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

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/

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. Gopi Shah, Dr. Romaine Johnson (UT Southwestern), and Dr. Alex Chiu (University of Kansas) discuss health disparities research and the Health Equity Collaborative. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/ZkIxQ0 --- SHOW NOTES First, Dr. Chiu explains the difference between equality and equity. Equality is giving everyone the same resources to reach a goal, while equity is giving people different resources based on their different background and obstacles to reach a goal. Health equity emphasizes the importance of the provider focusing on interpersonal relationships and caregivers of patients, not just on their patients as individuals. Dr. Johnson explains that although there are many research studies that prove the existence of inequalities, there are not enough research studies centered on how specific interventions can reduce disparities. Then, Dr. Chiu explains the Health Equity Collaborative, an initiative to drive more health equity research in the field of ENT across different institutions. The collaborative was started in February 2022 in Kansas City. Dr. Chiu and his team quickly realized that they did not have the adequate volume of patients needed to achieve a sizable impact, so they reached out to more ENT researchers in different cities. The collaborative uses qualitative research methods, such as the qualitative structured interview, and then formulates objective metrics to analyze the results. Future goals of the collaborative include gaining the support of societies and using their evidence to change policies and advocate for minority patients. Dr. Chiu also explains obstacles he had to overcome when forming the collaborative and the benefit of working with a diverse team. Finally, Dr. Chiu shares how his disparity research has affected his medical practice by making him a more patient physician. He listens closer to his patients to try and understand his patients’ decisions and non-compliance before judging them. He is also inspired by research initiatives from other medical specialties.

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Julie Wei, president of the American Society of Pediatric Otolaryngology, discuss how lifestyle medicine can resolve common chronic pediatric ENT complaints. --- SHOW NOTES First, Dr. Wei explains the “milk and cookie disease”, a condition she coined that relates to a triad of symptoms in children that include chronic cough, nasal congestion, and rhinorrhea. In her practice, she noted that consuming dairy and sugar products close to bedtime was directly correlated with the triad of symptoms. Thus, she emphasizes that diet is the main pillar in lifestyle medicine in children. She then explains her general workup for pediatric patients. She notes that pediatric ENT patients often have multiple complaints, so it is helpful to categorize each as chronic or acute. She always asks how many total ounces of milk the child consumes in a day, the type of milk, and the timing of dairy consumption. She has noticed that excess consumption of sugary beverages, yogurt products, and flavored milk have correlated with increased ENT complaints in children. However, Dr. Wei emphasizes the importance of educating parents about a diet of moderation instead of judging or shaming them. Dr. Wei notes that in teenagers, sleep hygiene is even more important and that eating is tied to emotions and mental states. She encourages pediatric ENTs to share previous patient stories and to be familiar with the American Academy of Pediatrics guidelines. Other techniques for family counseling include: prioritizing key changes for a short duration and giving specific action items. She also explains how she created a pilot study and discovered that increased sugar consumption correlated with increased inflammatory cytokines. Finally, she discusses her published books, blog posts, and online courses about the importance of lifestyle medicine in pediatric ENT. --- RESOURCES “A Healthier Wei” by Julie Wei https://www.drjuliewei.com/pages/a-healthier-wei Dr. Julie Wei’s Blog https://www.drjuliewei.com/blogs/news Dr. Julie Wei’s Online Courses https://drjuliewei.mykajabi.com/

In this episode of BackTable ENT, Dr. Gopi Shah discusses a lean approach to pediatric airway foreign body aspiration with Dr. Wolfgang Stehr, a pediatric surgeon and medical director of surgery at Presbyterian Healthcare in Albuquerque. --- SHOW NOTES First, the doctors discuss the typical presentation of a pediatric patient who has aspirated an object. They agree that the most common scenario is a toddler choking on a nut, but older kids can also be affected. Dr. Shah notes that although severe aspiration cases can result in respiratory distress, most patients often look fine upon arrival to the ER. For this reason, an experienced clinician should listen for whistling sounds from the bronchi or the lack of breath sounds. Because X-rays can fail to visualize the object, witnessed history of a child choking is very important to consider. Differential diagnoses include reactive airway disease, asthma, pneumonia, and a viral URI. Next, Dr. Stehr discusses how he implemented the lean process improvement system into the foreign body aspiration bronchoscopy procedure at his hospital. He was motivated to develop a more efficient process after realizing that the most difficult part about a bronchoscopy was putting together the equipment. The lean system is built on the principle that there needs to be a correct order for standardized steps in a procedure in order to reduce waste and train staff more efficiently. He used the “5 S’s” to organize the equipment in the ENT cart, which stands for: sort, set an order, shine, standardize, sustain. Additionally, he gives tips for physicians wanting to start their own quality improvement programs, such as including staff in decision making, having the most resistant stakeholder in the room first, prioritizing the case of patient safety, and inviting collaboration between different specialties when appropriate. He mentions that it is helpful to have a lean expert guide the quality improvement process in the beginning; eventually this third party consultant will train an internal employee to manage the lean process themselves. He also discusses the kaizen workshop, in which his team broke down a process, evaluated each step, and put it back together in a more efficient way. PDSA (Plan, Do, Study, Act) is another helpful framework he recommends. Finally, he discusses how he measured the efficacy of his lean intervention. He used surrogate measures of time and success, which included watching techs and nurses assemble bronchoscopy equipment while timing them and seeing how many drawers they had to open to gather all the materials. Although he had favorable results, he emphasizes the importance of always being open to new ideas for improvement.

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. 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. 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.

