In this episode, Dr. Raj Sindwani, rhinologist at the Cleveland Clinic, joins host Dr. Gopi Shah to discuss advanced navigation systems, such as virtual reality (VR), to improve functional endoscopic sinus surgery (FESS).

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CHECK OUT OUR SPONSOR

Stryker ENT

https://ent.stryker.com

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SYNPOSIS

First, Dr. Sindwani shares how he combines pre-operative imaging data and navigation to plan successful surgeries. Then, he delves into features available in newer navigation systems, including target/anti-target technology, which notifies surgeons as their instruments approach critical structures. He covers topics relevant to navigation in clinical practice, including reimbursement, patient counseling, and troubleshooting in the OR. The episode concludes with a short conversation on the future of navigation-assisted FESS.

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TIMESTAMPS

00:00 - When to Use Navigation

10:42 - Harnessing Augmented Reality for Better Surgical Planning

20:43 - Registering Landmarks with Navigation

22:27 - How Navigation Systems Enhance Surgical Education

27:53 - Navigation in Office-Based Procedures

35:05 - Troubleshooting Problems with Navigation Systems

42:25 - The Future of Navigation-Assisted FESS

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RESOURCES

Stryker ENT Products:

https://www.stryker.com/us/en/ent.html

Dr. Sindwani’s Cleveland Clinic Profile:

https://my.clevelandclinic.org/staff/14102-raj-sindwani

In this episode of the BackTable ENT Podcast, thyroid expert Dr. Dana Gibbs speaks with host Dr. Ashley Agan about Hashimoto’s Thyroiditis and hypothyroidism. Despite the high prevalence of Hashimoto’s Thyroiditis (1-2%), the condition is often misunderstood. Otolaryngologists and internists alike will benefit from Dr. Gibbs’ insight into Hashimoto’s presentation, diagnosis, and treatment.

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SYNPOSIS

First, Dr. Gibbs explains how she shifted her clinical focus from comprehensive otolaryngology to thyroid disease. Recounting her decades-long, personal experience with hypothyroidism, she describes how nonspecific symptoms of fatigue, hair loss, and weight gain can lead clinicians astray. Then, she reviews the pathophysiology and diagnosis of Hashimoto’s Thyroiditis. Using labs and questionnaires, she interrogates the patient’s overall endocrine health, which she addresses using a combination of levothyroxine (T4), liothyronine (T3), and select supplements. She demonstrates how lessons learned treating Hashimoto’s extend to hypothyroidism management more broadly. Finally, the use of integrative medicine strategies to treat thyroid disorders is discussed.

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TIMESTAMPS

00:00 - Introduction

02:33 - Dr. Gibbs’ Personal Experience with Hypothyroidism

11:32 - Understanding Hashimoto’s Thyroiditis

18:26 - Hashimoto’s: A Challenging Diagnosis

33:17 - The Role of Stress in Thyroid Disease

35:04 - Thyroid Medications

51:21 - The Role of Surgery in Managing Hypothyroidism

55:01 - An Integrative Medicine Perspective on Hypothyroidism

59:27 - Final Thoughts on Hashimoto’s & Hypothyroidism

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RESOURCES

Dr. Gibbs’ Consultants in Metabolism Profile:

https://www.danagibbsmd.com/

Dr. Gibbs’ Instagram:

https://www.instagram.com/danagibbsmd/

In this episode, Dr. Mihir Patel, Professor of Otolaryngology at Emory University and expert in Transoral Robotic Surgery (TORS), discusses HPV-positive head and neck cancer with host Dr. Ashley Agan.

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CHECK OUT OUR SPONSOR

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

Dr. Patel opens by briefly sharing his journey to head & neck surgery, and, more specifically, expertise in TORS. After, Dr. Patel explains the epidemiology and pathophysiology of HPV-caused cancers, which frequently present as painless neck masses. Then, Dr. Patel describes workup and treatment of these cancers. He shares surgical strategies, paying special attention to cases of unknown primary lesions. He underscores the importance of collaboration with medical and radiation oncologists, particularly given the rapid pace of treatment innovation. Finally, Dr. Agan and Dr. Patel examine how increased HPV vaccine uptake could drastically lower the burden of this disease in the coming decades.

