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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. --- Get the BackTable apphttps://www.backtable.com/app --- 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 --- 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. --- Resources Dr. Payel Gupta https://www.zocdoc.com/doctor/payel-gupta-md-facaai-571583

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

So many patients deal with a runny, stuffy nose every day, and sprays only go so far. Let’s talk about what’s new for chronic rhinitis. In this episode of the BackTable ENT podcast, Dr. Dennis Tang, a Rhinologist at Cedars-Sinai Medical Center discusses chronic rhinitis and the latest treatment advancements with hosts Dr. Gopi Shah and Dr. Ashley Agan. ---This podcast is supported by:Aerin Medicalhttps://aerinmedical.com/---SYNPOSISDr. Tang discusses the benefits of posterior nasal nerve (PNN) ablation and the recent approval of the procedure by Cigna Insurance, which expands accessibility for patients. The conversation covers the typical presentation of chronic rhinitis, the procedural details, patient selection, preoperative and postoperative care, and billing considerations. Dr. Tang also touches on the anatomy involved and the technological innovations that are enabling contemporary rhinitis treatment.---TIMESTAMPS00:00 - Introduction03:01 - Insurance Coverage for Posterior Nasal Nerve Ablation04:23 - Patient Presentation, Diagnostic & Treatment Approaches11:07 - Posterior Nasal Nerve (PNN) Ablation Explained17:57 - Physical Examination and In-Office Procedure20:47 - Allergy Patients and Immunotherapy22:21 - Chronic Rhinosinusitis vs. Chronic Rhinitis32:33 - Radiofrequency Ablation Technology39:49 - Procedure Techniques and Anatomical Considerations46:42 - In-Office Procedure Logistics01:06:10 - Final Thoughts ---RESOURCESDr. Dennis Tanghttps://www.cedars-sinai.org/provider/dennis-tang-3316614.html

Is the future of nasal polyp treatment right under our nose? In this episode of Backtable ENT, Dr. Martin Citardi, a world-renowned rhinologist and skull-based surgeon at UTHealth Houston, discusses the latest advancements in the management of nasal polyps with hosts Dr. Gopi Shah and Dr. Ashley Agan. --- This podcast is supported by:Medtronic ENT https://www.medtronic.com/en-us/healthcare-professionals/specialties/ear-nose-throat.html --- SYNPOSIS Dr. Citardi shares insights from his comprehensive career, spanning patient care, device, and drug development. The surgeons discuss the evolving treatment landscape, challenges in managing recurrent nasal polyps, the role of steroids and biologics, and the importance of correctly identifying the type of polyps. Additionally, Dr. Citardi emphasizes the need for a better understanding of healthcare economics, particularly concerning the high costs of new treatments. The discussion also touches on the future of research and the need for a system to deploy treatment options effectively. --- TIMESTAMPS 00:00 - Introduction04:39 - Nasal Polyps: Patient Presentation and Initial Examination10:25 - Detailed Examination and Endoscopy Techniques17:26 - Imaging and Lab Workup20:11 - Treatment Strategies and Patient Management31:08 - Managing Patients with Allergies, AERD, and Asthma34:09 - Biologics vs. Surgery: A Comparative Discussion42:50 - Steroid Delivery Methods and Their Effectiveness52:24 - Follow-Up, Long-Term Management and Future Research57:01 - Conclusion and Final Thoughts --- RESOURCES Dr. Martin Citardi’s Profile:https://www.utphysicians.com/provider/martin-j-citardi/ Medtronic ENT:https://www.medtronic.com/en-us/healthcare-professionals/products/ear-nose-throat

Is nasal obstruction the hidden culprit behind CPAP failure in obstructive sleep apnea (OSA) patients? In this episode of BackTable ENT, host Dr. Ashley Agan discusses nasal airway obstruction’s impact on OSA with guests Dr. Keith Matheny and Dr. Ashwin Ananth. --- This podcast is supported by: Aerin Medical https://aerinmedical.com/ --- SYNPOSIS The doctors emphasize the crucial role otolaryngologists play in diagnosing and treating nasal obstruction to enhance sleep quality, particularly in patients who struggle with CPAP therapy. They share their approaches to the nasal exam, treatments like VivAer and RhinAer, the importance of sleep endoscopies for CPAP-intolerant patients, and they also debunk some common misconceptions around treating OSA. This is a must-listen for ENTs and clinicians engaged in sleep medicine. --- TIMESTAMPS 00:00 - Introduction 01:57 - Discussion on Nasal Airway Obstruction 06:11 - Evolution of Sleep Disorder Treatments 12:05 - Challenges with CPAP and Alternatives 16:39 - Importance of Nasal Examination 28:44 - Nasal Medication Practices 33:20 - Sleep Endoscopy and CPAP Alternatives 35:44 - Nasal Surgery and OSA Treatment 39:57 - Posterior Nasal Nerve Ablation 46:10 - Final Thoughts and Recommendations --- RESOURCES Dr. Ashwin Ananth https://www.esentc.com/dr-ashwin-ananth Dr. Keith Matheny https://collincountyent.com/bio/keith-e-matheny/ BackTable+ for ENT https://plus.backtable.com/pages/ent Check out BackTable+ for ENT, our sponsor and new e-learning platform! https://plus.backtable.com/pages/ent

