BackTable ENT & Allergy

Aspirin or biologics? How do you choose the right treatment for AERD? On this episode of the BackTable ENT & Allergy Podcast, Dr. Basil Kahwash interviews Dr. Andrew White, Director of the AERD Clinic at Scripps Clinic, to discuss the diagnosis and management of this often underrecognized condition. They cover practical strategies for identifying AERD, the importance of a detailed NSAID history, and how treatment decisions are shaped by patient goals and disease severity.

---

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

---

Timestamps

00:00 - Introduction02:08 - What Is AERD and Prevalence 06:32 - History Taking and Mechanism 11:10 - Typical Symptom Progression and Alcohol Intolerance 16:41 - When to Do Aspirin Challenge 19:00 - Challenge Protocol And Upper Airway Reactions24:53 - Aspirin Desensitization vs Challenge27:58 - Aspirin therapy after desensitization and Risk of GI Bleeds31:17 - Biologics Change AERD33:42 - Choosing Aspirin Desensitization vs Biologics 35:52 - Patient Counseling and Motivational Interviewing 41:26 - Convenience and Cost of Therapy 44:10 - ENT Allergy Collaboration47:22 - Rapid Fire Pearls51:13 - Future Research & Management Direction54:05 - Final Takeaways

---

More about this episode

Dr. White explains that AERD affects about 8 to 10 percent of asthmatics, with even higher rates in those with severe asthma or nasal polyps. He reviews typical adult-onset progression, alcohol-related respiratory symptoms, and the underlying pathophysiology, including imbalances in arachidonic acid mediators and leukotriene surges after NSAID exposure.The conversation includes practical questions to ask when taking an NSAID history, such as reactions to common pain relievers or alcohol, and when to consider aspirin challenge. Dr. White also details long-term treatment strategies, including the role of biologics like dupilumab and aspirin therapy after desensitization, with considerations for dosing and gastrointestinal risk. He explains how factors like asthma severity, recurrent polyp disease, sense of smell, cost, and convenience all influence therapy choice. The episode concludes with a discussion of multidisciplinary collaboration, patient counseling, and Dr. White’s insights on future research directions in AERD management.

---

Resources

Aspirin sensitivity and severity of asthma: evidence for irreversible airway obstruction in patients with severe or difficult-to-treat asthmahttps://pubmed.ncbi.nlm.nih.gov/16275362/

Polyphenolic Activation of Basophils Explains Alcohol Hypersensitivity in AERDhttps://pubmed.ncbi.nlm.nih.gov/41065188/

New insights into the mechanisms of aspirin-exacerbated respiratory diseasehttps://pubmed.ncbi.nlm.nih.gov/39641750/

The role of aspirin desensitization followed by oral aspirin therapy in managing patients with aspirin-exacerbated respiratory disease: A Work Group Report from the Rhinitis, Rhinosinusitis and Ocular Allergy Committee of the American Academy of Allergy, Asthma & Immunologyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC7980229/

Safety and outcomes of aspirin desensitization for aspirin-exacerbated respiratory disease: A single-center studyhttps://pubmed.ncbi.nlm.nih.gov/28550988/

Selection of aspirin dosages for aspirin desensitization treatment in patients with aspirin-exacerbated respiratory diseasehttps://pubmed.ncbi.nlm.nih.gov/17208597/

Factors influencing aspirin therapy after desensitization (ATAD) tolerance in aspirin-exacerbated respiratory disease (AERD) patientshttps://pubmed.ncbi.nlm.nih.gov/41022281/

Feed the Good Wolf: Motivational Interviewing, Cognitive Behavioral Therapy, and Mindsethttps://pubmed.ncbi.nlm.nih.gov/42103433/

---

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

Can viewing the airway as one connected system change the future of respiratory care and improve patient outcomes? On this episode of the BackTable ENT & Allergy Podcast, Dr. Cedric Jamie Rutland, pulmonary and critical care medicine physician, joins Dr. Basil Kahwash to discuss the unified airway hypothesis and its implications for clinical care. They explore how upper and lower airway inflammation are closely linked, and why multidisciplinary collaboration is essential for treating the whole patient.

