BackTable ENT

Behind every smooth surgery is a team member you may not see in the spotlight—but without them, the operation doesn’t run. In this episode of the BackTable ENT podcast, Jose Flores, a surgical technologist at Rady Children’s Hospital in San Diego and ENT service coordinator, joins host Dr. Gopi Shah to discuss the importance of the surgical technologist’s role in the OR and how it directly impacts patient care. --- SYNPOSIS Jose discusses his journey from being a medical assistant to finding his calling in the operating room, specifically in ENT. They explore the critical yet often overlooked role of OR scrub techs, the necessity of proper preparation and organization, and the importance of good communication and teamwork within the surgical team. Jose also shares personal experiences and advice for both new surgical techs and medical students, emphasizing the rewarding nature of working in pediatric ENT. --- TIMESTAMPS 00:00 - Introduction 01:29 - Jose Flores’s Journey to Becoming a Surgical Tech05:41 - Daily Responsibilities and Preparation10:11 - Communication and Teamwork in the OR15:30 - Building Strong Surgical Tech Relationships18:51 - Advice for New Surgical Techs21:25 - The Role of Techs in Quality and Safety23:15 - Giving and Receiving Feedback27:02 - Fostering Respect and Recognition30:40 - Final Thoughts and Contact Information --- RESOURCES Jose Flores’s Story:https://vimeo.com/1096085041

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. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 02:04 - First Principles of Workup05:23 - Case 1: Maxillary Sinus Mass 06:23 - Imaging and Biopsy Strategy08:11 - Inverted Papilloma Pathology and Surgical Planning20:28 - Case 2: Unilateral Disease Red Flags24:34 - MRI Clues for Malignancy31:47 - Video Walkthrough of Endonasal Resection38:51 - Surveillance41:41 - Key Papers---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. --- ResourcesJoao Paulo Almeida, MD, PhDhttps://medicine.iu.edu/faculty/68351/almeida-joao-paulo Satyan B. Sreenath, MDhttps://medicine.iu.edu/faculty/60724/sreenath-satyan Zara M. Patel, MD https://med.stanford.edu/profiles/zara-patel Garret W. Choby, MDhttps://providers.upmc.com/provider/garret-w-choby/2592344 --- 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

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. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction05:13 - Understanding the Subconscious Mind09:29 - The Hypnotherapy Process15:43 - Patient Selection18:58 - Anxiety, Stress, and Pain Perception23:54 - Use in General ENT Population28:14 - When to Refer31:51 - History of Hypnotherapy in Cancer Care32:56 - Awareness, Access, and Billing Insurance38:59 - Setting Expectations, Visits Required, and Smoking Cessation43:42 - Virtual Visits and Possible Limitations46:57 - Techniques for ENTs49:14 - Closing Thoughts --- 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. --- Resources Dr. Sonia Gupte https://enso-nia.com/about-sonia/

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 --- 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. --- TIMESTAMPS 00:00 - Introduction 02:35 - When to Repair Perforations 10:36 - Physical Exam, Audiogram, & Treatment Decisions18:06 - Butterfly Graft Candidacy20:42 - Step by Step Butterfly Technique25:52 - Butterfly Technique Pearls and Pitfalls29:16 - Example Case Video and Indications35:12 - Restrictions, Pain, & Recovery37:10 - Risk Factors and Complications40:09 - Revision Timing and Failure Modes42:37 - Final Pearls and Wrap Up --- 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. --- 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. --- TIMESTAMPS 00:00 - Introduction02:13 - RRP Patient Types and Symptoms05:06 - Adult vs Juvenile Transmission10:46 - When to Escalate Treatment15:40 - Immunotherapy 18:55 - Trial Enrollment, Results and Dosing Rules26:17 - Durable Long Term Response30:47 - Who Should Get Treated32:34 - Logistics And Public Perception37:50 - Future Research And Prevention --- Recurrent Respiratory Papillomatosis Foundation Position Statement on the Management of Adults With RRPhttps://pubmed.ncbi.nlm.nih.gov/41543033/ Dr. Stephen Schoeffhttps://healthy.kaiserpermanente.org/washington/clinicians/stephen-schoeff-6848607 Dr. Aaron Friedman https://www.uchealth.com/en/provider-profiles/friedman-aaron-d-1609057587

