BackTable ENT & Allergy

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

Recurrent respiratory papillomatosis (RRP) has long been managed with repeated surgical debulking, sometimes requiring dozens of procedures over a lifetime. In this episode of BackTable, Dr. Aaron Friedman and guest host Dr. Stephen Schoeff discuss a major shift in care: immune-directed therapy targeting HPV 6 and 11.

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SYNPOSIS

Dr. Friedman reviews the recent FDA approval of the Precigen product PAPZIMEOS (August 2025), a therapeutic vaccine designed to stimulate HPV-specific T-cell responses. Clinical trial data show that about half of treated adults required no additional surgeries over the following year, with many responders maintaining durable benefit for years. The conversation also covers traditional management strategies, adjuvant therapies like bevacizumab, HPV vaccination, and the evolving algorithm for adult RRP care.

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TIMESTAMPS

00:00 - Introduction
02:13 - RRP Patient Types and Symptoms
05:06 - Adult vs Juvenile Transmission
10:46 - When to Escalate Treatment
15:40 - Immunotherapy
18:55 - Trial Enrollment, Results and Dosing Rules
26:17 - Durable Long Term Response
30:47 - Who Should Get Treated
32:34 - Logistics And Public Perception
37:50 - Future Research And Prevention

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Recurrent Respiratory Papillomatosis Foundation Position Statement on the Management of Adults With RRP
https://pubmed.ncbi.nlm.nih.gov/41543033/

Dr. Stephen Schoeff
https://healthy.kaiserpermanente.org/washington/clinicians/stephen-schoeff-6848607

Dr. Aaron Friedman
https://www.uchealth.com/en/provider-profiles/friedman-aaron-d-1609057587

Not every airway is a tonsil problem. Pediatric obstructive sleep apnea is often more nuanced than it appears, requiring thoughtful evaluation beyond routine surgery. In this episode of the BackTable ENT Podcast, pediatric otolaryngologist Dr. Tali Lando discusses managing pediatric obstructive sleep apnea (OSA) with hosts Dr. Gopi Shah and Dr. Ashley Agan.

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SYNPOSIS

Dr. Lando shares insights into her clinical practice, outlining a systematic approach to diagnosing and treating pediatric OSA, and emphasizing the value of sleep endoscopy. She explores the spectrum of interventions from adenoidectomy and tonsillectomy to complex airway evaluations and surgical management, while highlighting the roles of sleep studies, obesity, and emerging therapies such as hypoglossal nerve stimulation. Dr. Lando also reflects on balancing a busy clinical career with family life and discusses her two books, Hell & Back: Wife & Mother, Doctor & Patient, Dragon Slayer and Breathless: Surgical Tales from the Brink (and Back).

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TIMESTAMPS

00:00 - Introduction
06:21 - When Noisy Breathing Signals More Than Tonsils
10:01 - When to Add DISE: Combining T&A with Airway Evaluation
18:08 - Turbinates, Septum and Nasal Valve Matter
22:03 - Red Flags in Clinic
29:12 - When Surgery Helps and When It Doesn’t
41:33 - Sleep Studies
43:09 - Down Syndrome and OSA
55:19 - Finding Hidden Sites of Airway Collapse
01:06:13 - Hypoglossal Nerve Stimulation and Advanced Options

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RESOURCES

Dr. Tali Lando
https://www.wmchealth.org/physician-locator/tali-lando-1548383763?address_id=413
About Dr. Tali – Dr. Tali Lando

Only 7–10% of patients who qualify for cochlear implants actually receive one. Why are so many older adults missing out on life-changing hearing care? In this episode of the BackTable ENT Podcast, guest hosts Dr. Joe Walter Kutz and Dr. Brandon Isaacson are joined by Dr. Cameron Wick of University Hospitals Cleveland Medical Center to discuss cochlear implantation in the elderly population.

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SYNPOSIS

The doctors explore common barriers to cochlear implantation, persistently low referral rates, and the substantial benefits these devices can offer older adults. Dr. Wick shares insights from his recent study on patients in their 80s and 90s, highlighting meaningful improvements in speech perception and overall quality of life. The conversation also addresses surgical considerations, postoperative care, the importance of timely intervention, and updated Medicare guidelines.

