BackTable ENT & Allergy

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.

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Medtronic ENT

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

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SYNPOSIS

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

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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

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

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SYNPOSIS

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

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TIMESTAMPS

00:00 - Introduction

02:17 - Challenges in Pediatric ENT Care

05:43 - Healthcare Inequities in the Gulf South

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

21:33 - Helping Patients Tackle Financial Challenges

26:52 - Caring for All in Public Hospitals

37:57 - Keeping the Big Picture in Mind

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RESOURCES

PearsonRavitz

https://pearsonravitz.com/

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

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.

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Medtronic ENT

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

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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.

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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

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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/

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

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CHECK OUT OUR SPONSOR

Hummingbird PE Ear Tubes

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

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SYNPOSIS

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

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TIMESTAMPS

00:00 - Introduction

02:25 - Ear Infections & Ear Tubes

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

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

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

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

56:23 - Parent Feedback on the Hummingbird System

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RESOURCES

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

Hummingbird TTS Website:

https://www.hummingbirdeartubes.com/

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

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CHECK OUT OUR SPONSOR

Medtronic ENT

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

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SYNPOSIS

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

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

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TIMESTAMPS

00:00 - Welcome to the BackTable ENT Podcast

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

08:15 - Challenges Diagnosing Sleep Apnea in Women

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

20:06 - Hormonal Influences on Sleep Apnea

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

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

36:34 - Weight Loss to Combat OSA

41:04 - Countering Disparities in OSA Treatment

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

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RESOURCES

Medtronic ENT

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

Dr. Durr’s UCSF Profile:

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

Dr. Durr’s X:

https://x.com/drmegandurr

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

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CHECK OUT OUR SPONSOR

Medtronic ENT Propel Implants

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

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SYNPOSIS

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

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TIMESTAMPS

00:00 - Introduction

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

04:31 - Understanding Local Drug Delivery for Sinus Disease

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

18:33 - Contraindications & Post-Op Protocols

32:35 - Understanding Insurance Coverage & Preauthorization

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

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

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

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RESOURCES

Dr. Pandit’s Dallas ENT Profile:

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

Dallas ENT Instagram:

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

Dr. Pandit’s Email:

[email protected]

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

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SYNPOSIS

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

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TIMESTAMPS

00:00 - Welcome to the BackTable ENT Podcast

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

13:59 - Implant Activation & Programming

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

26:31 - Uses of Telehealth in Audiology

32:49 - Learning to Use New CI Technologies

41:47 - Equitable Access to Cochlear Implants

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

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RESOURCES

Dr. Cordingley’s Peak ENT Profile:

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

Dr. Cordingley’s email:

[email protected]

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

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SYNPOSIS

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

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TIMESTAMPS

00:00 - Introduction

01:32 - Decision Fatigue Defined

03:51 - Personal Strategies to Combat Decision Fatigue

06:10 - Decision Fatigue in the Clinic

24:29 - Decision Fatigue in the Operating Room

29:49 - Decision Fatigue at Home

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

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RESOURCES

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

Article on Judges & Decision Fatigue:

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

Article on Orthopedic Surgeons & Decision Fatigue:

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

Article on Interruptions in the Trauma OR:

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

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

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CHECK OUT OUR SPONSOR

Medtronic ENT

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

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SYNPOSIS

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

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TIMESTAMPS

00:00 - Introduction

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

07:26 - Teaching Adult Learners

24:14 - Challenges in Modern Surgical Education

31:39 - Setting Goals & Expectations

36:40 - The Importance of Feedback in Surgical Education

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

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

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RESOURCES

Dr. Oswaldo Henriquez’s Wellstar Profile:

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

Medtronic ENT

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