BackTable Podcast, head and neck surgical oncologist Dr. Adam Luginbuhl is joined by colleagues Dr. Dylan Roden and Dr. Ravindra Uppaluri to discuss the implementation and implications of the Keynote-689 trial, which introduced neoadjuvant and adjuvant immunotherapy for locally advanced head and neck cancer.
---
SYNPOSIS
The doctors discuss the trial details, FDA approval, and practical challenges of integrating this new paradigm into clinical practice. The conversation covers critical points such as the necessity of CPS score testing, timely drug administration, patient monitoring, and the importance of collaboration among multidisciplinary teams.
---
TIMESTAMPS
00:00 - Introduction
02:18 - Keynote-689 Trial Explained
04:42 - Implementation Challenges and Strategies
06:40 - Practical Considerations for CPS Testing
13:59 - Case Studies and Real-World Applications
30:48 - Future Directions and Final Thoughts
---
RESOURCES
Keynote-689
https://www.nejm.org/doi/full/10.1056/NEJMoa2415434
2004 Cisplatin Phase III Trial
https://www.nejm.org/doi/full/10.1056/NEJMoa032646

Ep. 244 AI's Role in ENT Physical Exams with Dr. Jonathan Simmonds

Tue, 21 Oct 2025 07:00:00 -0000

Endoscopes, AI, and the future of ENT care—otolaryngologist and Presidio CEO Dr. Jonathan Simmonds shares why the tech game is just getting started in this episode of the BackTable ENT Podcast.
---
SYNPOSIS
Dr. Simmonds shares his journey from the UK to becoming a sinus surgeon in New York, and the founding of Presidio to create affordable endoscopic equipment. They discuss how AI can transform ENT practice, emphasizing the unique position ENTs hold due to their routine use of camera systems in exams. The conversation also tackles the economic aspects of implementing new technology, the importance of capturing clinical data, and the necessity of ENT specialists to advocate for their role in the evolving landscape. Dr. Simmonds offers insights into the various AI tools and the significance of contributing to the development and implementation of AI models in ENT.
---
TIMESTAMPS
00:00 - Introduction
03:38 - AI in ENT: Opportunities and Challenges
12:46 - Protecting the Role of ENTs
17:26 - The Future of ENT Exams
24:41 - Ownership of Medical Data: The Ethical Dilemma
30:09 - Human-Like Behavior in AI Models
31:18 - The Role of AI in ENT Practice
34:30 - Challenges and Opportunities in AI Implementation
42:12 - Economic Considerations for AI in Private Practice
45:03 - Final Thoughts and Future Directions
---
RESOURCES
Dr. Jonathan Simmonds
https://www.summithealth.com/doctors/provider/1538549936

Ep. 243 Parotid Malignancies: Diagnosis, Biopsy & Treatment Strategies with Dr. Mirabelle Sajisevi

Tue, 14 Oct 2025 07:00:00 -0000

When should a parotid mass raise red flags? In this episode of the BackTable ENT podcast, Dr. Mirabelle Sajisevi, head and neck surgeon at the University of Vermont Medical Center, joins hosts Dr. Gopi Shah and Dr. Ashley Agan to discuss her approach to diagnosing and managing parotid malignancies.
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SYNPOSIS
Dr. Sajisevi shares insights from her practice, including the importance of thorough physical exams, the utility of ultrasound and biopsy, and the intricacies of surgical planning. They also cover post-operative care, the role of radiation and chemotherapy, surveillance strategies, and the potential of emerging treatments and technologies.
---
RESOURCES
Dr. Mirabelle Sajisevi
https://www.uvmhealth.org/providers/mirabelle-sajisevi-md

Ep. 242 Advances in Posterior Nasal Nerve Ablation with Dr. Greg Davis

Tue, 07 Oct 2025 07:00:00 -0000

We’re keeping the chronic rhinitis conversation going in this week’s episode of BackTable ENT. Otolaryngologist Dr. Greg Davis joins Dr. Ashley Agan and Dr. Gopi Shah to break down his approach to posterior nasal nerve (PNN) ablation with the NeuroMark Gen 3, including patient prep, anesthesia, technique, and postoperative care.
---
This podcast is supported by:
Neurent Medical
http://neuromark.com/
---
SYNPOSIS
Beyond his posterior nasal nerve ablation technique, Dr. Davis shares his experiences with the various generations of the NeuroMark device, and also discusses the insurance and billing side of its use. The conversation also touches on topics like eustachian tube dysfunction, chronic cough, and the future of chronic rhinitis treatment.
---
TIMESTAMPS
00:00 - Introduction
03:04 - NeuroMark Device Trials
04:15 - Patient Presentation and Diagnosis
11:50 - Medical Management and Treatment Options
21:44 - Procedure Setup and Anesthesia Protocol
30:49 - Understanding RF Devices and Their Usage
31:13 - Deploying the Device for Turbinate Treatment
31:52 - Tips and Tricks for Difficult Anatomy
33:58 - Posterior Nasal Nerve Ablation in the OR
34:40 - Addressing Posterior Nasal Drainage and Chronic Cough
36:51 - Impedance Control vs. Temperature Control RF
38:02 - Choosing the Right Device for Patients
40:52 - Managing Post-Procedure Care and Risks
53:18 - Insurance and Billing
56:13 - Final Thoughts and Future Directions
---
RESOURCES
Dr. Greg Davis
https://www.gregdavismd.com/
10th International Otolaryngology Underwater Update Course
https://ssf.cloud-cme.com/course/courseoverview?P=0&EID=1254

Ep. 241 Chronic Rhinitis: Emerging Approaches & Treatments with Dr. Dennis Tang

Tue, 30 Sep 2025 07:00:00 -0000

So many patients deal with a runny, stuffy nose every day, and sprays only go so far. Let’s talk about what’s new for chronic rhinitis. In this episode of the BackTable ENT podcast, Dr. Dennis Tang, a Rhinologist at Cedars-Sinai Medical Center discusses chronic rhinitis and the latest treatment advancements with hosts Dr. Gopi Shah and Dr. Ashley Agan.
---
This podcast is supported by:
Aerin Medical
https://aerinmedical.com/
---
SYNPOSIS
Dr. Tang discusses the benefits of posterior nasal nerve (PNN) ablation and the recent approval of the procedure by Cigna Insurance, which expands accessibility for patients. The conversation covers the typical presentation of chronic rhinitis, the procedural details, patient selection, preoperative and postoperative care, and billing considerations. Dr. Tang also touches on the anatomy involved and the technological innovations that are enabling contemporary rhinitis treatment.
---
TIMESTAMPS
00:00 - Introduction
03:01 - Insurance Coverage for Posterior Nasal Nerve Ablation
04:23 - Patient Presentation, Diagnostic & Treatment Approaches
11:07 - Posterior Nasal Nerve (PNN) Ablation Explained
17:57 - Physical Examination and In-Office Procedure
20:47 - Allergy Patients and Immunotherapy
22:21 - Chronic Rhinosinusitis vs. Chronic Rhinitis
32:33 - Radiofrequency Ablation Technology
39:49 - Procedure Techniques and Anatomical Considerations
46:42 - In-Office Procedure Logistics
01:06:10 - Final Thoughts
---
RESOURCES
Dr. Dennis Tang
https://www.cedars-sinai.org/provider/dennis-tang-3316614.html

Ep. 240 Intracapsular Tonsillectomy: Monopolar Technique & Applications with Dr. Evan Tobin

Tue, 23 Sep 2025 07:00:00 -0000

Is there a different way to do an Intracapsular tonsillectomy without using a microdebrider or a Coblator? In this episode of the BackTable ENT Podcast, otolaryngologist Dr. Evan Tobin from Ohio ENT and Allergy Physicians sits down to discuss the intracapsular technique for tonsillectomy with hosts Dr. Gopi Shah and Dr. Ashley Agan.
---
SYNPOSIS
Dr. Tobin shares his journey and practice in Ohio, emphasizing his transition to using intracapsular tonsillectomy with monopolar electrocautery. The discussion covers the historical evolution of tonsillectomy techniques, the benefits of intracapsular tonsillectomy (such as reduced bleed rates and postoperative pain), as well as the practical aspects and indications for different methods. Dr. Tobin presents his technique in detail, supported by video demonstrations and highlights the significance of patient counseling in making surgical decisions.
---
TIMESTAMPS
00:00 - Introduction
04:38 - Tonsillectomy Techniques
07:20 - Evolution and Debate of Tonsillectomy Practices
11:09 - Personal Experiences and Techniques in Tonsillectomy
21:42 - Pain Management and Post-Operative Care
29:51 - Shared Decision Making and Future of Tonsillectomy
34:53 - Managing Bleeds: A Practical Approach
37:51 - Cost Analysis of Tonsillectomy Techniques
41:46 - Surgical Techniques and Settings
53:06 - Post-Operative Considerations and Outcomes
57:33 - Final Thoughts and Recommendations
---
RESOURCES
Dr. Evan Tobin
https://www.ohioentandallergy.com/physicians/evan-tobin-md/

Ep. 239 Measles in ENT: Symptoms, Complications & Vaccine Strategies with Dr. Daniel Chelius and Dr. Romaine Johnson

Tue, 09 Sep 2025 07:00:00 -0000

What every ENT needs to know about the resurgence of measles—and how to talk to patients about vaccines. In this episode of the Back Table ENT podcast, Dr. Romaine Johnson and Dr. Daniel Chelius, both pediatric otolaryngologists, talk about the resurgence of measles and vaccine hesitancy with host Dr. Gopi Shah.

---

SYNPOSIS

They delve into their professional backgrounds, the importance of recognizing symptoms early, and the risks associated with measles, such as otitis media and sensorineural hearing loss. The conversation highlights the role of ENT specialists in identifying and managing the disease, strategies for addressing vaccine hesitancy, and the broader public health implications. They also touch on ways the medical community can tackle misinformation and advocate for vaccinations through collective efforts and patient education.

---

TIMESTAMPS

00:00 - Introduction

07:07 - Measles Contagion and Symptoms

23:23 - Complications and Long-term Effects

28:37 - Assessing Respiratory Status and Complications

29:44 - Addressing Common Vaccine Myths

31:18 - Challenges in Vaccination Conversations

32:38 - Personal Stories and Impact of Vaccination Choices

35:00 - Building Trust and Addressing Concerns

38:15 - Approaching Non-Vaccination in Clinical Practice

53:12 - Global Perspective on Vaccination

54:17 - Final Thoughts and Contact Information

Ep. 238 How to Perform Pediatric Otoplasty: Techniques & Tips with Dr. Charlotte Célérier

Tue, 02 Sep 2025 07:00:00 -0000

How to help children with ear deformities look and feel their best. In this episode of the BackTable ENT Podcast, Dr. Jason Qian from Rady Children's in San Diego and special guest Dr. Charlotte Célérier, a pediatric otolaryngologist at Neckar-Enfants Malades Hospital in Paris, France discuss the technical aspects of pediatric otoplasty with Dr. Gopi Shah.
---
SYNPOSIS
The conversation covers surgical techniques, patient selection, procedural nuances, and post-operative care for various ear deformities including prominent ears, Stahl's ear, cauliflower ear, and cryptotia. Both experts share their insights on different methodologies, handling complications, and the importance of ensuring the child is motivated for surgery. Learn practical tips and evolving practices in the field of pediatric otoplasty.
---
TIMESTAMPS
00:00 - Introduction
02:22 - Otoplasty Techniques and Patient Referrals
05:35 - Terminology and Ear Abnormalities
13:16 - Surgical Considerations
20:04 - Prepping and Draping for Surgery
30:22 - Suturing Techniques
33:38 - Instrument Preferences
35:12 - Repairing Stahls Ear Deformity
37:16 - Cauliflower Ear Challenges
38:46 - Cryptotia Repair Techniques
40:59 - Post-Operative Care and Managing Complications
52:30 - Final Thoughts and Innovations
---
RESOURCES
Jason Qian:
https://www.rchsd.org/doctors/zhen-jason-qian-md/
Charlotte Célérier:
https://www.researchgate.net/profile/Charlotte-Celerier

Ep. 237 Approaches to Mandibular Osteo Radionecrosis Management with Dr. Eli Gordin and Dr. Ariel Frost

Tue, 26 Aug 2025 07:00:00 -0000

Hyperbaric oxygen is out and surgical innovation is in—here’s how the rescue flap is reshaping ORN care. Facial plastic and microvascular surgeons Dr. Ariel Frost and Dr. Eli Gordin join host Dr. Ashley Agan to discuss osteoradionecrosis (ORN) of the mandible.
---
SYNPOSIS
The discussion begins with a detailed overview of the condition and patient presentation, and the impact of radiation therapy. The conversation then delves into historical and contemporary staging systems, highlighting the innovative 'rescue flap' technique developed by Cleveland Clinic. The episode emphasizes the ineffectiveness of hyperbaric oxygen therapy and showcases the superior outcomes and cost-effectiveness of the rescue flap procedure. Practical insights on surgical techniques, patient management, and future directions in treating ORN are also discussed.
---
TIMESTAMPS
00:00 - Introduction
01:26 - Understanding Osteoradionecrosis (ORN)
08:49 - Clinical Presentation of ORN
13:56 - Diagnosis and Imaging
16:58 - Staging and Treatment Options
27:39 - Conservative Therapy for ORN
37:19 - Understanding Disease Progression and Imaging
39:46 - Exploring the Rescue Flap Technique
52:46 - Post-Operative Care and Recovery
59:20 - Advanced Stages and Bone Grafting
01:13:38 - Cost Effectiveness and Referral Guidelines
---
RESOURCES
Dr. Ariel Frost
https://utswmed.org/doctors/ariel-frost/
Dr. Eli Gordin
https://utswmed.org/doctors/eli-gordin/

Ep. 236 Career Transitions: Coaching and Mentorship in Academic Medicine with Dr. Stacey Ishman

Tue, 19 Aug 2025 07:00:00 -0000

Is the advice you’re getting from your mentor really what you need, or is the real breakthrough hidden in your own answers? In this episode of the BackTable ENT podcast, Dr. Gopi Shah welcomes Dr. Stacey Ishman, a chief medical officer, pediatric ENT, real estate investor, syndicator, and career coach for physicians, to discuss transitioning from academic medicine to utilization management.
---
SYNPOSIS
Dr. Ishman emphasizes the significance of mentorship and coaching in academic medicine, the difference between the two, and how understanding one's values is crucial for career fulfillment. The conversation addresses common challenges faced by physicians such as setting boundaries, managing time effectively, and achieving work-life balance. Dr. Ishman also shares practical tips for personal and professional growth, encourages networking, and highlights how coaching can help physicians realign their careers with their values. The episode concludes with resources and strategies for physicians feeling burnt out and advice on navigating career transitions.
---
TIMESTAMPS
00:00 - Introduction
03:56 - Mentoring vs. Coaching
11:10 - Time Management and Setting Boundaries
17:38 - Gender and Equity in Academic Medicine
22:18 - Exploring Personal Values
23:41 - Time Management Tips for Physicians
26:17 - Mid-Career Physician Challenges
28:28 - Networking and Self-Promotion
30:12 - Translational Skills in Medicine
32:04 - Knowing When to Make a Change
39:02 - Coaching Programs and Resources
---
RESOURCES
Dr. Stacey Ishman
https://www.childrensdayton.org/doctors/stacey-ishman-md-mph
https://www.medicalmentorcoaching.com/

Ep. 235 Biologics for Chronic Rhinosinusitis with Nasal Polyps with Dr. Reena Mehta

Tue, 12 Aug 2025 07:00:00 -0000

How do we integrate biologics into the existing stepwise treatment model for chronic rhinosinusitis with nasal polyps (CRSwNP)? In this episode, Dr. Reena Mehta, an allergist from Uptown Allergy and Asthma in New Orleans, discusses the use of biologics for treating chronic rhinosinusitis with nasal polyps.
---
SYNPOSIS
Dr. Mehta elaborates on the common presentations of patients, the role of biologics such as dupilumab and tezepelumab, and the nuances of patient management post-sinus surgery. Dr. Mehta also covers the workup process, the significance of patient comorbidities like asthma and allergies, and the future perspectives on biologic treatments. Practical aspects of biologic therapy, including insurance hurdles, patient compliance, and the effectiveness of various biologics are thoroughly examined.
---
TIMESTAMPS
00:00 - Introduction
02:27 - Understanding Chronic Rhinosinusitis with Nasal Polyps & Presentation
05:22 - Workup and Management of Nasal Polyps
07:31 - Treatment Options: Steroids and Biologics
15:28 - Tezepelumab: A New Tool in the Toolkit
25:03 - Side Effects and Safety of Biologics
28:59 - Insurance and Approval Challenges
36:14 - Long-Term Safety and Efficacy
38:47 - Pediatric Considerations and Future Directions
41:37 - Collaboration Between ENT and Allergy Specialists
45:07 - Conclusion and Final Thoughts
---
RESOURCES
Dr. Reena Mehta
https://uptownallergyasthma.com/allergist-dr-reena-mehta/

Ep. 234 Navigating Midcareer Transitions & Finding Satisfaction in Healthcare with Dr. Tiffany Moon

Tue, 05 Aug 2025 07:00:00 -0000

What happens when a high-achieving physician trades perfectionism for purpose? In this episode of the BackTable ENT podcast, Dr. Tiffany Moon, an anesthesiologist, mom, entrepreneur, former Real Housewives of Dallas cast member, and author of the book 'Joy Prescriptions' joins host Dr. Ashley Agan.

---

SYNPOSIS

Tiffany shares her journey from a driven, high-achieving academic physician to exploring new passions outside of medicine. She discusses her midlife crisis, the inspiration behind her book, and the importance of finding joy through gratitude and letting go of perfectionism. They delve into the challenges of balancing a medical career with motherhood, the decision to go part-time, and the impact of her social media presence. Also, Tiffany introduces her upcoming Lead Her Summit, aimed at empowering female entrepreneurs. The episode wraps up with practical insights on maintaining joy and navigating career transitions.

---

TIMESTAMPS

00:00 - Introduction
01:37 - Tiffany’s Journey in Medicine
03:15 - Writing Joy Prescriptions
05:32 - Balancing Medicine and Personal Life
12:21 - The Decision to Go Part-Time
17:34 - Navigating Career and Personal Goals
20:42 - Understanding Joy Interrupted
23:05 - Practicing Gratitude in Daily Life
25:14 - The Struggle with Control
29:57 - Navigating Social Media Fame
34:57 - Upcoming Lead Her Summit
37:48 - Final Thoughts and Farewell

---

RESOURCES

Tiffany Moon
https://www.tiffanymoonmd.com/

LeadHer Summit 2025 (use code BACKTABLE300 for $300 off):
https://www.leadhersummit.com/

Ep. 233 CSF Leaks Part II: Techniques in Endoscopic Repair with Dr. Satyan Sreenath and Dr. Sanjeet Rangarajan

Tue, 29 Jul 2025 07:00:00 -0000

A 47 year old male presents with intermittent, unilateral nasal drainage and headache. What do you do? In this episode of the BackTable Podcast, Dr. Satyan Sreenath, a rhinologist at Indiana University, and Dr. Sanjeet Rangarajan, a rhinologist at Case Reserve University, examine complex cases involving CSF leaks and encephaloceles.

---

SYNPOSIS

The doctors discuss diagnostic approaches, imaging techniques, and innovative surgical methods, using endoscopic and minimally invasive strategies. The conversation highlights the difficulties of diagnosing and surgically repairing these leaks, focusing on their personal experiences and preferred techniques. Through detailed case studies with imaging and surgical videos, they explore the importance of meticulous planning, interdisciplinary collaboration, and adaptive strategies to manage these challenging conditions effectively. A must watch on Youtube!

---

TIMESTAMPS

00:00 - Introduction
02:17 - Patient Case 1: “Headache and Drippy Nose..”
02:58 - Diagnostic Imaging and Findings
07:55 - Surgical Approach and Postoperative Care
16:52 - Patient Case 2: “Drippy nose and nasal congestion… just allergies right?”
17:32 - Diagnostic Imaging and Findings
20:21 - Surgical Approach and Postoperative Care
29:03 - Patient Case 3: “Runny nose after my MVC 3 years ago…”
29:21 - Imaging and Surgical Approach Discussion
31:46 - Post-Operative Challenges and Patient Follow-Up
42:46 - Patient Case 4: “Continuous nasal drainage BOTH sides”
43:31 - Imaging and Findings
44:43 - Surgical Approach for Bilateral Defects
56:39 - Final Thoughts

---

RESOURCES

Dr. Satyan Sreenath profile:
https://iuhealth.org/find-providers/provider/satyan-b-sreenath-md-1821999

Dr. Sanjeet Rangarajan’s profile:
https://www.uhhospitals.org/doctors/Rangarajan-Sanjeet-164956839

Ep. 232 CSF Leak Evaluation Part I: Presentation & Management with Dr. Satyan Sreenath and Dr. Sanjeet Rangarajan

Tue, 22 Jul 2025 07:00:00 -0000

A patient walks in with a persistent runny nose. Is it allergies, or something more dangerous? In this episode of the BackTable ENT Podcast, two renowned rhinologists, Dr. Satyan Sreenath
and Dr. Sanjeet Rangarajan, delve into the evaluation and management of cerebrospinal fluid (CSF) leaks at the anterior skull base with host Dr. Gopi Shah.

---

SYNPOSIS

The discussion encompasses patient presentations, differential diagnosis, physical examination, and imaging techniques for localization. They also explore the impact of underlying conditions such as idiopathic intracranial hypertension (IIH) and obstructive sleep apnea (OSA) on CSF leaks. Dr. Sreenath and Dr. Rangarjan offer insight into diagnostic strategies, patient management, and surgical planning, providing a comprehensive overview of best practices in managing this complex condition.

---

TIMESTAMPS

00:00 - Introduction
02:48 - Patient Presentation and Initial Evaluation
04:45 - Common Symptoms and Diagnostic Challenges
06:02 - Risk Factors and Etiologies of CSF Leaks
10:59 - Management and Treatment Approaches
16:55 - Physical Examination and Diagnostic Techniques
22:35 - Patient Instructions for Sample Collection
24:29 - Differentiating CSF Leaks from Other Conditions
26:12 - Endoscopic Examination Techniques
30:21 - Imaging and Diagnostic Approaches
33:14 - Surgical Planning and Considerations
45:23 - Concluding Thoughts

---

RESOURCES

Satyan Sreenath
https://iuhealth.org/find-providers/provider/satyan-b-sreenath-md-1821999

Sanjeet Rangarajan
https://www.uhhospitals.org/doctors/Rangarajan-Sanjeet-1649568395

Ep. 231 Improving Surgical Outcomes Through Self-Awareness with Dr. Melinda Thacker

Tue, 15 Jul 2025 07:00:00 -0000

Let’s talk about what it really means to show up for your patients—and yourself—as a surgeon. In this episode of Backtable ENT, Dr. Mel Thacker, an otolaryngologist and founder of The Empowered Surgeon and the Surgeons with a Purpose Podcast, joins hosts Dr. Gopi Shah and Dr. Ashley Agan to discuss humanity in surgery, and how to stay grounded in a profession that demands so much of us.

---

SYNPOSIS

Dr. Thacker shares her journey from experiencing anxiety and panic attacks in the operating room to becoming a coach who helps surgeons discover their purpose and practice medicine with greater humanity. They discuss the significance of self-awareness, the importance of protecting oneself as a valuable asset, and how to serve patients with compassion and empathy. Practical advice is offered on shifting mindset, engaging in meaningful connections with patients, and fostering a collaborative, rather than hierarchical, approach in medical practice.

---

TIMESTAMPS

00:00 - Introduction
03:04 - Discovering Coaching
10:52 - Residency Reflections
23:06 - Improving Patient Relationships
29:48 - Coaching Surgeons and Addressing Emotional Growth
37:49 - Serving vs. Fixing: A New Perspective on Patient Care
44:09 - Daily Practices for Empathy and Self-Awareness
44:40 - Three Essentials for Success in Medicine
46:31 - Conclusion and Final Thoughts

Ep. 230 Setting Up an Overseas ENT Career with Dr. Ananya Majumder

Tue, 08 Jul 2025 07:00:00 -0000

How hard is it to move your medical practice across the globe? In this episode of BackTable ENT, otolaryngologist Dr. Ananya Majumder discusses her transition from practicing in Fort Worth, Texas to becoming a consultant otolaryngologist at North Shore Hospital in Auckland, New Zealand with host Dr. Gopi Shah.

---

SYNPOSIS

They explore Dr. Majumder’s career journey, the factors that led her to move abroad, the process of obtaining medical licensing and a visa in New Zealand, and the differences in medical practice and work culture between the U.S. and New Zealand. Dr. Majumder also shares insights into her daily routine, the challenges she faced during the transition, and the benefits of international experience in the medical field.

---

TIMESTAMPS

00:00 Introduction
01:40 Journey to New Zealand & Navigating Medical Licensing
08:26 Understanding the Healthcare System
15:24 Residency and Training Differences
21:37 Visa Process and Moving
28:49 Daily Practice in New Zealand
29:44 Clinic Workflow Differences & Operating Room Culture
37:14 Patient Relationships and Challenges
42:42 Professional and Personal Growth
48:02 Final Thoughts and Advice

---

RESOURCES

Dr. Ananya Majumder
https://www.enthealth.org/find-ent/ananya-majumder/

Ep. 229 Sialendoscopy: Office-Based Techniques and Best Practices with Dr. Wais Rahmati

Tue, 01 Jul 2025 07:00:00 -0000

The sour candy myth: why it’s not always the right Rx for salivary gland obstruction. In this episode, Dr. Wais Rahmati, a board-certified otolaryngologist at Mass Eye and Ear and Harvard Medical School, discusses the development of a comprehensive salivary gland center and the focus on office-based sialendoscopy with host Dr. Ashley Agan.

---

SYNPOSIS

The doctors explore the benefits of incorporating salivary endoscopy in the office setting, including minimally invasive and gland-sparing approaches to treat obstructive salivary gland diseases. Dr. Rahmati shares the criteria for patient selection, techniques in the procedure, and post-operative care. They also touch upon the challenges and strategies for reimbursement and the significance of tracking codes to eventually establish dedicated CPT codes for sialendoscopy.

---

TIMESTAMPS

00:00 - Introduction
02:40 - History and Evolution of Office-Based Endoscopy
05:32 - Understanding Obstructive Salivary Gland Disease
09:36 - Patient Selection and Office-Based Procedures
14:45 -Imaging and Diagnostic Approaches
20:50 - Office Setup and Procedure Details
30:38 - Injecting Mucosa for Better Access
31:10 - Using Sour Candy to Stimulate Saliva
32:29 - Dilation and Anesthesia Techniques
37:05 - Handling Stones and Stents
40:44 - Treating Stenosis in the Office
47:16 - Post-Procedure Care and Instructions
49:42 - Billing and Reimbursement Challenges
54:43 - Future of Salivary Gland Endoscopy

---

RESOURCES

Wais Rahmati MD:
https://doctors.masseyeandear.org/details/447/rahmatullah-wais_rahmati-rahmati-otolaryngology-head_and_neck_surgery-boston

Ep. 228 Sinus Headaches vs. Migraines: Diagnosis and Treatment with Dr. Jessica Lee

Tue, 24 Jun 2025 07:00:00 -0000

Sinusitis or migraine? Understanding the difference between rhinogenic and primary headaches could change your treatment algorithm. In this episode of Backtable ENT, Dr. Jessica Lee, an otolaryngologist from Charleston ENT and Allergy, discusses the prevalence and treatment of sinus headaches with hosts Dr. Gopi Shah and Dr. Ashley Agan.

---

SYNPOSIS

The doctors discuss how half of sinus infection diagnoses are often misdiagnosed, with many patients having normal CT scans and nasal endoscopies. Dr. Lee emphasizes the importance of distinguishing between sinus-related headaches and migraines, noting that 80% of sinus headache complaints meet migraine criteria. The conversation covers the use of lifestyle medicine, supplements, medications, and the role of neurologists in managing chronic headaches. Dr. Lee also touches on the role of mycotoxins, drawing from evidence-based practices while stressing patient education and collaboration in treatment.

---

TIMESTAMPS

00:00 - Introduction
04:10 - Differentiating Sinus Headaches from Other Conditions
10:07 - Lifestyle Factors and Migraine Management
25:45 - Supplements and Treatments for Migraine
30:01 - Iron Supplementation and Dietary Adjustments
31:42 - Medication Management for Migraines
34:52 - Botox as a Treatment Option
44:50 - Mycotoxins and Mold Illness
50:11 - Non-Pharmacologic Options for Headaches
54:00 - Final Thoughts and Recommendations

---

RESOURCES

Dr. Jessica Lee
https://charlestonent.com/bio/jessica-lee/

Ep. 227 Healthcare Leadership Strategies for Otolaryngologists with Dr. Carol Bradford

Tue, 17 Jun 2025 07:00:00 -0000

Leadership isn’t just about saying yes—it’s about knowing when to say no too. In this episode of Backtable ENT, Dr. Carol Bradford, Dean of the Ohio State University College of Medicine and Vice President for Health Sciences at the Ohio State University Wexner Medical Center, shares her leadership journey with hosts Dr. Gopi Shah and Dr. Sunil Verma.

---

SYNPOSIS

Dr. Bradford shares insights into her journey in otolaryngology, emphasizing the importance of feedback, emotional intelligence, and leadership development. She discusses her experiences in various leadership roles, the significance of maintaining clinical practice, and strategies for fostering future leaders. The conversation touches on the challenges and rewards of leadership in academic medicine, the impact of change, and the enduring mission to improve patient care and education.

---

TIMESTAMPS

00:00 - Introduction
04:32 - Role and Responsibilities of a Dean & Balancing Clinical Practice
10:25 - Leadership Development & Mentorship
21:41 - Building and Leading Effective Teams
28:23 - Challenges in Leadership Roles
30:40 - Balancing Academic and Clinical Missions
33:41 - Leadership Style and Meeting Management
39:07 - Emotional Intelligence in Medicine
47:12 - Navigating Change and Future Goals
51:45 - Final Advice for Aspiring Leaders

---

RESOURCES

Dr. Carol Bradford:
https://wexnermedical.osu.edu/about-us/our-people/carol-bradford

Dr. Sunil Verma:
https://www.ucihealth.org/clinicians/sunil-verma-1124279344

Ep. 226 Managing Allergy Symptoms Amid Environmental Changes with Dr. Jennifer Villwock and Dr. William Reisacher

Tue, 10 Jun 2025 07:00:00 -0000

Are your allergies getting worse, or is it the environment? In this episode of Backtable ENT, Dr. Jennifer Villwock, a rhinologist at the University of Kansas, and Dr. William Reisacher, an otolaryngologist at New York Presbyterian Hospital, join the podcast to discuss the impact of environmental extremes on the unified airway with hosts Dr. Ashley Agan and Dr. Gopi Shah.

---

SYNPOSIS

Topics include the increasing prevalence of allergies and asthma due to climate change, the effects of environmental pollutants and particulates on respiratory health, and the role of healthcare providers in educating and advocating for patients. The conversation also addresses practical strategies for managing symptoms, the importance of urban planning and sustainable practices, and the hope that collective individual efforts can lead to meaningful change.

---

TIMESTAMPS

00:00 - Introduction
01:43 - Understanding the Unified Airway
03:09 - Patient Concerns and Environmental Factors
10:24 - Impact of Temperature and CO2 on Allergies
14:57 - Barometric Pressure and Migraines
21:03 - Pollution, Particulate Matter, and Solutions
24:49 - Urban Planning
29:32 - Epigenetics and Environmental Impact
34:15 - Indoor Air Quality and Mold Issues
41:01 - Advocacy and Environmental Health
45:46 - Final Thoughts and Hope for the Future

---

RESOURCES

Dr. Jennifer Villwock
https://www.kumc.edu/jvillwock.html

Dr. William Reisacher
https://weillcornell.org/wreisacher

Ep. 225 Sinusitis and Cognitive Impairment: Exploring the Inflammatory Pathway with Dr. Aria Jafari

Tue, 03 Jun 2025 07:00:00 -0000

Chronic sinusitis might be doing more than just clogging your nose–it could be clouding your brain. In this episode of Backtable ENT, Dr. Aria Jafari, an assistant professor at the University of Washington and co-director of the Neuroendocrinology Advanced Sinus and Skull-base Surgery Fellowship, discusses the connection between sinusitis and cognitive dysfunction with hosts Dr. Gopi Shah and Dr. Ashley Agan.

---

SYNPOSIS

Dr. Jafari shares how his interest in this field developed and details his research on the relationship between chronic rhinosinusitis (CRS) and brain function. The conversation highlights the comprehensive impact of sinus inflammation on overall health, emphasizing the importance of viewing CRS as a whole-body condition. They also discuss patient experiences, the methodologies used to assess cognitive dysfunction, potential treatments, and what’s next in the research frontier.
---
TIMESTAMPS
00:00 - Introduction
06:18 - The Impact of CRS on Quality of Life
14:02 - Understanding Brain Fog and Cognitive Dysfunction
24:29 - Pathophysiology and Theories of Cognitive Dysfunction
27:44 - Chronic Inflammation and Cognitive Effects
28:59 - Impact of Biologics on Cognitive Function
31:28 - Risk Factors for Cognitive Dysfunction
35:02 - Olfactory Symptoms
37:13 - Future Research and Treatment Approaches
45:31 - Conclusion and Final Thoughts

---

RESOURCES

Dr. Aria Jafari
https://www.uwmedicine.org/bios/aria-jafari

Ep. 224 Safety & Preparedness in Office Based Procedures with Dr. Scott Fortune

Tue, 27 May 2025 07:00:00 -0000

The best doctors aren’t lucky—they’re prepared. Discover how to keep your office safe during in-office procedures. In this episode of BackTable ENT, Dr. Scott Fortune, an otolaryngologist from Allergy and ENT Associates of Middle Tennessee, discusses office-based procedural safety with Dr. Gopi Shah and Dr. Ashley Agan.

---

SYNPOSIS

The doctors delve into the importance of preparedness in handling potential complications, emphasizing the necessity of having the right equipment and protocols in place. Dr. Fortune provides detailed guidelines on managing anesthesia, preventing and handling bleeding, and addressing possible complications such as vasovagal reactions and anaphylaxis. The conversation covers practical tips, including the use of local anesthetics, sedatives, and the importance of patient history and clearance forms. This comprehensive discussion is a valuable resource for ENT professionals looking to enhance the safety and efficacy of their office-based procedures.

---

TIMESTAMPS

00:00 - Introduction
01:34 - Discussing Safety in Office Procedures
07:47 - Safety Protocols and Equipment
19:11 - Anesthesia and Sedation Protocols
27:29 - Handling Emergencies and Reversal Agents
30:00 - Local Anesthesia and Toxicity
38:29 - Effective Anesthesia Techniques for Office Procedures
41:25 - Bleeding Control in Office Procedures
53:36 - Handling Office Procedure Complications
01:00:19 - Final Thoughts and Contact Information

---

RESOURCES

Dr. Scott Fortune
https://www.enthealth.org/find-ent/d-scott-fortune/

Patient Selection, Safety, and Preparedness for Office-Based Otolaryngology Procedures
https://www.oto.theclinics.com/article/S0030-6665(25)00020-9/abstract

AAOA anaphylaxis guidelines
https://www.aaoallergy.org/wp-content/uploads/2017/05/2015-Clinical-Care-Statements-Anaphylaxis.pdf

Ep. 223 Evaluation and Management of Bilateral Vocal Fold Paralysis with Dr. James Daniero

Tue, 20 May 2025 07:00:00 -0000

Never let the sun set on bilateral vocal fold paralysis–timely diagnosis and intervention are key. In this episode of Backtable ENT, Dr. James Daniero, a laryngologist from the University of Virginia, discusses the evaluation and management of bilateral vocal fold paralysis with Dr. Gopi Shah and guest host Dr. Stephen Schoeff.
---
SYNPOSIS
The trio delves into the complexities of diagnosing and managing bilateral vocal fold paralysis in adults, examining etiologies, diagnostic procedures, and current treatment options. They specifically highlight the differences between bilateral vocal fold immobility and paralysis, discuss innovative techniques such as bilateral selective reinnervation and laryngeal pacing, and share practical tips for securing the airway in an acute setting. The episode also emphasizes the evolving nature of treatments and the importance of timely intervention.
---
TIMESTAMPS
00:00 - Introduction
02:05 - Understanding and Diagnosing Bilateral Vocal Fold Paralysis
09:19 - Management and Treatment Options
25:40 - Tracheotomy Techniques and Considerations
31:31 - Exploring Surgical Options for Patients
34:22 - Addressing Dysphagia in Airway Surgeries
35:50 - Innovative Techniques in Laryngeal Reinnervation
39:34 - Patient Selection for Advanced Surgeries
47:11 - Laryngeal Pacing: A Future Option
54:50 - Final Thoughts and Recommendations
---
RESOURCES
Dr. James Daniero
https://uvahealth.com/findadoctor/James-Daniero-1386817484
Dr. Stephen Schoeff
https://www.enthealth.org/find-ent/stephen-s-schoeff/

Ep. 222 Survivorship in Head and Neck Cancer with Dr. Michael Moore and Heather Starmer, PhD, CCC-SLP

Tue, 13 May 2025 07:00:00 -0000

What does it take to improve quality of life after head and neck cancer? In this episode of Backtable ENT, guests Dr. Heather Starmer, a speech and language pathologist at Stanford University, and Dr. Michael Moore, a head and neck cancer surgeon at Indiana University explore the topic of head and neck cancer survivorship.
---
SYNPOSIS
The discussion centers on the multifaceted challenges faced by survivors, including dysphagia, dry mouth, chronic pain, and mental health issues. The experts emphasize the importance of early intervention, community support, and comprehensive care to enhance the quality of life for survivors. Various resources, such as the Head and Neck Cancer Alliance, are highlighted to assist patients and providers in navigating survivorship. The conversation also outlines future directions in research and the need for more qualitative studies to better understand long-term survivorship outcomes.
---
TIMESTAMPS
00:00 - Introduction
03:23 - Understanding Survivorship & Challenges in Head and Neck Cancer
14:06 - Managing Mobility and Lymphedema
18:47 - Addressing Chronic Pain and Mental Health
21:37 - Dental Care and Trismus Therapy
25:58 - Long-Term Survivorship and Quality of Life
31:36 - Survivorship Clinics and Multidisciplinary Care
34:39 - Resources for Patients and Providers
38:49 - Future Research and Educational Gaps
---
RESOURCES
Dr. Heather Starmer
https://med.stanford.edu/profiles/heather-starmer
Dr. Michael Moore
https://iuhealth.org/find-providers/provider/michael-g-moore-md-64028

Ep. 221 Chronic Cough: An Allergist’s Perspective with Dr. Basil Kahwash

Tue, 06 May 2025 07:00:00 -0000

How can you treat a chronic cough when you’re not sure what’s causing it? In this episode of BackTable ENT, Dr. Basil Kahwash, a board-certified allergist and immunologist from Ohio ENT and Allergy, discusses the complexities of diagnosing and treating chronic cough.
---
SYNPOSIS
Dr. Kahwash explains common causes, such as upper airway cough syndrome, allergic rhinitis, and asthma, and delves into the importance of patient history and physical exams in identifying the root cause. The conversation also covers diagnostic tools, including allergy testing, spirometry, and chest X-rays, as well as treatment options like allergy medication, immunotherapy, and cough suppressants. Dr. Kahwash also touches upon new therapies on the horizon and emphasizes the role of multidisciplinary collaboration with ENTs, pulmonologists, GI specialists, and speech therapists in managing chronic cough.
---
TIMESTAMPS
00:00 - Introduction
03:20 - Defining Chronic Cough
06:47 - Patient Evaluation and Key Questions
11:10 - Asthma vs. Allergic Rhinitis Cough
18:31 - Red Flags in Chronic Cough
30:20 - Diagnostic Testing for Chronic Cough
34:46 - ENT Collaboration in Allergy
36:08 - Skin Testing vs. Blood Testing for Allergies
44:30 - Eosinophilic Esophagitis (EOE) & Upper Airway Cough Syndrome
50:28 - Allergy Treatment Pathways
01:03:05 - Conclusion and Contact Information
---
RESOURCES
Dr. Basil Kahwash
https://www.ohioentandallergy.com/physicians/basil-kahwash-md/

Ep. 220 Managing Nasal Polyps: Treatments and Insights with Dr. Martin Citardi

Tue, 29 Apr 2025 06:00:00 -0000

Is the future of nasal polyp treatment right under our nose? In this episode of Backtable ENT, Dr. Martin Citardi, a world-renowned rhinologist and skull-based surgeon at UTHealth Houston, discusses the latest advancements in the management of nasal polyps with hosts Dr. Gopi Shah and Dr. Ashley Agan.

---

This podcast is supported by:
Medtronic ENT

https://www.medtronic.com/en-us/healthcare-professionals/specialties/ear-nose-throat.html

---

SYNPOSIS

Dr. Citardi shares insights from his comprehensive career, spanning patient care, device, and drug development. The surgeons discuss the evolving treatment landscape, challenges in managing recurrent nasal polyps, the role of steroids and biologics, and the importance of correctly identifying the type of polyps. Additionally, Dr. Citardi emphasizes the need for a better understanding of healthcare economics, particularly concerning the high costs of new treatments. The discussion also touches on the future of research and the need for a system to deploy treatment options effectively.

---

TIMESTAMPS

00:00 - Introduction
04:39 - Nasal Polyps: Patient Presentation and Initial Examination
10:25 - Detailed Examination and Endoscopy Techniques
17:26 - Imaging and Lab Workup
20:11 - Treatment Strategies and Patient Management
31:08 - Managing Patients with Allergies, AERD, and Asthma
34:09 - Biologics vs. Surgery: A Comparative Discussion
42:50 - Steroid Delivery Methods and Their Effectiveness
52:24 - Follow-Up, Long-Term Management and Future Research
57:01 - Conclusion and Final Thoughts

---

RESOURCES

Dr. Martin Citardi’s Profile:
https://www.utphysicians.com/provider/martin-j-citardi/

Medtronic ENT:
https://www.medtronic.com/en-us/healthcare-professionals/products/ear-nose-throat

Ep. 219 New Frontiers in Pediatric Hearing Loss: Implants, Gene Therapy, and CMV with Dr. Daniela Carvalho

Tue, 22 Apr 2025 06:00:00 -0000

Are new solutions for pediatric hearing loss finally within earshot? In this episode of the Back Table ENT Podcast, we talk with Dr. Daniela Carvalho, pediatric otolaryngologist and director of the Cochlear Implant Program at Rady Children's Hospital in San Diego.

---

SYNPOSIS

Dr. Carvalho discusses the latest advancements and practices in the field of pediatric hearing loss, including newer indications for cochlear implants and innovative gene therapies. They delve into the genetic causes of congenital hearing loss, current screening practices, and various gene therapies being tested for hearing deficiencies, such as those involving the OTOF gene and its application through viral vectors. The conversation also touches on the potential for future treatments, including completely implantable cochlear devices and the role of vaccines in preventing CMV-related hearing loss.

---

TIMESTAMPS

00:00 - Introduction

01:54 - Understanding Congenital Hearing Loss and Screening

05:41 - Challenges with Older Children and Hearing Loss

08:48 - Cochlear Implants: Indications and Advances

15:59 - Exploring Gene Therapy for Hearing Loss

23:54 - Challenges and Considerations in Gene Therapy

25:23 - Counseling Families on Hearing Loss

27:04 - Future of Genetic Therapy and Cochlear Implants

32:46 - Addressing Congenital CMV

40:59 - Final Thoughts and Future Research

---

RESOURCES

Dr. Daniela Carvalho

https://www.rchsd.org/doctors/daniela-carvalho-md-mmm/

Ep. 218 The Role of Dentistry in Pediatric Sleep Disordered Breathing with Dr. Loria Nahatis

Tue, 15 Apr 2025 06:00:00 -0000

What role does craniofacial growth play in childhood sleep health? Dr. Loria Nahatis, pediatric dentist from Beyond Pediatric Dentistry in Dallas, Texas, discusses the importance of early intervention in pediatric dentistry, focusing on evaluating and treating children with sleep disordered breathing.

---

SYNPOSIS

Dr. Nahatis shares her personal experience with her daughter and how noticing sleep-related issues shifted her focus in dental practice. Dr. Nahatis covers various treatment methods such as habit correctors, palatal expanders, and myofunctional therapy. The podcast emphasizes the importance of interdisciplinary collaboration between dentists, ENTs, and other healthcare providers to improve patient outcomes. Key points include the significance of nasal breathing, conservative treatment options, and the impact of jaw and dental structure on overall health.

---

TIMESTAMPS

00:00 - The Importance of Screening for Sleep Disorders in Children

06:26 - Treatment Options and Approaches

10:29 - Guidelines and Policies on Sleep Disorders

19:42 - Teeth Grinding and Myofunctional Therapy

27:32 - Imaging and Evaluation Techniques

29:01 - Surgical Considerations and Early Interventions

36:44 - Counseling Families on Oral Appliances

50:12 - Insurance and Cost Considerations

56:15 - Collaborative Approaches and Final Thoughts

---

RESOURCES

Dr. Loria Nahatis’s practice profile:

https://beyondpediatricdentistry.com/dr-loria-nahatis-dds/

Ep. 217 Environmental Sustainability in ENT with Dr. Julie Strychowsky

Tue, 08 Apr 2025 06:00:00 -0000

Operating rooms generate up to 30% of a hospital's waste–what can ENT do to change that? In this episode, Dr. Julie Strychowsky, a pediatric otolaryngologist at London Health Sciences Center in Ontario, discusses environmental sustainability in ENT.

---

SYNPOSIS

The discussion covers the inefficiencies and environmental impacts of current practices, such as the use of nitrous oxide, disposable equipment, and OR waste. Dr. Strychowsky shares insights on transitioning to more sustainable practices, including the use of reusable and multi-use equipment, standardizing procedures, and patient education initiatives like the ‘Bring Your Own Bag’ campaign. The doctors highlight the importance of climate change, the carbon footprint of healthcare, and the role of policy and innovation in reducing environmental impact. Finally, they discuss resources for further learning and potential areas for research and development in sustainable healthcare practices.

---

TIMESTAMPS

00:00 - Introduction

02:51 - Climate Change and Its Impact on Health

05:07 - Surgical Sustainability: Reducing OR Waste

08:27 - Clinic Waste and Efficiency Improvements

16:12 - Anesthesia Gases and Environmental Impact

23:06 - In-Office Procedures and Telemedicine in ENT

28:58 - Global Efforts & Patient Involvement in Sustainability

37:03 - Policy Changes and Education for Sustainability

39:59 - Future Research and Innovation in ENT

42:26 - Final Thoughts and Mentorship

---

RESOURCES

Dr. Julie Strychowsky

https://www.schulich.uwo.ca/paediatricsurgery/people/faculty/Strychowsky,%20Julie.html

Kidane J, Thiel CL, Wang K, Rosen CA, Gandhi S. A Comparison of Environmental Impacts Between Reusable and Disposable Flexible Laryngoscopes. Laryngoscope. 2024 Dec 26. doi: 10.1002/lary.31927. Epub ahead of print. PMID: 39723758.

https://pubmed.ncbi.nlm.nih.gov/39723758/

Anderson J, Hu H. Environmental Sustainability: Waste Audit Comparison Operating Room and In-Office Laryngeal Surgery. Laryngoscope. 2024 Feb;134(2):803-806. doi: 10.1002/lary.31005. Epub 2023 Sep 2. PMID: 37658737.

https://pubmed.ncbi.nlm.nih.gov/37658737/

Cascade OR playbook

https://cascadescanada.ca/

Ep. 216 Navigation in Sinus and Skull Base Surgery with Dr. Arif Janjua

Tue, 01 Apr 2025 06:00:00 -0000

Getting lost on a road trip is one thing, but the stakes are much higher in skull base surgery. In this episode of Backtable ENT, Dr. Arif Janjua, rhinologist and fellowship director at the University of British Columbia, delves into the intricacies and advancements in navigation for sinus and skull base surgery.

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This podcast is supported by:

Medtronic ENT

https://www.medtronic.com/en-us/healthcare-professionals/specialties/ear-nose-throat.html

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SYNPOSIS

Dr. Janjua touches on his role in the Seattle Science Foundation, emphasizing continuous education and hands-on practice for surgeons. He emphasizes the importance of accuracy in patient tracking and registration, sharing techniques for optimizing navigation system setups by using a combination of tracing and touch points for precise registration. The doctors discuss the advantages of integrating navigation systems with specific instruments like microdebriders and suctions for improved surgical outcomes. Dr. Janjua also shares his preferred navigation tech, how he utilizes specific features in his surgical practice, and what’s on the horizon in sinus and skull base surgery.

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TIMESTAMPS

00:00 - Introduction

04:03 - Understanding Navigation in Sinus Surgery

07:41 - Navigating Instruments and Tools

21:58 - Challenges with Staff Training

22:43 - Choosing and Using Navigation Systems

24:25 - Advancements in Navigation Technology

32:30 - The Future of Navigation Technology

35:03 - Final Thoughts and Contact Information

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RESOURCES

Medtronic ENT - Sponsor

https://www.medtronic.com/en-us/healthcare-professionals/products.html

Dr. Arif Janjua

https://surgery.med.ubc.ca/people/ajanjua/

Ep. 215 Navigating the ENT Residency Match Process with Dr. Johnathan McGinn

Tue, 25 Mar 2025 06:00:00 -0000

The road to matching in ENT looks different for every applicant. Dr. Johnathan McGinn, Vice Chair of the Department of Otolaryngology at Penn State, shares how to make yours a success in this episode of the BackTable ENT Podcast, providing an insider’s look at the otolaryngology residency match process. A must listen for aspiring ENTs!

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SYNPOSIS

First, Dr. McGinn discusses the impact of applicants’ backgrounds and institutional resources on their evaluations, the evolution of the interview process from virtual to in-person post-COVID, and the introduction and benefits of the signaling process in residency applications. Dr. McGinn also offers valuable advice for medical students on choosing away rotations, obtaining meaningful recommendation letters, and understanding the complexities of the holistic review system. Finally, he emphasizes the importance of mentorship and the personal journey of each applicant.

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TIMESTAMPS

00:00 - Introduction

01:49 - Evolution of the Residency Match Process

07:18 - The Role of Research in Residency Applications

12:11 - Advice for Students Without Home Programs

15:19 - Navigating Away Rotations

21:24 - Geographic Preferences and Signaling

32:25 - Choosing the Right Program for You

38:17 - Virtual vs. In-Person Interviews

42:09 - Application Review Process at Penn State

48:36 - Letters of Recommendation: Tips and Insights

52:28 - Special Considerations for DO Students

58:34 - Final Thoughts and Advice for Applicants

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RESOURCES

Dr. Johnathan McGinn

https://www.pennstatehealth.org/doctors/johnathan-d-mcginn-md-facs

BackTable+ for ENT

https://plus.backtable.com/pages/ent

Check out BackTable+ for ENT, our sponsor and new e-learning platform! https://plus.backtable.com/pages/ent

Ep. 214 Navigating ENT Careers in the Armed Forces with Dr. Matthew Brigger and Dr. Philip Gaudreau

Tue, 18 Mar 2025 06:00:00 -0000

What does it take to become a physician in the military, and how does it differ from the civilian path? In this episode of Backtable ENT, Dr. Matthew Brigger and Dr. Philip Gaudreau, discuss their unique career paths in the Navy and how military service shaped their medical practices.

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SYNPOSIS

Dr. Brigger, Division Chief of Pediatric Otolaryngology and professor at San Diego Children’s Hospital, and Dr. Gaudreau, pediatric otolaryngologist and associate professor of surgery at the Uniformed Services University practicing at Naval Medical Center San Diego, share their career paths from medical school to serving in the Navy. The conversation delves into the application processes for military and civilian medical schools, differences in training, and how military service instills a sense of purpose and leadership. The episode also covers the intricate balance required to practice in both civilian and military settings, emphasizing the importance of flexibility, resourcefulness, and teamwork.

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TIMESTAMPS

00:00 - Introduction

02:57 - Military Medical Education Pathways

09:29 - Differences in Military and Civilian Medical Training

17:23 - Applying for ENT Residency in the Military

22:04 - Advice for Medical Students

23:16 - Military Medical Career Insights

28:36 - Military and Civilian Practices

31:19 - Leadership and Mentorship in Medicine

34:07 - Transitioning to Civilian Practice

42:44 - Final Thoughts and Reflections

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RESOURCES

Dr. Philip Gaudreau

https://health.usnews.com/doctors/philip-gaudreau-807965

Dr. Matthew Brigger

https://www.rchsd.org/doctors/matthew-brigger-md-mph/

BackTable+ for ENT

https://plus.backtable.com/pages/ent

Backtable Brief: Diagnosing Sleep Apnea in Women

Tue, 11 Mar 2025 06:00:00 -0000

What if the most common symptoms of obstructive sleep apnea in women aren’t the ones doctors are trained to recognize? In this episode, Dr. Megan Durr, an otolaryngologist from the University of California San Francisco, discusses obstructive sleep apnea in women with host Dr. Gopi Shah.

The doctors explore how symptoms in women differ from men, leading to missed diagnoses. They delve into the lack of literature on the topic and the potential for underrepresented groups to be overlooked. The conversation highlights the need for more inclusive screening tools and the long-term cardiovascular risks women face due to untreated sleep apnea. Dr. Durr emphasizes the importance of better diagnosing and treating sleep apnea in women.

TIMESTAMPS

00:00 - Introduction

00:18 - Recognizing Obstructive Sleep Apnea in Women

00:36 - Pregnancy and Obstructive Sleep Apnea

01:13 - Menopause and Sleep Disorders

01:59 - Underrepresented Groups and OSA

02:47 - Symptoms and Misdiagnosis in Women

04:40 - Screening Questionnaires and Gender Bias

05:59 - Clinical Observations and Gender Disparities

09:39 - Long-term Effects of OSA in Women

CHECK OUT THE FULL EPISODE

BackTable ENT Podcast Episode #182

Understanding OSA in Women with Dr. Megan Durr

https://www.backtable.com/shows/ent/podcasts/182/understanding-osa-in-women

Ep. 213 Ear Molding for Infants with Dr. Jason Qian

Tue, 04 Mar 2025 07:00:00 -0000

What should parents and pediatricians know about early ear molding interventions? In this episode of the BackTable ENT podcast, pediatric otolaryngologist Dr. Jason Qian discusses the practice of ear molding in infants and new advancements in the field with host Dr. Gopi Shah.

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SYNPOSIS

Dr. Qian, a surgeon scientist at the University of California, San Diego, shares his journey in integrating ear molding into his clinical practice, explaining the importance of early intervention and the process involved in molding infant ears. They delve into the challenges of billing, different molding techniques, and the growing demand for non-invasive ear correction methods. Dr. Qian also highlights the potential future developments in the field, including enhanced education and simulation models.

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TIMESTAMPS

00:00 - Introduction

01:13 - Understanding Ear Molding in Infants

03:49 - Training and Incorporating Ear Molding

06:06 - Challenges and Success Stories

10:13 - Clinical Workflow and Procedures

30:08 - Billing and Insurance Issues

32:13 - Collaborations and Advanced Techniques

37:42 - Future of Ear Molding and Final Thoughts

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RESOURCES

Dr. Jason Qian

https://health.usnews.com/doctors/zhen-jason-qian-1078594

BackTable+ for ENT

https://plus.backtable.com/pages/ent

Check out BackTable+ for ENT, our sponsor and new e-learning platform! https://plus.backtable.com/pages/ent

Ep. 212 Allergy Immunotherapy and the Microbiome with Dr. Jennifer Villwock

Tue, 25 Feb 2025 07:00:00 -0000

Could the key to more effective allergy therapies lie in the nasal microbiome? In this episode of BackTable ENT, Dr. Jennifer Villwock from Kansas University Medical Center discusses the intricacies of treating allergies and sinus issues with hosts Dr. Ashley Agan and Dr. Gopi Shah.

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SYNPOSIS

Dr. Villwock begins by highlighting the importance of personalized medicine and the role of the microbiome in immunotherapy. Topics include topical and oral probiotics, the nasal microbiome, intralymphatic immunotherapy, and the significance of accurate allergy testing. Dr. Villwock also shares insights on sublingual and subcutaneous immunotherapy, the future of allergy treatments, and the impact of environmental factors on sinus health.

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TIMESTAMPS

00:00 - Introduction

01:53 - Understanding the Sinus Microbiome

04:34 - The Role of the Microbiome in Health

09:31 - Challenges in Microbiome Research

23:21 - Clinical Decision-Making in Antibiotic Use

25:07 - Exploring Probiotics & Dietary Factors for Sinus Health

30:12 - Immunotherapy and Microbiome

35:47 - Allergy Testing Methods

41:40 - Future Directions in Immunotherapy

44:18 - Conclusion and Final Thoughts

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RESOURCES

Jennifer Villwock Profile

https://www.kumc.edu/jvillwock.html

AAOA 2025 Explorers Course in Allergy and Immunology, Vail, CO. March 27-29, 2025

https://www.aaoallergy.org/education/aaoa-explorers-course-2025/

BackTable+ for ENT

https://plus.backtable.com/pages/ent

Check out BackTable+ for ENT, our sponsor and new e-learning platform! https://plus.backtable.com/pages/ent

Ep. 211 Aging Voice: The Science and the Art with Dr. Neel Bhatt

Tue, 18 Feb 2025 07:00:00 -0000

We often think about exercising to stay fit as we age–but what about keeping our voices in shape? In this episode of BackTable ENT, Dr. Neel Bhatt, a laryngologist from the University of Washington in Seattle, discusses the intricacies of the aging voice with hosts Dr. Gopi Shah and Dr. Ashley Agan.

