BackTable ENT

Is a subtle voice change something to ignore? In this episode of the Backtable ENT podcast, hosts Gopi Shah and Dr. Ashley Agan speak with Dr. Bharat Panuganti, a laryngologist from Washington University in St. Louis, about the diagnosis, treatment, and management of early glottic cancer.

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SYNPOSIS

First, the doctors discuss the importance of not underestimating voice changes such as dysphonia. Then, they discuss the evolving demographics and risk factors of laryngeal cancers. Dr. Panuganti also explains his approach to using advanced imaging techniques and lasers in treatment. The conversation highlights the necessity of personalized and compassionate patient care, considering both surgical and radiation therapy options. The discussion concludes with advice on the importance of consistent patient follow-up for early detection and treatment of recurrences.

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TIMESTAMPS

00:00 - Introduction

03:09 - Understanding Early Glottic Cancer and Symptoms

08:09 - Physical Examination, FEES and Stroboscopy

14:19 - Intraoperative Imaging Techniques

31:33 - Radiation vs. Surgery: Predicting Outcomes

32:18 - Laser Surgery and Technologial Advances

42:51 - Robotic Surgery

47:13 - Postoperative Care and Patient Counseling

52:53 - Equitable Care and Treatment Choices

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RESOURCES

BackTable+ for ENT

https://plus.backtable.com/pages/ent

Dr. Bharat Panuganti’s WashU Profile:

https://oto.wustl.edu/people/bharat-panuganti-md/

From cable grafts to free muscle transfer, surgical treatments for facial paralysis are evolving quickly. In this episode of the Backtable ENT Podcast, Dr. Myriam Loyo Li, facial plastic surgeon at OHSU, joins guest host Dr. Shiayin Yang of Vanderbilt to discuss dynamic procedures for facial paralysis.

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This podcast is supported by:

BackTable + ENT

https://www.backtable.com/shows/ent

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SYNPOSIS

First, the surgeons review workup of flaccid and non-flaccid (synkinetic) facial paralysis. Then, they review the principles of facial reanimation. Topics such as nerve graft selection and staged surgery are covered. Dr. Loyo Li explains her timelines for staged surgery and how patient characteristics affect her decision planning. Finally, the surgeons discuss free muscle transfer – an exciting new technique in the world of facial plastic surgery – to treat facial paralysis.

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TIMESTAMPS

00:00 - Introduction

02:48 - Evaluating and Managing Flaccid Facial Palsy

05:18 - Imaging and Treatment Pathways

07:16 - Nerve Grafting Techniques and Preferences

10:08 - Challenges and Innovations in Facial Reanimation

25:50 - Patient-Centered Approaches and Decision Making

37:30 - Evaluating Facial Nerve Recovery

43:25 - Timing and Criteria for Nerve Transfers

46:41 - Free Muscle Transfer Techniques

49:47 - Innovations in Cross Facial Nerve Grafts

01:06:04 - Exploring Free Strap Muscle Transfers

01:14:05 - The Future of Facial Reanimation

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RESOURCES

Dr. Loyo Li’s OHSU Profile:

https://www.ohsu.edu/providers/myriam-loyoli-md-mcr

Dr. Yang’s Vanderbilt Profile:

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

It’s not an overstatement to say that surgeons from The House Clinic revolutionized otology / neurotology in the second half of the twentieth century. In this episode of the BackTable ENT podcast, Dr. John House, son of the clinic’s founder, Howard, discusses the clinic’s fabled history with guest host Dr. Walter Kutz (UT Southwestern).

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SYNPOSIS

Dr. House recounts his father’s journey traveling the world to learn from renowned otolaryngologists, ultimately settling in Los Angeles where he established his practice. Working with his brother William, Howard started a clinic that popularized innovative treatments for otosclerosis, acoustic neuroma, and sensorineural hearing loss. While innovations like Howard’s cochlear implant and John’s House’s House-Brackmann Facial Nerve Grading Scale faced resistance at first, they eventually won widespread acceptance. The episode concludes with Dr. Kutz’s moving personal reflection on his time as a fellow at the House Clinic.

