BackTable ENT

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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PearsonRavitz

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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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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.

Rhinoplasty stands out as one of the most transformative yet technically challenging procedures in facial plastic surgery. In this episode of the BackTable ENT Podcast, rhinoplasty expert Dr. Patrick Cleveland of West Palm Beach shares his approach to the procedure with host Dr. Gopi Shah.

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SYNPOSIS

First, Dr. Cleveland addresses the initial rhinoplasty consultation, including patient history, physical exam, and photo documentation. Then, the surgeons delve into technical approaches to rhinoplasty. Tackling valuable topics including graft choices, cartilage sources for revision rhinoplasty, and tools used. Dr. Cleveland offers lessons to help any otolaryngologist improve their knowledge of this essential surgery. Finally, the episode concludes with a survey of contemporary trends in rhinoplasty.

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TIMESTAMPS

00:00 - Introduction

03:28 - Fundamentals of Rhinoplasty

04:19 - Interviewing Patients & Identifying Red Flags

10:25 - Physical Exam for Rhinoplasty

15:14 - The Importance of Photo Documentation

30:26 - Cephalic Trim & Turnover Flap Techniques

32:52 - Tip Supporting Grafts and Cartilage Harvesting

36:46 - Instruments for Rhinoplasty

39:42 - Sourcing Cartilage in Revision Rhinoplasty

49:20 - Post-operative Care & Complications

56:07 - Future Directions in Rhinoplasty

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RESOURCES

Patrick Cleveland Facial Plastic Surgery:

https://www.drpatrickcleveland.com/

Deformity, etiology, solution, sequence (DESS): Facial analysis in rhinoplasty: https://pubmed.ncbi.nlm.nih.gov/37952257/

Facial nerve injury affects each patient in a unique way. Accordingly, surgical treatment of facial paralysis must be meticulously planned and personalized. In this episode, Dr. Shiayin Yang, Associate Professor of Otolaryngology at Vanderbilt University, addresses management of synkinesis and static procedures for flaccid facial palsy with host Dr. Ashley Agan.

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PearsonRavitz

https://pearsonravitz.com/backtable

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SYNPOSIS

First, Dr. Yang reviews the difference between flaccid and non-flaccid (including synkinetic) facial paralysis. She describes her approach to facial paralysis, which includes clarifying the patient’s diagnosis and thoroughly examining the facial nerve function. Dr. Yang then transitions the conversation to surgical solutions, emphasizing dual goals of restoring symmetry and function. She divides her discussion to first tackle synkinesis and then static procedures for flaccid paralysis. Procedures discussed include Botox, brow lift, blepharoplasty, myectomy, and neurectomy as well as lower eyelid and midface procedures and temporalis tendon transfer. While surgical approaches to the two conditions differ, eye protection represents an important theme throughout. The episode concludes with Dr. Yang’s pearls for approaching these complex surgical problems and a reminder of how facial paralysis affects patients’ emotional health.

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TIMESTAMPS

00:00 - Introduction

02:36 - Understanding Flaccid & Non-Flaccid Facial Paralysis

07:13 - Botox for Facial Synkinesis

12:38 - History-Taking & Physical Exam in Facial Paralysis

15:07 - Surgical Management of Synkinesis

30:47 - Patient Counseling and Motivation

32:47 - Static Procedures for Flaccid Facial Palsy

37:26 - Nuances of Peri-Ocular Procedures

43:42 - Lower Eyelid & Midface Considerations

53:00 - Dynamic Surgery Options

56:56 - Final Surgical Pearls

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RESOURCES

Dr. Shiayin Yang’s Vanderbilt University Profile: https://www.vanderbilthealth.com/doctors/yang-shiayin

BackTable ENT Episode 151- Navigating Synkinesis: From Diagnosis to Comprehensive Care with Dr. Shiayin Yang

https://open.spotify.com/episode/1JucnHB8tNC5qRW6u82ie8?si=ba729d3f3e164d6f

Adding allergy services to your practice can improve your comprehensive ENT care. When otolaryngologists treat allergies, they more effectively address related conditions, such as sinusitis and otitis media. In this episode, Dr. Michelle Liu, general ENT in Fairfax, Virginia, shares her wisdom on starting an otolaryngologic allergy practice with host Dr. Ashley Agan.

