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In this episode of BackTable ENT, Dr. Varun Varadarajan and Dr. Gopi Shah discuss their personal advice and stories of navigating the challenges of a dual physician household with Dr. Bill Collins, chief of Pediatric Otolaryngology at the University of Florida College of Medicine. The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/o4ATPJ --- CHECK OUT OUR SPONSOR Athletic Greens https://www.athleticgreens.com/backtableent --- SHOW NOTES In this episode of BackTable ENT, Dr. Varun Varadarajan and Dr. Gopi Shah discuss their personal advice and stories of navigating the challenges of a dual physician household with Dr. Bill Collins, chief of Pediatric Otolaryngology at the University of Florida College of Medicine. First, the doctors discuss the considerations involved in deciding to participate in the couples match. They agree that it is best to keep larger cities with multiple programs in mind when forming a rank list but note that the match can also be complicated if one partner is choosing to pursue a more competitive specialty. Additionally, although staying together would be ideal, couples might not have another choice besides engaging in a long-distance relationship during residency and fellowship. Dr. Collins highlights the importance of finding program directors and other mentors who can help to maintain value in relationships during training. During residency applications and beyond, he emphasizes that communication, honesty, and compromise are key to sustaining a strong relationship. Next, they discuss raising children in dual physician households. All three doctors agree that there is no “perfect” time to have children because it depends on the circumstances and preferences of every couple. If a couple wanted to have a child during both of their residencies, they would also have to consider the long uncontrollable hours of residency as well as the need for extensive child care. Additionally, Dr. Collins emphasizes that physician schedules will remain busy, even after residency, so it is important to schedule concrete family time sooner than later. Dr. Shah mentions the difficulty surgeons have with separating work from home and Dr. Varadarajan encourages them to devote quality time to their kids before getting on their phones to answer emails and finish notes. Lastly, the doctors consider scenarios in which one partner is seeking a job change. Although being further along in their careers and having older children may complicate the job search and moving demands, all three doctors agree that decisions should be made for the overall good of the family. Thus, all factors and possibilities should be considered and discussed. Finally, Dr. Shah emphasizes the importance of having discussions about family planning with medical residents and medical students in order to open channels for advice and mentorship.

In this episode of BackTable ENT, Dr. Ashley Agan and Dr. Gopi Shah discuss the complications of ear tubes and differences in adult and pediatric ear tube management. The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/qQS22s

In this episode of BackTable ENT, Dr. Walter Kutz interviews otologist Dr. Hamid Djalilian about the link between the hearing/vestibular disorders and migraines. The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/eCd3zl

Theresa Richard, SLP educates us on the best approach to evaluating the adult patient with swallowing difficulty, including the importance and challenges of obtaining high quality assessments, and recommendations for therapy. The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/gY34n9 --- CHECK OUT OUR SPONSOR DI4MDs Protect your most valuable asset, the skill and ability to practice your medical specialty. Be prepared by establishing a specialty specific disability insurance policy from the experts at DI4MDs. Contact them today at www.Di4MDS.com or call 888-934-4637. --- SHOW NOTES In this episode of BackTable ENT, Dr. Ashley Agan, Dr. Gopi Shah, and Theresa Richard, a board-certified speech language specialist (SLP) in swallowing and swallowing disorders, about diagnosing and managing adult dysphagia. First, Richard speaks about starting Mobile Dysphagia Diagnostics, a company that provides mobile FEES studies, her experience with having a son with a swallowing disorder, and her recent career shift towards providing speech-language education for her colleagues. Then, she discusses the two primary swallowing imaging studies: the modified barium study (MBS) and fiberoptic endoscopic evaluation of swallowing (FEES). MBS, also known as video fluoroscopy, was traditionally the gold standard for swallowing imagery. It is the superior imaging technique for detecting esophageal issues and provides a better understanding of the oral phase of swallowing. Richard prefers to use FEES first because it provides a live picture of laryngeal and pharyngeal structures. It is useful in patients with secretion issues and post-head and neck cancer surgery patients. Mobile FEES is also an option, which involves an endoscope with recording capabilities and a laptop. Next, Richard discusses how to work up a patient with dysphagia. She starts with taking a thorough history and asks the patient about their dietary routine, and their medical and surgical history. Common medications that may cause dysphagia are muscle relaxants, L-DOPA, and medications that can cause dry mouth, such as scopolamine patches. Next, she discusses eating habits, with special considerations for cultural practices, age, and disability status. She notes that functional swallowing can look different for individual patients. Patients who repetitively aspirate may have recurrent pneumonia and require further evaluation. The first basic test she performs is watching her patients swallow 3 ounces of water. If they cannot swallow the three ounces, she moves to imaging studies. If they can swallow the three ounces, she escalates the test and starts to give the patients thicker liquids and different food types. Some patients with dysphagia may require special considerations, such as ICU patients, patients with nasogastric (NG) tubes, and head and neck cancer patients. Finally, Richard discusses how ENTs can help SLPs by providing a solid case history and being available for communication throughout the patient’s therapy. She also discusses a new type of therapy, adult neuromuscular stimulation, but notes that the parameters may be dangerous and not FDA approved. --- RESOURCES “So You’re Having Trouble Swallowing” by Theresa Richard https://theresarichard.com/so-youre-having-trouble-swallowing/ Theresa Richard Blog https://theresarichard.com/blog/ Swallow Your Pride Podcast https://podcast.theresarichard.com/