In this episode of BackTable ENT, Dr. Julie Wei discusses navigating disability insurance as a physician with Dr. Stephanie Pearson, a former OB/GYN who started her own personal insurance brokerage firm. --- SHOW NOTES First, Dr. Pearson shares about her struggle with disability. Early in her career, she suffered a traumatic injury that led to the development of a frozen shoulder and ended her clinical practice. Her group disability insurance did not cover work-related injuries, and she had to sue in order to receive her worker’s compensation insurance. She did not feel like she was properly educated about insurance policy and was promptly terminated from her OB/GYN job after her medical leave was over. Her emotional recovery was challenging, but she found support from her spouse, children, and dog. She eventually found her identity outside of her role as a physician, which helped ease her guilt of being a financial burden on her family. Her personal disability journey motivated her to co-found a personal insurance brokerage firm with an insurance broker. PearsonRavitz was started five and a half years ago and has nationwide clients, the majority of whom are medical professionals. She frequently gives online and in-person lectures about the importance of buying disability insurance to residents and new attendings. Dr. Wei agrees and compares working in a surgical subspecialty to physical labor, as repetitive motions may increase injury risk. Both doctors agree that standardized education for residents and medical students about disability insurance is needed. Some common myths that Dr. Pearson debunks the myths that group insurance benefits are adequate, healthy doctors do not need insurance coverage, and residents cannot afford disability insurance. Finally, the doctors end the episode by discussing unique health concerns of female surgeons, such as Infertility risk and delivery complications. --- RESOURCES PearsonRavitz https://pearsonravitz.com/

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/

In this episode of BackTable ENT, Dr. Julie Wei speaks with Dr. Gita Pensa, an emergency medicine physician, about her journey to becoming a physician coach. --- SHOW NOTES After enduring a 12 year malpractice lawsuit, Dr. Pensa explains why she chose to become a physician coach focused on helping physicians maintain their wellness through malpractice lawsuits. She started out by creating her own podcast to release 11 episodes about malpractice litigation basics. Once she realized her podcast was beneficial to many physicians, she started accepting speaking engagements and monetizing her skillset as a coach. To Dr. Pensa, physician coaching is not therapy for litigation. She doesn’t ask about details of the case that have happened, but she does help her clients reflect on the thoughts and feelings that impact their actions and reactions to their cases. Additionally, the doctors discuss Dr. Pensa’s client distribution in terms of sex and specialty. They also reflect on the relationships of malpractice attorneys with physician coaches. Although some attorneys may push back because of privacy concerns, some attorneys include Dr. Pensa on the team. She always tries to frame physician coaching as a wellness aspect of litigation period, not a substitution for legal advice. Finally Dr. Pensa ends the episode by talking about rising physician suicide rates and physician disillusionment. --- RESOURCES Dr. Gita Pensa’s Website https://doctorsandlitigation.com/ Doctors and Litigation: The L Word (11 podcast episodes) https://doctorsandlitigation.com/podcast-2 BackTable ENT Episode 42- Physicians and Litigation: The L Word https://www.backtable.com/shows/ent/podcasts/42/doctors-litigation-the-l-word The Upside of Stress: Why Stress Is Good for You, and How to Get Good at It by Kelly McGonigal https://www.amazon.com/Upside-Stress-Why-Good-You/dp/1101982934

In this episode of BackTable ENT, Dr. Shah and Dr. Agan discuss turbinate hypertrophy, turbinate reduction, and empty nose syndrome with Dr. Jayakar V. Nayak, associate professor of otolaryngology at Stanford University. --- SHOW NOTES First, Dr. Nayak gives an introduction to nasal obstruction, which may be present in patients presenting with congestion or a “stuffy nose”. Common causes of nasal obstruction include a deviated septum, nasal polyps, large adenoids in children, and turbinate hypertrophy. There are three sets of turbinates, and the inferior turbinates are located in the nose. The function of turbinates is to filter and warm incoming air. The majority of airflow happens in the lowest one third of the nose around inferior turbinates and base of middle turbinates. Turbinate hypertrophy is one of the most common causes of nasal obstruction. Dr. Nayak also notes that the same level of obstruction can affect individual patients differently. Next, he explains his workup for patients with turbinate hypertrophy. He always asks about specific symptoms the patient is experiencing, being sure to analyze both the right and left nasal cavities. He also inquires about their current nasal regimen (i.e. use of sprays, moisturizers, ointments, gels, etc.), past surgeries, past trauma to the nose, and their breathing goals. Then, he performs an endoscopy on everyone in order to examine the anterior nasal cavity of the native nose before administering decongestant. If he observes turbinate hypertrophy, he will apply topical decongestant and observe if the patient’s symptoms are mitigated. He avoids using decongestant spray because they may irritate patients’ throats. Dr. Nayak recommends a basic nasal spray regimen in all his patients with turbinate hypertrophy as a first line treatment. Benefits of nasal saline include clearing out mucus and drawing out fluid from tissues to reduce turbinate hypertrophy. Nasal steroid sprays like Flonase work well but other prescription sprays also exist. He notes that tolerance and side effects are usually rare, but possible reasons why medication might have to be changed or discontinued. Combination rinses are also available for patients with additional symptoms, such as allergies. If the conservative medical approach fails, he will move onto turbinate reduction surgery. Next, he discusses a complication of turbinate reduction, which is empty nose syndrome (ENS). ENS occurs when too much tissue in the nose has been resected, leaving a massively open nasal cavity. Patients experience a wide variety of symptoms, such as difficulty breathing fully, nasal crusting, cold or burning air rushing into the nose, and congestion. Symptoms are assessed using the SNOT 22 score; a score above 11 on a scale of 0-30 indicates a possible ENS diagnosis. Dr. Nayak also explains his in-office blinded cotton test technique to accurately diagnose ENS. Finally, Dr. Nayak discusses his turbinate reduction technique to reduce the probability of ENS. He only reduces the turbinate size while keeping shape and contour of the bone. He believes that a gradual and conservative reduction is better than a quick and excessive one. He also notes that there needs to be more standardization of turbinate reduction procedures worldwide and data on which techniques are best for preventing ENS as a postoperative complication.

