BackTable ENT & Allergy

In this episode, Dr. Gopi Shah and Dr. Ashley Agan invite Dr. Omar Ahmed, rhinologist at Houston Methodist Hospital, to discuss innovative treatments for chronic rhinitis.

First, Dr. Ahmed shares his experience with treating chronic rhinitis using medications, in-office procedures, and surgery. Patients who fail to respond to medication find rhinitis relief up to 95% of the time following posterior nasal nerve ablation. He explains the difference between radiofrequency ablation (RhinAer and Neurent) and cryoablation (ClariFix). Then, Dr. Ahmed explains relevant anatomy, patient counseling, and potential adverse effects of ablation. Finally, he touches on recent developments in billing for these treatments.

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CHECK OUT OUR SPONSOR

Aerin Medical

https://aerinmedical.com/

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SHOW NOTES

00:00 - Introduction

04:11 - Discussion on Chronic Rhinitis and Office-Based Procedures

07:03 - Understanding Rhinitis Patients and Their Symptoms

09:27 - Examination, Workup, and Treatment for Rhinitis Patients

24:03 - Surgical Treatments for Rhinitis

29:44 - Overview of In-Office Procedures for Rhinitis

36:50 - The Impact of Anatomical Challenges on the Procedure

43:20 - Post-Procedure Instructions and Potential Complications

52:29 - Understanding the New Billing and CPT Approval

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RESOURCES

RhinAer Chronic Rhinitis Treatment

https://rhinaer.com/hcp/

Dr. Ahmed’s Houston Methodist Profile:

https://www.houstonmethodist.org/doctor/omar-g-ahmed/

In this episode, Dr. Ashley Agan and Dr. Gopi Shah cover in-office laryngology procedures with Dr. Lesley Childs, Associate Professor of Laryngology, Neuro-Laryngology, and Professional Voice at the University of Texas Southwestern Medical Center.

The surgeons cover laryngologic diseases commonly treated in the clinic. Dr. Childs describes procedures she performs, including video stroboscopy for mucosal wave assessment, steroid injections for subglottic stenosis, and Botox injections for neurologic voice disorders. She also speaks to the benefits of treating patients in-office, anesthesia for in-office procedures, and the role her medical assistants play during various in-office procedures.

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

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SHOW NOTES

00:00 Introduction

02:58 In-Office Laryngology Procedures Overview

03:49 Understanding Video Stroboscopy

05:27 Preparing for In-Office Procedures

08:09 Procedure Techniques and Patient Positioning

13:40 Anesthetic Protocol for Different Procedures

15:11 Handling Patient Reactions and Complications

26:11 Botox Injections and Anesthetic Considerations

29:08 Understanding False Vocal Folds and Abraham Cannula

35:01 Understanding the Process of Vocal Fold Botox Injections

36:06 The Risks and Challenges of Vocal Fold Injections

40:41 The Process of Vocal Fold Augmentation

52:33 The Use of Lasers in Vocal Fold Procedures

53:40 The Evolution of Vocal Fold Procedures Over Time

In this podcast, Dr. Gopi Shah invites Dr. Nicole Schmitt, an associate professor in the Department of Otolaryngology at Emory University to discuss drug repurposing for head and neck cancer.

Dr. Schmitt explains that drug repurposing involves using a drug developed for one purpose for an entirely different purpose. She highlights some of the main drugs being repurposed for head and neck cancer treatment, including statins and NSAIDs. For example, Dr. Schmitt shares how manipulating cholesterol levels can enhance antineoplastic T lymphocyte responses to increase survival and treatment tolerability. The surgeons then consider the therapeutic, safety, and financial benefits of repurposed drugs. Special attention is given to drug repurposing in HPV-positive cancer. Lastly, Dr. Schmitt describes the pleiotropic effect and how it applies to drug repurposing efforts.

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/EgX3zL

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SHOW NOTES

0:00 - Drug Repurposing and Cancer Treatment

08:40 - Statins and NSAIDs for Head and Neck Cancer

12:18 - Enhancing Tumor Control With Pre-Surgery Drugs

22:14 - Treatment of Pre-Malignant Lesions With Repurposed Drugs

In this episode, Dr. Eric Gantwerker and Dr. Nilesh Vasan, Founder/CEO of Adroit Surgical and Head & Neck Surgeon at University of Oklahoma (OU Health), discuss the development of Adroit Surgical.

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/4Wi8D5

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SHOW NOTES

First, Dr. Vasan describes his surgical training and lifelong passion for invention. Originally from New Zealand, Dr. Vasan completed a head & neck fellowship at OU Health. His surgical experience includes private and academic practice. During his time in private practice, Dr. Vasan worked on interdisciplinary teams to manage difficult airways. He credits this experience with sparking his interest in developing better tools for intubation.