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TIMESTAMPS

00:00 - Introduction

05:26 - The Evolution of HPV-Related Oropharyngeal Cancer Treatment

17:26 - Contemporary Diagnostics for Head & Neck Cancer

24:39 - Surgical Strategies for Unknown Primary Lesions

38:15 - The Role of ctDNA in Cancer Management

46:10 - Advancements in HPV-Driven Cancer Treatment

53:30 - The Future of Cancer Screening and Vaccination

01:01:54 - Vaccination: A Tool for Cancer Prevention

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RESOURCES

Medtronic ENT:

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

Dr. Mihir Patel’s Emory University Profile:

https://winshipcancer.emory.edu/bios/faculty/patel-mihir-r.html

AVOID Trial:

https://pubmed.ncbi.nlm.nih.gov/31785337/

In this episode, hosts Dr. Ashley Agan and Dr. Gopi Shah discuss the ENT workforce with Dr. Andrew (“AJ”) Tompkins, an Ohio-based comprehensive otolaryngologist and member of the American Academy of Otolaryngology-Head and Neck Surgery’s socioeconomic task force.

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SYNPOSIS

First, Dr. Tompkins provides an overview of the ENT workforce from trainee to retiree stages. He describes his work with the Academy’s socioeconomic task force, which provides important feedback on the number, location and work environments of practicing otolaryngologists. He emphasizes participation in the Academy’s workforce survey as the source of this data. Offering a sneak preview of 2023 survey results, Dr. Tompkins underscores the need to increase resident exposure to private practice settings and to plan for how treatment breakthroughs (such as the HPV vaccine) might affect future workforce needs. The surgeons finish by discussing necessary improvements in resident selection and continuing education.

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TIMESTAMPS

00:00 - Introduction

03:09 - Exploring the ENT Workforce: A Provocative Topic

08:09 - Unpacking the Challenges of ENT Workforce Data

22:16 - The Impact of Fellowship Training & Practice Shifts

31:59 - Previewing 2023 Data Insights

37:09 - Addressing Workforce Distribution and Access Issues

43:30 - How Technology & Training Influence the ENT Workforce

56:20 - Collaborations & Future Directions

01:01:24 - Concluding Thoughts on Workforce Dynamics

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RESOURCES

Dr. Andrew Tompkins’ Ohio ENT & Allergy Profile:

https://www.ohioentandallergy.com/physicians/andrew-tompkins-md-mba/

Triological Society Otolaryngology Workforce Analysis from 2016: https://onlinelibrary.wiley.com/doi/abs/10.1002/lary.26238

“The 2022 Otolaryngology Workforce” Report from AAO-HNS:

https://www.entnet.org/wp-content/uploads/2023/07/2022-Otolaryngology-Workforce.pdf

Tompkins AJ. The Otolaryngology Workforce, Part I: Supply. ENTtoday. May 2022.

https://www.enttoday.org/article/some-studies-predict-a-shortage-of-otolaryngologists-do-the-numbers-support-them/

Tompkins AJ. The Otolaryngology Workforce, Part II: Structure & Rethinking Supply. ENTtoday. June 2022.

https://www.enttoday.org/article/transparent-regular-data-vital-to-reworking-how-we-think-about-workforce-supply/

Tompkins AJ. The Otolaryngology Workforce, Part III: Competition & Future Design. ENTtoday. July 2022.

https://www.enttoday.org/article/tips-for-creating-a-dynamic-otolaryngology-workforce/

In this episode of the BackTable ENT podcast, Dr. Pete Manes, associate professor of rhinology at Yale, discusses political advocacy with host Dr. Ashley Agan.

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SYNPOSIS

Dr. Manes begins by explaining how a life-long interest in government underlies his work as a physician-advocate with the American Academy of Otolaryngology-Head & Neck Surgery. Currently, he serves as the Academy’s Coordinator of Health Policy, where he contributes to private payer advocacy and Academy position statements. Drawing on this experience, he explains political challenges associated with being a smaller specialty, roles played by of Action Committees (PACs), and steps in legislative advocacy. Then, he shifts focus to cover how the Academy works with private payers to ensure fair reimbursement. The podcast concludes with resources to connect otolaryngologists with advocacy work.

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TIMESTAMPS

00:00 - Introduction

01:02 - Dr. Pete Manes’s Advocacy Role

08:04 - The Importance of Advocacy in Medicine

20:24 - Scope of Practice and Physician Payment Reform

30:02 - Building Relationships for Healthcare Advocacy

37:12 - Navigating Insurance Companies for Patient Advocacy

42:33 - Utilizing Position Statements in Healthcare Advocacy

48:29 - Accessing Academy Resources for Healthcare Advocacy

50:43 - Exploring Opportunities for Engagement and Advocacy

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RESOURCES

Dr. Pete Manes’s Yale University Profile:

https://medicine.yale.edu/surgery/otolaryngology/profile/rpeter-manes/

American Academy of Head & Neck Surgery (AAO-HNS) Position Statements:

https://www.entnet.org/business-of-medicine/position-statements/

AAO-HNS Health Policy Contact:

[email protected]

In this episode, Dr. Hamdy El-Hakim, pediatric airway surgeon and Associate Professor at the University of Alberta, joins host Dr. Gopi Shah to review laryngeal clefts in children.

