BackTable ENT & Allergy

In this episode, Dr. Anita Jeyakumar, pediatric ENT at Mercy Health (Youngstown, Ohio) discusses language for Deaf and Hard of Hearing (HoH) children with podcast host Dr. Gopi Shah.

First, Dr. Jeyakumar explains the difference between speech and language. She then introduces the concept of “language nutrition,” which describes social exposure to rich and varied language. Acknowledging that language fluency–spoken or visual such as American Sign Language–underlies success, she shares strategies to foster these skills in Deaf and HoH children. Dr. Jeyakumar describes resources that support these patients, including early intervention services for children under age three and school-based resources for older children. She reviews assistive technologies including hearing aids, cochlear implants, and closed captioning. To conclude, she urges physician advocacy to better support the needs of Deaf and HoH children.

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SHOW NOTES

00:00 - Introduction

02:08 - Understanding Language and Speech

04:23 - The Concept of Language Nutrition

07:53 - Addressing Speech Delay in Children

21:32 - The Role of Technology in Supporting Deaf and HoH Children

24:10 - Promoting Health Equity for Deaf and HoH Children

27:52 - Resources for Families of Deaf and HoH Children

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RESOURCES

Dr. Anita Jeyakumar’s Mercy Health Profile:

https://www.mercy.com/find-a-doctor/physicians/anita-s-jeyakumar/1985497

Hands & Voices Guide By Your Side™:

https://www.handsandvoices.org/gbys/

American Speech-Language-Hearing Association (ASHA):

https://www.asha.org/

American Cochlear Implant Alliance (ACI Alliance):

https://www.acialliance.org/

A.G. Bell Association for the Deaf & Hard of Hearing:

https://www.agbell.org/

In this episode, Dr. Spencer Payne, a rhinologist at the University of Virginia School of Medicine, shares his journey developing RefluxRaft, a natural, alginate-based reflux therapy, with host Dr. Ashley Agan.

First, Dr. Payne describes how his research interests and father’s premature death spurred his interest in functional medicine. Wary of side effects associated with conventional reflux medications, he teamed up with fellow UVA faculty member and laryngologist Dr. James (Jim) Daniero to develop RefluxRaft, a natural dietary supplement. Starting from his initial concept, Dr. Payne delves into challenges marketing, manufacturing, and distributing RefluxRaft. He then explains how RefluxRaft uses alginates to combine with stomach acid and form a gel-like “raft” that stops movement of acid into the esophagus. The episode concludes with an overview of how to dose and order RefluxRaft.

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SHOW NOTES

00:00 - Introduction

03:45 - Holistic Approaches to Medicine

06:46 - Functional Medicine Perspective on Reflux

08:54 - Dietary Modifications for Reflux Patients

17:07 - The Development of RefluxRaft

20:00 - From Concept to Prototype: The Kitchen Lab Experiments

20:57 - The Business Side: Marketing, Manufacturing, & Logistics

27:21 - The Product: Understanding Alginates & Their Benefits

36:29 - The Future: New Flavors & Holistic Reflux Therapies

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RESOURCES

Dr. Payne’s UVA Profile

https://med.virginia.edu/otolaryngology/faculty/spencer-c-payne-m-d/

Dr. Daniero’s UVA Profile:

https://med.virginia.edu/otolaryngology/faculty/james-j-daniero-m-d-m-s/

RefluxRaft: Natural Reflux Relief:

https://refluxraft.com/

RefluxRaft YouTube Channel:

https://www.youtube.com/@refluxraft

In this episode, Dr. Gerard Gianoli of The Ear & Balance Institute (Covington, Louisiana), joins host Dr. Ashley Agan to discuss his experience with the third-party-free practice model.

First, Dr. Gianoli describes how his work treating vestibular disorders spurred his interest in the third-party-free practice model, where patients pay upfront for services, then submit insurance claims for reimbursement as appropriate. Dr. Gianoli walks listeners through his practice’s transition, focusing on referral patterns and patient concerns. Then, the surgeons speak to the model’s advantages, including reduced rates of physician burnout, higher-value patient care, and reduced administrative burden. Looking ahead, Dr. Gianoli assesses the role of third-party-free practices in the U.S. healthcare landscape. Finally, the episode wraps with a discussion of Dr. Gianoli’s recent book on Third Mobile Window Syndrome.

