BackTable ENT (BackTable)

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

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

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. --- 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. --- 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

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! --- 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. --- 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 --- 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

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. --- 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. --- 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/

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. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/jn8hp9 --- 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.

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. The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/SKIPQb --- CHECK OUT OUR SPONSOR Athletic Greens https://www.athleticgreens.com/backtableent --- 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.

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

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. --- CHECK OUT OUR SPONSOR Stryker ENT https://ent.stryker.com --- 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. --- RESOURCES Eustachian Tube Disorder Questionnaire: https://earandsinusinstitute.com/online-questionnaires/etdq-7-questionnaire/ ​​ Xhance Nasal Spray: https://www.xhancehcp.com/

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. --- 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. --- 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/

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. --- CHECK OUT OUR SPONSOR Stryker ENT https://ent.stryker.com --- 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.

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. --- 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.

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. --- CHECK OUT OUR SPONSOR Aerin Medical https://aerinmedical.com/ --- 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.

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. --- 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. --- 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/

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. --- 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

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

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

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. --- 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. --- 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 --- 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

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. --- 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. --- 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/

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

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. --- 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/

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. --- 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/

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. The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/UmeBWU --- CHECK OUT OUR SPONSOR Athletic Greens https://www.athleticgreens.com/backtableent --- 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.

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. --- CHECK OUT OUR SPONSOR Cook Medical Otolaryngology https://www.cookmedical.com/otolaryngology --- 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. --- RESOURCES Dr. Mankekar’s Profile: https://www.ochsnerlsuhs.org/doctors/gauri-mankekar

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/

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. --- CHECK OUT OUR SPONSOR Cook Medical Otolaryngology https://www.cookmedical.com/otolaryngology --- 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.

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. --- 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/

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. --- 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. --- 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

We talk with Dr. Brianne Roby from Children's Minnesota about airway evaluation and surgical management of the infant with retro/micrognathia. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/MGHRcG --- 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.

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. --- 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. --- 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/

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

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! --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/xwej9p --- 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. --- 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/

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. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/Jw85Cq --- SHOW NOTES 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.

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). --- 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/

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. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/9XoE0E --- 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.

In this episode of BackTable ENT, Dr. Shah interviews rhinologist Dr. Jeffrey Suh (UCLA) about cryotherapy as a new treatment for chronic rhinitis. --- 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. --- 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/

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. --- 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. --- 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

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. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/xT6cpR --- 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. --- 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

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 --- 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.

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. --- CHECK OUT OUR SPONSOR Medtronic ENT Propel Implants https://www.medtronic.com/en-us/healthcare-professionals/specialties/ear-nose-throat.html --- 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. --- 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

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. --- 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. --- RESOURCES David’s Penn State Profile: https://www.pennstatehealth.org/doctors/david-goldenberg-md-facs

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.

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. --- CHECK OUT OUR SPONSOR Laurel Road for Doctors https://www.laurelroad.com/healthcare-banking/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/E8re37 --- SHOW NOTES 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. 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. --- RESOURCES Dr. Seidman’s Youtube Channel: https://www.youtube.com/channel/UChWOA4mPaq4Pa0Mi4jv2n3w Peak 365 website: ​​https://peak365nutrition.com/

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. --- 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.

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. --- 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 --- 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

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. --- 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. --- 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

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! --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/Ca6702 --- 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!

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. --- 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/

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. --- 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.

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. --- 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 --- 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/

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. --- 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.

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. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/WxyvKG --- 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. --- 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

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. --- 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. --- 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/

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

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. The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/CKCP0W  --- CHECK OUT OUR SPONSOR Laurel Road for Doctors https://www.laurelroad.com/healthcare-banking/ --- 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. --- RESOURCES Oto Tinnitus Management App: https://www.joinoto.com/

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. --- 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.