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SYNPOSIS

Dr. Bhatt sheds light on the pathophysiology behind vocal fold atrophy, the role of glottic image capture, and the innovative use of the GlottIC (Glottal Image Capture) in measuring vocal fold bowing. They explore the impact of aging on the voice and swallowing, the relationship between vocal fold activity and overall health, and the benefits of voice therapy and procedural interventions in treating age-related voice changes. Overall, this episode summarizes valuable insights into maintaining vocal health as we age.

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TIMESTAMPS

00:00 - Introduction

01:33 - Understanding the Aging Voice and Clinical Presentations

10:41 - Impact of Aging Voice on Quality of Life

15:31 - Pathophysiology of Aging Voice

24:45 - Clinical Examination and Diagnosis

32:09 - Challenges in Scope Exams

39:33 - Swallow Studies: Fees vs. Video Fluoroscopy

41:16 - Management of Age-Related Voice Changes

58:27 - Maintaining Vocal Health with Age

01:01:01 - Conclusion and Contact Information

---

RESOURCES

Dr. Neel Bhatt

https://otolaryngology.uw.edu/our-people/faculty/neel-k-bhatt-md

BackTable+ for ENT

https://plus.backtable.com/pages/ent

Check out BackTable+ for ENT, our sponsor and new e-learning platform! https://plus.backtable.com/pages/ent

Ep. 210 Rethinking OSA: Role of the Nose with Dr. Keith Matheny and Dr. Ashwin Ananth

Tue, 11 Feb 2025 07:00:00 -0000

Is nasal obstruction the hidden culprit behind CPAP failure in obstructive sleep apnea (OSA) patients? In this episode of BackTable ENT, host Dr. Ashley Agan discusses nasal airway obstruction’s impact on OSA with guests Dr. Keith Matheny and Dr. Ashwin Ananth.

---

This podcast is supported by:

Aerin Medical

https://aerinmedical.com/

---

SYNPOSIS

The doctors emphasize the crucial role otolaryngologists play in diagnosing and treating nasal obstruction to enhance sleep quality, particularly in patients who struggle with CPAP therapy. They share their approaches to the nasal exam, treatments like VivAer and RhinAer, the importance of sleep endoscopies for CPAP-intolerant patients, and they also debunk some common misconceptions around treating OSA. This is a must-listen for ENTs and clinicians engaged in sleep medicine.

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TIMESTAMPS

00:00 - Introduction

01:57 - Discussion on Nasal Airway Obstruction

06:11 - Evolution of Sleep Disorder Treatments

12:05 - Challenges with CPAP and Alternatives

16:39 - Importance of Nasal Examination

28:44 - Nasal Medication Practices

33:20 - Sleep Endoscopy and CPAP Alternatives

35:44 - Nasal Surgery and OSA Treatment

39:57 - Posterior Nasal Nerve Ablation

46:10 - Final Thoughts and Recommendations

---

RESOURCES

Dr. Ashwin Ananth

https://www.esentc.com/dr-ashwin-ananth

Dr. Keith Matheny

https://collincountyent.com/bio/keith-e-matheny/

BackTable+ for ENT

https://plus.backtable.com/pages/ent

Check out BackTable+ for ENT, our sponsor and new e-learning platform! https://plus.backtable.com/pages/ent

Ep. 209 Innovations in Management of Age-Related Hearing Loss with Dr. Sreekant Cherukuri and Dr. Gina Geissler

Tue, 04 Feb 2025 07:00:00 -0000

Is there a better way to manage hearing loss before it gets worse? In this episode of BackTable ENT, experts Dr. Sreekant Cherukuri (otolaryngologist) and Dr. Gina Geissler (audiologist) discuss the importance of early intervention in age-related hearing loss, and the various options available beyond traditional hearing aids.

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SYNPOSIS

The doctors emphasize that early use of amplification devices can slow the progression of hearing loss, supported by numerous studies. The discussion covers scenarios where assistive listening devices, such as ClearCast, can serve as effective alternatives or supplements to hearing aids. They also talk about the need for more widespread hearing screenings and the potential applications of such devices across different age groups, including children with auditory processing disorders. This episode also offers a holistic approach to managing hearing loss and details how auditory health affects overall quality of life.

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TIMESTAMPS

00:00 - Introduction

02:45 - Challenges and Solutions in Hearing Aid Accessibility

13:27 - Understanding Hearing Aid Categories and Regulations

18:22 - Screening and Addressing Hearing Loss in Patients

29:20 - Challenges with Traditional Hearing Aids

30:32 - Benefits of Situational Hearing Devices

32:15 - Early Intervention and Brain Health

33:31 - Implementing ClearCast in Clinical Practice

49:26 - Screening and Monitoring Hearing Loss

55:21 - Final Thoughts and Future Developments

---

RESOURCES

Dr. Sreekant Cherukuri

https://reliefasi.com/providers/sreekant-cherukuri/

Dr. Gina Geissler

https://geisslerhearing.com/meet-the-team/

BackTable+ for ENT

https://plus.backtable.com/pages/ent

Ep. 208 ENT Education for APPs and Other Healthcare Partners with Dr. Jeffrey LaCour

Tue, 28 Jan 2025 07:00:00 -0000

Are you interested in learning basic ENT diagnostics and treatments? In this episode of BackTable ENT, the hosts welcome Dr. Jeffrey LaCour who discusses how he created Compassio Medical Education, an ENT educational platform for advanced practice providers. Dr. LaCour, an otolaryngologist from Hammond, Louisiana, elaborates on his efforts to educate primary care specialists and advanced practice providers through online courses and live webinars.

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SYNPOSIS

Dr. LaCour describes the structure and impact of his ENT courses, which include dynamic content on ear, nose, and throat diagnostics. Dr. LaCour also highlights the importance of proper ear diagnostics to reduce unnecessary antibiotic usage and shares insights into both the challenges and successes of running an educational startup. Finally, Dr. LaCour details his vision for expanding this educational model to other medical specialties.

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TIMESTAMPS

00:00 - Introduction

03:31 - Developing ENT Courses for APPs

05:25 - Addressing Common ENT Issues

07:10 - Live Webinars and Continuous Learning

12:10 - Building a Supportive Learning Community

16:48 - Teaching Surgical Decision Making

19:03 - Hands-On Courses and Training

22:51 - Subscription Models and Membership

24:56 - Tailoring Curriculum for New Hires

28:42 - Expanding to Other Specialties

34:37 - Conclusion and Contact Information

---

RESOURCES

Jeffrey LaCour Profile

https://www.northoaks.org/find-a-provider/jeffrey-b-lacour-md/

Compassio Medical

https://www.compassiomedical.com/

BackTable+ for ENT

https://plus.backtable.com/pages/ent

Check out BackTable+ for ENT, our sponsor and new e-learning platform! https://plus.backtable.com/pages/ent

Ep. 207 Innovations in Bioresorbable ENT Packing Materials with Dr. Satyan Sreenath

Tue, 21 Jan 2025 07:00:00 -0000

What role does bioresorbable packing play in improving outcomes for ENT patients? In this episode of BackTable ENT, hosts Dr. Ashley Agan and Dr. Gopi Shah are joined by Dr. Satyan Sreenath, a rhinologist at Indiana University, to discuss the use of bioresorbable packing in ENT surgeries.

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SYNPOSIS

First, Dr. Sreenath offers insights into the advancements in sinus and skull base surgery, the types of packing materials available (such as HemoPore, NasoPore, and chitosan-based products), and their application for hemostasis, scar prevention, and patient comfort. The surgeons emphasize the importance of tailored postoperative care and use of nasal irrigations and debridements to optimize healing and surgical results. Dr. Sreenath also mentions the evolving field of drug delivery through bioresorbables and the benefits of exploring new technologies to enhance patient outcomes.

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TIMESTAMPS

00:00 - Introduction

01:53 - Bioresorbables for the Nose

06:44 - Patient Comfort and Postoperative Care

20:18 - Packing Techniques

24:52 - Chitosan-Based Products

32:51 - Techniques for Debridement & Postoperative Management

42:40 - Skull Base Surgery Considerations

55:25 - Nosebleeds and Emergency Care

01:02:05 - Complications and Innovations

01:07:40 - Conclusion

---

RESOURCES

Dr. Sreenath’s IU profile

https://iuhealth.org/find-providers/provider/satyan-b-sreenath-md-1821999

BackTable+ for ENT

https://plus.backtable.com/pages/ent

Check out BackTable+ for ENT, our sponsor and new e-learning platform! https://plus.backtable.com/pages/ent

Ep. 206 ENT Hospitalists: Transforming Inpatient Care Models with Dr. Annie Wang

Tue, 14 Jan 2025 08:00:00 -0000

How can a dedicated ENT hospitalist improve patient care? In this episode of Backtable ENT Podcast, Dr. Annie Wang, an otolaryngologist at Houston Methodist Hospital, discusses her experience as a hospital-based ENT, also known as an ENT hospitalist, with hosts Dr. Gopi Shah and Dr. Ashley Agan.

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SYNPOSIS

Dr. Wang talks about the inception and development of her position, the daily responsibilities and challenges she faces, and the positive impact of having a dedicated inpatient ENT service. She also delves into the historical context and future potential of this model in improving patient outcomes and hospital efficiency, highlighting both qualitative and quantitative benefits. The conversation provides valuable insights for ENT departments considering the adoption of a hospitalist model.

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TIMESTAMPS

00:00 - Introduction

02:22 - Hospital-Based ENT Practice Model

04:33 - Daily Routine and Responsibilities

10:55 - Challenges and Solutions in ENT Practice

19:38 - Insights and Advice for New Programs

24:40 - Billing and Financial Tracking in the First Year

25:19 - Challenges and Insights from Inpatient Consults

28:42 - Coordination and Metrics in Patient Care

31:28 - The Value of ENT Hospitalists

43:50 - Vacation Protocols and Final Thoughts

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RESOURCES

Dr. Annie Wang’s Profile

https://www.houstonmethodist.org/doctor/ran-annie-wang/

BackTable+ for ENT

https://plus.backtable.com/pages/ent

Check out BackTable+ for ENT, our sponsor and new e-learning platform! https://plus.backtable.com/pages/ent

Ep. 205 Weight Loss Medications & Impact on OSA with Dr. John Carter and Dr. Michael Weber

Tue, 07 Jan 2025 08:00:00 -0000

How are weight loss medications, like Ozempic, reshaping obstructive sleep apnea care? In this episode of the BackTable ENT podcast, host Dr. Gopi Shah discusses emerging weight loss medications and their impact on obstructive sleep apnea (OSA) with Dr. John Carter, a neurologist and sleep specialist, and Dr. Michael Weber, an otolaryngologist.

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SYNPOSIS

The doctors examine optimal candidates for GLP-1 medications, their side effects, and how these drugs integrate into current OSA treatment pathways. The conversation delves into patients’ experiences, new research findings, and the implications for future sleep apnea management and weight loss strategies. In sum, the episode highlights the promising role of GLP-1 medications while addressing potential challenges and unanswered questions.

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TIMESTAMPS

00:00 - Introduction

03:06 - Understanding Weight Loss Medications

06:18 - Impact of Weight Loss on OSA

12:56 - Clinical Trials and Research

18:57 - Future of OSA Management

23:19 - Challenges and Considerations

29:27 - Pediatric Considerations

37:05 - Final Thoughts and Contact Information

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RESOURCES

Dr. John Carter Profile

https://www.metrohealth.org/physician/john-carter-176808

Dr. Michael Weber

https://www.metrohealth.org/physician/michael-weber-174663

BackTable+ for ENT

https://plus.backtable.com/pages/ent

Check out BackTable+ for ENT, our sponsor and new e-learning platform! https://plus.backtable.com/pages/ent

Ep. 204 Best of Backtable ENT: 2024 Year in Review

Fri, 27 Dec 2024 08:00:00 -0000

The BackTable ENT show is closing out 2024 with gratitude, reflections, and plans for the year to come! In this episode of the Backtable ENT Podcast, hosts Dr. Ashley Agan and Dr. Gopi Shah celebrate a year of growth and milestones, including reaching 200 episodes and expanding their audience.

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SYNPOSIS

They highlight key episodes from 2024, covering various discussions like eustachian tube dilation in children, gender diversity in ENT, and unique aspects of treating OSA in women. Featuring guests Dr. Anthony Law, Dr. Jill D’Souza, Dr. Megan Durr, Dr. Dennis Poe, Dr. Daniel Knott, and Dr. Rahul Seth, the episode underscores the podcast’s commitment to delivering meaningful and educational content for practicing ENTs, trainees, and partners in the ENT community.

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TIMESTAMPS

00:00 - Introduction

01:56 - 2024 Highlights

02:40 - Personal and Professional Milestones

03:56 - Audience Demographics and New Initiatives

08:31 - AI and Laryngology with Dr. Anthony Law

15:21 - Challenges in Pediatric ENT with Dr. Jill D’Souza

23:50 - OSA in Women with Dr. Megan Durr

30:23 - Pediatric Eustachian Tube Dilation with Dr. Dennis Poe

37:53 - Gender Diversity in ENT: Education and Advocacy with Drs. Daniel Knott and Rahul Seth

43:46 - Reflections and Gratitude

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RESOURCES

BackTable+ for ENT

https://plus.backtable.com/pages/ent

Check out BackTable+ for ENT, our sponsor and new e-learning platform! https://plus.backtable.com/pages/ent

Ep. 203 Navigating Frontal Sinus Surgery with Dr. P.J. Wormald

Tue, 17 Dec 2024 08:00:00 -0000

How can new tools help you be successful in sinus surgery? In this episode of the BackTable ENT Podcast, Dr. Peter-John “PJ” Wormald, Chair of Otolaryngology at Adelaide and Flinders Universities, delves into the complexities of frontal sinus surgery and innovative solutions for common surgical challenges with hosts Dr. Ashley Agan and Dr. Gopi Shah.

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SYNPOSIS

The surgeons discuss chronic frontal sinus disease, when to consider surgery, and optimal post-operative care. Dr. Wormald shares his surgical strategies, including the use of innovative technologies like Chitogel and 3D CT planning software for better surgical outcomes. He also touches on the challenges in training new surgeons and the potential for advances in medical simulation to improve surgical education. This thorough discussion offers insights into the latest techniques and innovations in sinus surgery.

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TIMESTAMPS

00:00 - Introduction

03:46 - Understanding Chronic Frontal Sinus Disease

07:57 - Approach to Sinus Surgery

13:27 - Antibiotic and Steroid Use in Sinus Treatment

18:23 - Patient Consultation and Decision Making

22:51 - Training the Next Generation of Surgeons

36:29 - Analyzing Surgical Factors & Predicting Surgical Outcomes

47:37 - Post-Operative Management

59:02 - Biologics and Long-Term Care

01:07:42 - Innovations in Surgical Training & Final Thoughts

---

RESOURCES

BackTable+ for ENT

https://plus.backtable.com/pages/ent

PJ Wormald Profile

https://researchers.adelaide.edu.au/profile/peterj.wormald

Free Stryker Software for Windows

https://www.dropbox.com/s/r4sodtqv221c5yk/Stryker%20Building%20Blocks%203.6.0%20Windows%20Setup%20-%20FESS%202022.exe?dl=0

Free Stryker Software for Mac

https://www.dropbox.com/s/0iac9pmzdz0lqkz/Stryker%20Building%20Blocks%203.6.0%20macOS%20Setup%20-%20FESS%202022.dmg?dl=0

Ep. 202 When Otolaryngologists Hold Leadership Positions in Health Systems with Dr. Sunil Verma

Tue, 10 Dec 2024 08:00:00 -0000

What does it take for a physician-leader to thrive in today's healthcare landscape? In this episode of the BackTable ENT Podcast, Dr. Sunil Verma has an inspiring conversation with host Dr. Gopi Shah about medicine, leadership, and personal growth. Dr. Verma is a laryngologist, Associate CMO of Ambulatory Care, and Associate Dean at UC Irvine Health.

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SYNPOSIS

Dr. Verma shares his journey from clinical practice to holding health system level positions. He discusses the importance of physician leadership, adapting to evolving healthcare systems, and finding personal and professional fulfillment. They also delve into challenges like balancing administrative and clinical roles, the impact of virtual meetings, and the essential need for support within medical teams. Dr. Verma offers insights on making a positive impact within health systems while maintaining personal well-being and growth.

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TIMESTAMPS

00:00 - Introduction

12:41 - Balancing Clinical and Administrative Roles

15:16 - The Importance of Physician Leadership

20:49 - Support Systems and Personal Growth

23:40 - Impact of Physician Leadership on Health Policy

25:43 - The Evolution of Health Systems

33:02 - Physician Burnout and Retention

40:45 - Adapting to Virtual Meetings

44:11 - Advice for Aspiring Leaders

50:45 - Final Thoughts and Pearls of Wisdom

---

RESOURCES

BackTable+ for ENT

https://plus.backtable.com/pages/ent

Dr. Sunil’s UCI profile

https://www.ucihealth.org/find-a-doctor/v/sunil-verma

Ep. 201 Trailblazers in ENT: Otolaryngology, Politics and Patient Advocacy with Dr. K.J. Lee

Tue, 26 Nov 2024 08:00:00 -0000

As a physician, how would you like to be treated as a patient? A simple shift in perspective can improve both patient care and the medical system at large. In this episode of the BackTable ENT Podcast, hosts Ashley Agan and Gopi Shah are joined by Dr. K.J. Lee, a renowned otolaryngologist, educator, and health policy advisor.

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SYNPOSIS

The discussion covers Dr. Lee’s journey into health policy and advocacy, his experiences with political figures like Barack Obama, and the importance of compassionate patient care through his concept of ‘The Patient is U’ (TPIU). Dr. Lee shares insights on the intersection of healthcare and politics, addresses challenges in the current medical system, and emphasizes the need for empathy and good stewardship in medical practice.

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TIMESTAMPS

00:00 - Introduction

03:39 - Dr. Lee’s Journey into Policy and Advocacy

11:46 - The Role of Otolaryngologists in Leadership

15:14 - Practicing TPIU: Treating Patients as You Would Want to Be Treated

20:20 - Dr. Lee’s Early Influences in Malaysia

29:32 - Healthcare Economics and Quality

31:48 - Complexities in Healthcare Decisions

36:31 - Reflections on a Medical Career

---

RESOURCES

BackTable+ for ENT

https://plus.backtable.com/pages/ent

Official TPIU Organization Link

https://tpiu.org/about/

TPIU

https://tpiu.org/k-j-lee-md-received-the-2024-distinguished-service-award/

Ep. 200 Identifying Parathyroid Glands: Challenges and Innovations with Dr. Michael Singer

Tue, 19 Nov 2024 08:00:00 -0000

Can technology improve the accuracy of parathyroid tissue identification during surgery? In this episode of Backtable ENT Podcast, Dr. Gopi Shah and Dr. Ashley Agan welcome Dr. Michael Singer, an otolaryngologist specializing in minimally invasive parathyroid and thyroid surgery at Henry Ford Health in Michigan.

---

This podcast is supported by:

Medtronic ENT

https://www.medtronic.com/en-us/healthcare-professionals/specialties/ear-nose-throat.html

---

SYNPOSIS

First, Dr. Singer discusses various aspects of identifying parathyroid glands during surgery, differentiating between hypoparathyroidism and hypocalcemia, and the impact of concurrent thyroid disease on patient outcomes. He highlights the importance of continuous improvement and being open to new technologies, specifically the use of autofluorescence and fluorescence imaging to enhance surgical accuracy and patient safety. The conversation also addresses the practical applications of these technologies, including the Medtronic PTeye parathyroid detection system, and their potential to change the approach to thyroid and parathyroid surgeries. Throughout the discussion, Dr. Singer emphasizes the importance of being honest with oneself as a surgeon in order to improve skills and provide the best care for patients.

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TIMESTAMPS

00:00 - Introduction

04:37 - Challenges in Identifying Parathyroid Glands

12:14 - Preoperative Workup and Imaging

16:41 - Understanding Hypoparathyroidism and Hypocalcemia

23:25 - Surgical Techniques and Identifying Parathyroid Glands

33:48 - New Technologies in Parathyroid Surgery

43:15 - Challenges and Benefits of New Surgical Technologies

44:49 - Practical Applications and Personal Experiences

59:33 - Impact of Technology on Surgical Practices

01:08:40 - Final Thoughts and Continuous Learning

---

RESOURCES

BackTable+ for ENT

https://plus.backtable.com/pages/ent

Dr. Singer’s profile

https://www.henryford.com/physician-directory/s/singer-michael

Ep. 199 Advances in Early Glottic Cancer Treatment Options with Dr. Bharat Panuganti

Tue, 12 Nov 2024 08:00:00 -0000

Is a subtle voice change something to ignore? In this episode of the Backtable ENT podcast, hosts Gopi Shah and Dr. Ashley Agan speak with Dr. Bharat Panuganti, a laryngologist from Washington University in St. Louis, about the diagnosis, treatment, and management of early glottic cancer.

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SYNPOSIS

First, the doctors discuss the importance of not underestimating voice changes such as dysphonia. Then, they discuss the evolving demographics and risk factors of laryngeal cancers. Dr. Panuganti also explains his approach to using advanced imaging techniques and lasers in treatment. The conversation highlights the necessity of personalized and compassionate patient care, considering both surgical and radiation therapy options. The discussion concludes with advice on the importance of consistent patient follow-up for early detection and treatment of recurrences.

---

TIMESTAMPS

00:00 - Introduction

03:09 - Understanding Early Glottic Cancer and Symptoms

08:09 - Physical Examination, FEES and Stroboscopy

14:19 - Intraoperative Imaging Techniques

31:33 - Radiation vs. Surgery: Predicting Outcomes

32:18 - Laser Surgery and Technologial Advances

42:51 - Robotic Surgery

47:13 - Postoperative Care and Patient Counseling

52:53 - Equitable Care and Treatment Choices

---

RESOURCES

BackTable+ for ENT

https://plus.backtable.com/pages/ent

Dr. Bharat Panuganti’s WashU Profile:

https://oto.wustl.edu/people/bharat-panuganti-md/

Ep. 198 Advanced Techniques in Facial Reanimation with Dr. Myriam Loyo Li and Guest Host with Dr. Shiayin Yang

Tue, 05 Nov 2024 08:00:00 -0000

From cable grafts to free muscle transfer, surgical treatments for facial paralysis are evolving quickly. In this episode of the Backtable ENT Podcast, Dr. Myriam Loyo Li, facial plastic surgeon at OHSU, joins guest host Dr. Shiayin Yang of Vanderbilt to discuss dynamic procedures for facial paralysis.

---

This podcast is supported by:

BackTable + ENT

https://www.backtable.com/shows/ent

---

SYNPOSIS

First, the surgeons review workup of flaccid and non-flaccid (synkinetic) facial paralysis. Then, they review the principles of facial reanimation. Topics such as nerve graft selection and staged surgery are covered. Dr. Loyo Li explains her timelines for staged surgery and how patient characteristics affect her decision planning. Finally, the surgeons discuss free muscle transfer – an exciting new technique in the world of facial plastic surgery – to treat facial paralysis.

---

TIMESTAMPS

00:00 - Introduction

02:48 - Evaluating and Managing Flaccid Facial Palsy

05:18 - Imaging and Treatment Pathways

07:16 - Nerve Grafting Techniques and Preferences

10:08 - Challenges and Innovations in Facial Reanimation

25:50 - Patient-Centered Approaches and Decision Making

37:30 - Evaluating Facial Nerve Recovery

43:25 - Timing and Criteria for Nerve Transfers

46:41 - Free Muscle Transfer Techniques

49:47 - Innovations in Cross Facial Nerve Grafts

01:06:04 - Exploring Free Strap Muscle Transfers

01:14:05 - The Future of Facial Reanimation

---

RESOURCES

Dr. Loyo Li’s OHSU Profile:

https://www.ohsu.edu/providers/myriam-loyoli-md-mcr

Dr. Yang’s Vanderbilt Profile:

https://www.vanderbilthealth.com/doctors/yang-shiayin

Ep. 197 Trailblazers in ENT: Stories from House Clinic with Dr. John House

Tue, 29 Oct 2024 07:00:00 -0000

It’s not an overstatement to say that surgeons from The House Clinic revolutionized otology / neurotology in the second half of the twentieth century. In this episode of the BackTable ENT podcast, Dr. John House, son of the clinic’s founder, Howard, discusses the clinic’s fabled history with guest host Dr. Walter Kutz (UT Southwestern).

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SYNPOSIS

Dr. House recounts his father’s journey traveling the world to learn from renowned otolaryngologists, ultimately settling in Los Angeles where he established his practice. Working with his brother William, Howard started a clinic that popularized innovative treatments for otosclerosis, acoustic neuroma, and sensorineural hearing loss. While innovations like Howard’s cochlear implant and John’s House’s House-Brackmann Facial Nerve Grading Scale faced resistance at first, they eventually won widespread acceptance. The episode concludes with Dr. Kutz’s moving personal reflection on his time as a fellow at the House Clinic.

---

TIMESTAMPS

00:00 - Introduction

05:41 - Dr. Howard House’s Path to Neurotology

17:14 - Dr. Bill House’s Passion Project: The Cochlear Implant

28:39 - Development of the House-Brackmann Facial Nerve Grading System

38:49 - The Evolution of Stapes Surgery

45:14 - House Alumnus Dr. Walter Kutz’s Journey

---

RESOURCES

Dr. John House’s House Clinic Profile:

https://www.houseclinic.com/home/meet-the-team/profile/john-william-house-1/

Dr. Walter Kutz’s UT Southwestern Profile:

https://utswmed.org/doctors/joe-kutz/

Ep. 196 Revolución en Higiene Nasal con Dr. Luisam Tarrats

Tue, 22 Oct 2024 07:00:00 -0000

En este episodio de Backable ENT, El Dr. Carlos Torre entrevista al Dr. Luisam Tarrats, un otorrinolaringólogo de Puerto Rico, sobre su práctica médica y su viaje empresarial para construir Burble, una empresa de enjuagues nasales.

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SYNPOSIS

Primero, el episodio explora la trayectoria del Dr. Luisam Tarrats, quien decidió regresar a Puerto Rico para mejorar la oferta quirúrgica y enfrentar los desafíos tras el huracán María. Se destaca su innovación empresarial con Burble Inc., una empresa que desarrolló un sistema de irrigación nasal salina aprobado por la FDA. La conversación incluye temas como la importancia de la higiene nasal para la salud y el bienestar, estrategias para emprender en el campo médico, y el balance entre la vida profesional y personal. Se subraya la importancia de educar a médicos y pacientes sobre el uso adecuado de productos de higiene nasal y el papel proactivo de la medicina preventiva.

---

TIMESTAMPS

00:00 - Trayectoria profesional del Dr. Luisam Tarrats

03:45 - Fundación y desarrollo de Burble

16:51 - Innovaciones y beneficios del producto Burble

37:40 - Educación y concienciación sobre la higiene nasal

48:03 - Equilibrio entre la vida profesional y personal

58:39 - Consideraciones legales y estructurales

01:16:54 - Consejos para emprendedores aspirantes

---

RESOURCES

Burble

https://letsburble.com/

Ep. 195 Financial Literacy in ENT: Diversifying Your Learnings and Earnings with Dr. Robert Puchalski

Tue, 15 Oct 2024 07:00:00 -0000

Surgeons are fortunate that their work is both fulfilling and well compensated. When this earning potential meets solid financial planning, personal and material satisfaction results. In this episode of BackTable ENT, Dr. Robert Puchalski (South Carolina ENT) discusses financial wellness with guest host Dr. Ayesha Khalid (Cambridge Health Alliance).

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SYNPOSIS

First, Dr. Puchalski describes the benefits and challenges of different private practice models, emphasizing the importance of market share. Then, he explores income generation beyond clinical work, including ancillary services and investment. Transitioning to personal finance, he shares financial planning strategies so that practicing medicine is a choice rather than a necessity. The episode wraps with Dr. Puchalski’s thoughts on practicing medicine.

---

TIMESTAMPS

00:00 - Introduction

06:56 - Market Share: Why it Matters

10:16 - The Importance of Passive Income & Ancillaries

21:47 - Personal Finance for Physicians

28:13 - Supporting Wellness Through Financial Planning

43:11 - Final Thoughts

---

RESOURCES

Dr. Robert Puchalski’s SC ENT Profile: https://www.southcarolinaent.com/providers/robert-puchalski

Dr. Ayesha Khalid’s Cambridge Health Alliance Profile: https://www.challiance.org/doctors/profile?n=899

Ep. 194 Tinnitus and Migraine: Expert Insight with Dr. Hamid Djalilian

Tue, 08 Oct 2024 07:00:00 -0000

Tinnitus remains one of otology’s greatest, most challenging, and unsolved clinical problems. In this episode of the BackTable ENT Podcast, Dr. Hamid Djalilian, chair of otolaryngology at University of California Irvine (UCI), joins guest host and fellow otologist Dr. Walter Kutz (UT Southwestern) to discuss contemporary tinnitus therapy.

---

This podcast is supported by:

PearsonRavitz

https://pearsonravitz.com/backtable

---

SYNPOSIS

First, Dr. Djalilian shares how he got interested in tinnitus. After observing how migraines and tinnitus share many similar triggers, he hypothesized that increased central sensitivity underlies both diseases. He successfully adopted migraine management strategies for his tinnitus patients and found great clinical success. After sharing pathophysiologic similarities between the two diseases, Dr. Djalilian expounds on how he evaluates and treats tinnitus. His discussion includes lifestyle modifications, medication, and emerging surgical therapies. Finally, he advises listeners to think of tinnitus as a manageable condition, rather than a poorly-understood phenomenon.

---

TIMESTAMPS

00:00 - Introduction

02:34 - The Challenge of Treating Tinnitus

07:19 - Connecting Tinnitus & Migraine

15:59 - Atypical (Otologic) Migraine & Diagnostic Challenges

19:59 - Managing Tinnitus Triggers

26:27 - Dietary Triggers of Tinnitus

28:44 - The Role of Sleep Quality in Tinnitus

33:04 - Caring for Older Patients with Tinnitus

37:59 - New Therapies for Tinnitus: Sound & Cognitive Behavioral Therapy

44:08 - Neuromodulation: The Future of Tinnitus Therapy?

51:34 - Final Thoughts on Tinnitus Treatment

---

RESOURCES

BackTable ENT Episode 60 Otologic Manifestations of Migraine with Dr. Hamid Djalilian

https://www.backtable.com/shows/ent/podcasts/60/otologic-manifestations-of-migraine

Dr. Hamid Djalilian University of California, Irvine Profile: https://www.ent.uci.edu/faculty/hamid-djalilian-md.asp

Dr. Hamid Djalilian’s Website:

https://hamiddjalilianmd.com/

Fan-Gang Zeng (Hearing and Speech) Lab at UCI:

https://faculty.sites.uci.edu/hesplab/

PearsonRavitz:

https://pearsonravitz.com/

Ep. 193 Revolutionizing ENT with Artificial Intelligence with Dr. Mas Takashima

Tue, 01 Oct 2024 07:00:00 -0000

Many of us continue to associate “Artificial Intelligence” (AI) with the worst moments in The Terminator, Ex Machina, or The Matrix. Others think first of the known ethical challenges of AI and the potential workforce disruption of widespread AI implementation in healthcare and beyond. Dr. Mas Takashima, AI expert and chair of Houston Methodist’s Otolaryngology Department, wants to change our lingering apprehensions around AI. In this episode, Dr. Takashima interviews his Houston Methodist colleague and guest host Dr. Omar Ahmed.

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SYNPOSIS

First, Dr. Takashima shares his journey from video gamer to sinus surgeon and advocate for AI in medicine. He explains relevant concepts such as Generative Preformed Transformer (GPT) and neural network. Then, he and Dr. Ahmed dive into applications of AI to ENT, which include (but aren’t limited to) analysis of CT images, prediction of surgical success, and screening of residency applications. They review the unique challenges of applying this powerful technology to healthcare and emphasize the importance of safeguarding patient privacy in the era of Big Data. Finally, Dr. Takashima challenges his fellow otolaryngologists and researchers to embrace this transformative technology.

---

TIMESTAMPS

00:00 - Introduction

11:43 - AI 101

23:26 - Applications of AI in Medicine

31:21 - Current & Emerging Applications of AI in ENT

33:44 - Using AI to Improve Surgical Robotics

39:09 - AI in Personalized Medicine

46:41 - AI in Medical Education

57:23 - Ethics & AI: The Need for an Updated HIPAA

01:02:20 - The Future of AI in ENT

---

RESOURCES

Dr. Mas Takashima’s Houston Methodist profile: https://www.houstonmethodist.org/doctor/masayoshi-takashima/

Dr. Omar Ahmed’s Houston Methodist profile: https://www.houstonmethodist.org/doctor/omar-g-ahmed/

Ep. 192 Safeguarding Physician Wellbeing: Julie Wei’s Journey

Tue, 24 Sep 2024 07:00:00 -0000

Many doctors enjoy writing, but how does a meaningful idea become a published book? Just ask Dr. Julie Wei, director of pediatric otolaryngology at Akron Children’s Hospital and author of two books. In this episode of the BackTable ENT podcast, Dr. Wei discusses her third book “Safeguarding Physician Wellbeing” with podcast host Dr. Gopi Shah.

---

CHECK OUT OUR SPONSOR

PearsonRavitz

https://pearsonravitz.com/backtable

---

SYNPOSIS

First, Dr. Wei shares her journey to authorship, which grew out of her efforts as an advocate for physician wellness. Then, she delves into topics covered in her book, including personal relationships, finances, fertility, and career growth. Much like operating room time-outs, “Safeguarding Physician Wellbeing” uses checklists at the end of each chapter to provide action items for readers. Drawing from her own experience as a surgeon and writer, Dr. Wei offers practical advice for prospective authors. The podcast wraps with thoughts on the need to prioritize physician wellness in an increasingly productivity-focused healthcare system.

---

TIMESTAMPS

00:00 - Introduction

02:28 - Dr. Julie Wei’s Journey to Authorship

08:17 - The Concept of Well-being

16:10 - Checklists: A Tool for Patient Safety & Surgeon Well-Being

30:59 - Empowering Trainees to Speak Up

33:41 - The Importance of Taking Time Off

39:54 - Physician Well-being in the U.S. Healthcare System

44:06 - The Process of Writing A Book

52:45 - Final Thoughts & Encouragement for Aspiring Authors

---

RESOURCES

Dr. Julie Wei’s Akron Children’s Hospital Profile: https://www.akronchildrens.org/people/Julie-Wei.html

“Safeguarding Physician Wellbeing,” Dr. Julie Wei: https://www.amazon.com/Safeguarding-Physician-Wellbeing-Julie-Wei/dp/1032589892

Ep. 191 AI in Laryngology: Enhancing Patient Diagnosis with Dr. Anthony Law

Tue, 17 Sep 2024 07:00:00 -0000

Artificial Intelligence (AI) already powers search results and chat bots, but what if it could help physicians diagnose cancer? In this episode of the BackTable ENT podcast, laryngologist Dr. Anthony Law of Emory University discusses applications of AI to laryngology with host Dr. Ashley Agan and guest host Dr. Mihir Patel, also of Emory.

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CHECK OUT OUR SPONSOR

PearsonRavitz

https://pearsonravitz.com/backtable

---

SYNPOSIS

First, Dr. Law discusses how he connects his passions for laryngology and machine learning as a surgeon-scientist. Before opening the conversation, he defines terms needed to understand AI in medicine. Then, he discusses his work using deep learning models to identify laryngeal cancer patients based on voice recordings. Ideally, he envisions deploying his model (which is over 90% accurate) to help primary care physicians make timely ENT referrals. Mindful of the impact technology has, Dr. Law reviews technical and ethical concerns accompanying use of AI in medicine, which include underrepresented patient groups in research, patient privacy, and safe use of technology. Finally, he offers insight into the future of AI research more broadly.

---

TIMESTAMPS

00:00 - Introduction

04:18 - Understanding Deep Neural Networks

07:13 - Applications of AI in Clinical Practice

15:08 - Data Security and Privacy Concerns

25:09 - Collecting Representative Data

31:13 - Biometrics: The Future of Medicine?

39:12 - Challenges & Costs of AI

42:26 - Final Thoughts & Future Directions

---

RESOURCES

Pearson Ravitz

https://pearsonravitz.com/

Dr. Anthony Law’s Emory University Profile: https://winshipcancer.emory.edu/profiles/law-anthony.php

Dr. Anthony Law Lab:

https://anthonylaw2.wixsite.com/website

“What Our Voice Reveals About Our Health,” Dr. Anthony Law at TedxAtlanta: https://www.youtube.com/watch?v=-J2W5IVCECE

Ep. 190 Managing Retropharyngeal Abscesses in Children with Dr. John McClay

Tue, 10 Sep 2024 07:00:00 -0000

Nothing is more satisfying than draining an abscess, right? But when is medical management sufficient or even better? In this episode of the BackTable ENT Podcast, pediatric otolaryngologist Dr. John McClay joins host Dr. Gopi Shah to educate listeners on the diagnosis and management of pediatric retropharyngeal abscess (RPA).

---

CHECK OUT OUR SPONSOR

PearsonRavitz

https://pearsonravitz.com/backtable

---

SYNPOSIS

First, Dr. McClay reviews the symptoms, pathophysiology, and workup of neck abscesses (including RPA) in children. When evaluating any suspected neck abscess, he uses CT results to evaluate its precise size and location. Then, he addresses the role of surgery in treatment of neck abscesses. While many patients will improve with IV antibiotics alone, he mentions that most abscesses lateral to the carotid sheath and greater than 2 cm in size require surgical drainage. Finally, the conversation shifts to cover important topics including antibiotic selection, the role of steroids, and cost-effective care.

---

TIMESTAMPS

00:00 - Introduction

03:34 - Pathophysiology & Presentation of Retropharyngeal Abscess

09:54 - Physical Examination in the Child with Suspected Neck Abscess

17:43 - The Importance of CT Scans

31:40 - Treatment of Neck Abscesses: Antibiotics vs Surgery

37:56 - The Role of Steroids in Abscess Treatment

53:41 - Applying Value-Based Care as a Pediatric Otolaryngologist

55:44 - Recap & Final Pearls

---

RESOURCES

Dr. McClay’s website:

https://www.johnmcclaymd.com/pediatric-sinus-center/

Pearson Ravitz

https://pearsonravitz.com/

McClay JE, Murray AD, Booth T. Intravenous antibiotic therapy for deep neck abscesses defined by computed tomography. Arch Otolaryngol Head Neck Surg. 2003 Nov;129(11):1207-12.

Johnson RF. Emergency department visits, hospitalizations, and readmissions of patients with a peritonsillar abscess. Laryngoscope. 2017 Oct;127 Suppl 5:S1-S9.

Ep. 189 Rhinoplasty Fundamentals and Beyond: In-Depth with Dr. Patrick Cleveland

Tue, 03 Sep 2024 07:00:00 -0000

Rhinoplasty stands out as one of the most transformative yet technically challenging procedures in facial plastic surgery. In this episode of the BackTable ENT Podcast, rhinoplasty expert Dr. Patrick Cleveland of West Palm Beach shares his approach to the procedure with host Dr. Gopi Shah.

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SYNPOSIS

First, Dr. Cleveland addresses the initial rhinoplasty consultation, including patient history, physical exam, and photo documentation. Then, the surgeons delve into technical approaches to rhinoplasty. Tackling valuable topics including graft choices, cartilage sources for revision rhinoplasty, and tools used. Dr. Cleveland offers lessons to help any otolaryngologist improve their knowledge of this essential surgery. Finally, the episode concludes with a survey of contemporary trends in rhinoplasty.

---

TIMESTAMPS

00:00 - Introduction

03:28 - Fundamentals of Rhinoplasty

04:19 - Interviewing Patients & Identifying Red Flags

10:25 - Physical Exam for Rhinoplasty

15:14 - The Importance of Photo Documentation

30:26 - Cephalic Trim & Turnover Flap Techniques

32:52 - Tip Supporting Grafts and Cartilage Harvesting

36:46 - Instruments for Rhinoplasty

39:42 - Sourcing Cartilage in Revision Rhinoplasty

49:20 - Post-operative Care & Complications

56:07 - Future Directions in Rhinoplasty

---

RESOURCES

Patrick Cleveland Facial Plastic Surgery:

https://www.drpatrickcleveland.com/

Deformity, etiology, solution, sequence (DESS): Facial analysis in rhinoplasty: https://pubmed.ncbi.nlm.nih.gov/37952257/

Ep. 188 Surgical Management of Synkinesis and Static Procedures for Flaccid Facial Palsy with Dr. Shiayin Yang

Tue, 27 Aug 2024 07:00:00 -0000

Facial nerve injury affects each patient in a unique way. Accordingly, surgical treatment of facial paralysis must be meticulously planned and personalized. In this episode, Dr. Shiayin Yang, Associate Professor of Otolaryngology at Vanderbilt University, addresses management of synkinesis and static procedures for flaccid facial palsy with host Dr. Ashley Agan.

---

CHECK OUT OUR SPONSOR

PearsonRavitz

https://pearsonravitz.com/backtable

---

SYNPOSIS

First, Dr. Yang reviews the difference between flaccid and non-flaccid (including synkinetic) facial paralysis. She describes her approach to facial paralysis, which includes clarifying the patient’s diagnosis and thoroughly examining the facial nerve function. Dr. Yang then transitions the conversation to surgical solutions, emphasizing dual goals of restoring symmetry and function. She divides her discussion to first tackle synkinesis and then static procedures for flaccid paralysis. Procedures discussed include Botox, brow lift, blepharoplasty, myectomy, and neurectomy as well as lower eyelid and midface procedures and temporalis tendon transfer. While surgical approaches to the two conditions differ, eye protection represents an important theme throughout. The episode concludes with Dr. Yang’s pearls for approaching these complex surgical problems and a reminder of how facial paralysis affects patients’ emotional health.

---

TIMESTAMPS

00:00 - Introduction

02:36 - Understanding Flaccid & Non-Flaccid Facial Paralysis

07:13 - Botox for Facial Synkinesis

12:38 - History-Taking & Physical Exam in Facial Paralysis

15:07 - Surgical Management of Synkinesis

30:47 - Patient Counseling and Motivation

32:47 - Static Procedures for Flaccid Facial Palsy

37:26 - Nuances of Peri-Ocular Procedures

43:42 - Lower Eyelid & Midface Considerations

53:00 - Dynamic Surgery Options

56:56 - Final Surgical Pearls

---

RESOURCES

Dr. Shiayin Yang’s Vanderbilt University Profile: https://www.vanderbilthealth.com/doctors/yang-shiayin

BackTable ENT Episode 151- Navigating Synkinesis: From Diagnosis to Comprehensive Care with Dr. Shiayin Yang

https://open.spotify.com/episode/1JucnHB8tNC5qRW6u82ie8?si=ba729d3f3e164d6f

Ep. 187 Boosting Your ENT Practice with Allergy Services with Dr. Michelle Liu

Tue, 20 Aug 2024 07:00:00 -0000

Adding allergy services to your practice can improve your comprehensive ENT care. When otolaryngologists treat allergies, they more effectively address related conditions, such as sinusitis and otitis media. In this episode, Dr. Michelle Liu, general ENT in Fairfax, Virginia, shares her wisdom on starting an otolaryngologic allergy practice with host Dr. Ashley Agan.

---

CHECK OUT OUR SPONSOR

Medtronic ENT

https://www.medtronic.com/us-en/healthcare-professionals/medical-specialties/ear-nose-throat.html?cmpid=Vanity_URL_MIX_medtronicent-com_202212_US_EN_NS_ENT_FY23

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SYNPOSIS

First, Dr. Liu summarizes her journey to treating allergy as an otolaryngologist. She finds the continuity of care and personal connections that accompany allergy care fulfilling. Then, she describes the different testing and treatment modalities used in her clinic. While subcutaneous immunotherapy is more common, sublingual immunotherapy offers an appealing needle-free alternative for some patients. Finally, she explains the logistics of starting an allergy practice, including finances, continuing education, and safety considerations for immunotherapy initiation.

---

TIMESTAMPS

00:00 - Introduction

03:36 - Dr. Liu’s Medical Journey: From Military Resident to Civilian Otolaryngologist

08:46 - Adding Allergy Testing to Your Practice

28:44 - Adding Immunotherapy to Your Practice

31:22 - Patient Selection & Financial Considerations

39:39 - Pediatric Allergy

45:09 - Emergency Preparedness in Allergy Clinics

49:15 - Sublingual Immunotherapy & Tablets

53:48 - Continuing Medical Education in Allergy

---

RESOURCES

Medtronic ENT

https://www.medtronic.com/us-en/healthcare-professionals/products/ear-nose-throat.html

Dr. Michelle Liu’s Inova Profile:

https://www.inova.org/doctors/michelle-f-liu-md

Otolaryngology Associates’ Facebook Page:

https://www.facebook.com/otoassoc/

American Academy of Otolaryngologic Allergy:

https://www.aaoallergy.org/

Ep. 186 Improving Health Equity in Pediatric ENT Care with Dr. Jill D'Souza

Tue, 13 Aug 2024 07:00:00 -0000

In today’s complex healthcare landscape, how can pediatric otolaryngologists help more children access evidence-based, quality care? In this episode, Dr. Jill D’Souza, pediatric otolaryngologist at Children’s Hospital of New Orleans, discusses pediatric health equity in the Gulf South with hosts Dr. Gopi Shah and Dr. Ashley Agan.

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SYNPOSIS

First, Dr. D’Souza defines the “Gulf South” to include parts of Louisiana, Texas, Mississippi, Alabama, and the Florida panhandle. Challenges to healthcare delivery in this region include rural settings, high poverty rates, and difficulties funding out-of-state Medicaid patients. Then, using tonsillectomy and tracheostomy as examples, Dr. D’Souza explains how social factors complicate access to care. She shares her successes connecting underprivileged children to the care they need. Finally, the episode concludes with her thoughts on how interprofessional teamwork powers better pediatric ENT care.

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TIMESTAMPS

00:00 - Introduction

02:17 - Challenges in Pediatric ENT Care

05:43 - Healthcare Inequities in the Gulf South

10:38 - Tracheostomy Education in Rural, Resource-Limited Settings

21:33 - Helping Patients Tackle Financial Challenges

26:52 - Caring for All in Public Hospitals

37:57 - Keeping the Big Picture in Mind

---

RESOURCES

PearsonRavitz

https://pearsonravitz.com/

Dr. Jill D’Souza’s LSU Health Profile: https://www.medschool.lsuhsc.edu/otorhinolaryngology/dsouza_jill.aspx

Ep. 185 Price Transparency in Healthcare with Dr. Keith Smith

Fri, 09 Aug 2024 07:00:00 -0000

Ep. 184 Thyroglossal Duct Cysts in Children: a Comprehensive Approach with Dr. Christopher Liu

Tue, 06 Aug 2024 07:00:00 -0000

What is the best way to manage an infected thyroglossal duct cyst? In this episode, hosts Dr. Gopi Shah and Dr. Ashley Agan welcome Dr. Christopher Liu, associate professor of pediatric otolaryngology at UT Southwestern, to learn about his vast experience with evaluation and management of thyroglossal duct cysts and the nuances of other congenital neck masses.

---

CHECK OUT OUR SPONSOR

Medtronic ENT

https://www.medtronic.com/en-us/healthcare-professionals/specialties/ear-nose-throat.html

---

SYNPOSIS

First, Dr. Liu describes how thyroglossal duct cysts present. Patients often become aware of their cyst when a parent palpates a midline neck mass or when the cyst gets infected. Then, Dr. Liu describes non-operative management of thyroglossal duct cysts, including antibiotics to treat infection and cases in which drainage is appropriate. The conversation proceeds to surgical strategy, with Dr. Liu describing how his approach to cyst excision evolved over the years. The episode concludes with pearls on post-operative management and potential surgical complications.

---

TIMESTAMPS

00:00 - Introduction

02:53 - Understanding Thyroglossal Duct Cysts

11:48 - Managing Infected Thyroglossal Duct Cysts

14:02 - Antibiotic Choices & Drainage Techniques

21:05 - Imaging & Workup

25:39 - Surgical Approach and Techniques

27:29 - Koempel’s Technique for Thyroglossal Duct Cyst Surgery

39:04 - Surgical Complications, Risk of Recurrence, & Post-Operative Care

52:37 - Key Takeaways for Thyroglossal Duct Cyst Surgery

---

RESOURCES

Dr. Christopher Liu’s UT Southwestern Profile:

https://utswmed.org/doctors/christopher-liu/

Jeffrey Koempel, “Thyroglossal Duct Remnant Surgery: A Reliable, Reproducible Approach to the Suprahyoid Region”:

https://pubmed.ncbi.nlm.nih.gov/25193588/

Ep. 183 Office-Based Ear Tubes in Children with Dr. Shelagh Cofer

Tue, 30 Jul 2024 07:00:00 -0000

Given that recurrent otitis media can expose children to hearing loss, delayed speech development, and repeated antibiotic use, it is not at all surprising that ear tube insertion is the most common ambulatory procedure performed in the United States. But what if there was a way to insert ear tubes in children without going to the operating room? In this episode, host Dr. Ashley Agan speaks with Dr. Shelagh Cofer, pediatric otolaryngologist at the Mayo Clinic, about the Hummingbird Tympanostomy Tube insertion system.

---

CHECK OUT OUR SPONSOR

Hummingbird PE Ear Tubes

https://www.hummingbirdeartubes.com/physicians/hummingbird-tts-device/

---

SYNPOSIS

First, Dr. Cofer reviews the epidemiology of pediatric otitis media. When a child has 3 ear infections in three months or 5-7 in a year, tympanostomy tubes are indicated. Wanting to facilitate this procedure, Dr. Cofer brought the in-office Hummingbird tympanostomy tube system to her practice as one of the principal investigators in the clinical trials. After reviewing how the device was developed, she walks listeners through how she uses it, including how to avoid pitfalls such as “dunking” a tube. Finally, she shares feedback from parents whose children had ear tubes inserted using the Hummingbird system.

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TIMESTAMPS

00:00 - Introduction

02:25 - Ear Infections & Ear Tubes

09:34 - Selecting Patients for In-Office Ear Tube Placement

15:50 - Inserting Ear Tubes in the Office: A Step-by-Step Guide

34:33 - Benefits of In-Office Ear Tube Placement

42:35 - Avoiding & Mitigating Complications from Ear Tube Insertion

56:23 - Parent Feedback on the Hummingbird System

---

RESOURCES

Dr. Shelagh Cofer’s Mayo Clinic Profile: https://www.mayoclinic.org/biographies/cofer-shelagh-a-m-d/bio-20055176

Hummingbird TTS Website:

https://www.hummingbirdeartubes.com/

Ep. 182 Understanding OSA in Women with Dr. Megan Durr

Tue, 23 Jul 2024 07:00:00 -0000

Epidemiological studies reveal that women make up 25% of all obstructive sleep apnea (OSA) patients, yet only 11% of patients carrying OSA diagnoses are women. What drives this disparity? In this episode of the BackTable ENT Podcast, sleep surgeon and UCSF Associate Professor Dr. Megan Durr joins host Dr. Gopi Shah to discuss OSA in women.

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CHECK OUT OUR SPONSOR

Medtronic ENT

https://www.medtronic.com/en-us/healthcare-professionals/specialties/ear-nose-throat.html

---

SYNPOSIS

First, Dr. Durr recounts her path to sleep surgery, including her interest in women’s sleep issues, which grew out of discussions with her female friends experiencing pregnancy-related sleep disturbances. When asked why OSA is under-diagnosed in women, Dr. Durr underscores how women’s OSA symptoms – mental fog, memory issues, and insomnia – are relatively nonspecific. While it presents differently in women, OSA increases the risk of heart failure, hypertension, and dementia in all patients, regardless of sex. Then, Dr. Durr shares her physical exam and testing strategies to uncover OSA in female patients. Once diagnosed, she advocates multimodal treatment, including CPAP, weight loss, and surgery.

The podcast concludes with discussion of how ENTs can eliminate barriers to better sleep in women, underrepresented minorities, and low-income patients.

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TIMESTAMPS

00:00 - Welcome to the BackTable ENT Podcast

03:06 - Dr. Megan Durr’s Background & Journey

08:15 - Challenges Diagnosing Sleep Apnea in Women

14:55 - Long-term Effects of Sleep Apnea in Women

20:06 - Hormonal Influences on Sleep Apnea

29:56 - CPAP & Oral Devices in Women with OSA

32:21 - Positional Therapy & Surgery in Women with OSA

36:34 - Weight Loss to Combat OSA

41:04 - Countering Disparities in OSA Treatment

48:06 - Identifying & Caring For “Unseen” OSA Patients: A Team Effort

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RESOURCES

Medtronic ENT

https://www.medtronic.com/us-en/healthcare-professionals/products/ear-nose-throat.html

Dr. Durr’s UCSF Profile:

https://ohns.ucsf.edu/megan-durr

Dr. Durr’s X:

https://x.com/drmegandurr

Ep. 181 Localized Drug Delivery for CRS with Dr. Rajiv Pandit

Tue, 16 Jul 2024 07:00:00 -0000

Before bringing a new device into your practice, it’s prudent to understand the science behind, indications for, and insurance coverage of that device. In this episode, Dr. Rajiv Pandit, comprehensive otolaryngologist at Dallas ENT Head & Neck Surgery Center, joins BackTable to discuss his success treating sinusitis with drug-eluting stents.

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CHECK OUT OUR SPONSOR

Medtronic ENT Propel Implants

https://www.medtronic.com/en-us/healthcare-professionals/specialties/ear-nose-throat.html

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SYNPOSIS

First, Dr. Pandit shares the benefits of localized drug delivery, including fewer systemic steroid effects and improved compliance. He shares his experience deploying Propel and SINUVA stents to treat sinusitis. Then, Dr. Pandit shares his workflow for treating sinusitis, including patient education, anesthesia protocols, stent placement, and billing. The episode wraps with his tips on incorporating a new device into your practice.

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TIMESTAMPS

00:00 - Introduction

02:44 - Dr. Rajiv Pandit’s Path to Treating Sinusitis in Private Practice

04:31 - Understanding Local Drug Delivery for Sinus Disease

06:17 - The Evolution of Propel & Sinuva Sinus Stents

18:33 - Contraindications & Post-Op Protocols

32:35 - Understanding Insurance Coverage & Preauthorization

37:47 - Patient Education & Long-Term Treatment Plans

48:10 - Anesthetic Protocols for In-Office Sinonasal Procedures

54:48 - Bringing Drug-Eluting Sinus Stents to Your Practice

---

RESOURCES

Dr. Pandit’s Dallas ENT Profile:

https://www.dallasent.com/providers/rajiv-pandit

Dallas ENT Instagram:

https://www.instagram.com/dallas.ent/embed/

Dr. Pandit’s Email:

drpandit@dallasent.com

Ep. 180 Aural Rehabilitation After Pediatric Cochlear Implantation: Expert Insight from Audiology with Dr. Sarah Cordingley, Aud, CCC-A

Tue, 09 Jul 2024 07:00:00 -0000

Any otolaryngologist or cochlear implant (CI) patient can tell you that the journey to better hearing begins in earnest after CI activation. When the patient in question is a child, what does that journey look like? In this episode of the BackTable ENT podcast, Dr. Sarah Cordingley, audiologist with Peak ENT (Provo, Utah), joins host Dr. Gopi Shah to discuss aural rehabilitation for pediatric CI patients.

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SYNPOSIS

First, Dr. Cordingley explains how audiologists work alongside otolaryngologists, social workers, and occupational therapists to prepare patients for cochlear implantation. Since younger patients cannot sit for a standard audiogram, she uses auditory milestones, visual reinforcement audiology (VRA) and conditioned play audiometry (CPA) to assess pediatric hearing loss. Then, she explains how audiologists help patients learn to use their implant, underscoring the importance of regular use, streaming, and participation in structured aural rehabilitation programs. The podcast concludes with a discussion of efforts to increase patient access to cochlear implants.

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TIMESTAMPS

00:00 - Welcome to the BackTable ENT Podcast

05:05 - Audiologists’ Crucial Role in Cochlear Implant Evaluation

13:59 - Implant Activation & Programming

20:11 - The Importance of Family Support in Pediatric Hearing Loss

26:31 - Uses of Telehealth in Audiology

32:49 - Learning to Use New CI Technologies

41:47 - Equitable Access to Cochlear Implants

45:27 - Audiologists & Otolaryngologists: Partners for CI Success

---

RESOURCES

Dr. Cordingley’s Peak ENT Profile:

https://peakent.com/our-healthcare-providers/

Dr. Cordingley’s email:

scordingley@peakent.com

Ep. 179 Decision Fatigue in Medicine: Insights from Dr. Steven Goudy

Tue, 02 Jul 2024 07:00:00 -0000

Part of being a doctor is making high-stakes decisions nearly every day. However, making quality choices becomes even harder when you’re inundated with work and not sure where to start. In this episode, Dr. Steven Goudy, Professor of Pediatric Otolaryngology at Emory University (Atlanta), joins host Dr. Gopi Shah to cover decision fatigue.

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SYNPOSIS

First, Dr. Goudy defines decision fatigue and explains its relation to clinician burnout. Based on their experience, decision fatigue might look different in an early-career versus a mid-career surgeon, but it will leave both feeling depleted. Then, Dr. Goudy shares strategies to mitigate decision fatigue, including delegation, coaching, and standardization. He uses examples from the business world to illustrate the importance of saying “no” to opportunities you aren’t interested in. Finally, the podcast concludes with a reflection on how your values should guide the choices you make.

