This Week in Otolaryngology — Sep 24, 2026

This AudioScholar briefing is generated by artificial intelligence for healthcare professionals and trainees. It is not medical advice.

Welcome to This Week in Otolaryngology. This week we're covering 10 notable papers spanning airway and laryngology, hearing and sleep interventions, and new ways of stratifying risk in head and neck disease. Let's dive in.

We'll start with the airway, where three papers deal with how much larynx and how much intervention a patient really needs. In The Laryngoscope, Ilmarinen and colleagues reviewed 20 patients with laryngeal chondrosarcoma treated at a single Finnish centre over more than two decades. Four of those twenty went straight to total laryngectomy; the remaining sixteen had open partial surgery or endoscopic debulking. Among patients with cricoid tumours managed with larynx-preserving surgery, two things tracked strongly with ending up with a permanent tracheostomy: reoperation for recurrence or continued growth, and transformation of the histology from well or moderately differentiated to poorly differentiated or dedifferentiated disease. Two patients presented with distant metastases and two died of their chondrosarcoma. This is a small retrospective series, so it settles nothing definitively, but the authors argue that the field's shift from radical to function-preserving surgery now needs matching guidance on surveillance, because a tumour that starts low grade does not always stay that way [1]. Alongside that, in Otolaryngology-Head and Neck Surgery, Awadallah and colleagues asked whether systemic hormone replacement therapy modifies the course of idiopathic subglottic stenosis in postmenopausal women. Among 125 women who underwent laser wedge excision at a tertiary centre, comparing any hormone therapy exposure against never-use showed no significant difference in recurrence rates. But in the subgroup of 19 women actively on hormone therapy at presentation, the adjusted recurrence rate was about half that of never-users, a statistically significant difference. Surgery-free intervals and time to first recurrence trended longer but did not reach significance. This is retrospective, the current-user group is small, and the overall comparison was null, so the authors frame it as something to inform shared decision-making rather than as a reason to prescribe hormones for airway disease [2].

Staying in the paediatric airway, the International Journal of Pediatric Otorhinolaryngology reports a single-centre Brazilian series of thirteen children with juvenile recurrent respiratory papillomatosis treated with monthly systemic bevacizumab at 5 to 10 milligrams per kilogram. All had disease below the epiglottis and most were tracheostomy-dependent. After ten cycles, every child showed marked lesion reduction, complete remission was achieved in just over three quarters of them, the median number of surgeries per year fell from about seven and a half to under two, and every tracheostomised child was decannulated, with no serious adverse events recorded. That is a striking signal, but it is thirteen children, uncontrolled and retrospective, and Almeida and colleagues themselves call for multicentre work to define optimal duration [3]. And in Head and Neck, Huang and colleagues used a porcine continuous intraoperative neuromonitoring model to test something many of us assume is benign: cooling the recurrent laryngeal nerve. Across sixteen nerves exposed for one minute, room temperature and simply cold water produced no or only mild electromyographic change with full recovery, ice water produced moderate to severe disturbance that was only partly reversible, and direct ice block contact produced the worst effects, including transient loss of signal and incomplete recovery in some nerves. The conclusion is that near-freezing exposure, often presumed neuroprotective, carries a real risk of iatrogenic injury. It is an animal model, but it is mechanistically clean and directly relevant to thyroid and airway surgery [4].

The second theme is sleep and hearing, where two papers ask why outcomes vary so much between patients with the same device. In JAMA Otolaryngology-Head and Neck Surgery, Kaki and colleagues looked at 160 adults across two academic centres who underwent hypoglossal nerve stimulator implantation, classifying each by arousal threshold endotype calculated from routine preoperative sleep study data. About four in ten had a low arousal threshold. Those patients had lower baseline apnea-hypopnea indices and smaller relative reductions after implantation, but the striking finding was adherence over time: roughly a quarter of low arousal threshold patients who were adherent at three months had become nonadherent by six months, compared with about one in twenty of the high threshold group, a more than tenfold difference in odds. Importantly, average nightly use and pauses per night did not differ; the pattern was missed nights rather than intolerance within a night. This is retrospective and the arousal threshold algorithm is an estimate rather than a direct measurement, but it supports the idea that preoperative endotyping could flag patients at risk of progressive disengagement [5]. In Ear and Hearing, Kunnath and colleagues report a pilot randomised trial of donepezil in adult cochlear implant users, on the hypothesis that cholinergic enhancement could boost auditory plasticity. Thirteen experienced users were enrolled and only nine completed the ninety-day protocol, four on donepezil 5 milligrams daily and five on placebo. Both groups increased device use by about three hours a day. The donepezil group gained about fourteen and a half points on implanted-ear word recognition, above the ten-point threshold usually considered clinically meaningful, while the placebo group was essentially flat. Functional near-infrared spectroscopy showed significantly greater left frontal activation during a speech-in-noise task in the donepezil arm. The authors are explicit that with nine completers this trial was underpowered to establish efficacy, and it should be read as hypothesis-generating groundwork for a proper trial, not as evidence for prescribing [6].

