BackTable ENT & Allergy

BackTable Inc.
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The go-to podcast for otolaryngologists, allergists, and head and neck surgeons. Tune in every week for practical, physician-led conversations on common and complex clinical topics in allergy, immunology otolaryngology, rhinology, laryngology, otology, and head and neck surgery. Hear how experienced physicians approach real cases, and get practical advice from your peers in your field.

  1. 1 day ago

    Ep. 298 Optimizing CRS Outcomes with Posterior Nasal Nerve Ablation with Dr. Chris Davis

    Claims data suggest roughly one in three patients return after sinus surgery with persistent symptoms, and for many of them the complaint is drainage. On this episode of BackTable ENT & Allergy, host Dr. Ashley Agan welcomes Dr. Chris Davis, a comprehensive otolaryngologist in Birmingham, Alabama, whose practice is largely rhinology, to make the case that the persistent drainage after a technically perfect sinus surgery is a treatable problem rather than an acceptable residual. They discuss the anatomy and neuroimmune function of the posterior nasal nerve, how ablation may affect symptom scores and local inflammation, and the stepwise approach to patient selection and operative technique. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Aerin Medicalhttps://vivaer.com/ --- Timestamps 00:00 - Introduction05:12 - CRS as a Chronic Disease and the Patient Still Draining09:31 - Posterior Nasal Nerve Anatomy and Type 2 Inflammation12:42 - Sensory Nerves, TRP Receptors and Neuroimmunomodulation17:27 - Placebo Questions and Three-Year Durability19:34 - Screening With TNSS, SNOT-22 and NOSE23:21 - Ipratropium Bromide Trials and Patient Selection26:52 - Combining Ablation With Sinus Surgery31:13 - Where to Treat and Adding the Swell Body34:47 - Sphenopalatine Artery Risk and Staggered Treatment37:34 - Coding and Reimbursement42:21 - Temperature Control Versus Impedance Control47:13 - Cryoablation, Device Design and Closing Thoughts --- More about this episode The conversation follows the posterior nasal nerve from anatomy to the operating room. Dr. Davis describes a nerve that turned out to be a branching network rather than a single trunk, the early research on type 2 cytokine and sensory receptor changes in nasal secretions after ablation, and why he now thinks of the procedure as possible immune modulation rather than simply closing a tap. He then gets practical: the symptom scores he treats as nasal vital signs, the ipratropium bromide trial and what failing it really means, treating at the start of a sinus case while the field is dry, the staggered technique he credits for keeping delayed posterior bleeds rare, and the coding detail that makes combining the procedures viable. The episode closes on temperature control against impedance control, why he left cryoablation behind, and whether this nerve could one day keep patients off biologics. --- Resources Lanza DC, Kennedy DW. Adult rhinosinusitis defined. Otolaryngol Head Neck Surg. 1997https://pubmed.ncbi.nlm.nih.gov/9334782/ BIOKLEAR, Effect of Temperature-Controlled Radiofrequency Ablation of the Posterior Nasal Nerve on Inflammatory Biomarkers in Patients With Allergic and Nonallergic Chronic Rhinitis (NCT06599736)https://clinicaltrials.gov/study/NCT06599736 Allen DZ, et al. The Effect of Radiofrequency Ablation of Posterior Nasal Nerves on Inflammatory Cytokines, Peak Nasal Inspiratory Flow, and Subjective Symptom Scores in Chronic Rhinitis: A Prospective Clinical Trial. Ann Otol Rhinol Laryngol. 2026https://doi.org/10.1177/00034894261449672 Stolovitzky JP, et al. 3-Year Outcomes of Temperature-Controlled Radiofrequency Ablation of the Posterior Nasal Nerve in Patients With Chronic Rhinitis. Int Forum Allergy Rhinol. 2025https://doi.org/10.1002/alr.23577 Jamileh E, et al. Radiofrequency Neurolysis of the Posterior Nasal Nerve: A Systematic Review and Meta-Analysis. Laryngoscope. 2026https://doi.org/10.1002/lary.70763 Kang YJ, et al. Comparative Effectiveness of Cryotherapy and Radiofrequency Ablation for Chronic Rhinitis: A Systematic Review and Meta-analysis. Clin Exp Otorhinolaryngol. 2023https://doi.org/10.21053/ceo.2023.01214 Hopkins C, et al. Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol. 2009https://doi.org/10.1111/j.1749-4486.2009.01995.x ExcelENT of Alabama, Dr. Chris Davis's practicehttps://www.excelental.com Dr. Ashley Agan, BackTable ENT contributor pagehttps://backtable.com/shows/ent/contributors/dr-ashley-agan --- 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

