BackTable ENT BackTable

In this episode, Dr. Ashley Agan and Dr. Gopi Shah cover in-office laryngology procedures with Dr. Lesley Childs, Associate Professor of Laryngology, Neuro-Laryngology, and Professional Voice at the University of Texas Southwestern Medical Center.

The surgeons cover laryngologic diseases commonly treated in the clinic. Dr. Childs describes procedures she performs, including video stroboscopy for mucosal wave assessment, steroid injections for subglottic stenosis, and Botox injections for neurologic voice disorders. She also speaks to the benefits of treating patients in-office, anesthesia for in-office procedures, and the role her medical assistants play during various in-office procedures.

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EARN CME

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

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SHOW NOTES

00:00 Introduction
02:58 In-Office Laryngology Procedures Overview
03:49 Understanding Video Stroboscopy
05:27 Preparing for In-Office Procedures
08:09 Procedure Techniques and Patient Positioning
13:40 Anesthetic Protocol for Different Procedures
15:11 Handling Patient Reactions and Complications
26:11 Botox Injections and Anesthetic Considerations
29:08 Understanding False Vocal Folds and Abraham Cannula
35:01 Understanding the Process of Vocal Fold Botox Injections
36:06 The Risks and Challenges of Vocal Fold Injections
40:41 The Process of Vocal Fold Augmentation
52:33 The Use of Lasers in Vocal Fold Procedures
53:40 The Evolution of Vocal Fold Procedures Over Time

In this podcast, Dr. Gopi Shah invites Dr. Nicole Schmitt, an associate professor in the Department of Otolaryngology at Emory University to discuss drug repurposing for head and neck cancer.

Dr. Schmitt explains that drug repurposing involves using a drug developed for one purpose for an entirely different purpose. She highlights some of the main drugs being repurposed for head and neck cancer treatment, including statins and NSAIDs. For example, Dr. Schmitt shares how manipulating cholesterol levels can enhance antineoplastic T lymphocyte responses to increase survival and treatment tolerability. The surgeons then consider the therapeutic, safety, and financial benefits of repurposed drugs. Special attention is given to drug repurposing in HPV-positive cancer. Lastly, Dr. Schmitt describes the pleiotropic effect and how it applies to drug repurposing efforts.

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/EgX3zL

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SHOW NOTES

0:00 - Drug Repurposing and Cancer Treatment
08:40 - Statins and NSAIDs for Head and Neck Cancer
12:18 - Enhancing Tumor Control With Pre-Surgery Drugs
22:14 - Treatment of Pre-Malignant Lesions With Repurposed Drugs

In this episode, Dr. Eric Gantwerker and Dr. Nilesh Vasan, Founder/CEO of Adroit Surgical and Head & Neck Surgeon at University of Oklahoma (OU Health), discuss the development of Adroit Surgical.

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/4Wi8D5

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SHOW NOTES

First, Dr. Vasan describes his surgical training and lifelong passion for invention. Originally from New Zealand, Dr. Vasan completed a head & neck fellowship at OU Health. His surgical experience includes private and academic practice. During his time in private practice, Dr. Vasan worked on interdisciplinary teams to manage difficult airways. He credits this experience with sparking his interest in developing better tools for intubation.

Next, Dr. Gantwerker and Dr. Vasan review the development of Adroit Surgical’s first product, the Vie-Scope. The battery-powered Vie-Scope combines superior visualization with portability to facilitate intubation across settings. Hoping to improve visualization during hand-held laryngoscopy, Dr. Vasan sketched a modified anterior commissure laryngoscope that would become the Vie-Scope. He then worked with an experienced patent attorney who helped him develop and notarize his innovation.

Then, the surgeons cover advice to building networks. A pitch competition in Oklahoma City connected Dr. Vasan with associates whose complementary expertise helped grow Adroit Surgical. Dr. Vasan then worked alongside a well-connected distributor who raised awareness of the Vie-Scope in his target markets. Today, the Vie-Scope enables successful first-pass intubation in emergent and operating room settings.