First, Dr. El-Hakim describes the presentation of laryngeal clefts. Affected children have coughing fits bad enough to cause watery eyes and “blue spells.” These fits are sometimes misattributed to other airway abnormalities or GERD. Then, discussion shifts to the workup of laryngeal clefts. All patients with a suspected laryngeal cleft need a comprehensive physical exam, a risk factor assessment and a swallow assessment, most commonly a FEES. Many patients will also require a diagnostic laryngoscopy with bronchoscopy (DLB). Dr. El-Hakim advises listeners on performing this test in children. Treatment of laryngeal clefts include thickened feeds, injection laryngoplasty, or surgical repair. Finally, Dr. El-Hakim advises listeners on compassionate care for families living with this condition.

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SHOW NOTES

00:00 - Introduction

03:39 - Laryngeal Clefts in Children: Diagnosis & Classification

06:36 - Presentation of Laryngeal Cleft

12:07 - Risk Factors & Associated Conditions

21:38 - Physical Examination Insights and Diagnostic Approaches

30:15 - The Role of FEES and Modified Barium Swallow in Diagnosis

37:37 - Navigating Pediatric Swallowing Disorders: Strategies and Challenges

41:12 - The Complexities of Diagnosing & Treating Laryngeal Cleft

45:28 - Surgical Techniques & Postoperative Care

01:03:13 - Evaluating Success Post-Surgery

01:09:20 - Final Thoughts: The Impact of Pediatric Dysphagia on Families

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RESOURCES

Dr. Hamdy El-Hakim’s University of Alberta Profile:

https://www.ualberta.ca/airway-research/iarc-team/hamdy-el-hakim.html

Article demonstrating superiority of cold steel relative to laser in type I laryngeal cleft repair:

https://pubmed.ncbi.nlm.nih.gov/34184769/

In this episode, Dr. Mark Royer, private practice otolaryngologist and medical director of ENTLocums.com, joins BackTable to discuss salary negotiation for physicians.

Dr. Royer begins by using his personal career journey to highlight the importance of negotiation skills. Then, he describes how to develop these skills. Throughout the episode, Dr. Royer emphasizes the importance of knowing one’s value as a surgical subspecialist and tailoring your strategy to best suit your employer’s perspective and your needs. Relevant topics covered include selecting a practice, starting salaries, RVUs, locums, and non-compete agreements. Dr. Royer concludes by encouraging otolaryngologists to reflect on what they truly want out of their careers as they approach the negotiation table.

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SHOW NOTES

00:00 - Introduction

01:22 - Salary Negotiation

05:24 - Dr. Royer’s Journey from Residency to Entrepreneurship

10:16 - Negotiating Your Salary: Essential Tips and Strategies

26:27 - Different Approaches to Negotiation: Hospital vs. Private Practice

28:40 - Exploring the World of Locum Tenens

31:59 - Mid-Career Physician Negotiations and Raises

41:26 - Mastering Negotiation Tactics and Strategies: Tips from “Never Split the Difference”

47:38 - Navigating Non-Compete Clauses & Final Thoughts

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RESOURCES

ENT Surgery Solutions, LLC:

https://www.entlocums.com/

BackTable ENT Episode 57, “Locums Opportunities in ENT with Dr. Allison Royer:”

https://www.backtable.com/shows/ent/podcasts/57/locums-opportunities-in-ent

BackTable ENT Episode 107, “How Do I Negotiate My Physician Contract? Part I with Michael Johnson Jr., Esq:”

https://www.backtable.com/shows/ent/podcasts/107/how-do-i-negotiate-my-physician-contract-part-i

BackTable ENT Episode 108, “How Do I Negotiate My Physician Contract? Part II with Michael Johnson Jr., Esq:”

https://www.backtable.com/shows/ent/podcasts/108/how-do-i-negotiate-my-physician-contract-part-ii

“Never Split the Difference” by Chris Voss:

https://www.amazon.com/Never-Split-Difference-Negotiating-Depended/dp/0062407805

In this episode, Dr. Gavin Setzen of Albany ENT & Allergy Services addresses the current landscape of insurance reimbursement with host Dr. Ashley Agan.

The episode opens by reviewing the current state of healthcare financing, where climbing costs, declining reimbursement, and continued consolidation of medical groups confront physician-owned private practices. Mindful of this context, Dr. Setzen describes his experiences tackling reimbursement challenges. Recounting his successes, Dr. Setzen encourages physicians to base their claims in evidence-based medicine, enlist allies (such as patient unions), and develop relationships with insurers. He then provides strategies to efficiently manage Prior Authorizations, including Peer-to-Peer conversations. Finally, Dr. Setzen shares how coordinating one’s reimbursement strategy with colleagues and advocacy groups helps increase odds of success.