We talk with Dr. Julie Wei about what it means to connect with a mentor, the challenges of finding the right fit, and how mentoring relationships will grow and change throughout our career and undoubtedly contribute to overall wellness. --- CHECK OUT OUR SPONSOR Laurel Road for Doctors https://www.laurelroad.com/healthcare-banking/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/3tnqFx --- SHOW NOTES In this episode of BackTable ENT, Dr. Ashley Agan, Dr. Gopi Shah, and Dr. Julie Wei discuss the benefits and evolution of mentorship in the medical field. First, Dr. Wei shares her personal definition of mentorship. Traditionally, mentorship involves a dyad: one junior and one senior partner with the knowledge. However, she challenges this dynamic by broadening the definition of mentorship by coining the term “co-mentorship”, a term that encompasses the mentor’s ability to learn from the mentee and the experience of reflecting as well. The doctors also discuss the challenges of finding mentors after training, since the natural hierarchy of academic medicine is not present. Dr. Wei encourages ENTs to attend society meetings and seek multidisciplinary mentors and mentees in different fields. She mentions that she has served as a mentor for respiratory techs and nurses as well. Next, the doctors explore the idea of work-life balance. Dr. Wei disagrees with the consistent compartmentalization of career and personal wellness and prefers to advocate for and use the term “work-life integration” instead. She also recommends unconventional meeting platforms, such as Zoom, phone calls, and “walking meetings” in order to build relationships. Peer support groups can also be helpful, but the optimal size of the group may depend on the issue being discussed. Additionally, Dr. Wei observes that more female physicians today are able to share their struggles and vulnerabilities openly with their trainees and patients, thus building stronger relationships. She also talks about the importance of allies and notes that mentors and mentees do not have to have all of the same shared experiences–both can still be sources of insight and wisdom for each other. Finally, the three doctors reflect on their personal experiences with mentorship and executive coaching. --- RESOURCES “Leadership, Engagement, and Well Being” by Julie Wei https://www.enttoday.org/article/leadership-engagement-and-well-being/3/?singlepage=1 A Healthier Wei https://www.drjuliewei.com/pages/a-healthier-wei Acid Reflux in Children https://www.drjuliewei.com/pages/acid-reflux-in-children#:~:text=Acid%20Reflux%20in%20Children%3A%20A,Julie%20Wei&text=CONGESTION%2C%20COUGH%20%2B%20CROUP-,Co%2Dauthored%20by%20Dr.,symptoms%20this%20condition%20can%20create.

We talk with Dr. Allison Royer about locums opportunities for otolaryngologists, why locums is becoming more popular amongst ENTs, and how to get started as a locums physician. The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/MMVvXV --- CHECK OUT OUR SPONSORS DI4MDs https://www.di4mds.com Laurel Road for Doctors https://www.laurelroad.com/healthcare-banking/ --- SHOW NOTES In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Ashley Agan interview Dr. Allison Royer, a private practice ENT who co-founded ENT Surgery Solutions, a staffing company that organizes ENT locums. First, Dr. Royer shares her transition from being a hospital-employed ENT to becoming a locum physician with her husband. Once they met other locum physicians and heard about their experiences, they decided to start their own locum staffing company. Dr. Royer believes ENT Surgery Solutions is unique because it is managed directly by ENT physicians; Dr. Royer and her husband directly work with the doctors they employ to find work opportunities that will fit their unique needs. Although ENT Surgery Solutions is primarily Midwest-based, it is quickly expanding in the West and South. Next, Dr. Royer transitions to discussing why many doctors are moving toward locums work. She explains that because many small private practice groups and community hospitals have been bought by hospital systems, there are now significant call burdens needing to be covered by small ENT groups. For this reason, many ENTs decide to do locums in order to balance work and life. Additionally, with locums, doctors don’t have to renegotiate their salaries or their call schedules. Finally, Dr. Royer highlights that locums are fun for her because she likes to work in different hospitals and ORs and see different patient populations and pathology. --- RESOURCES ENT Surgery Solutions ​​https://www.entlocums.com/

