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BackTable ENT & Allergy

BackTable ENT & Allergy

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The go-to podcast for otolaryngologists, allergists, and head and neck surgeons. Tune in every week for practical, physician-led conversations on common and complex clinical topics in allergy, immunology otolaryngology, rhinology, laryngology, otology, and head and neck surgery. Hear how experienced physicians approach real cases, and get practical advice from your peers in your field.All rights reserved. Hygiëne en gezond leven
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  • Ep. 298 Optimizing CRS Outcomes with Posterior Nasal Nerve Ablation with Dr. Chris Davis

    Ep. 298 Optimizing CRS Outcomes with Posterior Nasal Nerve Ablation with Dr. Chris Davis
    Oct 15 2026
    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. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Aerin Medicalhttps://vivaer.com/ --- 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 --- 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. --- 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 --- 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
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    54 min
  • Ep. 283 Streamlining Surgery: The Future of the OR with Dr. Raj Sindwani

    Ep. 283 Streamlining Surgery: The Future of the OR with Dr. Raj Sindwani
    Jul 21 2026
    What if the next major advance in ENT surgery isn’t a new instrument, but a better-integrated operating room? In this episode of the BackTable ENT & Allergy Podcast, Cleveland Clinic rhinologist and skull base surgeon Dr. Raj Sindwani joins Dr. Gopi Shah and Dr. Ashley Agan to discuss how reducing cognitive load, improving workflows, and creating a more efficient OR environment can enhance the surgical experience. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Strykerhttps://www.stryker.com/us/en/ent.html --- Timestamps 00:00 - Introduction03:50 - Where Surgery Happens: Choosing the Right Site for Service06:27 - Quality Safety And Throughput09:48 - Reducing Cognitive Load In Surgery15:34 - Building an Efficient OR Ecosystem And Culture23:06 - Tech Adoption and Team Training26:19 - Smarter Surgical Navigation and Augmented Reality37:02 - Navigation Accuracy, Registration, and Smart Coaching40:29 - Inside the Stryker RISE Platform49:55 - Integration Challenges and Voice-Control Safety56:36 - Surgical Ergonomics and Injury Prevention01:09:14 - The Future of Surgical Innovation and AI in the OR --- More about this episode Dr. Sindwani explores how minimizing unnecessary friction, improving team dynamics, and thoughtfully integrating technology can help surgical teams focus on what matters most: patient care. The conversation examines the operating room as an ecosystem where people, processes, and technology all contribute to patient outcomes. Dr. Sindwani shares strategies for reducing extrinsic cognitive load, including standardizing room setup, minimizing interruptions, and optimizing the surgical environment.He also discusses advances in sinus and skull base navigation, augmented reality guidance, and Stryker’s RISE platform, highlighting how integrated technology can simplify workflow, improve ergonomics, and reduce distractions in the OR. Throughout the episode, Dr. Sindwani emphasizes the importance of thoughtful technology adoption, team collaboration, and designing the operating room of the future around safety, efficiency, and the needs of both patients and surgeons. --- Resources Dr. Raj Sindwanihttps://providers.clevelandclinic.org/provider/raj-sindwani/4268990 Stryker ENThttps://www.stryker.com/us/en/ent.html Stryker RISE Platformhttps://www.stryker.com/us/en/portfolios/medical-surgical-equipment/integration-and-connectivity/or-integration/rise.html Technological Advances in Sinus and Skull Base Surgery by Dr. Raj Sindwanihttps://www.oto.theclinics.com/article/S0030-6665(17)30050-6/fulltext Ergonomics in ENT Practice NIH Articlehttps://pmc.ncbi.nlm.nih.gov/articles/PMC11455805/ --- 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
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    1 u en 15 min
  • Ep. 282 Awake Cochlear Implantation: An Expert Guide with Dr. Sarah Mowry

    Ep. 282 Awake Cochlear Implantation: An Expert Guide with Dr. Sarah Mowry
    Jul 14 2026
    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. --- Get the BackTable apphttps://www.backtable.com/app --- 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 --- 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. --- 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/ --- 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
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    36 min
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