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TIMESTAMPS

00:00 - Introduction
02:52 - Risks and Benefits of CI in Older Adults
11:57 - Handling Anticoagulation During CI Surgery
13:59 - Post-Surgery Expectations and Balance Issues
16:35 - Next Day Activation and Surgical Considerations
19:17 - Assessing Patient Suitability for Cochlear Implants
22:45 - Setting Patient Expectations for Cochlear Implants
23:39 - Barriers to Cochlear Implant Access
28:07 - Importance of Early Identification and Referral
31:47 - Postoperative Rehabilitation and Patient Support
39:30 - Concluding Thoughts and Acknowledgements

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RESOURCES

J. Walter Kutz, M.D.
https://utswmed.org/doctors/joe-kutz/

Brandon Isaacson, M.D.
https://utswmed.org/doctors/brandon-isaacson/

Cameron Wick, MD
https://www.uhhospitals.org/doctors/Wick-Cameron-1063737799

At what point does a “routine” sinus or ear infection become a warning sign of immunodeficiency? In this episode of the BackTable ENT Podcast, board-certified allergist-immunologist Dr. Basil Kahwash explores the intersection of immunodeficiency and otolaryngology with Dr. Lauren Gunderman, a pediatric immunologist at Seattle Children’s Hospital. Learn why ENTs should remain vigilant for underlying immune disorders, and how to manage suspected immunodeficiency.

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SYNPOSIS

The conversation reviews common signs and symptoms of immunodeficiency, key elements of the diagnostic workup, and when ENT physicians should consider referral to immunology. Dr. Kahwash and Dr. Gunderman discuss the role of family history and genetics, as well as current management strategies, including antibiotic use, immunoglobulin replacement therapy, and lifestyle modifications. Throughout the episode, Dr. Gunderman emphasizes the importance of multidisciplinary collaboration between otolaryngologists and immunologists to improve outcomes for patients with recurrent or severe infections.

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TIMESTAMPS

00:00 - Introduction
02:45 - Understanding Immunodeficiency in ENT
08:20 - Common Immunodeficiencies and Indicators
11:02 - Basic Immunology Refresher
22:13 - Initial Diagnostic Workup
25:05 - Challenges in Allergy and Immunology Testing
27:57 - When to Refer to an Immunologist
34:01 - Antibiotic Stewardship in Immunodeficient Patients
46:07 - Advances in Diagnosing Immunodeficiency
50:31 - Final Thoughts and Takeaways

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RESOURCES

Lauren Michelle Gunderman, MD
https://www.seattlechildrens.org/directory/lauren-michelle-gunderman/

Can one surgical approach reduce postoperative bleeding, shorten recovery, and save hundreds of dollars per case? In this episode of the BackTable ENT Podcast, Dr. Stephen Chorney, pediatric otolaryngologist at the University of Texas Southwestern Medical Center, joins hosts Dr. Ashley Agan and Dr. Gopi Shah to discuss the benefits and techniques of coblation intracapsular tonsillectomy. Drawing from his extensive clinical experience and findings from his recent Triological thesis, Dr. Chorney reviews the cost effectiveness of coblation intracapsular tonsillectomy compared to traditional extracapsular approaches.

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This podcast is supported by:

Smith+Nephew

https://www.smith-nephew.com/en-us/health-care-professionals/products/ear-nose-and-throat/coblation-technology-for-adenotonsillectomy#overview

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SYNPOSIS

The conversation highlights key advantages of coblation intracapsular tonsillectomy, including lower postoperative bleeding rates, reduced pain, faster recovery, and meaningful economic benefits. Dr. Chorney also shares practical pearls on surgical technique with coblation, equipment settings, and postoperative care, making this episode a valuable resource for surgeons considering or already performing intracapsular tonsillectomy.