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. --- 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. --- TIMESTAMPS 00:00 - Introduction 02:52 - Risks and Benefits of CI in Older Adults11:57 - Handling Anticoagulation During CI Surgery13:59 - Post-Surgery Expectations and Balance Issues16:35 - Next Day Activation and Surgical Considerations19:17 - Assessing Patient Suitability for Cochlear Implants22:45 - Setting Patient Expectations for Cochlear Implants23:39 - Barriers to Cochlear Implant Access28:07 - Importance of Early Identification and Referral31:47 - Postoperative Rehabilitation and Patient Support39:30 - Concluding Thoughts and Acknowledgements --- RESOURCES J. Walter Kutz, M.D.https://utswmed.org/doctors/joe-kutz/ Brandon Isaacson, M.D.https://utswmed.org/doctors/brandon-isaacson/ Cameron Wick, MDhttps://www.uhhospitals.org/doctors/Wick-Cameron-1063737799

Can one surgical approach reduce postoperative bleeding, shorten recovery, and save hundreds of dollars per case? In this episode of the BackTable ENT Podcast, Dr. Stephen Chorney, pediatric otolaryngologist at the University of Texas Southwestern Medical Center, joins hosts Dr. Ashley Agan and Dr. Gopi Shah to discuss the benefits and techniques of coblation intracapsular tonsillectomy. Drawing from his extensive clinical experience and findings from his recent Triological thesis, Dr. Chorney reviews the cost effectiveness of coblation intracapsular tonsillectomy compared to traditional extracapsular approaches. --- This podcast is supported by: Smith+Nephew https://www.smith-nephew.com/en-us/health-care-professionals/products/ear-nose-and-throat/coblation-technology-for-adenotonsillectomy#overview --- SYNPOSIS The conversation highlights key advantages of coblation intracapsular tonsillectomy, including lower postoperative bleeding rates, reduced pain, faster recovery, and meaningful economic benefits. Dr. Chorney also shares practical pearls on surgical technique with coblation, equipment settings, and postoperative care, making this episode a valuable resource for surgeons considering or already performing intracapsular tonsillectomy. --- TIMESTAMPS 00:00 - Introduction03:34 - Intracapsular Tonsillectomy: Training and Adoption08:46 - Patient Selection and Surgical Techniques15:50 - Postoperative Care and Pain Management37:26 - Understanding Post-Workout Pain and Recovery38:13 - Comparing Surgical Tools: Microdebrider vs. Coblator38:54 - Visual Cues and Techniques in Tonsillectomy39:22 - Challenges and Solutions in Tonsillectomy Procedures46:37 - Case Studies and Video Demonstrations56:12 - Cost-Effectiveness of Intracapsular Tonsillectomy01:07:19 - Conclusion and Final Thoughts --- RESOURCES Dr. Stephen Chorney https://utswmed.org/doctors/stephen-chorney/ Trio Thesis https://onlinelibrary.wiley.com/doi/full/10.1002/lary.32448

Think beyond the esophagus. Up to 75% of eosinophilic esophagitis (EoE) patients have ENT-relevant atopic disease that is often best managed with a multidisciplinary approach. Get caught up on best practices in EoE diagnosis and treatment with this episode of the BackTable ENT Podcast, featuring dual board-certified gastroenterologist and allergist-immunologist Dr. John Leung and host Dr. Basil Kahwash. --- SYNPOSIS The discussion covers the definition, symptoms, and diagnosis of EoE, highlighting the role of food and environmental allergies. Dr. Leung and Dr. Kahwash cover diagnostic techniques like endoscopy and emerging non-invasive methods, as well as various treatment options including dietary modifications, pharmacology, and biologics. The doctors also emphasize the importance of multidisciplinary collaboration between gastroenterologists, allergists, and otolaryngologists to provide optimal care for patients with EoE. --- TIMESTAMPS 00:00 - Introduction 03:13 - Understanding Eosinophilic Esophagitis (EoE)05:45 - EoE Symptoms and Diagnosis08:41 - Role of ENT in EoE Diagnosis11:32 - Diagnostic Criteria for EoE16:34 - Treatment Options for EoE20:55 - Role of Allergists and Environmental Allergies23:24 - Pharmacological Management of EoE29:38 - Complications and Risks of EoE36:21 - Follow-Up Endoscopies and Surveillance40:34 - Future Directions in EoE Management45:21 - Conclusion and Final Thoughts --- RESOURCES Dr. John Leunghttps://www.bostonspecialists.org/dr-leung-full-profile