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Medtronic ENT

https://www.medtronic.com/us-en/healthcare-professionals/medical-specialties/ear-nose-throat.html?cmpid=Vanity_URL_MIX_medtronicent-com_202212_US_EN_NS_ENT_FY23

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SYNPOSIS

First, Dr. Liu summarizes her journey to treating allergy as an otolaryngologist. She finds the continuity of care and personal connections that accompany allergy care fulfilling. Then, she describes the different testing and treatment modalities used in her clinic. While subcutaneous immunotherapy is more common, sublingual immunotherapy offers an appealing needle-free alternative for some patients. Finally, she explains the logistics of starting an allergy practice, including finances, continuing education, and safety considerations for immunotherapy initiation.

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TIMESTAMPS

00:00 - Introduction

03:36 - Dr. Liu’s Medical Journey: From Military Resident to Civilian Otolaryngologist

08:46 - Adding Allergy Testing to Your Practice

28:44 - Adding Immunotherapy to Your Practice

31:22 - Patient Selection & Financial Considerations

39:39 - Pediatric Allergy

45:09 - Emergency Preparedness in Allergy Clinics

49:15 - Sublingual Immunotherapy & Tablets

53:48 - Continuing Medical Education in Allergy

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RESOURCES

Medtronic ENT

https://www.medtronic.com/us-en/healthcare-professionals/products/ear-nose-throat.html

Dr. Michelle Liu’s Inova Profile:

https://www.inova.org/doctors/michelle-f-liu-md

Otolaryngology Associates’ Facebook Page:

https://www.facebook.com/otoassoc/

American Academy of Otolaryngologic Allergy:

https://www.aaoallergy.org/

In today’s complex healthcare landscape, how can pediatric otolaryngologists help more children access evidence-based, quality care? In this episode, Dr. Jill D’Souza, pediatric otolaryngologist at Children’s Hospital of New Orleans, discusses pediatric health equity in the Gulf South with hosts Dr. Gopi Shah and Dr. Ashley Agan.

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SYNPOSIS

First, Dr. D’Souza defines the “Gulf South” to include parts of Louisiana, Texas, Mississippi, Alabama, and the Florida panhandle. Challenges to healthcare delivery in this region include rural settings, high poverty rates, and difficulties funding out-of-state Medicaid patients. Then, using tonsillectomy and tracheostomy as examples, Dr. D’Souza explains how social factors complicate access to care. She shares her successes connecting underprivileged children to the care they need. Finally, the episode concludes with her thoughts on how interprofessional teamwork powers better pediatric ENT care.

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TIMESTAMPS

00:00 - Introduction

02:17 - Challenges in Pediatric ENT Care

05:43 - Healthcare Inequities in the Gulf South

10:38 - Tracheostomy Education in Rural, Resource-Limited Settings

21:33 - Helping Patients Tackle Financial Challenges

26:52 - Caring for All in Public Hospitals

37:57 - Keeping the Big Picture in Mind

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RESOURCES

PearsonRavitz

https://pearsonravitz.com/

Dr. Jill D’Souza’s LSU Health Profile: https://www.medschool.lsuhsc.edu/otorhinolaryngology/dsouza_jill.aspx

What is the best way to manage an infected thyroglossal duct cyst? In this episode, hosts Dr. Gopi Shah and Dr. Ashley Agan welcome Dr. Christopher Liu, associate professor of pediatric otolaryngology at UT Southwestern, to learn about his vast experience with evaluation and management of thyroglossal duct cysts and the nuances of other congenital neck masses.

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Medtronic ENT

https://www.medtronic.com/us-en/healthcare-professionals/medical-specialties/ear-nose-throat.html?cmpid=Vanity_URL_MIX_medtronicent-com_202212_US_EN_NS_ENT_FY23

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SYNPOSIS

First, Dr. Liu describes how thyroglossal duct cysts present. Patients often become aware of their cyst when a parent palpates a midline neck mass or when the cyst gets infected. Then, Dr. Liu describes non-operative management of thyroglossal duct cysts, including antibiotics to treat infection and cases in which drainage is appropriate. The conversation proceeds to surgical strategy, with Dr. Liu describing how his approach to cyst excision evolved over the years. The episode concludes with pearls on post-operative management and potential surgical complications.

