BackTable ENT & Allergy

Claims data suggest roughly one in three patients return after sinus surgery with persistent symptoms, and for many of them the complaint is drainage. On this episode of BackTable ENT & Allergy, host Dr. Ashley Agan welcomes Dr. Chris Davis, a comprehensive otolaryngologist in Birmingham, Alabama, whose practice is largely rhinology, to make the case that the persistent drainage after a technically perfect sinus surgery is a treatable problem rather than an acceptable residual. They discuss the anatomy and neuroimmune function of the posterior nasal nerve, how ablation may affect symptom scores and local inflammation, and the stepwise approach to patient selection and operative technique.

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This podcast is supported by

Aerin Medicalhttps://vivaer.com/

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Timestamps

00:00 - Introduction05:12 - CRS as a Chronic Disease and the Patient Still Draining09:31 - Posterior Nasal Nerve Anatomy and Type 2 Inflammation12:42 - Sensory Nerves, TRP Receptors and Neuroimmunomodulation17:27 - Placebo Questions and Three-Year Durability19:34 - Screening With TNSS, SNOT-22 and NOSE23:21 - Ipratropium Bromide Trials and Patient Selection26:52 - Combining Ablation With Sinus Surgery31:13 - Where to Treat and Adding the Swell Body34:47 - Sphenopalatine Artery Risk and Staggered Treatment37:34 - Coding and Reimbursement42:21 - Temperature Control Versus Impedance Control47:13 - Cryoablation, Device Design and Closing Thoughts

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More about this episode

The conversation follows the posterior nasal nerve from anatomy to the operating room. Dr. Davis describes a nerve that turned out to be a branching network rather than a single trunk, the early research on type 2 cytokine and sensory receptor changes in nasal secretions after ablation, and why he now thinks of the procedure as possible immune modulation rather than simply closing a tap. He then gets practical: the symptom scores he treats as nasal vital signs, the ipratropium bromide trial and what failing it really means, treating at the start of a sinus case while the field is dry, the staggered technique he credits for keeping delayed posterior bleeds rare, and the coding detail that makes combining the procedures viable. The episode closes on temperature control against impedance control, why he left cryoablation behind, and whether this nerve could one day keep patients off biologics.

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Resources

Lanza DC, Kennedy DW. Adult rhinosinusitis defined. Otolaryngol Head Neck Surg. 1997https://pubmed.ncbi.nlm.nih.gov/9334782/ BIOKLEAR, Effect of Temperature-Controlled Radiofrequency Ablation of the Posterior Nasal Nerve on Inflammatory Biomarkers in Patients With Allergic and Nonallergic Chronic Rhinitis (NCT06599736)https://clinicaltrials.gov/study/NCT06599736 Allen DZ, et al. The Effect of Radiofrequency Ablation of Posterior Nasal Nerves on Inflammatory Cytokines, Peak Nasal Inspiratory Flow, and Subjective Symptom Scores in Chronic Rhinitis: A Prospective Clinical Trial. Ann Otol Rhinol Laryngol. 2026https://doi.org/10.1177/00034894261449672 Stolovitzky JP, et al. 3-Year Outcomes of Temperature-Controlled Radiofrequency Ablation of the Posterior Nasal Nerve in Patients With Chronic Rhinitis. Int Forum Allergy Rhinol. 2025https://doi.org/10.1002/alr.23577 Jamileh E, et al. Radiofrequency Neurolysis of the Posterior Nasal Nerve: A Systematic Review and Meta-Analysis. Laryngoscope. 2026https://doi.org/10.1002/lary.70763 Kang YJ, et al. Comparative Effectiveness of Cryotherapy and Radiofrequency Ablation for Chronic Rhinitis: A Systematic Review and Meta-analysis. Clin Exp Otorhinolaryngol. 2023https://doi.org/10.21053/ceo.2023.01214 Hopkins C, et al. Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol. 2009https://doi.org/10.1111/j.1749-4486.2009.01995.x ExcelENT of Alabama, Dr. Chris Davis's practicehttps://www.excelental.com Dr. Ashley Agan, BackTable ENT contributor pagehttps://backtable.com/shows/ent/contributors/dr-ashley-agan

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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 a child's cancer treatment threatens a child’s ability to speak, eat, or breath, how does a team decide what to address first? On this episode of BackTable ENT, host Dr. Gopi Shah welcomes Dr. Anthony Sheyn, pediatric otolaryngologist at Le Bonheur Children’s Hospital and St. Jude, and Amber Bonner, MS, CCC-SLP, acute care speech-language pathologist at Le Bonheur, to explore how a multidisciplinary team navigates the most challenging functional decisions in pediatric head and neck oncology.

