This Week in Otolaryngology — May 28, 2026

Welcome to This Week in Otolaryngology. This week we're covering nine notable papers spanning advances in head and neck oncology, new insights into sinonasal disease, and key updates in otology and neurotology. Let's dive in.

First, in head and neck oncology, we have several papers looking at surgical planning, postoperative management, and future reconstructive techniques.

The Study A systematic review and meta-analysis in Otolaryngology--Head and Neck Surgery looked at the difficult decision of when to perform an elective tracheostomy during major head and neck cancer reconstruction [1]. Investigators analyzed 25 studies including nearly 6,000 patients to identify predictors of adverse airway events in those managed without a tracheostomy.

Results The pooled incidence of adverse airway events, such as reintubation or emergent tracheostomy, in patients managed without an initial trach was about 10%. The analysis identified key predictors for these events. Compared to other oral cavity sites, tumors of the floor-of-mouth increased the odds of an adverse event nearly six-fold, while oropharynx tumors more than doubled the risk. Bilateral neck dissection was also a major risk factor, increasing odds over six-fold. Higher American Society of Anesthesiologists class was also associated with increased risk.

Discussion However, the authors caution that elective tracheostomy is not without its own risks. The procedure was associated with an increased risk of flap complications, more unplanned returns to the operating room, and a longer time to oral feeding by an average of nearly 6 days. These findings support using the identified risk factors to guide selective tracheostomy in high-risk patients, while acknowledging the potential for increased morbidity with the procedure itself.

Moving from major reconstruction to the management of premalignant lesions, a study in Otolaryngology--Head and Neck Surgery presents a refined technique for excising oral leukoplakia [2]. The authors' goal was to achieve complete removal by enhancing visualization, which can be compromised by the blanching effect of local anesthetics containing vasoconstrictors.

Methods To address this, the authors used a two-stage local anesthesia protocol. First, plain lidocaine is administered for anesthesia. Then, under narrow-band imaging, or NBI, illumination, the excision margin is precisely defined and marked with a CO2 laser. Only after the margin is set is lidocaine with epinephrine injected for hemostasis during the resection. This sequence prevents the vasoconstrictor from obscuring the lesion's true border during the critical marking phase.

Results In 21 patients with a total of 50 lesions, all surgical margins were free of residual disease on final pathology. During a follow-up period of at least 12 months, only one recurrence occurred, and no cases of malignant transformation were observed. The technique appears to be effective at facilitating complete removal.

For patients undergoing neoadjuvant therapy, a case report in Head & Neck demonstrates a novel way to assess treatment response intraoperatively [3]. This is clinically important as characterizing the spatial pattern of pathologic response remains a challenge. A 79-year-old female with recurrent oral tongue cancer received neoadjuvant pembrolizumab, paclitaxel, and carboplatin. During the subsequent definitive surgical resection, a novel intraoperative positron emission tomography/computed tomography, or PET/CT, scanner was used. Final histopathology revealed two discrete foci of residual cancer, measuring 1.8 and 0.5 centimeters, which were separated by an 8-millimeter bridge of inflammation without any viable tumor. The intraoperative PET/CT imaging with 3D specimen mapping confirmed this scattered, multifocal regression pattern, suggesting that such real-time approaches to assessing treatment response warrant further investigation.

And looking toward the future of airway reconstruction, a preclinical study in Otolaryngology--Head and Neck Surgery explored how different biomaterials can improve tracheal grafts [4]. Airway collapse is a life-threatening complication, and current strategies are limited. Using a mouse model, investigators created composite tracheal grafts with biodegradable splints made of different polymers like PGA and PLCL. They found that the material choice significantly influenced how the graft remodeled over two weeks. A splint composed of polyglycolic acid, or PGA, resulted in increased collagen deposition compared to other materials or grafts without splints. This highlights how material science may one day help us engineer better, more stable airway grafts with improved long-term viability.

Next, we turn to rhinology, with updates on diagnosing nasal masses, understanding the environmental drivers of CRS, and optimizing biologic therapy.

A major publication in JAMA Otolaryngology–Head & Neck Surgery provides a new multidisciplinary consensus statement on the appropriate workup of sinonasal masses [5]. Recognizing that suboptimal practices can lead to poor outcomes, an international panel of 25 experts from otolaryngology, rhinology, head and neck surgery, neurosurgery, and medical oncology was convened. Using a modified Delphi approach, the panel evaluated 23 statements covering initial evaluation, biopsy, imaging, and pathology. Twenty-two of these statements reached consensus. This document provides a clear, expert-driven guide to help practitioners avoid common pitfalls and standardize care for these often-complex cases.