Next, Dr. Gantwerker and Dr. Vasan review the development of Adroit Surgical’s first product, the Vie-Scope. The battery-powered Vie-Scope combines superior visualization with portability to facilitate intubation across settings. Hoping to improve visualization during hand-held laryngoscopy, Dr. Vasan sketched a modified anterior commissure laryngoscope that would become the Vie-Scope. He then worked with an experienced patent attorney who helped him develop and notarize his innovation.

Then, the surgeons cover advice to building networks. A pitch competition in Oklahoma City connected Dr. Vasan with associates whose complementary expertise helped grow Adroit Surgical. Dr. Vasan then worked alongside a well-connected distributor who raised awareness of the Vie-Scope in his target markets. Today, the Vie-Scope enables successful first-pass intubation in emergent and operating room settings.

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RESOURCES

Adroit Surgical:

https://adroitsurgical.com/

“Crossing the Chasm” by Geoffrey Moore

https://www.amazon.com/Crossing-Chasm-3rd-Disruptive-Mainstream/dp/0062292986

“Creativity, Inc: Overcoming the Unseen Forces that Stand in the Way of True Innovation” Ed Catmull & Amy Wallace

https://www.amazon.com/Creativity-Inc-Overcoming-Unseen-Inspiration/dp/0812993012

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Jens Andersson, practicing ENT at Sweden’s Skåne University Hospital, tackle chronic frontal sinusitis.

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SHOW NOTES

First, Dr. Andersson talks about the Swedish healthcare systems, focusing on access to care and cost. The discussion then shifts to chronic frontal sinusitis. Symptoms associated with this disease include frontal headache, stuffiness, congestion, and low-grade fever. In cases of orbital involvement, patients may complain of proptosis or diplopia. Risk factors include frontal sinus fracture, barotrauma, an immunocompromised state, and dental infection. Most, but not all, patients have involvement of multiple sinuses.

Next, Dr. Andersson illuminates workup and treatment of chronic frontal sinusitis. His physical exam includes close inspection of the oral cavity, anterior rhinoscopy (performed with a microscope), and flexible fiberoptic laryngoscopy. When ordering imaging, he prefers cone-beam CT of the sinuses, though he orders MRI when bony invasion or extra-sinus disease are present.

Finally, the surgeons discuss operative management of chronic frontal sinusitis. Dr. Andersson talks listeners through his pre-operative planning, focusing on how he uses imaging. Moving to the OR, the surgeons share their techniques for operating on the frontal sinus. Dr. Andersson reviews strategies to avoid scarring, use of navigation systems, and post-operative management. Dr. Shah shares pearls from her pediatric sinus practice. The episode finishes with Dr. Andersson’s witty and high-yield advice for otolaryngologists.

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Briac Thierry, Pediatric ENT at Necker Hospital for Sick Children in Paris, France, review stridor in newborns, with a special emphasis on laryngomalacia.

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SHOW NOTES

First, Briac and Gopi discuss how a newborn with stridor can present. Though stridor does occur among NICU babies, most of Briac’s patients are referred by outpatient pediatricians. They discuss a list of questions to ask while taking a history and emphasize the importance of assessing growth trends. In the absence of other medical problems, declining weight can suggest severe aerodigestive tract abnormality. Any pathology that narrows the airway can cause stridor: in infants, these include laryngomalacia, vallecular cysts, subglottic cysts, tracheal rings, and bilateral vocal fold immobility.

Then, Briac talks listeners through his physical exam, with special attention paid to flexible fiberoptic laryngoscopy. Briac shares his tips to maximize visualization and clinician ergonomics when scoping a small child. If bilateral vocal fold immobility is suspected, Briac recommends performing a longer fiberoptic exam so that the clinician can determine whether vocal fold immobility is present at rest or due to an uncomfortable child crying.

Next, Gopi and Briac differentiate between mild, moderate, and severe laryngomalacia and the indications for going to the operating room for an airway evaluation. As 20% of children with laryngomalacia have secondary airway lesions, a meticulous laryngoscopy/bronchoscopy is mandatory in these patients when a trip to the OR is required. Moving to the OR, Briac talks about his workflow when performing diagnostic bronchoscopy/laryngoscopy (DLB) to assess various causes of stridor. The episode concludes with Briac’s meditations on airway surgery as a team endeavor.

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RESOURCES

Briac’s Necker Hospital Profile:

https://www.aphp.fr/offre-de-soin/medecin/3168653/061/16

International Pediatric ORL Group (IPOG) Laryngomalacia Consensus Recommendations:

https://www.sciencedirect.com/science/article/abs/pii/S0165587616300519

Pediatric Airway Channel in Paris (@voies_aeriennes):

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

In this episode of BackTable ENT, Dr. Gopi Shah sits down with pediatric Otolaryngologist, Dr. Erynne Faucett at the University California Davis-Sacramento to discuss diversity, equity, and inclusion (DEI) in the field in Otolaryngology and its importance.

