Could that routine epistaxis actually be the first sign of a challenging skull base tumor? This week’s episode of the BackTable ENT Podcast is part two of the sinonasal tumor and skull base involvement discussion. Host Dr. Satyan Sreenath is joined again by Dr. Joao Paulo Almeida, Dr. Zara Patel, and Dr. Garret Choby for a case-based deep dive into the multidisciplinary management of complex sinonasal tumors.

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Timestamps

00:00 - Introduction
01:20 - Case 1: Juvenile Nasopharyngeal Angiofibroma
05:03 - Considerations for Pre-Operative Embolization
08:10 - Disaster Scenario: High Volume Loss
09:21 - Operative Approach
18:10 - Post-Op Imaging Considerations
21:00 - Case 2: Invasive Keratinizing Squamous Cell Carcinoma
24:40 - Operative Approach vs. Neoadjuvant Treatment Strategies
28:30 - Importance of Diagnostic Nasal Endoscopy
30:15 - Operative Approach
32:37 - Lumbar Drain Considerations
40:35 - Closing Thoughts

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More about this episode

The panel works through advanced cases presenting with epistaxis, using them to highlight key principles in evaluation, imaging, staging, and operative planning. They first discuss a 16-year-old male with a large juvenile nasopharyngeal angiofibroma extending to the skull base and middle cranial fossa, focusing on vascular supply, preoperative embolization, surgical strategy near the carotid, and planning for intraoperative hemorrhage and postoperative surveillance. They also emphasize the importance of thorough endoscopic evaluation and early referral to experienced centers.

They then review a 72-year-old female with invasive, HPV-negative keratinizing squamous cell carcinoma involving the anterior cranial fossa and dura. The conversation addresses tumor board decision-making, neoadjuvant considerations, endoscopic craniofacial resection, reconstruction strategies, and management of delayed positive margins. It highlights how accurate histopathology and coordinated multidisciplinary care guide outcomes in these complex cases.

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Resources

Joao Paulo Almeida, MD, PhD
https://medicine.iu.edu/faculty/68351/almeida-joao-paulo

Satyan B. Sreenath, MD
https://medicine.iu.edu/faculty/60724/sreenath-satyan

Zara M. Patel, MD
https://med.stanford.edu/profiles/zara-patel

Garret W. Choby, MD
https://providers.upmc.com/provider/garret-w-choby/2592344

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BackTable ENT & Allergy is the go-to podcast for otolaryngologists, allergists, and head and neck surgeons.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Pathology, anatomy, and staging: how do these three pillars come together to guide sinonasal tumor management? In this episode of the BackTable ENT Podcast, host Dr. Satyan Sreenath is joined by Dr. Joao Paulo Almeida, Dr. Zara Patel, and Dr. Garret Choby to discuss a multidisciplinary approach to sinonasal tumors, emphasizing the triad of pathology, anatomy, and staging to guide treatment.

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https://www.backtable.com/app

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Timestamps

00:00 - Introduction
02:04 - First Principles of Workup
05:23 - Case 1: Maxillary Sinus Mass
06:23 - Imaging and Biopsy Strategy
08:11 - Inverted Papilloma Pathology and Surgical Planning
20:28 - Case 2: Unilateral Disease Red Flags
24:34 - MRI Clues for Malignancy
31:47 - Video Walkthrough of Endonasal Resection
38:51 - Surveillance
41:41 - Key Papers
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More about this episode

The panel reviews key workup considerations, including in-office biopsy and the use of CT and MRI to distinguish tumor from retained secretions and guide operative planning. They walk through two illustrative cases of inverted papilloma. The first involves a left maxillary sinus mass treated with an endoscopic medial maxillectomy using a Denker-type approach, with emphasis on complete attachment-site eradication. The second case highlights an elderly patient with frontal and anterior ethmoid disease abutting the orbit and skull base, requiring meticulous endoscopic technique, careful management of the anterior ethmoid artery, and thoughtful handling of bone and periorbita.

The discussion also covers imaging features suggestive of malignant transformation, as well as emerging AI-based CT and MRI tools that show high accuracy in distinguishing benign inverted papillomas from those associated with squamous cell carcinoma. The episode concludes with postoperative surveillance strategies and key consensus and review publications.