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Timestamps

00:00 - Introduction03:26 - Treatment Effects vs Tumor Effects06:30 - Swallow and Airway Evaluation Timing10:09 - Voice Assessment Protocols13:13 - Feeding Decisions and Vocal Fold Immobility17:23 - Vocal Fold Injection and Reinnervation21:36 - Tracheostomy Timing and Family Teaching26:08 - Complications and Swallowing Outcomes29:48 - FEES Collaboration and Voice Prognosis34:15 - Decannulation and Functional Outcomes37:40 - Closing Remarks

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More about this episode

They discuss baseline preoperative evaluation, strategies to distinguish tumor effects from treatment complications, and the pivotal role of instrumental swallow studies. The discussion covers standardized voice assessments, decisions around feeding tubes and tracheostomy, early vocal fold interventions, and the realities of family education and post-op rehab. Through real-world examples and collaborative protocols, Dr. Sheyn and Amber Bonner share how teams can set children up for meaningful recovery and long-term survivorship, bringing hope to families facing the toughest cases.

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Resources

Nagy P, Beckmann N, Cox S, Sheyn A. Management of Vocal Fold Paralysis and Dysphagia for Neurologic Malignancies in Children. Ann Otol Rhinol Laryngol. 2019 https://pubmed.ncbi.nlm.nih.gov/31215235/ ASHA Practice Portal: Flexible Endoscopic Evaluation of Swallowing (FEES)https://www.asha.org/practice-portal/resources/flexible-endoscopic-evaluation-of-swallowing/ ASHA Practice Portal: Videofluoroscopic Swallow Study (VFSS / modified barium swallow)https://www.asha.org/practice-portal/resources/videofluoroscopic-swallow-study/ Zur KB et al. Pediatric Voice Handicap Index (pVHI): a new tool for evaluating pediatric dysphonia. Int J Pediatr Otorhinolaryngol. 2007https://pubmed.ncbi.nlm.nih.gov/17046072/ Pediatric Auditory-Perceptual Evaluation of Voice, Part 2: A Protocol. J Speech Lang Hear Res. 2026 https://pubmed.ncbi.nlm.nih.gov/42600142/ Care of Infants and Children with Tracheostomies: An Official American Thoracic Society Clinical Practice Guidelinehttps://pmc.ncbi.nlm.nih.gov/articles/PMC12618984/

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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

Behind every complex pediatric cancer patient is a care team, and advanced practice providers are the key to keeping every moving piece connected. On this episode of BackTable ENT & Allergy, host Dr. Sara Helmig welcomes St. Jude APPs Sara Meehan (pediatric solid tumor oncology nurse practitioner) and Megan Murphy (ENT family nurse practitioner) to discuss the critical role APPs play across the full continuum of care. They walk through clinical responsibilities from pre-op to follow-up, the logistics of organizing multidisciplinary tumor boards, and the importance of care coordination across surgery, oncology, endocrinology, rehab, nutrition, and beyond.

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

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Timestamps

00:00 - Introduction03:00 - APP Roles in Pediatric Oncology08:01 - Epic and Workflow Tools11:03 - Family Education and AI Support17:26 - Expanding the APP Scope22:08 - Telehealth and Remote Care24:47 - Vision for Program Growth27:31 - Closing Remarks

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More about this episode

The conversation highlights the use of Epic tools and Abridge for documentation, patient education, and tumor board preparation, as well as the APP-family relationship, expectation setting, and early side effect management. Meehan and Murphy share opportunities for expanded APP scope, discuss telehealth and program growth, and reflect on challenges like cross-site communication and intake for out-of-state and international patients. The episode closes with insights on building well-rounded, family-centered care and strategies to strengthen the APP team’s impact.

