This Week in Otolaryngology — Jun 22, 2026

Welcome to This Week in Otolaryngology. This week we're covering 10 notable papers spanning pediatric surgical management, otology and audiology advancements, and innovative clinical technologies. Let's dive in.

We begin in pediatric otolaryngology, where we look at optimizing perioperative care and implementing safer surgical techniques. Published in The Laryngoscope, Elias and colleagues examined the clinical utility of preoperative cardiac workups in children aged 2 to 18 with very severe obstructive sleep apnea, defined as an Apnea-Hypopnea Index of 25 or greater [8]. Out of 144 children meeting these criteria, about a quarter underwent a preoperative cardiac evaluation. Interestingly, only about eight percent of those evaluated had abnormal findings—all of whom were obese adolescents with an Apnea-Hypopnea Index over 50. Crucially, none of these abnormal findings led to further testing or changes in preoperative management, such as starting continuous positive airway pressure. The authors found no association between having a cardiac workup and postoperative outcomes or hospital length of stay. Instead, a younger age and a higher baseline Apnea-Hypopnea Index were the actual drivers of a longer hospital stay. This suggests that routine preoperative cardiac workups in this population have a very low clinical yield, and clinicians should reserve these resource-intensive evaluations for obese adolescents with an Apnea-Hypopnea Index exceeding 50. Also in The Laryngoscope, Ling and co-authors explored how departments can successfully transition to safer surgical practices, specifically looking at the shift from total tonsillectomy to intracapsular tonsillectomy [10]. Looking at nearly 14,000 pediatric patients over a six-year period, the department successfully increased its adoption of intracapsular tonsillectomy from just over two percent to over eighty percent. This transition was accompanied by a massive drop in morbidity: while ten percent of patients who underwent total tonsillectomy returned to the emergency department within 30 days, only about three percent of those who underwent intracapsular tonsillectomy returned. Through qualitative interviews, the researchers identified that data transparency and sharing individual surgeon experiences were the key motivators that overcame barriers like concerns about training, family interactions, and partner impact. This demonstrates that transitioning to newer, safer surgical techniques is highly scalable when backed by institutional data transparency.

Next, we turn to otology and audiology, where clinical trials are redefining how we manage hearing loss, from over-the-counter devices to cochlear implants. A systematic review and meta-analysis published in Otolaryngology--Head and Neck Surgery by De Sousa and colleagues evaluated the effectiveness of self-fitting over-the-counter hearing aids compared to traditional professionally fitted devices [7]. Analyzing 15 unique studies representing over 700 patients, the researchers found no significant differences between self-fitting over-the-counter devices and audiologist-fitted devices across multiple validated scales, including the Abbreviated Profile of Hearing Aid Benefit and the Quick Speech-in-Noise test. While the overall certainty of evidence was rated as low and most trials were short-term, these findings suggest that self-fitting over-the-counter hearing aids can provide clinical outcomes comparable to professional fittings, offering a more accessible option for adults with mild-to-moderate hearing loss. Meanwhile, for patients with more profound, unilateral hearing loss, cochlear implantation is emerging as a highly effective intervention. Writing in Otology & Neurotology, Zeitler and colleagues presented results from a prospective, multicenter post-market study of 30 adults with single-sided deafness who received a unilateral cochlear implant [9]. At 12 months post-implantation, patients demonstrated significant improvements in speech perception in both quiet and noisy environments. The study also documented substantial subjective benefits, including significant reductions in tinnitus and listening fatigue, alongside marked improvements in spatial hearing and overall quality of life. This high-quality prospective data confirms that cochlear implantation is an excellent treatment option for adults suffering from single-sided deafness.

In head and neck oncology, optimizing the timing of adjuvant therapies and understanding rare tumor behavior remain critical to improving survival. Delays in initiating postoperative radiotherapy beyond six weeks are well known to worsen survival outcomes in head and neck cancer. To address this, Radevic and colleagues published a study in Head & Neck evaluating a simple electronic health record-based discharge summary prompt designed to flag the need for timely adjuvant therapy [5]. Following the implementation of this clinical prompt, the rate of delayed postoperative radiotherapy—defined as starting more than 42 days after surgery—decreased dramatically from roughly 74 percent down to just under 47 percent. On multivariate analysis, the presence of this simple electronic prompt cut the odds of a treatment delay by nearly three-quarters and doubled the likelihood of rapid radiotherapy initiation. This highlights how a low-cost, automated electronic health record intervention can successfully overcome systemic care coordination barriers. Understanding the natural history of rare malignancies is equally vital. In The Laryngoscope, Wang and colleagues utilized the National Cancer Database to compare nearly 17,000 patients with adenoid cystic carcinoma arising from salivary and nonsalivary sites [2]. They found that clinical behavior and presentation vary dramatically by primary site. For instance, minor salivary gland tumors were the most likely to present with locally advanced disease, whereas respiratory tract primaries were the most likely to present with regional or distant metastases. When controlling for age, sex, treatment, and disease stage, only patients with breast primary tumors had a significantly different survival rate compared to major salivary gland primaries, with a nearly 40 percent reduction in mortality risk. This underscores the need for site-specific staging and treatment paradigms rather than managing all adenoid cystic carcinomas under a single clinical umbrella.