When should an antibiotic allergy actually be tested? In this episode of the BackTable ENT Podcast, guest host Dr. Basil Kahwash, an allergist and immunologist at Ohio ENT & Allergy, sits down with Dr. Cosby Stone, an allergist and immunologist at Vanderbilt University Medical Center, to discuss antibiotic allergies and how to distinguish true allergies from intolerances. --- SYNPOSIS Dr. Stone breaks down common misconceptions around antibiotic allergies, with a focus on penicillin and cephalosporins. The conversation explores how these allergies are evaluated, including when skin testing is appropriate, why inaccurate allergy labels matter, and how confirmed allergies should be managed long term. They also dive into more advanced topics such as drug desensitization, current research in the field, and where the future of drug allergy evaluation is headed. --- TIMESTAMPS 00:00 - Introduction 01:03 - Understanding Antibiotic Allergies07:28 - The Importance of Accurate Allergy Diagnosis10:55 - Key Questions for Diagnosing Allergies17:10 - Implementing Allergy Testing in Healthcare Settings19:06 - Identifying Severe Allergic Reactions26:31 - Interpreting Allergy Skin Testing Procedures33:17 - Penicillin and Cephalosporin Cross-Reactivity37:15 - Drug Desensitization: Indications and Process40:30 - Prognosis and Long-Term Outcomes of Drug Allergies47:22 - Conclusion and Final Thoughts --- RESOURCES Dr. Basil Kahwash https://www.ohioentandallergy.com/physicians/basil-kahwash-md/ Dr. Cosby Stonehttps://www.vanderbilthealth.com/doctors/stone-cosby

How can your clinical experience translate into industry leadership? In this episode of the BackTable ENT Podcast, otolaryngologist Dr. Karen Hoffmann at Piedmont ENT in Atlanta joins hosts Dr. Gopi Shah and Dr. Ashley Agan to discuss the many opportunities for industry involvement within otolaryngology. --- SYNPOSIS Dr. Hoffmann shares her extensive experience in otology and rhinology, highlighting her involvement in clinical trials, public speaking, and industry collaborations. The discussion focuses on the vast opportunities available for ENTs in industry, addressing how clinical experience can translate into meaningful contributions beyond traditional practice. Dr. Hoffmann offers insights on balancing clinical practice with industry work, the importance of gender diversity in advancing medical tools and practices, and the potential for future innovations in ENT driven by women in the field. --- TIMESTAMPS 00:00 - Introduction02:31 - Opportunities for ENTs in Industry08:43 - Balancing Career and Family16:39 - Navigating Industry Partnerships21:39 - Addressing Criticism in Medicine25:09 - Getting Started with Clinical Trials in Private Practice28:57 - The Role of Mentorship and Networking36:13 - The Importance of Women in Medicine42:10 - Future Opportunities for Women in ENT --- RESOURCES Dr. Karen Hoffmannhttps://www.piedent.com/about-us/providers/karen-hoffmann