We talk Naso Sano Associazione founder Puya Dehgani Mobaraki about the importance of connecting with Otolaryngologists around the world for education, how social media has made this possible, and the impact of listening to the needs of the future generation. The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/vP06PS --- SHOW NOTES In this episode of BackTable ENT, Dr. Gopi Shah talks with Dr. Puya Dehgani-Mobaraki, founder and president of Associazione Naso Sano, a global non-profit organization that provides free education for otorhinolaryngology and head and neck cancer physicians and trainees. Naso Sano supports international trainees by providing them with grants for instrument kits, dissection courses, and textbooks. Dr. Dehgani-Mobaraki emphasizes the importance of surveying trainees to determine which resources and educational opportunities will best help them achieve their future goals. Another important aspect of Naso Sano is the virtual grand rounds. Although organization of these sessions can be challenging due to differing time zones, Naso Sano grand rounds sessions have reached attendance levels of up to 1000 participants. These sessions are available on a variety of platforms, including Facebook, Youtube, and Twitch. Dr. Dehgani-Mobaraki lets the medical and public community decide the topics they would like to learn about, which has included cystic fibrosis, anatomy and dissection courses, and many more diverse subjects. Finally, the doctors discuss the duty of physicians to use their credibility and knowledge to address human rights violations and gender inequality in healthcare. Both doctors agree that marginalized populations still do not receive adequate healthcare and that small conversations with colleagues and trainees can have a great impact in resolving these matters. --- RESOURCES Dr. Dehgani-Mobaraki Twitter: https://twitter.com/puyadehganimd Naso Sano Twitter: https://twitter.com/nasosano Naso Sano Website: https://www.nasosano.it/

In this episode Dr. Eric Gantwerker talks with Dr. Steve Goudy about the importance of finding and thoroughly researching pain points for patients and their families, to then drive innovative solutions. Reflect on how this Podcast applies to your day-to-day and engage to earn AMA PRA Category 1 Credit(s)™ via point-of-care learning activities here: https://earnc.me/Jhj06n

We talk with Dr. Ashley Sikand and Dr. Brian Weeks about performing In-Office Sinus procedures, including differences in technique, and keeping up with the latest technologies. --- CHECK OUT OUR SPONSOR Stryker ENT https://ent.stryker.com --- SHOW NOTES In this episode of BackTable ENT, Dr. Gopi Shah talks with Dr. Ashley Sikand (Nevada Sinus Relief in Las Vegas, NV) and Dr. Brian Weeks (SENTA Clinic in San Diego, CA) about tips for starting in-office procedures and forming effective industry partnerships. First, Dr. Sikand and Dr. Weeks outline their motivations for entering the medical device industry space and serving as consultants for Acclarent, an otolaryngology medical device company. Next, they summarize the types of nasal conditions they can treat with an office-based procedure. These conditions include: deviated nasal septum, nasal valve disorders, turbinate obstructions, nasal polyps, and chronic rhinitis. They note that these procedures have only been made possible due to advances in anesthesia and blocking techniques. Although anesthesia varies based on the type of procedure, anesthesia for sinus work in general consists of three steps: anxiolysis (lorazepam or benzodiazepine), topical anesthesia (lidocaine and tetracaine), and infiltrative anesthesia (sphenopalatine block). Patient selection criteria is also very important when considering good candidates for office-based procedures. The doctors note that younger patients may have more apprehension towards in office procedures. Additionally, if a patient presents with a complex condition that requires multiple procedures, operating in the OR may be a better option. With experience, surgeons will be able to discern whether an in-office procedure is possible for different types of patients. Finally, the doctors emphasize how important good in-office resources are. The starting toolbox for an otolaryngologist should contain: a good endoscopic system, a camera, an instrument tray, effective suction, and an image guidance system. Knowing the room set up is a crucial requirement as well. Although the doctors admit that young otolaryngologists may not have the capital to purchase all the essentials, they encourage them to leverage their industry connections by inviting representatives to bring different equipment for demonstrations first. Finally, they end by advocating for doctors to critically evaluate medical technology using their medical education and training before adopting a device into their standard practice.

