BackTable ENT

Behind every smooth surgery is a team member you may not see in the spotlight—but without them, the operation doesn’t run. In this episode of the BackTable ENT podcast, Jose Flores, a surgical technologist at Rady Children’s Hospital in San Diego and ENT service coordinator, joins host Dr. Gopi Shah to discuss the importance of the surgical technologist’s role in the OR and how it directly impacts patient care.

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SYNPOSIS

Jose discusses his journey from being a medical assistant to finding his calling in the operating room, specifically in ENT. They explore the critical yet often overlooked role of OR scrub techs, the necessity of proper preparation and organization, and the importance of good communication and teamwork within the surgical team. Jose also shares personal experiences and advice for both new surgical techs and medical students, emphasizing the rewarding nature of working in pediatric ENT.

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TIMESTAMPS

00:00 - Introduction 01:29 - Jose Flores’s Journey to Becoming a Surgical Tech05:41 - Daily Responsibilities and Preparation10:11 - Communication and Teamwork in the OR15:30 - Building Strong Surgical Tech Relationships18:51 - Advice for New Surgical Techs21:25 - The Role of Techs in Quality and Safety23:15 - Giving and Receiving Feedback27:02 - Fostering Respect and Recognition30:40 - Final Thoughts and Contact Information

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RESOURCES

Jose Flores’s Story:https://vimeo.com/1096085041

Could that routine epistaxis actually be the first sign of a challenging skull base tumor? This week’s episode of the BackTable ENT Podcast is part two of the sinonasal tumor and skull base involvement discussion. Host Dr. Satyan Sreenath is joined again by Dr. Joao Paulo Almeida, Dr. Zara Patel, and Dr. Garret Choby for a case-based deep dive into the multidisciplinary management of complex sinonasal tumors.

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Timestamps

00:00 - Introduction 01:20 - Case 1: Juvenile Nasopharyngeal Angiofibroma05:03 - Considerations for Pre-Operative Embolization 08:10 - Disaster Scenario: High Volume Loss09:21 - Operative Approach18:10 - Post-Op Imaging Considerations21:00 - Case 2: Invasive Keratinizing Squamous Cell Carcinoma24:40 - Operative Approach vs. Neoadjuvant Treatment Strategies28:30 - Importance of Diagnostic Nasal Endoscopy30:15 - Operative Approach32:37 - Lumbar Drain Considerations 40:35 - Closing Thoughts

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More about this episode

The panel works through advanced cases presenting with epistaxis, using them to highlight key principles in evaluation, imaging, staging, and operative planning. They first discuss a 16-year-old male with a large juvenile nasopharyngeal angiofibroma extending to the skull base and middle cranial fossa, focusing on vascular supply, preoperative embolization, surgical strategy near the carotid, and planning for intraoperative hemorrhage and postoperative surveillance. They also emphasize the importance of thorough endoscopic evaluation and early referral to experienced centers.

They then review a 72-year-old female with invasive, HPV-negative keratinizing squamous cell carcinoma involving the anterior cranial fossa and dura. The conversation addresses tumor board decision-making, neoadjuvant considerations, endoscopic craniofacial resection, reconstruction strategies, and management of delayed positive margins. It highlights how accurate histopathology and coordinated multidisciplinary care guide outcomes in these complex cases.

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Resources

Joao Paulo Almeida, MD, PhDhttps://medicine.iu.edu/faculty/68351/almeida-joao-paulo

Satyan B. Sreenath, MDhttps://medicine.iu.edu/faculty/60724/sreenath-satyan

Zara M. Patel, MD https://med.stanford.edu/profiles/zara-patel

Garret W. Choby, MDhttps://providers.upmc.com/provider/garret-w-choby/2592344

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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

Pathology, anatomy, and staging: how do these three pillars come together to guide sinonasal tumor management? In this episode of the BackTable ENT Podcast, host Dr. Satyan Sreenath is joined by Dr. Joao Paulo Almeida, Dr. Zara Patel, and Dr. Garret Choby to discuss a multidisciplinary approach to sinonasal tumors, emphasizing the triad of pathology, anatomy, and staging to guide treatment.

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

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Timestamps

00:00 - Introduction 02:04 - First Principles of Workup05:23 - Case 1: Maxillary Sinus Mass 06:23 - Imaging and Biopsy Strategy08:11 - Inverted Papilloma Pathology and Surgical Planning20:28 - Case 2: Unilateral Disease Red Flags24:34 - MRI Clues for Malignancy31:47 - Video Walkthrough of Endonasal Resection38:51 - Surveillance41:41 - Key Papers---More about this episode

The panel reviews key workup considerations, including in-office biopsy and the use of CT and MRI to distinguish tumor from retained secretions and guide operative planning. They walk through two illustrative cases of inverted papilloma. The first involves a left maxillary sinus mass treated with an endoscopic medial maxillectomy using a Denker-type approach, with emphasis on complete attachment-site eradication. The second case highlights an elderly patient with frontal and anterior ethmoid disease abutting the orbit and skull base, requiring meticulous endoscopic technique, careful management of the anterior ethmoid artery, and thoughtful handling of bone and periorbita.