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TIMESTAMPS

00:00 - Introduction

05:41 - Dr. Howard House’s Path to Neurotology

17:14 - Dr. Bill House’s Passion Project: The Cochlear Implant

28:39 - Development of the House-Brackmann Facial Nerve Grading System

38:49 - The Evolution of Stapes Surgery

45:14 - House Alumnus Dr. Walter Kutz’s Journey

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RESOURCES

Dr. John House’s House Clinic Profile:

https://www.houseclinic.com/home/meet-the-team/profile/john-william-house-1/

Dr. Walter Kutz’s UT Southwestern Profile:

https://utswmed.org/doctors/joe-kutz/

En este episodio de Backable ENT, El Dr. Carlos Torre entrevista al Dr. Luisam Tarrats, un otorrinolaringólogo de Puerto Rico, sobre su práctica médica y su viaje empresarial para construir Burble, una empresa de enjuagues nasales.

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SYNPOSIS

Primero, el episodio explora la trayectoria del Dr. Luisam Tarrats, quien decidió regresar a Puerto Rico para mejorar la oferta quirúrgica y enfrentar los desafíos tras el huracán María. Se destaca su innovación empresarial con Burble Inc., una empresa que desarrolló un sistema de irrigación nasal salina aprobado por la FDA. La conversación incluye temas como la importancia de la higiene nasal para la salud y el bienestar, estrategias para emprender en el campo médico, y el balance entre la vida profesional y personal. Se subraya la importancia de educar a médicos y pacientes sobre el uso adecuado de productos de higiene nasal y el papel proactivo de la medicina preventiva.

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TIMESTAMPS

00:00 - Trayectoria profesional del Dr. Luisam Tarrats

03:45 - Fundación y desarrollo de Burble

16:51 - Innovaciones y beneficios del producto Burble

37:40 - Educación y concienciación sobre la higiene nasal

48:03 - Equilibrio entre la vida profesional y personal

58:39 - Consideraciones legales y estructurales

01:16:54 - Consejos para emprendedores aspirantes

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RESOURCES

Burble

https://letsburble.com/

Surgeons are fortunate that their work is both fulfilling and well compensated. When this earning potential meets solid financial planning, personal and material satisfaction results. In this episode of BackTable ENT, Dr. Robert Puchalski (South Carolina ENT) discusses financial wellness with guest host Dr. Ayesha Khalid (Cambridge Health Alliance).

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SYNPOSIS

First, Dr. Puchalski describes the benefits and challenges of different private practice models, emphasizing the importance of market share. Then, he explores income generation beyond clinical work, including ancillary services and investment. Transitioning to personal finance, he shares financial planning strategies so that practicing medicine is a choice rather than a necessity. The episode wraps with Dr. Puchalski’s thoughts on practicing medicine.

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TIMESTAMPS

00:00 - Introduction

06:56 - Market Share: Why it Matters

10:16 - The Importance of Passive Income & Ancillaries

21:47 - Personal Finance for Physicians

28:13 - Supporting Wellness Through Financial Planning

43:11 - Final Thoughts

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RESOURCES

Dr. Robert Puchalski’s SC ENT Profile: https://www.southcarolinaent.com/providers/robert-puchalski

Dr. Ayesha Khalid’s Cambridge Health Alliance Profile: https://www.challiance.org/doctors/profile?n=899

Tinnitus remains one of otology’s greatest, most challenging, and unsolved clinical problems. In this episode of the BackTable ENT Podcast, Dr. Hamid Djalilian, chair of otolaryngology at University of California Irvine (UCI), joins guest host and fellow otologist Dr. Walter Kutz (UT Southwestern) to discuss contemporary tinnitus therapy.

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This podcast is supported by:

PearsonRavitz

https://pearsonravitz.com/backtable

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SYNPOSIS

First, Dr. Djalilian shares how he got interested in tinnitus. After observing how migraines and tinnitus share many similar triggers, he hypothesized that increased central sensitivity underlies both diseases. He successfully adopted migraine management strategies for his tinnitus patients and found great clinical success. After sharing pathophysiologic similarities between the two diseases, Dr. Djalilian expounds on how he evaluates and treats tinnitus. His discussion includes lifestyle modifications, medication, and emerging surgical therapies. Finally, he advises listeners to think of tinnitus as a manageable condition, rather than a poorly-understood phenomenon.