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SHOW NOTES

00:00 - Introduction

05:34 - Transitioning to a Third-Party-Free Practice

07:48 - The Financial Impact of Going Third-Party-Free

12:11 - Benefits of a Third-Party-Free Practice

27:28 - Navigating Surgery Costs in a Third-Party-Free Practice

32:01 - Determining Prices in a Cash-Based Practice

35:10 - The Importance of Patient Education in Medical Practice

38:15 - Drawbacks of the Third-Party-Free Model

52:32 - Trends in Physician Practice Models

56:38 - Dr. Gianoli’s Book on Third Mobile Window Syndrome

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RESOURCES

Dr. Gianoli’s physician profile at the Ear & Balance Institute:

https://earandbalance.net/dr-gianoli/

Dr. Gianoli’s Wall Street Journal Editorial from January 2015: “Saying Goodbye to Third-Party Medical Payments.”

https://www.wsj.com/articles/gerard-j-gianoli-saying-goodbye-to-third-party-medical-payments-1421280968

“Third Mobile Window Syndrome of the Ear: Superior Semicircular Canal Dehiscence and Associated Disorders,” edited by Gerard Gianoli and Philippa Thomson:

https://link.springer.com/book/10.1007/978-3-031-16586-3

“The Private Practice Solution: Reclaiming Physician Autonomy and Restoring the Doctor-Patient Relationship,” by Grace Torres-Hodges:

https://www.amazon.com/Private-Practice-Solution-Doctor-Patient-Relationship/dp/B0CK3QR1XX

In this episode, Dr. Sujana Chandrasekhar, neurotologist with New York City’s ENT and Allergy Associates, joins host Dr. Ashley Agan to discuss labyrinthitis.

The podcast begins by reviewing the clinical presentation of labyrinthitis, drawing on Dr. Agan’s personal experience with the condition. Then, Dr. Chandrasekhar explains in-depth the physical exam of the dizzy patient, focusing on differentiating central vestibular lesions (such as strokes) from peripheral ones (such as labyrinthitis). While labyrinthitis is a self-limited condition, Dr. Chandrasekhar shares strategies to mitigate the associated nausea, imbalance, and hearing loss patients find debilitating. Finally, the surgeons discuss how vestibular physical therapy and adequate rest enable prompt recovery.

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SHOW NOTES

00:00 - Introduction

01:22 - Discussion of and Personal Experience with Labyrinthitis

08:14 - Recovery and Treatment of Labyrinthitis

11:01 - Examination and Workup of Labyrinthitis

16:11 - Understanding Nystagmus in Labyrinthitis

20:29 - Further Testing and Examination for Labyrinthitis

33:49 - Treatment for Labyrinthitis

40:53 - The Role of Physical Therapy

43:12 - Follow-up and Recovery

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RESOURCES

Dr. Chandrasekhar’s ENT and Allergy Associates Profile: https://www.entandallergy.com/find-a-doctor/sujana-s-chandrasekhar-md-facs/

Backtable ENT Ep. 87 – “Sudden Sensorineural Hearing Loss with Dr. Sujana Chandrasekhar:” https://www.backtable.com/shows/ent/podcasts/87/sudden-sensorineural-hearing-loss

“The Ten-Minute Examination of the Dizzy Patient,” J.A. Goebel: https://pubmed.ncbi.nlm.nih.gov/11774054/

“She’s On Call” Podcast featuring Dr. Sujana Chandrasekhar and Dr. Maurina Kurian: https://podcasts.apple.com/us/podcast/shes-on-call-weekly-medical-show/id1582727930

“Otolaryngologic Clinics” Podcast hosted by Consulting Editor Sujana S. Chandrasekhar, features in-depth discussions and commentary on the articles in each issue by the guest editors themselves.

Otolaryngologic Clinics (Elsevier) on Apple Podcasts

In this episode, Dr. Gopi Shah, welcomes Dr. Elton Lambert, a pediatric otolaryngologist at Texas Children’s Hospital in Houston, to discuss the use of ultrasound in pediatric otolaryngology.

First, the surgeons delve into why ultrasound offers a precise and convenient method for diagnosing pathologies ranging from parotitis to vocal fold immobility in children. Dr. Lambert describes treating sialorrhea with ultrasound-guided Botox injections. From this point, the discussion transitions to the use of ultrasound for voice and airway issues. Use of ultrasound provides additional detail to complement (or occasionally replace) flexible scope exams in children with vocal cord immobility. The discussion finishes with Dr. Lambert’s pearls to successfully obtain and document ultrasound results.