Can technology improve the accuracy of parathyroid tissue identification during surgery? In this episode of Backtable ENT Podcast, Dr. Gopi Shah and Dr. Ashley Agan welcome Dr. Michael Singer, an otolaryngologist specializing in minimally invasive parathyroid and thyroid surgery at Henry Ford Health in Michigan. --- This podcast is supported by: Medtronic ENT https://www.medtronic.com/en-us/healthcare-professionals/specialties/ear-nose-throat.html --- SYNPOSIS First, Dr. Singer discusses various aspects of identifying parathyroid glands during surgery, differentiating between hypoparathyroidism and hypocalcemia, and the impact of concurrent thyroid disease on patient outcomes. He highlights the importance of continuous improvement and being open to new technologies, specifically the use of autofluorescence and fluorescence imaging to enhance surgical accuracy and patient safety. The conversation also addresses the practical applications of these technologies, including the Medtronic PTeye parathyroid detection system, and their potential to change the approach to thyroid and parathyroid surgeries. Throughout the discussion, Dr. Singer emphasizes the importance of being honest with oneself as a surgeon in order to improve skills and provide the best care for patients. --- TIMESTAMPS 00:00 - Introduction 04:37 - Challenges in Identifying Parathyroid Glands 12:14 - Preoperative Workup and Imaging 16:41 - Understanding Hypoparathyroidism and Hypocalcemia 23:25 - Surgical Techniques and Identifying Parathyroid Glands 33:48 - New Technologies in Parathyroid Surgery 43:15 - Challenges and Benefits of New Surgical Technologies 44:49 - Practical Applications and Personal Experiences 59:33 - Impact of Technology on Surgical Practices 01:08:40 - Final Thoughts and Continuous Learning --- RESOURCES BackTable+ for ENT https://plus.backtable.com/pages/ent Dr. Singer’s profile https://www.henryford.com/physician-directory/s/singer-michael

Is a subtle voice change something to ignore? In this episode of the Backtable ENT podcast, hosts Gopi Shah and Dr. Ashley Agan speak with Dr. Bharat Panuganti, a laryngologist from Washington University in St. Louis, about the diagnosis, treatment, and management of early glottic cancer. --- SYNPOSIS First, the doctors discuss the importance of not underestimating voice changes such as dysphonia. Then, they discuss the evolving demographics and risk factors of laryngeal cancers. Dr. Panuganti also explains his approach to using advanced imaging techniques and lasers in treatment. The conversation highlights the necessity of personalized and compassionate patient care, considering both surgical and radiation therapy options. The discussion concludes with advice on the importance of consistent patient follow-up for early detection and treatment of recurrences. --- TIMESTAMPS 00:00 - Introduction 03:09 - Understanding Early Glottic Cancer and Symptoms 08:09 - Physical Examination, FEES and Stroboscopy 14:19 - Intraoperative Imaging Techniques 31:33 - Radiation vs. Surgery: Predicting Outcomes 32:18 - Laser Surgery and Technologial Advances 42:51 - Robotic Surgery 47:13 - Postoperative Care and Patient Counseling 52:53 - Equitable Care and Treatment Choices --- RESOURCES BackTable+ for ENT https://plus.backtable.com/pages/ent Dr. Bharat Panuganti’s WashU Profile: https://oto.wustl.edu/people/bharat-panuganti-md/

Tinnitus remains one of otology’s greatest, most challenging, and unsolved clinical problems. In this episode of the BackTable ENT Podcast, Dr. Hamid Djalilian, chair of otolaryngology at University of California Irvine (UCI), joins guest host and fellow otologist Dr. Walter Kutz (UT Southwestern) to discuss contemporary tinnitus therapy. --- This podcast is supported by: PearsonRavitz https://pearsonravitz.com/backtable --- SYNPOSIS First, Dr. Djalilian shares how he got interested in tinnitus. After observing how migraines and tinnitus share many similar triggers, he hypothesized that increased central sensitivity underlies both diseases. He successfully adopted migraine management strategies for his tinnitus patients and found great clinical success. After sharing pathophysiologic similarities between the two diseases, Dr. Djalilian expounds on how he evaluates and treats tinnitus. His discussion includes lifestyle modifications, medication, and emerging surgical therapies. Finally, he advises listeners to think of tinnitus as a manageable condition, rather than a poorly-understood phenomenon. --- TIMESTAMPS 00:00 - Introduction 02:34 - The Challenge of Treating Tinnitus 07:19 - Connecting Tinnitus & Migraine 15:59 - Atypical (Otologic) Migraine & Diagnostic Challenges 19:59 - Managing Tinnitus Triggers 26:27 - Dietary Triggers of Tinnitus 28:44 - The Role of Sleep Quality in Tinnitus 33:04 - Caring for Older Patients with Tinnitus 37:59 - New Therapies for Tinnitus: Sound & Cognitive Behavioral Therapy 44:08 - Neuromodulation: The Future of Tinnitus Therapy? 51:34 - Final Thoughts on Tinnitus Treatment --- RESOURCES BackTable ENT Episode 60 Otologic Manifestations of Migraine with Dr. Hamid Djalilian https://www.backtable.com/shows/ent/podcasts/60/otologic-manifestations-of-migraine Dr. Hamid Djalilian University of California, Irvine Profile: https://www.ent.uci.edu/faculty/hamid-djalilian-md.asp Dr. Hamid Djalilian’s Website: https://hamiddjalilianmd.com/ Fan-Gang Zeng (Hearing and Speech) Lab at UCI: https://faculty.sites.uci.edu/hesplab/ PearsonRavitz: https://pearsonravitz.com/