  2. 21 Jul

    Ep. 283 Streamlining Surgery: The Future of the OR with Dr. Raj Sindwani

    What if the next major advance in ENT surgery isn’t a new instrument, but a better-integrated operating room? In this episode of the BackTable ENT & Allergy Podcast, Cleveland Clinic rhinologist and skull base surgeon Dr. Raj Sindwani joins Dr. Gopi Shah and Dr. Ashley Agan to discuss how reducing cognitive load, improving workflows, and creating a more efficient OR environment can enhance the surgical experience. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Strykerhttps://www.stryker.com/us/en/ent.html --- Timestamps 00:00 - Introduction03:50 - Where Surgery Happens: Choosing the Right Site for Service06:27 - Quality Safety And Throughput09:48 - Reducing Cognitive Load In Surgery15:34 - Building an Efficient OR Ecosystem And Culture23:06 - Tech Adoption and Team Training26:19 - Smarter Surgical Navigation and Augmented Reality37:02 - Navigation Accuracy, Registration, and Smart Coaching40:29 - Inside the Stryker RISE Platform49:55 - Integration Challenges and Voice-Control Safety56:36 - Surgical Ergonomics and Injury Prevention01:09:14 - The Future of Surgical Innovation and AI in the OR --- More about this episode Dr. Sindwani explores how minimizing unnecessary friction, improving team dynamics, and thoughtfully integrating technology can help surgical teams focus on what matters most: patient care. The conversation examines the operating room as an ecosystem where people, processes, and technology all contribute to patient outcomes. Dr. Sindwani shares strategies for reducing extrinsic cognitive load, including standardizing room setup, minimizing interruptions, and optimizing the surgical environment.He also discusses advances in sinus and skull base navigation, augmented reality guidance, and Stryker’s RISE platform, highlighting how integrated technology can simplify workflow, improve ergonomics, and reduce distractions in the OR. Throughout the episode, Dr. Sindwani emphasizes the importance of thoughtful technology adoption, team collaboration, and designing the operating room of the future around safety, efficiency, and the needs of both patients and surgeons. --- Resources Dr. Raj Sindwanihttps://providers.clevelandclinic.org/provider/raj-sindwani/4268990 Stryker ENThttps://www.stryker.com/us/en/ent.html Stryker RISE Platformhttps://www.stryker.com/us/en/portfolios/medical-surgical-equipment/integration-and-connectivity/or-integration/rise.html Technological Advances in Sinus and Skull Base Surgery by Dr. Raj Sindwanihttps://www.oto.theclinics.com/article/S0030-6665(17)30050-6/fulltext Ergonomics in ENT Practice NIH Articlehttps://pmc.ncbi.nlm.nih.gov/articles/PMC11455805/ --- 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

  3. 14 Jul

    Ep. 282 Awake Cochlear Implantation: An Expert Guide with Dr. Sarah Mowry

    Have you considered performing a cochlear implant while your patient is awake? In this episode of the Backtable ENT & Allergy Podcast, Dr. Walter Kutz and Dr. Brandon Isaacson sit down with Dr. Sarah Mowry to explore her protocol for cochlear implants under local anesthesia, an approach especially relevant for older adults concerned about the cognitive risks of general anesthesia. Dr. Mowry shares her criteria for patient selection, preoperative counseling strategies, and how she adapts the OR setup to maximize comfort and communication during awake surgery. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:06 - Why to Consider Awake Cochlear Implants05:32 - Indications for Awake CI 08:50 - Local Blocks and Pain Control10:58 - Counseling and Expectations14:40 - Preventing Intraoperative Vertigo and Converting to General Anesthesia 17:17 - Set Up and Communication with Patient 19:14 - Lesser Occipital Nerve Block and Potential Role of Processed EEG26:32 - Pitch Matching for Single-Sided Deafness, CI, and Anxiety Considerations29:00 - Feedback from Patients and Electrode Choice 31:30 - Advice to Surgeons and Closing Remarks --- More about this episode The conversation covers her anesthesia protocol, including lesser occipital and postauricular nerve blocks, minimizing propofol, and using topical 2% lidocaine in sensate areas like the facial recess and epitympanum. Dr. Mowry discusses practical strategies of using warmed irrigation to reduce intraoperative vertigo and contingency plans for conversion to general anesthesia. She discusses electrode considerations and the potential role of processed EEG to titrate anesthesia depth and practical tips for surgeons interested in adopting awake cochlear implantation. Throughout, they highlight the importance of individualized patient care, multidisciplinary teamwork, and the growing role of local anesthesia in otologic surgery. --- Resources Cochlear Implantation Under Local Anesthesia With Conscious Sedation in the Elderly: First 100 Caseshttps://pubmed.ncbi.nlm.nih.gov/32663339/ Cochlear implantation under local anesthesia in 117 cases: patients' subjective experience and outcomeshttps://pubmed.ncbi.nlm.nih.gov/34487218/ --- 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