---

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

---

Timestamps

00:00 - Introduction05:06 - Understanding the Unified Airway14:27 - Decoding Asthma Biomarkers20:34 - Endotyping in Clinical Practice26:36 - Addressing Asthma Symptom and “Outgrowing” Asthma32:13 - Strategies for Precision Biologics34:23 - Navigating Insurance and Treatment Indications35:36 - Treating the Whole Patient and Breaking Down Specialty Silos46:07 - Effective Patient Communication51:36 - Asthma Lightning Round57:33 - Biologics and Airway Remodeling1:00:00 - Closing Thoughts

---

More about this episode

The conversation covers the biology of type II inflammation, the use of biomarkers and biologics for more personalized treatment, and practical strategies for overcoming insurance barriers and specialty silos. Dr. Rutland shares insights on patient communication, the limitations of current diagnostics, and the impact of chronic inflammation on systemic disease. The episode highlights the need for ENT, allergy, and pulmonology teams to work together and embrace a connected view of airway disease to achieve better patient outcomes.

---

Resources

Dr. Jamie Rutland - https://www.lung.org/media/meet-our-experts/cedric-jamie-rutland-md

---

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

BackTable is moving beyond the traditional podcast experience and into a platform built specifically for clinicians. On this episode of the BackTable ENT & Allergy Podcast, hosts Drs. Gopi Shah and Ashley Agan welcome Dr. Aaron Fritts, interventional radiologist and BackTable CEO and Co-Founder, to discuss the history and future of BackTable, and what listeners can look forward to on the new BackTable App.

---

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

---

Timestamps00:00 - Introduction00:51 - Meet the CEO and Co-Founder02:32 - How Backtable Got Its Name04:32 - Why Move to the App07:31 - Community and Learning Features12:36 - Playlists and Transcripts15:42 - Beyond Backtable Content18:07 - Searchability and Other Platform Limits19:35 - Privacy and NPI Verification21:31 - Download the App and Give Feedback22:53 - October Timeline and Academy Party24:26 - Closing Thoughts

---

More about this episode

Dr. Fritts shares how BackTable started as an app concept for medical devices in 2016, evolved into the IR podcast in 2017, and expanded to the ENT show in 2020. He explains how Gopi coined the name “BackTable” as an homage to the informal, behind-the-scenes conversations that fuel clinical learning. With eight shows now producing 30 to 40 episodes each month, BackTable will begin releasing most new podcast episodes exclusively on the BackTable app starting in October.

The conversation highlights the app’s robust features designed for busy clinicians, including physician-only NPI-verified guest Q&As, quick-study cases, searchable and organized playlists, episode transcripts, offline listening, upcoming CarPlay integration, and access to resources like the Curbsiders internal medicine podcast. The BackTable app is free to download and free to use, providing easy access to a growing library of high-yield medical education content.

---

Resources

Download the BackTable App on Google Playhttps://play.google.com/store/apps/details?id=com.backtable.app&hl=en_GB

Download the BackTable App on the Apple App Store https://apps.apple.com/us/app/backtable/id6751363383

---

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

Most surgeons trained learning extracapsular tonsillectomies. What does the evidence say about intracapsular tonsillectomies? Two pediatric otolaryngologists explain why they made the switch and never looked back. On this episode of the BackTable ENT Podcast, hosts Dr. Ashley Agan and Dr. Gopi Shah sit down with pediatric otolaryngologists Dr. Stephen Chorney from UT Southwestern and Children's Health Dallas and Dr. Kevin Huoh from Children's of Orange County to examine post-operative complications after tonsillectomy and adenoidectomy, with a focus on coblation intracapsular tonsillectomy.

---

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

---

This podcast is supported by

Smith + Nephewhttps://www.smith-nephew.com/en/

---

Timestamps

00:00 - Introduction02:53 - Why Switch Techniques?07:58 - Risk Stratification and Patient Selection11:04 - Respiratory Complications and Management15:57 - Preop Screening21:35 - Risks for Post-op Bleeding and Counseling26:16 - Managing Post-op Bleeding31:56 - Surgical Tips to Prevent Bleeds and Management39:30 - Intracapsular Tonsillectomy in Older Kids43:44 - Post Op Pain Plan and Return To School48:33 - Use of Toradol & Readmission for Pain and Dehydration53:16 - Caution of Burn and Stenosis Injuries61:01 - Final Takeaways