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SHOW NOTES

The episode begins with Erynne breaking down what DEI means to her. She mentions how there is a misconception in grouping diversity, equity, and inclusion all together but instead needing to look at each element individually for what they mean, instead of just “checking off a check box.” Connecting to this, Erynne brings up the importance of DEI efforts in the field of Otolaryngology as it reflects the importance of patient care, in a population that is constantly evolving in diversity, and it emphasizes the role of diversifying the field to match the patient population.

Focusing on DEI efforts, at UCSD-Sacramento where Erynne practices, she mentions the DEI efforts that her department has made in recruiting diverse residents and attendings. She emphasizes to continue to push the narrative for why it is important within the field and further, how it impacts patient care.

Erynne then delves into DEI initiatives within the Otolaryngology workforce from her perspective of being a part of the Academy of Otolaryngology DEI committee and mentions her work in building curriculum teaching DEI for residents and the challenges that comes with it.

Gopi and Erynne then end the episode talking about efforts in delivering equitable care, health equity research and recent legislative actions in certain areas of the U.S that have restricted DEI efforts. Erynne emphasizes that even in areas across the country with bans against DEI initiatives, it is still important to speak up about these issues, to continue to teach and educate policy makers to see the impact of these bans on marginalized communities and that DEI efforts aren’t political but instead a human rights initiative.

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RESOURCES

American Academy of Otolaryngology Advocacy:

https://www.entnet.org/advocacy/

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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.

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In this episode of BackTable ENT, Dr. Gopi Shah and Dr. David Goldenberg, head and neck surgeon and department chair at PennState Health in Pennsylvania, discuss radiofrequency ablation (RFA) of thyroid nodules.

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SHOW NOTES

First, Gopi and David review workup of thyroid nodules. Before considering RFA, patients need thyroid function tests, ultrasound imaging, and a biopsy showing benign disease. In David’s opinion, radiofrequency ablation is a good option for benign nodules larger than two centimeters that are enlarging and causing compressive symptoms. RFA is not appropriate for malignant disease, with the potential application for papillary microcarcinoma, which is currently being evaluated in other parts of the world.

Next, David outlines how he performs RFA. Using a combination of mild sedation, local anesthesia, and regional anesthesia, he performs this procedure in-office under continuous ultrasound guidance. Radiofrequency ablation uses heat to cause coagulative necrosis of nodular tissue. After cervical block and anesthetization of the thyroid capsule, David introduces the RFA probe through a small midline neck incision. Drawing on the “moving shock technique,” he moves the RFA probe back and forth, watching for signs of tissue necrosis on ultrasound. Complications of RFA are similar to those of thyroid surgery, but they occur at lower rates due to the less invasive nature of this procedure.

Finally, the conversation places RFA in a larger context for the thyroid surgeon. RFA patients return to the clinic that same week for a physical exam. Surveillance ultrasounds occur six and twelve months post-procedure. David counsels his patients that their nodule will not shrink immediately, and may swell in the days following their procedure. However, he expects the nodule to shrink 50-80% in the year following RFA. The podcast wraps up with an overview of how to bring RFA to your practice.

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RESOURCES

David’s Penn State Profile:

https://www.pennstatehealth.org/doctors/david-goldenberg-md-facs

In this episode of BackTable ENT, Dr. Gopi Shah sits down with Dr. Anthony Sheyn, associate professor of otolaryngology at the University of Tennesse-Memphis and Dr. Jennifer Lavin, associate professor of otolaryngology at Northwestern University-Feinberg, to talk about what clinical care pathways are and their usage in the field of pediatric otolaryngology.

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SHOW NOTES

First, the doctors discuss their journey into their current roles and then transition into answering the question of what clinical care pathways are. Jennifer explains clinical care pathways being standardized protocols and algorithms, which help in further developing other ways to standardize interventions. Jennifer brings up an example about tonsillectomies at her institution, where if a child is under the age of 5, opioids aren’t offered as an medication option.

Next, Anthony and Jennifer talk about the challenges in getting buy-in for standardized care from stakeholders and deciding who plans out clinical care pathways. Jennifer and Anthony emphasize the importance of getting individuals involved in patient care as stakeholders, such as pharmacists, anesthesiologists, and nurses.

Anthony then mentions how clinical care pathways work for both high and low volume procedures using examples from his own institution. Finally, Jennifer and Anthony share resources in finding current clinical care pathways that have been implemented at other institutions, such as ones posted by the American Society of Pediatric Otolaryngology (ASPO) and American College of Surgeons.

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RESOURCES

ACS Quality Programs:

https://www.facs.org/quality-programs/?page=1

ASPO Clinical Care Pathways:

https://aspo.us/page/StandardizedRoutinePerioperativeCareofthePediatricOtolaryngologyPatient