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TIMESTAMPS

00:00 - Introduction

01:32 - Decision Fatigue Defined

03:51 - Personal Strategies to Combat Decision Fatigue

06:10 - Decision Fatigue in the Clinic

24:29 - Decision Fatigue in the Operating Room

29:49 - Decision Fatigue at Home

37:37 - Making Choices that Align with Your Values & The Importance of Saying “No”

---

RESOURCES

Dr. Steven Goudy’s Emory University Profile: https://med.emory.edu/directory/profile/?u=SGOUDY

Article on Judges & Decision Fatigue:

https://www.pnas.org/doi/10.1073/pnas.1018033108

Article on Orthopedic Surgeons & Decision Fatigue:

https://onlinelibrary.wiley.com/doi/full/10.1002/hec.3933

Article on Interruptions in the Trauma OR:

https://pubmed.ncbi.nlm.nih.gov/22124638/

Ep. 178 Teaching Surgical Residents in the XXI Century: Beyond See One, Do One, Teach One with Dr. Oswaldo Henriquez

Tue, 25 Jun 2024 07:00:00 -0000

While resident education represents the top priority of most otolaryngology departments, few attending surgeons receive formal training on teaching. In this episode of the BackTable ENT podcast, host Dr. Gopi Shah covers surgical education with Dr. Oswaldo Henriquez, rhinologist at Wellstar Health and adjunct associate professor at Emory School of Medicine.

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CHECK OUT OUR SPONSOR

Medtronic ENT

https://www.medtronic.com/en-us/healthcare-professionals/specialties/ear-nose-throat.html

---

SYNPOSIS

First, Dr. Henriquez shares his passion for teaching and learning. In his view, surgeons are career-long learners: even established otolaryngologists benefit from surgical coaching. Then, he describes the unique needs of adult learners. When teaching technical skills, Dr. Henriquez emphasizes providing realistic goals, actionable feedback, and opportunities for supervised practice. When teaching “soft skills,” Dr. Henriquez focuses on modeling the professionalism and compassion he expects of his trainees. Finally, the episode concludes with Dr. Henriquez’s thoughts on teaching as a skill all academic surgeons should hone.

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TIMESTAMPS

00:00 - Introduction

03:29 - Dr. Enriquez’s Journey as a Surgical Educator

07:26 - Teaching Adult Learners

24:14 - Challenges in Modern Surgical Education

31:39 - Setting Goals & Expectations

36:40 - The Importance of Feedback in Surgical Education

43:25 - Modeling & Teaching Surgical “Soft Skills”

53:01 - Learning How to Teach: Lessons From a Surgical Educator

---

RESOURCES

Dr. Oswaldo Henriquez’s Wellstar Profile:

https://www.wellstar.org/physicians/oswaldo-henriquez-md

Medtronic ENT

https://www.medtronic.com/us-en/healthcare-professionals/products/ear-nose-throat.html

Ep. 177 AI Scribes: Enhancing Patient and Physician Interaction with Elie Toubiana

Fri, 21 Jun 2024 07:00:00 -0000

Dr. Aditya Bagrodia sits down with Elie Toubiana, founder and CEO of ScribeMD.ai, to discuss the transformative potential of artificial intelligence (AI) in medical documentation.

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SYNPOSIS

Their conversation covers the capabilities and benefits of using an AI-driven medical scribe that ensures HIPAA compliance, reduces physician burnout, and enhances patient interactions. Elie also shares his insights about the technology’s adaptability across various medical fields. Finally, Dr. Bagrodia and Elie discuss ethical considerations surrounding applications of AI in other aspects of healthcare, such as medical workup and diagnosis.

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TIMESTAMPS

00:00 - Introduction

06:00 - How ScribeMD AI Works

14:14 - Integration with EMR

20:31 - Legal Considerations with AI Technology

26:34 - Cost Implications of AI Scribes

38:46 - Future of AI in Medical Diagnosis

41:45 - Conclusion and Final Thoughts

---

RESOURCES

ScribeMD.ai

https://www.scribemd.ai/

Ep. 176 Advancing Surgical Education: 3D Models and Videos with Dr. François Simon

Tue, 18 Jun 2024 07:00:00 -0000

While the mantra “see one, do one, teach one” once guided surgical education, nowadays, technologies like 3D printed models and realistic surgical videos allow trainees to safely gain hands-on experience. In this episode of the BackTable ENT podcast, Dr. François Simon, pediatric otolaryngologist at Necker Hospital for Sick Children (Paris, France) joins host Dr. Gopi Shah to discuss technological innovations in surgical education.

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SYNPOSIS

First, Dr. Simon explains how 3D printing technology expands trainees’ anatomical knowledge. He speaks to his experience working alongside a 3D printing engineer to develop models used to teach otoscopy and ear surgery. Then, Dr. Simon tackles the role of videos in surgical education. His conversation with Dr. Shah focuses on the composition, ethics, and distribution of effective educational videos. Finally, Dr. Simon discusses how attending surgeons can leverage technology to maximize trainee learning in the operating room.

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TIMESTAMPS

00:00 - Introduction

02:36 - Embracing 3D Printing in Surgical Education

14:32 - Collaborating with Engineers to Produce High-Fidelity Anatomic Models

17:59 - The Future of 3D Printing in Medicine

20:44 - The Role of Video in Surgical Education

24:59 - Creating Effective Educational Videos

34:49 - How to Distribute Your Video to its Target Audience

36:23 - Ethical Considerations: Patient Consent & Privacy

44:56 - Final Thoughts & Resources for Educators

---

RESOURCES

3D Printed Model to Teach Otoscopy:

https://www.m3d-print.com/en/products/otoscopic-simulator-tympano/

Dr. Simon’s Guide to Making an Effective Surgical Video:

https://videos-chirurgicales.u-paris.fr/en/

IVORY (Instructional Videos in Otorhinolaryngology by YO-IFOS): A Consensus on Surgical Videos in Ear, Nose, and Throat: https://onlinelibrary.wiley.com/doi/full/10.1002/lary.29020

Ep. 175 Understanding Atypical LPR: Beyond the Larynx with Dr. Inna Husain

Tue, 11 Jun 2024 07:00:00 -0000

In this episode, laryngologist Dr. Inna Husain joins host Dr. Ashley Agan for a deep dive into laryngopharyngeal reflux (LPR) to illuminate patient presentation, diagnostic tests, and future directions in LPR research.

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CHECK OUT OUR SPONSOR

Medtronic ENT

https://www.medtronic.com/en-us/healthcare-professionals/specialties/ear-nose-throat.html

---

SYNPOSIS

The episode begins with a recap of Episode 83, in which Dr. Husain explained LPR fundamentals. Continuing from where they left off, the surgeons discuss various presentations of LPR, emphasizing the distinctions between acidic/non-acidic and direct/indirect reflux. Then, they review tests used to diagnose LPR and role of collaboration with gastroenterology colleagues. Dr. Husain shares her therapeutic approach to LPR, which includes lifestyle modifications for all patients, alginates for those with mechanical reflux, and nerve blocks for those with neurally mediated symptoms. The podcast wraps with a discussion of hot topics in LPR research.

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TIMESTAMPS

00:00 - Introduction

01:01 - Sponsor Spotlight: Medtronic ENT Innovations

04:37 - Summary of BackTable Episode 83 on Laryngopharyngeal Reflux (LPR)

08:34 - Typical vs. Atypical Presentations of LPR

23:36 - Dr. Husain’s Personal Experience with LPR

38:27 - Diagnosing LPR

46:43 - Lifestyle & Dietary Changes for LPR

50:53 - Hot Topics in Contemporary LPR Research

53:17 - The Brain-Gut Connection & LPR

---

RESOURCES

BackTable ENT Episode 83: “Laryngopharyngeal Reflux with Dr. Inna Hussain:” https://www.backtable.com/shows/ent/podcasts/83/laryngopharyngeal-reflux

Medtronic ENT

www.medtronicent.com

Dr. Inna Husain’s Community Healthcare System profile: https://www.comhs.org/find-a-doctor/h/husain-inna

Dr. Inna Husain’s X:

https://x.com/drinnahusain

Dr. Inna Husain’s Instagram:

https://www.instagram.com/innahusainmd/

Dr. Inna Husain’s TikTok:

https://www.tiktok.com/@throatdoc

Ep. 174 Advanced Navigation Systems for FESS: Enhancing Safety with Dr. Raj Sindwani

Tue, 04 Jun 2024 07:00:00 -0000

In this episode, Dr. Raj Sindwani, rhinologist at the Cleveland Clinic, joins host Dr. Gopi Shah to discuss advanced navigation systems, such as virtual reality (VR), to improve functional endoscopic sinus surgery (FESS).

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CHECK OUT OUR SPONSOR

Stryker ENT

https://ent.stryker.com

---

SYNPOSIS

First, Dr. Sindwani shares how he combines pre-operative imaging data and navigation to plan successful surgeries. Then, he delves into features available in newer navigation systems, including target/anti-target technology, which notifies surgeons as their instruments approach critical structures. He covers topics relevant to navigation in clinical practice, including reimbursement, patient counseling, and troubleshooting in the OR. The episode concludes with a short conversation on the future of navigation-assisted FESS.

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TIMESTAMPS

00:00 - When to Use Navigation

10:42 - Harnessing Augmented Reality for Better Surgical Planning

20:43 - Registering Landmarks with Navigation

22:27 - How Navigation Systems Enhance Surgical Education

27:53 - Navigation in Office-Based Procedures

35:05 - Troubleshooting Problems with Navigation Systems

42:25 - The Future of Navigation-Assisted FESS

---

RESOURCES

Stryker ENT Products:

https://www.stryker.com/us/en/ent.html

Dr. Sindwani’s Cleveland Clinic Profile:

https://my.clevelandclinic.org/staff/14102-raj-sindwani

Ep. 173 Hypothyroidism Unmasked: The ENT’s Diagnostic Journey with Dr. Dana Gibbs

Tue, 28 May 2024 07:00:00 -0000

In this episode of the BackTable ENT Podcast, thyroid expert Dr. Dana Gibbs speaks with host Dr. Ashley Agan about Hashimoto’s Thyroiditis and hypothyroidism. Despite the high prevalence of Hashimoto’s Thyroiditis (1-2%), the condition is often misunderstood. Otolaryngologists and internists alike will benefit from Dr. Gibbs’ insight into Hashimoto’s presentation, diagnosis, and treatment.

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SYNPOSIS

First, Dr. Gibbs explains how she shifted her clinical focus from comprehensive otolaryngology to thyroid disease. Recounting her decades-long, personal experience with hypothyroidism, she describes how nonspecific symptoms of fatigue, hair loss, and weight gain can lead clinicians astray. Then, she reviews the pathophysiology and diagnosis of Hashimoto’s Thyroiditis. Using labs and questionnaires, she interrogates the patient’s overall endocrine health, which she addresses using a combination of levothyroxine (T4), liothyronine (T3), and select supplements. She demonstrates how lessons learned treating Hashimoto’s extend to hypothyroidism management more broadly. Finally, the use of integrative medicine strategies to treat thyroid disorders is discussed.

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TIMESTAMPS

00:00 - Introduction

02:33 - Dr. Gibbs’ Personal Experience with Hypothyroidism

11:32 - Understanding Hashimoto’s Thyroiditis

18:26 - Hashimoto’s: A Challenging Diagnosis

33:17 - The Role of Stress in Thyroid Disease

35:04 - Thyroid Medications

51:21 - The Role of Surgery in Managing Hypothyroidism

55:01 - An Integrative Medicine Perspective on Hypothyroidism

59:27 - Final Thoughts on Hashimoto’s & Hypothyroidism

---

RESOURCES

Dr. Gibbs’ Consultants in Metabolism Profile:

https://www.danagibbsmd.com/

Dr. Gibbs’ Instagram:

https://www.instagram.com/danagibbsmd/

Ep. 172 HPV and Oropharyngeal Cancer: Evolving Insights and Implications with Dr. Mihir Patel

Tue, 21 May 2024 07:00:00 -0000

In this episode, Dr. Mihir Patel, Professor of Otolaryngology at Emory University and expert in Transoral Robotic Surgery (TORS), discusses HPV-positive head and neck cancer with host Dr. Ashley Agan.

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CHECK OUT OUR SPONSOR

Medtronic ENT

https://www.medtronic.com/en-us/healthcare-professionals/specialties/ear-nose-throat.html

---

SYNPOSIS

Dr. Patel opens by briefly sharing his journey to head & neck surgery, and, more specifically, expertise in TORS. After, Dr. Patel explains the epidemiology and pathophysiology of HPV-caused cancers, which frequently present as painless neck masses. Then, Dr. Patel describes workup and treatment of these cancers. He shares surgical strategies, paying special attention to cases of unknown primary lesions. He underscores the importance of collaboration with medical and radiation oncologists, particularly given the rapid pace of treatment innovation. Finally, Dr. Agan and Dr. Patel examine how increased HPV vaccine uptake could drastically lower the burden of this disease in the coming decades.

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TIMESTAMPS

00:00 - Introduction

05:26 - The Evolution of HPV-Related Oropharyngeal Cancer Treatment

17:26 - Contemporary Diagnostics for Head & Neck Cancer

24:39 - Surgical Strategies for Unknown Primary Lesions

38:15 - The Role of ctDNA in Cancer Management

46:10 - Advancements in HPV-Driven Cancer Treatment

53:30 - The Future of Cancer Screening and Vaccination

01:01:54 - Vaccination: A Tool for Cancer Prevention

---

RESOURCES

Medtronic ENT:

https://www.medtronic.com/us-en/healthcare-professionals/products/ear-nose-throat.html

Dr. Mihir Patel’s Emory University Profile:

https://winshipcancer.emory.edu/bios/faculty/patel-mihir-r.html

AVOID Trial:

https://pubmed.ncbi.nlm.nih.gov/31785337/

Ep. 171 Workforce Analysis and Why It’s Important with Dr. Andrew J. Tompkins

Tue, 14 May 2024 07:00:00 -0000

In this episode, hosts Dr. Ashley Agan and Dr. Gopi Shah discuss the ENT workforce with Dr. Andrew (“AJ”) Tompkins, an Ohio-based comprehensive otolaryngologist and member of the American Academy of Otolaryngology-Head and Neck Surgery’s socioeconomic task force.

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SYNPOSIS

First, Dr. Tompkins provides an overview of the ENT workforce from trainee to retiree stages. He describes his work with the Academy’s socioeconomic task force, which provides important feedback on the number, location and work environments of practicing otolaryngologists. He emphasizes participation in the Academy’s workforce survey as the source of this data. Offering a sneak preview of 2023 survey results, Dr. Tompkins underscores the need to increase resident exposure to private practice settings and to plan for how treatment breakthroughs (such as the HPV vaccine) might affect future workforce needs. The surgeons finish by discussing necessary improvements in resident selection and continuing education.

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TIMESTAMPS

00:00 - Introduction

03:09 - Exploring the ENT Workforce: A Provocative Topic

08:09 - Unpacking the Challenges of ENT Workforce Data

22:16 - The Impact of Fellowship Training & Practice Shifts

31:59 - Previewing 2023 Data Insights

37:09 - Addressing Workforce Distribution and Access Issues

43:30 - How Technology & Training Influence the ENT Workforce

56:20 - Collaborations & Future Directions

01:01:24 - Concluding Thoughts on Workforce Dynamics

---

RESOURCES

Dr. Andrew Tompkins’ Ohio ENT & Allergy Profile:

https://www.ohioentandallergy.com/physicians/andrew-tompkins-md-mba/

Triological Society Otolaryngology Workforce Analysis from 2016: https://onlinelibrary.wiley.com/doi/abs/10.1002/lary.26238

“The 2022 Otolaryngology Workforce” Report from AAO-HNS:

https://www.entnet.org/wp-content/uploads/2023/07/2022-Otolaryngology-Workforce.pdf

Tompkins AJ. The Otolaryngology Workforce, Part I: Supply. ENTtoday. May 2022.

https://www.enttoday.org/article/some-studies-predict-a-shortage-of-otolaryngologists-do-the-numbers-support-them/

Tompkins AJ. The Otolaryngology Workforce, Part II: Structure & Rethinking Supply. ENTtoday. June 2022.

https://www.enttoday.org/article/transparent-regular-data-vital-to-reworking-how-we-think-about-workforce-supply/

Tompkins AJ. The Otolaryngology Workforce, Part III: Competition & Future Design. ENTtoday. July 2022.

https://www.enttoday.org/article/tips-for-creating-a-dynamic-otolaryngology-workforce/

Ep. 170 ENT Advocacy: Strategies and Impact with Dr. Peter Manes

Tue, 07 May 2024 07:00:00 -0000

In this episode of the BackTable ENT podcast, Dr. Pete Manes, associate professor of rhinology at Yale, discusses political advocacy with host Dr. Ashley Agan.

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SYNPOSIS

Dr. Manes begins by explaining how a life-long interest in government underlies his work as a physician-advocate with the American Academy of Otolaryngology-Head & Neck Surgery. Currently, he serves as the Academy’s Coordinator of Health Policy, where he contributes to private payer advocacy and Academy position statements. Drawing on this experience, he explains political challenges associated with being a smaller specialty, roles played by of Action Committees (PACs), and steps in legislative advocacy. Then, he shifts focus to cover how the Academy works with private payers to ensure fair reimbursement. The podcast concludes with resources to connect otolaryngologists with advocacy work.

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TIMESTAMPS

00:00 - Introduction

01:02 - Dr. Pete Manes’s Advocacy Role

08:04 - The Importance of Advocacy in Medicine

20:24 - Scope of Practice and Physician Payment Reform

30:02 - Building Relationships for Healthcare Advocacy

37:12 - Navigating Insurance Companies for Patient Advocacy

42:33 - Utilizing Position Statements in Healthcare Advocacy

48:29 - Accessing Academy Resources for Healthcare Advocacy

50:43 - Exploring Opportunities for Engagement and Advocacy

---

RESOURCES

Dr. Pete Manes’s Yale University Profile:

https://medicine.yale.edu/surgery/otolaryngology/profile/rpeter-manes/

American Academy of Head & Neck Surgery (AAO-HNS) Position Statements:

https://www.entnet.org/business-of-medicine/position-statements/

AAO-HNS Health Policy Contact:

healthpolicy@entnet.org

Ep. 169 Navigating Type I Laryngeal Clefts in Children with Dr. Hamdy El-Hakim

Tue, 30 Apr 2024 07:00:00 -0000

In this episode, Dr. Hamdy El-Hakim, pediatric airway surgeon and Associate Professor at the University of Alberta, joins host Dr. Gopi Shah to review laryngeal clefts in children.

First, Dr. El-Hakim describes the presentation of laryngeal clefts. Affected children have coughing fits bad enough to cause watery eyes and “blue spells.” These fits are sometimes misattributed to other airway abnormalities or GERD. Then, discussion shifts to the workup of laryngeal clefts. All patients with a suspected laryngeal cleft need a comprehensive physical exam, a risk factor assessment and a swallow assessment, most commonly a FEES. Many patients will also require a diagnostic laryngoscopy with bronchoscopy (DLB). Dr. El-Hakim advises listeners on performing this test in children. Treatment of laryngeal clefts include thickened feeds, injection laryngoplasty, or surgical repair. Finally, Dr. El-Hakim advises listeners on compassionate care for families living with this condition.

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SHOW NOTES

00:00 - Introduction

03:39 - Laryngeal Clefts in Children: Diagnosis & Classification

06:36 - Presentation of Laryngeal Cleft

12:07 - Risk Factors & Associated Conditions

21:38 - Physical Examination Insights and Diagnostic Approaches

30:15 - The Role of FEES and Modified Barium Swallow in Diagnosis

37:37 - Navigating Pediatric Swallowing Disorders: Strategies and Challenges

41:12 - The Complexities of Diagnosing & Treating Laryngeal Cleft

45:28 - Surgical Techniques & Postoperative Care

01:03:13 - Evaluating Success Post-Surgery

01:09:20 - Final Thoughts: The Impact of Pediatric Dysphagia on Families

---

RESOURCES

Dr. Hamdy El-Hakim’s University of Alberta Profile:

https://www.ualberta.ca/airway-research/iarc-team/hamdy-el-hakim.html

Article demonstrating superiority of cold steel relative to laser in type I laryngeal cleft repair:

https://pubmed.ncbi.nlm.nih.gov/34184769/

Ep. 168 The Art of Negotiation: Securing Worth for Clinicians with Dr. Mark Royer

Tue, 23 Apr 2024 07:00:00 -0000

In this episode, Dr. Mark Royer, private practice otolaryngologist and medical director of ENTLocums.com, joins BackTable to discuss salary negotiation for physicians.

Dr. Royer begins by using his personal career journey to highlight the importance of negotiation skills. Then, he describes how to develop these skills. Throughout the episode, Dr. Royer emphasizes the importance of knowing one’s value as a surgical subspecialist and tailoring your strategy to best suit your employer’s perspective and your needs. Relevant topics covered include selecting a practice, starting salaries, RVUs, locums, and non-compete agreements. Dr. Royer concludes by encouraging otolaryngologists to reflect on what they truly want out of their careers as they approach the negotiation table.

---

SHOW NOTES

00:00 - Introduction

01:22 - Salary Negotiation

05:24 - Dr. Royer’s Journey from Residency to Entrepreneurship

10:16 - Negotiating Your Salary: Essential Tips and Strategies

26:27 - Different Approaches to Negotiation: Hospital vs. Private Practice

28:40 - Exploring the World of Locum Tenens

31:59 - Mid-Career Physician Negotiations and Raises

41:26 - Mastering Negotiation Tactics and Strategies: Tips from “Never Split the Difference”

47:38 - Navigating Non-Compete Clauses & Final Thoughts

---

RESOURCES

ENT Surgery Solutions, LLC:

https://www.entlocums.com/

BackTable ENT Episode 57, “Locums Opportunities in ENT with Dr. Allison Royer:”

https://www.backtable.com/shows/ent/podcasts/57/locums-opportunities-in-ent

BackTable ENT Episode 107, “How Do I Negotiate My Physician Contract? Part I with Michael Johnson Jr., Esq:”

https://www.backtable.com/shows/ent/podcasts/107/how-do-i-negotiate-my-physician-contract-part-i

BackTable ENT Episode 108, “How Do I Negotiate My Physician Contract? Part II with Michael Johnson Jr., Esq:”

https://www.backtable.com/shows/ent/podcasts/108/how-do-i-negotiate-my-physician-contract-part-ii

“Never Split the Difference” by Chris Voss:

https://www.amazon.com/Never-Split-Difference-Negotiating-Depended/dp/0062407805

Ep. 167 Reimbursement Realities in Today’s Medical Practices with Dr. Gavin Setzen

Tue, 16 Apr 2024 07:00:00 -0000

In this episode, Dr. Gavin Setzen of Albany ENT & Allergy Services addresses the current landscape of insurance reimbursement with host Dr. Ashley Agan.

The episode opens by reviewing the current state of healthcare financing, where climbing costs, declining reimbursement, and continued consolidation of medical groups confront physician-owned private practices. Mindful of this context, Dr. Setzen describes his experiences tackling reimbursement challenges. Recounting his successes, Dr. Setzen encourages physicians to base their claims in evidence-based medicine, enlist allies (such as patient unions), and develop relationships with insurers. He then provides strategies to efficiently manage Prior Authorizations, including Peer-to-Peer conversations. Finally, Dr. Setzen shares how coordinating one’s reimbursement strategy with colleagues and advocacy groups helps increase odds of success.

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CHECK OUT OUR SPONSOR

Stryker ENT

https://ent.stryker.com

---

SHOW NOTES

00:00 - Introduction

01:55 - Dr. Gavin Setzen’s Journey and Practice Insights

05:30 - The Challenges of Healthcare Landscape and Insurance

10:06 - Innovations in ENT: Navigating New Technologies & Reimbursement Challenges

20:23 - Strategies for Overcoming Insurance Denials

52:30 - The Importance of Data and Collaboration in Patient Advocacy

55:19 - Closing Thoughts

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RESOURCES

Dr. Setzen’s Albany ENT & Allergy Services Profile:

https://albanyentandallergy.com/bio/gavin-setzen/

Ep. 166 The Human Side of Surgery: Confronting Burnout Together with Dr. Herdley Paolini, Dr. Julie Wei and Dr. Anthony Sheyn

Tue, 09 Apr 2024 07:00:00 -0000

In this episode, pediatric otolaryngologist Dr. Julie Wei (Akron Children’s Hospital) and psychologist Dr. Herdley Paolini discuss surgeon burnout with guest host, pediatric otolaryngologist Dr. Anthony Sheyn (Le Bonheur Children’s Hospital).

First, Dr. Paolini reviews causes of surgeon burnout, drawing on three decades of experience working in physician wellness. Then, Dr. Sheyn and Dr. Wei discuss steps they’ve taken to combat burnout. Dr. Wei illuminates challenges unique to female surgeons, including higher levels of emotional exhaustion, fertility struggles, and ‘mom guilt.’ Then, the discussion shifts to address the roles that healthcare administration and medical education play in surgeon burnout. The podcast concludes with Dr. Wei’s experience advocating for needed changes in her hospital’s call policies.

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SHOW NOTES

00:00 - Introduction

03:18 - Operating Through Challenges: Dr. Wei’s Experience with Burnout

06:02 - Exploring Causes of Surgeon Burnout with Dr. Paolini

16:03 - Squashing the Stigma: Embracing Vulnerability in Surgery

25:37 - The Power of Advocacy and Building a Case for Wellness Programs

31:06 - Early Interventions and Transforming Medical Education

34:10 - Balancing Professional & Personal Life As A Surgeon

42:47 - Initiating System Changes for Physician Well-being

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RESOURCES

Dr. Anthony Sheyn’s Le Bonheur Children’s Hospital Profile:

https://www.lebonheur.org/doctors/anthony-sheyn

Dr. Julie Wei’s Akron Children’s Hospital Profile:

https://akronchildrens.org/people/Julie-Wei.html

About Dr. Herdley Paolini:

https://www.physicianintegration.org/about

“Safeguarding Physician Wellbeing” by Dr. Julie Wei:

https://www.routledge.com/Safeguarding-Physician-Wellbeing-Using-Checklists-for-Personal-Professional-and-Psychological-Safety/Wei/p/book/9781032589893

“Inside the Mind of a Physician: Illuminating the Mystery of How Doctors Think, What they Feel, and Why they Do the Things They Do” by Dr. Herdley Paolini:

https://www.amazon.com/Inside-Mind-Physician-Illuminating-Publishing/dp/0982040903

Ep. 165 Implementing FEES for Infants in CVICU and NICU with Olivia Brooks, SLP

Tue, 02 Apr 2024 07:00:00 -0000

In this episode, Pediatric Speech Language Pathologist (SLP) Olivia Brooks (University of Florida Shands Hospital) shares her experience performing inpatient fiberoptic endoscopic evaluation of swallowing (FEES) with host Dr. Gopi Shah.

First, Olivia reviews the presentation of swallowing disorders in infants. She explains differences between the two most common swallowing tests: videofluoroscopic swallow study (VFSS) and (FEES). Then, she reviews how she uses patient comorbidities and the physical exam to select the appropriate test for each infant. Underscoring the importance of collaboration across care teams, she describes her role performing swallow studies in the NICU and pediatric CVICU. She then shares tips on equipment, ergonomics, and teamwork while performing bedside FEES. The podcast wraps with her advice about working on an interprofessional team to care for children with swallowing disorders.

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CHECK OUT OUR SPONSOR

Karl Storz Tele Pack

https://www.karlstorz.com/

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SHOW NOTES

00:00 - Introduction

06:26 - The Importance of a Comprehensive Evaluation

13:00 - Choosing Between VFSS & FEES

22:44 - The Evolution of Inpatient Bedside FEES

31:27 - The Role of Speech Pathologists in Swallow Assessment

33:23 - Collaboration between Speech Pathologists & Otolaryngologists

35:31 - Developing Safety Protocols for Bedside FEES

41:21 - Equipment for Bedside FEES

53:20 - Differences between the NICU and the CVICU

01:00:03 - Final Thoughts and Advice Regarding Swallow Studies

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RESOURCES

KARL STORZ ENT Products:

https://www.karlstorznetwork1.com/ent

Olivia Brooks CCC-SLP’s UF Profile

https://ufhealth.org/doctors/olivia-a-brooks/bio

Ep. 164 Chronic Invasive Fungal Sinusitis: Diagnosis and Management with Dr. Ashleigh Halderman

Tue, 26 Mar 2024 07:00:00 -0000

In this episode, Dr. Ashleigh Halderman, Rhinologist and Associate Professor at the University of Texas Southwestern Medical Center, discusses chronic invasive fungal sinusitis with hosts Dr. Gopi Shah and Dr. Ashley Agan,

First, Dr. Halderman outlines her advocacy work as President of the Texas Association of Otolaryngology. Then, the discussion transitions to chronic invasive fungal sinusitis. Dr. Halderman defines the disease, describes typical patient presentation, and reviews concerning imaging findings. Until biopsy can clinch the diagnosis, she maintains a high index of suspicion in cases of bizarre clinical presentation or facial paresthesia. The surgeons then shift their attention to management, which consists of culture-directed antifungals and judicious surgical intervention. Dr. Halderman wraps up the episode by sharing her pearls for operative management and long-term surveillance.

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SHOW NOTES

00:00 - Introduction

02:10 - Exploring the Texas Association of Otolaryngology

05:58 - Understanding Chronic Invasive Fungal Sinusitis: Types & Treatments

20:25 - Diagnostic Challenges and Imaging Insights

27:07 - Navigating Diagnostic Challenges and Treatment Options

29:40 - The Role of Biopsy in Confirming Fungal Infections

30:52 - Surgical Considerations and Pre-Operative Strategies

40:29 - Surveillance Strategies: Managing Chronic Invasive Fungal Sinusitis

46:34 - The Future of Surgical & Antifungal Therapies for Chronic Invasive Fungal Sinusitis

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RESOURCES

Dr. Ashleigh Halderman’s UT Southwestern Profile:

https://utswmed.org/doctors/ashleigh-halderman/

BackTable ENT Episode 30, “Revision Endoscopic Sinus Surgery"

https://www.backtable.com/shows/ent/podcasts/30/revision-endoscopic-sinus-surgery

Texas Association of Otolarynogology:

https://www.taohns.org/

Ep. 163 Evolving Paths: Navigating Career Transitions in Medicine with Dr. Jennifer Villwock

Tue, 19 Mar 2024 07:00:00 -0000

Ep. 162 Pediatric Open Airway Surgery: It’s All About the Decision-Making with Dr. Sohit P. Kanotra

Tue, 12 Mar 2024 07:00:00 -0000

In this episode, Dr. Sohit Kanotra, director of UCLA’s Complex Pediatric Airway Program, discusses open airway surgery in children with host Dr. Gopi Shah.

First, the surgeons review the presentation of pediatric airway stenosis, which causes stridor in younger children and exercise intolerance in older ones. Drawing on his experience at UCLA, Dr. Kanotra addresses how to build a pediatric airway program, emphasizing the importance of relationships with the NICU and PICU. He advises airway surgeons to coordinate with these units to share protocols, organize conferences, and assist with bedside swallow assessments. Then, the discussion transitions to pre-operative evaluation of and contemporary strategies in pediatric airway reconstruction. Dr. Kanotra shares pearls for surgical planning, operative technique, and post-operative management. The episode concludes with Dr. Kanotra’s high-level advice to fellow pediatric airway surgeons.

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SHOW NOTES

00:00 - Introduction

03:03 - Building UCLA’s Complex Airway Program

09:37 - Decision-Making in Pediatric Open Airway Surgery

20:10 - Pediatric Airway Surgery: A Multidisciplinary Effort

32:24 - Preoperative Assessment for Open Airway Surgery

38:16 - Evaluating the Airway: Techniques & Tools

39:34 - Planning for Open Airway Surgery

40:15 - Understanding Expansion & Resection Procedures

56:58 - Using Release Maneuvers in Pediatric Open Airway Surgery

01:00:29 - Post-operative Management and Follow-up

01:06:33 - Concluding Thoughts & Pearls

---

RESOURCES

Dr. Sohit Kanotra’s UCLA Profile

https://www.uclahealth.org/providers/sohit-kanotra

Ep. 161 Idiopathic Subglottic Stenosis Evaluation and Management with Dr. Stephen Schoeff

Tue, 05 Mar 2024 08:00:00 -0000

In this episode, hosts Dr. Gopi Shah and Dr. Ashley Agan talk to Dr. Stephen Schoeff, laryngologist at Kaiser Permanente (Tacoma, WA) about subglottic stenosis in adults.

Dr. Schoeff introduces subglottic stenosis (SS) as a rare condition affecting adult women of all ages. Patients complain of progressive dyspnea, declining exercise tolerance, and mucus sensation. Sometimes confused for asthma, globus sensation, LPR, or paradoxical vocal fold motion, SS is diagnosed when airway scarring and narrowing is visible on laryngoscopy. After describing workup, Dr. Schoeff reviews etiologies of SS, including iatrogenic, idiopathic, and autoimmune. Treatment options for SS include cricotracheal resection, endoscopic dilation, and airway steroid injections. Dr. Schoeff concludes the episode by sharing his success using periodic airway steroid injections for treatment of SS.

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SHOW NOTES

00:00 - Introduction

01:21 - Dr. Schoeff’s Journey & Practice

08:28 - Symptoms & Differential Diagnosis

12:31 - Physical Examination & Diagnosis

27:23 - Introduction to Endoscopic Dilation

28:57 - Steroid Injections as a Management Option

31:24 - The Three Big Categories of Treatment

33:05 - How Steroids Address Disease Pathophysiology

38:58 - Technique for Airway Dilation

49:06 - Deciding on Cricotracheal Resection

51:14 - How Insurance Affects Treatment Options

55:05 - Final Thoughts & Pearls

Ep. 160 What I Wish I Knew My 1st Year Out in Practice with Dr. Christopher Gentile

Tue, 27 Feb 2024 08:00:00 -0000

In this episode, hosts Dr. Ashley Agan and Dr. Gopi Shah discuss the transition from residency to private practice with Dr. Christopher Gentile of Northeast Atlanta ENT.

First, Dr. Gentile briefly describes his career journey from medical school to private practice. Shedding light on the residency to private practice transition, he addresses the challenges of adapting to a new clinical environment and negotiating an employment contract. Then, he dives into the day-to-day realities of private practice. He advises young otolaryngologists to build strong connections with their clinic team, which includes practice managers, medical assistants, and fellow surgeons. By advocating for themselves, young otolaryngologists can balance their load of surgical cases and pursue areas of clinical interest. Finally, he shares tips on choosing a first job out of residency.

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/2jhXN8

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SHOW NOTES

00:00 - Introduction

01:36 - Dr. Gentile’s Journey and Current Practice

08:03 - Determining How Your Contract is Structured

12:02 - Tips for Negotiating Contracts

15:16 - Understanding Patient Scheduling & Practice Structure

20:35 - The Struggles of Balancing Work & Personal Life

24:18 - The Importance of Building a Team Around You

26:37 - Establishing Yourself in a New Practice

31:39 - The Job Hunting Experience: Lessons Learned

38:24 - Final Thoughts & Advice for New Graduates

---

RESOURCES

Dr. Gentile’s Northeast Atlanta ENT Profile:

https://northeastatlantaent.com/christopher-gentile-m-d/

Ep. 159 Eustachian Tube Dilation in the Pediatric Population with Dr. Dennis Poe

Tue, 20 Feb 2024 08:00:00 -0000

In this episode, host Dr. Ashley Agan discusses eustachian tube (ET) dilation with Dr. Dennis Poe, neurotologist and Professor of Otolaryngology at Harvard Medical School.

First, the surgeons describe clinically meaningful differences between adult and pediatric ETs. Then, Dr. Poe reviews workup of pediatric ET disorders. Since inflammation accounts for most ET dysfunction, controlling comorbid allergies and/or performing adenoidectomy provides relief to some patients. For patients with continued symptoms, balloon dilation – now approved for children as young as eight years of age– directly counteracts obstructive inflammation in the tube lumen. To conclude, Dr. Poe describes how to select patients for, perform, and avoid complications of balloon dilation.

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CHECK OUT OUR SPONSOR

Acclarent AERA Eustachian Tube Balloon Dilation System

https://www.jnjmedtech.com/en-US/product/Acclarent-aera-eustachian-tube-balloon-dilation-system

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SHOW NOTES

00:00 - Introduction

04:03 - Understanding Eustachian Tube Anatomy

07:22 - Causes of Eustachian Tube Dysfunction in Children

12:53 - Examination and Diagnosis of Eustachian Tube Dysfunction

19:10 - Treatment Options for Eustachian Tube Dysfunction

27:05 - Avoiding Unpredictable Injury and Scarring During Balloon Dilation

31:51 - Contraindications and Precautions for Balloon Dilation

37:49 - Understanding Risks & Complications of Balloon Dilation

48:34 - Closing Remarks & Future Prospects

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RESOURCES

Dr. Dennis Poe’s Harvard Profile:

https://oto.hms.harvard.edu/people/dennis-poe

BackTable ENT Ep. 40 – “Diagnosis & Management of Eustachian Tube Disorders with Dr. Dennis Poe:”

https://www.backtable.com/shows/ent/podcasts/40/diagnosis-management-of-eustachian-tube-disorders

American Academy of Otolaryngology-Head and Neck Surgery Clinical Practice Guideline: Otitis Media with Effusion (Update):

https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/ome/

“Complications of Eustachian Tube Balloon Dilation: Manufacturer and User Facility Device Experience (MAUDE) Database Analysis and Literature Review,” Chisolm, P.F. et al: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10731503/

Ep. 158 Nasal Airway Management: Evolving Practices in Diagnosis and Treatment with Dr. Nora Perkins

Tue, 13 Feb 2024 08:00:00 -0000

In this episode, Dr. Nora Perkins (Albany ENT & Allergy Services), discusses in-office procedural management of nasal airway obstruction with hosts Dr. Ashley Agan and Dr. Gopi Shah.

First, the surgeons discuss the advantages of in-office procedures. Then, Dr. Perkins describes different presentations of nasal airway obstruction and their medical management. Diving deeper, Dr. Perkins shares her procedural workflow, including anesthetic protocols, her VivAer Aerin device technique, and billing considerations. Finally, the episode concludes with Dr. Perkins’ advice to otolaryngologists interested in performing more in-office procedures.

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CHECK OUT OUR SPONSOR

Aerin Medical

https://aerinmedical.com/

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SHOW NOTES

00:00 - Introduction

02:07 - Discussion of Nasal Airway Obstruction

08:21 - The Patient with Nasal Airway Obstruction

15:29 - Medical Management of Nasal Airway Obstruction

26:17 - The Aerin VivAer RF Ablation Device

32:12 - Anatomical Considerations and Treatment Options

35:10 - Anesthetic Protocol & Patient Comfort

47:56 - Long-term Outcomes and Quality of Life

49:42 - Billing and Insurance Considerations

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RESOURCES

Dr. Nora Perkins’ Albany ENT & Allergy Services Profile:

https://albanyentandallergy.com/bio/nora-w-perkins/

Aerin VivAer Website:

https://vivaer.com/

Ep. 157 Working Together: Language Development in Deaf and Hard of Hearing Children with Dr. Anita Jeyakumar

Tue, 06 Feb 2024 08:00:00 -0000

In this episode, Dr. Anita Jeyakumar, pediatric ENT at Mercy Health (Youngstown, Ohio) discusses language for Deaf and Hard of Hearing (HoH) children with podcast host Dr. Gopi Shah.

First, Dr. Jeyakumar explains the difference between speech and language. She then introduces the concept of “language nutrition,” which describes social exposure to rich and varied language. Acknowledging that language fluency–spoken or visual such as American Sign Language–underlies success, she shares strategies to foster these skills in Deaf and HoH children. Dr. Jeyakumar describes resources that support these patients, including early intervention services for children under age three and school-based resources for older children. She reviews assistive technologies including hearing aids, cochlear implants, and closed captioning. To conclude, she urges physician advocacy to better support the needs of Deaf and HoH children.

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SHOW NOTES

00:00 - Introduction

02:08 - Understanding Language and Speech

04:23 - The Concept of Language Nutrition

07:53 - Addressing Speech Delay in Children

21:32 - The Role of Technology in Supporting Deaf and HoH Children

24:10 - Promoting Health Equity for Deaf and HoH Children

27:52 - Resources for Families of Deaf and HoH Children

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RESOURCES

Dr. Anita Jeyakumar’s Mercy Health Profile:

https://www.mercy.com/find-a-doctor/physicians/anita-s-jeyakumar/1985497

Hands & Voices Guide By Your Side™:

https://www.handsandvoices.org/gbys/

American Speech-Language-Hearing Association (ASHA):

https://www.asha.org/

American Cochlear Implant Alliance (ACI Alliance):

https://www.acialliance.org/

A.G. Bell Association for the Deaf & Hard of Hearing:

https://www.agbell.org/

Ep. 156 RefluxRaft: A New Option Beyond Conventional Therapy with Dr. Spencer Payne

Tue, 30 Jan 2024 08:00:00 -0000

In this episode, Dr. Spencer Payne, a rhinologist at the University of Virginia School of Medicine, shares his journey developing RefluxRaft, a natural, alginate-based reflux therapy, with host Dr. Ashley Agan.

First, Dr. Payne describes how his research interests and father’s premature death spurred his interest in functional medicine. Wary of side effects associated with conventional reflux medications, he teamed up with fellow UVA faculty member and laryngologist Dr. James (Jim) Daniero to develop RefluxRaft, a natural dietary supplement. Starting from his initial concept, Dr. Payne delves into challenges marketing, manufacturing, and distributing RefluxRaft. He then explains how RefluxRaft uses alginates to combine with stomach acid and form a gel-like “raft” that stops movement of acid into the esophagus. The episode concludes with an overview of how to dose and order RefluxRaft.

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SHOW NOTES

00:00 - Introduction

03:45 - Holistic Approaches to Medicine

06:46 - Functional Medicine Perspective on Reflux

08:54 - Dietary Modifications for Reflux Patients

17:07 - The Development of RefluxRaft

20:00 - From Concept to Prototype: The Kitchen Lab Experiments

20:57 - The Business Side: Marketing, Manufacturing, & Logistics

27:21 - The Product: Understanding Alginates & Their Benefits

36:29 - The Future: New Flavors & Holistic Reflux Therapies

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RESOURCES

Dr. Payne’s UVA Profile

https://med.virginia.edu/otolaryngology/faculty/spencer-c-payne-m-d/

Dr. Daniero’s UVA Profile:

https://med.virginia.edu/otolaryngology/faculty/james-j-daniero-m-d-m-s/

RefluxRaft: Natural Reflux Relief:

https://refluxraft.com/

RefluxRaft YouTube Channel:

https://www.youtube.com/@refluxraft

Ep. 155 The Third-Party-Free Model: Redefining Patient Care with Dr. Gerard Gianoli

Tue, 23 Jan 2024 08:00:00 -0000

In this episode, Dr. Gerard Gianoli of The Ear & Balance Institute (Covington, Louisiana), joins host Dr. Ashley Agan to discuss his experience with the third-party-free practice model.

First, Dr. Gianoli describes how his work treating vestibular disorders spurred his interest in the third-party-free practice model, where patients pay upfront for services, then submit insurance claims for reimbursement as appropriate. Dr. Gianoli walks listeners through his practice’s transition, focusing on referral patterns and patient concerns. Then, the surgeons speak to the model’s advantages, including reduced rates of physician burnout, higher-value patient care, and reduced administrative burden. Looking ahead, Dr. Gianoli assesses the role of third-party-free practices in the U.S. healthcare landscape. Finally, the episode wraps with a discussion of Dr. Gianoli’s recent book on Third Mobile Window Syndrome.

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SHOW NOTES

00:00 - Introduction

05:34 - Transitioning to a Third-Party-Free Practice

07:48 - The Financial Impact of Going Third-Party-Free

12:11 - Benefits of a Third-Party-Free Practice

27:28 - Navigating Surgery Costs in a Third-Party-Free Practice

32:01 - Determining Prices in a Cash-Based Practice

35:10 - The Importance of Patient Education in Medical Practice

38:15 - Drawbacks of the Third-Party-Free Model

52:32 - Trends in Physician Practice Models

56:38 - Dr. Gianoli’s Book on Third Mobile Window Syndrome

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RESOURCES

Dr. Gianoli’s physician profile at the Ear & Balance Institute:

https://earandbalance.net/dr-gianoli/

Dr. Gianoli’s Wall Street Journal Editorial from January 2015: “Saying Goodbye to Third-Party Medical Payments.”

https://www.wsj.com/articles/gerard-j-gianoli-saying-goodbye-to-third-party-medical-payments-1421280968

“Third Mobile Window Syndrome of the Ear: Superior Semicircular Canal Dehiscence and Associated Disorders,” edited by Gerard Gianoli and Philippa Thomson:

https://link.springer.com/book/10.1007/978-3-031-16586-3

“The Private Practice Solution: Reclaiming Physician Autonomy and Restoring the Doctor-Patient Relationship,” by Grace Torres-Hodges:

https://www.amazon.com/Private-Practice-Solution-Doctor-Patient-Relationship/dp/B0CK3QR1XX

Ep. 154 Labyrinthitis Unpacked: Clinical Perspectives and Management with Dr. Sujana Chandrasekhar

Tue, 16 Jan 2024 08:00:00 -0000

In this episode, Dr. Sujana Chandrasekhar, neurotologist with New York City’s ENT and Allergy Associates, joins host Dr. Ashley Agan to discuss labyrinthitis.

The podcast begins by reviewing the clinical presentation of labyrinthitis, drawing on Dr. Agan’s personal experience with the condition. Then, Dr. Chandrasekhar explains in-depth the physical exam of the dizzy patient, focusing on differentiating central vestibular lesions (such as strokes) from peripheral ones (such as labyrinthitis). While labyrinthitis is a self-limited condition, Dr. Chandrasekhar shares strategies to mitigate the associated nausea, imbalance, and hearing loss patients find debilitating. Finally, the surgeons discuss how vestibular physical therapy and adequate rest enable prompt recovery.

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SHOW NOTES

00:00 - Introduction

01:22 - Discussion of and Personal Experience with Labyrinthitis

08:14 - Recovery and Treatment of Labyrinthitis

11:01 - Examination and Workup of Labyrinthitis

16:11 - Understanding Nystagmus in Labyrinthitis

20:29 - Further Testing and Examination for Labyrinthitis

33:49 - Treatment for Labyrinthitis

40:53 - The Role of Physical Therapy

43:12 - Follow-up and Recovery

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RESOURCES

Dr. Chandrasekhar’s ENT and Allergy Associates Profile: https://www.entandallergy.com/find-a-doctor/sujana-s-chandrasekhar-md-facs/

Backtable ENT Ep. 87 – “Sudden Sensorineural Hearing Loss with Dr. Sujana Chandrasekhar:” https://www.backtable.com/shows/ent/podcasts/87/sudden-sensorineural-hearing-loss

“The Ten-Minute Examination of the Dizzy Patient,” J.A. Goebel: https://pubmed.ncbi.nlm.nih.gov/11774054/

“She’s On Call” Podcast featuring Dr. Sujana Chandrasekhar and Dr. Maurina Kurian: https://podcasts.apple.com/us/podcast/shes-on-call-weekly-medical-show/id1582727930

“Otolaryngologic Clinics” Podcast hosted by Consulting Editor Sujana S. Chandrasekhar, features in-depth discussions and commentary on the articles in each issue by the guest editors themselves.

Otolaryngologic Clinics (Elsevier) on Apple Podcasts

Ep. 153 Ultrasound Applications in Pediatric ENT with Dr. Elton Lambert

Tue, 09 Jan 2024 08:00:00 -0000

In this episode, Dr. Gopi Shah, welcomes Dr. Elton Lambert, a pediatric otolaryngologist at Texas Children’s Hospital in Houston, to discuss the use of ultrasound in pediatric otolaryngology.

First, the surgeons delve into why ultrasound offers a precise and convenient method for diagnosing pathologies ranging from parotitis to vocal fold immobility in children. Dr. Lambert describes treating sialorrhea with ultrasound-guided Botox injections. From this point, the discussion transitions to the use of ultrasound for voice and airway issues. Use of ultrasound provides additional detail to complement (or occasionally replace) flexible scope exams in children with vocal cord immobility. The discussion finishes with Dr. Lambert’s pearls to successfully obtain and document ultrasound results.

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SHOW NOTES

00:00 - Introduction

02:10 - Understanding Ultrasound in Pediatric Otolaryngology

05:35 - Training and Incorporation of Ultrasound in Medical Curriculum

08:43 - Ultrasound for Salivary Pathology in Children

14:04 - Salivary Botox Injections

25:34 - Ultrasound for Voice and Airway in Children

29:59 - Vocal Cord Immobility Post Cardiac Surgery

30:23 - Ultrasound for Vocal Cord Mobility

30:45 - Detecting Nodules and Granulomas with Ultrasound

32:38 - Ultrasound for Laryngomalacia

34:52 - Ultrasound for Subglottic Stenosis

41:55 - Ultrasound for Tracheostomy Patients

45:43 - Ultrasound for Dysphagia

50:38 - Documenting Ultrasound Findings

53:37 - Limitations of Ultrasound

56:21 - Final Thoughts on Ultrasound in Pediatric Otolaryngology

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RESOURCES

Dr. Lambert’s Texas Children’s Hospital Profile:

https://www.texaschildrens.org/find-a-doctor/elton-m-lambert-md

Dr. Lambert’s Contact:

emashela@texaschildrens.org

Ep. 152 Understanding Health Equity Research with Kevin Sykes, PhD, MPH

Tue, 02 Jan 2024 06:00:00 -0000

In this episode, Dr. Kevin Sykes, PhD, MPH, director of clinical research at Baylor Scott & White Health in Dallas, explores health equity research in otolaryngology with host Dr. Gopi Shah.

First, Dr. Sykes underscores how historical injustices contribute to health disparities seen today, using differences in life expectancy as an example. He then addresses challenges with assessing head & neck cancer outcomes, including small sample sizes, limited community participation, and data aggregation. Speaking to study design, Dr. Sykes shares his experience working with community health workers, whom he finds invaluable for their ability to build relationships with research participants. Finally, Dr. Shah and Dr. Sykes brainstorm how health equity research can shape public health policies and medical education.

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SHOW NOTES

00:00 – Introduction

01:29 – Understanding Health Equity Research

09:44 – The Role of Social Determinants in Health Equity

12:00 – The Importance of Community Representation in Research

14:34 – Challenges in Health Equity Research

17:32 – The Role of Community Health Workers in Research

26:00 – Designing a Health Equity Research Study

30:48 – The Role of Qualitative Data in Health Equity Research

32:39 – Understanding Racial Differences in Treatment Choices

33:30 – The Power of Qualitative Data in Uncovering Lived Experiences

35:32 – The Rigor and Challenges of Qualitative Research

42:35 – The Impact of Health Equity Research on Policy and Advocacy

48:33 – The Role of Medical Education in Health Equity Research

56:54 – Resources and Recommendations for Health Equity ResearcH

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RESOURCES

Backtable ENT Episode 98, “Health Equity Collaborative in ENT with Dr. Alexander Chiu and Dr. Romaine Johnson:” https://www.backtable.com/shows/ent/podcasts/98/health-equity-collaborative-in-ent

Backtable ENT Episode 31, “Mentorship Feedback & Coaching with Dr. Carrie Francis:” https://www.backtable.com/shows/ent/podcasts/31/mentorship-feedback-coaching

Backtable ENT Episode 129, “American Head and Neck Society Scholarship for Underrepresented Minority Medical Students with Dr. Tammara Watts:” https://www.backtable.com/shows/ent/podcasts/129/american-head-neck-society-scholarship-for-underrepresented-minority-medical-students

Ep. 151 Navigating Synkinesis: From Diagnosis to Comprehensive Care with Dr. Shiayin Yang

Tue, 26 Dec 2023 06:00:00 -0000

In this episode, host Dr. Ashley Agan discusses management of synkinesis with Dr. Shiayin (Shi) Yang, facial plastic surgeon at Vanderbilt University Medical Center.

The surgeons begin by defining synkinesis, a condition in which voluntary facial muscle movement triggers involuntary contraction of other facial muscles. Though the pathophysiology of synkinesis remains incompletely understood, damage to and aberrant “rewiring” of the facial nerve is thought to trigger these symptoms. Causes of synkinesis include Bell’s Palsy, facial tumors, and intra-operative injury. Dr. Yang explains the importance of appropriate patient counseling, especially given the misperception that synkinesis is a “disease of vanity.” The discussion then transitions to treatment options, including physical therapy, Botox injections, and surgical intervention (including myectomy and selective neurectomy). The podcast finishes with Dr. Yang’s insights into the mental health impact of synkinesis.

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SHOW NOTES

00:00 – Introduction

02:26 – Understanding Synkinesis

05:08 – Common Patient Presentations

06:11 – Importance of Early Treatment and Patient Education

07:48 – Referral and Timeliness of Treatment

09:35 – Pathophysiology of Nerve Rewiring

12:11 – Workup and Diagnosis

17:57 – Treatment Options: Botox Therapy

25:51 – Treatment Options: Surgical Interventions

30:31 – Long-term Management and Expectations

33:27 – Eye Protection in Facial Paralysis

37:16 – Mental Health Impact of Synkinesis

38:27 – Conclusion and Contact Information

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RESOURCES

Dr. Yang’s Vanderbilt University Medical Center profile:

https://search.vanderbilthealth.com/doctors/yang-shiayin

Ep. 150 ENT and Gender Diversity: Breaking Down Barriers in Patient Care with Dr. Daniel Knott and Dr. Rahul Seth

Thu, 21 Dec 2023 06:00:00 -0000

In this episode, Dr. Gopi Shah discusses the role of ENT in gender-affirming care with facial plastic surgeons Dr. Daniel Knott of UCSF and Dr. Rahul Seth of Golden State Plastic Surgery. This episode is the second half of a two-part series featuring Drs. Knott and Seth.

First, the surgeons emphasize the importance of understanding terms related to gender identity and using patients’ correct pronouns. Relative to the general population, transgender individuals face higher rates of poverty, unemployment, and serious mental illness, all of which shape their interaction with the healthcare system. Then, using California as a case study, doctors Knott and Seth discuss strategies that successfully increase access to gender-affirming care. The episode finishes by addressing how insurance coverage, clinical research, education and advocacy shape gender-affirming care.

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SHOW NOTES

00:00 - Introduction to the Podcast

01:23 - Understanding Transgender and Gender Diverse Individuals

03:06 - Challenges Faced by Transgender and Gender Diverse Individuals

08:55 - The Role of Otolaryngologists in Gender Affirming Care

17:02 - The Impact of Insurance and State Laws on Access to Care

28:40 - The Importance of Education and Advocacy in Gender Affirming Care

40:21 - Closing Thoughts and Final Remarks

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RESOURCES

Dr. Knott's and Dr. Seth’s Facial Plastic Clinic:

https://ohns.ucsf.edu/facialplastics

Backtable ENT Ep. 148 – “Facial Masculinization in Gender Affirming Care with Dr. P Daniel Knott and Dr. Rahul Seth:”

https://www.backtable.com/shows/ent/podcasts/148/facial-masculinization-in-gender-affirming-care

Backtable ENT Ep. 125 - “Gender Affirming Voice Care with Sara Schneider MS, CCC-SLP and Dr. Mark Courey:”

https://www.backtable.com/shows/ent/podcasts/125/gender-affirming-voice-care

Backtable ENT Ep. 27 – “Facial Feminization with Dr. Sarah Saxon:”

https://www.backtable.com/shows/ent/podcasts/27/facial-feminization

Operative Techniques in Otolaryngology chapter covering facial masculinization surgery:

https://www.optecoto.com/article/S1043-1810(23)00011-8/fulltext

ENTtoday: “Gender Affirmation Surgery in California,” Suresh Mohan, MD, Rahul Seth, MD, and Daniel Knott, MD:

https://www.enttoday.org/article/gender-affirmation-surgery-in-california/

ENTtoday: “Transgender Care: Otolaryngologists Can Help Fill an Unmet Need for This Patient Population,” P. Daniel Knott, MD and Rahul Seth, MD

https://www.enttoday.org/article/transgender-care-otolaryngologists-can-help-fill-an-unmet-need-for-this-patient-population/

Otolaryngologic Clinics of America August 2022 issue – “Gender Affirmation Surgery in Otolaryngology:” https://www.oto.theclinics.com/issue/S0030-6665(22)X0004-2

“National Variation of Insurance Coverage for Gender-Affirming Facial Feminization Surgery,” S. Gadkaree et al.:

https://pubmed.ncbi.nlm.nih.gov/32865436/

Ep. 149 Innovating Recognition in Healthcare with nDorse with Dr. Rohan Walvekar

Tue, 19 Dec 2023 06:00:00 -0000

In this episode of Back Table ENT, host Dr. Gopi Shah explores the entrepreneurial journey of Dr. Rohan Walvekar, an otolaryngologist at Louisiana State University-New Orleans and innovator/CEO of nDorse, a team engagement software application.

Dr. Walvekar shares his experience in launching ‘nDorse’ — his novel team engagement software designed for healthcare providers. This idea was sparked from his realization that daily contributions and positivity within the healthcare space could be better recognized with real time feedback. He noticed that hospital nursing turnover was high, which could have been attributed to insufficient engagement and connection with coworkers.

The nDorse software application can be used by anyone in an organization and allows users to post meaningful recognitions (via messages, emojis, pictures, GIFs) for their coworkers, with the ability to tag recognitions to the organization’s specific mission and values. Since its implementation, nDorse has been adopted even in various educational and financial institutional settings. Dr. Walvekar describes his journey to creating the application, including the software building process, initial sales, mentors, and the nDorse team. He also offers advice for physician entrepreneurs about being thoughtful with innovation and resilience in the startup sphere.