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. --- 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 --- 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

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. --- 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 --- 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

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. --- 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

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. --- 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

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/

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). --- 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. --- 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

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. --- CHECK OUT OUR SPONSOR Aerin Medical https://aerinmedical.com/ --- 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 --- RESOURCES Dr. Nora Perkins’ Albany ENT & Allergy Services Profile: https://albanyentandallergy.com/bio/nora-w-perkins/ Aerin VivAer Website: https://vivaer.com/

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. --- CHECK OUT OUR SPONSOR FOR THIS EPISODE iotaMotion https://iotamotion.com/ --- 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.

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. --- 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

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. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/OqKifW --- 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. --- RESOURCES Dr. Langdon’s Youtube https://www.youtube.com/c/BarcelonaRhinologySchool

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. --- 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. --- 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 --- 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

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. --- 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.

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. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/FnL1R4 --- 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. --- RESOURCES ASPO Fellowships https://aspo.us/page/fellowshiplisting Dr. Isaiah’s LinkedIn Profile https://www.linkedin.com/in/amal-isaiah-a6a71b6/

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. --- 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. --- RESOURCES Dr. Arnaoutakis’ website: https://www.drdemetrimd.com/

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

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. --- 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. --- 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

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. --- 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.

Dr. David Goldenberg talks with us about the management of thyroid nodules, including workup, imaging and patient counseling. --- CHECK OUT OUR SPONSOR Karl Storz TELE PACK+ https://www.karlstorz.com/us/en/telepack.htm --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/edD6pe --- SHOW NOTES 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. --- RESOURCES “Head and Neck Endocrine Surgery” by Dr. David Goldenberg: https://www.thieme.com/books-main/otolaryngology/product/6136-head-neck-endocrine-surgery

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. --- 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. --- 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 --- 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

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. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/VJvXZx --- 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. --- RESOURCES Knock Knock Hi Podcast https://podcasts.apple.com/us/podcast/knock-knock-hi-with-the-glaucomfleckens/id1659572053 First Descents https://firstdescents.org/

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. --- 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.

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. --- CHECK OUT OUR SPONSOR DI4MDs 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 --- 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. --- 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/

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. --- 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. --- 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

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. --- 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/

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. --- 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. --- 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

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. --- 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. --- 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

We talk with Vestibular Therapist Matthew Johnston about the workup of dizziness and setting up patients for success with Vestibular Rehab. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/7Z6HZO --- SHOW NOTES 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. --- RESOURCES Excel Physical Therapy: https://excelphysicaltherapy.com/

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. --- 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 --- RESOURCES Dr. Yang’s Vanderbilt University Medical Center profile: https://search.vanderbilthealth.com/doctors/yang-shiayin

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/

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. --- CHECK OUT OUR SPONSOR Karl Storz Tele Pack https://www.karlstorz.com/ --- 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 --- 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

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 --- CHECK OUT OUR SPONSOR DI4MDs 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. --- 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. --- 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/

In this episode of BackTable ENT, Dr. Shah and Dr. Agan talk about in-office management of salivary stones and tips for sialolithotomy. --- CHECK OUT OUR SPONSOR Cook Medical Otolaryngology https://www.cookmedical.com/otolaryngology --- 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. --- RESOURCES BackTable ENT Ep. 25 Sialendoscopy with Dr. David Cognetti: https://www.backtable.com/shows/ent/podcasts/25/sialendoscopy

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. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/XAOh9k --- 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. --- RESOURCES American Society of Pediatric Otolaryngology: https://aspo.us/ Triological Society: https://www.triological.org/ American Broncho-Esophagological Association: https://www.abea.net/

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. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/nUekSE --- 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. --- 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/

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 --- 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.

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. --- 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 --- 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/

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. --- 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

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). --- CHECK OUT OUR SPONSOR Cook Medical Otolaryngology https://www.cookmedical.com/otolaryngology --- 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.

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. --- 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

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. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/aXEKIr --- 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. --- 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

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. --- 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. --- 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/

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 --- 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. --- RESOURCES Dr. Dehgani-Mobaraki Twitter: https://twitter.com/puyadehganimd Naso Sano Twitter: https://twitter.com/nasosano Naso Sano Website: https://www.nasosano.it/

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. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/3w9pL5 --- 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.