BackTable ENT & Allergy

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Ayesha Khalid, rhinologist with Cambridge Health Alliance in Massachusetts, discuss balloon sinuplasty indications, techniques, and post-operative management.

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Stryker ENT

https://ent.stryker.com

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SHOW NOTES

First, Ayesha reviews the history of balloon sinuplasty. Originally used in cardiology, otolaryngologists adopted balloons as a less-invasive option to widen sinus ostia. Over time, balloon sinuplasty transitioned from being an operative procedure to one that can be done in-office with select patients. In Ayesha’s experience, facial pain and nasal stuffiness are the symptoms most responsive to balloon sinuplasty.

Then, the conversation shifts to application of balloon technology. Rather than thinking about balloon procedures and traditional functional sinus surgery as mutually exclusive, Ayesha sees them as complementary tools. Patients with straightforward sinusitis or barotrauma often improve with an in-office balloon procedure and sinus rinses. When scheduling an in-office balloon procedure, Ayesha counsels on the odds of success (over seventy percent) and possible need for further surgery. For example, patients with polyp disease might be better suited to a more traditional sinus surgery. Even in these cases, Ayesha uses balloons to widen ostia, as they inflict less trauma than traditional sinus instrumentation. Ayesha then walks listeners through her preparation for and performance of an in-office balloon procedure.

Finally, Ayesha fits balloon sinuplasty into the larger context of sinusitis treatment. She emphasizes the importance of sinus rinses for sinusitis patients both pre-and post-operatively. She sees patients one week, one month, and then three months following any balloon procedure. Depending on the nature of their disease, patients sometimes require steroids or biologics after their balloon, but most report improvement of their sinus symptoms. Ayesha leaves listeners with advice on expanding one’s procedural toolkit as a practicing ENT.

En este episodio de BackTable ENT, Dr. Cristóbal Langdon de Hospital Sant Joan de Déu Barcelona y Dr. Serafín Sánchez de Hospital Universitario Virgen Macarena de Sevilla discuten los beneficios educativos de gamificación en la otorrinolaringología.

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SHOW NOTES

Dr. Sánchez relata su viaje personal hacia la especialidad de otorrinolaringología. Originario de Salamanca, su conexión con la medicina le llevó a formarse en un programa en Sevilla. Optó por ese lugar específicamente debido a la gran autonomía que se ofrece a los residentes. Con Con el tiempo, logró consolidarse como profesor de otorrinolaringología en su hospital actual. Más allá de su trabajo clínico, lo que realmente le apasiona es poder guiar y compartir sus conocimientos con la próxima generación de médicos. Su entusiasmo por enseñar y aprender de sus alumnos es palpable cada día.

El Dr. Sánchez nos introduce con entusiasmo a la gamificación, un enfoque interactivo de aprendizaje inspirado en videojuegos. Esta técnica, dice, combina juego y educación para capturar la atención, especialmente de los jóvenes. Aunque valora los métodos tradicionales, los considera a veces monótonos. En la gamificación, los estudiantes se transforman en “jugadores” enfrentando desafíos, compitiendo y colaborando en equipo. Sin embargo, el Dr.Langdon recuerda que la investigación sobre gamificación en educación aún es incipiente. El Dr. Sánchez reconoce sus limitaciones, como los retos de evaluación y la necesidad de creatividad en el diseño. Propone involucrar a antiguos estudiantes para aportar perspectiva. Con visión, imagina un escenario donde médicos, enfermeros y docentes aprenden conceptos audiológicos a través de juegos. Para él, la gamificación puede revolucionar la enseñanza.

El Dr. Sánchez, con una chispa de pasión, comparte la estructura típica de sus sesiones de gamificación. Divide a los estudiantes en equipos multidisciplinarios de cuatro o cinco miembros. Estos grupos enfrentan historias clínicas y deben colaborar para resolverlas. Observa que la diversidad enriquece y da lugar a soluciones más creativas. A veces, integra realidad aumentada en desafíos estilo “escape room”. Ambos doctores subrayan cómo la conexión humana y el trabajo en equipo cobraron más relevancia postpandemia. Dr. Sánchez concluye recordando los retos y recompensas de implementar la gamificación en su institución.

In this episode of BackTable ENT, hosts Dr. Ashley Agan and Dr. Gopi Shah sit down with Dr. Gina Jefferson, professor and division chief of head and neck surgery at the University of Mississippi, to discuss the challenges of cutaneous squamous cell carcinoma (CSCC).