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SHOW NOTES

00:00 Introduction to the Podcast

02:46 A Focus on Real Time Recognition for Coworkers

04:48 Introduction to nDorse: A Team Engagement Software

13:06 Market Research and a Minimum Viable Product

20:16 Product Launch and First Customers

23:04 Financing the Project

26:03 Pitching to New Clients

29:00 Team Members and Mentors

31:44 Balancing Innovation with Clinical Practice

36:20 Challenges During the Entrepreneurship Journey

---

RESOURCES

nDorse:

https://www.ndorse.net/

BackTable ENT Ep. 115- Management of the Plunging Ranula:

https://www.backtable.com/shows/ent/podcasts/115/management-of-the-plunging-ranula

Healthcare Plus Solutions Group:

https://healthcareplussg.com/

Ep. 148 Facial Masculinization in Gender Affirming Care with Dr. P. Daniel Knott and Dr. Rahul Seth

Thu, 14 Dec 2023 06:00:00 -0000

In this episode, Dr. Gopi Shah discusses facial masculinization surgery with facial plastic surgeons Dr. P. Daniel Knott of UCSF and Dr. Rahul Seth of Golden State Plastic Surgery.

First, the surgeons begin by defining gender terminology, facial analysis, and surgical planning as they relate to gender-affirming care. Narrowing in on facial masculinization, they address common surgical procedures including augmentation rhinoplasty, buccal fat removal, reverse brow lifts, chin implants, and thyroid cartilage augmentation. Then, Dr. Knott and Dr. Seth describe the challenge of maintaining a natural appearance while enlarging facial features. In many cases, non-operative adjuncts, such as fillers and Botox, assist in this goal. Finally, Dr. Knott emphasizes the importance of management of the hair in gender-affirming care.

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SHOW NOTES

00:00 - Introduction

05:43 - Importance of Gender Terminology

13:00 - Facial Analysis in Gender Affirming Care

21:45 - Approach to Facial Masculinization

24:11 - Impact of Hormone Therapy

32:56 - Role of Technology in Gender Affirming Care

35:22 - Using Fillers and Botox in Facial Plastic Surgery

36:28 - The Importance of Intentionality in Achieving Patient Goals

37:39 - Exploring Surgical Options for Facial Modification

39:15 - Understanding the Process of Brow Projection Surgery

45:10 - The Process and Challenges of Rhinoplasty

51:31 - The Process and Challenges of Mandible Augmentation

59:20 - The Process and Challenges of Thyroid Cartilage Augmentation

---

RESOURCES

Dr. Rahul Seth’s Golden State Plastic Surgery profile:

https://www.goldenstatedermatology.com/staff/rahul-seth-md-facs/

Dr. Daniel Knott’s UCSF profile:

https://www.ucsfhealth.org/providers/dr-p-daniel-knott

Operative Techniques in Otolaryngology chapter covering facial masculinization surgery:

https://www.optecoto.com/article/S1043-1810(23)00011-8/fulltext

Article on three-dimensional morphology to assess gender differences in facial appearance: https://pubmed.ncbi.nlm.nih.gov/35357226/

ENTtoday: “Transgender Care: Otolaryngologists Can Help Fill an Unmet Need for this Patient Population,” Daniel Knott, MD, and Rahul Seth, MD: https://www.enttoday.org/article/transgender-care-otolaryngologists-can-help-fill-an-unmet-need-for-this-patient-population/

ENTtoday: “Gender Affirmation Surgery in California,” Suresh Mohan, MD, Rahul Seth, MD, and Daniel Knott, MD:

https://www.enttoday.org/article/gender-affirmation-surgery-in-california/

Otolaryngologic Clinics of America August 2022 issue – “Gender Affirmation Surgery in Otolaryngology”:

https://www.oto.theclinics.com/issue/S0030-6665(22)X0004-2

Ep. 147 Latest Innovations in Rhinitis Treatment: A Comprehensive Guide with Dr. Omar Ahmed

Tue, 12 Dec 2023 06:00:00 -0000

In this episode, Dr. Gopi Shah and Dr. Ashley Agan invite Dr. Omar Ahmed, rhinologist at Houston Methodist Hospital, to discuss innovative treatments for chronic rhinitis.

First, Dr. Ahmed shares his experience with treating chronic rhinitis using medications, in-office procedures, and surgery. Patients who fail to respond to medication find rhinitis relief up to 95% of the time following posterior nasal nerve ablation. He explains the difference between radiofrequency ablation (RhinAer and Neurent) and cryoablation (ClariFix). Then, Dr. Ahmed explains relevant anatomy, patient counseling, and potential adverse effects of ablation. Finally, he touches on recent developments in billing for these treatments.

---

CHECK OUT OUR SPONSOR

Aerin Medical

https://aerinmedical.com/

---

SHOW NOTES

00:00 - Introduction

04:11 - Discussion on Chronic Rhinitis and Office-Based Procedures

07:03 - Understanding Rhinitis Patients and Their Symptoms

09:27 - Examination, Workup, and Treatment for Rhinitis Patients

24:03 - Surgical Treatments for Rhinitis

29:44 - Overview of In-Office Procedures for Rhinitis

36:50 - The Impact of Anatomical Challenges on the Procedure

43:20 - Post-Procedure Instructions and Potential Complications

52:29 - Understanding the New Billing and CPT Approval

---

RESOURCES

RhinAer Chronic Rhinitis Treatment

https://rhinaer.com/hcp/

Dr. Ahmed’s Houston Methodist Profile:

https://www.houstonmethodist.org/doctor/omar-g-ahmed/

Ep. 146 In-Office Laryngology Procedures: A Deep Dive with Dr. Lesley Childs

Tue, 05 Dec 2023 06:00:00 -0000

In this episode, Dr. Ashley Agan and Dr. Gopi Shah cover in-office laryngology procedures with Dr. Lesley Childs, Associate Professor of Laryngology, Neuro-Laryngology, and Professional Voice at the University of Texas Southwestern Medical Center.

The surgeons cover laryngologic diseases commonly treated in the clinic. Dr. Childs describes procedures she performs, including video stroboscopy for mucosal wave assessment, steroid injections for subglottic stenosis, and Botox injections for neurologic voice disorders. She also speaks to the benefits of treating patients in-office, anesthesia for in-office procedures, and the role her medical assistants play during various in-office procedures.

---

EARN CME

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---

SHOW NOTES

00:00 Introduction

02:58 In-Office Laryngology Procedures Overview

03:49 Understanding Video Stroboscopy

05:27 Preparing for In-Office Procedures

08:09 Procedure Techniques and Patient Positioning

13:40 Anesthetic Protocol for Different Procedures

15:11 Handling Patient Reactions and Complications

26:11 Botox Injections and Anesthetic Considerations

29:08 Understanding False Vocal Folds and Abraham Cannula

35:01 Understanding the Process of Vocal Fold Botox Injections

36:06 The Risks and Challenges of Vocal Fold Injections

40:41 The Process of Vocal Fold Augmentation

52:33 The Use of Lasers in Vocal Fold Procedures

53:40 The Evolution of Vocal Fold Procedures Over Time

Ep. 145 Understanding Drug Repurposing in Head and Neck Cancer: An Interview with Dr. Nicole Schmitt

Thu, 30 Nov 2023 06:00:00 -0000

In this podcast, Dr. Gopi Shah invites Dr. Nicole Schmitt, an associate professor in the Department of Otolaryngology at Emory University to discuss drug repurposing for head and neck cancer.

Dr. Schmitt explains that drug repurposing involves using a drug developed for one purpose for an entirely different purpose. She highlights some of the main drugs being repurposed for head and neck cancer treatment, including statins and NSAIDs. For example, Dr. Schmitt shares how manipulating cholesterol levels can enhance antineoplastic T lymphocyte responses to increase survival and treatment tolerability. The surgeons then consider the therapeutic, safety, and financial benefits of repurposed drugs. Special attention is given to drug repurposing in HPV-positive cancer. Lastly, Dr. Schmitt describes the pleiotropic effect and how it applies to drug repurposing efforts.

---

EARN CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/EgX3zL

---

SHOW NOTES

0:00 - Drug Repurposing and Cancer Treatment

08:40 - Statins and NSAIDs for Head and Neck Cancer

12:18 - Enhancing Tumor Control With Pre-Surgery Drugs

22:14 - Treatment of Pre-Malignant Lesions With Repurposed Drugs

Ep. 144 Managing the Difficult Airway Through Innovation: The Adroit Surgical Story with Dr. Nilesh Vasan

Tue, 28 Nov 2023 06:00:00 -0000

In this episode, Dr. Eric Gantwerker and Dr. Nilesh Vasan, Founder/CEO of Adroit Surgical and Head & Neck Surgeon at University of Oklahoma (OU Health), discuss the development of Adroit Surgical.

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---

SHOW NOTES

First, Dr. Vasan describes his surgical training and lifelong passion for invention. Originally from New Zealand, Dr. Vasan completed a head & neck fellowship at OU Health. His surgical experience includes private and academic practice. During his time in private practice, Dr. Vasan worked on interdisciplinary teams to manage difficult airways. He credits this experience with sparking his interest in developing better tools for intubation.

Next, Dr. Gantwerker and Dr. Vasan review the development of Adroit Surgical’s first product, the Vie-Scope. The battery-powered Vie-Scope combines superior visualization with portability to facilitate intubation across settings. Hoping to improve visualization during hand-held laryngoscopy, Dr. Vasan sketched a modified anterior commissure laryngoscope that would become the Vie-Scope. He then worked with an experienced patent attorney who helped him develop and notarize his innovation.

Then, the surgeons cover advice to building networks. A pitch competition in Oklahoma City connected Dr. Vasan with associates whose complementary expertise helped grow Adroit Surgical. Dr. Vasan then worked alongside a well-connected distributor who raised awareness of the Vie-Scope in his target markets. Today, the Vie-Scope enables successful first-pass intubation in emergent and operating room settings.

---

RESOURCES

Adroit Surgical:

https://adroitsurgical.com/

“Crossing the Chasm” by Geoffrey Moore

https://www.amazon.com/Crossing-Chasm-3rd-Disruptive-Mainstream/dp/0062292986

“Creativity, Inc: Overcoming the Unseen Forces that Stand in the Way of True Innovation” Ed Catmull & Amy Wallace

https://www.amazon.com/Creativity-Inc-Overcoming-Unseen-Inspiration/dp/0812993012

Ep. 143 The Future of Otolaryngology: A Collaborative Approach with Dr. Gene Brown

Tue, 21 Nov 2023 06:00:00 -0000

Ep. 142 Evaluation and Management of Chronic Frontal Sinusitis in Sweden with Dr. Jens Andersson

Tue, 14 Nov 2023 06:00:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Jens Andersson, practicing ENT at Sweden’s Skåne University Hospital, tackle chronic frontal sinusitis.

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SHOW NOTES

First, Dr. Andersson talks about the Swedish healthcare systems, focusing on access to care and cost. The discussion then shifts to chronic frontal sinusitis. Symptoms associated with this disease include frontal headache, stuffiness, congestion, and low-grade fever. In cases of orbital involvement, patients may complain of proptosis or diplopia. Risk factors include frontal sinus fracture, barotrauma, an immunocompromised state, and dental infection. Most, but not all, patients have involvement of multiple sinuses.

Next, Dr. Andersson illuminates workup and treatment of chronic frontal sinusitis. His physical exam includes close inspection of the oral cavity, anterior rhinoscopy (performed with a microscope), and flexible fiberoptic laryngoscopy. When ordering imaging, he prefers cone-beam CT of the sinuses, though he orders MRI when bony invasion or extra-sinus disease are present.

Finally, the surgeons discuss operative management of chronic frontal sinusitis. Dr. Andersson talks listeners through his pre-operative planning, focusing on how he uses imaging. Moving to the OR, the surgeons share their techniques for operating on the frontal sinus. Dr. Andersson reviews strategies to avoid scarring, use of navigation systems, and post-operative management. Dr. Shah shares pearls from her pediatric sinus practice. The episode finishes with Dr. Andersson’s witty and high-yield advice for otolaryngologists.

Ep. 141 Stridor in Newborns: Evaluation and Management with Dr. Briac Thierry

Tue, 07 Nov 2023 06:05:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Briac Thierry, Pediatric ENT at Necker Hospital for Sick Children in Paris, France, review stridor in newborns, with a special emphasis on laryngomalacia.

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SHOW NOTES

First, Briac and Gopi discuss how a newborn with stridor can present. Though stridor does occur among NICU babies, most of Briac’s patients are referred by outpatient pediatricians. They discuss a list of questions to ask while taking a history and emphasize the importance of assessing growth trends. In the absence of other medical problems, declining weight can suggest severe aerodigestive tract abnormality. Any pathology that narrows the airway can cause stridor: in infants, these include laryngomalacia, vallecular cysts, subglottic cysts, tracheal rings, and bilateral vocal fold immobility.

Then, Briac talks listeners through his physical exam, with special attention paid to flexible fiberoptic laryngoscopy. Briac shares his tips to maximize visualization and clinician ergonomics when scoping a small child. If bilateral vocal fold immobility is suspected, Briac recommends performing a longer fiberoptic exam so that the clinician can determine whether vocal fold immobility is present at rest or due to an uncomfortable child crying.

Next, Gopi and Briac differentiate between mild, moderate, and severe laryngomalacia and the indications for going to the operating room for an airway evaluation. As 20% of children with laryngomalacia have secondary airway lesions, a meticulous laryngoscopy/bronchoscopy is mandatory in these patients when a trip to the OR is required. Moving to the OR, Briac talks about his workflow when performing diagnostic bronchoscopy/laryngoscopy (DLB) to assess various causes of stridor. The episode concludes with Briac’s meditations on airway surgery as a team endeavor.

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RESOURCES

Briac’s Necker Hospital Profile:

https://www.aphp.fr/offre-de-soin/medecin/3168653/061/16

International Pediatric ORL Group (IPOG) Laryngomalacia Consensus Recommendations:

https://www.sciencedirect.com/science/article/abs/pii/S0165587616300519

Pediatric Airway Channel in Paris (@voies_aeriennes):

https://www.youtube.com/@voies_aeriennes

Ep. 140 Unpacking DEI: Advancing Patient Care in Otolaryngology with Dr. Erynne Faucett

Thu, 02 Nov 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah sits down with pediatric Otolaryngologist, Dr. Erynne Faucett at the University California Davis-Sacramento to discuss diversity, equity, and inclusion (DEI) in the field in Otolaryngology and its importance.

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SHOW NOTES

The episode begins with Erynne breaking down what DEI means to her. She mentions how there is a misconception in grouping diversity, equity, and inclusion all together but instead needing to look at each element individually for what they mean, instead of just “checking off a check box.” Connecting to this, Erynne brings up the importance of DEI efforts in the field of Otolaryngology as it reflects the importance of patient care, in a population that is constantly evolving in diversity, and it emphasizes the role of diversifying the field to match the patient population.

Focusing on DEI efforts, at UCSD-Sacramento where Erynne practices, she mentions the DEI efforts that her department has made in recruiting diverse residents and attendings. She emphasizes to continue to push the narrative for why it is important within the field and further, how it impacts patient care.

Erynne then delves into DEI initiatives within the Otolaryngology workforce from her perspective of being a part of the Academy of Otolaryngology DEI committee and mentions her work in building curriculum teaching DEI for residents and the challenges that comes with it.

Gopi and Erynne then end the episode talking about efforts in delivering equitable care, health equity research and recent legislative actions in certain areas of the U.S that have restricted DEI efforts. Erynne emphasizes that even in areas across the country with bans against DEI initiatives, it is still important to speak up about these issues, to continue to teach and educate policy makers to see the impact of these bans on marginalized communities and that DEI efforts aren’t political but instead a human rights initiative.

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RESOURCES

American Academy of Otolaryngology Advocacy:

https://www.entnet.org/advocacy/

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The BackTable ENT Podcast is a resource for otolaryngologists to learn tips, techniques, and practical advice on all things ear, nose, and throat. Tune in to the BackTable ENT Podcast every week for candid conversations about rhinology, laryngology, otology, and head and neck surgery.

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Ep. 139 Radiofrequency Ablation: Modern Management of Thyroid Nodules with Dr. David Goldenberg

Tue, 31 Oct 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. David Goldenberg, head and neck surgeon and department chair at PennState Health in Pennsylvania, discuss radiofrequency ablation (RFA) of thyroid nodules.

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SHOW NOTES

First, Gopi and David review workup of thyroid nodules. Before considering RFA, patients need thyroid function tests, ultrasound imaging, and a biopsy showing benign disease. In David’s opinion, radiofrequency ablation is a good option for benign nodules larger than two centimeters that are enlarging and causing compressive symptoms. RFA is not appropriate for malignant disease, with the potential application for papillary microcarcinoma, which is currently being evaluated in other parts of the world.

Next, David outlines how he performs RFA. Using a combination of mild sedation, local anesthesia, and regional anesthesia, he performs this procedure in-office under continuous ultrasound guidance. Radiofrequency ablation uses heat to cause coagulative necrosis of nodular tissue. After cervical block and anesthetization of the thyroid capsule, David introduces the RFA probe through a small midline neck incision. Drawing on the “moving shock technique,” he moves the RFA probe back and forth, watching for signs of tissue necrosis on ultrasound. Complications of RFA are similar to those of thyroid surgery, but they occur at lower rates due to the less invasive nature of this procedure.

Finally, the conversation places RFA in a larger context for the thyroid surgeon. RFA patients return to the clinic that same week for a physical exam. Surveillance ultrasounds occur six and twelve months post-procedure. David counsels his patients that their nodule will not shrink immediately, and may swell in the days following their procedure. However, he expects the nodule to shrink 50-80% in the year following RFA. The podcast wraps up with an overview of how to bring RFA to your practice.

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RESOURCES

David’s Penn State Profile:

https://www.pennstatehealth.org/doctors/david-goldenberg-md-facs

Ep. 138 Crafting Clinical Care Pathways in Pediatric ENT with Dr. Anthony Sheyn and Dr. Jennifer Lavin

Thu, 26 Oct 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah sits down with Dr. Anthony Sheyn, associate professor of otolaryngology at the University of Tennesse-Memphis and Dr. Jennifer Lavin, associate professor of otolaryngology at Northwestern University-Feinberg, to talk about what clinical care pathways are and their usage in the field of pediatric otolaryngology.

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SHOW NOTES

First, the doctors discuss their journey into their current roles and then transition into answering the question of what clinical care pathways are. Jennifer explains clinical care pathways being standardized protocols and algorithms, which help in further developing other ways to standardize interventions. Jennifer brings up an example about tonsillectomies at her institution, where if a child is under the age of 5, opioids aren’t offered as an medication option.

Next, Anthony and Jennifer talk about the challenges in getting buy-in for standardized care from stakeholders and deciding who plans out clinical care pathways. Jennifer and Anthony emphasize the importance of getting individuals involved in patient care as stakeholders, such as pharmacists, anesthesiologists, and nurses.

Anthony then mentions how clinical care pathways work for both high and low volume procedures using examples from his own institution. Finally, Jennifer and Anthony share resources in finding current clinical care pathways that have been implemented at other institutions, such as ones posted by the American Society of Pediatric Otolaryngology (ASPO) and American College of Surgeons.

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RESOURCES

ACS Quality Programs:

https://www.facs.org/quality-programs/?page=1

ASPO Clinical Care Pathways:

https://aspo.us/page/StandardizedRoutinePerioperativeCareofthePediatricOtolaryngologyPatient

Ep. 137 Balloon Sinuplasty: Evolution, Efficacy and Expert Insights with Dr. Ayesha Khalid

Tue, 24 Oct 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Ayesha Khalid, rhinologist with Cambridge Health Alliance in Massachusetts, discuss balloon sinuplasty indications, techniques, and post-operative management.

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CHECK OUT OUR SPONSOR

Stryker ENT

https://ent.stryker.com

---

SHOW NOTES

First, Ayesha reviews the history of balloon sinuplasty. Originally used in cardiology, otolaryngologists adopted balloons as a less-invasive option to widen sinus ostia. Over time, balloon sinuplasty transitioned from being an operative procedure to one that can be done in-office with select patients. In Ayesha’s experience, facial pain and nasal stuffiness are the symptoms most responsive to balloon sinuplasty.

Then, the conversation shifts to application of balloon technology. Rather than thinking about balloon procedures and traditional functional sinus surgery as mutually exclusive, Ayesha sees them as complementary tools. Patients with straightforward sinusitis or barotrauma often improve with an in-office balloon procedure and sinus rinses. When scheduling an in-office balloon procedure, Ayesha counsels on the odds of success (over seventy percent) and possible need for further surgery. For example, patients with polyp disease might be better suited to a more traditional sinus surgery. Even in these cases, Ayesha uses balloons to widen ostia, as they inflict less trauma than traditional sinus instrumentation. Ayesha then walks listeners through her preparation for and performance of an in-office balloon procedure.

Finally, Ayesha fits balloon sinuplasty into the larger context of sinusitis treatment. She emphasizes the importance of sinus rinses for sinusitis patients both pre-and post-operatively. She sees patients one week, one month, and then three months following any balloon procedure. Depending on the nature of their disease, patients sometimes require steroids or biologics after their balloon, but most report improvement of their sinus symptoms. Ayesha leaves listeners with advice on expanding one’s procedural toolkit as a practicing ENT.

Ep. 136 Oido, Nariz y Juegos: Gamificación en Otorrino con Dr. Serafin Sanchez

Thu, 19 Oct 2023 05:05:00 -0000

En este episodio de BackTable ENT, Dr. Cristóbal Langdon de Hospital Sant Joan de Déu Barcelona y Dr. Serafín Sánchez de Hospital Universitario Virgen Macarena de Sevilla discuten los beneficios educativos de gamificación en la otorrinolaringología.

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---

SHOW NOTES

Dr. Sánchez relata su viaje personal hacia la especialidad de otorrinolaringología. Originario de Salamanca, su conexión con la medicina le llevó a formarse en un programa en Sevilla. Optó por ese lugar específicamente debido a la gran autonomía que se ofrece a los residentes. Con Con el tiempo, logró consolidarse como profesor de otorrinolaringología en su hospital actual. Más allá de su trabajo clínico, lo que realmente le apasiona es poder guiar y compartir sus conocimientos con la próxima generación de médicos. Su entusiasmo por enseñar y aprender de sus alumnos es palpable cada día.

El Dr. Sánchez nos introduce con entusiasmo a la gamificación, un enfoque interactivo de aprendizaje inspirado en videojuegos. Esta técnica, dice, combina juego y educación para capturar la atención, especialmente de los jóvenes. Aunque valora los métodos tradicionales, los considera a veces monótonos. En la gamificación, los estudiantes se transforman en “jugadores” enfrentando desafíos, compitiendo y colaborando en equipo. Sin embargo, el Dr.Langdon recuerda que la investigación sobre gamificación en educación aún es incipiente. El Dr. Sánchez reconoce sus limitaciones, como los retos de evaluación y la necesidad de creatividad en el diseño. Propone involucrar a antiguos estudiantes para aportar perspectiva. Con visión, imagina un escenario donde médicos, enfermeros y docentes aprenden conceptos audiológicos a través de juegos. Para él, la gamificación puede revolucionar la enseñanza.

El Dr. Sánchez, con una chispa de pasión, comparte la estructura típica de sus sesiones de gamificación. Divide a los estudiantes en equipos multidisciplinarios de cuatro o cinco miembros. Estos grupos enfrentan historias clínicas y deben colaborar para resolverlas. Observa que la diversidad enriquece y da lugar a soluciones más creativas. A veces, integra realidad aumentada en desafíos estilo “escape room”. Ambos doctores subrayan cómo la conexión humana y el trabajo en equipo cobraron más relevancia postpandemia. Dr. Sánchez concluye recordando los retos y recompensas de implementar la gamificación en su institución.

Ep. 135 Cutaneous SCC: Evaluating Risks and Navigating Complex Surgical Reconstruction with Dr. Gina Jefferson

Tue, 17 Oct 2023 05:05:00 -0000

In this episode of BackTable ENT, hosts Dr. Ashley Agan and Dr. Gopi Shah sit down with Dr. Gina Jefferson, professor and division chief of head and neck surgery at the University of Mississippi, to discuss the challenges of cutaneous squamous cell carcinoma (CSCC).

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CHECK OUT OUR SPONSOR

Cook Medical Otolaryngology

https://www.cookmedical.com/otolaryngology

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SHOW NOTES

First, Gina discusses how patients are referred to her practice, as many of her patients have been diagnosed and or previously treated by another provider. Then Gina talks about risk factors for CSCC which includes UV exposure, age, fair skin, genetic disposition and immunosuppressed patients.

Next, Gina discusses the challenges of taking a biopsy for potential CSCC depending on the size and location of the lesion. Gina also discusses the use of excisional biopsies on smaller lesions whereas a punch biopsy is more helpful for a larger lesion or one that is on a difficult area such as the eyelid or nose. A punch biopsy helps in assessing depth of invasion to help in staging and diagnosis.

From a treatment perspective, Gina shares her considerations when approaching reconstruction. She is mainly concerned about how to close the defect without causing significant deformity,if the patient is going to have exposed bone, or if there is the potential for radiation. Gina also mentions that areas such as the eyelid and nose are difficult places to reconstruct due to potentially injuring nearby structures, such as the lacrimal system. In difficult cases such as these, she may count on colleagues in ophthalmology to help out in the reconstruction.

Lastly, the hosts and Gina discuss post surgical management of CSCC patients and when radiation may be considered. Gina explains what follow up for these patients may look like and the role of surveillance imaging through PET scans.

Ep. 134 The Tympa Health Journey: From Clinical Challenge to Tech Solution with Dr. Krishan Ramdoo

Tue, 10 Oct 2023 05:05:00 -0000

In this episode, Dr. Gopi Shah interviews Dr. Krishan Ramdoo, CEO and founder of TympaHealth, a London-based startup that has developed an all-in-one device for hearing health assessment which incorporates otoscopy and microsuction functionalities.

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SHOW NOTES

Krishan is an ENT surgeon with a Ph.D. in global hearing health. In the early years of his career, while serving as a junior resident on the geriatric service, Krishan encountered a significant number of patients with undiagnosed hearing loss. He realized that this issue extended beyond just geriatric patients. Recognizing the scarcity of specialists and their lengthy waitlists, Krishan conceived the idea of developing a device to assess prevalent ear conditions such as hearing loss, cerumen impaction, and infections through a more accessible approach for primary care clinicians.

The TympaHealth device is a specialized otoscope that connects to a mobile viewing device, enabling high-definition imaging of the tympanic membrane. It also incorporates a spacing mechanism to facilitate cerumen removal with use of a standard suction probe, eliminating the need for a microscope. Additionally, the device is accompanied by headphones for accurate hearing screening assessments. TympaHealth offers a training program for healthcare clinicians to administer the service. In case of uncertainty regarding a finding, clinicians can alert a specialist for remote review and guidance with just one click. TympaHealth recently launched in the US and is currently conducting pilot studies.

Then, the hosts discuss the challenges of establishing a startup, including attracting investigators and building a diverse team. For physicians interested in entrepreneurship, Krishan highlights networking events as a way to gain insight into the commercial world and master the art of giving compelling pitches to potential investors.

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RESOURCES

AI in Clinical Medicine: Section III Ch. 24

https://www.wiley.com/en-gb/AI+in+Clinical+Medicine:+A+Practical+Guide+for+Healthcare+Professionals-p-9781119790648

Tympa Health

https://tympahealth.com/

Ep. 133 Evolving Pediatric Airway Surgery: A Look at Education and Outreach in India with Dr. Deepak Mehta

Tue, 03 Oct 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Shah and Dr. Deepak Mehta, pediatric otolaryngologist and director of the complex airway program at Texas Children’s Hospital, discuss Deepak’s work advancing pediatric airway surgery in India. This unique episode addresses the challenges and rewards of building a sustainable global health collaboration.

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SHOW NOTES

First, Gopi asks Deepak about his path to global surgery. Deepak’s commitment to surgical education includes his appointment as an associate professor at Baylor College of Medicine and role as founder of Csurgeries, the first peer-reviewed platform for surgical videos. Interested in finding a way to contribute to the country where he completed medical school, Deepak built on his experience as an innovator and educator to start an annual course in Bangalore for pediatric ENTs throughout South Asia. From this point, he began building a team of experts to deepen knowledge of pediatric airway surgery in the region.

Next, Deepak describes efforts to advance pediatric airway surgery in India. The centerpiece of his efforts remains his annual Bangalore course, which provides live surgical education in both endoscopic and open airway procedures. Patient education represents another important piece: given India’s linguistic diversity, he’s developed a pediatric tracheostomy parent handbook available in multiple different languages. While resources are a challenge to all global surgery efforts, Deepak’s found success using foundation funds to purchase supplies in India.

The episode rounds out with an invitation to BackTable listeners to engage with global surgery. Deepak is always looking for new lecturers at his Bangalore course. Benefits accrue to both educators and attendees: by connecting with an international network of surgeons, those involved gain exposure to new surgical approaches and new colleagues.

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RESOURCES

Dr. Mehta’s Texas Children’s Hospital profile: https://www.texaschildrens.org/find-a-doctor/deepak-mehta-md

Csurgeries: The leading platform for peer-reviewed surgical videos

https://csurgeries.com/

Ep. 132 Challenges and Innovations in Pediatric Dysphagia Management with Dr. Nikhila Raol

Tue, 26 Sep 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Nikhila Raol, pediatric otolaryngologist at Children’s Healthcare of Atlanta and Associate Professor at Emory University, discuss management of pediatric dysphagia.

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SHOW NOTES

First, Nikhila explains her educational background, starting from training in Texas to going to Atlanta to join Children’s Healthcare of Atlanta. Previously, she spent time in Boston getting her Masters of Public Health because she wanted to develop a niche focused on population health. This degree then sparked the idea of focusing on swallowing disorders in the pediatric population.

Then, Nikhila delves into how a child with dysphagia usually presents. These children typically have issues with breastfeeding, coughing, choking, and may even refuse food. In older children, they usually bring forth issues to their parents to prompt evaluation. Red flags to pay attention to in young children with dysphagia include weight loss and significant nasal congestion.

Next, Nikhila and Gopi discuss physical examination including evaluation of latch, tongue tie, nasal cavity and Nikhila’s tips for performing a FEES (Fiberoptic Endoscopic Evaluation of Swallow) in infants. Nikhila also mentions the value of having an SLP (Speech Language Pathologist) for every patient with dysphagia and involving GI colleagues to broaden her workup of complicated patients. The episode concludes with a discussion on how to choose between various treatment modalities such as injection or repair of a laryngeal cleft, and Nikhila’s Fulbright project happening in India.

Ep. 131 In-Office Ear Tubes in Children with Dr. Jordan Schramm

Thu, 21 Sep 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Jordan Schramm of Peak Pediatric ENT in Provo, Utah, chats with hosts Dr. Gopi Shah and Dr. Ashley Agan about in-office ear tubes for children.

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CHECK OUT OUR SPONSOR

Smith & Nephew ENT Solutions

https://smith-nephew.com

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SHOW NOTES

First, Jordan describes the technology behind in-office tube placement. Jordan uses the Tula ® Tympanostomy system (available from Smith + Nephew) to insert ear tubes in-office. Tula offers an integrated tympanostomy solution that combines local anesthetic with tube insertion. With the Tula system, a gentle current numbs the tympanic membrane in 10-15 minutes, after which a pre-packaged delivery device allows the operator to insert a tube by simply placing the device on a patient’s eardrum and then clicking a button.

Next, the discussion shifts towards Jordan’s personal experience with the Tula system. Gopi, Ashley, and Jordan compare Tula tubes with conventional T-tubes. Jordan emphasizes that almost all children needing tubes are candidates, though normal ear anatomy and motivated parents make the procedure easier. Jordan then offers additional practical technical pearls about the Tula system.

Finally, Jordan shares how his experience with in-office ear tubes pushed the boundaries of in-office procedures. Given that ear tube placement in the OR requires general anesthesia, time off of work and facility fees are major challenges to traditional tympanostomy tube placement. For this reason, many of his families are excited to help their children hear better with an in-office procedure. He finishes with his tips for training clinic staff, working with insurance companies, and counseling families on the procedure.

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RESOURCES

Jordan’s Peak Pediatric ENT Profile:

https://utahpedsent.com/doctors.php

Tula Tube System (for Physicians):

https://tulatubes.com/physicians/tula-tympanostomy-system/

Article comparing outcomes of Tula tubes with conventional ear tubes (mentioned by Jordan):

https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1002/ohn.336

Ep. 130 Surgical Ergonomics: The Unseen Risk to Surgeon Wellbeing with Dr. Geeta Lal

Tue, 19 Sep 2023 05:05:00 -0000

In this episode of BackTable ENT, Drs. Julie Wei and Geeta Lal, a surgical oncologist at the University of Iowa and current president of the Society of Surgical Ergonomics, discuss the importance of ergonomics in surgery.

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/TLTDzV

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SHOW NOTES

First, Julie and Geeta share their stories that have shaped their perspectives on the importance of ergonomics. Geeta details her journey of getting involved in the ergonomics industry dating back to 2016 after having persistent jaw pain. After consulting multiple physicians who offered her narcotics as a solution to her myofascial pain, Geena was inspired to start educating physicians about ergonomics. Geeta and Julie disclosed that from a survey from physicians, 80% of surgeons are in pain.

Geeta then discusses her daily routine for incorporating ergonomics during surgeries. She explains the importance of postural awareness in areas such as table height, laparoscopic machinery, and cameras in order to prevent excessive head and back strain. Furthermore, Geeta defines an “ergonomic timeout”, which are distinct moments to confirm that equipment is in the optimal position, thus mitigating potential risk of injury. Furthermore, Geeta and Julie note which surgical specialities are far worse in surgical ergonomics. Geeta also shares how she obtained her current role of president of the Society of Surgical Ergonomics.

Finally, Geeta and Julie discuss misconceptions in the area of surgical ergonomics and barriers that are present amongst the surgery community when discussing physician pain.

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RESOURCES

Society of Surgical Ergonomics:

https://www.societyofsurgicalergonomics.org/

Dr. Geeta Lal’s Website:

https://surgicalergonomics.com/about/

Dr. Julie Wei’s Article on Surgical Ergonomics in Physician Wellbeing:

https://www.enttoday.org/article/how-surgical-ergonomics-impact-surgeon-wellbeing-outcomes-and-careers/

Ep. 129 American Head and Neck Society Scholarship for Underrepresented Minority Medical Students with Dr. Tammara Watts

Thu, 14 Sep 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Tammara Watts, surgeon-scientist at Duke University, sits down with host Dr. Gopi Shah to discuss two exciting scholarship opportunities for medical students available through the American Head & Neck Society (AHNS).

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SHOW NOTES

Fewer than 5% of practicing otolaryngologists identify as members of underrepresented minority groups (URM), and these scholarships directly address that disparity. Gopi and Tammara then transition to discussing the importance of diversity in otolaryngology more broadly.

First, Tammara expounds on what is gained by having a workforce that includes individuals with diverse backgrounds and experiences. Through the Dr. Eddie Méndez Research Fellowship and the Myers’ Family Summer Fellowship, AHNS provides unique opportunities for aspiring otolaryngologists who identify as URM to connect with future colleagues. The Research Fellowship provides $10,000 to a medical student interested in spending one year immersed in otolaryngology research. It is unique in that AHNS provides a list of mentors (with bio-sketches) that interested applicants can connect with to formulate a research plan before applying. The Myers’ Family Summer Fellowship financially supports a rising MS2 or MS3 student to gain exposure in Head & Neck Surgery.

Next, Tammara offers tips on cultivating successful mentor-mentee relationships, emphasizing that mentors enjoy supporting their future colleagues, and that it is easier to do so when the mentee takes initiative. Finally, Tammara shares her philosophy regarding DEI. Though otolaryngologic patients come from all walks of life, their surgeons can’t always conceptualize how their experiences influence their care. By supporting URM students interested in ENT, she (along with her AHNS colleagues) are helping create a workforce that can better understand and heal.

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RESOURCES

AHNS’s Dr. Eddie Méndez Fellowship:

https://www.ahns.info/dr-eddie-mendez-research-fellowship/

AHNS’s Myers’ Family Summer Fellowship in Otolaryngology:

https://www.ahns.info/myers-summer-fellowship/

Dr. Tammara Watts MD, PhD’s Duke University Profile:

https://headnecksurgery.duke.edu/profile/tammara-lynn-watts

Ep. 128 Free Flaps 101 with Dr. Eli Gordin

Tue, 12 Sep 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Eli Gordin, microvascular surgeon at UT Southwestern, joins hosts Dr. Gopi Shah and Dr. Ashley Agan to discuss free flap surgery. This high-yield episode walks listeners through the basics of microvascular surgery, from indications to management of surgical complications.

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CHECK OUT OUR SPONSOR

Cook Medical Otolaryngology

https://www.cookmedical.com/otolaryngology

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SHOW NOTES

First, the surgeons discuss pre-operative management of free flap patients. The most common indications for microvascular surgery in otolaryngology include head & neck cancers. In his pre-operative clinic visits with free flap patients, Eli answers questions about surgery, hospital stay, and recovery. In his experience, patients often don’t understand the extensive nature of these surgeries prior to this visit, so he spends time explaining what a flap is and what the hospital course will look like.

Then, Eli speaks about his experience with virtual surgical planning, which entails remote meetings with engineers. He admits that the learning curve to virtual surgical planning is steep, but that contemplating reconstruction with the help of virtual planning helps him better account for details at the time of surgery. Gopi and Ashley then inquire about surgery and peri-operative management of these patients. Eli addresses vital topics including surgical technique, fluid management, and thrombosis risk.

Finally, the podcast addresses post-operative management of free flap patients. Eli briefly outlines his free flap protocol, emphasizing physical exam signs that indicate need for an OR takeback. He leaves listeners with an important insight: when surgeons have any doubts regarding the viability of a flap, they must return to the OR quickly: the best look they can get at a troubled flap is the one obtained in the OR.

Ep. 127 In-Office Facelifts with Dr. Demetri Arnaoutakis

Tue, 05 Sep 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Demetri Arnaoutakis, a facial plastic surgeon, and host Dr. Gopi Shah discuss planning and execution of in-office facelifts.

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SHOW NOTES

First, Demetri and Gopi begin with discussion of the clinic intake visit. During a first visit, Demetri takes time to understand each patient’s goals and priorities as they relate to their appearances. Using this knowledge, he walks each patient through all possible treatment choices, then helps the patient decide the best path forward. He takes a detailed procedural/surgical history and performs a top-down examination of the patient’s face.

Then, Demetri describes different surgical and non-surgical options to improve facial aesthetics. He divides these options into non-invasive (micro-needling, fillers, Botox), minimally invasive (radiofrequency-assisted lipolysis), and surgical (facelift). Demetri explains multiple approaches to facelift, noting that he tends to prefer a deep-plane approach that mobilizes the superficial musculoaponeurotic system (SMAS). Demetri then shares pearls from his practice about optimal incision sites, the importance of acquiring the right instruments, and the addition of tranexamic acid to tumescent anesthesia to reduce risk of hematoma.

Finally, Demetri outlines his post-operative management. In addition to standard post-operative protocols, his patients undergo hyperbaric oxygen treatment to increase oxygen delivery to tissues and lymphatic massage to aid lymph drainage. The episode wraps up with Demetri’s advice to listeners wanting to improve their cosmetic surgical skills.

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RESOURCES

Dr. Arnaoutakis’ website:

https://www.drdemetrimd.com/

Ep. 126 Odontogenic Sinusitis with Dr. John Craig

Tue, 29 Aug 2023 05:05:00 -0000

In this week’s episode of Backtable ENT, Dr. Ashley Agan and Dr. Gopi Shah talk with Dr. John Craig, chief of Rhinology and co-director of the Skull Base Center at Henry Ford Health in Detroit, about odontogenic sinusitis (ODS).

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SHOW NOTES

The episode begins by hearing about John’s path to rhinology and his work and research interests in ODS. First, John defines ODS and contrasts it with chronic rhinosinusitis (CRS). He notes that the cardinal symptoms of CRS are the same as ODS but for ODS, these symptoms are unilateral, such as unilateral nasal obstruction, unilateral nasal drainage and unilateral facial pressure. Also, a foul smell is a very common symptom of ODS.

The conversation then transitions to discussing the role of dental history in ruling in ODS. John explains his oral exam process and questions he asks related to a patient’s dental history such as upper dental pain, root canals, extractions, dental implants and dental bridges. Interestingly, current research has shown only 20-40% of patients have dental symptoms such as dental pain. The group discusses how insurance coverage plays a role in the treatment management patients with ODS may undergo, and John notes the importance of collaborating with dental providers for endodontic testing and imaging that includes dental roots.

John further delves into what he is looking for on an endoscopy exam including unilateral purulent drainage from the middle meatus, edema and polyps. CT sinus usually shows unilateral maxillary sinus opacification.

Then, John explains how he groups patients in two groups, treatable and untreatable dental pathologies, to help in deciding management of patients with ODS. Treating the sinus and the treatable dental pathology (i.e.-closure of oroantral fistula) will help the condition resolve in the majority of cases. Timing of treating the dental pathology and sinus surgery is complicated, but taking into account the patient’s symptom burden can help decide timing of these procedures. When there is no treatable dental pathology, management options include antibiotics (to temporize symptoms) and endoscopic sinus surgery (ESS) with 98% success. The episode concludes with the group discussing the role of ESS for ODS.

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RESOURCES

PubMed (Link to John’s list of Publications):

https://pubmed.ncbi.nlm.nih.gov/?term=Craig%20JR&cauthor_id=32656998

Ep. 125 Gender Affirming Voice Care with Sarah Schneider MS, CCC-SLP and Dr. Mark Courey

Tue, 22 Aug 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Mark Courey (chief of otolaryngology at Mount Sinai) and Sarah Schneider (Speech Language Pathologist at UCSF) join host Dr. Gopi Shah to discuss voice care for transgender patients.

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SHOW NOTES

First, Mark and Sarah define terms relevant to transgender healthcare and offer tips on welcoming transgender patients to clinic. They describe how voice care fits into the overall process of transition, and why patients seek care for voice-related concerns at different points in their journey. Gopi asks about collaboration with other specialties, and Mark discusses collaboration with other clinicians in a patient-centered transgender care team.

The conversation then shifts to workup and treatment of voice-related concerns. In Sarah’s experience, trans women present with voice fatigue if they are overly reliant on pitch modulation. By addressing pitch, articulation, rate of speech, volume, and resonance, Sarah helps her patients achieve a more feminine communication style while minimizing physical strain. Mark outlines his physical exam and process of history-taking as they relate to voice concerns. They also address the role of laryngoscopy in transgender patient populations.

Finally, Sarah and Mark address the importance of duration and goals of voice therapy. Both she and Mark emphasize the need to monitor progress over sessions of voice therapy. Delving into surgical management, Mark addresses the indications for, steps in, and complications of voice-modifying surgery. To wrap up, Sarah and Mark encourage listeners to educate their fellow clinicians regarding voice care for transgender patients.

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RESOURCES

https://www.enttoday.org/article/gender-affirmation-surgery-in-california/

https://www.enttoday.org/article/analyzing-the-latest-gender-affirming-care-restrictions-in-state-laws/

Sarah’s Twitter:

https://twitter.com/scharx16

Sarah’s UCSF Profile:

https://transcare.ucsf.edu/team/sarah-schneider

Mark’s Mount Sinai Profile:

https://profiles.mountsinai.org/mark-s-courey

Ep. 124 The Role of Speech Pathology in Professional Voice Care with Sarah Quintana, MS, CCC-SLP

Tue, 15 Aug 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah is joined with speech language pathologist (SLP) Sarah Quintana, MS, CCC-SLP from Louisiana State University-Shreveport who specializes in gender-affirming voice, singing, voice rehabilitation, and remote service delivery models. Sarah and Gopi discuss the role of speech language pathology in the care of those with professional voices.

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SHOW NOTES

First, Sarah delves into her background of being a singer and how this influenced her to become an SLP who works with professional voices. Next, they talk about the type of patients Sarah sees at the voice center and how she assesses patients. She expands on the types of questions she asks and explains her systematic approach of using a stroboscope to look at vocal cord function. Next, Sarah and Gopi discuss the other individuals who make up the voice care team and also talk about the distinction between a voice coach, voice trainer, and voice teacher. Additionally, they delineate the roles of voice rehabilitation versus vocal habitation. Sarah also explains how she works with laryngologists to provide multidisciplinary care for professional voice patients.

Finally, Gopi and Sarah close out the episode by discussing voice conservation, the role of equitable healthcare in the field of SLP, and Sarah’s interest in remote service delivery options.

Ep. 123 Health Equity Research in Pediatric Head and Neck Cancer with Dr. Daniel Chelius and Dr. Jeffrey Rastatter, Hosted by Dr. Anthony Sheyn

Tue, 08 Aug 2023 05:05:00 -0000

In this episode of BackTable ENT, pediatric otolaryngologists Dr. Anthony Sheyn (St. Jude Children’s Hospital & Le Bonheur Children’s Hospital), Dr. Jeffrey Rastatter (Lurie Children’s Hospital of Chicago), and Dr. Daniel Chelius (Texas Children’s Hospital), discuss challenges and research in health equity in pediatric head and neck cancer care.

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SHOW NOTES

First, the surgeons define the Social Determinants of Health (SDoH) and explain how studying these factors improves care. They share memories of when they first reckoned with health inequities as clinicians. For Dr. Chelius, this was during medical school, when he observed end-stage renal disease patients’ access to dialysis (and thus lifespan) depended on their insurance status, income, and education. Moving into his residency, he realized that similar forces shaped how patients accessed cancer care. As a young attending, Dr. Sheyn noticed that many of his patients missed appointments for logistical or financial reasons, which piqued his interest in characterizing how SDoH influence pediatric cancer care.

Next, the doctors discuss health equity research. Though they’re based at different institutions, the three surgeons collaborate to study how SDoH affect pediatric head and neck cancer outcomes. Dr. Rastatter shares his work identifying how different SDoH– including socioeconomic status, household composition, housing/transportation, and minority/language status – interact to affect access to cancer care. Dr. Chelius speaks to the importance of social work, advanced practice providers, and transportation services in connecting patients to care. The podcast concludes with a discussion of how tertiary care centers can better collaborate with community clinicians to ensure pediatric patients with rare cancers get the workup and treatment they need.

Ep. 122 Evaluation and Management of Patients with Olfactory Dysfunction with Dr. Zara Patel

Tue, 01 Aug 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Zara Patel, director of endoscopic skull base surgery and professor of otolaryngology at Stanford, joins Dr. Shah to discuss the physiology behind olfactory dysfunction and evidence-based cutting-edge therapies.

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SHOW NOTES

First, Dr. Shah and Dr. Patel outline different patterns of olfactory dysfunction and their etiologies. Damage to the olfactory system can result from inflammation, trauma, or neurodegeneration affecting olfactory bulb neurons. However, smell-based symptoms are common in migraine and seizure auras, so taking a thorough medical history is important in all patients. Also, they review “red-flag” medications contributing to smell loss.

Next, Dr. Shah asks Dr. Patel about the workup of patients with olfactory disturbance. Dr. Patel recommends rigid nasal endoscopy with and without decongestion for all patients with olfactory complaints. Unless another medical issue is suggested from the patient’s history, Dr. Patel does not routinely order labs for smell disturbance. The role of imaging is addressed, including use of MRIs for prognostication.

The doctors then cover evidence-based management of olfactory dysfunction. In cases where inflammation causes olfactory disturbance – such as post-viral etiologies – steroid therapy can help restore smell. To have effect, the drug must reach the olfactory cleft, so Dr. Patel prefers nasal rinses with budesonide over intranasal or oral steroids. Then, Dr. Shah shares her experience treating patients with olfactory training. Dr. Patel explains the neural basis of training and instructs clinicians on how to counsel patients for best outcomes.

Finally, Dr. Patel shares her expertise on hot topics in olfactory research, like the science behind platelet-rich plasma (PRP) for smell loss. She also reviews situations in which dietary supplements can improve symptoms. They end the episode with insights regarding equitable care of patients with smell-based symptoms.

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RESOURCES

Dr. Patel’s Stanford profile

https://profiles.stanford.edu/zara-patel

JAMA Patient Handout on Olfactory Training:

https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2782042

International Consensus Statement on Allergy and Rhinology:

Olfaction https://onlinelibrary.wiley.com/doi/10.1002/alr.22929

Ep. 121 Recruiting the Next Generation of Otolaryngologists with Robert Glazer

Tue, 25 Jul 2023 05:05:00 -0000

In this episode of BackTable ENT, Robert Glazer, executive vice president of ENT and Allergy Associates LLP joins Dr. Ashley Agan to speak about his process for recruiting the next generation of otolaryngologists, things otolaryngologists should look for in choosing a practice to join, and general tips and advice for otolaryngology residents to think of in their plans post residency.

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SHOW NOTES

Dr. Agan begins the episode by having Robert Glazer discuss his background in the healthcare field with over 40 years of healthcare experience in finance and operations, managed care contracting, physician recruitment, and healthcare marketing. Glazer discusses his beginnings in healthcare starting back in 1976 by getting a job as a clerk in NYU medical center in the grants and contracts division, helping physicians fill out grants for their medical research. During his nine years at NYU he went and got his masters degree in public administration with a focus on healthcare, and takes us through how these early jobs and his further promotions, led him to ENT & Allergy Associates LLP.

Next, Glazer explains what he looks for in recruiting otolaryngologists to his practice and advice for resident physicians looking to apply to the job market. Residents should take into consideration different practices and the importance of networking and meeting individuals at a particular practice. Glazer tries to meet candidates in their PGY2 and PGY3 years to get to know them and learn more about why they are interested in being in the NYC region. He also discusses some of the key questions that residents should be asking during the interview trail and discusses the importance of transparency in learning more about a practice.

Lastly, Glazer talks about strategies that he has found to be successful in recruiting new otolaryngologists to his practice and discusses COVID has changed recruitment and how physicians can manage burnout post-COVID.

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RESOURCES

ENT and Allergy Associates, LLP:

https://www.entandallergy.com

Ep. 120 Evaluation and Management of Cholesteatoma with Dr. Gauri Mankekar

Tue, 18 Jul 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Shah and Dr. Gauri Mankekar, assistant professor of Otolaryngology at LSU Health Shreveport, discuss cholesteatoma workup and surgical management.

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CHECK OUT OUR SPONSOR

Cook Medical Otolaryngology

https://www.cookmedical.com/otolaryngology

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SHOW NOTES

First, Drs. Shah and Mankekar review the basics of cholesteatoma: types, etiology, clinical presentation, and physical exam findings. Doctors should suspect cholesteatoma when they encounter a patient experiencing painless, malodorous ear drainage. Dr. Mankekar underscores the importance of tailoring the physical exam to each patient’s history and needs. For example, when evaluating children for potential cholesteatoma, she works to gain the child’s trust before examining the ear, sometimes using an initial visit to focus on rapport and deferring the exam to the second visit.

Next, the surgeons address workup of cholesteatoma, which should include audiometry, CT scan, and culture of ear drainage (if present). All patients with cholesteatoma require long-term surveillance, as recurrence can happen more than five years after initial treatment. Dr. Shah advises that doctors approach the topic of surveillance by emphasizing the importance of creating a safe ear. Dr. Mankekar then shares tips on how to help patients understand the chronicity of their disease.

Then, the surgeons discuss cholesteatoma operative techniques. Dr. Mankekar leads listeners through her approach to cholesteatoma surgery, from review of CT scans to supplies used in the OR. Dr. Shah delineates common challenges in ear surgery, such as “hard to reach areas”, and Dr. Mankekar shares technical strategies she uses in the OR. They then review the role of endoscopic tympanoplasty, ossicular chain reconstruction, and canal wall down mastoidectomy. As with her ear exam, Dr. Mankekar closely tailors each operation to the patient’s particular pathology. Finally, Dr. Mankekar summarizes her strategy for patient-centered, long-term management of cholesteatoma.

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RESOURCES

Dr. Mankekar’s Profile:

https://www.ochsnerlsuhs.org/doctors/gauri-mankekar

Ep. 119 Children with Complex Sleep Apnea with Dr. Javan Nation

Tue, 11 Jul 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Javan Nation, a pediatric otolaryngologist from Rady’s Children Hospital in San Diego, joins Dr. Shah to speak about the assessment and management of children with complex obstructive sleep apnea.

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SHOW NOTES

Dr. Nation and Gopi begin the episode by discussing some of the presentations and patient populations of young children who may be coming into the office with sleep apnea. Dr. Nation also discusses his approach in conducting a physical exam, including assessing their breathing and posture to identify if a pediatric patient may have sleep apnea.

Next, Drs. Nation and Gopi discuss important history taking skills that will help the larger interdisciplinary team, such as pulmonologist or craniofacial surgeon. Dr. Nation mentions that while controversial for some clinicians, he assesses teeth grinding and thumb sucking at young ages, among other physical exam findings. Dr. Nation evaluates the role of imaging, specifically CT imaging, and explains how he uses these results to communicate to families and patients. Additionally, Dr. Nation explains his approach for looking at sleep study results.

Lastly Dr. Nation summarizes how he uses sleep endoscopy in some patients to decide whether or not to recommend patients for tonsillectomy. He also explores the potential role of hypoglossal nerve stimulator in pediatric patients with sleep apnea and indications for patients getting a tracheostomy for treating obstructive sleep apnea.

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RESOURCES

SENTAC (Society for Ear, Nose, Throat Advancement in Children)

https://sentac.org/

Ep. 118 Expert Strategies for Achieving Success in Medical Research in Otolaryngology with Dr. Matthew Carlson

Tue, 04 Jul 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Walter Kutz (UT Southwestern, Dallas, TX), and guest Dr. Matthew (Matt) Carlson (Mayo Clinic, Rochester, MN) discuss high-yield research tips for medical students and physicians.

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SHOW NOTES

Dr. Carlson begins the episode by describing how one can approach scholarly activity so that research is genuinely an enjoyable pursuit. Dr. Carlson emphasizes organization throughout all stages, from idea generation to project management. The work of a diverse team – in terms of individual background, skills, and seniority – helps guide good ideas to publication. With this setup, research mirrors medicine’s chain of command: residents mentor medical students on a day-to-day basis, and principal investigators are able to manage on a high level. Both surgeons agree that the skills of statisticians and institutional research coordinators are indispensable for ensuring data quality and working with the IRB, respectively.

Next, Drs. Kutz and Carlson dive deeper into the research process. Dr. Carlson starts projects by diving into PubMed and identifying how his project can address yet-unanswered questions. Drs. Carlson and Kutz discuss resources they employ to insure data and manuscript integrity. Regardless of the manuscript’s topic, clarity of style and good grammar are non-negotiable. From the perspective of a researcher and reviewer, Dr. Carlson finds that sloppy writing leads one to question whether data analysis is similarly disorganized.

Then, Dr. Carlson explains how his research group manages to publish, on average, one manuscript a week. He attributes this productivity to organization, clear expectations for all involved, and genuine enthusiasm for investigation all contribute to this impressive statistic. Dr. Kutz comments that output is better when trainees are encouraged, rather than mandated, to take on research projects. Finally, Drs. Kutz and Carlson discuss how artificial intelligence and open-access journals could alter the research landscape in the near future. As a parting thought, Dr. Carlson encourages listeners to build a good team and be generous with mentees.

---

RESOURCES

The Dip: A Little Book that Teaches You When to Quit (and When to Stick), Seth Godin

Grammarly

https://www.grammarly.com/

Dr. Carlson’s Research Profile

https://www.mayo.edu/research/faculty/carlson-matthew-l-m-d/bio-20113086

Ep. 117 Advanced Endoscopy Techniques in the Management of Zenker's Diverticulum with Dr. Shumon Dhar

Tue, 27 Jun 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Agan and UT Southwestern laryngologist Dr. Shumon Dhar discuss new approaches like flexible scope techniques to managing Zenker's diverticulum.

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CHECK OUT OUR SPONSOR

Cook Medical Otolaryngology

https://www.cookmedical.com/otolaryngology

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SHOW NOTES

First, the doctors summarize flexible endoscopy techniques and hybrid techniques for treating patients with Zenker's diverticulum. They discuss the ideal candidates and how endoscopic Zenker's surgery has changed to achieve better results and lower rates of postoperative complications. Specifically, they discuss the importance of removing the muscular and mucosal septum of the Zenker's pouch to reduce the risk of postoperative complications.

Additionally, they examine the importance of creating a watertight mucosal seal, the use of distal attachment caps, and the importance of getting a good visualization of the septum for a successful surgery. They also discuss the role of intubation and general anesthesia and cover the use of gastrostomy tubes for patients with dysphagia. Next, Dr. Dhar explains the types of advanced energy devices used when performing the myotomy for the treatment of Zenker's diverticulum. He also goes into depth about the learning curve associated with this procedure and discuss the rate limiting factors when considering the wide-spread use of this technique. The doctors then comment on the differences between a Z-POEM, rigid, and flexible endoscopic surgical techniques. Ultimately, Dr. Dhar believes that having a variety of tools at one's disposal to be able to offer patients the best option for their needs is the key to successful treatment.

Finally, they discuss the importance of post-operative care for patients with Zenker's diverticulum. They explore the use of clips, the avoidance of positive pressure, the use of NG tubes, and an ideal post-operative diet.

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RESOURCES

Cook Medical Otolaryngology

https://www.cookmedical.com/otolaryngology/

Ep. 116 Chronic Cough with Dr. Karuna Dewan

Tue, 20 Jun 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Shah and Dr. Karuna Dewan discuss diagnosis, workup and medical therapy for chronic cough in adults.

