BackTable ENT

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.

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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.

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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

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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

Not every airway is a tonsil problem. Pediatric obstructive sleep apnea is often more nuanced than it appears, requiring thoughtful evaluation beyond routine surgery. In this episode of the BackTable ENT Podcast, pediatric otolaryngologist Dr. Tali Lando discusses managing pediatric obstructive sleep apnea (OSA) with hosts Dr. Gopi Shah and Dr. Ashley Agan.

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SYNPOSIS

Dr. Lando shares insights into her clinical practice, outlining a systematic approach to diagnosing and treating pediatric OSA, and emphasizing the value of sleep endoscopy. She explores the spectrum of interventions from adenoidectomy and tonsillectomy to complex airway evaluations and surgical management, while highlighting the roles of sleep studies, obesity, and emerging therapies such as hypoglossal nerve stimulation. Dr. Lando also reflects on balancing a busy clinical career with family life and discusses her two books, Hell & Back: Wife & Mother, Doctor & Patient, Dragon Slayer and Breathless: Surgical Tales from the Brink (and Back).

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TIMESTAMPS

00:00 - Introduction06:21 - When Noisy Breathing Signals More Than Tonsils10:01 - When to Add DISE: Combining T&A with Airway Evaluation18:08 - Turbinates, Septum and Nasal Valve Matter22:03 - Red Flags in Clinic29:12 - When Surgery Helps and When It Doesn’t41:33 - Sleep Studies43:09 - Down Syndrome and OSA55:19 - Finding Hidden Sites of Airway Collapse01:06:13 - Hypoglossal Nerve Stimulation and Advanced Options

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RESOURCES

Dr. Tali Lando https://www.wmchealth.org/physician-locator/tali-lando-1548383763?address_id=413 About Dr. Tali – Dr. Tali Lando

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.

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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.

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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

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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

At what point does a “routine” sinus or ear infection become a warning sign of immunodeficiency? In this episode of the BackTable ENT Podcast, board-certified allergist-immunologist Dr. Basil Kahwash explores the intersection of immunodeficiency and otolaryngology with Dr. Lauren Gunderman, a pediatric immunologist at Seattle Children’s Hospital. Learn why ENTs should remain vigilant for underlying immune disorders, and how to manage suspected immunodeficiency.

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SYNPOSIS

The conversation reviews common signs and symptoms of immunodeficiency, key elements of the diagnostic workup, and when ENT physicians should consider referral to immunology. Dr. Kahwash and Dr. Gunderman discuss the role of family history and genetics, as well as current management strategies, including antibiotic use, immunoglobulin replacement therapy, and lifestyle modifications. Throughout the episode, Dr. Gunderman emphasizes the importance of multidisciplinary collaboration between otolaryngologists and immunologists to improve outcomes for patients with recurrent or severe infections.

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TIMESTAMPS

00:00 - Introduction 02:45 - Understanding Immunodeficiency in ENT08:20 - Common Immunodeficiencies and Indicators11:02 - Basic Immunology Refresher22:13 - Initial Diagnostic Workup25:05 - Challenges in Allergy and Immunology Testing27:57 - When to Refer to an Immunologist34:01 - Antibiotic Stewardship in Immunodeficient Patients46:07 - Advances in Diagnosing Immunodeficiency50:31 - Final Thoughts and Takeaways

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RESOURCES

Lauren Michelle Gunderman, MDhttps://www.seattlechildrens.org/directory/lauren-michelle-gunderman/

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.

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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

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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.

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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

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RESOURCES

Dr. Stephen Chorney https://utswmed.org/doctors/stephen-chorney/

Trio Thesis https://onlinelibrary.wiley.com/doi/full/10.1002/lary.32448