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Cook Medical Otolaryngology

https://www.cookmedical.com/otolaryngology

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SHOW NOTES

First, Gina discusses how patients are referred to her practice, as many of her patients have been diagnosed and or previously treated by another provider. Then Gina talks about risk factors for CSCC which includes UV exposure, age, fair skin, genetic disposition and immunosuppressed patients.

Next, Gina discusses the challenges of taking a biopsy for potential CSCC depending on the size and location of the lesion. Gina also discusses the use of excisional biopsies on smaller lesions whereas a punch biopsy is more helpful for a larger lesion or one that is on a difficult area such as the eyelid or nose. A punch biopsy helps in assessing depth of invasion to help in staging and diagnosis.

From a treatment perspective, Gina shares her considerations when approaching reconstruction. She is mainly concerned about how to close the defect without causing significant deformity,if the patient is going to have exposed bone, or if there is the potential for radiation. Gina also mentions that areas such as the eyelid and nose are difficult places to reconstruct due to potentially injuring nearby structures, such as the lacrimal system. In difficult cases such as these, she may count on colleagues in ophthalmology to help out in the reconstruction.

Lastly, the hosts and Gina discuss post surgical management of CSCC patients and when radiation may be considered. Gina explains what follow up for these patients may look like and the role of surveillance imaging through PET scans.

In this episode, Dr. Gopi Shah interviews Dr. Krishan Ramdoo, CEO and founder of TympaHealth, a London-based startup that has developed an all-in-one device for hearing health assessment which incorporates otoscopy and microsuction functionalities.

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SHOW NOTES

Krishan is an ENT surgeon with a Ph.D. in global hearing health. In the early years of his career, while serving as a junior resident on the geriatric service, Krishan encountered a significant number of patients with undiagnosed hearing loss. He realized that this issue extended beyond just geriatric patients. Recognizing the scarcity of specialists and their lengthy waitlists, Krishan conceived the idea of developing a device to assess prevalent ear conditions such as hearing loss, cerumen impaction, and infections through a more accessible approach for primary care clinicians.

The TympaHealth device is a specialized otoscope that connects to a mobile viewing device, enabling high-definition imaging of the tympanic membrane. It also incorporates a spacing mechanism to facilitate cerumen removal with use of a standard suction probe, eliminating the need for a microscope. Additionally, the device is accompanied by headphones for accurate hearing screening assessments. TympaHealth offers a training program for healthcare clinicians to administer the service. In case of uncertainty regarding a finding, clinicians can alert a specialist for remote review and guidance with just one click. TympaHealth recently launched in the US and is currently conducting pilot studies.

Then, the hosts discuss the challenges of establishing a startup, including attracting investigators and building a diverse team. For physicians interested in entrepreneurship, Krishan highlights networking events as a way to gain insight into the commercial world and master the art of giving compelling pitches to potential investors.

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RESOURCES

AI in Clinical Medicine: Section III Ch. 24

https://www.wiley.com/en-gb/AI+in+Clinical+Medicine:+A+Practical+Guide+for+Healthcare+Professionals-p-9781119790648

Tympa Health

https://tympahealth.com/

In this episode of BackTable ENT, Dr. Shah and Dr. Deepak Mehta, pediatric otolaryngologist and director of the complex airway program at Texas Children’s Hospital, discuss Deepak’s work advancing pediatric airway surgery in India. This unique episode addresses the challenges and rewards of building a sustainable global health collaboration.

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SHOW NOTES

First, Gopi asks Deepak about his path to global surgery. Deepak’s commitment to surgical education includes his appointment as an associate professor at Baylor College of Medicine and role as founder of Csurgeries, the first peer-reviewed platform for surgical videos. Interested in finding a way to contribute to the country where he completed medical school, Deepak built on his experience as an innovator and educator to start an annual course in Bangalore for pediatric ENTs throughout South Asia. From this point, he began building a team of experts to deepen knowledge of pediatric airway surgery in the region.

Next, Deepak describes efforts to advance pediatric airway surgery in India. The centerpiece of his efforts remains his annual Bangalore course, which provides live surgical education in both endoscopic and open airway procedures. Patient education represents another important piece: given India’s linguistic diversity, he’s developed a pediatric tracheostomy parent handbook available in multiple different languages. While resources are a challenge to all global surgery efforts, Deepak’s found success using foundation funds to purchase supplies in India.