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CHECK OUT OUR SPONSOR

Cook Medical Otolaryngology

https://www.cookmedical.com/otolaryngology

---

SHOW NOTES

First, they discuss the array of surveys used to quantify and assess the severity of the cough, as well as the importance of physical exam and laryngoscopy for an accurate diagnosis. They also outline various diagnoses that could be contributing to the chronic cough.

Next, the critical role of speech pathologists in dysphagia diagnosis and management is explored. Dr. Dewan emphasizes the importance of the scope exam, as well as how speech pathologists are integral to the dysphagia diagnosis. Various testing options are discussed, such as modified barium swallow, esophagram, and pulmonary function testing. She then delves into how to decide which tests are necessary for each patient. Then, they discuss various treatments and medications for chronic coughing, including reflux medications, proton pump inhibitors, and steroids. They explore the importance of taking into account the potential side effects of these medications and of monitoring them closely. Additionally, they evaluate the efficacy of Tessalon perles, over the counter cough suppressants, and the two-arm approach for treating neurogenic cough. They also explain paradoxical vocal cord motion, its symptoms, and how it is treated with therapy and an ipratropium bromide inhaler. Procedures, like the superior laryngeal nerve block injections, may be effective for treating chronic cough.

Finally, the doctors reflect on the use of social media for professional purposes. They consider how to best use Twitter and Instagram to promote oneself, and the importance of having an easily accessible profile on the Internet. They also touch on the importance of developing an online presence in order to stay connected and visible in the professional world.

Ep. 115 Management of the Plunging Ranula with Dr. Rohan Walveker

Tue, 13 Jun 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Agan and Dr. Shah invite Dr. Rohan Walvekar, Chair in Head and Neck Surgery at Louisiana State University, to discuss his experience with innovating procedures for sialendoscopy and ranula excision.

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CHECK OUT OUR SPONSOR

Cook Medical Otolaryngology

https://www.cookmedical.com/otolaryngology

---

SHOW NOTES

First, Dr. Walvekar shares his insights on how to differentiate between cysts and sublingual gland masses. He explains the importance of examining the normal side of the floor of the mouth and comparing it to the abnormal side. He also discusses the advantages of using ultrasound in the office and when to consider imaging such as CT or MRI. Finally, he explains the importance of understanding different malformation types when making treatment decisions. Next, Dr. Rohan Walvekar talks about the importance of being familiar with the floor of mouth anatomy to avoid injuring the lingual nerve. He also explains his preferred approach to intubation and emphasizes the importance of examining the papilla.

Familiarity with floor of mouth anatomy is important for safe cannulation of the duct. Dr. Walvekar's stent is designed to have a flange that anchors itself to the floor of the mouth and can be used for both parotid and submandibular ducts. The stent helps to identify the duct and ensure the incision for the sublingual gland removal is made in the right place. Dr. Walvekar explains his approach to decompressing a pseudocyst, which includes transoral dissection and, if needed, aspirating with a thick 18 gauge needle. Finally, he discusses the importance of not injuring the submandibular duct and lingual nerve during closure and the possible use of a transcervical approach if needed.

---

RESOURCES

Walvekar Salivary Duct Stent:

https://hoodlabs.com/salivary-management/walvekar-salivary-duct-stent/

Ep. 114 Mentorship: a Practical Guide with Dr. David Haynes

Tue, 06 Jun 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Walter Kutz and Dr. David Haynes, program director of the Neurotology Fellowship at Vanderbilt University, discuss the importance of mentoring for both ENT trainees and faculty.

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SHOW NOTES

First, Dr. Haynes explores the concept of mastering a skill, the importance of coaching, and deliberate practice. He also talks about the importance of having mentors with adequate standards and expectations, and how having this type of relationship between mentor and mentee requires commitment on both sides. Additionally, he notes that the knowledge passed down from mentors is generational and cumulative. The doctors also discuss the importance of having a growth mindset, which they believe is just as important as having surgical skills. They compare the role of a mentor to that of a coach and explain that even the best athletes have coaches to help them improve. For medical trainees to be coachable, they have to have a positive attitude and willingness to learn. Finally, Dr. Haynes emphasizes the importance of taking classes to learn professionalism.

Then, Dr. Haynes shares stories about his own mentors and discusses how they have had a profound influence on my career. The doctors explain the benefit of having mentors both within and outside their organizations, as well as the difficulty of having a formal mentorship program due to the demands of the medical profession. Finally, they agree that the quality, not the quantity of time, spent with mentors counts.

Ep. 113 Intracranial Complications of Acute Sinusitis in Children with Dr. Amanda Stapleton

Tue, 30 May 2023 05:05:00 -0000

This week on the BackTable ENT podcast, Dr. Gopi Shah and Dr. Amanda Stapleton, a pediatric otolaryngologist from UPMC Children's Hospital of Pittsburgh, chat about the unique challenges of treating pediatric sinus and skull base diseases, orbital complications, and biofilm-covered Moraxella. They discuss source control, biofilm, and her research focused on the bacteriology of pediatric chronic sinusitis and patients with cystic fibrosis.

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SHOW NOTES

First, they discuss how to recognize the signs and symptoms of pediatric patients who present with orbital or intracranial abscesses and how age and location of the abscess can influence treatment decisions. They also explain how to distinguish between intracranial and orbital abscesses and how to recognize the symptoms of sphenoid sinusitis. Both doctors emphasize the importance of involving infectious disease colleagues to evaluate antibiotic coverage and surgical indications.

Next, the doctors discuss the techniques for sinus surgery, including the use of a scope for visualization, warm irrigations, navigation, and augmented reality systems in the acute setting. Dr. Stapleton also provides tips on when to remove a middle turbinate and the importance of source control, especially in patients under the age of seven. An adenoidectomy may be necessary if the patient has had multiple colds throughout the winter and the decision is made to take down the lamina to drain an abscess pocket.

Finally, the doctors discuss the follow up process for children with chronic sinusitis, which may include office endoscopy and allergy testing, and discuss the rare cases of intracranial abscesses. In addition to being vigilant and proactive in monitoring the potential for repeat infections, imaging to detect any scarring or residual mucosal inflammation that might have resulted from the initial infection is also helpful.

Ep. 112 Manejo de Condiciones Neurotologicas con Dr. Juan Chiosone

Tue, 23 May 2023 05:05:00 -0000

En este episodio de BackTable ENT, Dr. Carlos Torre entrevista al reumatólogo Dr. Juan Chiossone sobre su trayectoria profesional y su manejo de pacientes con problemas neurotológicos.

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SHOW NOTES

Primero, Dr. Chiossone explica su trasfondo médico, que incluye el entrenamiento en varios lugares como Venezuela e Inglaterra. Se dio cuenta de que tenía un interés en la investigación científica y la microcirugía durante su tiempo en la escuela medical en Caracas. Tuvo la oportunidad de estudiar en Cambridge también y explicó cómo buscó sus mentores y el rol integral que tiene su fellowship en su desarrollo como cirujano. Después de su tiempo en Inglaterra, hizo la decisión de quedarse en la medicina académica y explica más sobre las ventajas y desventajas de trabajar en una práctica privada. Dr. Chiossone hace la transición para explicar cómo obtuvo una posición en la Universidad de Miami y las diferencias entre practicar medicina en Venezuela y los Estados Unidos.

Próximamente, los doctores discuten la evaluación de los pacientes con problemas neurotológicos. Dr. Chiossone nota que el tiempo de presentación de los síntomas es importante, independientemente de si es una pérdida auditiva o problemas con el balance. Para los niños, es crítico diagnosticar los problemas temprano porque la falta de tratamiento puede tener un gran impacto por el resto de sus vidas. Para cada condición, es importante explicar la condición al paciente en vocabulario básico y tener un actitud optimista sobre el tratamiento para mitigar la ansiedad y el estrés del paciente.

Además, Dr. Chissone habla sobre su técnica de implantación coclear, su protocolo de inyecciones intratimpánicos, indicaciones para tubos para los oídos, y su reparación de las perforaciones timpánicas. Finalmente, los doctores comparan las ventajas y desventajas de la cirugía microscópica y la cirugía endoscopia y el impacto de los nuevos audífonos de venta libre.

Ep. 111 Pediatric Cochlear Implant Program in Costa Rica with Dr. Adriana Vega

Thu, 18 May 2023 05:05:00 -0000

Ep. 110 Intracapsular Tonsillectomy in Children with Dr. Kevin Huoh

Tue, 16 May 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Shah interviews pediatric otolaryngologist Dr. Kevin Huoh about intracapsular tonsillectomy, including the postoperative benefits of the procedure and his personal techniques.

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CHECK OUT OUR SPONSOR

Smith & Nephew ENT Solutions

https://smith-nephew.com

---

SHOW NOTES

First, Dr. Huoh explains the principle behind intracapsular tonsillectomy. This technique involves removing the tonsil but leaving the capsule intact to protect muscles of the pharyngeal wall and lateral vessels. When he performs this procedure on patients, he notices that their recovery period is less painful and their lower risk of hemorrhages when compared to extracapsular tonsillectomy patients. According to the literature, there is only 3% risk of tonsil regrowth, but he considers regrowth a safer complication than tonsillar hemorrhage. His postoperative recovery regimen includes Tylenol or Motrin for 24 hours, and his patients can start on a regular diet immediately after surgery. Then, he and Dr. Shah discuss differences between American and European guidelines on intracapsular tonsillectomy.

Next, Dr. Huoh explains the type of equipment he uses and his intracapsular tonsillectomy technique. He encourages surgeons to follow their tonsillar regrowth rate, as this data can inform surgeons on whether they are removing enough tissue during the procedure. Additionally, he also emphasizes that it is never too late to learn a new procedure like intracapsular tonsillectomy. He finds it easy to add on an intracapsular tonsillectomy as a minor procedure if he is already taking a patient to the OR for another surgery because of the minimal risks of the procedure. Finally, Dr. Shah and Dr. Huoh discuss tonsillectomies in adults and children with recurrent peritonsillar abscesses.

---

RESOURCES

Smith + Nephew Coblation Technology for Adenotonsillectomy

https://www.smith-nephew.com/en/health-care-professionals/products/ear-nose-and-throat/coblation-technology-for-adenotonsillectomy#overview

Ep. 109 Cryotherapy for Chronic Rhinitis and Nasal Congestion with Dr. Jeff Suh

Tue, 09 May 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Shah interviews rhinologist Dr. Jeffrey Suh (UCLA) about cryotherapy as a new treatment for chronic rhinitis.

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CHECK OUT OUR SPONSOR

Stryker ENT

https://ent.stryker.com

---

SHOW NOTES

First, the doctors discuss the typical presentation of a patient with rhinitis. Although all rhinitis patients present with a chief complaint of a runny nose, there are different subtypes of rhinitis, such as allergic rhinitis, gustatory rhinitis, and exercise-induced. Environmental exposures, duration of symptoms, and the presence of other symptoms should be elicited, as differentiating between allergic and non-allergic rhinitis changes treatment options. Next, Dr. Suh explains how he performs a physical exam in rhinitis patients. He uses a rigid endoscope to make sure there is not another cause of rhinitis. He is sure to premedicate patients with a lidocaine and Afrin nasal spray before using the endoscope. CT scans of the sinuses may be helpful if patients have drainage, polyps, or notable inflammation.

In general, Dr. Suh will pursue medical treatment options before considering procedural options. For allergic rhinitis patients, he educates patients about understanding their triggers for allergies and prescribes nasal steroid sprays and antihistamines. In non-allergic rhinitis patients, he recommends ipratropium bromide, which can also be used as a trial to see if cryotherapy would resolve their symptoms. He notes that sprays need to be used for at least 1 month before they show effects and that they should be used 30 minutes before trigger exposure for allergic rhinitis patients. He does not think that saline rinses help much with rhinitis, as they contain no medications to reduce swelling and dampen nerve stimulation.

Next, Dr. Suh explains two procedural options for chronic rhinitis: radioablation therapy and cryotherapy. Both procedures have similar success rates, but he prefers to use cryotherapy in patients with non-allergic rhinitis who have a positive response to ipratropium bromide. The procedure involves inserting balloon a into the middle meatus of the nasal cavity and in order to deliver liquid nitrogen to the nasal mucosa overlying the posterior nasal nerve. He explains different considerations for performing cryotherapy in the office versus in the OR. He also explains his anesthesia protocol and how to mitigate the common post-operative complaint of an “ice cream headache”, which he prophylactically treats with gabapentin. Radiofrequency ablation with the RhinAer procedure also targets the posterior nasal nerve, but it has other complications, like damaging other nerves that allow for the tearing of eyes. He chooses the cryotherapy option more often because it does not require as good visibility as the radiofrequency ablation therapy does.

Finally, he explains his postoperative care regimen which includes starting the patient back on their usual nasal sprays. His patients take 2 weeks to see results, and cryotherapy is effective in 80% of his patients. He notes that patients with recurrent rhinitis may need recurrent treatments.

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RESOURCES

Stryker ENT

https://www.stryker.com/us/en/portfolios/medical-surgical-equipment/ent.html

Stryker ClariFix Cryotherapy

https://clarifix.com/

RhinAer Radiofrequency Ablation

https://rhinaer.com/

Ep. 108 How Do I Negotiate My Physician Contract? Part II with Michael Johnson Jr. Esq

Thu, 04 May 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Varun Varadarajan speaks with Michael Johnson, a business lawyer, about advice for negotiating academic and hospital employment contracts.

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/0aliK0

---

SHOW NOTES

First, the doctors talk about the RVU system of compensation used by many hospitals and academic centers. They discuss what the price per RVU means and additional bonuses after the expected RVU goal is met. Michael adds that it may be beneficial to negotiate for more resources to earn more RVUs instead of negotiating more compensation, as the former strategy can lead to higher compensation. Additionally, he notes that subspecialty clinicians and surgeons have more leverage to negotiate their contracts if they are the first subspecialists in a large system. He recommends that physicians start negotiating at least a year in advance of their anticipated start date. They also discuss the compensation models based on productivity versus a flat salary.

Then, the doctors explain how to handle verbal offers from academic centers. Michael recommends talking to multiple employers at a time when starting the hiring process in order to weigh multiple options. However, he recommends physicians to be upfront about where they are interviewing with each employer. He notes that some academic institutions will send a letter of appointment, and not an employment contract, but physicians can still negotiate for firm deal breakers in the letter of appointment. He then explains different clauses in the contracts, such as restrictive covenants (non-compete and non-solicit clauses), non-disclosure agreements, and malpractice tail insurance. He advises against comparing salary offers to the MGMA compensation data, as different jobs require different obligations. Instead, he recommends making sure that the compensation matches the job obligations.

Finally, the doctors end the episode with reviewing common employer tactics, such as pressuring doctors to sign contracts quickly and only offering negotiation on the base salary and signing bonus. Michael explains that it is worthwhile to engage in higher levels of administration in the negotiation process if necessary.

---

RESOURCES

Michael Johnson’s Website:

https://www.michaeljohnsonlegal.com/physician-contracts/

Michael Johnson’s Instagram:

https://www.instagram.com/physiciancontracts/

Episode 45- Private Equity: Savior or Existential Threat?

https://www.backtable.com/shows/ent/podcasts/45/private-equity-savior-or-existential-threat

Ep. 107 How Do I Negotiate my Physician Contract? Part I with Michael Johnson Jr. Esq

Tue, 02 May 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Varun Varadarajan speaks with Michael Johnson, a business lawyer, about evaluating and negotiating physician employment contracts in private practice and academic settings.

---

EARN CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/nqV1Cs

---

SHOW NOTES

First Michael explains how hiring a contract lawyer can help physicians understand their employment contracts and prioritize their negotiations. He notes that there are pros and cons to all of these contracts, but they are not written to be read very easily by people without legal backgrounds to understand. He adds that although local lawyers may have intimate knowledge of the geographic area, finding a physician contract lawyer is most important. Then, he explains the “trinity of physician contracts”, which are the three most important factors of employment: compensation, obligations, and exit strategy. Additional clauses include non-compete clauses, non-solicit clauses, and malpractice tail expenses. He explains that accepting a base salary does not prevent future salary negotiations.

Next, Michael talks about private practice contract considerations, such as business risks, salary growth, the potential of selling the practice, private equity, and partnership tracks. He advises delaying partnership track if buy-in is too high or if the physician has different financial priorities. Advantages to partnership include more decision-making, autonomy, and ancillary revenue. Other factors he advises to research before signing a contract include payer mix distribution and the distribution of patients. He briefly explains what hospital recruitment agreements are. Although they may offer more competitive salaries than a stand alone private practice contract, they are often more complicated to understand.

Then, he discusses academic medicine contracts, which can offer different opportunities than just increased profits. He warns physicians to be aware of changes in administration and department turnover, as these events can lead to unplanned and unwanted shifts in obligations. He also notes that through the RVU system, teaching and administrative duties are not compensated. Thus, one of his goals is to protect physicians from being overworked.

---

RESOURCES

Michael Johnson’s Website:

https://www.michaeljohnsonlegal.com/physician-contracts/

Michael Johnson’s Instagram:

https://www.instagram.com/physiciancontracts/

Episode 45- Private Equity: Savior or Existential Threat?

https://www.backtable.com/shows/ent/podcasts/45/private-equity-savior-or-existential-threat

Ep. 106 Operating Room Innovation: the ExplORer Surgical Story with Dr. Alexander Langerman

Tue, 25 Apr 2023 05:05:00 -0000

In this episode, host Dr. Bryan Hartley interviews head and neck surgeon and entrepreneur Dr. Alex Langerman about the story of his startup, ExplORer Surgical and his idea generation advice for physician-innovators.

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/5yb4nD

---

SHOW NOTES

Dr. Langerman starts by describing his journey into head and neck surgery and his University of Chicago research lab, where he conducted research over improvements in the operating room (OR) setting. The idea to make the OR more efficient stemmed from a conversation with a medical student who wondered why so many operating tools were opened and laid out, but never used. This question led him on a tour of different ORs around the country, where he learned that a lot of his colleagues shared the same frustrations about inefficiencies in the OR. When he returned to his institution, he visited different surgical departments and integrated their concerns into a roadmap of aspects that could be improved upon.

We also discuss the value of bringing in non-physicians who have fresh perspectives. Dr. Langerman sought feedback and help from business and design students, which eventually led to the incorporation of his company, ExplORer Surgical, and a pitch at the New Venture Challenge Competition. While he worked on communication with surgeons about minimizing waste in the OR, his co-founder, Jennifer Fried, led the effort to find investors. The company’s inflection point occurred when they shifted the focus away from healthcare institutions and towards medical device companies. The ExplORer Surgical app became a playbook that device companies could use to educate operators and ensure that their devices were being implemented in the exact way that they were intended to be used, thus ensuring consistent outcomes and minimizing complications. It also offers a way for sales representatives to virtually teleconference into the OR and guide operators through the procedure. During COVID, this technology became incredibly useful to ensure that collaboration between the OR and medical device companies could still continue. The company was eventually acquired by GHX Medical in 2021.

Dr. Langerman encourages physician entrepreneurs to try “idea harvesting,” defined as pitching your idea to others, in the effort to see what resonates with them and learn how to improve your pitch. Additionally, finding a team of business professionals that can help run day-to-day operations is a great way to free up time and energy for further idea generation.

---

RESOURCES

Dr. Alex Langerman Website:

https://alexanderlangerman.com/

New Venture Challenge Competition:

https://polsky.uchicago.edu/programs-events/new-venture-challenge/

SBIR and STTR Grants:

https://www.sbir.gov/about

Social Physics by Alex Pentland:

https://www.penguinrandomhouse.com/books/314230/social-physics-by-alex-pentland/

Ep. 105 Difficult Conversations with Dr. Melanie Sulistio

Tue, 18 Apr 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Melanie Sulistio, associate dean of student affairs at UT Southwestern, talk about the importance and art of having difficult discussions with patients and medical colleagues.

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/ZCPAAr

---

SHOW NOTES

First, Dr. Sulistio explains why the humanity in medicine is centered on a foundation of communication between patients and physicians. She emphasizes that scientific advancements cannot help society if physicians cannot communicate them to their patients. Then, she gives examples of obstacles that may make communication challenging, such as an unfortunate diagnosis, language barriers, family dynamics, biases, cultural backgrounds, and different goals and priorities of each party.

She suggests strategies to overcome these barriers, such as scheduling the appropriate length of time to share the news, checking that it is a good time for the patient to receive the news, and making sure the provider themselves are emotionally ready to share news. She encourages providers to show emotion, but not to the point that the patient has to comfort them. Dr. Sulistio also emphasizes including the support system of the patient in the discussion and evaluating what the patient understands about their condition before beginning the discussion. She warns against assuming that you know what the patient is feeling, bringing up personal experiences, and apologizing inauthentically. Body language cues are also important, such as eye contact and pulling up a chair to meet the patient at their level. She recommends speaking to the nurses, techs, and medical assistants about the patient before entering their room, as they have the most exposure to the patient everyday.

Next, the doctors discuss how to deal with language barriers and translation services. Dr. Sulistio notes that physician humility is an important aspect to these discussions, as providers should never make non-English speaking patients feel like a burden to treat. She notes that although wording may be lost in translation, physicians need to remind themselves to speak to the patient instead of to the translator.

Finally, Dr. Sulistio gives advice about having difficult conversations with medical colleagues and trainees. Before entering these discussions, she makes sure to check on her own implicit biases and emotions. She proposes the idea of compassionate assumption, or believing that other people are always doing the best they can in every scenario. In her opinion, simulation is the best method for teaching medical trainees how to navigate difficult conversations.

---

RESOURCES

Dr, Sulistio’s Grand Rounds Presentation at the Mayo Clinic:

https://mssvideoupload.mayo.edu/media/Creating+a+Culture+of+Diversity+on+a+Personal+Level%2C+Navigating+Hard+Conversations/1_58oap0g7

Think Again: The Power of Knowing What You Don’t Know by Adam Grant:

https://www.amazon.com/s?k=think+again+adam+grant+paperback&hvadid=496397429222

Brené Brown podcasts:

https://brenebrown.com/podcasts/

Abraham Verghese books:

https://www.abrahamverghese.org/books/

Atul Gawande books:

http://atulgawande.com/books/

Ep. 104 Microtia Surgery in Children with Dr. Mai Thy Truong

Tue, 11 Apr 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah discusses microtia repair techniques with Dr. Mai Thy Truong, fellowship director of pediatric otolaryngology at Stanford University.

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/U3ERR8

---

SHOW NOTES

First, the doctors discuss the preoperative workup for children with microtia. Dr. Truong explains that it is very difficult to catch microtia or anotia in a prenatal ultrasound, so the diagnosis is usually a surprise at delivery. She takes time in explaining the diagnosis to the family with her co-surgeon and assesses the family’s emotions. Her follow up plan is to get the child fitted for hearing devices if needed and sets up conversations about preferential seating and FM systems in school. She will follow up with patients once every year; during these visits, she orders an audiogram and measures the length of the normal ear and chest frame. The length measurements of the normal ear help her get a sense of when the normal ear stops growing and the measurement of the chest frame helps her decide whether the rib cartilage is robust enough for surgery. She notes that ears will stop growing in length around 7-10 years of age and ear stops growing and that a chest frame size of 60 cm indicates that there is enough cartilage to make the entire ear. Once the family has decided on surgery, she orders a CT scan to learn about the temporal bone anatomy and other problems in the underdeveloped ear. Then, she works with computer programmers to create a 3D model of a mirror image of the normal ear to guide her carving during surgery.

Dr. Truong is trained to use the Firmin technique of microtia repair. This is a 2 stage procedure that involves harvesting rib cartilage and using it to carve out ear subunits. Her co-surgeon always harvests the graft from the ipsilateral rib cartilage while she creates the skin pocket where the new ear will be placed. Additionally, she explains how to avoid causing a pneumothorax and instruments needed for the rib cartilage harvest. She also emphasizes the importance of creating a harmonious skin pocket and warns listeners against manipulating the anterior blood supply of the ear by mistake. Then, she discusses how she carves the rib graft into 5 different subunits of the ear with an 11 blade and a 15 blade. She uses steel sutures to suture each part together using a particular order. Finally, she is able to put the ear framework into the skin pocket, close the incision site, and apply dressing.

Lastly, she explains her postoperative care of microtia repair patients. Her patients remain in the hospital for 3 days and receive antibiotics (Augmentin) for a week. She also obtains a chest x-ray after the procedure.

Ep. 103 Xerostomia: The Dentist's Perspective with Dr. Anushka Gaglani and Dr. Abhishek Nagaraj

Thu, 06 Apr 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Shah and Dr. Agan invite two comprehensive dentists, Dr. Abhishek Nagaraj and Dr. Anushka Gaglani, back to the show to discuss diagnosis and treatment of xerostomia.

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SHOW NOTES

First, the doctors explain common causes of xerostomia, which include multiple medications and comorbid conditions. Lifestyle factors, such as mouth breathing, alcohol consumption, tobacco usage, smoking, and dehydration can also contribute to xerostomia. Less common causes of xerostomia include Sjogren syndrome, chemotherapy, radiation, and radioactive iodine exposure. Then, they discuss how to perform a comprehensive xerostomia workup. Xerostomia is formally diagnosed by measuring the rate of salivary flow for 5 minutes. It can also be diagnosed through minor salivary gland biopsy, but this procedure is performed by ENTs or oral surgeons, not dentists. After taking a thorough patient history, dentists may be able to see evidence of xerostomia during physical examination through signs like fissures on tongue, halitosis, ill-fitting dentures, and angular cheilitis.

Then, the dentists explain the different treatments for xerostomia, from lifestyle changes to medications. They recommend that patients drink 60-65 ounces of water daily and brush at least two times a day. Fluoride mouthwashes and sugar-free lozenges may also help stimulate saliva production. Finally, a cholinergic medication like pilocarpine can be used if patients do not get better with non-pharmacologic intervention. Dr. Nagaraj also recommends that patients with xerostomia come in for dental cleaning four times a year instead of only twice because of their increased risk of developing dental caries. Finally, the doctors discuss how to distinguish the sensation of a dry mouth from the true diagnosis of xerostomia.

Ep. 102 When Providers Become Patients: Testicular Cancer and Beyond with Dr. William Flanary aka Dr. Glaucomflecken

Wed, 05 Apr 2023 05:05:00 -0000

In this episode of BackTable, Dr. Bagrodia interviews Dr. William Flanary, a physician-comedian popularly known as Dr. Glaucomflecken, about lessons he has learned as a two-time testicular cancer survivor and the importance of humor in medicine.

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---

SHOW NOTES

First, Dr. Glaucomflecken shares about his first diagnosis of testicular cancer. During his third year of medical school he felt a lump in his testicle, which led to a quick workup, diagnosis, and a full orchiectomy. The diagnosis was emotionally difficult, as he was in his mid-twenties and healthy. He returned to comedy, a skill he had developed in high school and college, to cope with his diagnosis. This time, however, he started to practice medical-based comedy with his new experiences as a medical student. He recounts other discussions he had about his cancer, such as fertility, the possibility of chemotherapy, and active surveillance.

Four years after his first orchiectomy, he received his second diagnosis of testicular cancer during his last year of residency. He recounts feeling distraught and overwhelmed, as questions about fertility, hormone replacement, medical expenses, and postponing residency became more serious. He decided to have a full orchiectomy and testosterone replacement therapy, which solved his issues with fatigue and irritability. Additionally, his wife got him involved in testicular cancer support groups and foundations, including one called First Descents, an organization that encourages young adults with cancer to explore the outdoors. He notes that young patients are often overlooked in cancer support groups and encourages cancer patients to find their support networks outside of friends and family as well.

Then, Dr. Flanary discusses his experience with suffering from cardiac arrest in 2020, which led to his wife doing ten minutes of chest compressions to keep him alive. He reflects on this event and concludes that it taught him how to be a better physician to his patients by making sure he involves patients’ families and encouraging him to address medical insurance issues directly.

Finally, Dr. Flanary discusses how he uses humor to advocate and educate patients on social media. He notes that comedy can stimulate conversation and debate and encourages physicians to have social media presence.

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RESOURCES

Knock Knock Hi Podcast

https://podcasts.apple.com/us/podcast/knock-knock-hi-with-the-glaucomfleckens/id1659572053

First Descents

https://firstdescents.org/

Ep. 101 Role of Dentistry in Head and Neck Cancer Patients with Dr. Abhishek Nagaraj and Dr. Anushka Gaglani

Tue, 04 Apr 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Shah and Dr. Agan speak with two comprehensive dentists, Dr. Abhishek Nagaraj and Dr. Anushka Gaglani, about common dentistry complaints and their treatments in head and neck cancer patients.

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SHOW NOTES

First, the dentists discuss the role of dental clearance before radiation or surgery initiation. Dr. Nagaraj explains that dental clearance is when dentists check for ulcers, dentures, caries, and any other issues that may bother patients from a treatment standpoint. He mentions that it is helpful for surgeons to specify which conditions they would like dentists to focus on in clearance assessments. Both dentists use a set of 5 clearance screenings and give either full or partial clearance. For minor dentistry treatments, they recommend waiting at least 14-21 days to start cancer treatment. For major dentistry treatments like root canals or wisdom teeth extraction, they recommend waiting for at least 4-6 weeks before major surgeries due to the different healing potentials of each patient.

Next, the dentists explain common side effects of radiation treatment, such as xerostomia, osteoradionecrosis (ORN), candidiasis, and mucositis. Dr. Nagaraj discusses how xerostomia can cause dental caries, which may result in a mandatory tooth extraction and ORN. He and dr. Gaglani recommend treating xerostomia with compounded mouthwashes, lubricants, xylitol, and fluoride toothpaste. They will use antifungals to treat candidiasis. For trismus, they recommend mouth stretching exercises and NSAIDs. Dr. Gaglani emphasizes the importance of upkeep dental hygiene routines in order to minimize the severity of these side effects. However, they both note that with the advent of intensity-modulated radiotherapy, less patients have complained about side effects of radiotherapy. Patients may also complain of post-radiation changes, such as ill-fitting dentures and loose dental implants due to decreased bone density and loss of osseous integration.

Finally, the ENTs and dentists speak about the importance of oral cancer screening in the dentist office. Both dentists perform a visual and tactile examination for all new patients, paying special attention to the tongue, floor of mouth, and lymph nodes. They end the episode by sharing ways how ENTs can collaborate better with dentists, such as encouraging patients to go in for regular dentist visits and specifying conditions they are concerned about during treatment.

Ep. 100 Tympanic Membrane Perforation in Children with Dr. Daniel Choo and Dr. Walter Kutz

Thu, 30 Mar 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah, Dr. Walter Kutz (UT Southwestern), and Dr. Daniel Choo (Cincinnati Children’s Hospital) discuss indications and repair techniques for tympanic membrane perforation in children.

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CHECK OUT OUR SPONSOR

Cook Medical Otolaryngology

https://www.cookmedical.com/otolaryngology

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---

SHOW NOTES

First, the doctors discuss the typical patient presentation of a child with a perforated tympanic membrane (TM). Tympanostomy tubes falling out are the most common causes of this condition. Trauma and suppurative otitis media can also cause a TM perforation. The doctors emphasize the importance of taking a thorough history and asking about previous tubes, craniofacial abnormalities, the function of the contralateral ear, and recent trauma. Then, they discuss physical exam techniques to inspect the affected ear. All agree that using a standard otoscope is most useful in clinic, as the endoscope is more useful in the OR. Additionally, Dr. Choo notes that he usually streams the inspection on video monitors on the wall for kids and families to see.

Not all children with TM perforations have to undergo tympanoplasty. If there is a small perforation without hearing loss, watchful waiting may be appropriate. However, Dr. Kutz adds that if there is evidence of cholesteatoma or severe hearing loss, repair may be the best option after explaining all options to the parents. The doctors then weigh the risks and benefits of immediate TM repair versus watchful waiting and assess whether size and location of perforation matter. They conclude that the functional status of the children, evident through school performance and language development, have an important contribution when choosing a treatment option as well.

Next, the doctors discuss different tympanoplasty techniques, including different types of grafts (cartilage, fat, synthetic, etc.), ways to shape the grafts, and taking a microscopic versus endoscopic approach to the repair surgery. They also discuss common causes of failure and postoperative complications. Finally, they each explain their postoperative regimens and alternative rehab options if hearing does not improve enough after surgery.

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RESOURCES

Cook Medical

https://www.cookmedical.com/otolaryngology/

Ep. 99 Management of Zenker’s Diverticula with Dr. Rebecca Howell

Tue, 28 Mar 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Ashley Agan interviews Dr. Rebecca Howell, division chief of laryngology at University of Cincinnati, about her diagnosis and management of Zenker’s diverticulum.

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Cook Medical Otolaryngology

https://www.cookmedical.com/otolaryngology

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---

SHOW NOTES

First, Dr. Howell explains that Zenker’s diverticulum (ZD) is a swallowing disorder caused by abnormal outpouching in the esophagus. ZD is only a herniation of the mucosal layers instead of all three tissue layers, so it is classified as a false diverticulum. To have a diagnosis of ZD, patients must have evidence of cricopharyngeus muscle dysfunction and congenital dehiscence. Oftentimes, these patients are in their seventh decade of life and will have problems with regurgitation. Dr. Howell also explains how to distinguish ZD from other differential diagnoses such as pure cricopharyngeus muscle dysfunction and nutcracker esophagus. She notes that a typical ZD patient will have a “rising tide”, or the ability to elicit frothy secretions as they talk.

Next, the doctors discuss different surveys used to diagnose and assess ZD severity. Dr. Howell also speaks about her current prospective study to determine risk factors and prognosticators of ZD. She explains that in general, men and women are affected evenly by this condition and that endoscopy has allowed the earlier diagnosis of ZD patients. Some important factors she always asks while history taking are: previous surgeries, the patient’s motivation for pursuing surgery, and the presence of neurologic diseases. Next, the doctors discuss different imaging modalities like flexible endoscopy, barium swallow studies, EGD, and manometry. Dr. Howell sees lots of potential in the field to develop and standardize workup for ZD diagnosis. While analyzing imaging studies, she also looks for concurrent diagnoses, such as paraesophageal hernia and hiatal hernia.

Then, Dr. Howell discusses how she counsels patients about treatment options for ZD. She frames ZD as a quality of life issue instead of a necessary surgery for everyone. If her patient does not choose to pursue surgery, she makes sure that they are aware of future red flags, such as pneumonia hospitalization and unintentional weight loss. The doctors also weigh the pros and cons of using an endoscopic versus open surgical approach. Based on Dr. Howell’s studies, there is no difference between both approaches, so surgeons should choose the method they prefer more. She summarizes her endoscopic technique, including her list of equipment and how she collaborates with anesthesia providers. Finally, she summarizes her postoperative care regimen and explains how she deals with leaks, an uncommon but serious complication of ZD surgery.

Ep. 98 Health Equity Collaborative in ENT with Dr. Alexander Chiu and Dr. Romaine Johnson

Thu, 23 Mar 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah, Dr. Romaine Johnson (UT Southwestern), and Dr. Alex Chiu (University of Kansas) discuss health disparities research and the Health Equity Collaborative.

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---

SHOW NOTES

First, Dr. Chiu explains the difference between equality and equity. Equality is giving everyone the same resources to reach a goal, while equity is giving people different resources based on their different background and obstacles to reach a goal. Health equity emphasizes the importance of the provider focusing on interpersonal relationships and caregivers of patients, not just on their patients as individuals. Dr. Johnson explains that although there are many research studies that prove the existence of inequalities, there are not enough research studies centered on how specific interventions can reduce disparities.

Then, Dr. Chiu explains the Health Equity Collaborative, an initiative to drive more health equity research in the field of ENT across different institutions. The collaborative was started in February 2022 in Kansas City. Dr. Chiu and his team quickly realized that they did not have the adequate volume of patients needed to achieve a sizable impact, so they reached out to more ENT researchers in different cities. The collaborative uses qualitative research methods, such as the qualitative structured interview, and then formulates objective metrics to analyze the results. Future goals of the collaborative include gaining the support of societies and using their evidence to change policies and advocate for minority patients. Dr. Chiu also explains obstacles he had to overcome when forming the collaborative and the benefit of working with a diverse team.

Finally, Dr. Chiu shares how his disparity research has affected his medical practice by making him a more patient physician. He listens closer to his patients to try and understand his patients’ decisions and non-compliance before judging them. He is also inspired by research initiatives from other medical specialties.

Ep. 97 Lifestyle Medicine in Pediatric ENT with Dr. Julie Wei

Tue, 21 Mar 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Julie Wei, president of the American Society of Pediatric Otolaryngology, discuss how lifestyle medicine can resolve common chronic pediatric ENT complaints.

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SHOW NOTES

First, Dr. Wei explains the “milk and cookie disease”, a condition she coined that relates to a triad of symptoms in children that include chronic cough, nasal congestion, and rhinorrhea. In her practice, she noted that consuming dairy and sugar products close to bedtime was directly correlated with the triad of symptoms. Thus, she emphasizes that diet is the main pillar in lifestyle medicine in children.

She then explains her general workup for pediatric patients. She notes that pediatric ENT patients often have multiple complaints, so it is helpful to categorize each as chronic or acute. She always asks how many total ounces of milk the child consumes in a day, the type of milk, and the timing of dairy consumption. She has noticed that excess consumption of sugary beverages, yogurt products, and flavored milk have correlated with increased ENT complaints in children. However, Dr. Wei emphasizes the importance of educating parents about a diet of moderation instead of judging or shaming them. Dr. Wei notes that in teenagers, sleep hygiene is even more important and that eating is tied to emotions and mental states.

She encourages pediatric ENTs to share previous patient stories and to be familiar with the American Academy of Pediatrics guidelines. Other techniques for family counseling include: prioritizing key changes for a short duration and giving specific action items. She also explains how she created a pilot study and discovered that increased sugar consumption correlated with increased inflammatory cytokines.

Finally, she discusses her published books, blog posts, and online courses about the importance of lifestyle medicine in pediatric ENT.

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RESOURCES

“A Healthier Wei” by Julie Wei

https://www.drjuliewei.com/pages/a-healthier-wei

Dr. Julie Wei’s Blog

https://www.drjuliewei.com/blogs/news

Dr. Julie Wei’s Online Courses

https://drjuliewei.mykajabi.com/

Ep. 96 Airway Foreign Bodies in Children: Risk Reduction with Dr. Wolfgang Stehr

Tue, 14 Mar 2023 05:05:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah discusses a lean approach to pediatric airway foreign body aspiration with Dr. Wolfgang Stehr, a pediatric surgeon and medical director of surgery at Presbyterian Healthcare in Albuquerque.

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SHOW NOTES

First, the doctors discuss the typical presentation of a pediatric patient who has aspirated an object. They agree that the most common scenario is a toddler choking on a nut, but older kids can also be affected. Dr. Shah notes that although severe aspiration cases can result in respiratory distress, most patients often look fine upon arrival to the ER. For this reason, an experienced clinician should listen for whistling sounds from the bronchi or the lack of breath sounds. Because X-rays can fail to visualize the object, witnessed history of a child choking is very important to consider. Differential diagnoses include reactive airway disease, asthma, pneumonia, and a viral URI.

Next, Dr. Stehr discusses how he implemented the lean process improvement system into the foreign body aspiration bronchoscopy procedure at his hospital. He was motivated to develop a more efficient process after realizing that the most difficult part about a bronchoscopy was putting together the equipment. The lean system is built on the principle that there needs to be a correct order for standardized steps in a procedure in order to reduce waste and train staff more efficiently. He used the “5 S’s” to organize the equipment in the ENT cart, which stands for: sort, set an order, shine, standardize, sustain. Additionally, he gives tips for physicians wanting to start their own quality improvement programs, such as including staff in decision making, having the most resistant stakeholder in the room first, prioritizing the case of patient safety, and inviting collaboration between different specialties when appropriate. He mentions that it is helpful to have a lean expert guide the quality improvement process in the beginning; eventually this third party consultant will train an internal employee to manage the lean process themselves. He also discusses the kaizen workshop, in which his team broke down a process, evaluated each step, and put it back together in a more efficient way. PDSA (Plan, Do, Study, Act) is another helpful framework he recommends.

Finally, he discusses how he measured the efficacy of his lean intervention. He used surrogate measures of time and success, which included watching techs and nurses assemble bronchoscopy equipment while timing them and seeing how many drawers they had to open to gather all the materials. Although he had favorable results, he emphasizes the importance of always being open to new ideas for improvement.

Ep. 95 Matching into ENT Residency as an International Medical Graduate with Dr. Amal Isaiah

Thu, 09 Mar 2023 06:05:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Amal Isaiah, a pediatric otolaryngologist at the University of Maryland, discuss how to apply to US residency programs as an international medical graduate (IMG) and the unique challenges applicants may face during the process.

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---

SHOW NOTES

First, Dr. Isaiah recaps his medical journey, which took him from India to the UK for a PhD, and then to the US for residency and fellowship. Then, he explains what IMG applicants can do to strengthen their applications before applying. He emphasizes the importance of making connections to the American programs through doing research work. These positions can be obtained through cold calling and emails, but he notes that there are also tenures and society fellowships available. Unfortunately, many of these positions are usually unpaid. Dr. Isaiah recommends that international medical students pursue postgraduate training in their home country and spend 5-6 years in the United States doing research before applying to US residency programs. There is a less common, alternative way to match into residency by first completing an unaccredited US fellowship program and then applying for residency.

Dr. Shah and Dr. Isaiah also discuss board exams for IMGs, which include Step 1, Step 2, and Educational Commission for Foreign Medical Graduates (ECFMG) certifications. They agree that letters of recommendation and personal statements are important. Dr. Isaiah recommends that IMG applicants read US applicant essays and have their mentors look over their essays for language and grammar revisions. Finally, the doctors discuss the different types of visas that are needed for IMG residents and attendings (i.e.- H-1 visa, J-1 visa) and differences between visas, sponsorships, and green cards. He notes that the process of obtaining a visa has been made more challenging by the COVID-19 pandemic.

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RESOURCES

ASPO Fellowships

https://aspo.us/page/fellowshiplisting

Dr. Isaiah’s LinkedIn Profile

https://www.linkedin.com/in/amal-isaiah-a6a71b6/

Ep. 94 What’s New in the ENT Residency Match Process? with Dr. Sarah Bowe

Tue, 07 Mar 2023 06:05:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah, Dr. Ashley Agan, and Dr. Sarah Bowe discuss new developments in the ENT residency match process as well as advice for future applicants.

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---

SHOW NOTES

First, the doctors explain new policies in the match process. In 2015, the merging of osteopathic and allopathic accreditation systems began, which led to a single accreditation system combining osteopathic and allopathic accreditation in 2021. In 2022, the USMLE Step 1 exam switched to a pass/fail system from a numerical scoring system. The doctors note that although Step 1 scores used to be an application filter, research has shown that there is no correlation between scores and success during residency. Dr. Bowe notes that many programs deemed it necessary to filter using Step 1 scores because residency applications take a long time to read through. Additionally, standardized test scores do correlate well with board passage rates. Dr. Agan mentions that programs may use Step 2 scores as a replacement for Step 1 scores, leading some applicants to feel conflicted about having a Step 2 score before submitting their ERAS application. However, there have not been set Step 2 metrics for filtering applicants yet.

Next, the doctors discuss reading through applications from a program perspective. Dr. Bowe explains that bigger programs have bigger faculty, which means more application readers are available. Some programs will set unique filters to screen for IMG applicants or career goals. Then, she discusses the use of the new signaling program, an initiative that distributes applicants a certain number of tokens to indicate their programs of interest. Signaling can equalize the playing field for applicants who do not have a home ENT program or do not have the resources to do as many sub-internship and away rotations as they would like. Additionally, signaling may serve as a surrogate application cap for programs.

Finally, the doctors explain other parts of the residency application, such as letters of recommendation, research, and gap years. Because almost every ENT applicant is listed as “above average” on the standardized application, Dr. Bowe emphasizes the importance of the narrative sections of letters. Additionally, many programs allow additional space on the application to let students explain more about their background and hardships. Dr. Bowe concedes that research is important on an application, but it depends on the resources of each applicant’s home institutions as well as their non-academic priorities, like part-time jobs. Additionally, in her opinion, a gap year to do research should only be taken if the applicant is aspiring to be a clinician scientist. Dr. Shah emphasizes the importance of taking a gap year because of personal interest, not for a stronger application. Finally, Dr. Agan speaks about differences between in-person and virtual interviews. There are cons of virtual interviews, such as interview hoarding and lack of interpersonal and environmental connection, but benefits include lowering expenses and environmental impact.

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RESOURCES

Head Mirror Website

https://www.headmirror.com/

National Otolaryngology Interest Group

https://www.headmirror.com/noig

ENT in a Nutshell Podcast:

https://podcasts.apple.com/us/podcast/headmirrors-ent-in-a-nutshell/id1504305051

Ep. 93 How to Take a Leave of Absence with Taymi Santiago

Fri, 24 Feb 2023 06:05:00 -0000

In this episode of BackTable ENT, Dr. Julie Wei brings Taymi Santiago, a human resources partner, about the process and benefits of taking a leave of absence.

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SHOW NOTES

First, Santiago recounts why she chose a career in HR, which gave her the ability to support others. She explains various reasons for taking a leave of absence, such as personal illness or illness of loved one, maternity/paternity leave, bereavement, education, adoption/foster care, care of elderly parents, and many more. She notes that physicians often ask for a leave of absence when their situation is already dire and there are no other options. Dr. Wei adds that many physicians may feel guilty for feeling like they have abandoned their patients and burdening their colleagues.

Next, Dr. Wei and Taymi discuss the basics of taking a leave of absence. Dr. Wei notes that HR may have negative connotations for physicians. However, Santiago explains that HR departments deal with behavioral issues and conflict management, but help with much more than just employee relations. Generally, a leave of absence is considered to be 12 weeks within 12 months that can be taken off in a continuous or fragmented pattern. They also discuss the various types of leaves that are available, such as short term leave, long term leave, and FMLA. One distinction Santiago makes is the difference between in-house versus third party leave management. For companies that outsource third parties to manage leave of absence paperwork, employees may miss out on company-specific benefits due to a lack of knowledge. For this reason, she recommends that physicians know the contact information of HR personnel at their own company.

Dr. Wei and Santiago also emphasize the two most important aspects of a leave of absence, which are job protection and wage benefit replacements. Finally, they end the discussion by discussing the harmful consequences of not prioritizing physician wellness.

Ep. 92 Disability Insurance for Physicians 101 with Dr. Stephanie Pearson

Thu, 23 Feb 2023 06:05:00 -0000

In this episode of BackTable ENT, Dr. Julie Wei discusses navigating disability insurance as a physician with Dr. Stephanie Pearson, a former OB/GYN who started her own personal insurance brokerage firm.

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SHOW NOTES

First, Dr. Pearson shares about her struggle with disability. Early in her career, she suffered a traumatic injury that led to the development of a frozen shoulder and ended her clinical practice. Her group disability insurance did not cover work-related injuries, and she had to sue in order to receive her worker’s compensation insurance. She did not feel like she was properly educated about insurance policy and was promptly terminated from her OB/GYN job after her medical leave was over. Her emotional recovery was challenging, but she found support from her spouse, children, and dog. She eventually found her identity outside of her role as a physician, which helped ease her guilt of being a financial burden on her family.

Her personal disability journey motivated her to co-found a personal insurance brokerage firm with an insurance broker. PearsonRavitz was started five and a half years ago and has nationwide clients, the majority of whom are medical professionals. She frequently gives online and in-person lectures about the importance of buying disability insurance to residents and new attendings. Dr. Wei agrees and compares working in a surgical subspecialty to physical labor, as repetitive motions may increase injury risk.

Both doctors agree that standardized education for residents and medical students about disability insurance is needed. Some common myths that Dr. Pearson debunks the myths that group insurance benefits are adequate, healthy doctors do not need insurance coverage, and residents cannot afford disability insurance. Finally, the doctors end the episode by discussing unique health concerns of female surgeons, such as Infertility risk and delivery complications.

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RESOURCES

PearsonRavitz

https://pearsonravitz.com/

Ep. 91 Financial Well-Being for Physicians with Marshall Gifford

Wed, 22 Feb 2023 06:05:00 -0000

In this episode of BackTable ENT, Dr. Julie Wei speaks with Marshall Gifford, an expert in financial physician well-being, about benefits of financial planning and financial tips for residents transitioning into independent practice.

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SHOW NOTES

First, Gifford explains that the transition from residency to independent practice is a window of opportunity for earning compound interest, even for physicians with debt. He explains that investment will help physicians earn money from having money, so they can stop trading more hours for dollars. In his opinion, the benefit of financial advisors is to help people take action and engage in more complex financial discussions. He notes that blogs, like The White Coat Investor, can be helpful supplements to financial advising.

Dr. Wei also inquires about the intersection of physician burnout and poor financial wellness. Gifford confirms that from his personal experience as an advisor, physicians who are financially stressed often feel stressed at work as well. He motivates graduating residents to save 20% of their paycheck, because the average debt for residents is $200-400k. Next, Gifford moves onto discussing common financial mistakes that physicians make; some physicians do not understand the economics of their decision, leading them to take out more loans than their salaries can sustain. Dr. Wei agrees that delayed gratification can be a challenging principle to practice, especially as trainees see their peers in non-medical careers prioritizing expenses other than paying off their debts. Gifford also shares financial pearls, such as setting up a system of automated saving from paychecks and consulting a financial advisor before big purchases, in order to prioritize expenses. He also recommends that physicians maximize their 401k, even if they have debt, and to enroll in life and disability coverage. He recognizes that finding the right financial advisor can be difficult, as many certifications for financial advising exist. However, he believes that experience of the individual matters more than certifications. He encourages physicians to have a general conversation about physician-related financial concerns, such as asset protection in lawsuits, with a potential financial advisor in order to assess knowledge and skill set. Additionally, Gifford touches on divorce and advises both parties to keep legal costs to a minimum and to consider prenuptial agreements.

Finally, he lists four actions that residents can take now to establish financial wellness: understanding their debt, setting up an emergency fund, protecting their income, and maximizing their Roth IRA accounts.

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RESOURCES

White Coat Investors Website

https://www.whitecoatinvestor.com/

BackTable ENT Episode 53: Financial Basics from the White Coat Investors

https://www.backtable.com/shows/ent/podcasts/53/financial-basics-from-the-white-coat-investor

Real Life Financial Planning for the New Physician by Todd D. Bramson and Marshall W. Gifford

https://www.amazon.com/Real-Life-Financial-Planning-Physician/dp/B09HJ3Y791/

Ep. 90 Coaching Physicians Through the Stress of Malpractice Litigation with Dr. Gita Pensa

Tue, 21 Feb 2023 06:05:00 -0000

In this episode of BackTable ENT, Dr. Julie Wei speaks with Dr. Gita Pensa, an emergency medicine physician, about her journey to becoming a physician coach.

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SHOW NOTES

After enduring a 12 year malpractice lawsuit, Dr. Pensa explains why she chose to become a physician coach focused on helping physicians maintain their wellness through malpractice lawsuits. She started out by creating her own podcast to release 11 episodes about malpractice litigation basics. Once she realized her podcast was beneficial to many physicians, she started accepting speaking engagements and monetizing her skillset as a coach. To Dr. Pensa, physician coaching is not therapy for litigation. She doesn’t ask about details of the case that have happened, but she does help her clients reflect on the thoughts and feelings that impact their actions and reactions to their cases.

Additionally, the doctors discuss Dr. Pensa’s client distribution in terms of sex and specialty. They also reflect on the relationships of malpractice attorneys with physician coaches. Although some attorneys may push back because of privacy concerns, some attorneys include Dr. Pensa on the team. She always tries to frame physician coaching as a wellness aspect of litigation period, not a substitution for legal advice. Finally Dr. Pensa ends the episode by talking about rising physician suicide rates and physician disillusionment.

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RESOURCES

Dr. Gita Pensa’s Website

https://doctorsandlitigation.com/

Doctors and Litigation: The L Word (11 podcast episodes)

https://doctorsandlitigation.com/podcast-2

BackTable ENT Episode 42- Physicians and Litigation: The L Word

https://www.backtable.com/shows/ent/podcasts/42/doctors-litigation-the-l-word

The Upside of Stress: Why Stress Is Good for You, and How to Get Good at It by Kelly McGonigal

https://www.amazon.com/Upside-Stress-Why-Good-You/dp/1101982934

Ep. 89 Turbinates, Nasal Congestion, and the Dreaded Empty Nose with Dr. Jayakar Nayak

Tue, 14 Feb 2023 06:05:00 -0000

In this episode of BackTable ENT, Dr. Shah and Dr. Agan discuss turbinate hypertrophy, turbinate reduction, and empty nose syndrome with Dr. Jayakar V. Nayak, associate professor of otolaryngology at Stanford University.

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SHOW NOTES

First, Dr. Nayak gives an introduction to nasal obstruction, which may be present in patients presenting with congestion or a “stuffy nose”. Common causes of nasal obstruction include a deviated septum, nasal polyps, large adenoids in children, and turbinate hypertrophy. There are three sets of turbinates, and the inferior turbinates are located in the nose. The function of turbinates is to filter and warm incoming air. The majority of airflow happens in the lowest one third of the nose around inferior turbinates and base of middle turbinates. Turbinate hypertrophy is one of the most common causes of nasal obstruction. Dr. Nayak also notes that the same level of obstruction can affect individual patients differently.

Next, he explains his workup for patients with turbinate hypertrophy. He always asks about specific symptoms the patient is experiencing, being sure to analyze both the right and left nasal cavities. He also inquires about their current nasal regimen (i.e. use of sprays, moisturizers, ointments, gels, etc.), past surgeries, past trauma to the nose, and their breathing goals. Then, he performs an endoscopy on everyone in order to examine the anterior nasal cavity of the native nose before administering decongestant. If he observes turbinate hypertrophy, he will apply topical decongestant and observe if the patient’s symptoms are mitigated. He avoids using decongestant spray because they may irritate patients’ throats.

Dr. Nayak recommends a basic nasal spray regimen in all his patients with turbinate hypertrophy as a first line treatment. Benefits of nasal saline include clearing out mucus and drawing out fluid from tissues to reduce turbinate hypertrophy. Nasal steroid sprays like Flonase work well but other prescription sprays also exist. He notes that tolerance and side effects are usually rare, but possible reasons why medication might have to be changed or discontinued. Combination rinses are also available for patients with additional symptoms, such as allergies. If the conservative medical approach fails, he will move onto turbinate reduction surgery.

Next, he discusses a complication of turbinate reduction, which is empty nose syndrome (ENS). ENS occurs when too much tissue in the nose has been resected, leaving a massively open nasal cavity. Patients experience a wide variety of symptoms, such as difficulty breathing fully, nasal crusting, cold or burning air rushing into the nose, and congestion. Symptoms are assessed using the SNOT 22 score; a score above 11 on a scale of 0-30 indicates a possible ENS diagnosis. Dr. Nayak also explains his in-office blinded cotton test technique to accurately diagnose ENS.

Finally, Dr. Nayak discusses his turbinate reduction technique to reduce the probability of ENS. He only reduces the turbinate size while keeping shape and contour of the bone. He believes that a gradual and conservative reduction is better than a quick and excessive one. He also notes that there needs to be more standardization of turbinate reduction procedures worldwide and data on which techniques are best for preventing ENS as a postoperative complication.

Ep. 88 In-Office Management of Salivary Stones with Dr. Ashley Agan

Tue, 07 Feb 2023 06:05:00 -0000

In this episode of BackTable ENT, Dr. Shah and Dr. Agan talk about in-office management of salivary stones and tips for sialolithotomy.

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Cook Medical Otolaryngology

https://www.cookmedical.com/otolaryngology

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SHOW NOTES

First, Dr. Agan discusses the typical patient presentation of sialolithiasis, or salivary gland stones. Sialolithiasis patients have swelling and pain in their salivary gland when eating. Sialadenitis, or inflammation of the gland, may come first, but it is also possible for sialolithiasis to be discovered on incidental imaging. In either scenario, salivary stones are benign, and the most common gland affected is the submandibular gland. Dr. Agan usually gets CT imaging and uses ultrasound as an alternative if the patient prefers. Next, she discusses her physical examination of the gland. She uses her loupes and a headlight during bimanual palpation to find the stone in the gland. She observes saliva flow as well and assesses how comfortable a patient is with oral manipulation in order to gauge their candidacy for an in-office procedure. The ideal stone for an in-office sialolithotomy is a hard stone close to the punctum. For infected stones that elicit pus and inflammation, she sends patients home Augmentin or clindamycin for 10 days before performing the sialolithotomy.

Next, Dr. Agan discusses her in-office procedure for sialolithotomy. With the patient in supine position, she uses hurricane spray on gauze and puts the gauze on the floor of mouth before injecting local lidocaine at her incision site, which is directly on top of the stone. She uses an 11 blade and keeps holding stone while taking it out to avoid losing it in the mouth. She notes that posterior stones are not good for in-office procedures, as it is close to important landmarks, such as the lingual nerve. After she removes the stone, she uses a small volume of saline irrigation to flush out the duct. Then, if the patient is able to tolerate it, she performs a sialodochoplasty, a procedure in which she sutures to create a new formal opening from the gland to the oral cavity. She notes that this procedure may require more lidocaine injection and surgeons will have to distinguish between lumen of duct and normal oral tissue.

Finally, she covers her postoperative care regimen. She does not prescribe routine antibiotics unless there was an infection discovered during the procedure. She has no diet restrictions for her patients, but notes that acidic or sour foods may make the incision burn. She recommends Tylenol or Motrin for pain and follows up with her patients in 1-2 weeks after the procedure.