Adding allergy services to your practice can improve your comprehensive ENT care. When otolaryngologists treat allergies, they more effectively address related conditions, such as sinusitis and otitis media. In this episode, Dr. Michelle Liu, general ENT in Fairfax, Virginia, shares her wisdom on starting an otolaryngologic allergy practice with host Dr. Ashley Agan. --- CHECK OUT OUR SPONSOR Medtronic ENT https://www.medtronic.com/us-en/healthcare-professionals/medical-specialties/ear-nose-throat.html?cmpid=Vanity_URL_MIX_medtronicent-com_202212_US_EN_NS_ENT_FY23 --- SYNPOSIS First, Dr. Liu summarizes her journey to treating allergy as an otolaryngologist. She finds the continuity of care and personal connections that accompany allergy care fulfilling. Then, she describes the different testing and treatment modalities used in her clinic. While subcutaneous immunotherapy is more common, sublingual immunotherapy offers an appealing needle-free alternative for some patients. Finally, she explains the logistics of starting an allergy practice, including finances, continuing education, and safety considerations for immunotherapy initiation. --- TIMESTAMPS 00:00 - Introduction 03:36 - Dr. Liu’s Medical Journey: From Military Resident to Civilian Otolaryngologist 08:46 - Adding Allergy Testing to Your Practice 28:44 - Adding Immunotherapy to Your Practice 31:22 - Patient Selection & Financial Considerations 39:39 - Pediatric Allergy 45:09 - Emergency Preparedness in Allergy Clinics 49:15 - Sublingual Immunotherapy & Tablets 53:48 - Continuing Medical Education in Allergy --- RESOURCES Medtronic ENT https://www.medtronic.com/us-en/healthcare-professionals/products/ear-nose-throat.html Dr. Michelle Liu’s Inova Profile: https://www.inova.org/doctors/michelle-f-liu-md Otolaryngology Associates’ Facebook Page: https://www.facebook.com/otoassoc/ American Academy of Otolaryngologic Allergy: https://www.aaoallergy.org/

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

In this episode of BackTable ENT, Dr. Shah and Dr. Agan interview Dr. Sujana Chandrasekhar, a private practice neurotologist, about diagnosis and treatment of patients with sudden sensorineural hearing loss (SSNHL). --- CHECK OUT OUR SPONSOR Cook Medical Otolaryngology https://www.cookmedical.com/otolaryngology --- SHOW NOTES First, Dr. Chandrasekhar explains the formal definition of sudden hearing loss, which is a loss of 30 dB over 3 consecutive frequencies over 72 hours, and notes that it is usually unilateral. She explains that the time from hearing loss presentation to ENT referral is usually delayed, as many patients attribute their hearing loss to a cold, the flu, or allergies. Frequently, they are also told over phone to take nasal sprays or prescribed amoxicillin. However, severe / profound hearing loss with or without tinnitus and vertigo necessitates immediate ENT consultation. Upon initial presentation, she usually gets a thorough health history, review of systems, and medication list from the patient. Common causes of SSNHL include: pregnancy and other thrombotic states, stroke, injected or intravenous drugs, high dose aspirin, PDE-5 inhibitors, and COVID-19 infection. She also describes how she uses the physical exam to distinguish between conductive and sensorineural hearing loss. First, she checks the outer ear and visualizes the tympanic membrane to look for external pathologies. Then, she utilizes the Weber and Rinne tests on every patient. Next, she explains her further workup for patients determined to have SSNHL. She emphasizes the need for retrocochlear examination to check for vestibular schwannoma, which is best done through MRI. If patients have MRI contraindications, a CT temporal bone with contrast paired with auditory brainstem response (ABR) testing may be an alternative option. Dr. Chandrasekhar explains that a single ABR test has a low specificity for vestibular schwannomas, missing up to 15-20% diagnoses. She also notes that patients with audiograms showing low frequency hearing loss have a better prognosis than those with high frequency hearing loss. Additional symptoms to look for are otalgia, erythema, healing vesicles, facial palsy, and blebs on the tympanic membrane. These symptoms may point to an infectious cause, such as syphilis, Lyme disease, and herpes zoster. Additionally, children may have syndromic causes of SSNHL. Dr. Chandrasekhar also explains her treatment options for SSNHL of different severities. For patients with mild and moderate hearing loss, she prescribes an oral prednisone taper, which patients can stop taking if hearing comes back. Intratympanic steroid injections with dexamethasone may be implicated if patients with moderate SSNHL do not respond to oral prednisone. She explains her steroid injection technique as well as tips for how to make patients more comfortable during and after the procedure. For patients with severe SSNHL, she emphasizes the importance of self-training to listen in the affected ear, starting to wear hearing aids early, and considering BAHA devices. Then, the doctors discuss the value of additional therapies for SSNHL, such as acupuncture, hyperbaric oxygen, papaverine, and B vitamins. Finally, she speaks about intratympanic stem cell injections to regrow inner hair cells as an exciting future treatment of sudden hearing loss. --- RESOURCES She’s on Call Podcast: https://podcasts.apple.com/us/podcast/shes-on-call-weekly-medical-show/id1582727930 WHO Free Hearing Test: https://www.who.int/teams/noncommunicable-diseases/sensory-functions-disability-and-rehabilitation/hearwho

In this episode of BackTable, Dr. Puya Dehgani-Mobaraki, president of Associazione Naso Sano, discusses his research and his experience as a rhinologist with SARS-CoV-2 and its effect on the olfactory system. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/4UhYPr --- SHOW NOTES First, Dr. Dehgani-Mobaraki explains the goals of the Associazione Naso Sano, which is to provide community education about rhinologic conditions, distribute research grants to young researchers, and host international grand rounds. Then, he discusses his own experience with SARS-CoV-2. He was infected with the virus in early 2020 and could not be tested because he had no upper respiratory symptoms, only anosmia. He also reflects on the research he did in 2020, which focused on immune adaptation after infection. His research group discovered that there was a strong relationship between antibody production and smell loss. He notes that later variants of the virus became more infectious, but not more lethal. After December 2021, he noticed that the virus mutations led to a different pathway of generating symptoms, resulting in more upper respiratory symptoms and less anosmia. Furthermore, he reminds listeners that smell and taste disorders are not unique to SARS-CoV-2 and can be triggered by Parkinson disease, Alzhiemer disease, brain trauma, and nasal polyposis. Next, he speaks about his personal experience with treating patients with anosmia. Usually, COVID patients will regain their sense of smell any time from 20 days to 6 months after infection. However, some patients experience longer lasting parosmia, an altered quality of smell, and phantosmia, the perception of smell without stimulus. He notes that these symptoms can be difficult and distressing to patients. Smell and taste disorders can lead to weight loss and psychological disturbances, as these two senses are integral to community formation and pleasure. Although some patients can self-train to live with altered smell and taste, some may require medical consultation for a structured smell re-training plan or medications, such as oral steroids, PRP injections, zinc, or alpha-lipoic acid. Finally, Dr. Dehgani-Mobaraki speaks about his most recent research project, which may suggest that SARS-CoV-2 can reactivate Epstein Barr virus through autoimmune pathways.

