In this episode, Dr. Ashleigh Halderman, Rhinologist and Associate Professor at the University of Texas Southwestern Medical Center, discusses chronic invasive fungal sinusitis with hosts Dr. Gopi Shah and Dr. Ashley Agan,

First, Dr. Halderman outlines her advocacy work as President of the Texas Association of Otolaryngology. Then, the discussion transitions to chronic invasive fungal sinusitis. Dr. Halderman defines the disease, describes typical patient presentation, and reviews concerning imaging findings. Until biopsy can clinch the diagnosis, she maintains a high index of suspicion in cases of bizarre clinical presentation or facial paresthesia. The surgeons then shift their attention to management, which consists of culture-directed antifungals and judicious surgical intervention. Dr. Halderman wraps up the episode by sharing her pearls for operative management and long-term surveillance.

---

SHOW NOTES

00:00 - Introduction

02:10 - Exploring the Texas Association of Otolaryngology

05:58 - Understanding Chronic Invasive Fungal Sinusitis: Types & Treatments

20:25 - Diagnostic Challenges and Imaging Insights

27:07 - Navigating Diagnostic Challenges and Treatment Options

29:40 - The Role of Biopsy in Confirming Fungal Infections

30:52 - Surgical Considerations and Pre-Operative Strategies

40:29 - Surveillance Strategies: Managing Chronic Invasive Fungal Sinusitis

46:34 - The Future of Surgical & Antifungal Therapies for Chronic Invasive Fungal Sinusitis

---

RESOURCES

Dr. Ashleigh Halderman’s UT Southwestern Profile:

https://utswmed.org/doctors/ashleigh-halderman/

BackTable ENT Episode 30, “Revision Endoscopic Sinus Surgery"

https://www.backtable.com/shows/ent/podcasts/30/revision-endoscopic-sinus-surgery

Texas Association of Otolarynogology:

https://www.taohns.org/

In this episode, Dr. Sohit Kanotra, director of UCLA’s Complex Pediatric Airway Program, discusses open airway surgery in children with host Dr. Gopi Shah.

First, the surgeons review the presentation of pediatric airway stenosis, which causes stridor in younger children and exercise intolerance in older ones. Drawing on his experience at UCLA, Dr. Kanotra addresses how to build a pediatric airway program, emphasizing the importance of relationships with the NICU and PICU. He advises airway surgeons to coordinate with these units to share protocols, organize conferences, and assist with bedside swallow assessments. Then, the discussion transitions to pre-operative evaluation of and contemporary strategies in pediatric airway reconstruction. Dr. Kanotra shares pearls for surgical planning, operative technique, and post-operative management. The episode concludes with Dr. Kanotra’s high-level advice to fellow pediatric airway surgeons.

---

SHOW NOTES

00:00 - Introduction

03:03 - Building UCLA’s Complex Airway Program

09:37 - Decision-Making in Pediatric Open Airway Surgery

20:10 - Pediatric Airway Surgery: A Multidisciplinary Effort

32:24 - Preoperative Assessment for Open Airway Surgery

38:16 - Evaluating the Airway: Techniques & Tools

39:34 - Planning for Open Airway Surgery

40:15 - Understanding Expansion & Resection Procedures

56:58 - Using Release Maneuvers in Pediatric Open Airway Surgery

01:00:29 - Post-operative Management and Follow-up

01:06:33 - Concluding Thoughts & Pearls

---

RESOURCES

Dr. Sohit Kanotra’s UCLA Profile

https://www.uclahealth.org/providers/sohit-kanotra

In this episode, hosts Dr. Gopi Shah and Dr. Ashley Agan talk to Dr. Stephen Schoeff, laryngologist at Kaiser Permanente (Tacoma, WA) about subglottic stenosis in adults.

