This Week in Otolaryngology — Aug 13, 2026

Welcome to This Week in Otolaryngology. This week we're covering 10 notable papers spanning head and neck oncology — from neoadjuvant therapy to survivorship and prescribing safety — plus inflammatory airway disease and biologic selection, and a group of papers on risk prediction and de-escalation in otology, laryngology, and pediatrics. Let's dive in.

Starting with head and neck cancer, and the most striking numbers of the week come from JAMA Otolaryngology-Head and Neck Surgery, where a single-center retrospective cohort looked at 86 patients with resectable head and neck squamous cell carcinoma treated off-trial with either neoadjuvant immunotherapy alone or neoadjuvant chemoimmunotherapy before definitive surgery [1]. Roughly two thirds OF PATIENTS who received the combination — 39 of 58 — achieved either a pathologic complete response or a major pathologic response, meaning ten percent or less viable tumor, compared with just one of 28 patients treated with immunotherapy alone. After propensity score adjustment the odds of a deep pathologic response were dramatically higher with the combination, with a confidence interval so wide it tells you the sample is small even as the signal is unmistakable. Treatment was generally tolerated with few adverse-event-related surgical delays. What this does not yet tell us is whether pathologic response translates into survival, and the authors are explicit that prospective trials are needed before this becomes standard. But for surgeons sitting in multidisciplinary conference, it argues that if you are going to give neoadjuvant therapy off-trial, single-agent checkpoint blockade is unlikely to deliver the tumor downstaging you are hoping for.

Staying with head and neck cancer but shifting to who we harm rather than how we treat, two papers this week deal with survivorship. In Head and Neck, an analysis of more than five thousand SEER-Medicare patients aged 65 and older found that 56 percent OF PATIENTS received at least one potentially inappropriate medication by Beers Criteria within a year of diagnosis, most often lorazepam, zolpidem, and alprazolam [6]. Two-year survival fell in a dose-dependent way, from about 88 percent in those on no such medication down to roughly 81 percent in those on three or more, and emergency department utilization was higher among users. This is observational and confounded by the reasons those drugs get prescribed — anxiety, insomnia, and pain are not randomly distributed in this population — but the gradient is hard to ignore, and it makes a case for formal medication reconciliation as part of head and neck cancer care rather than an afterthought. Alongside that, The Laryngoscope published an updated SEER analysis of suicide among more than 222,000 patients with head and neck cancer diagnosed between 2012 and 2021 [7]. There were 298 suicides, giving a rate nearly double that of the general United States population. Risk was concentrated in men, unmarried patients, those with distant metastatic disease, and by site in hypopharyngeal cancer, where the standardized mortality ratio was over four, and laryngeal cancer at nearly three. Patients treated with radiation alone, and especially those who received neither surgery nor radiation, carried the highest risk of all — a reminder that the patients we do not operate on may be the ones who most need active psychosocial follow-up. Most deaths occurred within five years, but excess risk persisted beyond ten years in some sites.

Rounding out oncology, JAMA Otolaryngology-Head and Neck Surgery also reported on PD-L1 as a biomarker in papillary thyroid carcinoma, comparing 31 patients with aggressive disease against 31 with nonaggressive disease, plus benign and healthy controls [8]. Serum PD-L1 measured by ELISA was substantially higher in aggressive papillary thyroid carcinoma than in every comparison group, and was driven particularly by macroscopic extrathyroidal extension and aggressive histology, though not by bulky nodal disease or distant metastases. Tumor PD-L1 positivity on immunohistochemistry, by contrast, tracked with BRAF V600E mutation rather than with serum levels — the two measures were essentially uncorrelated. That dissociation is the interesting part: serum PD-L1 may be capturing something different from tissue staining, and potentially something less vulnerable to sampling error in a heterogeneous tumor. This is a single-institution cohort with small subgroups, so treat it as hypothesis-generating rather than a test to order Monday morning.