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RESOURCES

Adroit Surgical:
https://adroitsurgical.com/

“Crossing the Chasm” by Geoffrey Moore
https://www.amazon.com/Crossing-Chasm-3rd-Disruptive-Mainstream/dp/0062292986

“Creativity, Inc: Overcoming the Unseen Forces that Stand in the Way of True Innovation” Ed Catmull & Amy Wallace
https://www.amazon.com/Creativity-Inc-Overcoming-Unseen-Inspiration/dp/0812993012

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Jens Andersson, practicing ENT at Sweden’s Skåne University Hospital, tackle chronic frontal sinusitis.

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SHOW NOTES

First, Dr. Andersson talks about the Swedish healthcare systems, focusing on access to care and cost. The discussion then shifts to chronic frontal sinusitis. Symptoms associated with this disease include frontal headache, stuffiness, congestion, and low-grade fever. In cases of orbital involvement, patients may complain of proptosis or diplopia. Risk factors include frontal sinus fracture, barotrauma, an immunocompromised state, and dental infection. Most, but not all, patients have involvement of multiple sinuses.

Next, Dr. Andersson illuminates workup and treatment of chronic frontal sinusitis. His physical exam includes close inspection of the oral cavity, anterior rhinoscopy (performed with a microscope), and flexible fiberoptic laryngoscopy. When ordering imaging, he prefers cone-beam CT of the sinuses, though he orders MRI when bony invasion or extra-sinus disease are present.

Finally, the surgeons discuss operative management of chronic frontal sinusitis. Dr. Andersson talks listeners through his pre-operative planning, focusing on how he uses imaging. Moving to the OR, the surgeons share their techniques for operating on the frontal sinus. Dr. Andersson reviews strategies to avoid scarring, use of navigation systems, and post-operative management. Dr. Shah shares pearls from her pediatric sinus practice. The episode finishes with Dr. Andersson’s witty and high-yield advice for otolaryngologists.

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Briac Thierry, Pediatric ENT at Necker Hospital for Sick Children in Paris, France, review stridor in newborns, with a special emphasis on laryngomalacia.

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SHOW NOTES

First, Briac and Gopi discuss how a newborn with stridor can present. Though stridor does occur among NICU babies, most of Briac’s patients are referred by outpatient pediatricians. They discuss a list of questions to ask while taking a history and emphasize the importance of assessing growth trends. In the absence of other medical problems, declining weight can suggest severe aerodigestive tract abnormality. Any pathology that narrows the airway can cause stridor: in infants, these include laryngomalacia, vallecular cysts, subglottic cysts, tracheal rings, and bilateral vocal fold immobility.

Then, Briac talks listeners through his physical exam, with special attention paid to flexible fiberoptic laryngoscopy. Briac shares his tips to maximize visualization and clinician ergonomics when scoping a small child. If bilateral vocal fold immobility is suspected, Briac recommends performing a longer fiberoptic exam so that the clinician can determine whether vocal fold immobility is present at rest or due to an uncomfortable child crying.

Next, Gopi and Briac differentiate between mild, moderate, and severe laryngomalacia and the indications for going to the operating room for an airway evaluation. As 20% of children with laryngomalacia have secondary airway lesions, a meticulous laryngoscopy/bronchoscopy is mandatory in these patients when a trip to the OR is required. Moving to the OR, Briac talks about his workflow when performing diagnostic bronchoscopy/laryngoscopy (DLB) to assess various causes of stridor. The episode concludes with Briac’s meditations on airway surgery as a team endeavor.

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RESOURCES

Briac’s Necker Hospital Profile:
https://www.aphp.fr/offre-de-soin/medecin/3168653/061/16

International Pediatric ORL Group (IPOG) Laryngomalacia Consensus Recommendations:
https://www.sciencedirect.com/science/article/abs/pii/S0165587616300519

Pediatric Airway Channel in Paris (@voies_aeriennes):
https://www.youtube.com/@voies_aeriennes