BackTable ENT

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

When allergy meds aren’t enough, how do you choose the form of immunotherapy that will work best for your patient? Board-certified allergist-immunologist Dr. Nikhila Schroeder and host Dr. Basil Kahwash answer that question and more in this episode of the BackTable ENT Podcast.

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SYNPOSIS

Dr. Schroeder shares her path from an engineering background to becoming a board-certified pediatric and adult allergist-immunologist, offering insight into how that perspective shapes her approach to patient care. The discussion focuses on the nuances of sublingual immunotherapy (SLIT) versus subcutaneous immunotherapy (SCIT), including administration, efficacy, safety, and patient adherence challenges. They also explore how immunotherapy can modulate the immune system and provide long-term symptom relief. Dr. Schroeder concludes by sharing her vision for the future of allergy immunotherapy, highlighting the accessibility and growing potential of SLIT. This episode offers ENT specialists a practical overview of why understanding and integrating allergy-immunotherapy can benefit both their practice and their patients.

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TIMESTAMPS

00:00 - Introduction05:01 - History and Evolution of Immunotherapy10:36 - Mechanisms of Immunotherapy14:59 - Subcutaneous Immunotherapy: Process and Benefits19:52 - Sublingual Immunotherapy: Process and Benefits27:56 - Comparing Subcutaneous and Sublingual Immunotherapy34:14 - Efficacy Comparison: Allergy Shots vs. SLIT39:51 - Patient Adherence and Treatment Choices41:58 - Contraindications for Allergy Immunotherapy48:58 - Long-term Benefits of Immunotherapy59:26 - Key Takeaways for ENT Professionals

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RESOURCES

Dr. Nikhila Schroeder https://allergenuityhealth.com/about-us/

Think beyond the esophagus. Up to 75% of eosinophilic esophagitis (EoE) patients have ENT-relevant atopic disease that is often best managed with a multidisciplinary approach. Get caught up on best practices in EoE diagnosis and treatment with this episode of the BackTable ENT Podcast, featuring dual board-certified gastroenterologist and allergist-immunologist Dr. John Leung and host Dr. Basil Kahwash.

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SYNPOSIS

The discussion covers the definition, symptoms, and diagnosis of EoE, highlighting the role of food and environmental allergies. Dr. Leung and Dr. Kahwash cover diagnostic techniques like endoscopy and emerging non-invasive methods, as well as various treatment options including dietary modifications, pharmacology, and biologics. The doctors also emphasize the importance of multidisciplinary collaboration between gastroenterologists, allergists, and otolaryngologists to provide optimal care for patients with EoE.

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TIMESTAMPS

00:00 - Introduction 03:13 - Understanding Eosinophilic Esophagitis (EoE)05:45 - EoE Symptoms and Diagnosis08:41 - Role of ENT in EoE Diagnosis11:32 - Diagnostic Criteria for EoE16:34 - Treatment Options for EoE20:55 - Role of Allergists and Environmental Allergies23:24 - Pharmacological Management of EoE29:38 - Complications and Risks of EoE36:21 - Follow-Up Endoscopies and Surveillance40:34 - Future Directions in EoE Management45:21 - Conclusion and Final Thoughts

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RESOURCES

Dr. John Leunghttps://www.bostonspecialists.org/dr-leung-full-profile

The best approach to sinus surgery is the one tailored to the patient in front of you. In this episode of the BackTable ENT podcast, guest host Dr. Satyan Sreenath, rhinologist and Assistant Professor at Indiana University, and Dr. Dennis Tang, rhinologist and Assistant Professor at Cedars-Sinai, discuss advanced surgical techniques and post-operative management strategies in Functional Endoscopic Sinus Surgery (FESS).

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SYNPOSIS

The conversation covers the latest practices in intraoperative maneuvers, the use of bioabsorbable materials, and the contentious topic of middle turbinate resections. They review patient cases, surgical approaches, and provide insights into optimizing patient outcomes. Additionally, they emphasize the importance of individualized care tailored to specific chronic sinusitis phenotypes and patient-specific factors.

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TIMESTAMPS

00:00 - Introduction 03:28 - Case Study #1: CRSsNP with Nasal Congestion 04:59 - Factors Influencing Minimal vs. Maximal Surgery 14:23 - Case Study #2: Severe Nasal Polyposis27:56 - Debating the Use of Packing in Sinus Surgery40:24 - Scrutinizing Overhead Costs in Patient Care42:45 - FESS Postoperative Care 43:54 - Evolving Biomaterials in Sinus Surgery49:46 - The Debate on Middle Turbinectomy50:46 - Middle Turbinate Management Strategies01:13:17 - Concluding Thoughts on Surgical Practices

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RESOURCES

Dr. Satyan Sreenath https://iuhealth.org/find-providers/provider/satyan-b-sreenath-md-1821999

Dr. Dennis Tanghttps://www.cedars-sinai.org/provider/dennis-tang-3316614.html