BackTable ENT & Allergy

If your patients still struggle with sleep apnea after other treatments, it might be time to look at the nose. In this episode of the BackTable ENT Podcast, otolaryngologist and facial plastic surgeon Dr. Scott McCusker joins hosts Dr. Gopi Shah and Dr. Ashley Agan to discuss the impact of nasal airway obstruction on obstructive sleep apnea (OSA).
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This podcast is supported by:
Aerin Medical
https://aerinmedical.com/
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SYNPOSIS
Dr. McCusker shares insights on his practice, evaluation techniques for nasal obstruction, and the use of minimally invasive procedures like VivAer. The conversation covers the importance of the septal swell bodies, the effectiveness of nasal treatments on OSA outcomes, and patient management strategies, including when to combine different surgical interventions. The episode also touches on post-operative care and the potential role of new technologies and treatments in enhancing patient outcomes.
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RESOURCES
Dr. Scott McCusker
https://ambrdfcs.org/doctors/scott-mccusker-md/

While the standard for adjuvant head and neck cancer treatment hasn't changed since 2004, a new trial using perioperative pembrolizumab is forcing clinicians to rethink their entire workflow, starting with diagnosis. In this episode of the BackTable Podcast, head and neck surgical oncologist Dr. Adam Luginbuhl is joined by colleagues Dr. Dylan Roden and Dr. Ravindra Uppaluri to discuss the implementation and implications of the Keynote-689 trial, which introduced neoadjuvant and adjuvant immunotherapy for locally advanced head and neck cancer.
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SYNPOSIS
The doctors discuss the trial details, FDA approval, and practical challenges of integrating this new paradigm into clinical practice. The conversation covers critical points such as the necessity of CPS score testing, timely drug administration, patient monitoring, and the importance of collaboration among multidisciplinary teams.
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TIMESTAMPS
00:00 - Introduction
02:18 - Keynote-689 Trial Explained
04:42 - Implementation Challenges and Strategies
06:40 - Practical Considerations for CPS Testing
13:59 - Case Studies and Real-World Applications
30:48 - Future Directions and Final Thoughts
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RESOURCES
Keynote-689
https://www.nejm.org/doi/full/10.1056/NEJMoa2415434
2004 Cisplatin Phase III Trial
https://www.nejm.org/doi/full/10.1056/NEJMoa032646

Endoscopes, AI, and the future of ENT care—otolaryngologist and Presidio CEO Dr. Jonathan Simmonds shares why the tech game is just getting started in this episode of the BackTable ENT Podcast.
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SYNPOSIS
Dr. Simmonds shares his journey from the UK to becoming a sinus surgeon in New York, and the founding of Presidio to create affordable endoscopic equipment. They discuss how AI can transform ENT practice, emphasizing the unique position ENTs hold due to their routine use of camera systems in exams. The conversation also tackles the economic aspects of implementing new technology, the importance of capturing clinical data, and the necessity of ENT specialists to advocate for their role in the evolving landscape. Dr. Simmonds offers insights into the various AI tools and the significance of contributing to the development and implementation of AI models in ENT.
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TIMESTAMPS
00:00 - Introduction
03:38 - AI in ENT: Opportunities and Challenges
12:46 - Protecting the Role of ENTs
17:26 - The Future of ENT Exams
24:41 - Ownership of Medical Data: The Ethical Dilemma
30:09 - Human-Like Behavior in AI Models
31:18 - The Role of AI in ENT Practice
34:30 - Challenges and Opportunities in AI Implementation
42:12 - Economic Considerations for AI in Private Practice
45:03 - Final Thoughts and Future Directions
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RESOURCES
Dr. Jonathan Simmonds
https://www.summithealth.com/doctors/provider/1538549936

When should a parotid mass raise red flags? In this episode of the BackTable ENT podcast, Dr. Mirabelle Sajisevi, head and neck surgeon at the University of Vermont Medical Center, joins hosts Dr. Gopi Shah and Dr. Ashley Agan to discuss her approach to diagnosing and managing parotid malignancies.
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SYNPOSIS
Dr. Sajisevi shares insights from her practice, including the importance of thorough physical exams, the utility of ultrasound and biopsy, and the intricacies of surgical planning. They also cover post-operative care, the role of radiation and chemotherapy, surveillance strategies, and the potential of emerging treatments and technologies.
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RESOURCES
Dr. Mirabelle Sajisevi
https://www.uvmhealth.org/providers/mirabelle-sajisevi-md

