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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 Std. und 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.
  • Ep. 266 Clinical Steps for Efficient Anaphylaxis Diagnosis & Treatment with Dr. Payel Gupta

    Ep. 266 Clinical Steps for Efficient Anaphylaxis Diagnosis & Treatment with Dr. Payel Gupta
    Mar 24 2026
    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
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    1 Std. und 5 Min.
  • Ep. 257 Understanding Eosinophilic Esophagitis: Diagnosis & Treatment Strategies with Dr. John Leung

    Ep. 257 Understanding Eosinophilic Esophagitis: Diagnosis & Treatment Strategies with Dr. John Leung
    Jan 20 2026
    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
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    49 Min.
  • Ep. 241 Chronic Rhinitis: Emerging Approaches & Treatments with Dr. Dennis Tang

    Ep. 241 Chronic Rhinitis: Emerging Approaches & Treatments with Dr. Dennis Tang
    Sep 30 2025
    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
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    1 Std. und 6 Min.
  • Ep. 220 Managing Nasal Polyps: Treatments and Insights with Dr. Martin Citardi

    Ep. 220 Managing Nasal Polyps: Treatments and Insights with Dr. Martin Citardi
    Apr 29 2025
    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
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    59 Min.
  • Ep. 210 Rethinking OSA: Role of the Nose with Dr. Keith Matheny and Dr. Ashwin Ananth

    Ep. 210 Rethinking OSA: Role of the Nose with Dr. Keith Matheny and Dr. Ashwin Ananth
    Feb 11 2025
    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
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    55 Min.