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TIMESTAMPS

00:00 - Introduction

02:34 - The Challenge of Treating Tinnitus

07:19 - Connecting Tinnitus & Migraine

15:59 - Atypical (Otologic) Migraine & Diagnostic Challenges

19:59 - Managing Tinnitus Triggers

26:27 - Dietary Triggers of Tinnitus

28:44 - The Role of Sleep Quality in Tinnitus

33:04 - Caring for Older Patients with Tinnitus

37:59 - New Therapies for Tinnitus: Sound & Cognitive Behavioral Therapy

44:08 - Neuromodulation: The Future of Tinnitus Therapy?

51:34 - Final Thoughts on Tinnitus Treatment

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RESOURCES

BackTable ENT Episode 60 Otologic Manifestations of Migraine with Dr. Hamid Djalilian

https://www.backtable.com/shows/ent/podcasts/60/otologic-manifestations-of-migraine

Dr. Hamid Djalilian University of California, Irvine Profile: https://www.ent.uci.edu/faculty/hamid-djalilian-md.asp

Dr. Hamid Djalilian’s Website:

https://hamiddjalilianmd.com/

Fan-Gang Zeng (Hearing and Speech) Lab at UCI:

https://faculty.sites.uci.edu/hesplab/

PearsonRavitz:

https://pearsonravitz.com/

Many of us continue to associate “Artificial Intelligence” (AI) with the worst moments in The Terminator, Ex Machina, or The Matrix. Others think first of the known ethical challenges of AI and the potential workforce disruption of widespread AI implementation in healthcare and beyond. Dr. Mas Takashima, AI expert and chair of Houston Methodist’s Otolaryngology Department, wants to change our lingering apprehensions around AI. In this episode, Dr. Takashima interviews his Houston Methodist colleague and guest host Dr. Omar Ahmed.

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SYNPOSIS

First, Dr. Takashima shares his journey from video gamer to sinus surgeon and advocate for AI in medicine. He explains relevant concepts such as Generative Preformed Transformer (GPT) and neural network. Then, he and Dr. Ahmed dive into applications of AI to ENT, which include (but aren’t limited to) analysis of CT images, prediction of surgical success, and screening of residency applications. They review the unique challenges of applying this powerful technology to healthcare and emphasize the importance of safeguarding patient privacy in the era of Big Data. Finally, Dr. Takashima challenges his fellow otolaryngologists and researchers to embrace this transformative technology.

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TIMESTAMPS

00:00 - Introduction

11:43 - AI 101

23:26 - Applications of AI in Medicine

31:21 - Current & Emerging Applications of AI in ENT

33:44 - Using AI to Improve Surgical Robotics

39:09 - AI in Personalized Medicine

46:41 - AI in Medical Education

57:23 - Ethics & AI: The Need for an Updated HIPAA

01:02:20 - The Future of AI in ENT

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RESOURCES

Dr. Mas Takashima’s Houston Methodist profile: https://www.houstonmethodist.org/doctor/masayoshi-takashima/

Dr. Omar Ahmed’s Houston Methodist profile: https://www.houstonmethodist.org/doctor/omar-g-ahmed/

Many doctors enjoy writing, but how does a meaningful idea become a published book? Just ask Dr. Julie Wei, director of pediatric otolaryngology at Akron Children’s Hospital and author of two books. In this episode of the BackTable ENT podcast, Dr. Wei discusses her third book “Safeguarding Physician Wellbeing” with podcast host Dr. Gopi Shah.

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CHECK OUT OUR SPONSOR

PearsonRavitz

https://pearsonravitz.com/backtable

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SYNPOSIS

First, Dr. Wei shares her journey to authorship, which grew out of her efforts as an advocate for physician wellness. Then, she delves into topics covered in her book, including personal relationships, finances, fertility, and career growth. Much like operating room time-outs, “Safeguarding Physician Wellbeing” uses checklists at the end of each chapter to provide action items for readers. Drawing from her own experience as a surgeon and writer, Dr. Wei offers practical advice for prospective authors. The podcast wraps with thoughts on the need to prioritize physician wellness in an increasingly productivity-focused healthcare system.