  4. 7 Jul

    Ep. 281 Expert Insight on Congenital CMV & Pediatric Hearing Loss with Dr. Albert Park

    Did you know that congenital CMV-related hearing loss can develop several years after birth? On the BackTable ENT & Allergy Podcast, hosts Dr. Gopi Shah and Dr. Jeff Hyzer interview pediatric otolaryngologist Dr. Albert Park about the latest evidence on congenital CMV and its role in pediatric sensorineural hearing loss. The discussion covers diagnosis, risk factors, screening protocols, testing strategies, antiviral treatment, genetic workup, long-term surveillance, and future directions for early detection and prevention. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 02:47 - Basics of CMV Infections and Hearing Loss Presentation 07:57 - CMV Screening Workflow 11:33 - Saliva vs. Urine Based Screening 14:00 - Early Workup and Communication 19:37 - Late Onset Workup and Use of Antivirals 24:39 - Treatment with Antiviral Medications 27:22 - Head Ultrasound vs. MRI 30:06 - Role of Genetic Testing 32:47 - Surveillance and Progression Risk37:29 - CI Outcomes and Predictors42:18 - BAHA and Older Candidates45:44 - Awareness, Prevention Efforts, and Education 54:25 - Vaccines and Universal Screening Pitfalls 57:40 - Advocacy and Closing Thoughts --- More about this episode Dr. Park explains the differences between congenital and acquired CMV, reviews epidemiology and, and highlights that hearing loss may be present at birth or develop later in childhood. He discusses Utah’s evolution from hearing-targeted CMV testing to universal NICU screening, emphasizing the importance of diagnosis within the first 21 days of life. The conversation covers saliva versus urine testing, dried blood spot testing, and the role of a multidisciplinary team in evaluation and management. Dr. Park also reviews antiviral treatment strategies, imaging and genetic testing considerations, audiologic surveillance, and cochlear implantation outcomes. Finally, he discusses ongoing advocacy efforts, emerging prenatal screening technologies, and future directions and challenges for CMV prevention and early detection. --- Resources Nance & Morton NEJM Paper Cited - 20% of Congenital SNHL linked to Congenital CMV https://www.nejm.org/doi/full/10.1056/NEJMra050700 Dr.Kimberlin’s work supporting antiviral treatment for 6 months https://www.nejm.org/doi/full/10.1056/NEJMoa1404599?utm_source=openevidence Dr.Vossen’s antiviral therapy research https://pubmed.ncbi.nlm.nih.gov/38336204/ AAP Red Book https://publications.aap.org/redbook Dr. Smith’s Research - Genetic Testing for Congenital Bilateral Hearing Loss in the Context of Targeted Cytomegalovirus Screeninghttps://pubmed.ncbi.nlm.nih.gov/31985074/ Dr.Park’s Research Congenital Cytomegalovirus Testing Outcomes From the ValEAR Trialhttps://pubmed.ncbi.nlm.nih.gov/38415855/ Dr.Park’s Research - Analysis of an Expanded Targeted Early Cytomegalovirus Testing Programhttps://pubmed.ncbi.nlm.nih.gov/36884018/ Dr.Foulon - Hearing Loss With Congenital Cytomegalovirus Infectionhttps://pubmed.ncbi.nlm.nih.gov/31266824/ Research about the use of Vaclovir to reduce vertical transmissionhttps://pubmed.ncbi.nlm.nih.gov/32919517/ Dr.Gantt’s research on the Ping-Pong Effecthttps://pubmed.ncbi.nlm.nih.gov/29889809/ --- 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

