BackTable ENT & Allergy

Treating pediatric head and neck cancer means thinking far beyond the initial diagnosis to ensure healthy growth, function, and future quality of life. For Pediatric Cancer Awareness Month, BackTable ENT & Allergy spotlights the unique challenges and innovations in caring for children with head and neck cancer. Host Dr. Gopi Shah is joined by Dr. Anthony Sheyn, leader of the head and neck cancer program at St. Jude Children’s Research Hospital, and Dr. Sara Helmig, pediatric oncologist at St. Jude, to discuss how multidisciplinary teams, advanced diagnostics, and family-centered care are reshaping outcomes for young patients.

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Timestamps

00:00 - Introduction 03:39 - Building a Multidisciplinary Program 06:54 - Patient Workup and Tumor Board Workflow 10:36 - Unique Considerations in Pediatric Head and Neck Cancer13:31 - Recent Advances in Diagnosis and Treatment16:42 - Balancing Margins, Function, and Protocols19:56 - Managing Treatment Side Effects23:35 - Endocrine and Craniofacial Development 27:30 - Fertility, Second Cancers, and Survivorship32:45 - Looking Ahead: Program Innovations 36:23 - Closing Remarks

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More about this episode

The episode explores how pediatric head and neck cancers differ from adult disease, including the critical role of molecular and genomic profiling, targeted therapies, proton radiation, and 3D surgical planning. Drs. Sheyn and Helmig describe the development of a comprehensive care program involving ENT, oncology, endocrinology, genetics, nutrition, dental, speech, and psychology specialists. They discuss strategies for balancing surgical margins with preservation of function, monitoring for treatment toxicity, and supporting endocrine and craniofacial development. Additional topics include fertility preservation, survivorship clinic models, long-term monitoring for secondary malignancies, and the use of AI to streamline tumor board workflows. The episode closes with a look at the future of pediatric head and neck oncology, including efforts to standardize protocols and enhance multidisciplinary collaboration.

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Resources

Episode on Pediatric Thyroid Nodules https://www.backtable.com/shows/ent/podcasts/274/pediatric-thyroid-nodules-clinical-insights-approaches

Episode on Molecular Diagnostics for Thyroid Nodules https://www.backtable.com/shows/ent/podcasts/277/molecular-diagnostics-for-thyroid-nodules

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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

How is the “arms race” for research and academic credentials reshaping the ENT workforce and residency process? On this episode of BackTable ENT & Allergy, Dr. Ashley Agan sits down with Dr. Al Merati and Dr. Mark Whipple from the University of Washington to discuss the pressures ENT residency applicants face, the impact on specialty equity and rural access, and the challenges programs encounter in selecting the next generation of otolaryngologists. They explore survey data showing up to two-thirds of applicants feel compelled to present an “academic” persona, and why this trend may erode unity, transparency, and opportunities across the field.

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Timestamps

00:00 - Introduction04:07 - Masking and Authentic Career Goals07:16 - Preview: Crucial Conversations Panel10:39 - Program Signaling and Application Volume13:56 - Addressing the Rural Access Crisis16:59 - Academic Drift and Fellowship Trends19:33 - Accountability in Graduate Medical Education25:22 - Defining Equity in the Application Process29:12 - What Program Directors Want33:58 - Prioritizing Impact Over Research Quantity38:14 - Measuring Workforce Accountability45:40 - Key Takeaways and Closing Remarks

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More about this episode

The conversation covers the shifting importance of research productivity, changes in Step 1 and grading, program signaling, and how rural access gaps and a growing preference for academic careers are shaping the field. Drs. Merati and Whipple discuss the need for more exposure to comprehensive and community ENT, greater program transparency, and moving away from a publication-counting culture toward impact and accountability. They close with proposed solutions for residency programs, including normalizing all career paths, increasing equity, and rebalancing incentives to better serve both trainees and patients.

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Resources

Crucial Conversations Panel – Sunday, October 18, 8:00 AMAAOHNS schedule

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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

Which patients with obstructive sleep apnea are candidates for a GLP-1, and how do you start, escalate, and monitor one safely? On this episode of BackTable ENT & Allergy, host Dr. Gopi Shah is joined by obesity medicine specialist Dr. Shanail Berry and sleep specialist Dr. John Carter to discuss the practical questions that arise when adding GLP-1 and GLP/GIP therapies in OSA management. They discuss drug mechanisms and formulations, patient selection, screening and referral, management of side effects and contraindications, adherence strategies, perioperative considerations, and nutritional issues.

