Pediatric thyroid nodules are rare, but their risk of malignancy is significantly higher than in adults, raising the stakes for accurate diagnosis and multidisciplinary management. In this episode of the BackTable ENT Podcast Dr. Gopi Shah and co-host Dr. Jeff Hyzer interview Dr. Wen Jiang, pediatric otolaryngologist at Rady Children’s Hospital in San Diego, for an in-depth discussion on the evaluation and management of thyroid nodules in children.

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Timestamps

00:00 - Introduction
02:27 - Thyroid Nodule Risks and Care Team
06:47 - Age-related Differences in Nodule Presentation and Outcomes
08:50 - Initial workup
13:42 - Ultrasound Interpretation
16:07 - Lymph Node Mapping and CT
19:58 - Incidental Findings
24:14 - Role of FNA, Molecular Testing, and Radiofrequency Ablation
32:40 - Molecular Testing Results and Counseling
38:04 - Neck Dissection Strategy
40:44 - Hypocalcemia Protocol Considerations
44:01 - Parathyroid and Recurrent Laryngeal Nerve Dissection Tips
47:33 - Postop Care and Follow-up
51:25 - Using Radioactive Iodine and Targeted Therapy
54:55 - AI’s and Ultrasound and Final Thoughts

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More about this episode

Dr. Jiang highlights the key differences between pediatric and adult thyroid nodules. She describes her multidisciplinary approach including collaboration with radiology, pathology, endocrinology and nuclear medicine. The discussion reviews the initial workup for pediatric thyroid nodules and why ultrasound remains the primary diagnostic tool. She also discusses situations where CT with contrast can be helpful for surgical planning. This episode explores the growing role of reflex molecular testing in guiding management decisions and outlines the impacts of molecular testing results. Dr. Jiang shares her approach to patient counseling along with management of calcium and PTH after surgery. The conversation concludes with emerging applications of molecular diagnostics and AI models for improving thyroid ultrasound interpretation.

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Resources

Dr. Jiang's Research on Pediatric Thyroid Nodule Management - https://pubmed.ncbi.nlm.nih.gov/26770219/

Bethesda System for Thyroid Cytopathology - https://pmc.ncbi.nlm.nih.gov/articles/PMC7182964/

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

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

► https://www.backtable.com/app

From clinic to the OR, storytelling quietly shapes every decision in clinical care. This episode of BackTable ENT & Allergy examines how narrative medicine and the stories at the heart of each patient encounter can elevate your clinical practice, enhance empathy, and deepen the doctor-patient relationship. Pediatric ENT Dr. Gopi Shah interviews Dr. Alessandra (Alessa) Colaianni, a head and neck surgical oncologist at the University of North Carolina, about the power and relevance of narrative medicine in modern surgical care.

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Timestamps

00:00 - Introduction
05:53 - What is Narrative Medicine?
11:36 - Narrative Medicine in Clinic
17:28 - Narrative Medicine in the OR
21:09 - Patient Case Presentation and Boundaries
25:05 - Writing For Reflection and the impact of AI
29:35 - Resources And Podcasts
33:19 - Final Takeaways

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More about this episode

Dr. Colaianni is a published writer whose work has been featured in the New York Times, New Yorker, and the New England Journal of Medicine. She describes her lifelong interest in writing and shares how earning a master’s degree in the history and philosophy of science at the University of Cambridge during medical school helped her reconnect with the humanistic side of medicine. She reframes narrative medicine not as an extra task, but as an approach already woven into daily clinical work through history-taking, listening, and documentation. The conversation explores the influence of patient identity, socioeconomic context, and the “characters” in each patient’s story on clinical decisions and care. Dr. Colaianni reflects on the role of storytelling in surgical training, the apprenticeship model, and how thoughtful boundaries can foster meaningful doctor-patient relationships. The episode concludes with a discussion of AI’s potential impact on empathy and recommended reading for further exploration of narrative medicine.

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Resources

Dr.Colaianni’s published work
https://www.alessandracolaianni.com

Columbia University Division of Narrative Medicine
https://www.mhe.cuimc.columbia.edu/division-narrative-medicine

Columbia University Narrative Medicine Youtube channel
https://www.youtube.com/@columbiauniversitynarrativ8472

The Nocturnists podcast
https://thenocturnists.org/podcast

Autobiography of a Face by Lucy Grealey
https://www.amazon.com/Autobiography-Face-Lucy-Grealy

The Empathy Exams by Leslie Jameson
https://www.graywolfpress.org/books/empathy-exams

The Collected Schizophrenias Essays by Esmé Weijun Wang
https://www.graywolfpress.org/books/collected-schizophrenias

My Own Country: A Doctor’s Story by Abraham Verghese
https://www.amazon.com/My-Own-Country-Doctors-Story

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

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

► https://www.backtable.com/app

From the clinic to the camera, discover how an allergist turned social media into a patient education powerhouse. On this week’s episode of the BackTable ENT & Allergy Podcast, allergist Dr. Zachary Rubin of Oak Brook Allergists joins host Dr. Basil Kahwash to discuss his path from fellowship training to becoming a widely followed social media educator and author of the New York Times bestselling book “All About Allergies”. He explains how the COVID-19 pandemic and the rapid spread of online medical misinformation inspired him to educate the public through social media, developing an authentic on-camera style and consistent brand that has expanded his reach far beyond the clinic.

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Timestamps

00:00 - Introduction
05:21 - Learning the Creator Playbook
10:10 - Authenticity and Creating a Personal Brand
16:51 - Writing for Patients and Clinicians
20:41 - Balancing Clinic and Content Creation
26:15 - How to Start Your Public Voice
29:11 - Professional Boundaries and Handling Criticism Online
36:34 - How Patients Following Your Content Impacts the Clinic
43:08 - The Unexpected Doors Content Creation Can Open
48:44 - Future of Public Health
53:09 - Final Advice

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More about this episode

The conversation explores strategies for communicating complex medical topics, such as using metaphors to improve public understanding, and the importance of professionalism, boundaries, and safety in the online space. Dr. Rubin offers advice on avoiding individualized medical advice, managing online harassment, and navigating the nonfiction publishing world. He also discusses the impact of advocacy and media engagement for both patients and healthcare professionals, showing how physicians can leverage media to make a difference well beyond their practice.

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Resources

Dr. Zachary Rubin
https://www.oakbrookallergists.com/our-team/zachary-e-rubin-md/

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

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

► https://www.backtable.com/app

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

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SYNPOSIS

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

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TIMESTAMPS

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

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RESOURCES

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

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

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https://www.backtable.com/app

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Timestamps

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

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More about this episode

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

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

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Resources

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

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

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

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

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

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

► https://www.backtable.com/app

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

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https://www.backtable.com/app

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Timestamps

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

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

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

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

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

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

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

---

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

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

► https://www.backtable.com/app

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

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Timestamps

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

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More about this episode

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

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

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Resources

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

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

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https://www.backtable.com/app

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Timestamps

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

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More about this episode

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

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Resources

Dr. Sonia Gupte

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

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

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Timestamps

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

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More about this episode

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

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Resources

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

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

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SYNPOSIS

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

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TIMESTAMPS

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

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RESOURCES

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