Special guest The White Coat Investor James M. Dahle talks with Christopher Beck about where physicians can start when it comes to financial literacy, including common financial mistakes docs make when start practicing, a primer on mortgage rates, and tips on insurance. --- CHECK OUT OUR SPONSOR DI4MDs Protect your most valuable asset, the skill and ability to practice your medical specialty. Be prepared by establishing a specialty specific disability insurance policy from the experts at DI4MDS. Contact them today at www.Di4MDS.com or call 888-934-4637 --- SHOW NOTES In this episode, White Coat Investor founder Dr. James Dahle and our host Dr. Chris Beck discuss strategies for physicians seeking to manage their personal finances and gain financial freedom. First, Dr. Dahle explains the reasoning behind the famous quote, “live like a resident.” He explains that for an early career physician, their greatest wealth-building tool is their income. The income jump from residency to attending years can be extremely useful for quickly paying off student loans. Then, he moves on to discuss another way to resolve student debt, the Public Service Loan Forgiveness (PSLF) program. This option is ideal for physicians who have spent a significant amount of time working for a nonprofit institution (for example, during training and in academic medicine). Dr. Dahle advises all physicians to reflect on their priorities when deciding where to allocate their assets. Possible categories could include retirement funds, 529 college savings funds, payment of high-interest debt, and emergency funds. We talk about the power of having a written plan to stay on track with financial goals and prevent ourselves from making rash decisions. Next, we discuss different financial vehicles that can provide benefits for physicians. The “back door Roth IRA” strategy allows for yearly contributions to a tax-free retirement fund, even when a physician’s income exceeds the maximum limit for the conventional Roth IRA. Additionally, the funds in a Health Savings Account (HSA) can be used for investment, and then withdrawn at a later date, penalty-free. Dr. Dahle explains the difference between fixed rate and variable rate mortgages, noting that the latter is better for short-term loans because interest rates are unlikely to dramatically increase from year to year. Finally, Dr. Dahle covers the advantages of buying disability insurance as a way to protect physician income, especially for those working in procedural specialties. --- RESOURCES White Coat Investor: https://www.whitecoatinvestor.com/ White Coat Investor Podcast: https://www.whitecoatinvestor.com/wci-podcast/ White Coat Investor Email: editor@whitecoatinvestor.com Passive Income MD: https://passiveincomemd.com/ Physician on FIRE: https://www.physicianonfire.com/

In this episode of BackTable ENT, Dr. Gopi Shah talks with Miami-based otolaryngologist Dr. Carlos Torre (Sleep, Snoring & Sinus Clinic of Florida) about his journey to building an adult sleep practice and management of sleep disorders, such as sleep apnea and insomnia. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/5lScN4 --- SHOW NOTES First, Dr. Torre shares his personal experience in the field of sleep medicine. He explains his path to becoming board-certified in otolaryngology, sleep study, and sleep medicine, and obesity medicine. During his sleep surgery fellowship, he was fortunate to train with good mentors who showed him a diversity of techniques and procedures to treat sleep disorders. Driven by his entrepreneurial mindset, he eventually transitioned to his own solo private practice in August 2021. Next, the doctors discuss how to work up an adult patient initially presenting with snoring. Dr. Torre first evaluates the presence and severity of the patient’s symptoms as well as other comorbidities. Next, he orders a home sleep study to confirm the diagnosis of sleep apnea and interprets the sleep studies himself. Many cases of sleep apnea can be resolved nonsurgically through nasal breathing training if the patients are chronic mouth breathers. Nasal breathing training is a type of myofunctional therapy that incorporates exercises such as correct tongue positioning, strengthening of facial muscles, and palatal coupling. Besides nasal breathing training, he recommends CPAP for every patient with obstructive sleep apnea. He prefers to perform surgery conservatively. Thus, he will only consider surgery (tonsil removal, septum deviation surgery) if the patient has failed CPAP therapy for a prolonged period of time and he will use surgery as a tool to optimize CPAP instead of aggressively trying to cure the patient’s sleep apnea. Dr. Torre mentions that nightly dental appliances are also a treatment option. Finally, Dr. Torre acknowledges that general wellness plays an integral role in sleep hygiene. The most common comorbidity associated with sleep apnea is obesity. He recommends fasting and eating early dinners to patients presenting with obesity-related sleep disorders. He also explains how meditation can help relieve anxiety and depression in patients suffering from insomnia. Dr. Torre ends the episode by emphasizing the benefits of multidisciplinary care for patients with sleep disorders.