Dr. Schoeff introduces subglottic stenosis (SS) as a rare condition affecting adult women of all ages. Patients complain of progressive dyspnea, declining exercise tolerance, and mucus sensation. Sometimes confused for asthma, globus sensation, LPR, or paradoxical vocal fold motion, SS is diagnosed when airway scarring and narrowing is visible on laryngoscopy. After describing workup, Dr. Schoeff reviews etiologies of SS, including iatrogenic, idiopathic, and autoimmune. Treatment options for SS include cricotracheal resection, endoscopic dilation, and airway steroid injections. Dr. Schoeff concludes the episode by sharing his success using periodic airway steroid injections for treatment of SS.

---

SHOW NOTES

00:00 - Introduction

01:21 - Dr. Schoeff’s Journey & Practice

08:28 - Symptoms & Differential Diagnosis

12:31 - Physical Examination & Diagnosis

27:23 - Introduction to Endoscopic Dilation

28:57 - Steroid Injections as a Management Option

31:24 - The Three Big Categories of Treatment

33:05 - How Steroids Address Disease Pathophysiology

38:58 - Technique for Airway Dilation

49:06 - Deciding on Cricotracheal Resection

51:14 - How Insurance Affects Treatment Options

55:05 - Final Thoughts & Pearls

In this episode, hosts Dr. Ashley Agan and Dr. Gopi Shah discuss the transition from residency to private practice with Dr. Christopher Gentile of Northeast Atlanta ENT.

First, Dr. Gentile briefly describes his career journey from medical school to private practice. Shedding light on the residency to private practice transition, he addresses the challenges of adapting to a new clinical environment and negotiating an employment contract. Then, he dives into the day-to-day realities of private practice. He advises young otolaryngologists to build strong connections with their clinic team, which includes practice managers, medical assistants, and fellow surgeons. By advocating for themselves, young otolaryngologists can balance their load of surgical cases and pursue areas of clinical interest. Finally, he shares tips on choosing a first job out of residency.

---

EARN CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/2jhXN8

---

SHOW NOTES

00:00 - Introduction

01:36 - Dr. Gentile’s Journey and Current Practice

08:03 - Determining How Your Contract is Structured

12:02 - Tips for Negotiating Contracts

15:16 - Understanding Patient Scheduling & Practice Structure

20:35 - The Struggles of Balancing Work & Personal Life

24:18 - The Importance of Building a Team Around You

26:37 - Establishing Yourself in a New Practice

31:39 - The Job Hunting Experience: Lessons Learned

38:24 - Final Thoughts & Advice for New Graduates

---

RESOURCES

Dr. Gentile’s Northeast Atlanta ENT Profile:

https://northeastatlantaent.com/christopher-gentile-m-d/

In this episode, host Dr. Ashley Agan discusses eustachian tube (ET) dilation with Dr. Dennis Poe, neurotologist and Professor of Otolaryngology at Harvard Medical School.

First, the surgeons describe clinically meaningful differences between adult and pediatric ETs. Then, Dr. Poe reviews workup of pediatric ET disorders. Since inflammation accounts for most ET dysfunction, controlling comorbid allergies and/or performing adenoidectomy provides relief to some patients. For patients with continued symptoms, balloon dilation – now approved for children as young as eight years of age– directly counteracts obstructive inflammation in the tube lumen. To conclude, Dr. Poe describes how to select patients for, perform, and avoid complications of balloon dilation.

---

CHECK OUT OUR SPONSOR

Acclarent AERA Eustachian Tube Balloon Dilation System

https://www.jnjmedtech.com/en-US/product/Acclarent-aera-eustachian-tube-balloon-dilation-system

---

SHOW NOTES

00:00 - Introduction

04:03 - Understanding Eustachian Tube Anatomy

07:22 - Causes of Eustachian Tube Dysfunction in Children

12:53 - Examination and Diagnosis of Eustachian Tube Dysfunction

19:10 - Treatment Options for Eustachian Tube Dysfunction

27:05 - Avoiding Unpredictable Injury and Scarring During Balloon Dilation

31:51 - Contraindications and Precautions for Balloon Dilation

37:49 - Understanding Risks & Complications of Balloon Dilation

48:34 - Closing Remarks & Future Prospects

---

RESOURCES

Dr. Dennis Poe’s Harvard Profile:

https://oto.hms.harvard.edu/people/dennis-poe

BackTable ENT Ep. 40 – “Diagnosis & Management of Eustachian Tube Disorders with Dr. Dennis Poe:”

https://www.backtable.com/shows/ent/podcasts/40/diagnosis-management-of-eustachian-tube-disorders