Moving to airway and sinus pathology, new evidence clarifies the roles of surgical and procedural interventions for chronic, bothersome symptoms. In rhinology, the role of surgery for recurrent acute rhinosinusitis has long been debated. Writing in JAMA Otolaryngology--Head & Neck Surgery, Kaski and colleagues conducted an open-label randomized clinical trial comparing endoscopic sinus surgery combined with medical therapy against medical therapy alone in 59 adults [4]. At the six-month follow-up, patients who underwent endoscopic sinus surgery experienced a highly significant and clinically meaningful improvement in their SinoNasal Outcome Test 22 scores, with a mean difference of over 22 points compared to the conservative group. In contrast, conservative medical treatment alone had no clinically meaningful effect on quality of life. Complications were minimal, suggesting that endoscopic sinus surgery is an exceptionally effective and safe treatment for patients suffering from recurrent acute rhinosinusitis who fail initial medical therapy. In laryngology, managing refractory neurogenic cough remains a therapeutic challenge. A single-arm meta-analysis published in Otolaryngology--Head and Neck Surgery by Cabral and colleagues pooled data from eight retrospective studies comprising over 500 patients to evaluate the efficacy of superior laryngeal nerve blocks [1]. The pooled analysis revealed that nearly three-quarters of patients experienced subjective cough improvement. Furthermore, patients had a statistically significant reduction in their Cough Severity Index scores, with the most pronounced improvements observed in those who received three or more injections. The procedure proved to be highly safe, with only a tiny fraction of patients experiencing serious or injection-limiting adverse events. This supporting evidence positions the superior laryngeal nerve block as a highly effective, low-risk office-based procedure for patients with neurogenic cough, particularly when administered in a series of three or more injections.

Finally, we explore how modern diagnostic tools and artificial intelligence are reshaping emergency decision-making. In The Laryngoscope, Todsen and colleagues conducted a multicenter randomized clinical trial to see if integrating transoral ultrasound into the evaluation of suspected peritonsillar abscesses could improve patient care [3]. They randomized 95 patients to either standard clinical examination alone or examination combined with transoral ultrasound. While the addition of ultrasound did not significantly improve overall diagnostic accuracy or patient outcomes, it did lead to a highly significant clinical benefit: a nearly 32 percent reduction in the number of painful, unsuccessful needle aspiration attempts. This suggests that while transoral ultrasound may not change the final diagnosis, it is a valuable tool for reducing patient discomfort and avoiding unnecessary invasive procedures in the clinic. Looking to the future of clinical decision support, Hack and colleagues published a study in Otolaryngology--Head and Neck Surgery evaluating the ability of large language models to assist with emergency triage decisions [6]. They compared the performance of four advanced AI models against four clinicians in triaging 30 emergency referral scenarios. The study revealed that the highest-performing model, GPT-5, achieved triage accuracy and quality of explanations comparable to an attending otolaryngologist, with no statistically significant difference between them. Interestingly, GPT-4 and other intermediate models actually outperformed emergency medicine residents and attendings in triaging these specialty-specific cases. While the authors caution that these models still require supervision and local calibration, they represent a powerful potential tool for supporting emergency decision-making in environments where specialist coverage is limited.

If you only have time for one paper this week, make it the randomized clinical trial on endoscopic sinus surgery for recurrent acute rhinosinusitis published in JAMA Otolaryngology--Head & Neck Surgery [4]. This study provides high-quality, long-awaited randomized evidence showing that surgery delivers a major, clinically meaningful quality of life benefit for recurrent acute sinus infections, whereas continuing conservative medical therapy alone offers virtually no benefit.

Here are the key takeaways from this week in Otolaryngology: First, endoscopic sinus surgery should be strongly considered for patients with recurrent acute rhinosinusitis who fail conservative therapy, as it offers a massive, 22-point improvement in sinonasal quality of life [4]. Second, transitioning your practice to intracapsular tonsillectomy can dramatically reduce 30-day emergency department return rates from ten percent down to just three percent, and this change can be successfully scaled through institutional data transparency [10]. Third, routine preoperative cardiac workups are unnecessary for most pediatric patients with very severe obstructive sleep apnea, and should be selectively reserved for obese adolescents with an Apnea-Hypopnea Index over 50 [8]. Fourth, self-fitting over-the-counter hearing aids achieve short-term clinical outcomes comparable to professionally fitted devices, representing a viable, accessible option for adult patients [7]. And finally, a simple, automated discharge summary prompt in the electronic health record can cut the rate of delayed postoperative radiotherapy in head and neck cancer patients by nearly three-quarters [5].

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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This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.