BackTable ENT & Allergy

Have you considered performing a cochlear implant while your patient is awake? In this episode of the Backtable ENT & Allergy Podcast, Dr. Walter Kutz and Dr. Brandon Isaacson sit down with Dr. Sarah Mowry to explore her protocol for cochlear implants under local anesthesia, an approach especially relevant for older adults concerned about the cognitive risks of general anesthesia. Dr. Mowry shares her criteria for patient selection, preoperative counseling strategies, and how she adapts the OR setup to maximize comfort and communication during awake surgery.

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Timestamps

00:00 - Introduction02:06 - Why to Consider Awake Cochlear Implants05:32 - Indications for Awake CI 08:50 - Local Blocks and Pain Control10:58 - Counseling and Expectations14:40 - Preventing Intraoperative Vertigo and Converting to General Anesthesia 17:17 - Set Up and Communication with Patient 19:14 - Lesser Occipital Nerve Block and Potential Role of Processed EEG26:32 - Pitch Matching for Single-Sided Deafness, CI, and Anxiety Considerations29:00 - Feedback from Patients and Electrode Choice 31:30 - Advice to Surgeons and Closing Remarks

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More about this episode

The conversation covers her anesthesia protocol, including lesser occipital and postauricular nerve blocks, minimizing propofol, and using topical 2% lidocaine in sensate areas like the facial recess and epitympanum. Dr. Mowry discusses practical strategies of using warmed irrigation to reduce intraoperative vertigo and contingency plans for conversion to general anesthesia. She discusses electrode considerations and the potential role of processed EEG to titrate anesthesia depth and practical tips for surgeons interested in adopting awake cochlear implantation. Throughout, they highlight the importance of individualized patient care, multidisciplinary teamwork, and the growing role of local anesthesia in otologic surgery.

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Resources

Cochlear Implantation Under Local Anesthesia With Conscious Sedation in the Elderly: First 100 Caseshttps://pubmed.ncbi.nlm.nih.gov/32663339/

Cochlear implantation under local anesthesia in 117 cases: patients' subjective experience and outcomeshttps://pubmed.ncbi.nlm.nih.gov/34487218/

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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.

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Did you know that congenital CMV-related hearing loss can develop several years after birth? On the BackTable ENT & Allergy Podcast, hosts Dr. Gopi Shah and Dr. Jeff Hyzer interview pediatric otolaryngologist Dr. Albert Park about the latest evidence on congenital CMV and its role in pediatric sensorineural hearing loss. The discussion covers diagnosis, risk factors, screening protocols, testing strategies, antiviral treatment, genetic workup, long-term surveillance, and future directions for early detection and prevention.

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Timestamps

00:00 - Introduction 02:47 - Basics of CMV Infections and Hearing Loss Presentation 07:57 - CMV Screening Workflow 11:33 - Saliva vs. Urine Based Screening 14:00 - Early Workup and Communication 19:37 - Late Onset Workup and Use of Antivirals 24:39 - Treatment with Antiviral Medications 27:22 - Head Ultrasound vs. MRI 30:06 - Role of Genetic Testing 32:47 - Surveillance and Progression Risk37:29 - CI Outcomes and Predictors42:18 - BAHA and Older Candidates45:44 - Awareness, Prevention Efforts, and Education 54:25 - Vaccines and Universal Screening Pitfalls 57:40 - Advocacy and Closing Thoughts

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More about this episode

Dr. Park explains the differences between congenital and acquired CMV, reviews epidemiology and, and highlights that hearing loss may be present at birth or develop later in childhood. He discusses Utah’s evolution from hearing-targeted CMV testing to universal NICU screening, emphasizing the importance of diagnosis within the first 21 days of life. The conversation covers saliva versus urine testing, dried blood spot testing, and the role of a multidisciplinary team in evaluation and management. Dr. Park also reviews antiviral treatment strategies, imaging and genetic testing considerations, audiologic surveillance, and cochlear implantation outcomes. Finally, he discusses ongoing advocacy efforts, emerging prenatal screening technologies, and future directions and challenges for CMV prevention and early detection.

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Resources

Nance & Morton NEJM Paper Cited - 20% of Congenital SNHL linked to Congenital CMV https://www.nejm.org/doi/full/10.1056/NEJMra050700

Dr.Kimberlin’s work supporting antiviral treatment for 6 months https://www.nejm.org/doi/full/10.1056/NEJMoa1404599?utm_source=openevidence

Dr.Vossen’s antiviral therapy research https://pubmed.ncbi.nlm.nih.gov/38336204/

AAP Red Book https://publications.aap.org/redbook

Dr. Smith’s Research - Genetic Testing for Congenital Bilateral Hearing Loss in the Context of Targeted Cytomegalovirus Screeninghttps://pubmed.ncbi.nlm.nih.gov/31985074/

Dr.Park’s Research Congenital Cytomegalovirus Testing Outcomes From the ValEAR Trialhttps://pubmed.ncbi.nlm.nih.gov/38415855/

Dr.Park’s Research - Analysis of an Expanded Targeted Early Cytomegalovirus Testing Programhttps://pubmed.ncbi.nlm.nih.gov/36884018/

Dr.Foulon - Hearing Loss With Congenital Cytomegalovirus Infectionhttps://pubmed.ncbi.nlm.nih.gov/31266824/

Research about the use of Vaclovir to reduce vertical transmissionhttps://pubmed.ncbi.nlm.nih.gov/32919517/

Dr.Gantt’s research on the Ping-Pong Effecthttps://pubmed.ncbi.nlm.nih.gov/29889809/

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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

Every leader has a story. The experiences, mentors, and moments along the way shape not only who we become, but how we lead. In this episode of BackTable ENT and Allergy, Drs. Ashley Agan and Gopi Shah interview internationally renowned rhinologist Dr. Troy Woodard about his leadership journey and the lessons learned along the way. Together, they explore how leadership is about actions rather than titles, the value of national involvement, and the importance of embracing change and personal growth throughout a career.