Also in JAMA Otolaryngology, a case-control study sheds light on the link between air pollution and chronic rhinosinusitis [6]. Investigators at a tertiary center compared 62 CRS patients with 30 controls. Using a validated land use regression model, they estimated five-year average exposures to various traffic-related and industry-related pollutants at each participant's geocoded home address.

Results After adjusting for demographic characteristics, smoking, and other confounders, they found powerful associations. Each standard deviation increase in nitrogen dioxide, a traffic-related pollutant, was independently associated with a 132% rise in the odds of having CRS. Similarly, benzene exposure was linked to a 115% rise in odds, and lead exposure was associated with a 248% rise in odds of CRS. The pollutants were also linked to distinct cytokine signatures, with nitrogen dioxide associated with elevated type 2 cytokines like IL-4, IL-5, and IL-13, while benzene and lead were associated with non-type 2 profiles.

For patients with chronic rhinosinusitis with nasal polyps, a post hoc analysis of the Phase III SYNAPSE trial published in Rhinology examines the efficacy of mepolizumab based on a patient's surgical history [7]. Patients with CRSwNP often undergo multiple surgeries, and this analysis explored whether outcomes differed based on having one, versus more than one, prior surgery. In both subgroups, mepolizumab administered every four weeks for a year led to significant improvements in nasal polyp score, nasal obstruction, loss of smell, and SNOT-22 scores compared to placebo. Mepolizumab also significantly reduced the risk of needing repeat surgery or oral corticosteroids in patients with only one prior surgery. The authors conclude that while mepolizumab is effective in patients with a history of multiple surgeries, the data suggest it may offer even greater benefit when initiated earlier in the disease course.

Finally, in otology and neurotology, two papers address long-term management: one for vestibular schwannomas and the other for cochlear implants.

A key study in The Laryngoscope provides compelling evidence for a 'size threshold surveillance' approach for very small vestibular schwannomas [8]. The management of these tumors remains controversial, hinging on whether early treatment improves on the natural history. This multicenter retrospective review specifically addressed this by looking at tumors measuring just 1 to 3 millimeters and comparing their natural history to a referent cohort with larger tumors.

Results The results were striking. For the very small tumors, the 5-year tumor growth-free survival rate was 84%, compared to just 45% for the larger tumors. The 5-year treatment-free survival was 92% for the small tumors versus 54% for the larger ones. Most importantly for patients, the rate of maintaining serviceable Class A, B, or C hearing at 5 years was 96% in the very small VS group, compared to 65% in the referent cohort. At the 5-year mark, only 8% of patients with very small tumors had received treatment. These data strongly substantiate an initial wait-and-scan strategy for this specific population, as their natural history is significantly more favorable than that of the broader VS population.

Rounding out our week, a study in Otolaryngology–Head and Neck Surgery analyzed national trends in cochlear implant complications using the United States Food and Drug Administration's MAUDE database from 2016 to 2024 [9]. Investigators extracted over 34,000 patient complications and 33,000 device complications. They found that while the overall number of reported complications has plateaued or declined since a major voluntary field corrective action in 2020, there are some concerning underlying trends. The proportion of specific issues, including healing and skin problems, infection and inflammation, and device fit or malposition, has continued to increase relative to the total number of complications. Furthermore, the proportion of events leading to hospitalization or life-threatening outcomes has also risen in the post-2020 period. The authors conclude that these findings highlight evolving safety profiles and underscore the need for targeted device refinements and robust post-market surveillance.

If you only have time for one paper this week, make it the study on very small vestibular schwannomas by Carlson and colleagues in The Laryngoscope [8]. This paper provides high-quality, multicenter data that gives clinicians strong evidence to support a wait-and-scan approach for tumors 3 millimeters or smaller, which can be immensely reassuring for both physicians and their patients.

Here are the key takeaways from this week in Otolaryngology.

First, for very small vestibular schwannomas between 1 and 3 millimeters, initial observation is strongly supported by new multicenter data. At five years, 92% of these patients remain treatment-free and 96% maintain serviceable hearing.

Second, in head and neck cancer reconstruction without elective tracheostomy, be aware that floor of mouth or oropharynx tumors and bilateral neck dissections significantly increase the risk of adverse airway events, which occur in about 10% of this population overall.

Third, long-term residential exposure to traffic and industrial pollutants like nitrogen dioxide, benzene, and lead is associated with a significantly increased risk of chronic rhinosinusitis, with some pollutants more than doubling the odds.

Fourth, mepolizumab is effective for CRSwNP in patients with one or more prior surgeries, though initiating it earlier in the disease course, after a single surgery, may offer greater benefit.

Finally, a new international multidisciplinary consensus statement is now available in JAMA Otolaryngology to guide the workup of sinonasal masses, aiming to standardize practice and avoid common pitfalls.

That's your roundup for This Week in Otolaryngology. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.