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TIMESTAMPS

00:00 - Introduction
03:34 - Intracapsular Tonsillectomy: Training and Adoption
08:46 - Patient Selection and Surgical Techniques
15:50 - Postoperative Care and Pain Management
37:26 - Understanding Post-Workout Pain and Recovery
38:13 - Comparing Surgical Tools: Microdebrider vs. Coblator
38:54 - Visual Cues and Techniques in Tonsillectomy
39:22 - Challenges and Solutions in Tonsillectomy Procedures
46:37 - Case Studies and Video Demonstrations
56:12 - Cost-Effectiveness of Intracapsular Tonsillectomy
01:07:19 - Conclusion and Final Thoughts

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RESOURCES

Dr. Stephen Chorney
https://utswmed.org/doctors/stephen-chorney/

Trio Thesis
https://onlinelibrary.wiley.com/doi/full/10.1002/lary.32448

When allergy meds aren’t enough, how do you choose the form of immunotherapy that will work best for your patient? Board-certified allergist-immunologist Dr. Nikhila Schroeder and host Dr. Basil Kahwash answer that question and more in this episode of the BackTable ENT Podcast.

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SYNPOSIS

Dr. Schroeder shares her path from an engineering background to becoming a board-certified pediatric and adult allergist-immunologist, offering insight into how that perspective shapes her approach to patient care. The discussion focuses on the nuances of sublingual immunotherapy (SLIT) versus subcutaneous immunotherapy (SCIT), including administration, efficacy, safety, and patient adherence challenges. They also explore how immunotherapy can modulate the immune system and provide long-term symptom relief. Dr. Schroeder concludes by sharing her vision for the future of allergy immunotherapy, highlighting the accessibility and growing potential of SLIT. This episode offers ENT specialists a practical overview of why understanding and integrating allergy-immunotherapy can benefit both their practice and their patients.

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TIMESTAMPS

00:00 - Introduction
05:01 - History and Evolution of Immunotherapy
10:36 - Mechanisms of Immunotherapy
14:59 - Subcutaneous Immunotherapy: Process and Benefits
19:52 - Sublingual Immunotherapy: Process and Benefits
27:56 - Comparing Subcutaneous and Sublingual Immunotherapy
34:14 - Efficacy Comparison: Allergy Shots vs. SLIT
39:51 - Patient Adherence and Treatment Choices
41:58 - Contraindications for Allergy Immunotherapy
48:58 - Long-term Benefits of Immunotherapy
59:26 - Key Takeaways for ENT Professionals

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RESOURCES

Dr. Nikhila Schroeder
https://allergenuityhealth.com/about-us/

Think beyond the esophagus. Up to 75% of eosinophilic esophagitis (EoE) patients have ENT-relevant atopic disease that is often best managed with a multidisciplinary approach. Get caught up on best practices in EoE diagnosis and treatment with this episode of the BackTable ENT Podcast, featuring dual board-certified gastroenterologist and allergist-immunologist Dr. John Leung and host Dr. Basil Kahwash.

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SYNPOSIS

The discussion covers the definition, symptoms, and diagnosis of EoE, highlighting the role of food and environmental allergies. Dr. Leung and Dr. Kahwash cover diagnostic techniques like endoscopy and emerging non-invasive methods, as well as various treatment options including dietary modifications, pharmacology, and biologics. The doctors also emphasize the importance of multidisciplinary collaboration between gastroenterologists, allergists, and otolaryngologists to provide optimal care for patients with EoE.

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TIMESTAMPS

00:00 - Introduction
03:13 - Understanding Eosinophilic Esophagitis (EoE)
05:45 - EoE Symptoms and Diagnosis
08:41 - Role of ENT in EoE Diagnosis
11:32 - Diagnostic Criteria for EoE
16:34 - Treatment Options for EoE
20:55 - Role of Allergists and Environmental Allergies
23:24 - Pharmacological Management of EoE
29:38 - Complications and Risks of EoE
36:21 - Follow-Up Endoscopies and Surveillance
40:34 - Future Directions in EoE Management
45:21 - Conclusion and Final Thoughts

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RESOURCES

Dr. John Leung
https://www.bostonspecialists.org/dr-leung-full-profile