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 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 of BackTable ENT, Dr. Ashley Agan interviews laryngologist Dr. Inna Husain about diagnosis, treatment, and multidisciplinary care of patients with laryngopharyngeal reflux (LPR). --- SHOW NOTES First, Dr. Husain defines LPR as acidic and/or non-acidic reflux that causes direct and indirect effects on the upper aerodigestive system. She emphasizes the importance of utilizing subclassifications of LPR and explains the difference between direct acid, direct non-acid, and indirect acid reflux. She notes that each subclassification has different treatment patterns and that overlapping diagnoses can make classification difficult. Another challenge in diagnosing LPR is the need to distinguish chronic problems from isolated episodes. If a patient’s LPR is chronic, she suspects the indirect acid LPR subclassification. During her primary visit with a patient, she asks key questions related to the root problem or sensation a patient is experiencing, such as mucus dripping, throat clearing, or globus. She notes the frequency and severity of their episodes. She also explains that unilaterality of sensation is unlikely to be LPR, and patients correctly diagnosed with GERD commonly have LPR. After taking an initial patient history, she utilizes flexible laryngoscopy to visualize the throat and rule out other diagnoses, such as polyps or tumors. She notes that she will not be able to see reflux through laryngoscopy, but just signs of throat irritation. Additionally, because there is not one defining visual characteristic of LPR, the imaging results are always interpreted through subjective means; thus, LPR is a diagnosis of exclusion. For patients suspected to have LPR, Dr. Husain initiates empirical medical therapy. She explains to all her patients lifestyle modifications like cessation of smoking / vaping and reduction of coffee, late night eating, carbonated water, and citric foods. Although the conventional treatment of LPR is acid suppression, she only prescribes patients with proton pump inhibitors if they have acid reflux symptoms because 50% of LPR patients don’t actually improve on the medication. Her PPI regime consists of 40 mg omeprazole in the morning and Pepcid at night for 1-2 months. If patients improve, she slowly tapers them off of the PPI to avoid rebound reflux. If the patients do not improve after 2 months, she will switch to another medication, such as alginate suspensions, a more natural alternative to PPI. Alginate suspensions create a barrier that prevents the upward movement of acid. Contraindications include concurrent use with other acid suppression medications and a history of lower GI issues. Finally, Dr. Husain discusses the 24-hour pH impedance testing, which is the gold standard for LPR diagnosis. A catheter with a probe is inserted into the patient’s throat and sends continuous pH readings to a monitor the patient carries. Patients return after 24 hours, and she is able to find correlations between patient symptoms and acid reflux and classify the LPR subtype. If she interprets any distal esophageal issues or dysmotility issues, she involves her GI colleagues to explore endoscopic solutions. She ends the episode by explaining her treatment regimen for refractory neurosensory (indirect) reflux, which includes neuromodulators (gabapentin, amitriptyline) or a superior laryngeal nerve block. --- RESOURCES Dr. Husain’s Twitter: https://twitter.com/Drinnahusain Dr. Husain’s Instagram: @innahusainmd

En este primer episodio español de BackTable ENT, Dr. Carlos Torre entrevista al Dr. Laureano Giraldez sobre sus motivaciones y lecciones de empezar su práctica privada de laringología y cáncer de cabeza y cuello en Puerto Rico. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/zW5bUS --- SHOW NOTES Primero, Dr. Giraldez discute su motivación y trayectoria de ser otorrinolaringólogo. Creció en una familia de médicos y le gustaba el otorrinolaringólogo debido a la diversidad del campo. Completó la residencia en la Universidad de Puerto Rico y entrenó en laringología en el Emory Voice Center. Entonces, desarrolló un interés en la reconstrucción del cáncer de la cabeza y cuello y añadió una especialización segunda en reconstrucción microvascular después de su entrenamiento en Mount Sinai. Después, Dr. Giraldez habla sobre el proceso de abrir su propia práctica privada en Puerto Rico después de su cognición de la falta de otorrinolaringólogos puertorriqueños. Él enfatiza la importancia de las principales de organización para un cirujano joven. Cuando empezó, necesitaba preguntar que necesitaba del hospital y de la comunidad. Por ejemplo, reconoció su necesidad de una unidad de cuidados intensivos, la terapia de respiración, y la terapia de rehabilitación. También, él quería hacer cirugía robótica, así que necesitaba tecnología avanzada. Además, hace unas comparaciones entre la práctica privada en los Estados Unidos versus en Puerto Rico. Los doctores también discuten los cambios del campo de otorrinolaringólogo en Puerto Rico y sus colegas que están avanzando en la investigación y las técnicas quirúrgicas Próximo, Dr. Giraldez habla sobre su población de pacientes. Dice que la mayoría de su práctica pertenece a la laringología y fueron recomendados por sus pacientes anteriores. Usó la red social, las publicaciones, y su sitio web para contactar pacientes nuevos. También, tiene algunos pacientes internacionales que están buscando tratamiento avanzado más barato pero de la misma calidad. Los doctores terminan el episodio con algunos consejos, como el beneficio del cambio y la importancia de ser autocrítico.