In this episode we talk with Dr. Matthew Hensler about Hypoglossal Nerve Stimulation for treating Adult Obstructive Sleep Apnea (OSA), including how he learned the procedure, patient selection, procedure tips, and advice on building a successful program. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/Jw85Cq --- SHOW NOTES First, Dr. Hensler explains the initial workup for a snoring patient. In this history, he addresses the impact snoring has on the patient’s quality of life and also assesses the environmental factors that may be responsible for the snoring, such as lack of sleep and alcohol consumption. Then, during the physical exam, he checks for anatomical reasons for snoring, such as large tonsils and a deviated septum. From the history and physical exam, he is able to classify patients into two categories: primary snorers (without sleep apnea) and snorers with sleep apnea. He recommends that all patients complaining of snoring obtain a sleep study. Dr. Hensler then explains his criteria for choosing good hypoglossal nerve stimulator candidates. He recommends choosing patients with an Apnea Hypopnea Index (AHI) score between 15-65, a BMI of less than 31, and patients who have less than 25% of apnea attributed to mixed and central apnea. Because the CPAP machine is still the gold standard treatment for treatment of OSA, he usually only recommends this surgery to patients who have failed CPAP treatment already. Next, Dr. Hensler explains the mechanics behind the hypoglossal nerve stimulator, which only treats obstructive sleep apnea. During the implantation surgery, the first incision is made in the right chest for placement of the processor. The processor is attached to a sensor lead that feeds into the rib cage space between the external and internal intercostal muscles. A second submandibular incision is made below the submandibular gland to place the stimulator lead. When the sensor lead in the rib cage senses the patient breathing, it relays a message to the stimulatory lead, which stimulates the protrusive branches of the hypoglossal nerve to fire and push the tongue outwards. The surgery can be performed in an outpatient setting andlasts less than 2 hours. Patients can start turning on the device before they sleep 3-5 weeks after implantation. Finally, Dr. Hensler obtains a 3 month follow up sleep study in order to monitor improvement in AHI scores. Post-operative complications like infection and pain are possible. Dr. Hensler prescribes his patients with a short duration of narcotics for submandibular pain and a 7-day course of antibiotics to prevent infection. Because of chest involvement during surgery, a pneumothorax is another post-operative complication. A chest X-ray should always be ordered after surgery to rule out this possibility. Finally, it is important to note that patients with a hypoglossal nerve stimulator are unable to undergo MRI scans involving their right chests because of the battery in the processor.

In this episode Dr. Kumar and Dr. Bennett discuss various levels of racism found in healthcare, and share allegories of racism as outlined by Dr. Camara P. Jones, including the gardeners tale. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/Y1eaX6 --- SHOW NOTES In this episode, guest host Dr. Vishal Kumar interviews Dr. Ayanna Bennett about how to train ourselves to recognize perpetuated health disparities within the medical system and how we can actively work to dismantle them. The doctors first talk about understanding racism on an institutional level, which results in a “machine” that selectively delivers better and worse aspects of healthcare to different populations. Dr. Bennett emphasizes that every disease process shows race disparities not because of inherent biological differences in racial groups, but because of unequal frequencies and quality of contact with healthcare systems. Throughout the episode, they reference the allegories of Dr. Camara Jones, a physician-epidemiologist and civil rights activist. These allegories provide a framework for discussing nature vs. nurture for health outcomes and also privilege defined as the lack of barriers to entry. In terms of actionable steps that providers can take toward reducing health inequity, Dr. Bennett encourages us to learn and engage with the communities that they serve. She advises us to be “counter-stereotypical” and show interest in patients’ lives outside of the healthcare setting. Finally, she calls us to analyze the impact that our institutions have on maintaining the health of the community as a whole, rather than solely focusing on individual patients. --- RESOURCES The Gardener’s Tale Allegory by Dr. Camara Jones: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446334/ Tedx Talk by Dr. Camara Jones: https://www.youtube.com/watch?v=GNhcY6fTyBM