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RESOURCES

BackTable ENT Ep. 25 Sialendoscopy with Dr. David Cognetti:

https://www.backtable.com/shows/ent/podcasts/25/sialendoscopy

Ep. 87 Sudden Sensorineural Hearing Loss with Dr. Sujana Chandrasekhar

Tue, 31 Jan 2023 06:05:00 -0000

In this episode of BackTable ENT, Dr. Shah and Dr. Agan interview Dr. Sujana Chandrasekhar, a private practice neurotologist, about diagnosis and treatment of patients with sudden sensorineural hearing loss (SSNHL).

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Cook Medical Otolaryngology

https://www.cookmedical.com/otolaryngology

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SHOW NOTES

First, Dr. Chandrasekhar explains the formal definition of sudden hearing loss, which is a loss of 30 dB over 3 consecutive frequencies over 72 hours, and notes that it is usually unilateral. She explains that the time from hearing loss presentation to ENT referral is usually delayed, as many patients attribute their hearing loss to a cold, the flu, or allergies. Frequently, they are also told over phone to take nasal sprays or prescribed amoxicillin. However, severe / profound hearing loss with or without tinnitus and vertigo necessitates immediate ENT consultation. Upon initial presentation, she usually gets a thorough health history, review of systems, and medication list from the patient. Common causes of SSNHL include: pregnancy and other thrombotic states, stroke, injected or intravenous drugs, high dose aspirin, PDE-5 inhibitors, and COVID-19 infection. She also describes how she uses the physical exam to distinguish between conductive and sensorineural hearing loss. First, she checks the outer ear and visualizes the tympanic membrane to look for external pathologies. Then, she utilizes the Weber and Rinne tests on every patient.

Next, she explains her further workup for patients determined to have SSNHL. She emphasizes the need for retrocochlear examination to check for vestibular schwannoma, which is best done through MRI. If patients have MRI contraindications, a CT temporal bone with contrast paired with auditory brainstem response (ABR) testing may be an alternative option. Dr. Chandrasekhar explains that a single ABR test has a low specificity for vestibular schwannomas, missing up to 15-20% diagnoses. She also notes that patients with audiograms showing low frequency hearing loss have a better prognosis than those with high frequency hearing loss. Additional symptoms to look for are otalgia, erythema, healing vesicles, facial palsy, and blebs on the tympanic membrane. These symptoms may point to an infectious cause, such as syphilis, Lyme disease, and herpes zoster. Additionally, children may have syndromic causes of SSNHL.

Dr. Chandrasekhar also explains her treatment options for SSNHL of different severities. For patients with mild and moderate hearing loss, she prescribes an oral prednisone taper, which patients can stop taking if hearing comes back. Intratympanic steroid injections with dexamethasone may be implicated if patients with moderate SSNHL do not respond to oral prednisone. She explains her steroid injection technique as well as tips for how to make patients more comfortable during and after the procedure. For patients with severe SSNHL, she emphasizes the importance of self-training to listen in the affected ear, starting to wear hearing aids early, and considering BAHA devices. Then, the doctors discuss the value of additional therapies for SSNHL, such as acupuncture, hyperbaric oxygen, papaverine, and B vitamins. Finally, she speaks about intratympanic stem cell injections to regrow inner hair cells as an exciting future treatment of sudden hearing loss.

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RESOURCES

She’s on Call Podcast:

https://podcasts.apple.com/us/podcast/shes-on-call-weekly-medical-show/id1582727930

WHO Free Hearing Test:

https://www.who.int/teams/noncommunicable-diseases/sensory-functions-disability-and-rehabilitation/hearwho

Ep. 86 The Effects of the Omicron Variant of SARS-CoV-2 on Smell and the Immune Response with Dr. Puya Dehgani-Mobaraki

Tue, 24 Jan 2023 06:05:00 -0000

In this episode of BackTable, Dr. Puya Dehgani-Mobaraki, president of Associazione Naso Sano, discusses his research and his experience as a rhinologist with SARS-CoV-2 and its effect on the olfactory system.

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SHOW NOTES

First, Dr. Dehgani-Mobaraki explains the goals of the Associazione Naso Sano, which is to provide community education about rhinologic conditions, distribute research grants to young researchers, and host international grand rounds. Then, he discusses his own experience with SARS-CoV-2. He was infected with the virus in early 2020 and could not be tested because he had no upper respiratory symptoms, only anosmia. He also reflects on the research he did in 2020, which focused on immune adaptation after infection. His research group discovered that there was a strong relationship between antibody production and smell loss. He notes that later variants of the virus became more infectious, but not more lethal. After December 2021, he noticed that the virus mutations led to a different pathway of generating symptoms, resulting in more upper respiratory symptoms and less anosmia. Furthermore, he reminds listeners that smell and taste disorders are not unique to SARS-CoV-2 and can be triggered by Parkinson disease, Alzhiemer disease, brain trauma, and nasal polyposis.

Next, he speaks about his personal experience with treating patients with anosmia. Usually, COVID patients will regain their sense of smell any time from 20 days to 6 months after infection. However, some patients experience longer lasting parosmia, an altered quality of smell, and phantosmia, the perception of smell without stimulus. He notes that these symptoms can be difficult and distressing to patients. Smell and taste disorders can lead to weight loss and psychological disturbances, as these two senses are integral to community formation and pleasure. Although some patients can self-train to live with altered smell and taste, some may require medical consultation for a structured smell re-training plan or medications, such as oral steroids, PRP injections, zinc, or alpha-lipoic acid. Finally, Dr. Dehgani-Mobaraki speaks about his most recent research project, which may suggest that SARS-CoV-2 can reactivate Epstein Barr virus through autoimmune pathways.

Ep. 85 Surgical Management of Parathyroid Disease with Dr. David Goldenberg

Tue, 17 Jan 2023 06:05:00 -0000

In this episode of BackTable, Dr. Ashley Agan and guest co-host Dipan Desai (Johns Hopkins) interview David Goldenberg (Penn State) about evaluation and surgical management of parathyroid disease.

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SHOW NOTES

First, the doctors discuss the typical primary parathyroid disease presentation. Patients often report non-specific symptoms, such as fatigue, abdominal pain, sleep issues. Primary hyperparathyroidism is most common in perimenopausal women and is easily misdiagnosed. However, Dr. Goldenberg notes that an elevated serum calcium and PTH level on labs without other causes are diagnostic of primary hyperthyroidism. It is important to rule out other reasons for an elevated calcium level, such as malignancy, thiazides, and lithium. For borderline patients with slightly high parathyroid and calcium levels, the diagnosis is a clinical decision. Dr. Goldenberg may order more imaging studies or check labs again in 6 months. Furthermore, secondary parathyroidism is related to kidney disease and should be treated medically first.

Dr. Goldenberg utilizes a 4D CT scan to localize the overactive parathyroid gland. He notes that a majority of patients will have a single adenoma. Some may have multiple parathyroid glands affected (e.g. 4 gland hyperplasia), and 1% of his patients will have an aggressive parathyroid carcinoma. Parathyroid carcinoma patients usually present with incredibly high calcium and PTH levels. He notes that 4D CT is the most accurate imaging modality for parathyroid visualization; ultrasound is affected by air and bone and a SPECT scan will not detect small or flat adenomas.

Next, Dr. Goldenberg discusses his surgical technique. He makes a clavicle incision at midline and uses the middle thyroid vein to find parathyroid glands. If he is manipulating the superior thyroid glands, he is careful not to damage the recurrent laryngeal nerve. For a 4 gland exploratory surgery, he finds all 4 glands before taking any of them out in order to make sure he is taking out the right one. He can usually distinguish the parathyroid glands from the surrounding tissues because of their unique brown color. If he is unsure about whether the sample he took out is a parathyroid gland or another type of tissue, he will send frozen sections for pathologic analysis. Other pearls he has are: picking up the parathyroid glands from their capsule to preserve blood supply, always using nerve monitoring, and common anatomical locations for missing parathyroid glands. He checks the PTH level before operating and again 15 minutes after parathyroid gland removal to see if he removed the offending gland. If there is at least 50% drop from the baseline PTH level, he considers the surgery a success.

Then, Dr. Goldenberg summarizes his post-operative care. For patients who underwent exploration surgery, he usually keeps them in hospital for 23 hours. Simple parathyroidectomy patients can be discharged on the same day. Patients also receive a calcium taper with calcium carbonate because of the risk of hungry bone syndrome, a condition where serum calcium is depleted quickly because of rapid bone absorption, leading to hypocalcemic symptoms. Hyperparathyroid symptoms usually abate very quickly after surgery. Finally, he discusses his new textbook and atlas, which contains key points and pearls, quiz questions, annotated bibliographies, and surgical videos about head and neck endocrine surgery.

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RESOURCES

Head & Neck Endocrine Surgery: A Comprehensive Textbook, Surgical, and Video Atlas by Dr. David Goldenberg:

https://shop.thieme.com/Head-Neck-Endocrine-Surgery/9781684201464

Ep. 84 Your Implant Robot: The Future of Robotic Assisted Surgery with iotaMotion Founders Dr. Marlan Hansen and Dr. Christopher Kaufmann

Tue, 10 Jan 2023 06:05:00 -0000

In this crossover episode of BackTable, Dr. Eric Gantwerker interviews Dr. Chris Kaufmann and Dr. Marlan Hansen from the University of Iowa about their startup company, iotaMotion, which has developed the first FDA-approved robotic cochlear implant insertion system.

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iotaMotion

https://iotamotion.com/

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SHOW NOTES

First, Dr. Kaufmann and Dr. Hansen speak about their backgrounds and interests in entrepreneurship and engineering along with their medical focus. As otolaryngologists, both wanted to find a way to improve cochlear implant insertion in order to preserve cochlea function and structure. Their device, iotaSOFT, robotically assists surgeons during implantation and minimizes the risk of advancing the implant too far within the cochlea. They emphasize that this is a tool to assist surgeons, not change the technique with which they operate. They also note that their primary motivation was to help patients, so they were more concerned about safety and effectiveness rather than market competition and monetization.

Then, they speak about the development path of their product and start up company. They filed for intellectual property rights under the University of Iowa and then formed a startup company that licensed the technology in order to commercialize the device. They discuss how they slowly added more employees and consultants to their company and set phases and goals for hiring and fundraising. Next, they explain challenges they had to overcome, such as the FDA approval process and COVID-19 setbacks on their clinical studies. They noted that iotaSOFT has received support from many surgeons once they understood that the robotic system merely assisted their surgeries without taking any control away from them.

Finally, they discuss future plans for iotaSOFT such as integrating it with other devices and developing it further to be able to reside in the cochlea with the implant.

Ep. 83 Laryngopharyngeal Reflux with Dr. Inna Husain

Tue, 03 Jan 2023 06:05:00 -0000

In this episode of BackTable ENT, Dr. Ashley Agan interviews laryngologist Dr. Inna Husain about diagnosis, treatment, and multidisciplinary care of patients with laryngopharyngeal reflux (LPR).

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SHOW NOTES

First, Dr. Husain defines LPR as acidic and/or non-acidic reflux that causes direct and indirect effects on the upper aerodigestive system. She emphasizes the importance of utilizing subclassifications of LPR and explains the difference between direct acid, direct non-acid, and indirect acid reflux. She notes that each subclassification has different treatment patterns and that overlapping diagnoses can make classification difficult. Another challenge in diagnosing LPR is the need to distinguish chronic problems from isolated episodes. If a patient’s LPR is chronic, she suspects the indirect acid LPR subclassification.

During her primary visit with a patient, she asks key questions related to the root problem or sensation a patient is experiencing, such as mucus dripping, throat clearing, or globus. She notes the frequency and severity of their episodes. She also explains that unilaterality of sensation is unlikely to be LPR, and patients correctly diagnosed with GERD commonly have LPR. After taking an initial patient history, she utilizes flexible laryngoscopy to visualize the throat and rule out other diagnoses, such as polyps or tumors. She notes that she will not be able to see reflux through laryngoscopy, but just signs of throat irritation. Additionally, because there is not one defining visual characteristic of LPR, the imaging results are always interpreted through subjective means; thus, LPR is a diagnosis of exclusion.

For patients suspected to have LPR, Dr. Husain initiates empirical medical therapy. She explains to all her patients lifestyle modifications like cessation of smoking / vaping and reduction of coffee, late night eating, carbonated water, and citric foods. Although the conventional treatment of LPR is acid suppression, she only prescribes patients with proton pump inhibitors if they have acid reflux symptoms because 50% of LPR patients don’t actually improve on the medication. Her PPI regime consists of 40 mg omeprazole in the morning and Pepcid at night for 1-2 months. If patients improve, she slowly tapers them off of the PPI to avoid rebound reflux. If the patients do not improve after 2 months, she will switch to another medication, such as alginate suspensions, a more natural alternative to PPI. Alginate suspensions create a barrier that prevents the upward movement of acid. Contraindications include concurrent use with other acid suppression medications and a history of lower GI issues.

Finally, Dr. Husain discusses the 24-hour pH impedance testing, which is the gold standard for LPR diagnosis. A catheter with a probe is inserted into the patient’s throat and sends continuous pH readings to a monitor the patient carries. Patients return after 24 hours, and she is able to find correlations between patient symptoms and acid reflux and classify the LPR subtype. If she interprets any distal esophageal issues or dysmotility issues, she involves her GI colleagues to explore endoscopic solutions. She ends the episode by explaining her treatment regimen for refractory neurosensory (indirect) reflux, which includes neuromodulators (gabapentin, amitriptyline) or a superior laryngeal nerve block.

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RESOURCES

Dr. Husain’s Twitter:

https://twitter.com/Drinnahusain

Dr. Husain’s Instagram:

@innahusainmd

Ep. 82 Manejo Avanzado de Cancer de Cabeza y Cuello en Práctica Privada con Dr. Laureano Giraldez

Tue, 27 Dec 2022 06:05:00 -0000

En este primer episodio español de BackTable ENT, Dr. Carlos Torre entrevista al Dr. Laureano Giraldez sobre sus motivaciones y lecciones de empezar su práctica privada de laringología y cáncer de cabeza y cuello en Puerto Rico.

The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/zW5bUS

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SHOW NOTES

Primero, Dr. Giraldez discute su motivación y trayectoria de ser otorrinolaringólogo. Creció en una familia de médicos y le gustaba el otorrinolaringólogo debido a la diversidad del campo. Completó la residencia en la Universidad de Puerto Rico y entrenó en laringología en el Emory Voice Center. Entonces, desarrolló un interés en la reconstrucción del cáncer de la cabeza y cuello y añadió una especialización segunda en reconstrucción microvascular después de su entrenamiento en Mount Sinai.

Después, Dr. Giraldez habla sobre el proceso de abrir su propia práctica privada en Puerto Rico después de su cognición de la falta de otorrinolaringólogos puertorriqueños. Él enfatiza la importancia de las principales de organización para un cirujano joven. Cuando empezó, necesitaba preguntar que necesitaba del hospital y de la comunidad. Por ejemplo, reconoció su necesidad de una unidad de cuidados intensivos, la terapia de respiración, y la terapia de rehabilitación. También, él quería hacer cirugía robótica, así que necesitaba tecnología avanzada. Además, hace unas comparaciones entre la práctica privada en los Estados Unidos versus en Puerto Rico. Los doctores también discuten los cambios del campo de otorrinolaringólogo en Puerto Rico y sus colegas que están avanzando en la investigación y las técnicas quirúrgicas

Próximo, Dr. Giraldez habla sobre su población de pacientes. Dice que la mayoría de su práctica pertenece a la laringología y fueron recomendados por sus pacientes anteriores. Usó la red social, las publicaciones, y su sitio web para contactar pacientes nuevos. También, tiene algunos pacientes internacionales que están buscando tratamiento avanzado más barato pero de la misma calidad. Los doctores terminan el episodio con algunos consejos, como el beneficio del cambio y la importancia de ser autocrítico.

Ep. 81 Creating Culture Through Leadership and Mentoring with Dr. Christopher Kane

Wed, 14 Dec 2022 06:00:00 -0000

In this episode, Dr. Bagrodia discusses cultivating a healthy culture inside and outside of the operating room with Dr. Chris Kane, Dean of Clinical Affairs at UCSD and CEO of the UCSD Physician Group.

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SHOW NOTES

First, the doctors discuss the definition of culture, which Dr. Kane defines as the norms of behavior and relationships within an organization. Culture can include dress code, meeting rules, and punctuality. Most of the time, institutional culture is established in an unspoken way. Dr. Kane emphasizes the importance of having a conscious strategy to create a healthy culture and reiterates that trust is a crucial foundation for motivating cultural changes.

Next, the doctors discuss helping team members find meaning in their work. Dr. Kane recommends that surgeons share patient gratitude with their other colleagues who are not frontline medical workers. He acknowledges his staff’s contributions during meetings and expresses his gratitude through written notes. He also recommends communication training for everybody on his team. Then, he shares tips for assessing organizational culture. He believes that it is most important to ask team members what they think the overarching goal of the institution is and to assess the attrition rate through exit surveys. He emphasizes that behavioral norms matter most, as department leaders often lead by example. One detrimental practice is favoritism, which Dr. Kane regards as disrespectful to other team members. Additionally, he shares his personal experiences with changing cultures at different institutions and utilizing change management theories.

Finally, Dr. Kane shares general leadership advice. He highlights the importance of creating a patient-centered environment, leading by influence rather than authority, and the power of positivity.

Ep. 80 Who is the Future Otolaryngologist? with Dr. Al Merati

Tue, 13 Dec 2022 06:05:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Ashley Agan interview Dr. Al Merati, chief of laryngology at the University of Washington, about the changing demographics of otolaryngology trainees.

The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/Jmho17

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SHOW NOTES

First, the doctors discuss the pros and cons of selecting trainees in a competitive specialty like otolaryngology. Dr. Merati also notes that applicant trends may fluctuate between years and that residency programs are becoming more diverse. He also recommends normalizing all career choices by encouraging professors to support trainees who want to practice community otolaryngology instead of becoming academic otolaryngologists. Although teaching and mentorship are highly valued within the field, he believes that trainees should not have to conceal their career aspirations in order to obtain a residency spot.

Dr. Merati then discusses the importance of considering diverse trainee experiences. He notes that many talented otolaryngology trainees had to overcome hardships, financial difficulties, and lack of medical mentorship to achieve their goals. For this reason, he questions the feasibility of unmatched students taking a research year. He believes that alternative options to a research year, such as accepting a surgical internship or exploring entrepreneurship opportunities, are equally commendable. He notes that although older generations of otolaryngologists may be cautious about nontraditional trainees, younger generations of attendings are excited to explore the potential and curiosity of non-traditional trainees.

Finally, the doctors discuss constant values in otolaryngology. Dr. Merati notes that being caring and communicative to patients and colleagues is universal across every field. He adds that it may be hard to demonstrate these values everyday because of burnout and debt. Additionally, he believes that being a trainee is more difficult than it used to be. In his opinion, current residents have to deal with the constant intrusion of work life into personal life and have a weaker perception of mastery because of the exponential growth of different surgeries and techniques.

Finally he lists the three elements he believes to be the most important steps to keep recruiting talented and passionate trainees: investing in outreach to younger students, normalizing all career paths, and including community otolaryngology in residency curriculum.

Ep. 79 Building a Microtia Program in Thailand with Dr. Dhave Setabutr

Tue, 06 Dec 2022 06:05:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah interviews Dr. Dhave Setabutr, assistant professor of otolaryngology at Thammasat University, about building a microtia repair program in Bangkok, Thailand.

The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/Jz2h8d

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SHOW NOTES

First, Dr. Setabutr explains his path through otolaryngology and microtia training and his motivation to move his family and practice to Thailand. Then, he explains how he transitioned from practicing in the United States to practicing in Thailand after he was notified of an opening for an English-speaking otolaryngology professor at a university hospital. He notes that pediatric otolaryngologists are scarce in Thailand, a country of 60-70 million with only 15 fellowship trained pediatric ENTs.

Next, he describes his microtia repair team, which consists of many different specialties, such as a facial plastics surgeon and audiologists. He emphasizes the importance of operating with a co-surgeon in the initial building of a microtia program. Additionally, he delineates differences in the Thai health care system that changed the way he manages his microtia patients. For example, although many of his patients have unilateral microtia, they cannot afford BAHA devices or hearing aids for the contralateral ear because the government does not provide funding for these devices. Also, there is no option to install an FM system in the classroom to amplify sounds for children with hearing deficits. Finally, he only uses rib harvest for reconstruction because it is the most cost-effective technique. Although Thailand has recently implemented universal newborn hearing screenings, many health gaps must be addressed before improving treatments of hearing loss in Thai children.

Then, Dr. Shah and Dr. Setabutr discuss tips on having the initial conversation with parents of a pediatric microtia patient. Because microtia is undetectable on ultrasound, many parents are surprised during the birth of their children. Additionally, parents may have difficulties dealing with this condition because there are no abundant parent support groups for microtia. Dr. Setabutr recommends being able to summarize information in a way parents can understand and to ease their concerns about hearing and development.

Finally, he delves into the technical aspects of microtia repair, including the grading system and surgical procedure. He usually only performs the three-stage surgery on children with grade III microtia who have enough rib cage cartilage to construct a pinna. He keeps the patients in the hospital until their shunts can be removed due to poor wound care resources in Thailand. Finally, he emphasizes the importance of gaining patient and family support before performing the repair surgery.

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Ep. 78 Leadership in Pediatric Otolaryngology with Dr. Dana Thompson and Dr. Daniel Choo

Tue, 22 Nov 2022 06:05:00 -0000

In this episode of BackTable ENT, Dr. Soham Roy, chair of pediatric otolaryngology at Children’s Hospital Colorado, invites 2 pediatric otolaryngology chairs, Dr. Daniel Choo (Cincinnati Children’s Hospital) and Dana Thompson (Lurie Children’s Hospital), to discuss their paths to leadership and advice for effective leadership.

The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/oA7jQe

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SHOW NOTES

First, Dr. Choo and Dr. Thompson discuss their motivations for becoming leaders in pediatric otolaryngology. Dr. Thompson emphasizes the importance of using her voice to create impact in the medical field as a black female physician. Although Dr. Choo was a reluctant leader at first, he now sees himself as a servant leader who finds job and personal satisfaction in uplifting others.

Then, Dr. Roy questions whether leadership is innate or learned. All three doctors agree that leadership can be learned, but potential leaders have to be willing and able to assume the position. Dr. Thompson notes that she gained leadership skills from career leadership programs, her leadership coach, and her MBA. Dr. Choo notes that introverted leaders can also succeed, as leadership places great importance on individual interactions and relationships with people.

Finally, the doctors discuss how to prepare for a leadership role. Effective healthcare leaders identify gaps in healthcare delivery to their patients, know the strengths and weaknesses of their programs, have the courage to show their vulnerability to their staff members, and never forget to point out the impact that their trainees are making every day.

Ep. 77 In-Office Procedures for Chronic Rhinitis with Dr. Stan McClurg

Tue, 15 Nov 2022 06:05:00 -0000

In this episode, Dr. Stan McClurg, a private practice rhinologist at Ascentist Healthcare in Kansas City, shares his approach to diagnosis and treatment of chronic rhinitis patients using the in-office RhinAer procedure.

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Aerin Medical

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SHOW NOTES

First, Dr. McClurg talks us through his patient base. When he initially started as a rhinologist, he would get referrals for patients with persistent rhinitis after a procedure. Before in-office procedures for chronic rhinitis were developed, he recommended ipratropium bromide spray to patients and referred them for allergy testing. However, his recent patient referrals have been for isolated chronic rhinitis (defined by consistent rhinorrhea for more than 4 weeks) with no other ENT problems. With these patients, he performs allergy skin testing to make sure the diagnosis is not really allergic rhinitis that can be treated with desensitization therapy. He also uses a rigid nasal endoscope to check the patient’s nose for colored purulence and polyps, two clues that can point to a diagnosis other than chronic rhinitis. When he scopes his patient, he does not use a decongestant spray and uses a small endoscope to avoid patient discomfort. If he believes that a patient has chronic rhinitis, he will perform a ipratropium bromide challenge; he asks patients to use the spray for 1 month. If their symptoms are mitigated by the spray, then he is more optimistic that an in-office procedure will mitigate the chronic rhinitis. If the patient fails the trial, the secretions are probably coming from a source other than the nose, and the diagnosis is unlikely to be chronic rhinitis.

Next, Dr. McClurg speaks about different in-office treatments for chronic rhinitis. He first explains his experience with ClariFix, a procedure that uses cryoablation to freeze the posterior nasal nerve. He has found that 40% of his patients experience the known side effect of post-treatment headache. Additionally, some of them may have crusting in the sphenopalatine region that causes post-nasal drip. Since then, he has switched to using the RhinAer system, which delivers radioablation through a stylus to treat the posterior nasal nerve more aggressively. It also has the capability of treating the inferior turbinate. Dr. McClurg notes that patients with normal nasal anatomy and a good ipratropium bromide response are the best candidates for this procedure. 80% of his patients see a favorable result after surgery.

He then describes his RhinAer in-office procedure. He does these procedures in exam rooms in order to help with flow of his day and make his patients more comfortable. He only uses lidocaine to anesthetize the patient, as he has found that epinephrine causes tachycardia and anxiety. The procedure, including anesthesia time, takes him about 10 minutes. However, he adds that he has performed this procedure in the OR as an adjunct procedure after a septoplasty or a rhinoplasty.

Finally, he describes his recommendations for postoperative care. He encourages his patients to do daily saline rinses. He notes it takes about 6-8 weeks for the RhinAer procedure to show a good response. During this time, he recommends that patients use ipratropium bromide concurrently in order to obtain an optimal response.

Ep. 76 Medical Missions in ENT: Spotlight on Project Ear with Dr. Edward Dodson

Tue, 08 Nov 2022 06:00:00 -0000

In this episode of BackTable ENT, Dr. Varun Varadarajan interviews Dr. Edward Dodson, President of Project Ear and a neurotologist at the Ohio State University Wexner Medical Center, about his humanitarian efforts in the Dominican Republic.

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SHOW NOTES

Dr. Dodson was first introduced to Project Ear when he joined his mentor and Project Ear founder, Dr. Paul Lambert, on a mission trip to Dominican Republic in 1995 to perform ear surgeries. Although they could only operate on 12 patients, seeing hundreds of patients waiting in line for medical care was eye-opening for him.

Dr. Dodson then shares about preparations needed for the Project Ear medical mission trips. He emphasizes the importance of their local neurotologist liaison, Dr. Roberto Batista, who helped Project Ear by performing preoperative and postoperative care for patients in exchange for equipment. In the first years of the organization, the doctors had to learn which supplies to bring and how to store them as well as how to organize staff and supplies in order to pass through customs. Dr. Dodson notes that he used to sterilize wasted equipment from American ORs during their first trips. Later, Project Ear was able to partner with Ohio State University and could give credit to residents who participated on the trips and negotiate time for employees to travel. Because the mission hospital they worked with allowed trainees, he was allowed to take senior level American residents to the Dominican Republic. Furthermore, Dr. Dodson also sought out to teach DR residents independently at another hospital and brought them new medical equipment. This initiative led DR residents to be granted permission to participate in Project Ear surgeries as well as rotate at Ohio State. Currently, multiple ENT subspecialties, besides neurotology, and audiology are now represented within Project Ear.

Next, Dr. Dodson speaks about Dominican Republic-related topics. He explains that the most common ear conditions he sees are chronic draining ears, perforation, cholesteatomas, congenital atresia, stapedectomy, and otosclerosis. When the COVID-19 pandemic hit, he and his Project Ear colleagues started teaching via Zoom through giving lectures and Grand Rounds talks to Dominican Republic residents. Dr. Dodson and Dr. Varadarajan also reflect on the open-mindedness and creativity required to operate in a resource-limited environment. Dr. Dodson also explains about how he navigated relationships with local ENT doctors in the area.

Finally, he shares advice and resources for doctors looking to start their own medical mission trips. He emphasizes the importance of understanding the time it takes to plan and lead a trip as well as determining that your medical services are actually wanted in the country.

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RESOURCES

Project Ear

https://projectear.org/

Coalition for Global Hearing Health

https://coalitionforglobalhearinghealth.org/

AAO-HNSF Humanitarian Efforts List

https://www.entnet.org/get-involved/humanitarian-efforts/

Ep. 75 Technology and 3D Imaging for Endoscopic Skull Base Surgery in Children with Dr. Cristobal Langdon

Tue, 25 Oct 2022 05:00:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah discusses 3D imaging and other surgical technology with Dr. Cristobal Langdon, an academic and private practice rhinologist and skull base surgeon working at Hospital Sant Joan de Déu Barcelona.

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SHOW NOTES

First, Dr. Langdon speaks about common conditions he treats as a skull base surgeon, such as Rathke cleft cysts and craniopharyngiomas. Most of his referrals come from neurosurgeons and opthamologists once the decision to take a transnasal approach over an open approach is made.

Next, he talks about pre-operative preparations. During his initial patient visit, he scopes his patients with a flexible scope and tries to record every scope procedure for educational and planning purposes. Every patient receives an MRI, and a CT scan is usually already obtained. Dr. Langdon does not prescribe any antibiotics or corticosteroids before surgery. Then, he discusses how he uses 3D models for surgical planning. For him, 3D models are useful in deciding between different surgical approaches and practicing difficult surgeries. He requests that his models are made true to size by biomedical engineers. He also tells his engineering team which structures need to be constructed (i.e.-nerves, carotid arteries, etc.). Then, Dr. Shah and Dr. Langdon discuss the implications of virtual reality for surgical education.

Then, the doctors discuss the use of technology in the operating room. Dr. Langdon does not often use image guidance. He sometimes uses neurosurgical guidance, but warns against becoming dependent on technology and not learning patient anatomy well. He thinks image-guided instruments are nice, but not necessary to have. Like Dr. Shah, he uses intrathecal fluorescein to look for CSF leaks. Then, the doctors also discuss the pros and cons of different types of flaps and packing.

Finally, Dr. Langdon speaks about his postoperative saline regimen. He recommends that all his pediatric patients use at least 100 mL for each side every 12 hours. Dr. Shah likes to show the patient and their families educational videos of sinus rinses before surgery so they are prepared postoperatively. Both doctors concede that synechiae (scar tissue) may form in kids, but they rarely take pediatric patients back to the OR for debridement.

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RESOURCES

Dr. Langdon’s Youtube

https://www.youtube.com/c/BarcelonaRhinologySchool

Ep. 74 Is Burnout For Real? Physician Well-Being with Dr. Alain Sabri and Dr. Kerry Olsen

Tue, 18 Oct 2022 05:00:00 -0000

In this episode of BackTable ENT, Dr. Julie Wei, Dr. Alain Sabri (Mayo Clinic Abu Dhabi), and Dr. Kerry Olsen (Mayo Clinic Rochester) discuss personal and professional strategies to overcome physician burnout.

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SHOW NOTES

First, the doctors discuss their personal motivations for engaging in wellness. For Dr. Sabri, wellness evolved as his career matured. Eventually, he moved abroad and studied cross-cultural practices of wellness. For Dr. Kerry, leadership roles forced him to have concern about the wellness of his employees, leading him to create his own company, 12 For Health. For Dr. Wei, a medical condition forced her to think about her life outside of the OR. All three doctors agree that head and neck surgeons have one of the highest burnout rates and the first step to solving this problem is recognizing burnout as a problem and not being ashamed of it.

Then, they discuss the impact that corporate influence has on medicine and physician wellness. Many physicians may feel stuck in a system they have no say in. Dr. Olsen encourages healthcare corporations to prioritize patient and physician welfare over finances while Dr. Sabri encourages institutional leadership to actually listen and elicit change when their physicians provide feedback. Dr. Olsen then explains how raising salaries to justify longer hours actually incentivizes doctors to cut their hours and makes it easier for them to leave. Additionally, both Dr. Wei and Dr. Sabri agree that the feelings of burnout can fluctuate from day to day.

Next, the doctors emphasize the importance of feeling valued as a physician and engaging in self-care techniques. Dr. Olsen advocates for training physicians to be leaders who get to know their team well and recognizes good work at an appropriate time. Dr. Sabri criticizes the American “hyper statistical” view that does not respect people for the work they do. He advises physicians to select the right institution for them and have the courage to walk away and reinvent themselves in new positions when they feel like they are not receiving the respect they deserve. Self-care techniques the doctors recommend from personal experience are: re-reading patient and mentee thank you notes, meditation, stretching, team sports, having a coffee with a friend, and learning how to say no to excess work and toxic relationships.

Finally, the doctors discuss how institutional leadership can help women surgeons succeed and prevent burnout. Dr. Olsen adds that leadership needs to change if the current leaders are not effective and explains ways to form effective work units.

Ep. 73 Allergic Fungal Rhinosinusitis with Dr. Amber Luong

Tue, 11 Oct 2022 05:00:00 -0000

In this episode of BackTable ENT, Dr. Shah and Dr. Agan speak about allergic fungal rhinosinusitis with Dr. Amber Luong, vice president of the American Rhinology Society and professor of otolaryngology at McGovern Medical School.

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SHOW NOTES

Allergic fungal sinusitis (AFS) is a subtype of chronic rhinosinusitis with nasal polyps that present with allergic inflammation against fungal antigens. It has some unique features, such as very expanded sinus cavities and a thick, sticky mucin. Oftentimes, patients have an allergy sensitivity and elevated IgE levels in the thousands. Diagnosis is usually made based on the Bent and Kuhn Classification, which is based on clinical/phenotypic criteria. However, Dr. Luong notes that AFS can have geographically diverse presentations. She has noticed that there is a higher AFS prevalence in the South because of the more hot and humid weather. Looking towards the future, she predicts that molecular pathophysiology will be more important in diagnosis, as distinction between the AFS endotypes can serve as targets for therapy. Her research laboratory works on finding these molecular targets.

Next, the doctors discuss typical AFS patient presentations. Dr. Luong usually sees young patients in their 20s with unilateral disease. If they have bilateral disease and other symptoms, it is most likely cystic fibrosis, not AFS. Additionally, AFS patients will have expanded sinuses on CT that may cause a mild headache. Dr. Shah adds that in severe cases, smell and vision loss is possible. However, AFS generally has a low symptom burden because patients get used to the symptoms. Dr. Luong notes that she usually only orders a CT scan. No MRI is needed unless other complications are noted (vision loss, meningitis, skull base / cranial nerve invasion). She orders labs like CBC with differential and total IgE levels.

Next, she shares surgical pearls for treating AFS. She believes that the first surgery is critical to controlling the disease and preventing recurrence. She performs a full FESS on the impacted side and inserts a PROPEL stent that releases steroids locally. Because the sinuses are difficult to clear, she uses angled scopes, warm saline, and the hydrodebrider to complete this task. Although the microdebrider with navigation can be helpful, she doesn’t really use it.

Finally, she shares her steroid regimen. She prescribes at least 40 mg of prednisone in adult patients 3-4 days before surgery. Postoperatively, she prescribes an oral steroid taper starting at 30 mg and decreasing the dosage by 10 mg each week. Additionally, she gives her patients a post-operative nasal rinse that consists of mupirocin and budesonide. She emphasizes the importance of making the postoperative regimen as easy as possible to ensure daily compliance. Finally, the doctors discuss trends in AFS patient follow up.

Ep. 72 The Future of Otolaryngology is in the Office with Dr. Madan Kandula

Tue, 04 Oct 2022 05:00:00 -0000

In this episode of BackTable ENT, Dr. Shah and Dr. Agan speak with Dr. Mandan Kandula, founder of ADVENT, an ENT private medical practice, about embracing in-office procedures and building an efficient ENT private practice.

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SHOW NOTES

First, Dr. Kandula talks about his journey to becoming a private practice ENT doctor. He became a proponent of office-based treatments when he opened up his solo private practice and has carried this approach into his expansion of ADVENT. Another approach he takes in his medical practice is simplifying all airway problems to identify the defect in the “breathing triangle”, a term he coined for the nose and throat. In order to identify the airway problem in patients, Dr. Kandula emphasizes the importance of defining a healthy airway, which he defines as normal anatomy and lining. Additionally, he notes that ENTs must assess the nose, throat, and sinuses together before choosing a treatment plan for the patient.

Another approach he takes in his medical practice is training nurse practitioners and physician assistants to deal with purely medical ENT matters, such as triage, intake, histories, and physicals. He even trains his NPs and PAs to perform scope examinations and to administer local anesthetic. Dr. Kandula prefers to free up time for his ENT surgeons to have extended conversations with patients and operate in the office or in the OR. However, he emphasizes the importance of having well-trained NPs and PAs. He also outsources sleep study reads to be more efficient.

The doctors then discuss treatments for obstructive sleep apnea. Dr. Kandula usually sees OSA patients who have already tried non-surgical options, such as nasal rinses and sprays. For OSA that is caused by an anatomical issue, he notes that turbinate hypertrophy is the most common cause. For these cases, he will perform a thorough turbinate reduction. He also obtains CT imaging to view the sinuses in order to assess if they are affecting airway patency.

Finally, Dr. Kandula speaks about challenges with insurance with regards to in-office procedures. His office usually takes the lead in dealing with insurance authorizations and repealing insurance denials. He explains that it is more difficult for academic ENTs to change to in-office procedures. Another challenge that doctors might face is the high cost of in-office equipment. He recommends working with industry and getting loans to help offset the financial burden of medical technology.

Ep. 71 Nasal vs. Mouth Breathing - Does it Matter? with Dr. Colleen Plein

Tue, 27 Sep 2022 05:00:00 -0000

In this episode of BackTable ENT, Dr. Shah and Dr. Agan speak with Dr. Colleen Plein about functional nasal breathing in the treatment of facial pain, sleep apnea, postural defects, and improving general quality of life.

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SHOW NOTES

First, Dr. Plein defines functional nasal breathing, which is unobstructed nasal breathing with a closed mouth. Nasal breathing is the best way to optimize airflow through the nose because the nose humidifies and filters air, the sinuses produce nitric oxide to increase oxygen delivery to tissue, and a slower breathing rate can be established, which stabilizes blood pH. Dr. Plein then explains the evolutionary transition from nasal to mouth breathing in humans. The “Great Leap Forward” involved the descension of the larynx and posterior displacement of the tongue so humans could develop speech. Unfortunately, these anatomical changes allowed airways to be more easily obstructed. Additionally, narrowing of the human skull occurred because humans now chew less due to our processed diets. The lack of mastication caused hypoplasia of the maxilla and mandible, which led to narrowing of nasal aperture.

In a child with mouth breathing, Dr. Plein emphasizes the importance of early orthodontic intervention; early maxillary expansion is more likely to occur because the sutures have not fused yet. Besides turbinate reduction therapy, she encourages non-invasive therapies for children such as myofunctional therapy and eating less processed foods. The doctors also discuss different pathologies linked to mouth breathing besides obstructive sleep apnea. Dr. Plein explains how mouth breathing can lead to TMJ pain, poor posture, facial pain, and migraines.

Next, Dr. Plein gives her tips for examining a mouth breathing patient. She believes that taking a thorough clinical history is important and always asks about snoring, posture, headaches, shoulder/neck pain, as some patients don’t realize they have problems with nasal breathing. She also mentions that some patients who grind their teeth may be using a mouth guard that pushes the tongue further back, which can worsen sleep apnea. She notes that tongue scalloping and outwardly oriented teeth are indicative of tongue thrust, which is diagnostic of sleep apnea. She has a low threshold for recommending home sleep tests and always examines the nose with nasal endoscopy. During endoscopy, she does Cottle’s maneuvers to look for static and dynamic nasal valve collapse. In addition to a scope exam, she gets CT imaging of the sinuses.

Next, Dr. Plein emphasizes the importance of collaborating with myofunctional therapists, dentists, orthodontists, and TMJ physical therapists to care for her nasal obstruction / mouth breathing patients. Finally, she summarizes some non-invasive technology and medications that can help optimize nasal breathing, such as intranasal steroids, antihistamines, nasal irrigation, Breathe Right strips, and a gluten-free diet.

Ep. 70 Quality in Otolaryngology: Why Is It Important to You? with Dr. Marc Bennett

Tue, 13 Sep 2022 05:00:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Kutz interview Dr. Marc Bennett, a Vanderbilt University ENT professor, about the importance of quality improvement, and initiatives and tips for quality initiative research.

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SHOW NOTES

First, Dr. Bennett delineates his path to quality improvement research and education. His father was involved in quality improvement in the pharmaceutical industry, and he was always interested in systems-based improvement. Additionally, he was encouraged by a mentor to find a niche outside of clinical medicine.

Next, the doctors discuss collaboration with hospitals and medical schools to encourage more quality improvement initiatives. For enticing hospital systems to care about quality initiatives, Dr. Bennett recommends showing them that administrative data is very important for financial and billing reasons as well as hospital rankings, which are important to patients and the public. Additionally, he encourages medical school lecturers and residency directors to incorporate quality improvement projects and measures in their trainee curriculums. For students and residents with a vested interest in quality improvement, identifying a mentor and starting with a simple project is the best way to explore the research field.

Next, Dr. Bennett discusses important aspects of quality improvement research. First, he highlights the importance of using run charts to compare mortality and complications across populations over time. Run charts can be further analyzed to see differences between different providers, statistical significance, and outliers. When collecting data from electronic health records, he collaborates with billing departments in order to identify relevant CPT codes. He also notes that the AAO-HNSF collects self-reported data from individual institutions as well. Then, he uses data analysis programs like Vizient and Leapfrog to organize and interpret data.

Finally, Dr. Bennett shares how otolaryngologists can improve quality of care in their everyday practice, most notably through proper documentation. He discusses the pros and cons of using dot phrases and emphasizes the importance of standardization of format and coding.

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RESOURCES

Vizient:

https://www.vizientinc.com/

Leapfrog:

https://www.leapfroggroup.org/

Ep. 69 Balloon Dilation of the Eustachian Tube with Dr. Seilesh Babu

Thu, 08 Sep 2022 05:00:00 -0000

In this episode of BackTable ENT, Dr. Ashley Agan and Dr. Seilesh Babu discuss Eustachian tube dysfunction and balloon dilation as a therapeutic option.

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SHOW NOTES

First, Dr. Babu provides background on Eustachian tube dysfunction. In kids and adults, Eustachian tube dysfunction can present as a sensation of “ear fullness”, recurrent fluid in the ear, or discomfort with pressure challenges, such as flying or scuba diving. Medical management involves nasal steroids, allergy medications, anti-reflux medications, avoidance of allergens, and doing a modified Valsalva maneuver at home. Additionally, ear tubes and balloon dilation are procedural options.

Next, Dr. Babu explains his workup for Eustachian tube dysfunction patients. He takes a thorough patient history and examines the patient’s tympanic membrane, nasopharynx, and serous outflow using a flexible scope. He orders an audiogram for all of his patients but notes that tympanograms are not as critical. For patients with discomfort during pressure challenges, he will consider doing a balloon dilation or placing an ear tube. For patients presenting with “ear fullness”, a more in-depth examination must be done through a trial tympanostomy tube or a myringotomy.

He also looks for red flags, which indicate Eustachian tube dysfunction may not be the correct etiology for their ear symptoms. These red flags include: aggravation of symptoms upon tube insertion, symptoms of dizziness and vertigo, autophony, and pulsatile tinnitus. Although it is rare, a diagnosis of Patulous Eustachian tube dysfunction must be considered. If the patient does not have these red flags and has had multiple ear tubes without symptom relief, they may be a good candidate for balloon dilation.

Dr. Babu then delineates his procedure for a Eustachian tube balloon dilation. He performs this procedure in the OR using the Acclarent AERA Eustachian tube dilation system. He inflates the balloon to achieve a pressure of 12 atm, keeps it dilated for 2 minutes, then removes the instrument. Some procedural pearls he shares are: putting the scope and balloon in at the same time to minimize bleeding in the nasopharynx and guiding the instruments in a lateral direction towards the external ear canal. He usually waits 2-3 weeks before reassessing the patient for recurrent symptoms. Upon discharge, he encourages patients to avoid nose blowing and Valsalva maneuvers, as these actions can cause a pneumothorax or pneumomediastinum. Common postoperative symptoms include minor nose bleeds and the sensation of a sore throat. Dr. Babu usually performs the balloon dilation in conjunction with other OR procedures, such as myringotomies and tympanoplasties, for efficacy.

Finally, the doctors discuss the specifics of billing for the Eustachian tube dilation procedure. In recent years, a specific billing code has been assigned for balloon dilation, and insurance companies are beginning to authorize this procedure for a variety of patients.

Devices discussed in this podcast are currently available in the US only.

Acclarent, Inc. 223616-220810

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RESOURCES

Acclarent:

https://www.jnjmedtech.com/en-US/companies/acclarent

AERA® Esutachian Tube Balloon Dilation System:

https://www.jnjmedtech.com/en-US/product/Acclarent-aera-eustachian-tube-balloon-dilation-system

Howard, A., Babu, S., Haupert, M., & Thottam, P. J. (2021). Balloon Eustachian Tuboplasty in Pediatric Patients: Is it Safe?. The Laryngoscope, 131(7), 1657–1662. https://doi.org/10.1002/lary.29241

Ep. 68 In-Office Procedures for Nasal Valve Obstruction with Dr. Mary Ashmead

Tue, 23 Aug 2022 05:00:00 -0000

In this episode of BackTable ENT, Dr. Ashley Agan and Dr. Gopi Shah speak with Dr. Mary Ashmead, a Dallas/Fort Worth based rhinologist (Texas Ear, Nose, & Throat Specialists) about in-office procedures for nasal valve obstruction.

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SHOW NOTES

First, Dr. Ashmead describes her typical work up for a patient presenting with nasal valve obstruction in the clinic. She explains that “congestion” is a common but ambiguous chief complaint that patients use when they are unable to be specific about their nasal problems. She emphasizes the importance of doing a thorough ENT review of systems and asking about nasal obstruction for patients with chief complaints other than nasal valve obstruction as well because one-fifth of patients with severe nasal valve obstruction are missed. Before she observes her patients, all of them will complete a NOSE score as well. During the physical exam, Dr. Ashmead observes the nasal bones and external nasal valves first and then uses a rigid scope to examine the internal valve, turbinates, septum, and nasal mucosa. She does not routinely give her patients a nasal decongestant before doing her primary scope exam, as she wishes to examine the patient’s nose in its native state. Then, she will administer a nasal decongestant and go through the second scope exam again. Miscellaneous issues she will look for include nasal polyps and sinusitis. For conservative treatments, she generally prescribes nasal steroid spray, topical antihistamines, Afrin at night, nasal dilators, Breathe Right strips, and nose cones.

Then, Dr. Ashmead delves into the different in-office procedures she employs for nasal valve obstruction patients. The type of therapy she embarks on will depend on the kind of patients she sees. Some of her patients will want to fix everything at once up front and others will want multiple procedures in smaller steps. Additionally, some patients will choose the operating room setting over the office setting. Finally, other details to consider are the patient’s desire to keep the same appearance of their nose, the patient’s skin thickness, and recovery time.

Dr. Ashmead recommends the VivAer procedure for patients with a positive modified Cottle maneuver test, dissatisfied patients post-septoplasty/turbinate reduction, rhinoplasty patients with a narrowed internal valve, and snorers. The VivAer procedure uses bipolar radiofrequency energy to shrink tissue and allow the surgeon to remodel the internal nasal valve, turbinates, and swell body. There are different cooling and heating cycles that take a total of 6-7 minutes to complete. During this procedure, Dr. Ashmead uses a scope to visualize where to place the small paddles. She notes that rebound swelling, nasal tip tension, and the development of scabs are three common minor consequences of this procedure. Next, she discusses the Latera nasal implant, which can only be used in dynamic valve collapse. She does not use this synthetic implant often, as it can get infected and many patients do not want an implant in their noses. A third option she mentions is a septal rhinoplasty, a procedure that she often refers to her facial plastics colleagues.

Finally, Dr. Ashmead goes into detail about her anesthesia procedure and the role of anxiolytics in her practice. Her patients will take either 0.125 mg of halcion or triazolam one hour before they arrive at her office for the procedure. In longer cases, she will prescribe her patients Valium. She emphasizes the importance of thorough topical numbing; she usually uses a 4% topical compounded tetracaine/lidocaine gel. Generally, she avoids administering epinephrine in the office, as adrenaline can aggravate an already nervous patient. Finally, she does everything she can to soothe the patient, such as having separate procedure rooms with soothing music and dimmed lights.

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RESOURCES

VivAer Procedure:

https://vivaer.com/hcp/

Ep. 67 Complementary and Integrative Medicine in ENT with Dr. Michael Seidman

Tue, 09 Aug 2022 05:00:00 -0000

In this episode of BackTable ENT, Dr. Ashley Agan and Dr. Walter Kutz talk with Dr. Michael Seidman, an AdventHealth neurotologist with a unique interest in complementary and integrative medicine (CIM), about his holistic health approach to treating ENT-related disorders and his supplement company, PEAK 365 Nutrition.

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SHOW NOTES

First, Dr. Seidman explains his background in CIM. While attending the University of Michigan for his undergraduate studies, he majored in nutrition at the school of public health and human nutrition. Additionally, when he played professional racquetball, he was introduced to the use of nutritional supplements and the importance of a balanced diet. Since then, he has secured multiple million dollar donations to establish the first center for integrative medicine.

Next, Dr. Seidman explains the CIM philosophy. He believes that conventional medicine and medications are good at resolving the “quick-fix” issues, but a more holistic CIM approach can help patients effectively manage their chronic diseases. Although getting patients to change their unhealthy behaviors can cut healthcare costs in half, he believes that the patients must want to change these behaviors themselves. Dr. Seidman discusses the efficacy of automatic pattern interruption, where the physician helps the patient identify and eliminate triggers of unhealthy behaviors. He notes that diet, exercise, meditation, rest, and optimistic outlook are important pillars of CIM.

Then, Dr. Seidman delves into how CIM can help manage ENT-specific disorders. For Menniere’s disease, he recommends restricting salt and caffeine intake as well as a diuretic, if necessary. He also prescribes his Menniere’s patients 24 mg of betahistine a day, taken three times in 8 mg capsules. He notes that hearing loss can be stalled or reversed by red wine extract, but this has only been proven to work in mice. Finally, he recommends a ginkgo supplement for tinnitus. However, he warns listeners that not all ginkgo is the same quality, and that patients should look for the product in knowledgeable supplement stores, not drug stores.

Finally, Dr. Seidman discusses his motivation for starting his own monthly supplement company, PEAK 365 Nutrition, and the health benefits his supplements provide. Additionally, he encourages doctors to explore referring their patients to licensed and quality acupuncturists, chiropractors, and hypnotists.

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RESOURCES

Dr. Seidman’s Youtube Channel:

https://www.youtube.com/channel/UChWOA4mPaq4Pa0Mi4jv2n3w

Peak 365 website:

https://peak365nutrition.com/

Ep. 66 From Weird to Wonderful: An Interview with Theator Founder Dr. Tamir Wolf

Fri, 29 Jul 2022 05:00:00 -0000

In this episode, Drs. Aaron Fritts and Eric Gantwerker interview Dr. Tamir Wolf, a trauma surgeon and founder of Theator, an artificial intelligence company that links intraoperative decision making with patient outcomes.

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SHOW NOTES

Dr. Wolf describes how his experience as a trauma surgeon with the Navy SEALs shaped his perspective on high acuity situations and surgical guidance. He realized that augmented decision making in trauma settings could help him and others perform better. Additionally, he had experiences with seeing family and coworkers undergoing the same procedure, but with drastically different outcomes due to variability in surgery and clinical management. With these ideas in mind, he started Theator. The company offers a software that seamlessly integrates into existing operating room video technology in minimally invasive robotic and laparoscopic procedures. The technology captures data over decision points and key milestones that have eventual impacts on patient outcomes. The data is then analyzed to find patterns and translated to best practices.

Dr. Wolf hopes that this aggregate of video data from multiple surgeons and institutions can provide evidence-based training for surgeons to operate at a safer level. Dr. Wolf emphasizes that Theator’s overall mission is to increase transparency in the operating room and break out of the traditional surgical apprentice training model. Ideally, trainees who are preparing for surgeries could draw on the experiences of thousands of surgeons in different places. Additionally, hospitals could gain information about their internal processes and address inefficiencies and safety gaps.

We discuss challenges in implementation, such as surgeons’ reluctance to be recorded, competition within the artificial intelligence space, and limitations for implementation in fluoroscopic imaging. Dr. Wolf also outlines Theator’s trajectory and the single most important factor to its success— the company culture. He emphasizes the need to hire competent and trustworthy people who can innovate and self-direct.

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RESOURCES

Theator:

https://theator.io/

Dr. Tamir Wolf LinkedIn:

https://www.linkedin.com/in/tamirwolf

OR Black Box & Trauma Black Box:

https://www.surgicalsafety.com/

Disparities in Access to High-Volume Surgeons Within High-Volume Hospitals for Hysterectomy:

https://journals.lww.com/greenjournal/Abstract/2021/08000/Disparities_in_Access_to_High_Volume_Surgeons.7.aspx

No Rules Rules: Netflix and the Culture of Reinvention: https://www.amazon.com/No-Rules-Netflix-Culture-Reinvention/dp/1984877860

BackTable Innovation Ep. 7: Improving Access to Stroke Care Using AI with Dr. Chris Mansi: https://www.backtable.com/shows/innovation/podcasts/7/vizai-improving-access-to-stroke-care-using-ai

Ep. 65 Lifestyle Medicine in Otolaryngology with Dr. Jessica Lee

Tue, 26 Jul 2022 05:00:00 -0000

In this episode of BackTable ENT, Dr. Shah and Dr. Agan discuss the role of lifestyle medicine and non-pharmacological therapy in otolaryngology with Dr. Jessica Lee, a general ENT who is certified in lifestyle medicine.

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SHOW NOTES

First, Dr. Lee explains the philosophy behind lifestyle medicine. The purpose of the field is to treat and/or reverse chronic ailments using basic pillars, such as plant based nutrition, quality sleep, emotional connections, avoidance of risky substances, adequate physical activity, etc. Certification in lifestyle medicine is open to all board-certified physicians. Dr. Lee underwent 1.5 years of preparation, which included 30 hours of CME courses online and 10 hours of in person CME. At the end of her program, she was required to pass a board certification exam. Her initial motivation for obtaining her lifestyle medicine certification stemmed from a realization that many ENT concerns were a result of systemic chronic diseases. Dr. Lee views her lifestyle medicine approach as a partnership between her, her patient, and their PCP. Before she offers lifestyle medicine counseling separate from ENT counseling, she always ensures that the patient is open to pursuing this approach.

Next, the doctors discuss diet, the most evidence-based pillar of lifestyle medicine. In this field of medicine, the best diet is plant-based. Dr. Lee notes that a “plant-based” diet does not mean vegetarian or vegan, but instead just a plant-heavy diet. Additionally, she recommends reducing alcohol use and starting a low histamine diet for patients with chronic inflammation. However, she emphasizes to always set an endpoint to restrictive diets in order to effectively find a good threshold for the patient. For laryngopharyngeal reflux, she recommends eliminating nighttime ice cream snacks and alcoholic beverages.

Then, the doctors discuss effective approaches to smoking cessation. Dr. Lee emphasizes the importance of discussing support systems with patients wanting to quit smoking. Additionally, she agrees that the most effective smoking cessation therapy is a combination of nicotine replacement and group counseling. Although the effects of marijuana and vaping as substitutes for cigarettes are not widely studied, Dr. Lee notes that marijuana can be an irritant and vaping can cause lung injury.

Another pillar of lifestyle medicine is emotional health. Through cognitive behavior therapy, she has been able to mitigate her patients’ symptoms of tinnitus and globus pharyngeus. Additionally, she does not prescribe medications for anxiety or depression, as research has shown that daily physical activity is equivalent to daily medications for mild to moderate depression. Regarding adequate sleep, Dr. Lee warns doctors not to correlate the number of hours the patient spends in bed with the number of hours they spend asleep. She acknowledges that health tracker devices can be helpful for tracking sleep hours and dysfunction. Finally, she advises doctors who are interested in lifestyle medicine to refer their patients to specialists who share the same philosophy for consistent continuation of care.

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RESOURCES

Oto Tinnitus Management App:

https://www.joinoto.com/

Ep. 64 Better Neck Health with Dr. Gerry Mattia

Tue, 19 Jul 2022 05:00:00 -0000

In this special crossover BackTable episode, Dr. Aaron Fritts and Dr. Julie Wei talk with Dr. Gerry Mattia, Chiropractor and Director of Rehabilitation of ViscoGen Clinic in Orlando, Florida.

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SHOW NOTES

First, Dr. Mattia recounts his journey to becoming a chiropractor, beginning with his medical history of aortic stenosis fixed by a chiropractor, his decision to enter chiropractic school, and starting his independent practice after graduation. Then, he explains how he deals with patients presenting with degenerative disc disease with spinal stenosis, which was the issue he resolved in Dr. Wei. A herniated disc is the most common cause of degenerative disc disease. The standard chiropractic treatment is cervical decompression to help the disc restore itself. Dr. Mattia also uses a level 4 laser to rehydrate the disc. For optimal results, he recommends that patients see him 4 times a week for 6 to 8 weeks in order to fully lift the pressure off of the brachial plexus. He notes that good chiropractors will use the correct formulas and appropriate technology while adjusting the patient gently.

Next, the doctors delve into why many physicians are wary of chiropractors, which is rooted in a 1988 legal case that prohibited doctors from referring their patients to chiropractors. Dr. Mattia encourages physicians to seek therapy before medical issues develop into very severe conditions. Additionally, Dr. Wei notes that medical culture often encourages physicians to put the health of their patients before theirs.