Our third theme is risk stratification, where four papers try to sharpen prediction using data we already collect. Also in JAMA Otolaryngology-Head and Neck Surgery, Johnson and colleagues applied a tracheostomy-specific risk tier system to more than fourteen thousand children undergoing index tracheostomy at 44 tertiary children's hospitals in the United States over nine years. Median length of stay climbed from about a month in the standard risk tier to well over five months in the critical tier, and in-hospital mortality rose from under five percent to about sixteen percent across those tiers. Discrimination was modest but clearly better than the general All Patient Refined Diagnosis Related Group severity classification, which performed close to chance. Between-hospital variance was negligible. The authors position this as a tool for risk-adjusted benchmarking across centres, and are careful to say the modest discrimination limits its use for predicting an individual child's course [7]. In Otolaryngology-Head and Neck Surgery, Le and Ngo prospectively studied 154 patients with chronic rhinosinusitis with nasal polyps in Ho Chi Minh City, asking whether computed tomography osteitis severity can identify the eosinophilic endotype. The Kennedy Osteitis Score correlated moderately with tissue eosinophil density and discriminated eosinophilic disease better than the conventional Lund-Mackay mucosal score, with an area under the curve of about 0.78 versus 0.66. A threshold of one or above gave roughly seventy percent sensitivity and just over eighty percent specificity. That is a single-centre cohort with a specific population, so external validation is needed, but it suggests a scan we already order carries endotype information [8]. And in Head and Neck, Mattioli and colleagues studied 134 patients undergoing compartmental surgery for locally advanced oral tongue and floor of mouth squamous cell carcinoma, finding that an infiltrative worst pattern of invasion was an independent predictor of nodal positivity at diagnosis and was significantly associated with increased overall and locoregional recurrence. Tumour budding and worst pattern of invasion are framed as promising markers that might guide treatment intensification, though this is retrospective multicentre data and not yet a basis for altering adjuvant decisions [9].

One more practical paper before we close. In Otology and Neurotology, Kwon and colleagues combined cadaveric dissection, three-dimensional modelling and perilymph sampling in five patients undergoing translabyrinthine surgery to define the optimal head position for intratympanic dexamethasone. The ideal orientation relative to the round window involved roughly fifty-nine degrees of yaw, thirty-one of roll and twenty-two of pitch, and modelling showed that roll and pitch together mattered while yaw alone did little. Pooled cadaveric and clinical samples showed nearly three times higher perilymph dexamethasone concentration in the ideal position than the traditional forty-five degree rotation, but that difference was not statistically significant, so this remains a mechanistic proposal rather than proven clinical benefit [10].

If you only have time for one paper this week, make it the hypoglossal nerve stimulation adherence study in JAMA Otolaryngology-Head and Neck Surgery [5]. It reframes stimulator failure as a longitudinal behavioural problem that may be predictable from a sleep study you already have, and it reopens the question of who should be counselled differently before implantation.

Here is what this week's evidence adds up to in otolaryngology. First, endotyping is quietly moving from research to selection: arousal threshold appears to predict disengagement from hypoglossal stimulation, and osteitis on computed tomography appears to track the eosinophilic polyp endotype, both on single or two-centre data that need replication before they enter guidelines. Second, function-preserving laryngeal surgery has outpaced the surveillance evidence supporting it, with low-grade chondrosarcoma capable of transforming and driving permanent tracheostomy. Third, systemic bevacizumab for juvenile papillomatosis continues to produce remarkable uncontrolled results, now including universal decannulation in a thirteen-child series, but there is still no controlled trial. Fourth, two null or underpowered findings deserve to be read as null: hormone therapy overall did not change subglottic stenosis recurrence, and the donepezil pilot could not establish efficacy. And finally, the porcine neuromonitoring work is a reminder that cooling the recurrent laryngeal nerve below about three degrees is not benign.

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.