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SHOW NOTES

00:00 - Introduction

02:10 - Understanding Ultrasound in Pediatric Otolaryngology

05:35 - Training and Incorporation of Ultrasound in Medical Curriculum

08:43 - Ultrasound for Salivary Pathology in Children

14:04 - Salivary Botox Injections

25:34 - Ultrasound for Voice and Airway in Children

29:59 - Vocal Cord Immobility Post Cardiac Surgery

30:23 - Ultrasound for Vocal Cord Mobility

30:45 - Detecting Nodules and Granulomas with Ultrasound

32:38 - Ultrasound for Laryngomalacia

34:52 - Ultrasound for Subglottic Stenosis

41:55 - Ultrasound for Tracheostomy Patients

45:43 - Ultrasound for Dysphagia

50:38 - Documenting Ultrasound Findings

53:37 - Limitations of Ultrasound

56:21 - Final Thoughts on Ultrasound in Pediatric Otolaryngology

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RESOURCES

Dr. Lambert’s Texas Children’s Hospital Profile:

https://www.texaschildrens.org/find-a-doctor/elton-m-lambert-md

Dr. Lambert’s Contact:

[email protected]

In this episode, Dr. Kevin Sykes, PhD, MPH, director of clinical research at Baylor Scott & White Health in Dallas, explores health equity research in otolaryngology with host Dr. Gopi Shah.

First, Dr. Sykes underscores how historical injustices contribute to health disparities seen today, using differences in life expectancy as an example. He then addresses challenges with assessing head & neck cancer outcomes, including small sample sizes, limited community participation, and data aggregation. Speaking to study design, Dr. Sykes shares his experience working with community health workers, whom he finds invaluable for their ability to build relationships with research participants. Finally, Dr. Shah and Dr. Sykes brainstorm how health equity research can shape public health policies and medical education.

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SHOW NOTES

00:00 – Introduction

01:29 – Understanding Health Equity Research

09:44 – The Role of Social Determinants in Health Equity

12:00 – The Importance of Community Representation in Research

14:34 – Challenges in Health Equity Research

17:32 – The Role of Community Health Workers in Research

26:00 – Designing a Health Equity Research Study

30:48 – The Role of Qualitative Data in Health Equity Research

32:39 – Understanding Racial Differences in Treatment Choices

33:30 – The Power of Qualitative Data in Uncovering Lived Experiences

35:32 – The Rigor and Challenges of Qualitative Research

42:35 – The Impact of Health Equity Research on Policy and Advocacy

48:33 – The Role of Medical Education in Health Equity Research

56:54 – Resources and Recommendations for Health Equity ResearcH

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RESOURCES

Backtable ENT Episode 98, “Health Equity Collaborative in ENT with Dr. Alexander Chiu and Dr. Romaine Johnson:” https://www.backtable.com/shows/ent/podcasts/98/health-equity-collaborative-in-ent

Backtable ENT Episode 31, “Mentorship Feedback & Coaching with Dr. Carrie Francis:” https://www.backtable.com/shows/ent/podcasts/31/mentorship-feedback-coaching

Backtable ENT Episode 129, “American Head and Neck Society Scholarship for Underrepresented Minority Medical Students with Dr. Tammara Watts:” https://www.backtable.com/shows/ent/podcasts/129/american-head-neck-society-scholarship-for-underrepresented-minority-medical-students

In this episode, host Dr. Ashley Agan discusses management of synkinesis with Dr. Shiayin (Shi) Yang, facial plastic surgeon at Vanderbilt University Medical Center.

The surgeons begin by defining synkinesis, a condition in which voluntary facial muscle movement triggers involuntary contraction of other facial muscles. Though the pathophysiology of synkinesis remains incompletely understood, damage to and aberrant “rewiring” of the facial nerve is thought to trigger these symptoms. Causes of synkinesis include Bell’s Palsy, facial tumors, and intra-operative injury. Dr. Yang explains the importance of appropriate patient counseling, especially given the misperception that synkinesis is a “disease of vanity.” The discussion then transitions to treatment options, including physical therapy, Botox injections, and surgical intervention (including myectomy and selective neurectomy). The podcast finishes with Dr. Yang’s insights into the mental health impact of synkinesis.