In this episode we talk with Dr. Reena Mehta about her experiences building a solo Allergy practice from scratch, including finding a space, staffing, essential equipment, and a successful marketing strategy. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/qiQz8G --- SHOW NOTES In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Ashley Agan talk with Dr. Reena Mehta about her path to starting her own allergy private practice, including tips on successful budgeting, hiring practices, advertising, and maintaining a work-life balance as a solo physician. FIrst, Dr. Mehta reflects on her personal journey to starting her own private practice. Although she started her post-graduate career in academic medicine, she transitioned to a group private practice. She then decided to open a solo private practice in order to practice medicine in the location and way she had always wanted to. In order to assess the feasibility of this idea, she consulted her network of private practice physicians. Then, she did market research to understand the location and demographics of the area in which she was planning to open her practice. Finally, she was able to find a space to rent, formulate a budget, apply for a loan, and start staffing her practice. Dr. Mehta acknowledges that cost projections and staffing were the two most difficult aspects of starting her solo private practice. There were many costs associated with private practice that she had to account for, such as rent, staff salaries, equipment, website and marketing, electronic health records, and insurance credentialing. Fortunately, she received help from advice forums for private practice doctors as well as American Academy of Allergy, Asthma, & Immunology (AAAI) resources. Next, Dr. Mehta recounts the difficulties of staffing her practice, including unpredictability and high turnover during the peak of the COVID-19 pandemic. She notes that learning to not take staffing issues personally, hiring younger and motivated employees, and using a hiring service such as Zip Recruiter and Indeed really helped her be successful in hiring the right candidates. Finally, Dr. Mehta discusses how she maintains a healthy work-life balance. As a solo private practitioner, she is able to close her clinic when she wants to but is still available via telehealth visits and remote consulting with her staff. One method she has found to be helpful is to hire second year fellows to manage emergency allergy events and give allergy shots to patients when she is on leave.

All-star panel Daniel Chelius, Jeff C. Rastatter, and Anthony Sheyn discuss the challenges and importance of building centers of excellence for pediatric head and neck cancer. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/SXwP9d --- SHOW NOTES In this episode of BackTable ENT, Dr. Gopi Shah leads a panel discussion about building centers of excellence for pediatric head and neck tumors. She invites Dr. Daniel Chelius (Baylor College of Medicine/Texas Children’s Hospital), Dr. Jeff C. Rastatter (Feinberg School of Medicine, Lurie Children’s Hospital), and Dr. Anthony Sheyn (University of Tennessee Medical School, St. Jude Children’s Hospital) to speak about their experiences and advice for establishing these centers of excellence. First, the three panelists discuss their career paths to becoming pediatric head and neck cancer surgeons. Then, they share their motivations for building these centers of excellence at their own institutions. All of them realized the importance of routing complex and rare pediatric cancer cases to centralized hospitals and experienced surgeons who saw high volumes of the same cases. Additionally, they saw the need for multidisciplinary collaboration with surgeons in the fields of plastic surgery and oncology. Finally, these centers of excellence facilitate the formation of multidisciplinary tumor boards for pediatric cancer cases. Additionally, they discuss the important elements they needed to form their centers of excellence of pediatric head and neck tumors. First, they needed support within their own otolaryngology division for a shared vision of division specialization and focused expertise. They also needed to form strong relationships with different specialties, namely pediatric plastic surgery and pediatric general surgery. Another important aspect was the institutional commitment of the affiliated children’s hospitals, which were tasked with patient outreach referrals. Finally, each center of excellence needed to be an open environment in which asking for advice and thinking outside of the box was encouraged.

We talk with Ashley Brown, SLP about how to approach the infant with feeding difficulties, including common causes and workup, therapeutic options, and the importance of family counseling and education. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/tuJttz --- SHOW NOTES In this episode of BackTable ENT, Dr. Gopi Shah interviews Ashley Brown, a speech language pathologist (SLP) at Children’s Health Hospital in Dallas, about the evaluation and management of the infant with dysphagia. An infant with dysphagia, or difficulty in swallowing, can present with many symptoms, but most commonly failure to thrive, refusing to feed, incomplete feeding, and aspiration. When primarily assessing these patients, a complete history must be taken. Standard questions cover the chief complaint, the birth history, observations of a typical feed routine, and parent concerns. Next, a holistic exam is conducted. Speech language pathologists will often observe an infant’s posture, tone, trunk support, and range of motion of the mouth and tongue. If necessary, instrumental studies, like a flexible endoscopic evaluation of swallowing (FEES) or a videofluoroscopic swallow study, can be performed. A FEES visualizes the pharyngeal space and is recommended for breastfeeding babies, NPO babies, head and neck cancer babies. A videofluoroscopic swallow study visualizes the oral and esophageal space and gives a better picture of flow rate consistency. Infant dysphagia can result from many etiologies, but some of the most common roots are: abnormalities in oral structure (e.g. tongue tie). problems with tone (e.g. injury to the recurrent laryngeal nerve), syndromes (e.g. Trisomy 21, DiGeorge Syndrome), laryngeal cleft, and laryngomalacia. Furthermore, GERD and nasal obstruction (e.g. pyriform aperture stenosis, choanal atresia) can also cause dysphagia. Although some deformities can be surgically fixed, most infants with dysphagia will either improve with maturity or through feeding therapy sessions with speech language pathologists. In these sessions, SLPs work with infants to train their sensory cues and motor skills through exercises such as oral motor stretches, sour/cold stimulation, facial taping, lip rounding, and neuromuscular stimulation. It is just as important to provide family counseling and parent training as it is to train the infant patients during these sessions.