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Resources
Joao Paulo Almeida, MD, PhD
https://medicine.iu.edu/faculty/68351/almeida-joao-paulo

Satyan B. Sreenath, MD
https://medicine.iu.edu/faculty/60724/sreenath-satyan

Zara M. Patel, MD
https://med.stanford.edu/profiles/zara-patel

Garret W. Choby, MD
https://providers.upmc.com/provider/garret-w-choby/2592344

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BackTable ENT & Allergy is the go-to podcast for otolaryngologists, allergists, and head and neck surgeons.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

What if you could build a skull base practice outside academia, without sacrificing complexity, income, or fulfillment? On this episode of the BackTable ENT Podcast, Dr. Kibwei McKinney from SSM Health St. Anthony Hospital in Oklahoma City joins guest host Dr. Dennis Tang to discuss building a rhinology and skull base surgery practice outside academia.

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Timestamps

01:30 - Introduction and Career
04:55 - Private Practice vs. Academics
10:38 - Defining Skull Based Surgery
15:10 - Patient Pool and Logistics in Academics vs Private Practice
19:03 - Marketing and Referral Sources
24:58 - Case Management and the O.R. in Private Practice
29:30 - Balanced Workload and Intentional Care
32:10 - Billing and Coding
38:55 - Lifestyle Benefits of Private Practice
44:21 - Strategic Advice and Advantages or Disadvantages of Private Practice.
47:38 - Common Misconceptions
50:00 - Advice and Closing Thoughts

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More about this episode

Dr. McKinney walks through his training journey, from dedicated research years to time in private-practice rhinology and a skull base fellowship, before ultimately starting his academic career in Oklahoma. He shares how shifting family priorities and the growing push for clinical productivity led him to step away from academia and into an employed private-practice model focused exclusively on rhinology and skull base surgery, without ER call. Along the way, he dives into what that transition really looks like, including the autonomy he’s gained, the role of marketing support, how he builds referrals through direct communication, and the operational differences of working without residents. He also touches on postoperative care structure, billing and coding, insurance challenges, and the impact on his overall lifestyle.

Check out this episode to hear Dr. McKinney’s perspective on why skull base surgery in private practice can be not only technically feasible and financially viable, but also emotionally sustainable, creating space for truly patient-centered care and the ability to pursue the work with genuine passion.

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Resources

Dr. Kibwei McKinney
https://www.getcare.ssmhealth.com/find-a-doctor/doctor-details/kibwei-mckinney-md

Why do some patients recover faster, cope better, and experience less pain despite similar diagnoses? The answer may lie not in the pathology, but in perception. In this episode of the BackTable ENT & Allergy Podcast, Dr. Sonia Gupte, a former family physician and board-certified clinical hypnotherapist, joins host Dr. Gopi Shah to explore how hypnotherapy works and where it fits in modern medical care.

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https://www.backtable.com/app

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Timestamps

00:00 - Introduction
05:13 - Understanding the Subconscious Mind
09:29 - The Hypnotherapy Process
15:43 - Patient Selection
18:58 - Anxiety, Stress, and Pain Perception
23:54 - Use in General ENT Population
28:14 - When to Refer
31:51 - History of Hypnotherapy in Cancer Care
32:56 - Awareness, Access, and Billing Insurance
38:59 - Setting Expectations, Visits Required, and Smoking Cessation
43:42 - Virtual Visits and Possible Limitations
46:57 - Techniques for ENTs
49:14 - Closing Thoughts

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More about this episode

Dr. Gupte shares how her mother’s cancer journey led her to recognize gaps in addressing the mind-body connection and ultimately transition into hypnotherapy. She clarifies the difference between hypnosis and clinical hypnotherapy, emphasizing the latter as a collaborative, goal-oriented process aimed at uncovering the “why” behind patient patterns and reshaping perceptions. The conversation covers the structure of a hypnotherapy session, relevant brainwave states, patient selection and contraindications, and clinical applications ranging from oncology support to ENT-related quality-of-life concerns. They also discuss use in pediatric patients, expected timelines for improvement, virtual care delivery, and practical communication strategies clinicians can use to reduce patient anxiety in everyday practice.

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Resources

Dr. Sonia Gupte

https://enso-nia.com/about-sonia/

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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Get the BackTable app
https://www.backtable.com/app

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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