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SHOW NOTES

00:00 – Introduction

02:26 – Understanding Synkinesis

05:08 – Common Patient Presentations

06:11 – Importance of Early Treatment and Patient Education

07:48 – Referral and Timeliness of Treatment

09:35 – Pathophysiology of Nerve Rewiring

12:11 – Workup and Diagnosis

17:57 – Treatment Options: Botox Therapy

25:51 – Treatment Options: Surgical Interventions

30:31 – Long-term Management and Expectations

33:27 – Eye Protection in Facial Paralysis

37:16 – Mental Health Impact of Synkinesis

38:27 – Conclusion and Contact Information

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RESOURCES

Dr. Yang’s Vanderbilt University Medical Center profile:

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

In this episode, Dr. Gopi Shah discusses the role of ENT in gender-affirming care with facial plastic surgeons Dr. Daniel Knott of UCSF and Dr. Rahul Seth of Golden State Plastic Surgery. This episode is the second half of a two-part series featuring Drs. Knott and Seth.

First, the surgeons emphasize the importance of understanding terms related to gender identity and using patients’ correct pronouns. Relative to the general population, transgender individuals face higher rates of poverty, unemployment, and serious mental illness, all of which shape their interaction with the healthcare system. Then, using California as a case study, doctors Knott and Seth discuss strategies that successfully increase access to gender-affirming care. The episode finishes by addressing how insurance coverage, clinical research, education and advocacy shape gender-affirming care.

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SHOW NOTES

00:00 - Introduction to the Podcast

01:23 - Understanding Transgender and Gender Diverse Individuals

03:06 - Challenges Faced by Transgender and Gender Diverse Individuals

08:55 - The Role of Otolaryngologists in Gender Affirming Care

17:02 - The Impact of Insurance and State Laws on Access to Care

28:40 - The Importance of Education and Advocacy in Gender Affirming Care

40:21 - Closing Thoughts and Final Remarks

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RESOURCES

Dr. Knott's and Dr. Seth’s Facial Plastic Clinic:

https://ohns.ucsf.edu/facialplastics

Backtable ENT Ep. 148 – “Facial Masculinization in Gender Affirming Care with Dr. P Daniel Knott and Dr. Rahul Seth:”

https://www.backtable.com/shows/ent/podcasts/148/facial-masculinization-in-gender-affirming-care

Backtable ENT Ep. 125 - “Gender Affirming Voice Care with Sara Schneider MS, CCC-SLP and Dr. Mark Courey:”

https://www.backtable.com/shows/ent/podcasts/125/gender-affirming-voice-care

Backtable ENT Ep. 27 – “Facial Feminization with Dr. Sarah Saxon:”

https://www.backtable.com/shows/ent/podcasts/27/facial-feminization

Operative Techniques in Otolaryngology chapter covering facial masculinization surgery:

https://www.optecoto.com/article/S1043-1810(23)00011-8/fulltext

ENTtoday: “Gender Affirmation Surgery in California,” Suresh Mohan, MD, Rahul Seth, MD, and Daniel Knott, MD:

https://www.enttoday.org/article/gender-affirmation-surgery-in-california/

ENTtoday: “Transgender Care: Otolaryngologists Can Help Fill an Unmet Need for This Patient Population,” P. Daniel Knott, MD and Rahul Seth, MD

https://www.enttoday.org/article/transgender-care-otolaryngologists-can-help-fill-an-unmet-need-for-this-patient-population/

Otolaryngologic Clinics of America August 2022 issue – “Gender Affirmation Surgery in Otolaryngology:” https://www.oto.theclinics.com/issue/S0030-6665(22)X0004-2

“National Variation of Insurance Coverage for Gender-Affirming Facial Feminization Surgery,” S. Gadkaree et al.:

https://pubmed.ncbi.nlm.nih.gov/32865436/

In this episode of Back Table ENT, host Dr. Gopi Shah explores the entrepreneurial journey of Dr. Rohan Walvekar, an otolaryngologist at Louisiana State University-New Orleans and innovator/CEO of nDorse, a team engagement software application.