Does tongue tie impact pediatric sleep disordered breathing? In this episode of the Back Table ENT Podcast, otolaryngologist Dr. Brennan Dodson and speech language pathologist Allegra Bereszniewicz discuss tongue-tie and the pediatric airway with hosts Dr Ashley Agan and Dr. Gopi Shah. --- SYNPOSIS The discussion covers the anatomy and pathophysiology of tongue tie, surgical techniques for its release, and the importance of pre- and post-operative myofunctional therapy. They delve into patient selection, the impact of tongue tie on sleep-disordered breathing, and contrasting surgical methodologies, including frenuloplasty. The episode also features an insightful case study with visuals, examining Dr. Dodson's surgical approach in detail. Additionally, they touch on insurance considerations and the challenges within current medical practice regarding tongue tie diagnosis and treatment. Check out detailed surgical techniques at the end with case presentations! --- TIMESTAMPS 00:00 - Introduction01:29 - Understanding Tongue Tie and Pediatric Airway06:17 - The Role of Myofunctional Therapy10:37 - Scientific Evidence and Research on Tongue Tie15:52 - Clinical Approaches and Patient Evaluations35:00 - Pre-Op and Post-Op Procedures39:02 - Post-Surgery Recovery and Exercises40:32 - Surgical Techniques and Tools44:31 - Post-Operative Care and Pain Management48:59 - Patient Selection and Considerations01:02:41 - Sleep Studies and Outcome Measures01:12:30 - Incision Techniques and Dissection Tools01:17:24 - Closure and Post-Operative Care01:23:51 - Innovations and Techniques in Surgery01:28:09 - Final Thoughts --- RESOURCES Dr. Brennan Dodson https://www.bridgerent.com/ Allegra Bereszniewicz MS, CCC-SLPhttps://grospeech.com/about/

Are you a med student with an upcoming away rotation? Get a head start with this episode of the BackTable ENT Podcast. Dr. Viraj Shah, a PGY-4 ENT resident at UT Southwestern and guest host Dr. Quynh-Chi Dang, PGY-1 at UC Davis Medical Center, discuss how to succeed on away rotations. --- SYNPOSIS They cover the basics of away rotations, factors to consider when applying, and effective strategies for excelling both in the operating room and within the residency team. Additionally, they delve into the importance of networking, securing recommendation letters, and making a positive impression through situational awareness and preparation. Personal anecdotes and practical tips make this a valuable listen for medical students gearing up for their rotations. --- TIMESTAMPS 00:00 Introduction 02:33 Diving into Away Rotations05:20 Factors to Consider for Away Rotations22:54 Handling Away Rotation Offers28:33 Succeeding in the OR34:30 Navigating OR Dynamics40:49 Securing Recommendation Letters46:11 Onsite Interviews: Preparation and Presentation50:48 Housing for Away Rotations56:03 Final Tips: Observing Team Dynamics and Being Proactive --- RESOURCES Chi Danghttps://health.ucdavis.edu/otolaryngology/our-team/residents.html Viraj Shah https://www.utsouthwestern.edu/departments/otolaryngology/education-training/residency-program/residents/

When treating head and neck cancer, how can you tell the difference between true disease progression and pseudoprogression? In this episode of the BackTable Podcast, we discuss the practical implementation of the KEYNOTE-689 trial published in the New England Journal of Medicine, which demonstrated the benefit of adding neoadjuvant and adjuvant immunotherapy to standard head and neck cancer care. Our tumor board panel includes Dr. Mihir Patel, a head and neck surgeon from UNC Chapel Hill, Dr. Siddharth Sheth, a head and neck medical oncologist from UNC, Dr. Jennifer Johnson, a professor of medical oncology and otolaryngology at Sidney Kimmel Comprehensive Cancer Center, and Dr. Adam Luginbuhl, a head and neck surgical oncologist at Thomas Jefferson University. --- SYNPOSIS The doctors address the trial's practical implications, patient selection, case management, dealing with tumor progression, and the integration of multidisciplinary care. They also emphasize the importance of communication, real-world application of trial protocols, and the potential benefits and challenges of such therapies. --- TIMESTAMPS 00:00 - Introduction03:18 - Discussing the New Indication for Immunotherapy11:42 - Challenges and Practical Implementation22:48 - Managing Tumor Progression: A Case Study28:07 - Exploring Treatment Options: Surgery vs. Chemotherapy36:46 - Operational Challenges and Future Directions43:58 - Concluding Thoughts and Future Directions --- RESOURCES Keynote 689https://www.nejm.org/doi/full/10.1056/NEJMoa2415434