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Get the BackTable apphttps://www.backtable.com/app

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Timestamps

00:00 - Introduction02:18 - The Overlap Between Obesity and Sleep Apnea04:02 - GLP-1 Medications: Basics and History05:52 - Dual and Triple Agonists in Development08:56 - Clinic Evaluation and Team-Based Referrals14:18 - Navigating Insurance Coverage17:28 - Key GLP-1 Trials in OSA18:25 - Results from SURMOUNT-OSA26:31 - Integrating CPAP and GLP-1 Therapy37:35 - Moving Beyond AHI: New Assessment Metrics40:40 - Safety, Perioperative Risks, and Sarcopenia50:16 - Wrap-Up

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More about this episode

The discussion also addresses the challenges of long-term GLP-1 therapy, including insurance barriers, prior authorizations, dose escalation, and common side effects. The doctors review when to reassess OSA after starting treatment, the growing importance of hypoxic burden beyond AHI, and strategies to prevent sarcopenia during weight loss. Throughout, they emphasize a multidisciplinary approach and the evolving landscape of OSA care in the era of GLP-1 therapies.

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Resources

SCALE Studyhttps://pubmed.ncbi.nlm.nih.gov/26132939/

SURMOUNT-OSA Trialhttps://pubmed.ncbi.nlm.nih.gov/38547961/

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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

With no FDA-approved therapies for Sjögren’s disease, how can ENTs and allergists provide effective care and keep up with emerging treatments? On this episode of BackTable ENT & Allergy, Dr. Basil Kahwash interviews Dr. Kara Wada, a Columbus-based allergist, immunologist, and lifestyle medicine physician, about her personal and clinical experience with Sjögren’s disease. They discuss the major gaps in current treatment, the evolving role of otolaryngologists and allergists in multidisciplinary care, and the new therapies on the horizon.

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Timestamps

00:00 - Introduction02:21 - Building A Direct Practice04:24 - Personal Sjogren's Diagnosis08:33 - ENT Presentations11:28 - Biopsy Challenges and Seronegative Disease15:48 - Pulmonary Complications17:55 - Clinical Trial Treatment19:47 - Immunology and Disease Mechanisms25:35 - Lab Workup and Risk Assessment29:32 - Overlooked Symptoms and Nutritional Considerations31:51 - Saliva Stimulants Tradeoffs34:42 - Deciding When to Escalate Systemic Therapy35:51 - Hydroxychloroquine Basics38:26 - Multidisciplinary Dream Team41:45 - Rituximab and IVIG44:35 - Investigating Phase Three Therapies47:23 - Path to Becoming a Sjogrens Expert53:33 - Key Takeaways And Resources

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More about this episode

Dr. Wada details her own diagnosis and the complex presentations of Sjögren’s across ENT subspecialties, including dry eyes, nasal and throat tissues, chronic sinus issues, laryngitis, reflux, salivary gland swelling, neuropathy, and dizziness. The conversation covers diagnostic workup, the importance of lip biopsy and expert pathology, the challenges of seronegative and pulmonary cases, and the limitations of current medications like hydroxychloroquine and rituximab. They also discuss ongoing clinical trials, dryness management, overlooked symptoms, and the emerging role of agents such as inalumab and dazedalimab in late-phase studies.

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Resources

Virtual Sjögren’s Summithttps://www.sjogrenssummit.com/

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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

What if your pharmacist could help optimize a patient’s asthma treatment before their next clinic visit? On this episode of the BackTable ENT & Allergy Podcast, Dr. Basil Kahwash welcomes clinical pharmacist Dr. Joelle Ayoub to discuss how ambulatory care pharmacists can partner with ENT and allergy clinics to optimize asthma management. Dr. Ayoub shares her experience working in a family medicine clinic, collaborating with providers through referrals, reviewing medications, and providing direct patient education on inhaler use and disease management.

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Get the BackTable apphttps://www.backtable.com/app

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Timestamps

00:00 - Introduction02:40 - The Role of the Clinic Pharmacist05:04 - Teaching Patients and Improving Inhaler Technique12:36 - Choosing Inhalers and Applying Guidelines18:51 - Comparing MDI, DPI, and SMI Devices28:15 - Tracking Asthma Control and Monitoring Adherence33:55 - Inhaler Education and Overcoming Barriers40:00 - Using Social Media for Patient and Provider Education44:16 - Pharmacist Collaboration and the Future of Team Care50:58 - Answering Biologics Patient Questions53:15 - SMART Therapy and Digital Inhaler Advances55:19 - Wrap Up

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More about this episode

They discuss common gaps in asthma care, with a focus on inhaler technique and medication adherence. Dr. Ayoub explains how device complexity, cost, and a patient’s ability to use their inhaler can all affect treatment. She also reviews the major inhaler types, common technique errors, and what to consider when choosing the right device for each patient. With this, Dr. Ayoub shares practical approaches to adherence monitoring, asthma guideline updates, and biologic monitoring. Throughout, Dr. Ayoub emphasizes the benefits of multidisciplinary collaboration and how pharmacists can help bridge gaps in care for patients with asthma.

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Resources

Joelle Ayoub, PharmD, BCACP, APh - https://www.westernu.edu/bios/?bio=jayoub

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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