In this episode, Dr. Bagrodia discusses cultivating a healthy culture inside and outside of the operating room with Dr. Chris Kane, Dean of Clinical Affairs at UCSD and CEO of the UCSD Physician Group. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/rVQG40 --- SHOW NOTES First, the doctors discuss the definition of culture, which Dr. Kane defines as the norms of behavior and relationships within an organization. Culture can include dress code, meeting rules, and punctuality. Most of the time, institutional culture is established in an unspoken way. Dr. Kane emphasizes the importance of having a conscious strategy to create a healthy culture and reiterates that trust is a crucial foundation for motivating cultural changes. Next, the doctors discuss helping team members find meaning in their work. Dr. Kane recommends that surgeons share patient gratitude with their other colleagues who are not frontline medical workers. He acknowledges his staff’s contributions during meetings and expresses his gratitude through written notes. He also recommends communication training for everybody on his team. Then, he shares tips for assessing organizational culture. He believes that it is most important to ask team members what they think the overarching goal of the institution is and to assess the attrition rate through exit surveys. He emphasizes that behavioral norms matter most, as department leaders often lead by example. One detrimental practice is favoritism, which Dr. Kane regards as disrespectful to other team members. Additionally, he shares his personal experiences with changing cultures at different institutions and utilizing change management theories. Finally, Dr. Kane shares general leadership advice. He highlights the importance of creating a patient-centered environment, leading by influence rather than authority, and the power of positivity.

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 of BackTable ENT, Dr. Gopi Shah interviews Dr. Dhave Setabutr, assistant professor of otolaryngology at Thammasat University, about building a microtia repair program in Bangkok, Thailand. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/Jz2h8d --- SHOW NOTES First, Dr. Setabutr explains his path through otolaryngology and microtia training and his motivation to move his family and practice to Thailand. Then, he explains how he transitioned from practicing in the United States to practicing in Thailand after he was notified of an opening for an English-speaking otolaryngology professor at a university hospital. He notes that pediatric otolaryngologists are scarce in Thailand, a country of 60-70 million with only 15 fellowship trained pediatric ENTs. Next, he describes his microtia repair team, which consists of many different specialties, such as a facial plastics surgeon and audiologists. He emphasizes the importance of operating with a co-surgeon in the initial building of a microtia program. Additionally, he delineates differences in the Thai health care system that changed the way he manages his microtia patients. For example, although many of his patients have unilateral microtia, they cannot afford BAHA devices or hearing aids for the contralateral ear because the government does not provide funding for these devices. Also, there is no option to install an FM system in the classroom to amplify sounds for children with hearing deficits. Finally, he only uses rib harvest for reconstruction because it is the most cost-effective technique. Although Thailand has recently implemented universal newborn hearing screenings, many health gaps must be addressed before improving treatments of hearing loss in Thai children. Then, Dr. Shah and Dr. Setabutr discuss tips on having the initial conversation with parents of a pediatric microtia patient. Because microtia is undetectable on ultrasound, many parents are surprised during the birth of their children. Additionally, parents may have difficulties dealing with this condition because there are no abundant parent support groups for microtia. Dr. Setabutr recommends being able to summarize information in a way parents can understand and to ease their concerns about hearing and development. Finally, he delves into the technical aspects of microtia repair, including the grading system and surgical procedure. He usually only performs the three-stage surgery on children with grade III microtia who have enough rib cage cartilage to construct a pinna. He keeps the patients in the hospital until their shunts can be removed due to poor wound care resources in Thailand. Finally, he emphasizes the importance of gaining patient and family support before performing the repair surgery. --- The BackTable ENT Podcast is a resource for otolaryngologists to learn tips, techniques, and practical advice on all things ear, nose, and throat. Tune in to the BackTable ENT Podcast every week for candid conversations about rhinology, laryngology, otology, and head and neck surgery. Get notified when new episodes drop! Subscribe to the BackTable ENT Podcast on your go-to podcast platform, and follow us on your social media platform of choice for regular otolaryngology updates. Apple ► https://podcasts.apple.com/us/podcast/backtable-ent/id1531545163 Spotify ► https://open.spotify.com/show/37rFUMANPeGURdmNkn2Vi7 YouTube ► https://www.youtube.com/channel/UCoI12lCyYggbdB-OC68wGlg?sub_confirmation=1 Twitter ► https://twitter.com/_backtableENT​ LinkedIn ► https://www.linkedin.com/company/backtable-ent/ Instagram ► https://www.instagram.com/_backtableent/ Newsletter ► https://www.backtable.com/shows/ent/subscribe

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

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.

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.

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 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

In this episode of BackTable ENT, Dr. Julie Wei, Dr. Alain Sabri (Mayo Clinic Abu Dhabi), and Dr. Kerry Olsen (Mayo Clinic Rochester) discuss personal and professional strategies to overcome physician burnout. --- 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/HKydZd --- SHOW NOTES First, the doctors discuss their personal motivations for engaging in wellness. For Dr. Sabri, wellness evolved as his career matured. Eventually, he moved abroad and studied cross-cultural practices of wellness. For Dr. Kerry, leadership roles forced him to have concern about the wellness of his employees, leading him to create his own company, 12 For Health. For Dr. Wei, a medical condition forced her to think about her life outside of the OR. All three doctors agree that head and neck surgeons have one of the highest burnout rates and the first step to solving this problem is recognizing burnout as a problem and not being ashamed of it. Then, they discuss the impact that corporate influence has on medicine and physician wellness. Many physicians may feel stuck in a system they have no say in. Dr. Olsen encourages healthcare corporations to prioritize patient and physician welfare over finances while Dr. Sabri encourages institutional leadership to actually listen and elicit change when their physicians provide feedback. Dr. Olsen then explains how raising salaries to justify longer hours actually incentivizes doctors to cut their hours and makes it easier for them to leave. Additionally, both Dr. Wei and Dr. Sabri agree that the feelings of burnout can fluctuate from day to day. Next, the doctors emphasize the importance of feeling valued as a physician and engaging in self-care techniques. Dr. Olsen advocates for training physicians to be leaders who get to know their team well and recognizes good work at an appropriate time. Dr. Sabri criticizes the American “hyper statistical” view that does not respect people for the work they do. He advises physicians to select the right institution for them and have the courage to walk away and reinvent themselves in new positions when they feel like they are not receiving the respect they deserve. Self-care techniques the doctors recommend from personal experience are: re-reading patient and mentee thank you notes, meditation, stretching, team sports, having a coffee with a friend, and learning how to say no to excess work and toxic relationships. Finally, the doctors discuss how institutional leadership can help women surgeons succeed and prevent burnout. Dr. Olsen adds that leadership needs to change if the current leaders are not effective and explains ways to form effective work units.