We’re keeping the chronic rhinitis conversation going in this week’s episode of BackTable ENT. Otolaryngologist Dr. Greg Davis joins Dr. Ashley Agan and Dr. Gopi Shah to break down his approach to posterior nasal nerve (PNN) ablation with the NeuroMark Gen 3, including patient prep, anesthesia, technique, and postoperative care.
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This podcast is supported by:
Neurent Medical
http://neuromark.com/
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SYNPOSIS
Beyond his posterior nasal nerve ablation technique, Dr. Davis shares his experiences with the various generations of the NeuroMark device, and also discusses the insurance and billing side of its use. The conversation also touches on topics like eustachian tube dysfunction, chronic cough, and the future of chronic rhinitis treatment.
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TIMESTAMPS
00:00 - Introduction
03:04 - NeuroMark Device Trials
04:15 - Patient Presentation and Diagnosis
11:50 - Medical Management and Treatment Options
21:44 - Procedure Setup and Anesthesia Protocol
30:49 - Understanding RF Devices and Their Usage
31:13 - Deploying the Device for Turbinate Treatment
31:52 - Tips and Tricks for Difficult Anatomy
33:58 - Posterior Nasal Nerve Ablation in the OR
34:40 - Addressing Posterior Nasal Drainage and Chronic Cough
36:51 - Impedance Control vs. Temperature Control RF
38:02 - Choosing the Right Device for Patients
40:52 - Managing Post-Procedure Care and Risks
53:18 - Insurance and Billing
56:13 - Final Thoughts and Future Directions
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RESOURCES
Dr. Greg Davis
https://www.gregdavismd.com/
10th International Otolaryngology Underwater Update Course
https://ssf.cloud-cme.com/course/courseoverview?P=0&EID=1254

So many patients deal with a runny, stuffy nose every day, and sprays only go so far. Let’s talk about what’s new for chronic rhinitis. In this episode of the BackTable ENT podcast, Dr. Dennis Tang, a Rhinologist at Cedars-Sinai Medical Center discusses chronic rhinitis and the latest treatment advancements with hosts Dr. Gopi Shah and Dr. Ashley Agan.
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This podcast is supported by:
Aerin Medical
https://aerinmedical.com/
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SYNPOSIS
Dr. Tang discusses the benefits of posterior nasal nerve (PNN) ablation and the recent approval of the procedure by Cigna Insurance, which expands accessibility for patients. The conversation covers the typical presentation of chronic rhinitis, the procedural details, patient selection, preoperative and postoperative care, and billing considerations. Dr. Tang also touches on the anatomy involved and the technological innovations that are enabling contemporary rhinitis treatment.
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TIMESTAMPS
00:00 - Introduction
03:01 - Insurance Coverage for Posterior Nasal Nerve Ablation
04:23 - Patient Presentation, Diagnostic & Treatment Approaches
11:07 - Posterior Nasal Nerve (PNN) Ablation Explained
17:57 - Physical Examination and In-Office Procedure
20:47 - Allergy Patients and Immunotherapy
22:21 - Chronic Rhinosinusitis vs. Chronic Rhinitis
32:33 - Radiofrequency Ablation Technology
39:49 - Procedure Techniques and Anatomical Considerations
46:42 - In-Office Procedure Logistics
01:06:10 - Final Thoughts
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RESOURCES
Dr. Dennis Tang
https://www.cedars-sinai.org/provider/dennis-tang-3316614.html

Is there a different way to do an Intracapsular tonsillectomy without using a microdebrider or a Coblator? In this episode of the BackTable ENT Podcast, otolaryngologist Dr. Evan Tobin from Ohio ENT and Allergy Physicians sits down to discuss the intracapsular technique for tonsillectomy with hosts Dr. Gopi Shah and Dr. Ashley Agan.
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SYNPOSIS
Dr. Tobin shares his journey and practice in Ohio, emphasizing his transition to using intracapsular tonsillectomy with monopolar electrocautery. The discussion covers the historical evolution of tonsillectomy techniques, the benefits of intracapsular tonsillectomy (such as reduced bleed rates and postoperative pain), as well as the practical aspects and indications for different methods. Dr. Tobin presents his technique in detail, supported by video demonstrations and highlights the significance of patient counseling in making surgical decisions.
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TIMESTAMPS
00:00 - Introduction
04:38 - Tonsillectomy Techniques
07:20 - Evolution and Debate of Tonsillectomy Practices
11:09 - Personal Experiences and Techniques in Tonsillectomy
21:42 - Pain Management and Post-Operative Care
29:51 - Shared Decision Making and Future of Tonsillectomy
34:53 - Managing Bleeds: A Practical Approach
37:51 - Cost Analysis of Tonsillectomy Techniques
41:46 - Surgical Techniques and Settings
53:06 - Post-Operative Considerations and Outcomes
57:33 - Final Thoughts and Recommendations
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RESOURCES
Dr. Evan Tobin
https://www.ohioentandallergy.com/physicians/evan-tobin-md/

What every ENT needs to know about the resurgence of measles—and how to talk to patients about vaccines. In this episode of the Back Table ENT podcast, Dr. Romaine Johnson and Dr. Daniel Chelius, both pediatric otolaryngologists, talk about the resurgence of measles and vaccine hesitancy with host Dr. Gopi Shah.