  5. 9 Jun

    Ep. 277 Molecular Diagnostics for Thyroid Nodules with Dr. Erik Alexander

    For years, an indeterminate thyroid biopsy meant diagnostic surgery but molecular testing is now changing that reality entirely. On this episode of the BackTable ENT podcast, Dr. Ashley Agan interviews endocrinologist Dr. Erik Alexander about how molecular testing and a systematic, layered approach to thyroid nodule evaluation are reducing diagnostic surgeries and enabling more individualized patient care. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Veracytehttps://www.veracyte.com/ --- Timestamps 00:00 - Introduction02:48 - Incidence, Presentation, and Workup of Thyroid Nodules 06:26 - Hormonal Impact and Indications for FNA 10:49 - FNA workflow and Bethesda Categories 16:10 - Role of Molecular Testing for Indeterminate Nodules19:59 - Evolution of Molecular Testing and Afirma 23:51 - Basics of DNA based Testing and RNA based Testing 28:34 - Comparing DNA based and RNA Based Testing 32:10 - Utility of Molecular Testing and Sampling Techniques 35:55 - Cost Coverage and Practical Limits39:20 - Clinical Implications and Future Impact42:00 - Final Takeaways --- More about this episode Together they walk through the full evaluation pathway, including ultrasound risk stratification using the TI-RADS criteria, the role of TSH testing, and how FNA indications have shifted from biopsying every solid nodule to a more selective, risk-adapted approach. The discussion covers the Bethesda classification system and addresses why the one-third of patients landing in indeterminate categories (Bethesda III, IV, and V) have historically been the most challenging and most overtreated group. The conversation then explores molecular diagnostics as an additional layer of risk assessment, highlighting key differences between DNA-based mutation panels and RNA-based expression classifiers. Dr. Alexander also discusses practical considerations like insurance coverage, sampling technique, turnaround time, and the future potential of molecular testing to move beyond diagnosis toward individualized prognosis. --- Resources American College of Radiology: TI-Rads Guidelines https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/RADS/TI-RADS/TI-RADS-Assessment-Categories.pdf American Thyroid Association - Nodule Guidelineshttps://pmc.ncbi.nlm.nih.gov/articles/PMC4739132/ Bethesda System for Reporting Thyroid Ctyopathology https://www.ncbi.nlm.nih.gov/books/NBK278969/table/thyroid-nod-canc-eld.T.bethesda_system_f/ --- 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

  6. 24 Mar

    Ep. 266 Clinical Steps for Efficient Anaphylaxis Diagnosis & Treatment with Dr. Payel Gupta

    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. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:02 - Defining Anaphylaxis and Key Signs04:09 - Anaphylaxis Versus Shock05:54 - Diagnostic Pitfalls12:43 - Epi First Epi Fast32:33 - ER Or Observe42:31 - Allergy Testing Limits47:16 - New Anaphylaxis Therapies51:34 - Public Awareness and Advocacy01:02:55 - Final Pearls and Wrap up --- 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. --- Resources Dr. Payel Gupta https://www.zocdoc.com/doctor/payel-gupta-md-facaai-571583

  7. 3 Feb

    Ep. 259 Understanding Coblation Tonsillectomy: Benefits, Outcomes & Techniques with Dr. Stephen Chorney

    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

  8. 20 Jan

    Ep. 257 Understanding Eosinophilic Esophagitis: Diagnosis & Treatment Strategies with Dr. John Leung

    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

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About

The go-to podcast for otolaryngologists, allergists, and head and neck surgeons. Tune in every week for practical, physician-led conversations on common and complex clinical topics in allergy, immunology otolaryngology, rhinology, laryngology, otology, and head and neck surgery. Hear how experienced physicians approach real cases, and get practical advice from your peers in your field.

Information

  • Creator
    BackTable Inc.
  • Years Active
    2020 - 2026
  • Episodes
    17
  • Rating
    Clean
  • Copyright
    © All rights reserved.
  • Show Website
    BackTable ENT & Allergy

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