The discussion also covers imaging features suggestive of malignant transformation, as well as emerging AI-based CT and MRI tools that show high accuracy in distinguishing benign inverted papillomas from those associated with squamous cell carcinoma. The episode concludes with postoperative surveillance strategies and key consensus and review publications.

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ResourcesJoao Paulo Almeida, MD, PhDhttps://medicine.iu.edu/faculty/68351/almeida-joao-paulo

Satyan B. Sreenath, MDhttps://medicine.iu.edu/faculty/60724/sreenath-satyan

Zara M. Patel, MD https://med.stanford.edu/profiles/zara-patel

Garret W. Choby, MDhttps://providers.upmc.com/provider/garret-w-choby/2592344

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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 you could build a skull base practice outside academia, without sacrificing complexity, income, or fulfillment? On this episode of the BackTable ENT Podcast, Dr. Kibwei McKinney from SSM Health St. Anthony Hospital in Oklahoma City joins guest host Dr. Dennis Tang to discuss building a rhinology and skull base surgery practice outside academia.

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Get the BackTable app

https://www.backtable.com/app

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Timestamps

01:30 - Introduction and Career04:55 - Private Practice vs. Academics10:38 - Defining Skull Based Surgery15:10 - Patient Pool and Logistics in Academics vs Private Practice19:03 - Marketing and Referral Sources24:58 - Case Management and the O.R. in Private Practice29:30 - Balanced Workload and Intentional Care32:10 - Billing and Coding38:55 - Lifestyle Benefits of Private Practice44:21 - Strategic Advice and Advantages or Disadvantages of Private Practice.47:38 - Common Misconceptions50:00 - Advice and Closing Thoughts

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More about this episode

Dr. McKinney walks through his training journey, from dedicated research years to time in private-practice rhinology and a skull base fellowship, before ultimately starting his academic career in Oklahoma. He shares how shifting family priorities and the growing push for clinical productivity led him to step away from academia and into an employed private-practice model focused exclusively on rhinology and skull base surgery, without ER call. Along the way, he dives into what that transition really looks like, including the autonomy he’s gained, the role of marketing support, how he builds referrals through direct communication, and the operational differences of working without residents. He also touches on postoperative care structure, billing and coding, insurance challenges, and the impact on his overall lifestyle.

Check out this episode to hear Dr. McKinney’s perspective on why skull base surgery in private practice can be not only technically feasible and financially viable, but also emotionally sustainable, creating space for truly patient-centered care and the ability to pursue the work with genuine passion.

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Resources

Dr. Kibwei McKinney https://www.getcare.ssmhealth.com/find-a-doctor/doctor-details/kibwei-mckinney-md

Why do some patients recover faster, cope better, and experience less pain despite similar diagnoses? The answer may lie not in the pathology, but in perception. In this episode of the BackTable ENT & Allergy Podcast, Dr. Sonia Gupte, a former family physician and board-certified clinical hypnotherapist, joins host Dr. Gopi Shah to explore how hypnotherapy works and where it fits in modern medical care.

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Get the BackTable app

https://www.backtable.com/app

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Timestamps

00:00 - Introduction05:13 - Understanding the Subconscious Mind09:29 - The Hypnotherapy Process15:43 - Patient Selection18:58 - Anxiety, Stress, and Pain Perception23:54 - Use in General ENT Population28:14 - When to Refer31:51 - History of Hypnotherapy in Cancer Care32:56 - Awareness, Access, and Billing Insurance38:59 - Setting Expectations, Visits Required, and Smoking Cessation43:42 - Virtual Visits and Possible Limitations46:57 - Techniques for ENTs49:14 - Closing Thoughts

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More about this episode

Dr. Gupte shares how her mother’s cancer journey led her to recognize gaps in addressing the mind-body connection and ultimately transition into hypnotherapy. She clarifies the difference between hypnosis and clinical hypnotherapy, emphasizing the latter as a collaborative, goal-oriented process aimed at uncovering the “why” behind patient patterns and reshaping perceptions. The conversation covers the structure of a hypnotherapy session, relevant brainwave states, patient selection and contraindications, and clinical applications ranging from oncology support to ENT-related quality-of-life concerns. They also discuss use in pediatric patients, expected timelines for improvement, virtual care delivery, and practical communication strategies clinicians can use to reduce patient anxiety in everyday practice.

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Resources

Dr. Sonia Gupte

https://enso-nia.com/about-sonia/