BackTable / ENT / Podcast / Episode #54
Keeping up with Technology for In-Office Sinus Procedures
with Dr. Brian Weeks and Dr. Ashley Sikand
We talk with Dr. Ashley Sikand and Dr. Brian Weeks about performing In-Office Sinus procedures, including differences in technique, and keeping up with the latest technologies.
BackTable, LLC (Producer). (2022, March 22). Ep. 54 – Keeping up with Technology for In-Office Sinus Procedures [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Brian Weeks
Dr. Brian Weeks is a private practice otolaryngologist with SENTA Clinic in San Diego, California.
Dr. Ashley Sikand
Dr. Ashley Sikand is a private practice otolaryngologist with Nevada Sinus Relief in Las Vegas, Nevada.
Dr. Gopi Shah
Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.
In this episode of BackTable ENT, Dr. Gopi Shah talks with Dr. Ashley Sikand (Nevada Sinus Relief in Las Vegas, NV) and Dr. Brian Weeks (SENTA Clinic in San Diego, CA) about tips for starting in-office procedures and forming effective industry partnerships.
First, Dr. Sikand and Dr. Weeks outline their motivations for entering the medical device industry space and serving as consultants for Acclarent, an otolaryngology medical device company. Next, they summarize the types of nasal conditions they can treat with an office-based procedure. These conditions include: deviated nasal septum, nasal valve disorders, turbinate obstructions, nasal polyps, and chronic rhinitis. They note that these procedures have only been made possible due to advances in anesthesia and blocking techniques. Although anesthesia varies based on the type of procedure, anesthesia for sinus work in general consists of three steps: anxiolysis (lorazepam or benzodiazepine), topical anesthesia (lidocaine and tetracaine), and infiltrative anesthesia (sphenopalatine block).
Patient selection criteria is also very important when considering good candidates for office-based procedures. The doctors note that younger patients may have more apprehension towards in office procedures. Additionally, if a patient presents with a complex condition that requires multiple procedures, operating in the OR may be a better option. With experience, surgeons will be able to discern whether an in-office procedure is possible for different types of patients.
Finally, the doctors emphasize how important good in-office resources are. The starting toolbox for an otolaryngologist should contain: a good endoscopic system, a camera, an instrument tray, effective suction, and an image guidance system. Knowing the room set up is a crucial requirement as well. Although the doctors admit that young otolaryngologists may not have the capital to purchase all the essentials, they encourage them to leverage their industry connections by inviting representatives to bring different equipment for demonstrations first. Finally, they end by advocating for doctors to critically evaluate medical technology using their medical education and training before adopting a device into their standard practice.
[Ashley Sikand MD]
Right. So I think you've, in your question, you touched on the two, sort of the bifurcation of, patient assessment or patient selection, right? So one is the focusing on the patient's sort of psychology, a personality inventory, if you will. The patient who just has a tremendous amount of anxiety, doesn't do well at all on any kind of dental procedures, or cannot do that. And, is very, very apprehensive during even your nasal endoscopic exam. So that is a subgroup of patients that may not be appropriate for this kind of situation. I've found that our older patients do extremely well in the office and that's fortunate because they also may have more problems with general anesthesia, right? So they do very well. And some younger high anxiety individuals are a little bit more problematic.
Then on the other side, the type of case, there are two considerations there. One is definitely, the number of procedures that are going to be performed. So if you're going to fix the deviated septum, but you also have to take out a reasonable number of polyps, an ethmoidectomy, and a balloon sinus dilation, the procedure might be a little too long for an office-based case. So, those are the kinds of considerations, and I think a lot of it has to do also with you experience and your confidence that builds over time.
[Brian Weeks MD]
Yeah, I would second pretty much the same thing. Definitely, if a patient tells you, I don't do well with local anesthesia. Listen, do yourself a favor, just take that patient to the operating room. If they're literally flashing the red lights in your face, “Doctor I have a horrible time at the dentist. I don't do well with local anesthesia.” The other one is, “I metabolize the anesthesia really fast. I'm kind of resistant.” Yeah. Don't even bother, just take the patient to the operating room. I think certain disease states, I mean, I allergic fungal sinusitis is not an office procedure most of the time. And patients who have disruption to the biome, chronic biofilms that need high volume irrigation and hydrobridement, have definite fluid management issues in the office when you get over 50 CCS of irrigant. If you're using one of the high-pressure irrigation vacuums that the technology partners make, you can do a fair bit of irrigating and suctioning effectively, but like when you're talking about four liters of irrigation to blast out, there's no way. So those patients all need to be appropriate site of service. And then lastly, I would, I would just second, there's a group of adolescent patients. You know, it's frequently that the adolescent macho man or the adolescent females that tend to have some difficulty. And the older patients usually fall asleep and they're the cutest sweetest people. They wake up, usually you're waking up Mrs. Jones. When you're finished, after she's been snoring for 30 minutes, you're like Mrs. Jones, you're done. And she's like, I'm done. What do you mean I'm done? I didn't even know you started. And that's exactly how we want it. You know, it's really a pleasure. And they're such sweet people.
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