Moving to inflammatory airway disease, Rhinology addressed a question every payer and every rhinologist faces: does the EPOS 2020 eligibility framework actually predict who benefits from a biologic? Investigators screened 224 patients with chronic rhinosinusitis with nasal polyps treated with dupilumab, and criteria could be assessed in 177, of whom 76 met them at baseline [3]. EPOS-eligible patients achieved larger improvements in polyp score, SNOT-22, and olfaction, and were more likely to reach the minimal clinically important difference for polyp score, with higher composite EPOS response scores. Notably, though, adequate EUFOREA response rates did not differ between eligible and ineligible groups — so the framework sorts magnitude of benefit better than it sorts responders from non-responders. Aspirin-exacerbated respiratory disease independently predicted adequate response, and higher baseline serum immunoglobulin E predicted faster improvement. The practical message is that categorical eligibility is a reasonable allocation tool, but markers of active type 2 inflammation may do more of the real predictive work. On the other end of the therapeutic spectrum, the International Journal of Pediatric Otorhinolaryngology published a systematic review and meta-analysis of nasal saline irrigation for allergic rhinitis in children and adolescents — seven studies, only 462 participants total [10]. Pooled analysis showed a large reduction in nasal symptom scores and a significant reduction in rescue antihistamine use, but the GRADE certainty was low and very low respectively, and the trend toward better disease control did not reach statistical significance. Adverse events were minor. Saline remains a cheap, safe adjunct worth recommending, but the evidence base is small and at high risk of bias, and we should say that to families rather than overselling it.

The last thread this week is about predicting who fails, and where we can safely do less. In Otology and Neurotology, a prospective single-arm pilot study tested a wait-and-scan protocol for small, asymptomatic postoperative cholesteatoma recurrence — lesions five millimeters or smaller on non-echo-planar diffusion-weighted MRI, with normal otoscopy and no proximity to critical structures [5]. Among 13 patients followed for a mean of 43 months, ten remained surgery-free; three needed intervention for growth or symptoms, and three actually showed spontaneous radiologic regression. Mean growth was about a third of a millimeter per year, and cumulative surgery-free survival was 100 percent at two years and 91 percent at three. Thirteen patients is a pilot, not a practice guideline, but it supports offering structured surveillance rather than automatic re-exploration in carefully selected patients. In The Laryngoscope, a retrospective review of 101 patients receiving cricopharyngeal botulinum toxin for retrograde cricopharyngeus dysfunction identified cervical esophageal inlet patches in about one in five, a finding not previously described in this population [4]. Inlet patches and increasing age were the only significant predictors of failing to sustain a long-term response, with inlet patches raising those odds roughly fivefold. That is a reason to look carefully at the proximal esophagus during esophagoscopy and to counsel these patients that a second intervention or myotomy may be more likely. And from the pediatric NSQIP database, an analysis of nearly 59,000 children undergoing otolaryngologic surgery found that underweight body mass index, once adjusted, was not consistently associated with complications — it persisted only for cardiopulmonary events after propensity matching [9]. Receipt of enteral or parenteral nutritional support, by contrast, roughly doubled cardiopulmonary complications and raised readmission and reoperation risk. In other words, the feeding tube is a better risk marker than the growth chart, likely because it flags underlying medical complexity.

Finally, a note on drug safety from The Laryngoscope, which used the TriNetX network to compare over 617,000 adults with obesity starting a GLP-1 receptor analogue against more than three million controls [2]. At six months, treated patients had modestly higher odds of any laryngeal manifestation, with the clearest signals for cough, globus sensation, and voice and resonance disorders. Absolute risk differences were small, and tirzepatide and albiglutide showed no significant association. Still, given how many patients are now on these drugs, it is worth adding GLP-1 use to your history when a patient presents with new cough or dysphonia.

If you only have time for one paper this week, make it the neoadjuvant chemoimmunotherapy cohort in JAMA Otolaryngology-Head and Neck Surgery [1]. The magnitude of the difference in deep pathologic response between combination therapy and single-agent immunotherapy is large enough to change how off-trial neoadjuvant regimens are chosen in multidisciplinary discussion, even while we wait for survival data.

Here are the key takeaways from this week in Otolaryngology. First, in resectable head and neck squamous cell carcinoma, neoadjuvant chemoimmunotherapy produced deep pathologic responses in about two thirds OF PATIENTS versus almost none with immunotherapy alone — promising, but survival data are still absent. Second, survivorship care matters: potentially inappropriate medications track with worse survival in elderly head and neck cancer patients, and suicide risk remains about double the general population, highest in hypopharyngeal and laryngeal cancer and in patients not treated with surgery or radiation. Third, EPOS 2020 criteria help allocate dupilumab and identify patients who gain more, but type 2 inflammatory markers and aspirin-exacerbated respiratory disease may predict response better than eligibility status alone. Fourth, watchful waiting with serial diffusion-weighted MRI looks feasible for small asymptomatic cholesteatoma recurrence in selected patients, and cervical inlet patches predict botulinum toxin failure in retrograde cricopharyngeus dysfunction. And fifth, in pediatric surgical risk assessment, being on nutritional support is a stronger warning sign than an underweight body mass index.

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.

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