The episode rounds out with an invitation to BackTable listeners to engage with global surgery. Deepak is always looking for new lecturers at his Bangalore course. Benefits accrue to both educators and attendees: by connecting with an international network of surgeons, those involved gain exposure to new surgical approaches and new colleagues.

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RESOURCES

Dr. Mehta’s Texas Children’s Hospital profile: https://www.texaschildrens.org/find-a-doctor/deepak-mehta-md

Csurgeries: The leading platform for peer-reviewed surgical videos

https://csurgeries.com/

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Nikhila Raol, pediatric otolaryngologist at Children’s Healthcare of Atlanta and Associate Professor at Emory University, discuss management of pediatric dysphagia.

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SHOW NOTES

First, Nikhila explains her educational background, starting from training in Texas to going to Atlanta to join Children’s Healthcare of Atlanta. Previously, she spent time in Boston getting her Masters of Public Health because she wanted to develop a niche focused on population health. This degree then sparked the idea of focusing on swallowing disorders in the pediatric population.

Then, Nikhila delves into how a child with dysphagia usually presents. These children typically have issues with breastfeeding, coughing, choking, and may even refuse food. In older children, they usually bring forth issues to their parents to prompt evaluation. Red flags to pay attention to in young children with dysphagia include weight loss and significant nasal congestion.

Next, Nikhila and Gopi discuss physical examination including evaluation of latch, tongue tie, nasal cavity and Nikhila’s tips for performing a FEES (Fiberoptic Endoscopic Evaluation of Swallow) in infants. Nikhila also mentions the value of having an SLP (Speech Language Pathologist) for every patient with dysphagia and involving GI colleagues to broaden her workup of complicated patients. The episode concludes with a discussion on how to choose between various treatment modalities such as injection or repair of a laryngeal cleft, and Nikhila’s Fulbright project happening in India.

In this episode of BackTable ENT, Dr. Jordan Schramm of Peak Pediatric ENT in Provo, Utah, chats with hosts Dr. Gopi Shah and Dr. Ashley Agan about in-office ear tubes for children.

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Smith & Nephew ENT Solutions

https://smith-nephew.com

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SHOW NOTES

First, Jordan describes the technology behind in-office tube placement. Jordan uses the Tula ® Tympanostomy system (available from Smith + Nephew) to insert ear tubes in-office. Tula offers an integrated tympanostomy solution that combines local anesthetic with tube insertion. With the Tula system, a gentle current numbs the tympanic membrane in 10-15 minutes, after which a pre-packaged delivery device allows the operator to insert a tube by simply placing the device on a patient’s eardrum and then clicking a button.

Next, the discussion shifts towards Jordan’s personal experience with the Tula system. Gopi, Ashley, and Jordan compare Tula tubes with conventional T-tubes. Jordan emphasizes that almost all children needing tubes are candidates, though normal ear anatomy and motivated parents make the procedure easier. Jordan then offers additional practical technical pearls about the Tula system.

Finally, Jordan shares how his experience with in-office ear tubes pushed the boundaries of in-office procedures. Given that ear tube placement in the OR requires general anesthesia, time off of work and facility fees are major challenges to traditional tympanostomy tube placement. For this reason, many of his families are excited to help their children hear better with an in-office procedure. He finishes with his tips for training clinic staff, working with insurance companies, and counseling families on the procedure.

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RESOURCES

Jordan’s Peak Pediatric ENT Profile:

https://utahpedsent.com/doctors.php

Tula Tube System (for Physicians):

https://tulatubes.com/physicians/tula-tympanostomy-system/

Article comparing outcomes of Tula tubes with conventional ear tubes (mentioned by Jordan):

https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1002/ohn.336

In this episode of BackTable ENT, Drs. Julie Wei and Geeta Lal, a surgical oncologist at the University of Iowa and current president of the Society of Surgical Ergonomics, discuss the importance of ergonomics in surgery.

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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/TLTDzV

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SHOW NOTES

First, Julie and Geeta share their stories that have shaped their perspectives on the importance of ergonomics. Geeta details her journey of getting involved in the ergonomics industry dating back to 2016 after having persistent jaw pain. After consulting multiple physicians who offered her narcotics as a solution to her myofascial pain, Geena was inspired to start educating physicians about ergonomics. Geeta and Julie disclosed that from a survey from physicians, 80% of surgeons are in pain.