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CHECK OUT OUR SPONSOR

Stryker ENT

https://ent.stryker.com

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SHOW NOTES

00:00 - Introduction

01:55 - Dr. Gavin Setzen’s Journey and Practice Insights

05:30 - The Challenges of Healthcare Landscape and Insurance

10:06 - Innovations in ENT: Navigating New Technologies & Reimbursement Challenges

20:23 - Strategies for Overcoming Insurance Denials

52:30 - The Importance of Data and Collaboration in Patient Advocacy

55:19 - Closing Thoughts

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RESOURCES

Dr. Setzen’s Albany ENT & Allergy Services Profile:

https://albanyentandallergy.com/bio/gavin-setzen/

In this episode, pediatric otolaryngologist Dr. Julie Wei (Akron Children’s Hospital) and psychologist Dr. Herdley Paolini discuss surgeon burnout with guest host, pediatric otolaryngologist Dr. Anthony Sheyn (Le Bonheur Children’s Hospital).

First, Dr. Paolini reviews causes of surgeon burnout, drawing on three decades of experience working in physician wellness. Then, Dr. Sheyn and Dr. Wei discuss steps they’ve taken to combat burnout. Dr. Wei illuminates challenges unique to female surgeons, including higher levels of emotional exhaustion, fertility struggles, and ‘mom guilt.’ Then, the discussion shifts to address the roles that healthcare administration and medical education play in surgeon burnout. The podcast concludes with Dr. Wei’s experience advocating for needed changes in her hospital’s call policies.

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SHOW NOTES

00:00 - Introduction

03:18 - Operating Through Challenges: Dr. Wei’s Experience with Burnout

06:02 - Exploring Causes of Surgeon Burnout with Dr. Paolini

16:03 - Squashing the Stigma: Embracing Vulnerability in Surgery

25:37 - The Power of Advocacy and Building a Case for Wellness Programs

31:06 - Early Interventions and Transforming Medical Education

34:10 - Balancing Professional & Personal Life As A Surgeon

42:47 - Initiating System Changes for Physician Well-being

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RESOURCES

Dr. Anthony Sheyn’s Le Bonheur Children’s Hospital Profile:

https://www.lebonheur.org/doctors/anthony-sheyn

Dr. Julie Wei’s Akron Children’s Hospital Profile:

https://akronchildrens.org/people/Julie-Wei.html

About Dr. Herdley Paolini:

https://www.physicianintegration.org/about

“Safeguarding Physician Wellbeing” by Dr. Julie Wei:

https://www.routledge.com/Safeguarding-Physician-Wellbeing-Using-Checklists-for-Personal-Professional-and-Psychological-Safety/Wei/p/book/9781032589893

“Inside the Mind of a Physician: Illuminating the Mystery of How Doctors Think, What they Feel, and Why they Do the Things They Do” by Dr. Herdley Paolini:

https://www.amazon.com/Inside-Mind-Physician-Illuminating-Publishing/dp/0982040903

In this episode, Pediatric Speech Language Pathologist (SLP) Olivia Brooks (University of Florida Shands Hospital) shares her experience performing inpatient fiberoptic endoscopic evaluation of swallowing (FEES) with host Dr. Gopi Shah.

First, Olivia reviews the presentation of swallowing disorders in infants. She explains differences between the two most common swallowing tests: videofluoroscopic swallow study (VFSS) and (FEES). Then, she reviews how she uses patient comorbidities and the physical exam to select the appropriate test for each infant. Underscoring the importance of collaboration across care teams, she describes her role performing swallow studies in the NICU and pediatric CVICU. She then shares tips on equipment, ergonomics, and teamwork while performing bedside FEES. The podcast wraps with her advice about working on an interprofessional team to care for children with swallowing disorders.

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CHECK OUT OUR SPONSOR

Karl Storz Tele Pack

https://www.karlstorz.com/

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SHOW NOTES

00:00 - Introduction

06:26 - The Importance of a Comprehensive Evaluation

13:00 - Choosing Between VFSS & FEES

22:44 - The Evolution of Inpatient Bedside FEES

31:27 - The Role of Speech Pathologists in Swallow Assessment

33:23 - Collaboration between Speech Pathologists & Otolaryngologists

35:31 - Developing Safety Protocols for Bedside FEES

41:21 - Equipment for Bedside FEES

53:20 - Differences between the NICU and the CVICU

01:00:03 - Final Thoughts and Advice Regarding Swallow Studies

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RESOURCES

KARL STORZ ENT Products:

https://www.karlstorznetwork1.com/ent

Olivia Brooks CCC-SLP’s UF Profile

https://ufhealth.org/doctors/olivia-a-brooks/bio