Dr. Walvekar shares his experience in launching ‘nDorse’ — his novel team engagement software designed for healthcare providers. This idea was sparked from his realization that daily contributions and positivity within the healthcare space could be better recognized with real time feedback. He noticed that hospital nursing turnover was high, which could have been attributed to insufficient engagement and connection with coworkers.

The nDorse software application can be used by anyone in an organization and allows users to post meaningful recognitions (via messages, emojis, pictures, GIFs) for their coworkers, with the ability to tag recognitions to the organization’s specific mission and values. Since its implementation, nDorse has been adopted even in various educational and financial institutional settings. Dr. Walvekar describes his journey to creating the application, including the software building process, initial sales, mentors, and the nDorse team. He also offers advice for physician entrepreneurs about being thoughtful with innovation and resilience in the startup sphere.

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SHOW NOTES

00:00 Introduction to the Podcast

02:46 A Focus on Real Time Recognition for Coworkers

04:48 Introduction to nDorse: A Team Engagement Software

13:06 Market Research and a Minimum Viable Product

20:16 Product Launch and First Customers

23:04 Financing the Project

26:03 Pitching to New Clients

29:00 Team Members and Mentors

31:44 Balancing Innovation with Clinical Practice

36:20 Challenges During the Entrepreneurship Journey

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RESOURCES

nDorse:

https://www.ndorse.net/

BackTable ENT Ep. 115- Management of the Plunging Ranula:

https://www.backtable.com/shows/ent/podcasts/115/management-of-the-plunging-ranula

Healthcare Plus Solutions Group:

https://healthcareplussg.com/

In this episode, Dr. Gopi Shah discusses facial masculinization surgery with facial plastic surgeons Dr. P. Daniel Knott of UCSF and Dr. Rahul Seth of Golden State Plastic Surgery.

First, the surgeons begin by defining gender terminology, facial analysis, and surgical planning as they relate to gender-affirming care. Narrowing in on facial masculinization, they address common surgical procedures including augmentation rhinoplasty, buccal fat removal, reverse brow lifts, chin implants, and thyroid cartilage augmentation. Then, Dr. Knott and Dr. Seth describe the challenge of maintaining a natural appearance while enlarging facial features. In many cases, non-operative adjuncts, such as fillers and Botox, assist in this goal. Finally, Dr. Knott emphasizes the importance of management of the hair in gender-affirming care.

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SHOW NOTES

00:00 - Introduction

05:43 - Importance of Gender Terminology

13:00 - Facial Analysis in Gender Affirming Care

21:45 - Approach to Facial Masculinization

24:11 - Impact of Hormone Therapy

32:56 - Role of Technology in Gender Affirming Care

35:22 - Using Fillers and Botox in Facial Plastic Surgery

36:28 - The Importance of Intentionality in Achieving Patient Goals

37:39 - Exploring Surgical Options for Facial Modification

39:15 - Understanding the Process of Brow Projection Surgery

45:10 - The Process and Challenges of Rhinoplasty

51:31 - The Process and Challenges of Mandible Augmentation

59:20 - The Process and Challenges of Thyroid Cartilage Augmentation

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RESOURCES

Dr. Rahul Seth’s Golden State Plastic Surgery profile:

https://www.goldenstatedermatology.com/staff/rahul-seth-md-facs/

Dr. Daniel Knott’s UCSF profile:

https://www.ucsfhealth.org/providers/dr-p-daniel-knott

Operative Techniques in Otolaryngology chapter covering facial masculinization surgery:

https://www.optecoto.com/article/S1043-1810(23)00011-8/fulltext

Article on three-dimensional morphology to assess gender differences in facial appearance: https://pubmed.ncbi.nlm.nih.gov/35357226/

ENTtoday: “Transgender Care: Otolaryngologists Can Help Fill an Unmet Need for this Patient Population,” Daniel Knott, MD, and Rahul Seth, MD: https://www.enttoday.org/article/transgender-care-otolaryngologists-can-help-fill-an-unmet-need-for-this-patient-population/

ENTtoday: “Gender Affirmation Surgery in California,” Suresh Mohan, MD, Rahul Seth, MD, and Daniel Knott, MD:

https://www.enttoday.org/article/gender-affirmation-surgery-in-california/

Otolaryngologic Clinics of America August 2022 issue – “Gender Affirmation Surgery in Otolaryngology”:

https://www.oto.theclinics.com/issue/S0030-6665(22)X0004-2