Then, Dr. Mattia discusses how younger people and surgeons can improve their neck health. He notes that excessive cell phone use can reverse the cervical curve, causing people to lose their normal lordotic curve, a structure which usually prevents compression. He also recommends strengthening the muscles in the neck and shoulders, sleeping with a cervical pillow, and going to a good chiropractor to get routine adjustments. Dr. Wei recommends avoiding slouching and adjusting screens to eye-level in OR. Both Dr. Wei and Dr. Mattia agree that maintaining a healthy body weight will have positive benefits on spinal health.

Finally, Dr. Mattia recommends which qualities to focus on when finding a good chiropractor. He recommends looking for an experienced, passionate family practice chiropractor. As a word of caution, he warns listeners to never let a chiropractor adjust them without reviewing their X-ray imaging first.

Ep. 63 Evaluation and Management of Nasal Valve Collapse with Dr. Moustafa Mourad

Tue, 05 Jul 2022 05:00:00 -0000

In this episode of BackTable ENT, Dr. Agan and Dr. Shah discuss nasal valve collapse and repair with Dr. Moustafa Mourad, a New York City-based facial plastic and reconstructive surgeon.

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SHOW NOTES

First, Dr. Mourad delineates how he evaluates patients presenting with possible nasal valve collapse. There are two sets of nasal valves, an internal set and an external set. The tell tale signs of nasal valve collapse is dynamic nasal airway obstruction, a situation in which airflow is affected by deep breathing or structural rearrangement by the patient is required to breathe more easily. Internal nasal valve collapse patients usually find relief with structural rearrangements, such as blowing up their cheeks in order to breathe or using nasal strips. External nasal valve collapse patients find difficulty in breathing while exercising. Diagnosis of nasal valve collapse can also be complicated because many breathing problems are multifactorial. Therefore, otolaryngologists must be thorough in their initial evaluations and choose which causes to prioritize.

Dr. Mourad also explains risk factors for nasal valve collapse. Because nasal cartilage grows weaker overtime, older patients are more likely to experience valve collapse. Younger patients presenting with valve collapse will most likely have had previous nasal surgeries, such as septoplasties and rhinoplasties. Other risk factors for valve collapse include trauma of the nasal tip or dorsum, avid athletes, and the Caucasian ethnicity (because of thinner and more cephalically oriented nasal cartilages).

Next, Dr. Mourad discusses how he conducts the physical exam. He always scopes patients to look for abnormal anatomy or signs of allergies. Then, he has the patient breath while observing each of their nostrils. He observes the nostrils before and after the administration of decongestant. If the patient has a very good response to the decongestant, he starts to investigate for evidence of allergies, turbinate hypertrophy, and irritation–all of which can be treated by medical therapy. Then, he observes the patient breathing and nasal pinching as he lifts up the nasal tip and performs a caudal maneuver on the patient’s nose. Finally, he takes photos and maps out the patient’s internal and external anatomy. Dr. Mourad only considers surgical repair if the patient’s complaint can be traced back to an anatomical abnormality.

Then, Dr. Mourad walks through his surgical technique for nasal valve collapse. For an internal valve repair, he uses a simple endonasal approach. However, whether he uses an open or closed approach for an external nasal valve repair depends on the type of cartilage defect. As external valve repairs have aesthetic impacts, it is important to warn patients about changes in appearance beforehand. Additionally, Dr. Mourad prefers to obtain his implanted cartilage graft directly from the patient’s rib, as cadaver rib may warp and ear cartilage may not be strong enough. He uses a taper needle to suture spreader graft because it allows him to be more gentle with the cartilage. He does not typically recommend synthetic nasal implants to patients, as they can become infected, but still educates patients about all their options. For anesthetic, he mixes a solution of lidocaine with epinephrine and tranexamic acid to reduce post-operative swelling.

Finally, Dr. Mourad discusses his post-operative care regimen for nasal valve surgery.

Ep. 62 The Challenges of a Dual Physician Household with Dr. Bill Collins

Tue, 21 Jun 2022 05:00:00 -0000

In this episode of BackTable ENT, Dr. Varun Varadarajan and Dr. Gopi Shah discuss their personal advice and stories of navigating the challenges of a dual physician household with Dr. Bill Collins, chief of Pediatric Otolaryngology at the University of Florida College of Medicine.

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SHOW NOTES

First, the doctors discuss the considerations involved in deciding to participate in the couples match. They agree that it is best to keep larger cities with multiple programs in mind when forming a rank list but note that the match can also be complicated if one partner is choosing to pursue a more competitive specialty. Additionally, although staying together would be ideal, couples might not have another choice besides engaging in a long-distance relationship during residency and fellowship. Dr. Collins highlights the importance of finding program directors and other mentors who can help to maintain value in relationships during training. During residency applications and beyond, he emphasizes that communication, honesty, and compromise are key to sustaining a strong relationship.

Next, they discuss raising children in dual physician households. All three doctors agree that there is no “perfect” time to have children because it depends on the circumstances and preferences of every couple. If a couple wanted to have a child during both of their residencies, they would also have to consider the long uncontrollable hours of residency as well as the need for extensive child care. Additionally, Dr. Collins emphasizes that physician schedules will remain busy, even after residency, so it is important to schedule concrete family time sooner than later. Dr. Shah mentions the difficulty surgeons have with separating work from home and Dr. Varadarajan encourages them to devote quality time to their kids before getting on their phones to answer emails and finish notes.

Lastly, the doctors consider scenarios in which one partner is seeking a job change. Although being further along in their careers and having older children may complicate the job search and moving demands, all three doctors agree that decisions should be made for the overall good of the family. Thus, all factors and possibilities should be considered and discussed. Finally, Dr. Shah emphasizes the importance of having discussions about family planning with medical residents and medical students in order to open channels for advice and mentorship.

Ep. 61 The Ins and Outs of Ear Tubes

Tue, 07 Jun 2022 05:00:00 -0000

In this episode of BackTable ENT, Dr. Ashley Agan and Dr. Gopi Shah discuss the complications of ear tubes and differences in adult and pediatric ear tube management.

The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/qQS22s

Ep. 60 Otologic Manifestations of Migraine with Dr. Hamid Djalilian

Tue, 24 May 2022 05:00:00 -0000

In this episode of BackTable ENT, Dr. Walter Kutz interviews otologist Dr. Hamid Djalilian about the link between the hearing/vestibular disorders and migraines.

The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/eCd3zl

Ep. 59 Feeding Difficulties in Adults with Theresa Richard SLP

Tue, 10 May 2022 05:00:00 -0000

Theresa Richard, SLP educates us on the best approach to evaluating the adult patient with swallowing difficulty, including the importance and challenges of obtaining high quality assessments, and recommendations for therapy.

The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/gY34n9

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Protect your most valuable asset, the skill and ability to practice your medical specialty. Be prepared by establishing a specialty specific disability insurance policy from the experts at DI4MDs. Contact them today at www.Di4MDS.com or call 888-934-4637.

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SHOW NOTES

In this episode of BackTable ENT, Dr. Ashley Agan, Dr. Gopi Shah, and Theresa Richard, a board-certified speech language specialist (SLP) in swallowing and swallowing disorders, about diagnosing and managing adult dysphagia.

First, Richard speaks about starting Mobile Dysphagia Diagnostics, a company that provides mobile FEES studies, her experience with having a son with a swallowing disorder, and her recent career shift towards providing speech-language education for her colleagues. Then, she discusses the two primary swallowing imaging studies: the modified barium study (MBS) and fiberoptic endoscopic evaluation of swallowing (FEES). MBS, also known as video fluoroscopy, was traditionally the gold standard for swallowing imagery. It is the superior imaging technique for detecting esophageal issues and provides a better understanding of the oral phase of swallowing. Richard prefers to use FEES first because it provides a live picture of laryngeal and pharyngeal structures. It is useful in patients with secretion issues and post-head and neck cancer surgery patients. Mobile FEES is also an option, which involves an endoscope with recording capabilities and a laptop.

Next, Richard discusses how to work up a patient with dysphagia. She starts with taking a thorough history and asks the patient about their dietary routine, and their medical and surgical history. Common medications that may cause dysphagia are muscle relaxants, L-DOPA, and medications that can cause dry mouth, such as scopolamine patches. Next, she discusses eating habits, with special considerations for cultural practices, age, and disability status. She notes that functional swallowing can look different for individual patients. Patients who repetitively aspirate may have recurrent pneumonia and require further evaluation. The first basic test she performs is watching her patients swallow 3 ounces of water. If they cannot swallow the three ounces, she moves to imaging studies. If they can swallow the three ounces, she escalates the test and starts to give the patients thicker liquids and different food types.

Some patients with dysphagia may require special considerations, such as ICU patients, patients with nasogastric (NG) tubes, and head and neck cancer patients.

Finally, Richard discusses how ENTs can help SLPs by providing a solid case history and being available for communication throughout the patient’s therapy. She also discusses a new type of therapy, adult neuromuscular stimulation, but notes that the parameters may be dangerous and not FDA approved.

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RESOURCES

“So You’re Having Trouble Swallowing” by Theresa Richard

https://theresarichard.com/so-youre-having-trouble-swallowing/

Theresa Richard Blog

https://theresarichard.com/blog/

Swallow Your Pride Podcast

https://podcast.theresarichard.com/

Ep. 58 Mentorship for Wellness with Dr. Julie Wei

Tue, 03 May 2022 05:00:00 -0000

We talk with Dr. Julie Wei about what it means to connect with a mentor, the challenges of finding the right fit, and how mentoring relationships will grow and change throughout our career and undoubtedly contribute to overall wellness.

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Laurel Road for Doctors

https://www.laurelroad.com/healthcare-banking/

---

EARN CME

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SHOW NOTES

In this episode of BackTable ENT, Dr. Ashley Agan, Dr. Gopi Shah, and Dr. Julie Wei discuss the benefits and evolution of mentorship in the medical field.

First, Dr. Wei shares her personal definition of mentorship. Traditionally, mentorship involves a dyad: one junior and one senior partner with the knowledge. However, she challenges this dynamic by broadening the definition of mentorship by coining the term “co-mentorship”, a term that encompasses the mentor’s ability to learn from the mentee and the experience of reflecting as well. The doctors also discuss the challenges of finding mentors after training, since the natural hierarchy of academic medicine is not present. Dr. Wei encourages ENTs to attend society meetings and seek multidisciplinary mentors and mentees in different fields. She mentions that she has served as a mentor for respiratory techs and nurses as well.

Next, the doctors explore the idea of work-life balance. Dr. Wei disagrees with the consistent compartmentalization of career and personal wellness and prefers to advocate for and use the term “work-life integration” instead. She also recommends unconventional meeting platforms, such as Zoom, phone calls, and “walking meetings” in order to build relationships. Peer support groups can also be helpful, but the optimal size of the group may depend on the issue being discussed. Additionally, Dr. Wei observes that more female physicians today are able to share their struggles and vulnerabilities openly with their trainees and patients, thus building stronger relationships. She also talks about the importance of allies and notes that mentors and mentees do not have to have all of the same shared experiences–both can still be sources of insight and wisdom for each other.

Finally, the three doctors reflect on their personal experiences with mentorship and executive coaching.

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RESOURCES

“Leadership, Engagement, and Well Being” by Julie Wei

https://www.enttoday.org/article/leadership-engagement-and-well-being/3/?singlepage=1

A Healthier Wei

https://www.drjuliewei.com/pages/a-healthier-wei

Acid Reflux in Children

https://www.drjuliewei.com/pages/acid-reflux-in-children#:~:text=Acid%20Reflux%20in%20Children%3A%20A,Julie%20Wei&text=CONGESTION%2C%20COUGH%20%2B%20CROUP-,Co%2Dauthored%20by%20Dr.,symptoms%20this%20condition%20can%20create.

Ep. 57 Locums Opportunities in ENT with Dr. Allison Royer

Tue, 19 Apr 2022 05:00:00 -0000

We talk with Dr. Allison Royer about locums opportunities for otolaryngologists, why locums is becoming more popular amongst ENTs, and how to get started as a locums physician.

The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/MMVvXV

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CHECK OUT OUR SPONSORS

DI4MDs

https://www.di4mds.com

Laurel Road for Doctors

https://www.laurelroad.com/healthcare-banking/

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SHOW NOTES

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Ashley Agan interview Dr. Allison Royer, a private practice ENT who co-founded ENT Surgery Solutions, a staffing company that organizes ENT locums.

First, Dr. Royer shares her transition from being a hospital-employed ENT to becoming a locum physician with her husband. Once they met other locum physicians and heard about their experiences, they decided to start their own locum staffing company. Dr. Royer believes ENT Surgery Solutions is unique because it is managed directly by ENT physicians; Dr. Royer and her husband directly work with the doctors they employ to find work opportunities that will fit their unique needs. Although ENT Surgery Solutions is primarily Midwest-based, it is quickly expanding in the West and South.

Next, Dr. Royer transitions to discussing why many doctors are moving toward locums work. She explains that because many small private practice groups and community hospitals have been bought by hospital systems, there are now significant call burdens needing to be covered by small ENT groups. For this reason, many ENTs decide to do locums in order to balance work and life. Additionally, with locums, doctors don’t have to renegotiate their salaries or their call schedules. Finally, Dr. Royer highlights that locums are fun for her because she likes to work in different hospitals and ORs and see different patient populations and pathology.

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RESOURCES

ENT Surgery Solutions

https://www.entlocums.com/

Ep. 56 Associazione Naso Sano: A Global Education In Otolaryngology with Dr. Puya Dehgani-Mobaraki

Tue, 12 Apr 2022 05:00:00 -0000

We talk Naso Sano Associazione founder Puya Dehgani Mobaraki about the importance of connecting with Otolaryngologists around the world for education, how social media has made this possible, and the impact of listening to the needs of the future generation.

The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/vP06PS

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SHOW NOTES

In this episode of BackTable ENT, Dr. Gopi Shah talks with Dr. Puya Dehgani-Mobaraki, founder and president of Associazione Naso Sano, a global non-profit organization that provides free education for otorhinolaryngology and head and neck cancer physicians and trainees.

Naso Sano supports international trainees by providing them with grants for instrument kits, dissection courses, and textbooks. Dr. Dehgani-Mobaraki emphasizes the importance of surveying trainees to determine which resources and educational opportunities will best help them achieve their future goals. Another important aspect of Naso Sano is the virtual grand rounds. Although organization of these sessions can be challenging due to differing time zones, Naso Sano grand rounds sessions have reached attendance levels of up to 1000 participants. These sessions are available on a variety of platforms, including Facebook, Youtube, and Twitch. Dr. Dehgani-Mobaraki lets the medical and public community decide the topics they would like to learn about, which has included cystic fibrosis, anatomy and dissection courses, and many more diverse subjects.

Finally, the doctors discuss the duty of physicians to use their credibility and knowledge to address human rights violations and gender inequality in healthcare. Both doctors agree that marginalized populations still do not receive adequate healthcare and that small conversations with colleagues and trainees can have a great impact in resolving these matters.

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RESOURCES

Dr. Dehgani-Mobaraki Twitter:

https://twitter.com/puyadehganimd

Naso Sano Twitter:

https://twitter.com/nasosano

Naso Sano Website:

https://www.nasosano.it/

Ep. 55 CEO/Founder of Dr. Noze Best to Brussel Sprout Farming with Dr. Steve Goudy

Tue, 05 Apr 2022 05:00:00 -0000

In this episode Dr. Eric Gantwerker talks with Dr. Steve Goudy about the importance of finding and thoroughly researching pain points for patients and their families, to then drive innovative solutions.

Reflect on how this Podcast applies to your day-to-day and engage to earn AMA PRA Category 1 Credit(s)™ via point-of-care learning activities here: https://earnc.me/Jhj06n

Ep. 54 Keeping up with Technology for In-Office Sinus Procedures with Dr. Brian Weeks and Dr. Ashley Sikand

Tue, 22 Mar 2022 05:00:00 -0000

We talk with Dr. Ashley Sikand and Dr. Brian Weeks about performing In-Office Sinus procedures, including differences in technique, and keeping up with the latest technologies.

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https://ent.stryker.com

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SHOW NOTES

In this episode of BackTable ENT, Dr. Gopi Shah talks with Dr. Ashley Sikand (Nevada Sinus Relief in Las Vegas, NV) and Dr. Brian Weeks (SENTA Clinic in San Diego, CA) about tips for starting in-office procedures and forming effective industry partnerships.

First, Dr. Sikand and Dr. Weeks outline their motivations for entering the medical device industry space and serving as consultants for Acclarent, an otolaryngology medical device company. Next, they summarize the types of nasal conditions they can treat with an office-based procedure. These conditions include: deviated nasal septum, nasal valve disorders, turbinate obstructions, nasal polyps, and chronic rhinitis. They note that these procedures have only been made possible due to advances in anesthesia and blocking techniques. Although anesthesia varies based on the type of procedure, anesthesia for sinus work in general consists of three steps: anxiolysis (lorazepam or benzodiazepine), topical anesthesia (lidocaine and tetracaine), and infiltrative anesthesia (sphenopalatine block).

Patient selection criteria is also very important when considering good candidates for office-based procedures. The doctors note that younger patients may have more apprehension towards in office procedures. Additionally, if a patient presents with a complex condition that requires multiple procedures, operating in the OR may be a better option. With experience, surgeons will be able to discern whether an in-office procedure is possible for different types of patients.

Finally, the doctors emphasize how important good in-office resources are. The starting toolbox for an otolaryngologist should contain: a good endoscopic system, a camera, an instrument tray, effective suction, and an image guidance system. Knowing the room set up is a crucial requirement as well. Although the doctors admit that young otolaryngologists may not have the capital to purchase all the essentials, they encourage them to leverage their industry connections by inviting representatives to bring different equipment for demonstrations first. Finally, they end by advocating for doctors to critically evaluate medical technology using their medical education and training before adopting a device into their standard practice.

Ep. 53 Financial Basics from the White Coat Investor with Dr. James Dahle

Fri, 18 Mar 2022 05:00:00 -0000

Special guest The White Coat Investor James M. Dahle talks with Christopher Beck about where physicians can start when it comes to financial literacy, including common financial mistakes docs make when start practicing, a primer on mortgage rates, and tips on insurance.

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SHOW NOTES

In this episode, White Coat Investor founder Dr. James Dahle and our host Dr. Chris Beck discuss strategies for physicians seeking to manage their personal finances and gain financial freedom.

First, Dr. Dahle explains the reasoning behind the famous quote, “live like a resident.” He explains that for an early career physician, their greatest wealth-building tool is their income. The income jump from residency to attending years can be extremely useful for quickly paying off student loans. Then, he moves on to discuss another way to resolve student debt, the Public Service Loan Forgiveness (PSLF) program. This option is ideal for physicians who have spent a significant amount of time working for a nonprofit institution (for example, during training and in academic medicine).

Dr. Dahle advises all physicians to reflect on their priorities when deciding where to allocate their assets. Possible categories could include retirement funds, 529 college savings funds, payment of high-interest debt, and emergency funds. We talk about the power of having a written plan to stay on track with financial goals and prevent ourselves from making rash decisions.

Next, we discuss different financial vehicles that can provide benefits for physicians. The “back door Roth IRA” strategy allows for yearly contributions to a tax-free retirement fund, even when a physician’s income exceeds the maximum limit for the conventional Roth IRA. Additionally, the funds in a Health Savings Account (HSA) can be used for investment, and then withdrawn at a later date, penalty-free. Dr. Dahle explains the difference between fixed rate and variable rate mortgages, noting that the latter is better for short-term loans because interest rates are unlikely to dramatically increase from year to year. Finally, Dr. Dahle covers the advantages of buying disability insurance as a way to protect physician income, especially for those working in procedural specialties.

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RESOURCES

White Coat Investor: https://www.whitecoatinvestor.com/

White Coat Investor Podcast: https://www.whitecoatinvestor.com/wci-podcast/

White Coat Investor Email: editor@whitecoatinvestor.com

Passive Income MD: https://passiveincomemd.com/

Physician on FIRE: https://www.physicianonfire.com/

Ep. 52 Comprehensive Management of Adult OSA with Dr. Carlos Torre

Tue, 15 Mar 2022 05:00:00 -0000

In this episode of BackTable ENT, Dr. Gopi Shah talks with Miami-based otolaryngologist Dr. Carlos Torre (Sleep, Snoring & Sinus Clinic of Florida) about his journey to building an adult sleep practice and management of sleep disorders, such as sleep apnea and insomnia.

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SHOW NOTES

First, Dr. Torre shares his personal experience in the field of sleep medicine. He explains his path to becoming board-certified in otolaryngology, sleep study, and sleep medicine, and obesity medicine. During his sleep surgery fellowship, he was fortunate to train with good mentors who showed him a diversity of techniques and procedures to treat sleep disorders. Driven by his entrepreneurial mindset, he eventually transitioned to his own solo private practice in August 2021.

Next, the doctors discuss how to work up an adult patient initially presenting with snoring. Dr. Torre first evaluates the presence and severity of the patient’s symptoms as well as other comorbidities. Next, he orders a home sleep study to confirm the diagnosis of sleep apnea and interprets the sleep studies himself. Many cases of sleep apnea can be resolved nonsurgically through nasal breathing training if the patients are chronic mouth breathers. Nasal breathing training is a type of myofunctional therapy that incorporates exercises such as correct tongue positioning, strengthening of facial muscles, and palatal coupling. Besides nasal breathing training, he recommends CPAP for every patient with obstructive sleep apnea. He prefers to perform surgery conservatively. Thus, he will only consider surgery (tonsil removal, septum deviation surgery) if the patient has failed CPAP therapy for a prolonged period of time and he will use surgery as a tool to optimize CPAP instead of aggressively trying to cure the patient’s sleep apnea. Dr. Torre mentions that nightly dental appliances are also a treatment option.

Finally, Dr. Torre acknowledges that general wellness plays an integral role in sleep hygiene. The most common comorbidity associated with sleep apnea is obesity. He recommends fasting and eating early dinners to patients presenting with obesity-related sleep disorders. He also explains how meditation can help relieve anxiety and depression in patients suffering from insomnia. Dr. Torre ends the episode by emphasizing the benefits of multidisciplinary care for patients with sleep disorders.

Ep. 51 Hypoglossal Nerve Stimulation for Adult OSA with Dr. Matthew Hensler

Tue, 01 Mar 2022 06:00:00 -0000

In this episode we talk with Dr. Matthew Hensler about Hypoglossal Nerve Stimulation for treating Adult Obstructive Sleep Apnea (OSA), including how he learned the procedure, patient selection, procedure tips, and advice on building a successful program.

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First, Dr. Hensler explains the initial workup for a snoring patient. In this history, he addresses the impact snoring has on the patient’s quality of life and also assesses the environmental factors that may be responsible for the snoring, such as lack of sleep and alcohol consumption. Then, during the physical exam, he checks for anatomical reasons for snoring, such as large tonsils and a deviated septum. From the history and physical exam, he is able to classify patients into two categories: primary snorers (without sleep apnea) and snorers with sleep apnea. He recommends that all patients complaining of snoring obtain a sleep study.

Dr. Hensler then explains his criteria for choosing good hypoglossal nerve stimulator candidates. He recommends choosing patients with an Apnea Hypopnea Index (AHI) score between 15-65, a BMI of less than 31, and patients who have less than 25% of apnea attributed to mixed and central apnea. Because the CPAP machine is still the gold standard treatment for treatment of OSA, he usually only recommends this surgery to patients who have failed CPAP treatment already.

Next, Dr. Hensler explains the mechanics behind the hypoglossal nerve stimulator, which only treats obstructive sleep apnea. During the implantation surgery, the first incision is made in the right chest for placement of the processor. The processor is attached to a sensor lead that feeds into the rib cage space between the external and internal intercostal muscles. A second submandibular incision is made below the submandibular gland to place the stimulator lead. When the sensor lead in the rib cage senses the patient breathing, it relays a message to the stimulatory lead, which stimulates the protrusive branches of the hypoglossal nerve to fire and push the tongue outwards. The surgery can be performed in an outpatient setting andlasts less than 2 hours. Patients can start turning on the device before they sleep 3-5 weeks after implantation. Finally, Dr. Hensler obtains a 3 month follow up sleep study in order to monitor improvement in AHI scores.

Post-operative complications like infection and pain are possible. Dr. Hensler prescribes his patients with a short duration of narcotics for submandibular pain and a 7-day course of antibiotics to prevent infection. Because of chest involvement during surgery, a pneumothorax is another post-operative complication. A chest X-ray should always be ordered after surgery to rule out this possibility. Finally, it is important to note that patients with a hypoglossal nerve stimulator are unable to undergo MRI scans involving their right chests because of the battery in the processor.

Centering the Conversation Around Health Equity with Dr. Ayanna Bennett

Fri, 25 Feb 2022 06:00:00 -0000

In this episode Dr. Kumar and Dr. Bennett discuss various levels of racism found in healthcare, and share allegories of racism as outlined by Dr. Camara P. Jones, including the gardeners tale.

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SHOW NOTES

In this episode, guest host Dr. Vishal Kumar interviews Dr. Ayanna Bennett about how to train ourselves to recognize perpetuated health disparities within the medical system and how we can actively work to dismantle them.

The doctors first talk about understanding racism on an institutional level, which results in a “machine” that selectively delivers better and worse aspects of healthcare to different populations. Dr. Bennett emphasizes that every disease process shows race disparities not because of inherent biological differences in racial groups, but because of unequal frequencies and quality of contact with healthcare systems.

Throughout the episode, they reference the allegories of Dr. Camara Jones, a physician-epidemiologist and civil rights activist. These allegories provide a framework for discussing nature vs. nurture for health outcomes and also privilege defined as the lack of barriers to entry.

In terms of actionable steps that providers can take toward reducing health inequity, Dr. Bennett encourages us to learn and engage with the communities that they serve. She advises us to be “counter-stereotypical” and show interest in patients’ lives outside of the healthcare setting. Finally, she calls us to analyze the impact that our institutions have on maintaining the health of the community as a whole, rather than solely focusing on individual patients.

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RESOURCES

The Gardener’s Tale Allegory by Dr. Camara Jones:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446334/

Tedx Talk by Dr. Camara Jones:

https://www.youtube.com/watch?v=GNhcY6fTyBM

Ep. 50 Building a Solo Practice with Dr. Reena Mehta

Tue, 22 Feb 2022 06:00:00 -0000

In this episode we talk with Dr. Reena Mehta about her experiences building a solo Allergy practice from scratch, including finding a space, staffing, essential equipment, and a successful marketing strategy.

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SHOW NOTES

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Ashley Agan talk with Dr. Reena Mehta about her path to starting her own allergy private practice, including tips on successful budgeting, hiring practices, advertising, and maintaining a work-life balance as a solo physician.

FIrst, Dr. Mehta reflects on her personal journey to starting her own private practice. Although she started her post-graduate career in academic medicine, she transitioned to a group private practice. She then decided to open a solo private practice in order to practice medicine in the location and way she had always wanted to. In order to assess the feasibility of this idea, she consulted her network of private practice physicians. Then, she did market research to understand the location and demographics of the area in which she was planning to open her practice. Finally, she was able to find a space to rent, formulate a budget, apply for a loan, and start staffing her practice.

Dr. Mehta acknowledges that cost projections and staffing were the two most difficult aspects of starting her solo private practice. There were many costs associated with private practice that she had to account for, such as rent, staff salaries, equipment, website and marketing, electronic health records, and insurance credentialing. Fortunately, she received help from advice forums for private practice doctors as well as American Academy of Allergy, Asthma, & Immunology (AAAI) resources. Next, Dr. Mehta recounts the difficulties of staffing her practice, including unpredictability and high turnover during the peak of the COVID-19 pandemic. She notes that learning to not take staffing issues personally, hiring younger and motivated employees, and using a hiring service such as Zip Recruiter and Indeed really helped her be successful in hiring the right candidates.

Finally, Dr. Mehta discusses how she maintains a healthy work-life balance. As a solo private practitioner, she is able to close her clinic when she wants to but is still available via telehealth visits and remote consulting with her staff. One method she has found to be helpful is to hire second year fellows to manage emergency allergy events and give allergy shots to patients when she is on leave.

Ep. 49 Building Centers of Excellence for Pediatric Head and Neck Tumors with Dr. Anthony Sheyn, Dr. Daniel C. Chelius, and Dr. Jeff C. Rastatter

Tue, 15 Feb 2022 05:00:00 -0000

All-star panel Daniel Chelius, Jeff C. Rastatter, and Anthony Sheyn discuss the challenges and importance of building centers of excellence for pediatric head and neck cancer.

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SHOW NOTES

In this episode of BackTable ENT, Dr. Gopi Shah leads a panel discussion about building centers of excellence for pediatric head and neck tumors. She invites Dr. Daniel Chelius (Baylor College of Medicine/Texas Children’s Hospital), Dr. Jeff C. Rastatter (Feinberg School of Medicine, Lurie Children’s Hospital), and Dr. Anthony Sheyn (University of Tennessee Medical School, St. Jude Children’s Hospital) to speak about their experiences and advice for establishing these centers of excellence.

First, the three panelists discuss their career paths to becoming pediatric head and neck cancer surgeons. Then, they share their motivations for building these centers of excellence at their own institutions. All of them realized the importance of routing complex and rare pediatric cancer cases to centralized hospitals and experienced surgeons who saw high volumes of the same cases. Additionally, they saw the need for multidisciplinary collaboration with surgeons in the fields of plastic surgery and oncology. Finally, these centers of excellence facilitate the formation of multidisciplinary tumor boards for pediatric cancer cases.

Additionally, they discuss the important elements they needed to form their centers of excellence of pediatric head and neck tumors. First, they needed support within their own otolaryngology division for a shared vision of division specialization and focused expertise. They also needed to form strong relationships with different specialties, namely pediatric plastic surgery and pediatric general surgery. Another important aspect was the institutional commitment of the affiliated children’s hospitals, which were tasked with patient outreach referrals. Finally, each center of excellence needed to be an open environment in which asking for advice and thinking outside of the box was encouraged.

Ep. 48 Feeding Difficulties in Infants with Ashley Brown SLP

Tue, 08 Feb 2022 05:00:00 -0000

We talk with Ashley Brown, SLP about how to approach the infant with feeding difficulties, including common causes and workup, therapeutic options, and the importance of family counseling and education.

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SHOW NOTES

In this episode of BackTable ENT, Dr. Gopi Shah interviews Ashley Brown, a speech language pathologist (SLP) at Children’s Health Hospital in Dallas, about the evaluation and management of the infant with dysphagia.

An infant with dysphagia, or difficulty in swallowing, can present with many symptoms, but most commonly failure to thrive, refusing to feed, incomplete feeding, and aspiration. When primarily assessing these patients, a complete history must be taken. Standard questions cover the chief complaint, the birth history, observations of a typical feed routine, and parent concerns. Next, a holistic exam is conducted. Speech language pathologists will often observe an infant’s posture, tone, trunk support, and range of motion of the mouth and tongue. If necessary, instrumental studies, like a flexible endoscopic evaluation of swallowing (FEES) or a videofluoroscopic swallow study, can be performed. A FEES visualizes the pharyngeal space and is recommended for breastfeeding babies, NPO babies, head and neck cancer babies. A videofluoroscopic swallow study visualizes the oral and esophageal space and gives a better picture of flow rate consistency.

Infant dysphagia can result from many etiologies, but some of the most common roots are: abnormalities in oral structure (e.g. tongue tie). problems with tone (e.g. injury to the recurrent laryngeal nerve), syndromes (e.g. Trisomy 21, DiGeorge Syndrome), laryngeal cleft, and laryngomalacia. Furthermore, GERD and nasal obstruction (e.g. pyriform aperture stenosis, choanal atresia) can also cause dysphagia.

Although some deformities can be surgically fixed, most infants with dysphagia will either improve with maturity or through feeding therapy sessions with speech language pathologists. In these sessions, SLPs work with infants to train their sensory cues and motor skills through exercises such as oral motor stretches, sour/cold stimulation, facial taping, lip rounding, and neuromuscular stimulation. It is just as important to provide family counseling and parent training as it is to train the infant patients during these sessions.

Ep. 47 Mavericks as Innovators: How Daring Leads to Discovery with Dr. Michael Rutter

Fri, 04 Feb 2022 05:00:00 -0000

Pediatric airway surgeon Dr. Michael Rutter and I discuss risk-taking and effective market analysis in entrepreneurship. In the operating room, Dr. Rutter cultivates a congenial OR environment and often seeks ideas from other team members with different areas of expertise. These problem solving-driven conversations often result in pioneering new airway surgery techniques. In the medical device sphere, he outlines his journey of creating a tracheal balloon dilation device, explaining how he obtained intellectual property rights, cleared FDA regulations, and marketed the product.

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SHOW NOTES

In this episode, pediatric airway surgeon Dr. Michael Rutter and our host Dr. Eric Gantwerker discuss risk-taking and effective market analysis in entrepreneurship.

Dr. Rutter shares about his career path from medical school, to orthopedic surgery training, to his current hybrid role in otolaryngology and device entrepreneurship. Interestingly, his experience in orthopedic surgery has inspired him to adopt orthopedic tools and techniques in solving complex ENT cases. He elaborates on this idea of borrowing concepts from other fields, saying that he cultivates a congenial OR environment and often seeks ideas from other team members with different areas of expertise. These problem solving-driven conversations often result in pioneering of new airway surgery techniques.

As we transition to discussing product development, Dr. Rutter outlines his twelve year journey of creating a balloon dilator for the trachea, explaining how he obtained intellectual property rights, cleared FDA regulations, and marketed the product. When in a competitive marketplace, he highlights the benefits of conducting a non-inferiority (“Pollyanna”) study combined with attractive value propositions. Finally, he discusses the reality that some good ideas will not necessarily be successful, due to insufficient market size or extremely high costs of research and development. We conclude on the point that an entrepreneur must evaluate the balance between benefits gained and losses incurred when bringing their product to market.

Ep. 46 Biologics for Nasal Polyps — What’s the Role? With Dr. Cecelia Damask and Dr. Matthew Ryan

Tue, 01 Feb 2022 05:00:00 -0000

We talk with Dr. Cecelia Damask and Dr. Matt Ryan about the role of Biologics for Nasal Polyps, including patient selection and its place in the treatment plan.

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SHOW NOTES

In this episode of BackTable ENT, Dr. Ashley Agan, Dr. Gopi Shah, Dr. Cecelia Damask (Lake Mary ENT and Allergy), and Dr. Matt Ryan (UT Southwestern Otolaryngology) discuss the growing role of biologics for nasal polyps.

Biologics are monoclonal antibodies that block T2-mediated immune responses (IL-3, IL-4, IL-13, IgE). They are administered subcutaneously and follow various dosing regimens. Biologics are a viable treatment option in patients with recurrent nasal polyps who have failed conventional therapies, such as high doses of antihistamines, topical steroids, and systemic steroids. It is still considered as a last line treatment because of the high cost associated with production of monoclonal antibodies.

However, not all patients with recurrent nasal polyps are good candidates for biologics. The patient must present with a specific endotype––the T2-mediated etiology. T2-mediated patients can be identified through their high responsiveness to steroid therapy, positive history for allergic asthma and atopic dermatitis, and high peripheral eosinophil and serum IgE levels on a CBC with differential. In a surgery-naive patient with a temporary steroid response, it is best to perform sinus surgery first in order to widen the nasal mucosal surface area for efficient delivery of topical therapies. However, if post-surgical intranasal steroid sprays and saline irrigations are ineffective, biologics should be considered. It is best to avoid surgery and skip straight to biologics in patients with comorbid conditions that prevent surgery, patients with severe asthma, and patients with high peripheral IgE counts (>1000).

Once the decision to start biologic therapy is made, many factors have to be considered, such as insurance pre-authorization, administration methods, and frequency of dosing. Each biologic manufacturer has a “hub” that assists physicians and patients in navigating biologic dosing, delivery, and insurance paperwork. They will often have co-pay assistance programs for patient benefit as well. Common side effects observed in biologic trials are arthralgia, injection site inflammation, oropharyngeal pain, and headaches. However, all the doctors agree that these side effects are more mild than those of long-term systemic steroid use, which include avascular necrosis, cataracts, sepsis, and thromboembolic events.

Picking which biologic to prescribe is a clinical decision because they have not been subjected to comparative trials yet. The three biologics currently on the market are: Dupilumab (anti-IL-4 receptor), Omalizumab (anti-IgE), and Mepolizumab (anti-IL-5 receptor). All work to prevent T2 immune signaling by targeting different receptors. Factoring in comorbid conditions, payer systems, and dosing regimens can help a physician choose the best biologic for a nasal polyps patient.

Ep. 45 Private Equity - Savior or Existential Threat? With Dr. William Blythe and Dr. Drew Locandro

Thu, 27 Jan 2022 05:00:00 -0000

In this special collaborative episode, guest host Dr. Bradley Block talks with Dr William Blythe and Dr. Drew Locandro about the pros and cons of private equity, including a discussion of the key things to think about when considering selling your practice.

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SHOW NOTES

In this episode of BackTable ENT, Dr. Bradley Block from ENT and Allergy interviews Dr. Drew Locandro (Northwest ENT and Allergy Center) and Dr. Bill Blythe (East Alabama Ear, Nose & Throat) about the benefits and pitfalls of opening their private practices to private equity companies.

Private equity can provide many benefits to community practitioners. Outside investment can contribute more money to marketing and hiring new supportive positions. Additionally, it also levels the playing field for older and younger doctors in the practice in the context of objective management. Finally, private equity firms can take care of administrative duties, such as billing and accounting, thus increasing the free time available to physicians.

On the other hand, retaining complete ownership of a medical practice can provide physicians with more satisfaction and decrease rates of burnout. Dr. Blythe notes that a physician can still retain total ownership of his practice but still outsource basic administrative duties, such as general accounting.

Finally, the doctors discuss the concept of a “second bite” deal. Oftentimes, the original smaller private equity firm will sell the medical practice to a larger private equity firm for a profit. Risks of the “second bite” include undervaluation of the practice as well as loss of physician control. However, Dr. Locandro notes that the second sale may also be financially beneficial for the physician stakeholders as well.

Ep. 44 Where to Start with Your Device Idea (and Other Entrepreneurial Pursuits!) with Dr. Keith Matheny

Tue, 25 Jan 2022 05:00:00 -0000

Dr Keith Matheny tells us how he first got involved in entrepreneurial pursuits, including starting a global purchasing organization for ENT's, as well as advice on where to start when you have a great idea for a new device!

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SHOW NOTES

In this episode of BackTable ENT, Dr. Shah and Dr. Agan interview Dr. Keith Matheny, a physician-entrepreneur and a fellow ENT.

First, Dr. Matheny discusses his personal device innovation and business journey. He started medical practice with no formal business background or training and had to learn these skills on-the-job during his first private practice job. After observing the need in his field for business consulting, he created US ENT, a formal consulting company, to help other ENT practices grow and develop different departments. US ENT later transformed into a group purchasing organization and was able to partner with medical suppliers to give physicians discounts on materials. During this time, he was also able to test new ENT devices and provide his input to large medical device companies; these experiences prompted him to venture into the field of device innovation and begin patenting his ideas.

Acquiring knowledgeable and supportive partners is essential for developing new devices. Dr. Matheny recommends reaching out to device representatives of major medical device companies in order to be introduced to their business development teams. However, he notes that major medical device companies do not specialize in early-stage development. For this reason, partnering with a startup business may be more productive when developing a product prototype. For every person an innovator discusses his idea with, a non-disclosure agreement (NDA) should be signed in order to ensure the integrity of information sharing. Additionally, innovators should file a patent as soon as they have a solid idea; patent lawyers are useful resources and can help innovators find angles that make their ideas different from previous devices. Although Dr. Mathey encourages innovators to seek funding from healthcare investors, venture capitalists, and private equity companies, he warns listeners against letting outside forces take control over a majority of their company.

Once a prototype is created, the product can be tested in the setting of a medical practice through the proper IRB channels. It is important to follow FDA regulations during this time period. For devices that are similar to pre-existing devices on the market, they can be classified as Class I exempt devices if all predicate devices are listed in the application. Approval for Class I exempt devices will follow in a few short months. However, for brand new devices, a formal study will need to be conducted before it can be used in human patients, thus invoking a longer approval time.

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RESOURCES

Dr, Matheny’s Linkedin:

https://www.linkedin.com/in/keith-matheny-38250811/

US ENT:

https://usent.com/

Septum Solutions:

https://septumsolutions.com

Sleep Vigil:

https://www.sleepvigil.com/

Ep. 43 ENT Societies: Why Join? With Dr. Romaine Johnson, Dr. Gaelyn Garrett, Dr. Ron Mitchell, and Dr. Seth Dailey

Tue, 11 Jan 2022 05:00:00 -0000

Romaine Johnson asks society leaders Gaelyn Garrett, Seth Dailey and Ron Mitchell about why otolaryngology societies are worth joining, including addressing questions that young ENT's have about the value of a membership.

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SHOW NOTES

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Johnson discuss the benefits and challenges of joining ENT societies in a panel discussion with Dr. Ron Mitchell (American Society of Pediatric Otolaryngology), Dr. Gaelyn Garrett (Triological Society), and Dr. Seth Dailey (American Broncho-Esophagological Association).

ENT societies can bring many professional opportunities to network and find mentorship outside of their own institutions. Society meetings can also advance research interests, as attendees can seek advice about research topics and find research funding and travel grants. Finally, ENT society members have a sense of belonging to a “tribe”, or a family of like-minded individuals who share the same goals for advancing their practice as well as community health.

Nevertheless, as ENT societies grow in scale, there is potential for more challenges to develop. For example, younger members may feel that their voices are not being heard, as there can be a leadership-member gap at society meetings. Additionally, financial barriers and admission requirements may deter new members from joining. Finally, many ENT societies remain academically focused and seem irrelevant to community practitioners.

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RESOURCES

American Society of Pediatric Otolaryngology: https://aspo.us/

Triological Society: https://www.triological.org/

American Broncho-Esophagological Association: https://www.abea.net/

Ep. 42 Doctors and Litigation: The L Word with Dr. Gita Pensa

Fri, 07 Jan 2022 05:00:00 -0000

Emergency medicine physician and podcast founder Dr. Gita Pensa and our co-hosts Dr. Chris Beck and Dr. Aaron Fritts discuss methods of navigating malpractice lawsuits, maintaining professional identity, and prioritizing mental health.

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SHOW NOTES

In this episode, emergency medicine physician and podcast founder Dr. Gita Pensa and our co-hosts Dr. Chris Beck and Dr. Aaron Fritts discuss methods of navigating malpractice lawsuits, maintaining professional identity, and prioritizing mental health.

Dr. Pensa starts by outlining her personal experience with a twelve year-long malpractice suit, which inspired her to start her own podcast, “Doctors and Litigation: The L Word.” She says that despite the fact that most physicians will face lawsuits in their career, there is a current lack of physician-centered educational resources over malpractice litigation. To combat this, she encourages physicians to share their experiences and learn from one another.

The doctors walk through major steps of a lawsuit, starting with the process of getting served with papers. Dr. Pensa emphasizes that it is important to recognize that this step could be used as the first tactical move in a lawsuit and designed to make physicians feel uneasy. The next step after getting served should always be to call the insurance carrier and have them start the process of initiating a claim. Dr. Pensa strongly advises against accessing or editing patient charts after getting served, as these actions are recorded in the EMR and can be used against the physician. Finally, Dr. Pensa discusses the process of deposition and how it serves as both a fact-finding mission and a strategic way to distort a physician’s words. She recommends practicing with lawyers to answer deposition questions clearly and concisely.

Throughout the episode, the doctors highlight the importance of maintaining one’s mental health during the litigation process. They advise listeners to seek support from friends, family, colleagues, and professionals, as long as the specific details of the case are not discussed. To close, Dr. Pensa reminds the audience that malpractice lawsuits usually have financial motivations, and they may not be an accurate representation of a physician’s competence or compassion for patients.

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RESOURCES

Doctors and Litigation: The L Word: https://doctorsandlitigation.com/

“The Defendant” by Sarah Charles: https://www.amazon.com/Defendant-Sarah-Charles/dp/0394746635

“Adverse Events, Stress, and Litigation” by Sarah Charles: https://www.amazon.com/Adverse-Events-Stress-Litigation-Physicians/dp/0195171489

“How to Survive a Medical Malpractice Lawsuit” by Ilene Brenner: https://www.amazon.com/How-Survive-Medical-Malpractice-Lawsuit-ebook/dp/B005C65X2M

“When Good Doctors Get Sued” by Angela Dodge and Steven Fitzer: https://www.amazon.com/When-Good-Doctors-Get-Sued/dp/0977751104

Ep. 41 How to Find the Right JOB! with Dr. Varun Varadarajan

Tue, 04 Jan 2022 05:00:00 -0000

We talk with Dr. Varun Varadarajan about how to find the right job for you, including pearls and pitfalls to avoid. Varun provides valuable insight based on his experiences with cold-calling groups, negotiating contracts, and important questions to ask at every interviews.

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SHOW NOTES

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Varun Varadarajan discuss tips for finding the right physician job.

First, Dr. Varadarajan shares his personal journey to finding his job as a neurotologist and skull base surgeon in a private practice located in Denver, Colorado. He started to job hunt for a private practice position after matching to fellowship, which was two years before finishing his training. However, he notes that this timeline may be too early for jobs in academic medicine. Although physicians can apply for jobs through word of mouth and job postings, he and Dr. Shah note that cold calling can also be effective.

Next, the doctors discuss the changes in job hunting that occurred as a result of the COVID-19 pandemic. During the pandemic, some job opportunities vanished because of decreased funding and patient volume in clinics. Dr. Varadarajan and Dr. Shah also summarize the types of questions that should be asked during and after a private practice interview. Some red flags are: multiple associates who never made partner, high turnover rates, big buy-in amounts for partnership, and non-transparency with finances. Dr. Varadarajan also shares the resources he used during the employment process; he had a local lawyer with experience who reviewed his contract beforehand and received mentorship from academic faculty and his former co-residents.

Finally, Dr. Shah discusses tips for academic job hunting. One difference between private practice and academic job hunting is that in the latter, the consideration of how much research time and clinical time doctors want to prioritize becomes an important decision. Dr. Shah also took into consideration her family life, and ultimately decided on a job at UT Southwestern because of the great ENT department faculty and mentors.

Ep. 40 Diagnosis and Management of Eustachian Tube Disorders with Dr. Dennis Poe

Tue, 21 Dec 2021 05:00:00 -0000

Dr. Ashley Agan sits down with the eustachian tube expert Dr. Dennis Poe to discuss his approach to management and treatment of eustachian tube dysfunction.

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SHOW NOTES

In this episode of BackTable ENT, Dr. Agan discusses eustachian tube disorders with Dr. Dennis Poe, professor of otolaryngology at Harvard Medical School.

First, the doctors discuss the difference between the two main types of Eustachian tube disorders: obstructive dysfunctions and Patulous dysfunctions. Obstructive dysfunctions are a result of pathologies that cause inflamed or clogged Eustachian tubes, while Patulous dysfunctions are a result of the Eustachian tube remaining perpetually open.

Obstructive and Patulous dysfunctions can be clinically differentiated. Patulous dysfunctions commonly experience extraordinary loud noises, variable pressure sensation, aural fullness, habitual sniffing, relief upon using the Valsalva maneuver, and autophony. Although autophony is not pathognomonic for Patulous dysfunction, it can give otolaryngologists a clue for a potential Patulous dysfunction diagnosis. Obstructive dysfunction patients commonly experience negative pressure in tympanic membrane, fluid in middle ear, scarring, and fixed retraction pockets.

Otolaryngologists can also insert an endoscope through the nose to perform a physical examination on Eustachian tube disorder patients. Dr. Poe recommends that otolaryngologists obtain a longitudinal view of the Eustachian tube lumen to observe the cartilaginous and membranous walls and the quality of the valve. He recommends using the MEELO assessment (mucus production, erythema, edema, lymphoid hyperplasia, and opening quality) to grade Eustachian tube disorder patients on a scale of 1-4, with 4 being the most severe dysfunction. He cautions against using tympanograms for diagnoses because of their inaccuracy.

Eustachian tube disorders can be treated with medication. Because the most common etiology of obstructive Eustachian tube disorder is allergic rhinitis, Dr. Poe starts with allergy testing to identify possible allergens. He notes that topical nasal steroids and nasal drops are effective, but may be difficult for patients to self-administer. For this reason, patient education is very important. If medications do not work after 6 weeks, Dr. Poe recommends performing a balloon dilation of the Eustachian tube. The length of balloon dilation depends on the MEELO grading scale. If obstructive Eustachian tube dysfunction patients are a grade 3 or 4 with moderate to severe inflammatory disease and a significantly compromised valve, he dilates for the full two minutes. If they are a grade 2 or low grade 3 with a lesser disease, he only dilates for one and a half minutes or even one minute. Because pediatric patients are very sensitive to balloons, he never goes above one and a half minutes in pediatric patients. Finally, he notes that Patulous Eustachian tube dysfunction patients can be surgically treated via a transtympanic tripod-shaped angiocatheter procedure.

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RESOURCES

Eustachian Tube Disorder Questionnaire:

https://earandsinusinstitute.com/online-questionnaires/etdq-7-questionnaire/

Xhance Nasal Spray:

https://www.xhancehcp.com/

Ep. 39 Evaluation and Management of an Infant with a Small Jaw with Dr. Brianne Roby

Tue, 14 Dec 2021 05:00:00 -0000

We talk with Dr. Brianne Roby from Children's Minnesota about airway evaluation and surgical management of the infant with retro/micrognathia.

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SHOW NOTES

First, the doctors discuss the difference between micrognathia and retrognathia, two terms that are commonly and incorrectly interchanged. Micrognathia refers to an infant having a small mandible, while retrognathia means the infant’s mandible is normal sized, but just recessed.

Dr. Roby usually makes the distinction through physical examination by feeling the angle and body of the mandible. In infants with retrognathia, she is able to feel a long body and defined angle in the mandible. She notes that diagnosis of micrognathia will most likely be postnatal, as obtaining a perfect sagittal view for measurement of inferior facial angle in a prenatal ultrasound is very difficult. However, she notes that polyhydramnios, or excess accumulation of amniotic fluid, is a significant indicator of an underdeveloped fetal jaw.

In her initial evaluation of an infant with micrognathia, she first confirms that the infant is stable and in optimal position. Then, she examines the infant for other comorbidities and syndromic developments. Although Stickler syndrome is the most common syndrome associated with micrognathia, Pierre-Robin sequence and Treacher Collins syndrome can also cause micrognathia. Before scoping the infant, she prefers to familiarize herself with the infant’s anatomy and feeding/breathing patterns first. In order to do this, she collaborates with the NICU staff and encourages them to informally document the infant’s behavior. Then, she will insert a bedside flexible scope through the infant’s nose to confirm that the infant has glossoptosis and not just a benign enlarged tongue base. She emphasizes that a surgeon should always confirm that there are no other airway malformations before performing surgery to place a mandibular distractor. Besides glossoptosis, other important indicators for mandibular distraction are airway obstruction and feeding difficulties. Dr. Roby only performs mandibular distractions on babies that are gestationally full term (37-38 wks) and weighing over 2 kg.

Next, Dr. Roby shares her tips for mandibular distraction surgery. Her general approach is to secure the airway first and then insert the distractor. She emphasizes that preparation for airway emergencies is the most important intraoperative consideration. She prefers to have an experienced anesthesiologist on hand and multiple methods to secure an infant’s airway, including nasotracheal intubation, oral intubation, a Glidescope, a Telescope, flexible fiberoptic nasal intubation, a tracheostomy set, and manual ventilation. The longer time it takes to secure an infant’s airway, the higher the risk of spontaneous laryngospasm and bleeding.

The otolaryngologist can either place an internal or external distractor. For an internal distractor, the plates and screws are placed under the skin so only the distraction arm is visible. This device can only distract in one direction, so it is commonly used in Pierre-Robin sequence infants. External distractors contain hardware that must be inserted externally and can distract in multiple directions. Dr. Roby prefers to place an internal distractor to minimize scarring and maximize parent and nurse comfort.

After the distractor is placed, it must be rotated daily to open the mandible. Dr. Roby turns the pins twice a day by 2 mm; she does 1 mm in the morning and 1 mm in the night. Her goal is to achieve a 12-14 mm distraction and a slight underbite in most infants. After achieving this distance, the plates have to be left in for 10 weeks in order for the bone to harden. After 10 weeks, she removes the distractor and observes the infant for improvement in feeding.

Ep. 38 Simulation for Complex Pediatric Airway Surgery with Dr. Romaine Johnson

Tue, 30 Nov 2021 05:00:00 -0000

Dr. Romaine Johnson tells us about The Simulation Program for open airway and foreign body training at UT Southwestern, including how he got it started, how it's being used, and what steps go into making a successful course.

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In this episode of BackTable ENT, Dr. Shah and Dr. Agan discuss simulation programs for complex pediatric airway surgery with Dr. Romaine Johnson from UT Southwestern.

First, Dr. Johnson explains his motivation to start an airway simulation program. In the past, he noticed that emergency airway obstructions were suboptimal educational experiences for his junior residents, so he wanted to create a space in which trainees could build the confidence to prevent severe laryngospasms and bronchospasms and develop familiarity with tools during airway obstruction cases.

Next, Dr. Johnson dives into the airway obstruction course details. He uses live animal simulations because it creates a more realistic situation and provides residents with the tactile sensation of removing a foreign body from tissue. Additionally, with a pig model, trainees are able to observe more audio and visual cues such as monitor statistics and skin color. In order to use live animals, he coordinates closely with anesthesiologists and veterinarians. Dr. Johnson recommends attending simulation courses at least twice a year, as repetition is the most effective method of learning procedural techniques in emergency situations. In addition to guiding residents through removing the foreign body, he encourages residents to play other roles, such as techs and anesthesiologists, to grasp a more complete understanding of the different tasks of each profession involved in airway management.

Finally, Dr. Johnson compares the use of simulations in emergency procedures and routine procedures. For emergency procedures, he emphasizes the importance of finding high-fidelity models. However, in routine procedures that educate trainees on decision making, Dr. Johnson concedes that perfect models are not necessary. He ends the episode by concluding that simulation education is not only beneficial for residents, but also for private practice physicians and academic attendings in order to keep their skills sharp.

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RESOURCES

Airway Reconstruction Surgical Dissection Manual:

https://www.pluralpublishing.com/publications/airway-reconstruction-surgical-dissection-manual

Ep. 37 Hearing Loss and Cognitive Decline with Dr. Jed Grisel

Tue, 16 Nov 2021 05:00:00 -0000

Dr. Joe Walter Kutz talks with Dr. Jed Grisel about practice patterns treating patients with hearing loss, as well as the correlation between hearing loss and cognitive decline, and how best to screen these patients.

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In this episode, otolaryngologist Dr. Jed Grisel joins neurotologist Dr. Walter Kutz to discuss the link between hearing and cognition, counseling families about treatment outcomes, and practice building opportunities for ENT/audiology clinics.

Dr. Grisel describes changing trends in the hearing care market, such as direct-to-consumer marketing and over the counter hearing aids, which can alter patients’ relationships with ENTs. He emphasizes that these low cost options make hearing care more accessible to patients. They also provide otolaryngologists with the stimulus to branch out into new service lines and position themselves as comprehensive hearing experts. His clinic has recently added cognitive screening to their diagnostic workup. Dr. Grisel highlights the advantages of cognitive screening, which include a better understanding of the patient experience, more effective management of patient and family expectations, and relationship building with primary care providers.

The doctors also talk about the implementation process of cognitive testing in ENT/audiology clinics. Dr. Grisel shares his practice’s experience with cognitive screening kiosks that minimize the requirements for patient dexterity.

As healthcare advances, more and more people are living longer and reaching ages of hearing loss onset. The doctors discuss what it means to have more years of sensory deprivation and how ENTs can offer interventions to reduce the patient’s cognitive load and improve overall cognitive function.

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RESOURCES

Texoma ENT and Allergy:

https://www.texomaentandallergy.com/

Dementia Prevention, Intervention, and Care: 2020 Report of the Lancet Commission:

https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext

Ep. 36 Vestibular Rehab: A Physical Therapist's Perspective with Matthew Johnston

Tue, 09 Nov 2021 05:00:00 -0000

We talk with Vestibular Therapist Matthew Johnston about the workup of dizziness and setting up patients for success with Vestibular Rehab.

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In this episode, physical therapist Matthew Johnston joins Dr. Gopi Shah and Dr. Ashley Agan to discuss the process of vestibular evaluation, rehabilitation, and long-term care.

First, Matthew speaks about the importance of obtaining a thorough past medical history to identify the patient’s onset, duration, and aggravators/alleviators of dizziness. These responses help him set up a physical examination, which includes the Vestibulo-Ocular (VOR) Cancellation test, the Clinical Test of Sensory Interaction in Balance (CTSIB), and the Dix-Hallpike test. All of these diagnostic tools help him evaluate the patient’s vestibulo-ocular reflex and check for nystagmus.

Matthew distinguishes between Benign Paroxysmal Positional Vertigo (BPPV) and other conditions of vestibular hypofunction such as Meniere’s Disease and vestibular neuronitis. While the former is curable, the latter conditions are more chronic and complex, so it is important to manage patient expectations and emphasize symptom alleviation. Overall, Matthew believes that identifying the affected ear canal and specifically matching the treatment to the canal is the most efficient way to treat patients.

We close by talking about ways to improve the patient’s physical therapy experience, through prescribed anti-nausea medications, maintenance exercises done in the home, and partnership between ENTs and physical therapists.

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RESOURCES

Excel Physical Therapy: https://excelphysicaltherapy.com/

Ep. 35 Thyroid Nodules with Dr. David Goldenberg

Tue, 02 Nov 2021 04:00:00 -0000

Dr. David Goldenberg talks with us about the management of thyroid nodules, including workup, imaging and patient counseling.