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. 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.

In this episode of BackTable ENT, Dr. Shah and Dr. Agan speak with Dr. Colleen Plein about functional nasal breathing in the treatment of facial pain, sleep apnea, postural defects, and improving general quality of life. --- 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/cP8H2Q --- SHOW NOTES First, Dr. Plein defines functional nasal breathing, which is unobstructed nasal breathing with a closed mouth. Nasal breathing is the best way to optimize airflow through the nose because the nose humidifies and filters air, the sinuses produce nitric oxide to increase oxygen delivery to tissue, and a slower breathing rate can be established, which stabilizes blood pH. Dr. Plein then explains the evolutionary transition from nasal to mouth breathing in humans. The “Great Leap Forward” involved the descension of the larynx and posterior displacement of the tongue so humans could develop speech. Unfortunately, these anatomical changes allowed airways to be more easily obstructed. Additionally, narrowing of the human skull occurred because humans now chew less due to our processed diets. The lack of mastication caused hypoplasia of the maxilla and mandible, which led to narrowing of nasal aperture. In a child with mouth breathing, Dr. Plein emphasizes the importance of early orthodontic intervention; early maxillary expansion is more likely to occur because the sutures have not fused yet. Besides turbinate reduction therapy, she encourages non-invasive therapies for children such as myofunctional therapy and eating less processed foods. The doctors also discuss different pathologies linked to mouth breathing besides obstructive sleep apnea. Dr. Plein explains how mouth breathing can lead to TMJ pain, poor posture, facial pain, and migraines. Next, Dr. Plein gives her tips for examining a mouth breathing patient. She believes that taking a thorough clinical history is important and always asks about snoring, posture, headaches, shoulder/neck pain, as some patients don’t realize they have problems with nasal breathing. She also mentions that some patients who grind their teeth may be using a mouth guard that pushes the tongue further back, which can worsen sleep apnea. She notes that tongue scalloping and outwardly oriented teeth are indicative of tongue thrust, which is diagnostic of sleep apnea. She has a low threshold for recommending home sleep tests and always examines the nose with nasal endoscopy. During endoscopy, she does Cottle’s maneuvers to look for static and dynamic nasal valve collapse. In addition to a scope exam, she gets CT imaging of the sinuses. Next, Dr. Plein emphasizes the importance of collaborating with myofunctional therapists, dentists, orthodontists, and TMJ physical therapists to care for her nasal obstruction / mouth breathing patients. Finally, she summarizes some non-invasive technology and medications that can help optimize nasal breathing, such as intranasal steroids, antihistamines, nasal irrigation, Breathe Right strips, and a gluten-free diet.

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Kutz interview Dr. Marc Bennett, a Vanderbilt University ENT professor, about the importance of quality improvement, and initiatives and tips for quality initiative research. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/BFTSrG --- SHOW NOTES First, Dr. Bennett delineates his path to quality improvement research and education. His father was involved in quality improvement in the pharmaceutical industry, and he was always interested in systems-based improvement. Additionally, he was encouraged by a mentor to find a niche outside of clinical medicine. Next, the doctors discuss collaboration with hospitals and medical schools to encourage more quality improvement initiatives. For enticing hospital systems to care about quality initiatives, Dr. Bennett recommends showing them that administrative data is very important for financial and billing reasons as well as hospital rankings, which are important to patients and the public. Additionally, he encourages medical school lecturers and residency directors to incorporate quality improvement projects and measures in their trainee curriculums. For students and residents with a vested interest in quality improvement, identifying a mentor and starting with a simple project is the best way to explore the research field. Next, Dr. Bennett discusses important aspects of quality improvement research. First, he highlights the importance of using run charts to compare mortality and complications across populations over time. Run charts can be further analyzed to see differences between different providers, statistical significance, and outliers. When collecting data from electronic health records, he collaborates with billing departments in order to identify relevant CPT codes. He also notes that the AAO-HNSF collects self-reported data from individual institutions as well. Then, he uses data analysis programs like Vizient and Leapfrog to organize and interpret data. Finally, Dr. Bennett shares how otolaryngologists can improve quality of care in their everyday practice, most notably through proper documentation. He discusses the pros and cons of using dot phrases and emphasizes the importance of standardization of format and coding. --- RESOURCES Vizient: https://www.vizientinc.com/ Leapfrog: https://www.leapfroggroup.org/