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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

Treating pediatric head and neck cancer means thinking far beyond the initial diagnosis to ensure healthy growth, function, and future quality of life. For Pediatric Cancer Awareness Month, BackTable ENT & Allergy spotlights the unique challenges and innovations in caring for children with head and neck cancer. Host Dr. Gopi Shah is joined by Dr. Anthony Sheyn, leader of the head and neck cancer program at St. Jude Children’s Research Hospital, and Dr. Sara Helmig, pediatric oncologist at St. Jude, to discuss how multidisciplinary teams, advanced diagnostics, and family-centered care are reshaping outcomes for young patients.

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

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Timestamps

00:00 - Introduction 03:39 - Building a Multidisciplinary Program 06:54 - Patient Workup and Tumor Board Workflow 10:36 - Unique Considerations in Pediatric Head and Neck Cancer13:31 - Recent Advances in Diagnosis and Treatment16:42 - Balancing Margins, Function, and Protocols19:56 - Managing Treatment Side Effects23:35 - Endocrine and Craniofacial Development 27:30 - Fertility, Second Cancers, and Survivorship32:45 - Looking Ahead: Program Innovations 36:23 - Closing Remarks

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More about this episode

The episode explores how pediatric head and neck cancers differ from adult disease, including the critical role of molecular and genomic profiling, targeted therapies, proton radiation, and 3D surgical planning. Drs. Sheyn and Helmig describe the development of a comprehensive care program involving ENT, oncology, endocrinology, genetics, nutrition, dental, speech, and psychology specialists. They discuss strategies for balancing surgical margins with preservation of function, monitoring for treatment toxicity, and supporting endocrine and craniofacial development. Additional topics include fertility preservation, survivorship clinic models, long-term monitoring for secondary malignancies, and the use of AI to streamline tumor board workflows. The episode closes with a look at the future of pediatric head and neck oncology, including efforts to standardize protocols and enhance multidisciplinary collaboration.

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Resources

Episode on Pediatric Thyroid Nodules https://www.backtable.com/shows/ent/podcasts/274/pediatric-thyroid-nodules-clinical-insights-approaches

Episode on Molecular Diagnostics for Thyroid Nodules https://www.backtable.com/shows/ent/podcasts/277/molecular-diagnostics-for-thyroid-nodules

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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

How is the “arms race” for research and academic credentials reshaping the ENT workforce and residency process? On this episode of BackTable ENT & Allergy, Dr. Ashley Agan sits down with Dr. Al Merati and Dr. Mark Whipple from the University of Washington to discuss the pressures ENT residency applicants face, the impact on specialty equity and rural access, and the challenges programs encounter in selecting the next generation of otolaryngologists. They explore survey data showing up to two-thirds of applicants feel compelled to present an “academic” persona, and why this trend may erode unity, transparency, and opportunities across the field.

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

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Timestamps

00:00 - Introduction04:07 - Masking and Authentic Career Goals07:16 - Preview: Crucial Conversations Panel10:39 - Program Signaling and Application Volume13:56 - Addressing the Rural Access Crisis16:59 - Academic Drift and Fellowship Trends19:33 - Accountability in Graduate Medical Education25:22 - Defining Equity in the Application Process29:12 - What Program Directors Want33:58 - Prioritizing Impact Over Research Quantity38:14 - Measuring Workforce Accountability45:40 - Key Takeaways and Closing Remarks

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More about this episode

The conversation covers the shifting importance of research productivity, changes in Step 1 and grading, program signaling, and how rural access gaps and a growing preference for academic careers are shaping the field. Drs. Merati and Whipple discuss the need for more exposure to comprehensive and community ENT, greater program transparency, and moving away from a publication-counting culture toward impact and accountability. They close with proposed solutions for residency programs, including normalizing all career paths, increasing equity, and rebalancing incentives to better serve both trainees and patients.

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Resources

Crucial Conversations Panel – Sunday, October 18, 8:00 AMAAOHNS schedule

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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