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SYNPOSIS

They delve into their professional backgrounds, the importance of recognizing symptoms early, and the risks associated with measles, such as otitis media and sensorineural hearing loss. The conversation highlights the role of ENT specialists in identifying and managing the disease, strategies for addressing vaccine hesitancy, and the broader public health implications. They also touch on ways the medical community can tackle misinformation and advocate for vaccinations through collective efforts and patient education.

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TIMESTAMPS

00:00 - Introduction

07:07 - Measles Contagion and Symptoms

23:23 - Complications and Long-term Effects

28:37 - Assessing Respiratory Status and Complications

29:44 - Addressing Common Vaccine Myths

31:18 - Challenges in Vaccination Conversations

32:38 - Personal Stories and Impact of Vaccination Choices

35:00 - Building Trust and Addressing Concerns

38:15 - Approaching Non-Vaccination in Clinical Practice

53:12 - Global Perspective on Vaccination

54:17 - Final Thoughts and Contact Information

How to help children with ear deformities look and feel their best. In this episode of the BackTable ENT Podcast, Dr. Jason Qian from Rady Children's in San Diego and special guest Dr. Charlotte Célérier, a pediatric otolaryngologist at Neckar-Enfants Malades Hospital in Paris, France discuss the technical aspects of pediatric otoplasty with Dr. Gopi Shah.
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SYNPOSIS
The conversation covers surgical techniques, patient selection, procedural nuances, and post-operative care for various ear deformities including prominent ears, Stahl's ear, cauliflower ear, and cryptotia. Both experts share their insights on different methodologies, handling complications, and the importance of ensuring the child is motivated for surgery. Learn practical tips and evolving practices in the field of pediatric otoplasty.
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TIMESTAMPS
00:00 - Introduction
02:22 - Otoplasty Techniques and Patient Referrals
05:35 - Terminology and Ear Abnormalities
13:16 - Surgical Considerations
20:04 - Prepping and Draping for Surgery
30:22 - Suturing Techniques
33:38 - Instrument Preferences
35:12 - Repairing Stahls Ear Deformity
37:16 - Cauliflower Ear Challenges
38:46 - Cryptotia Repair Techniques
40:59 - Post-Operative Care and Managing Complications
52:30 - Final Thoughts and Innovations
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RESOURCES
Jason Qian:
https://www.rchsd.org/doctors/zhen-jason-qian-md/
Charlotte Célérier:
https://www.researchgate.net/profile/Charlotte-Celerier

Hyperbaric oxygen is out and surgical innovation is in—here’s how the rescue flap is reshaping ORN care. Facial plastic and microvascular surgeons Dr. Ariel Frost and Dr. Eli Gordin join host Dr. Ashley Agan to discuss osteoradionecrosis (ORN) of the mandible.
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SYNPOSIS
The discussion begins with a detailed overview of the condition and patient presentation, and the impact of radiation therapy. The conversation then delves into historical and contemporary staging systems, highlighting the innovative 'rescue flap' technique developed by Cleveland Clinic. The episode emphasizes the ineffectiveness of hyperbaric oxygen therapy and showcases the superior outcomes and cost-effectiveness of the rescue flap procedure. Practical insights on surgical techniques, patient management, and future directions in treating ORN are also discussed.
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TIMESTAMPS
00:00 - Introduction
01:26 - Understanding Osteoradionecrosis (ORN)
08:49 - Clinical Presentation of ORN
13:56 - Diagnosis and Imaging
16:58 - Staging and Treatment Options
27:39 - Conservative Therapy for ORN
37:19 - Understanding Disease Progression and Imaging
39:46 - Exploring the Rescue Flap Technique
52:46 - Post-Operative Care and Recovery
59:20 - Advanced Stages and Bone Grafting
01:13:38 - Cost Effectiveness and Referral Guidelines
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RESOURCES
Dr. Ariel Frost
https://utswmed.org/doctors/ariel-frost/
Dr. Eli Gordin
https://utswmed.org/doctors/eli-gordin/