In this episode of BackTable ENT, Dr. Ashley Agan and Dr. Seilesh Babu discuss Eustachian tube dysfunction and balloon dilation as a therapeutic option. --- CHECK OUT OUR SPONSOR Acclarent https://www.jnjmedtech.com/en-US/companies/acclarent --- SHOW NOTES First, Dr. Babu provides background on Eustachian tube dysfunction. In kids and adults, Eustachian tube dysfunction can present as a sensation of “ear fullness”, recurrent fluid in the ear, or discomfort with pressure challenges, such as flying or scuba diving. Medical management involves nasal steroids, allergy medications, anti-reflux medications, avoidance of allergens, and doing a modified Valsalva maneuver at home. Additionally, ear tubes and balloon dilation are procedural options. Next, Dr. Babu explains his workup for Eustachian tube dysfunction patients. He takes a thorough patient history and examines the patient’s tympanic membrane, nasopharynx, and serous outflow using a flexible scope. He orders an audiogram for all of his patients but notes that tympanograms are not as critical. For patients with discomfort during pressure challenges, he will consider doing a balloon dilation or placing an ear tube. For patients presenting with “ear fullness”, a more in-depth examination must be done through a trial tympanostomy tube or a myringotomy. He also looks for red flags, which indicate Eustachian tube dysfunction may not be the correct etiology for their ear symptoms. These red flags include: aggravation of symptoms upon tube insertion, symptoms of dizziness and vertigo, autophony, and pulsatile tinnitus. Although it is rare, a diagnosis of Patulous Eustachian tube dysfunction must be considered. If the patient does not have these red flags and has had multiple ear tubes without symptom relief, they may be a good candidate for balloon dilation. Dr. Babu then delineates his procedure for a Eustachian tube balloon dilation. He performs this procedure in the OR using the Acclarent AERA Eustachian tube dilation system. He inflates the balloon to achieve a pressure of 12 atm, keeps it dilated for 2 minutes, then removes the instrument. Some procedural pearls he shares are: putting the scope and balloon in at the same time to minimize bleeding in the nasopharynx and guiding the instruments in a lateral direction towards the external ear canal. He usually waits 2-3 weeks before reassessing the patient for recurrent symptoms. Upon discharge, he encourages patients to avoid nose blowing and Valsalva maneuvers, as these actions can cause a pneumothorax or pneumomediastinum. Common postoperative symptoms include minor nose bleeds and the sensation of a sore throat. Dr. Babu usually performs the balloon dilation in conjunction with other OR procedures, such as myringotomies and tympanoplasties, for efficacy. Finally, the doctors discuss the specifics of billing for the Eustachian tube dilation procedure. In recent years, a specific billing code has been assigned for balloon dilation, and insurance companies are beginning to authorize this procedure for a variety of patients. Devices discussed in this podcast are currently available in the US only. Acclarent, Inc. 223616-220810 --- RESOURCES Acclarent: https://www.jnjmedtech.com/en-US/companies/acclarent AERA® Esutachian Tube Balloon Dilation System: https://www.jnjmedtech.com/en-US/product/Acclarent-aera-eustachian-tube-balloon-dilation-system Howard, A., Babu, S., Haupert, M., & Thottam, P. J. (2021). Balloon Eustachian Tuboplasty in Pediatric Patients: Is it Safe?. The Laryngoscope, 131(7), 1657–1662. https://doi.org/10.1002/lary.29241

In this episode of BackTable ENT, Dr. Ashley Agan and Dr. Gopi Shah speak with Dr. Mary Ashmead, a Dallas/Fort Worth based rhinologist (Texas Ear, Nose, & Throat Specialists) about in-office procedures for nasal valve obstruction. --- CHECK OUT OUR SPONSOR Aerin Medical https://aerinmedical.com/ --- SHOW NOTES First, Dr. Ashmead describes her typical work up for a patient presenting with nasal valve obstruction in the clinic. She explains that “congestion” is a common but ambiguous chief complaint that patients use when they are unable to be specific about their nasal problems. She emphasizes the importance of doing a thorough ENT review of systems and asking about nasal obstruction for patients with chief complaints other than nasal valve obstruction as well because one-fifth of patients with severe nasal valve obstruction are missed. Before she observes her patients, all of them will complete a NOSE score as well. During the physical exam, Dr. Ashmead observes the nasal bones and external nasal valves first and then uses a rigid scope to examine the internal valve, turbinates, septum, and nasal mucosa. She does not routinely give her patients a nasal decongestant before doing her primary scope exam, as she wishes to examine the patient’s nose in its native state. Then, she will administer a nasal decongestant and go through the second scope exam again. Miscellaneous issues she will look for include nasal polyps and sinusitis. For conservative treatments, she generally prescribes nasal steroid spray, topical antihistamines, Afrin at night, nasal dilators, Breathe Right strips, and nose cones. Then, Dr. Ashmead delves into the different in-office procedures she employs for nasal valve obstruction patients. The type of therapy she embarks on will depend on the kind of patients she sees. Some of her patients will want to fix everything at once up front and others will want multiple procedures in smaller steps. Additionally, some patients will choose the operating room setting over the office setting. Finally, other details to consider are the patient’s desire to keep the same appearance of their nose, the patient’s skin thickness, and recovery time. Dr. Ashmead recommends the VivAer procedure for patients with a positive modified Cottle maneuver test, dissatisfied patients post-septoplasty/turbinate reduction, rhinoplasty patients with a narrowed internal valve, and snorers. The VivAer procedure uses bipolar radiofrequency energy to shrink tissue and allow the surgeon to remodel the internal nasal valve, turbinates, and swell body. There are different cooling and heating cycles that take a total of 6-7 minutes to complete. During this procedure, Dr. Ashmead uses a scope to visualize where to place the small paddles. She notes that rebound swelling, nasal tip tension, and the development of scabs are three common minor consequences of this procedure. Next, she discusses the Latera nasal implant, which can only be used in dynamic valve collapse. She does not use this synthetic implant often, as it can get infected and many patients do not want an implant in their noses. A third option she mentions is a septal rhinoplasty, a procedure that she often refers to her facial plastics colleagues. Finally, Dr. Ashmead goes into detail about her anesthesia procedure and the role of anxiolytics in her practice. Her patients will take either 0.125 mg of halcion or triazolam one hour before they arrive at her office for the procedure. In longer cases, she will prescribe her patients Valium. She emphasizes the importance of thorough topical numbing; she usually uses a 4% topical compounded tetracaine/lidocaine gel. Generally, she avoids administering epinephrine in the office, as adrenaline can aggravate an already nervous patient. Finally, she does everything she can to soothe the patient, such as having separate procedure rooms with soothing music and dimmed lights. --- RESOURCES VivAer Procedure: https://vivaer.com/hcp/