Geeta then discusses her daily routine for incorporating ergonomics during surgeries. She explains the importance of postural awareness in areas such as table height, laparoscopic machinery, and cameras in order to prevent excessive head and back strain. Furthermore, Geeta defines an “ergonomic timeout”, which are distinct moments to confirm that equipment is in the optimal position, thus mitigating potential risk of injury. Furthermore, Geeta and Julie note which surgical specialities are far worse in surgical ergonomics. Geeta also shares how she obtained her current role of president of the Society of Surgical Ergonomics.

Finally, Geeta and Julie discuss misconceptions in the area of surgical ergonomics and barriers that are present amongst the surgery community when discussing physician pain.

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RESOURCES

Society of Surgical Ergonomics:

https://www.societyofsurgicalergonomics.org/

Dr. Geeta Lal’s Website:

https://surgicalergonomics.com/about/

Dr. Julie Wei’s Article on Surgical Ergonomics in Physician Wellbeing:

https://www.enttoday.org/article/how-surgical-ergonomics-impact-surgeon-wellbeing-outcomes-and-careers/

In this episode of BackTable ENT, Dr. Tammara Watts, surgeon-scientist at Duke University, sits down with host Dr. Gopi Shah to discuss two exciting scholarship opportunities for medical students available through the American Head & Neck Society (AHNS).

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SHOW NOTES

Fewer than 5% of practicing otolaryngologists identify as members of underrepresented minority groups (URM), and these scholarships directly address that disparity. Gopi and Tammara then transition to discussing the importance of diversity in otolaryngology more broadly.

First, Tammara expounds on what is gained by having a workforce that includes individuals with diverse backgrounds and experiences. Through the Dr. Eddie Méndez Research Fellowship and the Myers’ Family Summer Fellowship, AHNS provides unique opportunities for aspiring otolaryngologists who identify as URM to connect with future colleagues. The Research Fellowship provides $10,000 to a medical student interested in spending one year immersed in otolaryngology research. It is unique in that AHNS provides a list of mentors (with bio-sketches) that interested applicants can connect with to formulate a research plan before applying. The Myers’ Family Summer Fellowship financially supports a rising MS2 or MS3 student to gain exposure in Head & Neck Surgery.

Next, Tammara offers tips on cultivating successful mentor-mentee relationships, emphasizing that mentors enjoy supporting their future colleagues, and that it is easier to do so when the mentee takes initiative. Finally, Tammara shares her philosophy regarding DEI. Though otolaryngologic patients come from all walks of life, their surgeons can’t always conceptualize how their experiences influence their care. By supporting URM students interested in ENT, she (along with her AHNS colleagues) are helping create a workforce that can better understand and heal.

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RESOURCES

AHNS’s Dr. Eddie Méndez Fellowship:

https://www.ahns.info/dr-eddie-mendez-research-fellowship/

AHNS’s Myers’ Family Summer Fellowship in Otolaryngology:

https://www.ahns.info/myers-summer-fellowship/

Dr. Tammara Watts MD, PhD’s Duke University Profile:

https://headnecksurgery.duke.edu/profile/tammara-lynn-watts

In this episode of BackTable ENT, Dr. Eli Gordin, microvascular surgeon at UT Southwestern, joins hosts Dr. Gopi Shah and Dr. Ashley Agan to discuss free flap surgery. This high-yield episode walks listeners through the basics of microvascular surgery, from indications to management of surgical complications.

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Cook Medical Otolaryngology

https://www.cookmedical.com/otolaryngology

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SHOW NOTES

First, the surgeons discuss pre-operative management of free flap patients. The most common indications for microvascular surgery in otolaryngology include head & neck cancers. In his pre-operative clinic visits with free flap patients, Eli answers questions about surgery, hospital stay, and recovery. In his experience, patients often don’t understand the extensive nature of these surgeries prior to this visit, so he spends time explaining what a flap is and what the hospital course will look like.

Then, Eli speaks about his experience with virtual surgical planning, which entails remote meetings with engineers. He admits that the learning curve to virtual surgical planning is steep, but that contemplating reconstruction with the help of virtual planning helps him better account for details at the time of surgery. Gopi and Ashley then inquire about surgery and peri-operative management of these patients. Eli addresses vital topics including surgical technique, fluid management, and thrombosis risk.

Finally, the podcast addresses post-operative management of free flap patients. Eli briefly outlines his free flap protocol, emphasizing physical exam signs that indicate need for an OR takeback. He leaves listeners with an important insight: when surgeons have any doubts regarding the viability of a flap, they must return to the OR quickly: the best look they can get at a troubled flap is the one obtained in the OR.