BackTable ENT

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.

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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

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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.

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Resources

Dr. Payel Gupta https://www.zocdoc.com/doctor/payel-gupta-md-facaai-571583

What makes butterfly cartilage tympanoplasty such an elegant solution for pediatric eardrum perforations? In this episode of the BackTable ENT Podcast, Dr. Sean Evans of Children’s Healthcare of Atlanta joins hosts Dr. Ashley Agan and Dr. Gopi Shah to discuss the evaluation and management of pediatric tympanic membrane perforations, with a focus on the butterfly cartilage tympanoplasty technique

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SYNPOSIS

Dr. Evans describes his practice and reviews common etiologies of tympanic membrane perforations. He outlines his approach to the clinical workup and patient counseling, including the role of audiograms, careful otoscopic examination, and selective use of laboratory studies and CT imaging in patients with chronic otorrhea or suspected cholesteatoma. The discussion also addresses timing and age considerations for repair, as well as strategies for managing chronic drainage. Dr. Evans also discusses his evaluation of patient selection criteria and operative technique for butterfly cartilage tympanoplasty. He shares practical insights on surgical steps, technical pearls and pitfalls, postoperative care, recovery expectations, potential risks, coding considerations, and approaches to revision surgery.

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TIMESTAMPS

00:00 - Introduction 02:35 - When to Repair Perforations 10:36 - Physical Exam, Audiogram, & Treatment Decisions18:06 - Butterfly Graft Candidacy20:42 - Step by Step Butterfly Technique25:52 - Butterfly Technique Pearls and Pitfalls29:16 - Example Case Video and Indications35:12 - Restrictions, Pain, & Recovery37:10 - Risk Factors and Complications40:09 - Revision Timing and Failure Modes42:37 - Final Pearls and Wrap Up

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RESOURCES

Dr. Sean Evans https://med.emory.edu/directory/profile/?u=SSEVAN3

Recurrent respiratory papillomatosis (RRP) has long been managed with repeated surgical debulking, sometimes requiring dozens of procedures over a lifetime. In this episode of BackTable, Dr. Aaron Friedman and guest host Dr. Stephen Schoeff discuss a major shift in care: immune-directed therapy targeting HPV 6 and 11.

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SYNPOSIS

Dr. Friedman reviews the recent FDA approval of the Precigen product PAPZIMEOS (August 2025), a therapeutic vaccine designed to stimulate HPV-specific T-cell responses. Clinical trial data show that about half of treated adults required no additional surgeries over the following year, with many responders maintaining durable benefit for years. The conversation also covers traditional management strategies, adjuvant therapies like bevacizumab, HPV vaccination, and the evolving algorithm for adult RRP care.

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TIMESTAMPS

00:00 - Introduction02:13 - RRP Patient Types and Symptoms05:06 - Adult vs Juvenile Transmission10:46 - When to Escalate Treatment15:40 - Immunotherapy 18:55 - Trial Enrollment, Results and Dosing Rules26:17 - Durable Long Term Response30:47 - Who Should Get Treated32:34 - Logistics And Public Perception37:50 - Future Research And Prevention

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Recurrent Respiratory Papillomatosis Foundation Position Statement on the Management of Adults With RRPhttps://pubmed.ncbi.nlm.nih.gov/41543033/

Dr. Stephen Schoeffhttps://healthy.kaiserpermanente.org/washington/clinicians/stephen-schoeff-6848607

Dr. Aaron Friedman https://www.uchealth.com/en/provider-profiles/friedman-aaron-d-1609057587

Not every airway is a tonsil problem. Pediatric obstructive sleep apnea is often more nuanced than it appears, requiring thoughtful evaluation beyond routine surgery. In this episode of the BackTable ENT Podcast, pediatric otolaryngologist Dr. Tali Lando discusses managing pediatric obstructive sleep apnea (OSA) with hosts Dr. Gopi Shah and Dr. Ashley Agan.

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SYNPOSIS

Dr. Lando shares insights into her clinical practice, outlining a systematic approach to diagnosing and treating pediatric OSA, and emphasizing the value of sleep endoscopy. She explores the spectrum of interventions from adenoidectomy and tonsillectomy to complex airway evaluations and surgical management, while highlighting the roles of sleep studies, obesity, and emerging therapies such as hypoglossal nerve stimulation. Dr. Lando also reflects on balancing a busy clinical career with family life and discusses her two books, Hell & Back: Wife & Mother, Doctor & Patient, Dragon Slayer and Breathless: Surgical Tales from the Brink (and Back).

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TIMESTAMPS

00:00 - Introduction06:21 - When Noisy Breathing Signals More Than Tonsils10:01 - When to Add DISE: Combining T&A with Airway Evaluation18:08 - Turbinates, Septum and Nasal Valve Matter22:03 - Red Flags in Clinic29:12 - When Surgery Helps and When It Doesn’t41:33 - Sleep Studies43:09 - Down Syndrome and OSA55:19 - Finding Hidden Sites of Airway Collapse01:06:13 - Hypoglossal Nerve Stimulation and Advanced Options

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RESOURCES

Dr. Tali Lando https://www.wmchealth.org/physician-locator/tali-lando-1548383763?address_id=413 About Dr. Tali – Dr. Tali Lando