---

More about this episode

Dr. Chorney and Dr. Huoh share why they each committed fully to the intracapsular technique and what that shift has meant in practice, from secondary hemorrhage rates hovering around 0.5–0.6% to fewer nursing line calls, readmissions for pain and dehydration, and faster returns to school and normal activity. They walk through their approach to patient risk stratification and admission criteria (age 30/ICU consideration) as well as how to manage the most common post-operative respiratory complications. The conversation also covers practical guidance for handling outside-ER bleed calls, the role of nebulized TXA, toradol considerations, and managing dehydration. They also share for navigating intracapsular coblation in older children, strategies to reduce burn injuries, and a closer look at the rare but serious risk of pharyngeal stenosis.

Check out this episode to hear Dr. Chorney and Dr. Huoh discuss how intracapsular tonsillectomy doesn't just improve outcomes but can transform the recovery experience for patients and their families.

---

Resources

Extracapsular vs Intracapsular Tonsillectomy: Outcomes in Children with a Focus on Developmental Delayhttps://pubmed.ncbi.nlm.nih.gov/34839135/

Current Status and Future Trends: Pediatric Intracapsular Tonsillectomy in the United Stateshttps://pubmed.ncbi.nlm.nih.gov/32969500/

Dr. Chorney Episode 259 - Understanding Coblation Tonsillectomy https://www.backtable.com/shows/ent/podcasts/259/understanding-coblation-tonsillectomy-benefits-outcomes-techniques

Dr. Huoh Episode 110 - Intracapsular Tonsillectomy in Childrenhttps://www.backtable.com/shows/ent/podcasts/110/intracapsular-tonsillectomy-in-children

---

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

Is nasal obstruction the overlooked culprit behind CPAP intolerance? On this episode of BackTable ENT & Allergy, Dr. Gopi Shah interviews Dr. Atul Malhotra and Dr. Michael Hutz to examine the critical but often underappreciated role of the nose in obstructive sleep apnea management. They discuss how nasal obstruction can undermine CPAP adherence, why relying solely on AHI may miss key issues, and how identifying the true cause of intolerance can lead to more personalized and effective therapy.

---

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

---

This podcast is supported by

Aerin Medicalhttps://vivaer.com/

---

Timestamps

00:00 - Introduction04:05 - OSA Presentation and AHI Limitations08:13 - Understanding CPAP Intolerance and Nasal Obstruction15:24 - Evaluating Nasal Obstruction20:32 - Nasal Anatomy and Workup27:47 - DICE Technique and Assessing Dynamic Nasal Collapse32:51 - Medical and Non-Surgical Management37:29 - Surgical Options and VivAer43:39 - Nasal Procedures and CPAP Success51:57 - Nasal Surgery and Heart Outcomes55:23 - Beyond CPAP: Nasal Breathing, Myofunctional Therapy, and Collaborative Care01:04:51 - Wrap Up

---

More about this episode

The physicians review practical strategies for evaluating nasal obstruction, from targeted patient questionnaires, physical exams, nasal endoscopy, and selective imaging. The doctors also detail medical and surgical treatment options, from allergy management and nasal sprays to septoplasty, turbinate reduction, functional rhinoplasty, and temperature-controlled radiofrequency (VivAer). Throughout the episode, they highlight how comprehensive nasal evaluation and intervention can significantly improve CPAP comfort and adherence.

---

Resources

Dr. Atul Malhotra - https://providers.ucsd.edu/details/22362/sleep-medicine-pulmonology-(lung)

Dr. Michael Hutz- https://doctors.rush.edu/details/19100

CPAP treatment persistence following nasal procedures in obstructive sleep apnea - https://www.tandfonline.com/doi/pdf/10.1080/13696998.2026.2671550

Design and rationale for treating Obstructive Sleep Apnea using Targeted Hypoglossal Nerve Stimulation trial - https://www.sciencedirect.com/science/article/pii/S1551714422001306

The Impact of Mouth-Taping in Mouth-Breathers with Mild Obstructive Sleep Apnea - https://pmc.ncbi.nlm.nih.gov/articles/PMC9498537/

VATRAC Trial of VivAer - https://aerinmedical.com/company/news-and-media/aerin-medical-announces-positive-two-year-outcomes-from-the-vatrac-trial-of-vivaer/

---

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