Pediatric airway surgeon Dr. Michael Rutter and I discuss risk-taking and effective market analysis in entrepreneurship. In the operating room, Dr. Rutter cultivates a congenial OR environment and often seeks ideas from other team members with different areas of expertise. These problem solving-driven conversations often result in pioneering new airway surgery techniques. In the medical device sphere, he outlines his journey of creating a tracheal balloon dilation device, explaining how he obtained intellectual property rights, cleared FDA regulations, and marketed the product. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/jn8hp9 --- SHOW NOTES In this episode, pediatric airway surgeon Dr. Michael Rutter and our host Dr. Eric Gantwerker discuss risk-taking and effective market analysis in entrepreneurship. Dr. Rutter shares about his career path from medical school, to orthopedic surgery training, to his current hybrid role in otolaryngology and device entrepreneurship. Interestingly, his experience in orthopedic surgery has inspired him to adopt orthopedic tools and techniques in solving complex ENT cases. He elaborates on this idea of borrowing concepts from other fields, saying that he cultivates a congenial OR environment and often seeks ideas from other team members with different areas of expertise. These problem solving-driven conversations often result in pioneering of new airway surgery techniques. As we transition to discussing product development, Dr. Rutter outlines his twelve year journey of creating a balloon dilator for the trachea, explaining how he obtained intellectual property rights, cleared FDA regulations, and marketed the product. When in a competitive marketplace, he highlights the benefits of conducting a non-inferiority (“Pollyanna”) study combined with attractive value propositions. Finally, he discusses the reality that some good ideas will not necessarily be successful, due to insufficient market size or extremely high costs of research and development. We conclude on the point that an entrepreneur must evaluate the balance between benefits gained and losses incurred when bringing their product to market.

We talk with Dr. Cecelia Damask and Dr. Matt Ryan about the role of Biologics for Nasal Polyps, including patient selection and its place in the treatment plan. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/3w9pL5 --- SHOW NOTES In this episode of BackTable ENT, Dr. Ashley Agan, Dr. Gopi Shah, Dr. Cecelia Damask (Lake Mary ENT and Allergy), and Dr. Matt Ryan (UT Southwestern Otolaryngology) discuss the growing role of biologics for nasal polyps. Biologics are monoclonal antibodies that block T2-mediated immune responses (IL-3, IL-4, IL-13, IgE). They are administered subcutaneously and follow various dosing regimens. Biologics are a viable treatment option in patients with recurrent nasal polyps who have failed conventional therapies, such as high doses of antihistamines, topical steroids, and systemic steroids. It is still considered as a last line treatment because of the high cost associated with production of monoclonal antibodies. However, not all patients with recurrent nasal polyps are good candidates for biologics. The patient must present with a specific endotype––the T2-mediated etiology. T2-mediated patients can be identified through their high responsiveness to steroid therapy, positive history for allergic asthma and atopic dermatitis, and high peripheral eosinophil and serum IgE levels on a CBC with differential. In a surgery-naive patient with a temporary steroid response, it is best to perform sinus surgery first in order to widen the nasal mucosal surface area for efficient delivery of topical therapies. However, if post-surgical intranasal steroid sprays and saline irrigations are ineffective, biologics should be considered. It is best to avoid surgery and skip straight to biologics in patients with comorbid conditions that prevent surgery, patients with severe asthma, and patients with high peripheral IgE counts (>1000). Once the decision to start biologic therapy is made, many factors have to be considered, such as insurance pre-authorization, administration methods, and frequency of dosing. Each biologic manufacturer has a “hub” that assists physicians and patients in navigating biologic dosing, delivery, and insurance paperwork. They will often have co-pay assistance programs for patient benefit as well. Common side effects observed in biologic trials are arthralgia, injection site inflammation, oropharyngeal pain, and headaches. However, all the doctors agree that these side effects are more mild than those of long-term systemic steroid use, which include avascular necrosis, cataracts, sepsis, and thromboembolic events. Picking which biologic to prescribe is a clinical decision because they have not been subjected to comparative trials yet. The three biologics currently on the market are: Dupilumab (anti-IL-4 receptor), Omalizumab (anti-IgE), and Mepolizumab (anti-IL-5 receptor). All work to prevent T2 immune signaling by targeting different receptors. Factoring in comorbid conditions, payer systems, and dosing regimens can help a physician choose the best biologic for a nasal polyps patient.