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Timestamps

00:00 - Introduction02:20 - From Fan Moment to Bio04:15 - Early Leadership Roots06:40 - Lead Without a Title08:43 - Finding Leadership Itch14:56 - Burnout and the Pivot19:16 - Coaching and Victim Mindset22:31 - FMLA Reset and Purpose Shift27:11 - Letting Go to Grow30:14 - Listening Tour at Buffalo33:59 - DEI and Minority Leadership35:47 - Mentorship and Leaky Pipeline39:48 - Purpose Through Outreach44:28 - Respectful Change Leadership47:25 - Emotional Intelligence Growth50:27 - Advice for New Leaders52:53 - Handling Dream Crushers56:50 - Imposter Syndrome Breakthrough01:01:01 - Leadership Impact and Closing Remarks

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More about this episode

Dr. Woodard describes early leadership roles, being raised by a single mother, the mentors who impacted his career, and how responsibility and service shaped his work ethic. He explains that leadership doesn’t require a title and recounts pivoting from limited departmental opportunities to national involvement through the Academy and ARS, including advocacy work. Woodard discusses burnout, executive coaching, emotional intelligence, delegation, mentorship and ultimately, how recognizing and embracing a changing purpose mid-career is a normal part of professional growth. Now Chair of Otolaryngology-Head and Neck Surgery at the University at Buffalo, he practices “listening tours,” mentors faculty, and emphasizes how diversity drives excellence while highlighting mentorship and pipeline development.

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Resources

Dr. Troy Woodard’s Public Emailtwoodard@buffalo.edu

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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

When should recurrent sinus infections trigger an allergy or immune workup? In this episode of the BackTable ENT and Allergy podcast, Dr. Karen Kaufman of Kaufman Allergy, Asthma, & Immunology in Vienna, Virginia, sits down with Dr. Ashley Agan to discuss chronic sinusitis evaluation, allergy testing, immunotherapy, immune deficiency screening, and building a private practice.

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Timestamps

00:00 - Introduction02:53 - Chronic Sinusitis Basics06:44 - Sinusitis Types and Polyps10:18 - Testing and Treatment Plan18:40 - When to Suspect Immunodeficiency25:44 - Allergy Testing Methods38:39 - Why Go Solo43:10 - Practice Growth, Visibility, Team Building, and Systems51:55 - ENT and Allergy Collaboration55:50 - Closing Remarks

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More about this episode

Dr. Kaufman explains how to distinguish chronic sinusitis from other causes of nasal and facial symptoms, when to evaluate for allergy and immune dysfunction, and how sinusitis phenotypes influence treatment decisions. She also shares her experience launching a private practice during the pandemic and discusses strategies for practice growth through community engagement, increased visibility, and social media.

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Resources

Dr. Karen Kaufman - https://kaufmanallergy.com/

Jeffery Modell Foundation 10 Warning Signs of Primary Immunodeficiency - https://www.uhhospitals.org/-/media/files/rainbow/services/allergy-and-immunology/10warningsigns.pdf

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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

Septal perforations can be deceptively challenging, with a wide range of etiologies, symptoms, and treatment options to consider. In this episode of BackTable ENT and Allergy podcast, hosts Dr. Ashley Agan and Dr. Gopi Shah interview Dr. Oswaldo Henriquez, a board-certified otolaryngologist and rhinologist at WellStar Health System in Atlanta, to explore the complexities of evaluating and managing nasal septal perforations. The conversation covers how perforation size and location shape symptoms, the most common causes including iatrogenic trauma and chronic nose picking, and a thorough, stepwise approach to diagnosis and treatment.

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Timestamps00:00 - Introduction03:01 - Septal Perforations Overview07:58 - Causes and Risk Factors13:26 - History Red Flags and Differential Diagnosis16:28 - Exam and Documentation Tips21:22 - Labs Biopsy and Imaging Workup31:19 - Conservative Care and Septal Buttons34:20 - Surgery Candidacy and Counseling41:35 - Surgical Techniques Landscape47:38 - Scaffolds and Grafts49:07 - Septal Blood Supply Map53:00 - CAT Scan Planning Tips55:15 - AEA Flap Technique01:05:22 - Real Case Walkthrough01:10:41 - Postop Care and Swelling01:20:44 - Pitfalls and Success Rates01:24:09 - Wrap Up

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More about this episodeDr. Henriquez outlines the key components of a comprehensive workup, including endoscopic exam, measurement, biopsy, and CT imaging for surgical planning. He discusses management options from conservative care and septal buttons to advanced endoscopic pedicled flap repairs, sharing insight on surgical techniques, success rates, splinting, and post-op care. The episode provides practical tips for physicians at any career stage looking to refine their approach to septal perforations, from diagnosis through recovery.

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ResourcesENT Animationshttps://www.youtube.com/@Dr.IsamAlobid

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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