American Academy of Otolaryngology-Head and Neck Surgery Clinical Practice Guideline: Otitis Media with Effusion (Update):

https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/ome/

“Complications of Eustachian Tube Balloon Dilation: Manufacturer and User Facility Device Experience (MAUDE) Database Analysis and Literature Review,” Chisolm, P.F. et al: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10731503/

In this episode, Dr. Nora Perkins (Albany ENT & Allergy Services), discusses in-office procedural management of nasal airway obstruction with hosts Dr. Ashley Agan and Dr. Gopi Shah.

First, the surgeons discuss the advantages of in-office procedures. Then, Dr. Perkins describes different presentations of nasal airway obstruction and their medical management. Diving deeper, Dr. Perkins shares her procedural workflow, including anesthetic protocols, her VivAer Aerin device technique, and billing considerations. Finally, the episode concludes with Dr. Perkins’ advice to otolaryngologists interested in performing more in-office procedures.

---

CHECK OUT OUR SPONSOR

Aerin Medical

https://aerinmedical.com/

---

SHOW NOTES

00:00 - Introduction

02:07 - Discussion of Nasal Airway Obstruction

08:21 - The Patient with Nasal Airway Obstruction

15:29 - Medical Management of Nasal Airway Obstruction

26:17 - The Aerin VivAer RF Ablation Device

32:12 - Anatomical Considerations and Treatment Options

35:10 - Anesthetic Protocol & Patient Comfort

47:56 - Long-term Outcomes and Quality of Life

49:42 - Billing and Insurance Considerations

---

RESOURCES

Dr. Nora Perkins’ Albany ENT & Allergy Services Profile:

https://albanyentandallergy.com/bio/nora-w-perkins/

Aerin VivAer Website:

https://vivaer.com/

In this episode, Dr. Anita Jeyakumar, pediatric ENT at Mercy Health (Youngstown, Ohio) discusses language for Deaf and Hard of Hearing (HoH) children with podcast host Dr. Gopi Shah.

First, Dr. Jeyakumar explains the difference between speech and language. She then introduces the concept of “language nutrition,” which describes social exposure to rich and varied language. Acknowledging that language fluency–spoken or visual such as American Sign Language–underlies success, she shares strategies to foster these skills in Deaf and HoH children. Dr. Jeyakumar describes resources that support these patients, including early intervention services for children under age three and school-based resources for older children. She reviews assistive technologies including hearing aids, cochlear implants, and closed captioning. To conclude, she urges physician advocacy to better support the needs of Deaf and HoH children.

---

SHOW NOTES

00:00 - Introduction

02:08 - Understanding Language and Speech

04:23 - The Concept of Language Nutrition

07:53 - Addressing Speech Delay in Children

21:32 - The Role of Technology in Supporting Deaf and HoH Children

24:10 - Promoting Health Equity for Deaf and HoH Children

27:52 - Resources for Families of Deaf and HoH Children

---

RESOURCES

Dr. Anita Jeyakumar’s Mercy Health Profile:

https://www.mercy.com/find-a-doctor/physicians/anita-s-jeyakumar/1985497

Hands & Voices Guide By Your Side™:

https://www.handsandvoices.org/gbys/

American Speech-Language-Hearing Association (ASHA):

https://www.asha.org/

American Cochlear Implant Alliance (ACI Alliance):

https://www.acialliance.org/

A.G. Bell Association for the Deaf & Hard of Hearing:

https://www.agbell.org/

In this episode, Dr. Spencer Payne, a rhinologist at the University of Virginia School of Medicine, shares his journey developing RefluxRaft, a natural, alginate-based reflux therapy, with host Dr. Ashley Agan.