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TIMESTAMPS

00:00 - Introduction

02:53 - Understanding Thyroglossal Duct Cysts

11:48 - Managing Infected Thyroglossal Duct Cysts

14:02 - Antibiotic Choices & Drainage Techniques

21:05 - Imaging & Workup

25:39 - Surgical Approach and Techniques

27:29 - Koempel’s Technique for Thyroglossal Duct Cyst Surgery

39:04 - Surgical Complications, Risk of Recurrence, & Post-Operative Care

52:37 - Key Takeaways for Thyroglossal Duct Cyst Surgery

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RESOURCES

Dr. Christopher Liu’s UT Southwestern Profile:

https://utswmed.org/doctors/christopher-liu/

Jeffrey Koempel, “Thyroglossal Duct Remnant Surgery: A Reliable, Reproducible Approach to the Suprahyoid Region”:

https://pubmed.ncbi.nlm.nih.gov/25193588/

Given that recurrent otitis media can expose children to hearing loss, delayed speech development, and repeated antibiotic use, it is not at all surprising that ear tube insertion is the most common ambulatory procedure performed in the United States. But what if there was a way to insert ear tubes in children without going to the operating room? In this episode, host Dr. Ashley Agan speaks with Dr. Shelagh Cofer, pediatric otolaryngologist at the Mayo Clinic, about the Hummingbird Tympanostomy Tube insertion system.

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Hummingbird PE Ear Tubes

https://www.hummingbirdeartubes.com/physicians/hummingbird-tts-device/

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SYNPOSIS

First, Dr. Cofer reviews the epidemiology of pediatric otitis media. When a child has 3 ear infections in three months or 5-7 in a year, tympanostomy tubes are indicated. Wanting to facilitate this procedure, Dr. Cofer brought the in-office Hummingbird tympanostomy tube system to her practice as one of the principal investigators in the clinical trials. After reviewing how the device was developed, she walks listeners through how she uses it, including how to avoid pitfalls such as “dunking” a tube. Finally, she shares feedback from parents whose children had ear tubes inserted using the Hummingbird system.

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TIMESTAMPS

00:00 - Introduction

02:25 - Ear Infections & Ear Tubes

09:34 - Selecting Patients for In-Office Ear Tube Placement

15:50 - Inserting Ear Tubes in the Office: A Step-by-Step Guide

34:33 - Benefits of In-Office Ear Tube Placement

42:35 - Avoiding & Mitigating Complications from Ear Tube Insertion

56:23 - Parent Feedback on the Hummingbird System

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RESOURCES

Dr. Shelagh Cofer’s Mayo Clinic Profile: https://www.mayoclinic.org/biographies/cofer-shelagh-a-m-d/bio-20055176

Hummingbird TTS Website:

https://www.hummingbirdeartubes.com/

Epidemiological studies reveal that women make up 25% of all obstructive sleep apnea (OSA) patients, yet only 11% of patients carrying OSA diagnoses are women. What drives this disparity? In this episode of the BackTable ENT Podcast, sleep surgeon and UCSF Associate Professor Dr. Megan Durr joins host Dr. Gopi Shah to discuss OSA in women.

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Medtronic ENT

https://www.medtronic.com/us-en/healthcare-professionals/medical-specialties/ear-nose-throat.html?cmpid=Vanity_URL_MIX_medtronicent-com_202212_US_EN_NS_ENT_FY23

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SYNPOSIS

First, Dr. Durr recounts her path to sleep surgery, including her interest in women’s sleep issues, which grew out of discussions with her female friends experiencing pregnancy-related sleep disturbances. When asked why OSA is under-diagnosed in women, Dr. Durr underscores how women’s OSA symptoms – mental fog, memory issues, and insomnia – are relatively nonspecific. While it presents differently in women, OSA increases the risk of heart failure, hypertension, and dementia in all patients, regardless of sex. Then, Dr. Durr shares her physical exam and testing strategies to uncover OSA in female patients. Once diagnosed, she advocates multimodal treatment, including CPAP, weight loss, and surgery.

The podcast concludes with discussion of how ENTs can eliminate barriers to better sleep in women, underrepresented minorities, and low-income patients.

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TIMESTAMPS

00:00 - Welcome to the BackTable ENT Podcast

03:06 - Dr. Megan Durr’s Background & Journey

08:15 - Challenges Diagnosing Sleep Apnea in Women

14:55 - Long-term Effects of Sleep Apnea in Women

20:06 - Hormonal Influences on Sleep Apnea

29:56 - CPAP & Oral Devices in Women with OSA

32:21 - Positional Therapy & Surgery in Women with OSA

36:34 - Weight Loss to Combat OSA

41:04 - Countering Disparities in OSA Treatment

48:06 - Identifying & Caring For “Unseen” OSA Patients: A Team Effort

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RESOURCES

Medtronic ENT

https://www.medtronic.com/us-en/healthcare-professionals/products/ear-nose-throat.html

Dr. Durr’s UCSF Profile:

https://ohns.ucsf.edu/megan-durr

Dr. Durr’s X:

https://x.com/drmegandurr