In this special collaborative episode, guest host Dr. Bradley Block talks with Dr William Blythe and Dr. Drew Locandro about the pros and cons of private equity, including a discussion of the key things to think about when considering selling your practice. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/iiPh9y --- SHOW NOTES In this episode of BackTable ENT, Dr. Bradley Block from ENT and Allergy interviews Dr. Drew Locandro (Northwest ENT and Allergy Center) and Dr. Bill Blythe (East Alabama Ear, Nose & Throat) about the benefits and pitfalls of opening their private practices to private equity companies. Private equity can provide many benefits to community practitioners. Outside investment can contribute more money to marketing and hiring new supportive positions. Additionally, it also levels the playing field for older and younger doctors in the practice in the context of objective management. Finally, private equity firms can take care of administrative duties, such as billing and accounting, thus increasing the free time available to physicians. On the other hand, retaining complete ownership of a medical practice can provide physicians with more satisfaction and decrease rates of burnout. Dr. Blythe notes that a physician can still retain total ownership of his practice but still outsource basic administrative duties, such as general accounting. Finally, the doctors discuss the concept of a “second bite” deal. Oftentimes, the original smaller private equity firm will sell the medical practice to a larger private equity firm for a profit. Risks of the “second bite” include undervaluation of the practice as well as loss of physician control. However, Dr. Locandro notes that the second sale may also be financially beneficial for the physician stakeholders as well.

Dr Keith Matheny tells us how he first got involved in entrepreneurial pursuits, including starting a global purchasing organization for ENT's, as well as advice on where to start when you have a great idea for a new device! --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/xwej9p --- SHOW NOTES In this episode of BackTable ENT, Dr. Shah and Dr. Agan interview Dr. Keith Matheny, a physician-entrepreneur and a fellow ENT. First, Dr. Matheny discusses his personal device innovation and business journey. He started medical practice with no formal business background or training and had to learn these skills on-the-job during his first private practice job. After observing the need in his field for business consulting, he created US ENT, a formal consulting company, to help other ENT practices grow and develop different departments. US ENT later transformed into a group purchasing organization and was able to partner with medical suppliers to give physicians discounts on materials. During this time, he was also able to test new ENT devices and provide his input to large medical device companies; these experiences prompted him to venture into the field of device innovation and begin patenting his ideas. Acquiring knowledgeable and supportive partners is essential for developing new devices. Dr. Matheny recommends reaching out to device representatives of major medical device companies in order to be introduced to their business development teams. However, he notes that major medical device companies do not specialize in early-stage development. For this reason, partnering with a startup business may be more productive when developing a product prototype. For every person an innovator discusses his idea with, a non-disclosure agreement (NDA) should be signed in order to ensure the integrity of information sharing. Additionally, innovators should file a patent as soon as they have a solid idea; patent lawyers are useful resources and can help innovators find angles that make their ideas different from previous devices. Although Dr. Mathey encourages innovators to seek funding from healthcare investors, venture capitalists, and private equity companies, he warns listeners against letting outside forces take control over a majority of their company. Once a prototype is created, the product can be tested in the setting of a medical practice through the proper IRB channels. It is important to follow FDA regulations during this time period. For devices that are similar to pre-existing devices on the market, they can be classified as Class I exempt devices if all predicate devices are listed in the application. Approval for Class I exempt devices will follow in a few short months. However, for brand new devices, a formal study will need to be conducted before it can be used in human patients, thus invoking a longer approval time. --- RESOURCES Dr, Matheny’s Linkedin: https://www.linkedin.com/in/keith-matheny-38250811/ US ENT: https://usent.com/ Septum Solutions: https://septumsolutions.com Sleep Vigil: https://www.sleepvigil.com/