BackTable ENT

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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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.

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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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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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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/

Anaphylaxis doesn’t always look like hives and swelling. In up to 20% of cases, the skin is completely clear, making the diagnosis easy to miss. On this episode of the BackTable ENT & Allergy Podcast, Dr. Basil Kahwash speaks with Dr. Payel Gupta, allergist and immunologist at Mount Sinai in New York City, about how to recognize and manage anaphylaxis.

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Timestamps

00:00 - Introduction02:02 - Defining Anaphylaxis and Key Signs04:09 - Anaphylaxis Versus Shock05:54 - Diagnostic Pitfalls12:43 - Epi First Epi Fast32:33 - ER Or Observe42:31 - Allergy Testing Limits47:16 - New Anaphylaxis Therapies51:34 - Public Awareness and Advocacy01:02:55 - Final Pearls and Wrap up

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More about this episode

Dr. Gupta and Dr. Kahwash first define anaphylaxis and review common diagnostic pitfalls, including absent skin findings, overlap with asthma, atypical presentations, delayed reactions, and the effects of beta-blockers. Dr. Gupta emphasizes the importance of early treatment with intramuscular epinephrine. Antihistamines and steroids are discussed as adjunctive therapies and the episode reviews the risk and management of biphasic reactions. The conversation also covers optimal timing for tryptase testing, post-reaction counseling, evolving guidance on emergency department referral, and appropriate timing for allergy testing after a reaction. Dr. Gupta discusses emerging options such as intranasal epinephrine and the use of omalizumab to increase reaction thresholds in food allergy. The episode concludes with a discussion of public misconceptions around the term “allergy,” barriers to appropriate care, and Dr. Gupta’s advocacy and educational work.

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Resources

Dr. Payel Gupta https://www.zocdoc.com/doctor/payel-gupta-md-facaai-571583

What makes butterfly cartilage tympanoplasty such an elegant solution for pediatric eardrum perforations? In this episode of the BackTable ENT Podcast, Dr. Sean Evans of Children’s Healthcare of Atlanta joins hosts Dr. Ashley Agan and Dr. Gopi Shah to discuss the evaluation and management of pediatric tympanic membrane perforations, with a focus on the butterfly cartilage tympanoplasty technique

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SYNPOSIS

Dr. Evans describes his practice and reviews common etiologies of tympanic membrane perforations. He outlines his approach to the clinical workup and patient counseling, including the role of audiograms, careful otoscopic examination, and selective use of laboratory studies and CT imaging in patients with chronic otorrhea or suspected cholesteatoma. The discussion also addresses timing and age considerations for repair, as well as strategies for managing chronic drainage. Dr. Evans also discusses his evaluation of patient selection criteria and operative technique for butterfly cartilage tympanoplasty. He shares practical insights on surgical steps, technical pearls and pitfalls, postoperative care, recovery expectations, potential risks, coding considerations, and approaches to revision surgery.

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TIMESTAMPS

00:00 - Introduction 02:35 - When to Repair Perforations 10:36 - Physical Exam, Audiogram, & Treatment Decisions18:06 - Butterfly Graft Candidacy20:42 - Step by Step Butterfly Technique25:52 - Butterfly Technique Pearls and Pitfalls29:16 - Example Case Video and Indications35:12 - Restrictions, Pain, & Recovery37:10 - Risk Factors and Complications40:09 - Revision Timing and Failure Modes42:37 - Final Pearls and Wrap Up

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RESOURCES

Dr. Sean Evans https://med.emory.edu/directory/profile/?u=SSEVAN3