First, Dr. Payne describes how his research interests and father’s premature death spurred his interest in functional medicine. Wary of side effects associated with conventional reflux medications, he teamed up with fellow UVA faculty member and laryngologist Dr. James (Jim) Daniero to develop RefluxRaft, a natural dietary supplement. Starting from his initial concept, Dr. Payne delves into challenges marketing, manufacturing, and distributing RefluxRaft. He then explains how RefluxRaft uses alginates to combine with stomach acid and form a gel-like “raft” that stops movement of acid into the esophagus. The episode concludes with an overview of how to dose and order RefluxRaft.

---

SHOW NOTES

00:00 - Introduction

03:45 - Holistic Approaches to Medicine

06:46 - Functional Medicine Perspective on Reflux

08:54 - Dietary Modifications for Reflux Patients

17:07 - The Development of RefluxRaft

20:00 - From Concept to Prototype: The Kitchen Lab Experiments

20:57 - The Business Side: Marketing, Manufacturing, & Logistics

27:21 - The Product: Understanding Alginates & Their Benefits

36:29 - The Future: New Flavors & Holistic Reflux Therapies

---

RESOURCES

Dr. Payne’s UVA Profile

https://med.virginia.edu/otolaryngology/faculty/spencer-c-payne-m-d/

Dr. Daniero’s UVA Profile:

https://med.virginia.edu/otolaryngology/faculty/james-j-daniero-m-d-m-s/

RefluxRaft: Natural Reflux Relief:

https://refluxraft.com/

RefluxRaft YouTube Channel:

https://www.youtube.com/@refluxraft

In this episode, Dr. Gerard Gianoli of The Ear & Balance Institute (Covington, Louisiana), joins host Dr. Ashley Agan to discuss his experience with the third-party-free practice model.

First, Dr. Gianoli describes how his work treating vestibular disorders spurred his interest in the third-party-free practice model, where patients pay upfront for services, then submit insurance claims for reimbursement as appropriate. Dr. Gianoli walks listeners through his practice’s transition, focusing on referral patterns and patient concerns. Then, the surgeons speak to the model’s advantages, including reduced rates of physician burnout, higher-value patient care, and reduced administrative burden. Looking ahead, Dr. Gianoli assesses the role of third-party-free practices in the U.S. healthcare landscape. Finally, the episode wraps with a discussion of Dr. Gianoli’s recent book on Third Mobile Window Syndrome.

---

SHOW NOTES

00:00 - Introduction

05:34 - Transitioning to a Third-Party-Free Practice

07:48 - The Financial Impact of Going Third-Party-Free

12:11 - Benefits of a Third-Party-Free Practice

27:28 - Navigating Surgery Costs in a Third-Party-Free Practice

32:01 - Determining Prices in a Cash-Based Practice

35:10 - The Importance of Patient Education in Medical Practice

38:15 - Drawbacks of the Third-Party-Free Model

52:32 - Trends in Physician Practice Models

56:38 - Dr. Gianoli’s Book on Third Mobile Window Syndrome

---

RESOURCES

Dr. Gianoli’s physician profile at the Ear & Balance Institute:

https://earandbalance.net/dr-gianoli/

Dr. Gianoli’s Wall Street Journal Editorial from January 2015: “Saying Goodbye to Third-Party Medical Payments.”

https://www.wsj.com/articles/gerard-j-gianoli-saying-goodbye-to-third-party-medical-payments-1421280968

“Third Mobile Window Syndrome of the Ear: Superior Semicircular Canal Dehiscence and Associated Disorders,” edited by Gerard Gianoli and Philippa Thomson:

https://link.springer.com/book/10.1007/978-3-031-16586-3

“The Private Practice Solution: Reclaiming Physician Autonomy and Restoring the Doctor-Patient Relationship,” by Grace Torres-Hodges:

https://www.amazon.com/Private-Practice-Solution-Doctor-Patient-Relationship/dp/B0CK3QR1XX