In this episode, laryngologist Dr. Inna Husain joins host Dr. Ashley Agan for a deep dive into laryngopharyngeal reflux (LPR) to illuminate patient presentation, diagnostic tests, and future directions in LPR research. --- CHECK OUT OUR SPONSOR Medtronic ENT https://www.medtronic.com/en-us/healthcare-professionals/specialties/ear-nose-throat.html --- SYNPOSIS The episode begins with a recap of Episode 83, in which Dr. Husain explained LPR fundamentals. Continuing from where they left off, the surgeons discuss various presentations of LPR, emphasizing the distinctions between acidic/non-acidic and direct/indirect reflux. Then, they review tests used to diagnose LPR and role of collaboration with gastroenterology colleagues. Dr. Husain shares her therapeutic approach to LPR, which includes lifestyle modifications for all patients, alginates for those with mechanical reflux, and nerve blocks for those with neurally mediated symptoms. The podcast wraps with a discussion of hot topics in LPR research. --- TIMESTAMPS 00:00 - Introduction 01:01 - Sponsor Spotlight: Medtronic ENT Innovations 04:37 - Summary of BackTable Episode 83 on Laryngopharyngeal Reflux (LPR) 08:34 - Typical vs. Atypical Presentations of LPR 23:36 - Dr. Husain’s Personal Experience with LPR 38:27 - Diagnosing LPR 46:43 - Lifestyle & Dietary Changes for LPR 50:53 - Hot Topics in Contemporary LPR Research 53:17 - The Brain-Gut Connection & LPR --- RESOURCES BackTable ENT Episode 83: “Laryngopharyngeal Reflux with Dr. Inna Hussain:” https://www.backtable.com/shows/ent/podcasts/83/laryngopharyngeal-reflux Medtronic ENT www.medtronicent.com Dr. Inna Husain’s Community Healthcare System profile: https://www.comhs.org/find-a-doctor/h/husain-inna Dr. Inna Husain’s X: https://x.com/drinnahusain Dr. Inna Husain’s Instagram: https://www.instagram.com/innahusainmd/ Dr. Inna Husain’s TikTok: https://www.tiktok.com/@throatdoc

In this episode, host Dr. Ashley Agan discusses eustachian tube (ET) dilation with Dr. Dennis Poe, neurotologist and Professor of Otolaryngology at Harvard Medical School. First, the surgeons describe clinically meaningful differences between adult and pediatric ETs. Then, Dr. Poe reviews workup of pediatric ET disorders. Since inflammation accounts for most ET dysfunction, controlling comorbid allergies and/or performing adenoidectomy provides relief to some patients. For patients with continued symptoms, balloon dilation – now approved for children as young as eight years of age– directly counteracts obstructive inflammation in the tube lumen. To conclude, Dr. Poe describes how to select patients for, perform, and avoid complications of balloon dilation. --- CHECK OUT OUR SPONSOR Acclarent AERA Eustachian Tube Balloon Dilation System https://www.jnjmedtech.com/en-US/product/Acclarent-aera-eustachian-tube-balloon-dilation-system --- SHOW NOTES 00:00 - Introduction 04:03 - Understanding Eustachian Tube Anatomy 07:22 - Causes of Eustachian Tube Dysfunction in Children 12:53 - Examination and Diagnosis of Eustachian Tube Dysfunction 19:10 - Treatment Options for Eustachian Tube Dysfunction 27:05 - Avoiding Unpredictable Injury and Scarring During Balloon Dilation 31:51 - Contraindications and Precautions for Balloon Dilation 37:49 - Understanding Risks & Complications of Balloon Dilation 48:34 - Closing Remarks & Future Prospects --- RESOURCES Dr. Dennis Poe’s Harvard Profile: https://oto.hms.harvard.edu/people/dennis-poe BackTable ENT Ep. 40 – “Diagnosis & Management of Eustachian Tube Disorders with Dr. Dennis Poe:” https://www.backtable.com/shows/ent/podcasts/40/diagnosis-management-of-eustachian-tube-disorders American Academy of Otolaryngology-Head and Neck Surgery Clinical Practice Guideline: Otitis Media with Effusion (Update): https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/ome/ “Complications of Eustachian Tube Balloon Dilation: Manufacturer and User Facility Device Experience (MAUDE) Database Analysis and Literature Review,” Chisolm, P.F. et al: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10731503/