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, 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 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 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. 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. Varun Varadarajan and Dr. Gopi Shah discuss their personal advice and stories of navigating the challenges of a dual physician household with Dr. Bill Collins, chief of Pediatric Otolaryngology at the University of Florida College of Medicine. The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/o4ATPJ --- CHECK OUT OUR SPONSOR Athletic Greens https://www.athleticgreens.com/backtableent --- SHOW NOTES In this episode of BackTable ENT, Dr. Varun Varadarajan and Dr. Gopi Shah discuss their personal advice and stories of navigating the challenges of a dual physician household with Dr. Bill Collins, chief of Pediatric Otolaryngology at the University of Florida College of Medicine. First, the doctors discuss the considerations involved in deciding to participate in the couples match. They agree that it is best to keep larger cities with multiple programs in mind when forming a rank list but note that the match can also be complicated if one partner is choosing to pursue a more competitive specialty. Additionally, although staying together would be ideal, couples might not have another choice besides engaging in a long-distance relationship during residency and fellowship. Dr. Collins highlights the importance of finding program directors and other mentors who can help to maintain value in relationships during training. During residency applications and beyond, he emphasizes that communication, honesty, and compromise are key to sustaining a strong relationship. Next, they discuss raising children in dual physician households. All three doctors agree that there is no “perfect” time to have children because it depends on the circumstances and preferences of every couple. If a couple wanted to have a child during both of their residencies, they would also have to consider the long uncontrollable hours of residency as well as the need for extensive child care. Additionally, Dr. Collins emphasizes that physician schedules will remain busy, even after residency, so it is important to schedule concrete family time sooner than later. Dr. Shah mentions the difficulty surgeons have with separating work from home and Dr. Varadarajan encourages them to devote quality time to their kids before getting on their phones to answer emails and finish notes. Lastly, the doctors consider scenarios in which one partner is seeking a job change. Although being further along in their careers and having older children may complicate the job search and moving demands, all three doctors agree that decisions should be made for the overall good of the family. Thus, all factors and possibilities should be considered and discussed. Finally, Dr. Shah emphasizes the importance of having discussions about family planning with medical residents and medical students in order to open channels for advice and mentorship.

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. 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

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/

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/

We talk with Dr. Julie Wei about what it means to connect with a mentor, the challenges of finding the right fit, and how mentoring relationships will grow and change throughout our career and undoubtedly contribute to overall wellness. --- 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/3tnqFx --- SHOW NOTES In this episode of BackTable ENT, Dr. Ashley Agan, Dr. Gopi Shah, and Dr. Julie Wei discuss the benefits and evolution of mentorship in the medical field. First, Dr. Wei shares her personal definition of mentorship. Traditionally, mentorship involves a dyad: one junior and one senior partner with the knowledge. However, she challenges this dynamic by broadening the definition of mentorship by coining the term “co-mentorship”, a term that encompasses the mentor’s ability to learn from the mentee and the experience of reflecting as well. The doctors also discuss the challenges of finding mentors after training, since the natural hierarchy of academic medicine is not present. Dr. Wei encourages ENTs to attend society meetings and seek multidisciplinary mentors and mentees in different fields. She mentions that she has served as a mentor for respiratory techs and nurses as well. Next, the doctors explore the idea of work-life balance. Dr. Wei disagrees with the consistent compartmentalization of career and personal wellness and prefers to advocate for and use the term “work-life integration” instead. She also recommends unconventional meeting platforms, such as Zoom, phone calls, and “walking meetings” in order to build relationships. Peer support groups can also be helpful, but the optimal size of the group may depend on the issue being discussed. Additionally, Dr. Wei observes that more female physicians today are able to share their struggles and vulnerabilities openly with their trainees and patients, thus building stronger relationships. She also talks about the importance of allies and notes that mentors and mentees do not have to have all of the same shared experiences–both can still be sources of insight and wisdom for each other. Finally, the three doctors reflect on their personal experiences with mentorship and executive coaching. --- RESOURCES “Leadership, Engagement, and Well Being” by Julie Wei https://www.enttoday.org/article/leadership-engagement-and-well-being/3/?singlepage=1 A Healthier Wei https://www.drjuliewei.com/pages/a-healthier-wei Acid Reflux in Children https://www.drjuliewei.com/pages/acid-reflux-in-children#:~:text=Acid%20Reflux%20in%20Children%3A%20A,Julie%20Wei&text=CONGESTION%2C%20COUGH%20%2B%20CROUP-,Co%2Dauthored%20by%20Dr.,symptoms%20this%20condition%20can%20create.

We talk with Dr. Allison Royer about locums opportunities for otolaryngologists, why locums is becoming more popular amongst ENTs, and how to get started as a locums physician. The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/MMVvXV --- CHECK OUT OUR SPONSORS DI4MDs https://www.di4mds.com Laurel Road for Doctors https://www.laurelroad.com/healthcare-banking/ --- SHOW NOTES In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Ashley Agan interview Dr. Allison Royer, a private practice ENT who co-founded ENT Surgery Solutions, a staffing company that organizes ENT locums. First, Dr. Royer shares her transition from being a hospital-employed ENT to becoming a locum physician with her husband. Once they met other locum physicians and heard about their experiences, they decided to start their own locum staffing company. Dr. Royer believes ENT Surgery Solutions is unique because it is managed directly by ENT physicians; Dr. Royer and her husband directly work with the doctors they employ to find work opportunities that will fit their unique needs. Although ENT Surgery Solutions is primarily Midwest-based, it is quickly expanding in the West and South. Next, Dr. Royer transitions to discussing why many doctors are moving toward locums work. She explains that because many small private practice groups and community hospitals have been bought by hospital systems, there are now significant call burdens needing to be covered by small ENT groups. For this reason, many ENTs decide to do locums in order to balance work and life. Additionally, with locums, doctors don’t have to renegotiate their salaries or their call schedules. Finally, Dr. Royer highlights that locums are fun for her because she likes to work in different hospitals and ORs and see different patient populations and pathology. --- RESOURCES ENT Surgery Solutions ​​https://www.entlocums.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/