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TIMESTAMPS

00:00 - Introduction

02:28 - Dr. Julie Wei’s Journey to Authorship

08:17 - The Concept of Well-being

16:10 - Checklists: A Tool for Patient Safety & Surgeon Well-Being

30:59 - Empowering Trainees to Speak Up

33:41 - The Importance of Taking Time Off

39:54 - Physician Well-being in the U.S. Healthcare System

44:06 - The Process of Writing A Book

52:45 - Final Thoughts & Encouragement for Aspiring Authors

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RESOURCES

Dr. Julie Wei’s Akron Children’s Hospital Profile: https://www.akronchildrens.org/people/Julie-Wei.html

“Safeguarding Physician Wellbeing,” Dr. Julie Wei: https://www.amazon.com/Safeguarding-Physician-Wellbeing-Julie-Wei/dp/1032589892

Artificial Intelligence (AI) already powers search results and chat bots, but what if it could help physicians diagnose cancer? In this episode of the BackTable ENT podcast, laryngologist Dr. Anthony Law of Emory University discusses applications of AI to laryngology with host Dr. Ashley Agan and guest host Dr. Mihir Patel, also of Emory.

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CHECK OUT OUR SPONSOR

PearsonRavitz

https://pearsonravitz.com/backtable

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SYNPOSIS

First, Dr. Law discusses how he connects his passions for laryngology and machine learning as a surgeon-scientist. Before opening the conversation, he defines terms needed to understand AI in medicine. Then, he discusses his work using deep learning models to identify laryngeal cancer patients based on voice recordings. Ideally, he envisions deploying his model (which is over 90% accurate) to help primary care physicians make timely ENT referrals. Mindful of the impact technology has, Dr. Law reviews technical and ethical concerns accompanying use of AI in medicine, which include underrepresented patient groups in research, patient privacy, and safe use of technology. Finally, he offers insight into the future of AI research more broadly.

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TIMESTAMPS

00:00 - Introduction

04:18 - Understanding Deep Neural Networks

07:13 - Applications of AI in Clinical Practice

15:08 - Data Security and Privacy Concerns

25:09 - Collecting Representative Data

31:13 - Biometrics: The Future of Medicine?

39:12 - Challenges & Costs of AI

42:26 - Final Thoughts & Future Directions

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RESOURCES

Pearson Ravitz

https://pearsonravitz.com/

Dr. Anthony Law’s Emory University Profile: https://winshipcancer.emory.edu/profiles/law-anthony.php

Dr. Anthony Law Lab:

https://anthonylaw2.wixsite.com/website

“What Our Voice Reveals About Our Health,” Dr. Anthony Law at TedxAtlanta: https://www.youtube.com/watch?v=-J2W5IVCECE

Nothing is more satisfying than draining an abscess, right? But when is medical management sufficient or even better? In this episode of the BackTable ENT Podcast, pediatric otolaryngologist Dr. John McClay joins host Dr. Gopi Shah to educate listeners on the diagnosis and management of pediatric retropharyngeal abscess (RPA).

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CHECK OUT OUR SPONSOR

PearsonRavitz

https://pearsonravitz.com/backtable

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SYNPOSIS

First, Dr. McClay reviews the symptoms, pathophysiology, and workup of neck abscesses (including RPA) in children. When evaluating any suspected neck abscess, he uses CT results to evaluate its precise size and location. Then, he addresses the role of surgery in treatment of neck abscesses. While many patients will improve with IV antibiotics alone, he mentions that most abscesses lateral to the carotid sheath and greater than 2 cm in size require surgical drainage. Finally, the conversation shifts to cover important topics including antibiotic selection, the role of steroids, and cost-effective care.

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TIMESTAMPS

00:00 - Introduction

03:34 - Pathophysiology & Presentation of Retropharyngeal Abscess

09:54 - Physical Examination in the Child with Suspected Neck Abscess

17:43 - The Importance of CT Scans

31:40 - Treatment of Neck Abscesses: Antibiotics vs Surgery

37:56 - The Role of Steroids in Abscess Treatment

53:41 - Applying Value-Based Care as a Pediatric Otolaryngologist

55:44 - Recap & Final Pearls

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RESOURCES

Dr. McClay’s website:

https://www.johnmcclaymd.com/pediatric-sinus-center/

Pearson Ravitz

https://pearsonravitz.com/

McClay JE, Murray AD, Booth T. Intravenous antibiotic therapy for deep neck abscesses defined by computed tomography. Arch Otolaryngol Head Neck Surg. 2003 Nov;129(11):1207-12.

Johnson RF. Emergency department visits, hospitalizations, and readmissions of patients with a peritonsillar abscess. Laryngoscope. 2017 Oct;127 Suppl 5:S1-S9.