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In this episode, head & neck surgical oncologist Dr. David Goldenberg joins Dr. Gopi Shah and Dr. Ashley Agan to discuss diagnosis, treatment, and follow up for various types of thyroid nodules in adults.

First, Dr. Goldenberg describes his workup for thyroid nodules, which includes palpation, ultrasound, and TSH levels. He emphasizes that a thyroid ultrasound must involve the scanning of both sides of the neck in order to make comparisons between normal and abnormal findings. After evaluating the ultrasound and having open dialogue with pathologists and radiologists, his team decides if Fine Needle Aspiration (FNA) is necessary. The doctors discuss how to counsel patients when FNA yields indeterminate results. The course of further treatment and surveillance should take into account the patient’s risk tolerance, the presence/absence of compressive symptoms, and the patient’s ability to return for a later biopsy.

Dr. Goldenberg describes how the use of molecular testing is becoming more common in diagnosing thyroid cancers. Specifically, the BRAF mutation usually signifies thyroid cancer, and the TERT mutation signifies a very aggressive form of thyroid cancer.

Finally, the doctors discuss surgical decision-making between a full thyroidectomy and a partial lobectomy. Dr. Goldenberg focuses on damage to the recurrent laryngeal nerve as potential complication and emphasizes the importance of justified interventions and continual surveillance.

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RESOURCES

“Head and Neck Endocrine Surgery” by Dr. David Goldenberg:

https://www.thieme.com/books-main/otolaryngology/product/6136-head-neck-endocrine-surgery

Ep. 34 Optimizing Communication in the Outpatient Setting with Dr. Bradley Block

Tue, 26 Oct 2021 04:00:00 -0000

We talk with Dr. Bradley Block, creator and host of The Physician's Guide to Doctoring Podcast, about optimizing communication to improve workflow and for better patient care.

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In this episode, Dr. Bradley Block joins Dr. Gopi Shah and Dr. Ashley Agan to discuss tips for trust building and nonverbal communication with patients.

Dr. Block starts by sharing how he facilitates introductions at the beginning of a visit. He identifies himself as the doctor, and asks the patient about their preferred name and pronouns. Then, he acknowledges the patient’s discomfort and/or pain associated with their chief complaint. These patient-centered approaches help build trust and ensure the patient’s voice is being heard.

Nonverbal communication can also build trust. Dr. Block recommends moving computers to the side to ensure that they are not impeding communication. Additionally, patients will often mirror the physician’s level of engagement. One way to show engagement is to repeat the patient's words back to them.

Finally, we discuss methods of communication with disgruntled patients. For example, asking them to verbalize their specific concerns can make them feel seen and heard. Dr. Block emphasizes that in order to be effective, communication strategies must be consistent across all providers and staff in the clinic.

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RESOURCES

Physician’s Guide to Doctoring (Dr. Block’s podcast): https://physiciansguidetodoctoring.com/

Dr. Block’s Twitter: @PhysiciansGuide

Ep. 33 Single Sided Deafness in Children with Dr. Anita Jeyakumar

Tue, 12 Oct 2021 04:00:00 -0000

We talk with Dr. Anita Jeyakumar about her approach to Single Sided Deafness in Children, including workup, treatment and long-term care.

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In this episode, pediatric otolaryngologist Dr. Anita Jeyakumar joins Dr. Gopi Shah and Dr. Ashley Agan to discuss screening, counseling, and treatment options for single sided deafness in children.

Dr. Jeyakumar starts by outlining referral patterns for single sided deafness, which can arise from newborn or pediatric hearing screenings. When counseling families on the importance of close monitoring and early intervention, Dr. Jeyakumar believes that it is crucial to fully explain how hearing loss can affect academic success, social interactions, and general safety: When a child has retained normal hearing in one ear, their speech is usually unaffected. However, the child will likely struggle with cognitive overload and cognitive fatigue when relying solely on the hearing ear. The child can also feel overwhelmed with trying to hear in noisy social situations. As the child gets older, untreated hearing loss can also put them at risk in potentially hazardous scenarios, such as crossing busy intersections, and eventually, driving.

The doctors discuss imaging modalities such as CT and MRI. Dr. Jeyakumar prefers MRI, since it can identify hypoplastic and aplastic auditory nerves.

Finally, the doctors highlight a range of treatment options, including the use of CROS hearing aids, bone conduction hearing aids, and cochlear implantation. With all of these technologies, it is important to keep in mind the patient’s age, infection risk, cosmetic concerns, and insurance coverage. Dr. Jeyakumar emphasizes that staying in contact with the family is important, as children may need treatment adjustments due to changes in schooling and geographic location.

Ep. 32 BackTable ENT First Year Podiversary!

Tue, 28 Sep 2021 05:00:00 -0000

Join us to celebrate BackTable ENT's First Year Podiversary with co-hosts Dr. Gopi Shah and Dr. Ashley Agan! We take a look back at the year and discuss some of our favorite episodes as well as progress towards wellness since our first episode. Thank you to our amazing guests and loyal listeners!

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SHOW NOTES

In this episode, our hosts Dr. Ashley Agan and Dr. Gopi Shah reflect on the first year of the BackTable ENT podcast. They highlight colleagues that have shared their expertise on a wide variety of ENT topics, noting that organic conversations have brought valuable insight to the show. Additionally, they review the results of a listener survey and use feedback to generate new ideas for future episodes.

We’d like to give a special thanks to our listeners! We love hearing your thoughts and feedback, which can be submitted through our website, https://www.backtable.com/shows/ent/ . Stay tuned for more exciting episodes!

Ep. 31 Mentorship, Feedback and Coaching with Dr. Carrie Francis

Tue, 14 Sep 2021 11:23:00 -0000

We talk with Dr. Carrie Francis about her passion for guiding personal and professional development for physicians, trainees and students, while helping them build a strategy of authentic alignment between their career goals and purpose.

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In this episode, Dr. Carrie Francis joins Dr. Gopi Shah and Dr. Ashley Agan to discuss her philosophy of mentoring and her goal of fostering diversity and inclusion within the field of otolaryngology.

Dr. Francis begins by defining “mentoring” and “coaching,” noting that mentorship stems from specific expertise in a topic, but coaching can offer more general guidance. The roles are not mutually exclusive, and both can help learners in their career path. She emphasizes that mentors should encourage learners to set personal goals, which can be difficult in medicine, a field where milestones are often externally determined by institutions. The doctors weigh the differences between organic and assigned mentoring relationships; however, both require constant reflection and evaluation to serve the needs of both parties.

Next, Dr. Francis describes the art of giving feedback. While summative feedback is helpful at the end of a period, timely feedback helps the learner adjust their behaviors sooner. She encourages mentors to plan appropriate times and places to give feedback effectively and respectfully.

Finally, the doctors discuss diversity and inclusivity challenges in our field and ways that residency programs can capture individuals from the “leaky pipeline.” This starts with departments’ commitment to defining their values and conducting holistic evaluations of applicants.

Ep. 30 Revision Endoscopic Sinus Surgery with Dr. Ashleigh Halderman

Tue, 31 Aug 2021 11:10:00 -0000

We talk with Rhinologist Dr. Ashleigh Halderman about Revision Endoscopic Sinus Surgery, including patient selection, pre-op planning, and endoscopic technique.

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In this episode, Dr. Ashleigh Halderman joins Dr. Gopi Shah and Dr. Ashley Agan to discuss preoperative, procedural, and postoperative considerations for revision sinus surgery.

Dr. Halderman begins by describing her patient workup, which includes learning about the patient’s history with sinus problems and surgeries. It is critical to learn about the patient’s current maintenance regimen and whether it includes sinus rinses, steroids, and/or antibiotics. Dr. Halderman aims to teach patients how to maximize medical management techniques before performing a revision surgery. She discusses the steroids and antibiotics that she usually prescribes and her patient education technique for nasal rinses.

In addition, she conducts physical and endoscopic exams and obtains a preoperative CAT scan. She emphasizes that the CAT scan is important for determining the extent of the prior surgery and guiding future plans. Sometimes, the scan reveals that a patient’s symptoms are not sinus-driven (i.e. recurrent viral infections), leading her to consider options besides surgery.

Finally, the doctors discuss operative technique. Revision surgeries may be challenging due to abnormal anatomy and scarring, so Dr. Halderman advises surgeons to utilize image guidance and look for anatomical landmarks.

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RESOURCES

The International Frontal Sinus Anatomy Classification (IFAC) and Classification of the Extent of Endoscopic Frontal Sinus Surgery:

https://pubmed.ncbi.nlm.nih.gov/26991922/

Ep. 29 Improving Access to Hearing Care Services with Dr. Carrie Nieman

Tue, 17 Aug 2021 11:51:00 -0000

We talk with Dr. Carrie Nieman about improving hearing health disparities among older adults, particularly among vulnerable populations. Her practice and research focuses on an innovative, community-delivered approach to affordable, accessible hearing care.

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In this episode of BackTable ENT, Dr. Mark Williams joins Dr. Gopi Shah and Dr. Ashley Agan to discuss various diagnoses for voice problems, treatment options, and special considerations for treating singers.

Dr. Williams always begins a workup by taking a full history which includes questions about patterns in voice changes and pain. These questions help specify the type of voice change beyond the umbrella term of “hoarseness.” He describes the differences between examinations with a rigid laryngoscope, a flexible fiberoptic laryngoscope, and videostroboscopy (allows for observation of vocal fold vibration). He also performs laryngeal palpation to check for muscle tension dysphonia.

When discussing treatment, Dr. Williams speaks about the importance of getting allergies under control, to allow patients the best quality of voice possible. He prefers nasal steroid sprays over antihistamines. Dr. Williams also describes indications for microlaryngeal surgery, such as polyps and cysts. Dr. Williams notes that voice problems may have an underlying cause that is hidden by compensatory behaviors, which end up causing more issues than the original pathology. In these instances, voice therapy can help break harmful habits. Finally, by merging his experience as an otolaryngologist and a gospel singer, he shares insights on counseling singers about steroid shots, vocal hygiene, and voice rest.

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RESOURCES

Dr. Williams’ Website: https://www.drmarkwill.com/medicine/

Ep. 28 Music, Medicine and Ministry with Dr. Mark Williams

Tue, 03 Aug 2021 11:27:00 -0000

We talk with Dr. Mark Williams about building his solo ENT practice, taking care of recording artists in Nashville, and aligning his own music, medicine and ministry.

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In this episode of BackTable ENT, Dr. Carrie Nieman joins Dr. Gopi Shah and Dr. Ashley Agan to discuss disparities in hearing care for older adults and different care models to address these.

Dr. Nieman begins the show by sharing some striking statistics: of the 26 million older Americans who currently experience a clinically significant degree of hearing loss, only 3 million actually use hearing aids. Disparities in hearing care may arise from individual factors such as financial situation and patient education, but they can also arise from structural factors like physical distance from ENTs and audiologists.

Dr. Nieman believes that the conventional model of clinic-based hearing care can be augmented by different models of care delivery, specifically one that makes use of community health workers. She describes the HEARS (Hearing Health Equity Through Accessible Research and Solutions) Program that she developed and how her team trained older adult peer mentors to guide patients through education about over-the-counter hearing devices, communication strategies, and living with hearing loss. She emphasizes that these devices can be a gateway that leads patients to feel more comfortable with hearing aids later on.

For ENTs looking to reduce hearing care disparities, Dr. Nieman recommends that they learn how their patients want to engage with the world, provide patients with multiple options for hearing care, and collaborate with other players who are working towards the same goal.

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RESOURCES

HEARS Program: https://jhucochlearcenter.org/hears-hearing-equality-through-accessible-research-solutions.html

Access HEARS: http://accesshears.com/

Hearing Loss Association of America: https://www.hearingloss.org/

Dr. Nieman’s Twitter: @CarrieNiemanMD

Ep. 27 Facial Feminization with Dr. Sarah Saxon

Wed, 21 Jul 2021 01:17:00 -0000

We talk with Dr. Sarah Saxon about Facial Feminization Surgery, including the range of procedures, patient selection, and technique.

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In this episode, Dr. Sarah Saxon joins Dr. Gopi Shah and Dr. Ashley Agan to discuss the variety of facial feminization surgeries and important considerations for treating transgender patients.

Dr. Saxon defines “facial feminization surgeries” as a group of procedures that are geared towards feminizing the face. She highlights the fact that feminizing a patient’s appearance often aligns with striving for a more youthful appearance. Therefore, feminizing procedures can include facelifts, skin resurfacing, and skin tightening with radiofrequency. Additionally, Dr. Saxon describes her techniques for chondrolaryngoplasty (also known as tracheal shave), mandibular contouring, and type 3 cranioplasty. She also discusses post-operative care with exosome injections at incision sites and steroids.

Throughout this episode, Dr. Saxon offers advice for providers who treat transgender patients. From a pre-operative standpoint, she advises surgeons to ensure that their patients are off of hormone therapy during the two weeks prior to surgery in order to reduce the risk of DVT. She also encourages providers to ask about patients’ preferred pronouns and avoid making assumptions about their patients. Above all, she emphasizes that providers should be open-minded and recognize that patient care is a dynamic learning process throughout their entire careers.

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RESOURCES

Dr. Saxon’s Website: https://saxonmd.com/

Dr. Saxon’s Instagram: @saxonmd, @breathe_atx, @breathe_dallas

Ep. 26 Allergic Rhinitis and Immunotherapy with Dr. Matthew Ryan

Tue, 06 Jul 2021 12:00:00 -0000

We talk with Dr. Matthew Ryan about diagnosis and management of Allergic Rhinitis, as well as Immunotherapy as a potential treatment option.

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SHOW NOTES

In this episode, Dr. Matthew Ryan joins Dr. Gopi Shah and Dr. Ashley Agan to discuss symptoms and comorbidities of allergic rhinitis, as well as current treatments such as decongestants, antihistamines, steroids, and immunotherapy.

The methods of allergy testing (prick test, intradermal test, and blood draw) are clinically interchangeable, with skin tests being the cheapest. Unfortunately, there are nuances in interpreting allergy test results, and a patient’s symptom complex may have a great deal of variability. There may not be correlation between a patient’s symptoms and their allergy test results. While an allergy test can be helpful, chronic rhinitis can be diagnosed and treated without testing.

As a first-line therapy for allergic rhinitis, Dr. Ryan will prescribe a combination of a nasal steroid spray and a nasal antihistamine spray, and then follow up with the patient to see if these help with symptom relief. The doctors also talk about treating allergic rhinitis and medication considerations in subgroups such as children and patients with nasal polyps, asthma, and hypertension.

For patients who still struggle with symptom control, the doctors discuss two types of immunotherapy, subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). Both have advantages and disadvantages based on available clinical data, status of FDA approval, insurance coverage, and convenience for the patient.

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RESOURCES

Central Compartment Atopic Disease: https://pubmed.ncbi.nlm.nih.gov/28716173/

Ep. 25 Sialendoscopy with Dr. David Cognetti

Tue, 22 Jun 2021 12:00:00 -0000

We talk with Dr. David Cognetti about sialendoscopy including the importance of patient selection as well as tips and tricks for success.

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In this episode, Dr. David Cognetti joins Dr. Gopi Shah and Dr. Ashley Agan to discuss the workup for salivary gland obstruction and inflammation, the emerging use of sialendoscopy, and different approaches to sialolithotomy.

First, the doctors highlight key aspects of physical examination: observing swelling around the glands, bimanually palpating for stones, and massaging the glands to observe the quantity and quality of saliva produced. For imaging, Dr. Cognetti typically orders CT for suspected stones and MRI for suspected inflammatory disorders. He describes the process of sialography, noting that the outcome may be technician-dependent. The doctors also discuss inflammatory cases where laboratory tests may be appropriate and can reveal autoimmune disorders.

Then, Dr. Cognetti describes his preferred sialendoscopy tools and how he uses them to cannulate and dilate the parotid and submandibular ducts during surgery. He emphasizes the fragile nature of the scopes and the need to protect them from damage. For sialolithotomy, he describes various methods of lithotripsy and ways to prevent thermal damage. He also discusses how he deals with duct perforation and how he decides whether or not to use stents.

The doctors bring up management of patient expectations throughout the episode, as outcomes may vary depending on the individual’s history of stone recurrence.

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RESOURCES

“Sonopalpation: A Novel Application of Ultrasound for Detection of Submandibular Calculi” - https://journals.sagepub.com/doi/10.1177/0194599814545736?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

“Limited Distal Sialodochotomy to Facilitate Sialendoscopy of the Submandibular Duct” - https://onlinelibrary.wiley.com/doi/full/10.1002/lary.23801

4th Annual Jefferson Sialendoscopy Course- https://cme.jefferson.edu/content/sialendoscopy2021#group-tabs-node-course-default1

Ep. 24 Navigating the "Hype" with Dr. Nina Shapiro

Tue, 08 Jun 2021 11:41:00 -0000

We talk with Dr. Nina Shapiro about the importance of effective communication of medical information to patients, and helping them avoid bad medical advice. She is author of the book "Hype: A Doctor's Guide to Medical Myths, Exaggerated Claims, and Bad Advice - How to Tell What's Real and What's Not".

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SHOW NOTES

In this episode, pediatric otolaryngologist and author Dr. Nina Shapiro joins Dr. Gopi Shah and Dr. Ashley Agan to discuss writing for non-medical audiences, addressing health misinformation, and overcoming our own physician biases.

Dr. Shapiro discusses her journey towards authorship. As her children entered school, she had begun communicating information about common ENT issues to other parents. This passion evolved into writing op-eds, blog articles, and eventually, books. Her audiences are both medical and non-medical, and she discusses the differences in writing for each type.

We talk about concepts from her newest book, “Hype,” which aims to address popular health concerns, de-bunk media myths, and encourage readers to be intelligent consumers of health information and products. We dive into “The Curse of the Original Belief,” the idea that we are biased towards seeking out new information that confirms what we already believe.

Dr. Shapiro offers guidance for physicians when they converse with patients who have been misinformed by Internet sources. Her overall strategy is to listen to patients’ fears, be patient, and follow up with them. Finally, she encourages all practitioners to keep an open mind and stay flexible, as new research can change long-standing beliefs and recommendations.

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RESOURCES

Dr. Shapiro’s website and books- http://drninashapiro.com/

Dr. Shapiro’s Instagram, Twitter, and Facebook: @DrNinaShaprio

Ep. 23 Human Papillomavirus (HPV) and Head and Neck Cancers with Dr. Andrew Day

Tue, 25 May 2021 11:52:00 -0000

We talk with Dr. Andrew Day about the Human Papillomavirus (HPV) and Oropharyngeal Cancers.

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In this episode, head & neck surgical oncologist Dr. Andrew Day joins Dr. Gopi Shah and Dr. Ashley Agan in discussing the screening, treatments, prevention, and current research over HPV-positive oropharyngeal cancers.

We begin by discussing the ubiquitous Human Papillomavirus (HPV) and identifying high-risk strains. While there is still a lot of research to be done over this virus, Dr. Day describes the estimated prevalence of HPV in the adult population and available screening methods. He brings up the possibility of latent infections and differences in individuals’ immunogenic responses.

Moving into HPV-mediated cancers, Dr. Day distinguishes HPV-positive from HPV-negative head & neck cancers and discusses the differences in presentation and treatment for each type. HPV-positive oropharyngeal cancers usually present as neck masses with no other clear risk factors, and they can be confirmed through ultrasound-guided fine needle aspiration biopsy. Treatment options include various combinations of transoral robotic surgery, transoral laser microsurgery, chemotherapy, and radiation.

Finally, we discuss patient education over HPV and its associated cancers. We address patient inquiries about tonsillectomy as a preventative measure, advice for partners/spouses of HPV-positive cancer patients, and otolaryngologists’ role in raising awareness of the HPV vaccine (Gardasil 9).

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RESOURCES

CDC HPV Vaccine Recommendations: https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html

Ep. 22 Pediatric Cochlear Implants with Dr. Prashant Malhotra

Tue, 11 May 2021 11:57:00 -0000

We talk with Dr. Prashant Malhotra from Nationwide Children’s Hospital about Pediatric Cochlear Implants, including workup and patient selection.

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In this episode, pediatric otolaryngologist Dr. Prashant Malhotra and our hosts discuss hearing evaluations, pediatric cochlear implants, surgery considerations for patients with inner ear malformations, and patient/family education.

To start, Dr. Malhotra describes how pediatric cochlear implantation candidates present to him in terms of age and test results. He guides us through his diagnostic workup, which includes a questionnaire, physical exam, imaging, CMV IgG test, connexin test, and next-generation genetic sequencing. Dr. Malhotra also describes collaboration between otolaryngologists, audiologists, and social workers within his multidisciplinary cochlear implant center.

Next, we cover cochlear implantation in children with inner ear malformations, such as CHARGE syndrome and EVA syndrome. These cases present the challenge of abnormal cochleas and higher CSF pressure. Dr. Malhotra also discusses treatment considerations for patients with single-sided deafness and post-lingual deafness. Additionally, he discusses long-term complications of cochlear implants. Complications can include pain, vertigo, acute otitis media (OM) episodes, and meningitis.

Finally, we expand our discussion to encompass patient and family education. This last segment covers topics such as childhood vaccination awareness, benefits of early hearing screenings, management of family expectations, and tracking academic milestones in pediatric cochlear implantation patients.

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RESOURCES

American Cochlear Implant Alliance (ACIA)- https://www.acialliance.org/

General information about cochlear implants.

AG Bell- https://www.agbell.org/Families

Online resource for families seeking information about speech development and Auditory Verbal Therapy (AVT).

Ep. 21 Airway Surgery- What's in Your Toolbox? with Drs. Johnson, Matrka and Gerber

Tue, 27 Apr 2021 11:16:00 -0000

We talk with Laura Matrka MD and Mark Gerber MD about their approaches to airway surgery, including endoscopic vs open, tips on technique, and the importance of communication in the OR.

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SHOW NOTES

In this episode, Dr. Laura Matrka and Dr. Mark Gerber join Dr. Romaine Johnson and Dr. Gopi Shah to discuss airway surgery.

The evaluation of adult and pediatric patients requiring airway surgery is outlined. Key components include a thorough flexible scope exam, direct laryngoscopy/bronchoscopy and a detailed airway history. Deciding between an endoscopic and open approach depends on several factors including airway anatomy, surgical history, acuity of the procedure, and presence of a tracheostomy.

Dr. Matrka and Dr. Gerber review essential equipment for airway surgery - their “airway toolbox” – which can include a subglottic scope, bronchoscope, tracheoscope, or a drill depending on the extent of their procedure. The discussion then turns towards the selection of suture between PDS and Prolene. Dr. Johnson states that he has had less wound dehiscence, but more granulation tissue when using PDS as compared to Prolene.

Lastly, the panel describes technological improvements they would like to see in the coming years. All agree that new approaches to visualize what trainees are observing would significantly improve education and patient care. The panel concludes by discussing the importance of communication in the operating room, and the benefit of protocols in facilitating effective teamwork.

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RESOURCES

American Society of Pediatric Otolaryngology: https://aspo.us

Communication Protocol for Airway Surgery from Dr. Matrka and colleagues: https://onlinelibrary.wiley.com/doi/abs/10.1002/lary.28271

Ep. 20 Complete Cleft Care and Choosing Your Own Adventure with Dr. Steven Goudy

Tue, 13 Apr 2021 11:45:00 -0000

We talk with Steven Goudy MD, MBA about his clinical practice and research emphasis on cleft palate care in children at Emory Healthcare, as well as some tips on trying projects/adventures outside of clinical medicine.

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SHOW NOTES

In this episode, pediatric otolaryngologist Dr. Steven Goudy joins Dr. Gopi Shah and Dr. Ashley Agan to discuss diagnosis, treatment, follow-up care, and family education for children with cleft lips and cleft palates.

To start, we define cleft lip and cleft palate based on abnormalities in fetal developments. Then, we cover the timeline for identification and treatment of these conditions. Dr. Goudy emphasizes that cleft lip and cleft palate can have a large effect on basic needs such as feeding. While cleft lip repair can be performed early, it is best to wait until the 1-year mark for cleft palate repair. We discuss treatment of different variations of these conditions, including incomplete and bilateral cleft lips. As we move into post-surgical care, we cover Eustachian tube dysfunctions and post-surgical hearing screenings. Dr. Goudy also discusses co-morbid issues and the process of counseling families through genetic testing.

Dr. Goudy highlights the importance of multidisciplinary care. Within his cleft clinic, the surgeons work with audiologists, speech pathologists, geneticists, dentists, and social workers. He discusses barriers to care for patients who live in rural areas and how his team works to overcome them.

Finally, Dr. Goudy describes his own adventure in medicine, which extends beyond treating cleft lip and cleft palate. As he shares how he got started in translational research, he gives tips for assembling a research team and finding good mentors. He also explains how he addresses common parent concerns by starting a pediatric nasal suction device company, Dr. Noze Best.

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RESOURCES

American Cleft Palate Association- https://acpa-cpf.org/

Babies Can’t Wait- https://dph.georgia.gov/babies-cant-wait

Georgia’s early intervention program that offers a variety of coordinated services for infants and toddlers with special needs.

Dr. Noze Best- https://www.drnozebest.com/

Ep. 19 Immunotherapy for Head and Neck Cancer with Dr. Adam Luginbuhl

Tue, 30 Mar 2021 14:10:00 -0000

Dr. Adam Luginbuhl from Thomas Jefferson University Hospitals gives us the 101 on Immunotherapy as a treatment option for Head and Neck Cancer.

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SHOW NOTES

In this episode, Dr. Adam Luginbuhl joins Dr. Gopi Shah and Dr. Ashley Agan to discuss immunotherapy for treatment of head and neck cancer.

Dr. Luginbuhl describes the basics of cancer immunotherapy which aims to harness the body’s intrinsic immune system to target cancer cells. He provides an overview of the main checkpoint inhibitors (CTLA-4, PD-1, PDL-1) and their mechanisms of action. He also highlights new research developments aimed at exploring the role of immunotherapy as a neoadjuvant prior to surgery.

He then discusses the challenges in recruiting for clinical trials whereby he must find the balance between offering promising new treatments with limited evidence and traditional therapies. He states that the main contraindication and side-effect of immunotherapy is auto-immunity.

He emphasizes that the journey with head and neck cancer does not end after treatment. Since the head and neck region is vital to our interactions with the world – our appearance, our voice, our ability to eat and drink – he states that treatment should not only be focused on clearing cancer, but also maintaining patient quality-of-life.

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RESOURCES

Review Articles: Immunotherapy for Head and Neck Cancer:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586169/

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7749717/

National Cancer Databases:

National Comprehensive Cancer Network: https://www.nccn.org

American Head and Neck Society: https://www.ahns.info

National Cancer Institute: https://www.cancer.gov

Ep. 18 Office Based Rhinology with Dr. Scott Fortune

Tue, 16 Mar 2021 11:00:00 -0000

Dr. Scott Fortune talks with us about how he built an Office Based Rhinology practice (now a Center of Excellence), including a how-to on safely performing procedures in the office.

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SHOW NOTES

In this episode, Dr. Scott Fortune joins Dr. Gopi Shah and Dr. Ashley Agan to discuss office-based rhinology procedures.

Dr. Fortune provides an overview of the procedures he performs in the office setting. He outlines the pre-procedure evaluation of patients including the use of validated clinical questionnaires (i.e. SNOT, NOSE scores etc..), a thorough history and physical exam, and necessary imaging studies. Once a full workup has been completed, the severity of disease is assessed as in-office procedures are tailored towards mild- to moderate-severity disease.

Dr. Fortune emphasizes that proper anesthesia is the most important factor in ensuring a successful in-office procedure. He goes into depth on the pre-, intra-, and post-operative anesthesia considerations for different procedures and patient comorbidities and reviews his own anesthesia protocol.

Lastly, Dr. Fortune discusses the logistical factors including equipment, procedure room set-up, staff training, and scheduling. He also describes the peer-to-peer training opportunities that he provides at his practice for other physicians interested in learning about in-office procedures.

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RESOURCES

Dr. Fortune’s Email Address: sfentallergy@yahoo.com

Dr. Fortune’s Twitter Handle: @DrScottFortune

Website: https://www.myallergyent.com

American Academy of Otolaryngology Head and Neck Surgery FLEX Curriculum:

https://www.entnet.org/content/flex

Ep. 17 Endoscopic Ear Surgery with Dr. Brandon Isaacson and Dr. Alejandro Rivas

Tue, 02 Mar 2021 13:00:00 -0000

We chat with Dr. Brandon Isaacson and Dr. Alejandro Rivas on the topic of Endoscopic Ear Surgery, including tips and tricks for success, as well as pitfalls to avoid.

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SHOW NOTES

In this episode, Dr. Alejandro Rivas and Dr. Brandon Isaacson join Dr. Gopi Shah and Dr. Ashley Agan to discuss endoscopic ear surgery.

Dr. Rivas and Dr. Isaacson describe the evolution of endoscopic ear surgery and its adoption in the United States. They emphasize the utility of the endoscopic approach for visualization of the middle ear.

They then delve into indications and anatomic considerations when selecting the endoscopic approach. Dr. Isaacson states that for most diseases limited to the middle ear, he uses the endoscopic approach. For extensive mastoid disease, aggressive cholesteatomas, or skull base disorders, he prefers the microscope. Dr. Rivas touches upon his guidelines for selecting his approach for cholesteatomas and notes that the presence of ossicular or lateral canal erosion or an ossified mastoid typically preclude his use of the endoscope. He then highlights the benefit of the endoscopic approach in congenital, pediatric, and revision procedures. The advantages of both the endoscopic and microscopic approaches are also considered.

The discussion then focuses on optimal pre-operative and anesthesia set up to limit bleeding in endoscopic ear surgery. Lastly, the role of using endoscopes for a thorough ear exam is emphasized.

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RESOURCES

Dr. Rivas Twitter Handle: @Alejorivasc

Dr. Isaacson’s YouTube Channel: https://www.youtube.com/channel/UC43ovy9FzRT9OtBF2tUDjsg

International Working Group of Endoscopic Ear Surgery:

https://iwgees.org

Online Dissecting Course from Sydney:

https://sydneyearendoscopy.com/free-online-dissection-guide/

Dr. Isaacson and colleague’s work on endoscopic ear surgery outcomes in pediatric ossiculoplasty:

https://onlinelibrary.wiley.com/doi/10.1002/lary.28526

Ep. 16 Congenital Hearing Loss with Dr. Rachel St. John and Dr. Walter Kutz

Tue, 16 Feb 2021 13:00:00 -0000

We talk with Dr. Rachel St. John and Dr. Walter Kutz about Congenital Hearing Loss including causes, available treatments, and counseling.

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SHOW NOTES

In this episode, Dr. Rachel St. John and Dr. Walter Kutz join hosts Dr. Ashley Agan and Dr. Gopi Shah to discuss congenital hearing loss.

Dr. St. John and Dr. Kutz outline the newborn hearing screening process and describe the benefits of both the traditional otoacoustic emission (OAE) test and auditory brainstem response (ABR) test for different conditions. They emphasize the importance of imaging in patients with late-onset and/or asymmetric hearing loss. The factors that influence the selection of imaging modality are also discussed.

Next, the diagnosis and management of hearing loss in children with auditory neuropathy, cytomegalovirus, and meningitis are reviewed. The potential role of cochlear implantation (CI) in each of these conditions is highlighted. Dr. St. John and Dr. Kutz emphasize that the journey following CI varies for each child, and that it often takes time to reap the benefits of the procedure. Lastly, Dr. St. John stresses the importance of early language exposure – through multiple mediums – to ensure that children do not miss out on crucial early brain development.

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RESOURCES

Dr. Walter Kutz’s Twitter Handle: @EarDoc1

UT Southwestern Cytomegalovirus Screening Study (CHIMES Study):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5260148/

Ep. 15 Adult Cochlear Implantation with Dr. Jacob Hunter

Tue, 02 Feb 2021 13:26:00 -0000

We speak with Dr. Jacob Hunter about Adult Cochlear Implantation, including patient workup and counseling, surgical tips and tricks, and post procedure followup.

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SHOW NOTES

In this episode, Dr. Jacob Hunter joins hosts Dr. Ashley Agan and Dr. Gopi Shah to discuss cochlear implantation in adults.

Dr. Hunter outlines the indications for cochlear implantation and walks us through the evaluation process to assess candidacy in adults. He emphasizes the importance of patient counseling in setting expectations for post-implantation hearing. He also describes routine preoperative imaging weighing the relative strengths of CT vs MRI.

The discussion then delves into the nuances of cochlear implant devices focusing on factors such as electrode length, stiffness, and shape as well as hearing aid compatibility. The major surgical approaches are then reviewed along with potential surgical complications. Lastly, the disparities in access to cochlear implantation and hearing care in adults are highlighted.

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RESOURCES

Disparities in Cochlear Implantation:

Dr. Hunter and Colleagues at UT Southwestern:

https://journals.sagepub.com/doi/abs/10.1177/0003489419888232

Dr. Samy and Colleagues at University of Cincinnati:

https://journals.lww.com/co-otolaryngology/Abstract/2017/10000/Closing_the_gap_in_cochlear_implant_access_for.7.aspx

Disparities in Hearing Care:

Dr. Carrie Nieman and Colleagues at Johns Hopkins:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6363549/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881797/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4826391/

The video version of this Podcast has closed captions on YouTube:

https://youtu.be/3IHUMhH9x0E

Ep. 14 Quality & Safety In Pediatric ENT Panel Discussion Hosted by Dr. Romaine Johnson

Thu, 07 Jan 2021 14:41:00 -0000

Dr. Romaine Johnson from Children's Health in Dallas, TX brings together an all-star panel of pediatric ENT's to discuss the importance of continuous improvement of Quality and Safety in Pediatric ENT. Guests include Dr. Soham Roy, Dr. Jennifer Lavin and Dr. Jonathan Ida.

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SHOW NOTES

In this episode, Dr. Soham Roy, Dr. Jennifer Lavin, and Dr. Jonathan Ida join hosts Dr. Romaine Johnson and Dr. Gopi Shah to discuss quality improvement (QI) and safety in pediatric ENT.

Dr. Roy emphasizes the importance of transforming quality metrics data into personalized stories to help convey the significance of QI efforts. The panel discusses best practices including a focus on understanding the nuances of a problem prior to identifying solutions, implementing solutions in a manner in which deviations are made more difficult, and maintaining a commitment to continual QI which is a cyclical process with no defined endpoint.

The discussion then evolves to highlight the impact of the COVID pandemic on QI efforts, the urgency with which protocols were developed in its immediate aftermath, as well as looking towards the impact of the pandemic on future care delivery. The panel delves into the ongoing need for studies to explore the gaps in knowledge which are often identified in clinical consensus statements. They conclude by providing advice on how to align QI efforts with broader institutional goals.

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RESOURCES

Tracheostomy During COVID-19 Pandemic:

https://journals.sagepub.com/doi/full/10.1177/0194599820961985

American Academic of Otolaryngology-Head and Neck Surgery Patient Safety and Quality Improvement Committee Report:

https://bulletin.entnet.org/article/committee-report-psqi/

Ep. 13 Treatment of Nasal Polyps with Dr. Patricia Loftus

Fri, 01 Jan 2021 14:00:00 -0000

We speak with Dr. Patricia Loftus from UCSF Otolaryngology - Head & Neck Surgery discussing her clinical and surgical approach to treating Nasal Polyps.

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SHOW NOTES

In this episode, Dr. Patricia Loftus joins Dr. Gopi Shah and Dr. Ashley Agan to outline the diagnosis and management of patients with nasal polyps. They identify common presenting symptoms and physical exam findings as well as discuss the roles of imaging, culture, and biopsy.

Medical management including the risks and benefits of antibiotics and oral steroids are reviewed. Endoscopic surgical approaches and their utility in different clinical presentations are described. Pre-, peri- and post-operative considerations are also discussed.

The discussion then evolves to focus on conditions that clinicians should be aware of including allergic fungal sinusitis (AFS), cystic fibrosis (CF), primary ciliary dyskinesia (PCD), and central compartment atopic disease (CCAD). Finally, they highlight recent developments in management including the role of biologic therapies such as Dupixent.

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RESOURCES

Dr. Loftus’ Email Address: Patricia.Loftus@UCSF.edu

Women in Rhinology Twitter Handle: @Women_Rhinology

Women in Rhinology Instagram: @women_in_rhinology

Biologics for Nasal Polyps: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013513.pub2/full

Ep. 12 Lessons in Leadership- Early Career with Dr. Dana Crosby

Tue, 22 Dec 2020 13:47:00 -0000

We talk to Dr. Dana Crosby about early career leadership insight.

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SHOW NOTES

In this episode, Dr. Dana Crosby joins hosts Dr. Gopi Shah and Dr. Ashley Agan to discuss leadership in Otolaryngology and how to navigate and build a program from the ground up.

Dr. Crosby describes her initial experiences post-Rhinology fellowship starting to build up a small Otolaryngology division into a department as a co-Chair. She discusses the importance of identifying good mentors and resilience in starting out. She continues to speak to the importance of navigating through the best interests of both all the faculty involved as well as the department. Additionally, the importance of reading and constantly learning from books and other resources as such is vital to complement the experiential learning.

Dr. Crosby continues to talk about different leadership styles and how they complement each other. She describes a style of allowing everyone to have input, while being aware that certain situations call for quick decision making. She also mentions how best to manage disagreements through open discussion and compromise. Dr. Crosby closes out by discussing the implementation of leadership curriculums in training at all different levels. Although residency is incredibly busy, dedicated leadership skill discussions may be beneficial. Lastly, she ends with the key points about being yourself, leading by example, and being open to new opportunities and learning from each one.

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RESOURCES

Dr. Crosby’s Email: dcrosby53@siumed.edu

Leadership Books: Good to Great, James Collins

Ep. 11 Love What You Do- Career Inspiration with Dr. Cherie-Ann Nathan

Mon, 07 Dec 2020 16:50:00 -0000

We talk to Dr. Cherie-Ann Nathan about her pathway to Chair of Otolaryngology Head & Neck Surgery at LSU Shreveport, inspiration and challenges along the way, and making the most of opportunities in building a successful career.

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SHOW NOTES

In this episode, Dr. Cherie-Ann Nathan joins hosts Dr. Gopi Shah and Dr. Ashley Agan to discuss career inspiration and learning to thrive with an inspiring attitude.

Dr. Nathan describes her initial journey into Head and Neck Cancer through inspirations she had as a child growing up in Mumbai and going to medical school, through her research at Johns Hopkins in Head and Neck Cancer, followed by residency at UCSD and current chair of Otolaryngology at LSU-Shreveport. She describes the importance of being able to balance your professional life and with your personal life and using that to guide career decisions. She then discusses how her interest in Head and Neck Cancer, inspired when she was younger, spurred her dedicated research undertakings and progress at LSU-Shreveport, funded by the National Cancer Institute and the NIH.

Dr. Nathan continues to speak about job satisfaction and being able to balance saying yes to opportunities but knowing when to say no; balance is key though hard to attain at times. She then continues to stress the importance of intentionality and dedication to research early on in careers and navigating the world of academic research, including mentorship, grants, and networking. Additionally, being open to network with different institutions and resilience in the setting of rejection in research, with learning and persistence, is vital to a successful research career.

Dr. Nathan rounds up the discussion in speaking about her experience as a woman in Otolaryngology, becoming a Chairwoman, and the various challenges that come with leadership positions, noting the progress that women in Otolaryngology have made with and will continue to. She ends by stressing the importance of consistent hard work and to start early, and in loving what you do, the motivation to do so is endless.

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RESOURCES

Dr. Nathan’s Email: cnatha@lsuhsc.edu

Ep. 10 Comprehensive Care For Deaf And Hard Of Hearing Children With Dr. Rachel St. John

Tue, 24 Nov 2020 14:32:00 -0000

We talk with Dr. Rachel St. John from Children's Health about the importance of early language access and collaborative care for children who are deaf or hard of hearing.

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SHOW NOTES

In this episode, Dr. Rachel St. John joins our hosts Dr. Ashley Agan and Dr. Gopi Shah to speak about different aspects of care for Deaf and Hard of Hearing children, from counseling to medical treatment.

Dr. St. John first speaks about what a comprehensive evaluation of a deaf child entails; from counseling the patient and their families, to educating families about current and future management, and rounding it off with the importance and effectiveness of collaborating with a multidisciplinary approach. She continues to talk specifics in terms of work-up regarding labs, imaging, and the possibility of genetic testing. A key aspect of this decision making is in speaking with families and understanding what their priorities and goals are and working as a team to set realistic ones.

The discussion continues while touching on specific causes of pediatric hearing loss, including Enlarged Vestibular Aqueduct among others, and the management and treatment thereof. Dr. St. John also speaks about counseling the patient as well and taking into account their age and giving guidance to setting realistic expectations, both in their school and home life.

Lastly, Dr. St. John discusses the importance of early language intervention and stresses the importance of introducing some aspect of language into the child’s development as early as possible, regardless of hearing loss or not. The early years can be vital for learning and chidren have a narrow window for language development; early intervention can greatly improve learning later down in life in Deaf and Hard of Hearing children.

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RESOURCES

Family Focus Center website - https://www.childrens.com/specialties-services/specialty-centers-and-programs/ear-nose-and-throat/programs-and-services/ffc-for-deaf-and-hard-of-hearing-children

American Academy of Pediatrics, Early Hearing Detection and Intervention - https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/PEHDIC/Pages/Early-Hearing-Detection-and-Intervention.aspx

Ep. 9 Keeping it Lean with Dr. DJ Verret

Tue, 03 Nov 2020 12:39:00 -0000

Dr. D.J. Verret teaches us what he's learned over the years getting a practice up and running: "when you start out, start out lean!"

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SHOW NOTES

In this episode, Dr. DJ Verret joins our hosts Dr. Gopi Shah and Dr. Ashley Agan to talk about how to successfully start and manage a private practice.

Dr. DJ Verret starts off by discussing what drew him to private practice and facial plastic surgery after deciding on Otolaryngology as a residency choice. He speaks about the details in starting out and the difficulties of the nuances. One detail he mentions is that it is important to assess all the possibilities of practice models, whether that is practice sharing, group practices, or other such models that may best fit your goals. He continues to discuss the importance of taking advantage of employers, such as CEO’s, about possible arrangements for new practice models. Dr. DJ Verret then moves to speak about experience being an important teaching factor in learning the financial ins and outs. He also discusses aspects that can help setting up a practice, including practice management companies, healthcare lawyers, CPA’s, and ideas about the future direction of the practice.

The discussion continues into the steps taken to start a practice, from creating an EIN for the company to commercial real estate in finding an appropriate practice location. Next steps include considerations for practice equipment specifically for your practice type. Important things to keep in mind when purchasing equipment and location is starting out lean, both space and equipment wise. Given the natural limitation of time, it is better to start small to where a practice is financially manageable. Time management is a key aspect discussed, in deciding how much you want to do on your own vs how much you’re willing to delegate to others.

Dr. DJ Verret rounds off the discussion by speaking about practice management vs clinical time. He discusses how to manage overhead, employee roles, and dedicating time to practice management each week, including tracking practice progress on a quarterly basis. A combination of timely and financial efficiency is key in running a successful practice.

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RESOURCES

Dr. DJ Verret’s Podcast: https://askmemd.buzzsprout.com/

Dr. DJ Verret’s Website: https://innovationsfps.com/

Ep. 8 Treating Tongue-Tie with Dr. Felicity Lenes-Voit

Tue, 20 Oct 2020 12:00:00 -0000

Dr. Felicity Lenes-Voit from Dallas Children's Health discusses her approach to diagnosis and treatment of Tongue-Tie, or Ankyloglossia, in the infant.

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SHOW NOTES

In this episode, Dr. Felicity Lenes-Voit joins our hosts Dr. Gopi Shah and Dr. Ashley Again to speak about Tongue-Tie, or Ankyloglossia, and its comprehensive management.

Dr. Lenes-Voit starts the discussion by describing what Tongue-Tie is and how to conduct an initial evaluation and workup. She describes the importance of lactation consultation and the effects tongue-tie can have on both mother and baby. The discussion then continues to discuss physical examination as an important aspect of the workup and how best to determine the extent of the ankyloglossia, while also factoring in the weight of the child as a key aspect of workup.

Next, Dr. Lenes-Voit and our hosts discuss points to keep in mind when considering frenectomy as a correcting procedure, which include conducting a thorough lactation evaluation prior to making that decision. Speech impairments are also a potential worry from parents and, as a controversial topic in frenectomy evaluations, should be clarified with families. Other risks and benefits are further discussed such as timing of intervention and the use of general anesthesia at certain ages. This portion of the discussion ends with Dr. Lenes-Voit talking about the different operative techniques that can be employed as well as tips for smooth procedures.

Lastly, the discussion concludes with Dr. Lenes-Voit speaking to the importance of counseling and a multidisciplinary approach with mothers of tongue-tie patients. The team effort between ENT’s, pediatricians, and lactation and breastfeeding consultants is key in the comprehensive management for both mother and baby. Setting realistic goals and expectations, especially for new mothers, will be beneficial and something to incorporate with each patient.

Ep. 7 Promoting Your Practice with Dr. Eric Cerrati

Sun, 04 Oct 2020 12:00:00 -0000

Dr. Eric Cerrati from University of Utah Health gives us his pearls and pitfalls using social media to promote his clinical practice.

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SHOW NOTES

In this episode, our hosts Dr. Ashley Agan and Dr. Gopi Shah are joined by Dr. Eric Cerrati to discuss the different ways to promote a practice and the increasing role of social media in professional development.

Dr. Cerrati initially starts by describing how he set up his academic practice in Facial Plastic Surgery with a mix of cosmetic patients as well as reconstructive. He highlights the importance of outside marketing in addition to being affiliated with an academic center. These two can be different and both have pros and cons. He describes the use of Instagram and Facebook in marketing with somewhat a private practice mindset. The use of social media has also grown during the COVID pandemic due to an increased need to reach out to prospective interested students in programs across the country. Dr. Cerrati speaks then about the details, including demographics, that can be reached based on the specific social media platform used. He does highlight the importance of consistency and the way one chooses to present themselves on a social media platform. Balancing that which is appropriate for social media can be challenging, with the overarching theme of being honest and ethical. Patient consent is vital prior to sharing any form of media regarding them.

Dr. Cerrati goes on to talk about the risks of putting yourself out there and being in the constant public eye and risks that come with. In addition to social media, he continues to discuss the importance of building good collegial relationships with fellow physicians and taking care of patients referred to you while being respectful to the referring provider.

The discussion ends on the impact COVID has had on a private practice cosmetic setup, including considerations for COVID testing, role of virtual visits, and evaluation for surgery and follow-ups post-op. Dr. Cerrati ends on the important note of remaining flexible and continuing to work hard in the face of adversity, and growth will come.

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RESOURCES

Dr. Cerrati’s Instagram: @Dr.Cerrati

Dr. Cerrati’s Website: www.drericcerrati.com

Ep. 6 Managing Pediatric OSA Like A Boss With Dr. Ron Mitchell

Tue, 15 Sep 2020 18:21:00 -0000

We speak with Dallas Children's Hospital's Section Chief Dr. Ron Mitchell about Management of Pediatric OSA.

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Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/3VIka3

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SHOW NOTES

In this episode, Dr. Ron Mitchell, a Pediatric Otolaryngologist, joins our hosts Dr. Gopi Shah and Dr. Ashley Agan to speak about pediatric Obstructive Sleep Apnea (OSA) and its evaluation and management.

Dr. Mitchell starts off the discussion by speaking about the importance of sleep and initial presentations and symptoms of sleep apnea in children, including apneic episodes, fatigue, and inattention as well as studies that recommend tonsillectomy for pediatric OSA. Dr. Mitchell then speaks about a current study underway that looks at OSA in pediatric patients with mild symptoms and the indications of surgery and if it is necessary in all patients. It is analyzing patients undergoing medical therapies, including Montelukast, nasal steroids, and others to evaluate efficacy against surgery. Specific indications and situations are also discussed. Dr. Mitchell notes that initially, with patients with mild symptoms, a sleep study may not be necessary. On the other hand, those undergoing high risk surgery or other developmental delay may need a sleep study, with observation and symptoms being the primary method of evaluation of progress. It is important to assess goals of the family prior to making the decision to obtain a sleep study with shared decision making.

Dr. Mitchell then speaks about the impact of COVID on obtaining sleep studies and the effects on evaluation of pediatric OSA. He then indicates that home sleep studies may not be beneficial to obtain in the pediatric population, unlike in adults. The discussion continues onto the topic of tonsil size and the variable effect it can have on pediatric OSA. The history of tonsillectomies is further discussed with possible causes for the increase in the number of tonsillectomies for sleep related problems.

The discussion rounds out on the important consideration of patients who undergo surgery with tonsillectomy and adenoidectomy with persistent OSA. Dr. Mitchell mentions possible etiologies (adenoid regrowth, nasal obstruction, etc.) which can be evaluated with nasal endoscopy and managed with nasal steroids. Weight loss in overweight and obese patients may also be beneficial. Other important considerations would be in patients with Down Syndrome, due to the difficulty of implementing CPAP and other managements. In these patients, sleep MRI is useful in determining the site of airway obstruction, usually at the tongue base, with additional surgery being useful for them.

Ep. 5 Pediatric Tracheostomy- The Long Game With Dr. Romaine Johnson

Tue, 15 Sep 2020 02:11:00 -0000

Dr. Romaine Johnson talks us through the challenges of pediatric tracheostomy care and the importance of building high reliability tracheostomy teams.

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/v6eJb2

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SHOW NOTES

In this episode, Dr. Romaine Johnson joins Dr. Gopi Shah and Dr. Ashley Agan to discuss the essentials of building a successful pediatric tracheostomy program and the importance of a multidisciplinary team. He emphasizes that the triage and management of pediatric tracheostomy patients must be approached through the lens of long-term care.

He states that essential members of the multidisciplinary pediatric tracheostomy team include pediatric pulmonologists, advanced practice nurses/nurse practitioners, respiratory and speech therapists, as well as social workers and case managers. Dr. Johnson also describes his multidisciplinary clinic set up through which patients are able to see all members of their care team at a single visit, thereby improving the quality and safety of care.

Dr. Johnson provides some key insights into the management of inherited pediatric tracheostomies with regards to how and when to up-size a trach as well as the role of palliative care in complex pediatric tracheostomy cases. Finally, we go into some notes on how to manage bleeding complications in pediatric tracheostomy patients, including the role of a pulmonary sick plan, and management of anterior/posterior tracheal erosions.

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RESOURCES

Dr. Johnson’s YouTube Channel

https://www.youtube.com/channel/UCMyWMjLbWbi_jM_tk7-57eg

Dr. Johnson regularly posts procedure videos, as well as videos from the Harry Barnes society virtual grand round series.

Ep. 4 Managing Eustachian Tube Disorders With Dr. Walter Kutz

Sun, 13 Sep 2020 18:33:00 -0000

Dr. Ashley Agan and Dr. Gopi Shah talk with Dr. Joe Walter Kutz about the management of Eustachian Tube Disorders, including pearls and pitfalls on treating the "clogged ear".

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/CmPTBe

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SHOW NOTES

In this episode, Dr. Walter Kutz joins Dr. Gopi Shah and Dr. Ashley Agan to discuss the essentials of caring for patients with chronic eustachian tube disorders. They emphasize that the diagnosis of patients with chronic eustachian tube disorders can be challenging. Patient history is often the driving factor in evaluation of these patients, but objective measures such as tympanograms can aid in the diagnostic process.

They describe in detail the differentiating features of patulous eustachian tube, a commonly missed diagnosis with a similar presentation as eustachian tube dysfunction. The best practices for evaluation of patulous eustachian tube are outlined, including the ideal set up for otoscopic and endoscopic nasal exams. They also touch on the treatment options for patulous eustachian tube, giving insight into procedure details as well as complications.

The discussion then evolves to focus on more complicated cases of eustachian tube dysfunction, including patients with atrophic tympanic membranes as well as those refractory to tympanostomy tube placement. The efficacy and challenges of eustachian tube targeted procedures such as balloon dilation are reviewed. The role of allergy evaluations in management and care of eustachian tube dysfunction patients are also considered. Finally, they touch briefly on some notes on the diagnosis of eosinophilic otitis media and superior canal dehiscence.

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RESOURCES

Dr. Kutz’s Website: https://utswmed.org/doctors/joe-kutz/

Dr. Kutz’s Twitter Handle: @EarDoc1

Dr. Kutz’s Instagram Handle: @walterkutzmd

PatulEND - Patulend.com

Ep. 3 Managing Epistaxis alongside IR with Dr. Sabeen Dhand

Sat, 12 Sep 2020 00:26:00 -0000

IR Sabeen Dhand and ENT Ashley Agan discuss management of Epistaxis, including how to effectively pack the nose, and when SPA ligation or arterial embolization are necessary. Dr. Dhand also describes his arterial embolization technique, including important pitfalls to avoid.

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/xQPc7h

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SHOW NOTES

In this episode, Dr. Sabeen Dhand, an Interventional Radiologist, joins our hosts Dr. Gopi Shah and Dr. Ashley Agan to discuss epistaxis and the evaluation and management of different causes of epistaxis.

Dr. Agan and Dr. Dhand start the discussion by bringing up common presentations of epistaxis from both an ENT standpoint as well as IR; with the usual presentation being initially to ENT with possible referral to IR for embolization. They then continue to speak about initial treatments for epistaxis in the ED, which entails use of pressure, Afrin, and nasal packing or cauterization. If those measures aren’t sufficient, further examination in the OR may be warranted to find specific location and cause. In the case of a posterior nosebleed, usually from the sphenopalatine artery (SPA), with brisk bleeding and/or failure of ligation, SPA embolization by IR may be of use. Dr. Dhand mentions a contraindication for SPA embolization in the case of the ophthalmic artery anastomosis between the Internal Carotid Artery and External Carotid Artery due to risk of stroke and blindness. Different sources of bleeding should also be evaluated.

The discussion rounds off with the summarization of initial treatment of epistaxis. Two important considerations include proper nasal packing, pushing back into the nose and not straight up, as well as avoiding compressing nasal structures and causing necrosis and further mucosal irritation increasing bleeding risk.

Ep. 2 The Struggle Is Real(ly Important!) With Dr. Eric Gantwerker

Sat, 12 Sep 2020 00:21:00 -0000

We talk with Dr. Eric Gantwerker about tips and strategies to make medical education and teaching more effective.

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/R4MaJI

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SHOW NOTES

In this episode, our hosts Dr. Ashley Agan and Dr. Gopi Shah are joined by Dr. Eric Gantwerker to speak about medical education and the nuances involved along different levels of training.

Dr. Gantwerker begins by discussing different possible teaching and learning styles. One idea he speaks about is cognitive load, which describes that a novice only has a certain amount of attention and cognitive attention they can focus on a topic. He also mentions the ideas of “chunking” and “zone of proximal development”; these ideas combine the ideas of constantly challenging learners with gradual responsibility and allowing the learner to repeat the same activity or action repetitively while slowly increasing the amount of activity involved as well. This keeps people in a challenged enough state to where they struggle, but not enough to where it is completely out of their ability to succeed. Dr. Gantwerker then rounds off the process by having a debriefing session afterwards, in which feedback is exchanged between both student and teacher on how the experience went. This allows for tailor-made teaching experiences for students and establishing rapport between students and teachers.

The discussion continues in what Dr. Gantwerker focuses on during the teaching process. He mentions the concept of “Line, Speed, Beauty”, which highlights the importance of first mastering basics, followed by increasing efficiency, and the aspect of beauty which naturally follows. Dr. Gantwerker ends the discussion by highlighting different learning techniques, including organizational thinking, thorough understanding, and experiential learning. He then speaks about challenges faced in current virtual environments and how to manage them.

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RESOURCES

Level Ex Learning App: www.levelex.com

Dr. Gantwerker’s Twitter Handle: @DrEricGant

Ep. 1 You Can't Pour From An Empty Cup- Wellness In ENT with Dr. Agan and Dr. Shah

Wed, 09 Sep 2020 03:55:00 -0000

Dr. Ashley Agan and Dr. Gopi Shah talk wellness in life and practice!

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/JvDSuy

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SHOW NOTES

In this episode, hosts Dr. Ashley Agan and Dr. Gopi Shah discuss the important topic of wellness, what it is, and how to incorporate it into our professional lives.

They begin by discussing what exactly wellness is and what it entails. Wellness can be different for different people, but essentially it comes down to taking care of yourself before you take care of others. As this can be hard to do in such a service-oriented career, dedicating time to it is important to be able to recharge, whether that be spending time with family, exercising, or just intentionally relaxing. Dr. Shah and Dr. Agan continue to talk about time management and how to incorporate wellness into busy lives in medical school, residency, and beyond. Balancing may not always be easy but taking time for yourself is just as important as the time you dedicate to others.

Our hosts then continue to speak to the impact COVID-19 has had on the physician community and wellness. One of the biggest factors it has had is regarding the human-to-human connection that is gratifying and often motivating during patient encounters. Dealing with those challenges has taken its toll, but one that both providers and patients are learning to manage together.

Lastly, Dr. Agan and Dr. Shah conclude by discussing specific examples of incorporating wellness. They speak about groups, such as Wellness in Oto, and other ways to keep in touch, whether that be with mentors or trainees, to check in on each other and make sure everyone is doing well and taking the time to take care of themselves during an otherwise challenging time. As well as keeping in touch with others, keeping in touch with yourself is just as important and reflecting is often a great way to do just that.

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RESOURCES

Backtable ENT Twitter and Instagram handle: @_backtableENT