This Week in Otolaryngology — Oct 29, 2026
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The week's practice-changing Otolaryngology (ENT) research, summarized for clinicians.
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Nasal Obstruction and Treatment With Oxymetazoline and Corticosteroids: A Randomized Clinical Trial.
In steroid-refractory chronic nasal obstruction, combined oxymetazoline and budesonide produced responders in 83 percent versus 36 percent with budesonide alone, without rebound over four weeks of treatment.
JAMA Otolaryngology-Head & Neck Surgery · 2026 · PubMed
This week’s papers
- 01
Nasal Obstruction and Treatment With Oxymetazoline and Corticosteroids: A Randomized Clinical Trial.
In steroid-refractory chronic nasal obstruction, combined oxymetazoline and budesonide produced responders in 83 percent versus 36 percent with budesonide alone, without rebound over four weeks of treatment.
Cruz L et al. · JAMA Otolaryngology-Head & Neck Surgery · 2026
From the briefingThe most provocative is a double-blind randomized trial in JAMA Otolaryngology-Head and Neck Surgery from Cruz and colleagues at Washington University, which tested the idea that an intranasal steroid can protect against the rebound congestion we associate with prolonged oxymetazoline use [1]. Sixty adults with chronic nasal obstruction who had already failed topical steroids, and who did not have chronic sinusitis, used either a combined oxymetazoline and budesonide spray or budesonide alone twice daily for four weeks, followed by a three-week wean. About four in five patients on the combination were responders on a global improvement scale, compared with just over a third of patients on budesonide alone, a gap of roughly 47 percentage points. No participant in the combination arm developed worsening obstruction suggestive of rebound, and every participant weaned off without difficulty. The authors are careful to say that rebound with longer-term use cannot be excluded; this is a single-centre trial of four weeks of active treatment, with turbinate biopsies in only ten participants, so it reopens a question rather than settling it.
If you only have time for one paper this week, make it the oxymetazoline and budesonide trial from Cruz and colleagues [1]. It directly challenges one of the most repeated warnings in rhinology and reopens the question of whether rebound congestion is inevitable when a decongestant is paired with a steroid.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 02
Study on the Efficacy of Vidian Neurectomy in Combined Ocular-Nasal Therapy for Allergic Rhinoconjunctivitis.
In 220 patients with drug-refractory allergic rhinoconjunctivitis, vidian neurectomy gave greater, more sustained nasal and ocular relief than fluticasone, with lower one-year recurrence but more complications.
Hu C et al. · Otolaryngology-Head and Neck Surgery · 2026
From the briefingFor patients with truly drug-refractory disease, a randomized trial in Otolaryngology-Head and Neck Surgery from Hu and colleagues compared vidian neurectomy with fluticasone in 220 patients with allergic rhinoconjunctivitis [2]. Neurectomy produced greater and more sustained improvement in both nasal and ocular symptoms, along with lower serum immunoglobulin and inflammatory markers and better tear film measures, whereas the fluticasone group plateaued after the first month. Recurrence at one year was lower after surgery, but complications were more frequent, and the trial was single-centre with short follow-up, so it supports neurectomy as an option under study rather than an established step.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 03
Intralymphatic immunotherapy (ILIT) versus standard care or placebo in allergic rhinitis: A systematic review and meta-analysis of randomized controlled trials.
Across 16 trials, intralymphatic immunotherapy reduced allergic rhinitis symptom and medication scores versus placebo without improving quality of life, and matched subcutaneous immunotherapy for one year.
Almezher MU et al. · American Journal of Otolaryngology · 2026
From the briefingRounding out the theme, a meta-analysis by Almezher and colleagues in the American Journal of Otolaryngology pooled 16 randomized trials of intralymphatic immunotherapy, involving 606 patients [3]. Compared with placebo, the short injection course produced a moderate reduction in combined symptom and medication scores, but no meaningful improvement in quality of life. Against subcutaneous immunotherapy it looked similar out to a year, with trends toward better durability for subcutaneous therapy at two and three years that did not reach significance. Local swelling was about four times more common than with placebo, yet total adverse events were roughly 58 percent lower than with subcutaneous therapy. The evidence base remains small trials, so the durability question is open.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 04
Survivorship Care Before Completion of Definitive Radiotherapy and Oncologic Outcomes in Head and Neck Cancer.
In 471 head and neck cancer patients, attending survivorship care before finishing radiotherapy was associated with better treatment adherence, lower three-year recurrence, and improved disease-free survival in retrospective analysis.
Nilsen ML et al. · JAMA Otolaryngology-Head & Neck Surgery · 2026
From the briefingIn JAMA Otolaryngology-Head and Neck Surgery, Nilsen and colleagues looked at 471 patients receiving definitive curative-intent radiotherapy at one academic centre, about a third of whom attended a multidisciplinary survivorship clinic before radiotherapy was finished [4]. After adjusting for tumour stage, systemic therapy, insurance, area deprivation and other factors, attendees had roughly half the odds of radiotherapy nonadherence, about a 40 percent lower three-year recurrence risk, and similarly better disease-free survival. This is retrospective, and patients who engage with an early clinic may differ in ways no model captures, but it makes a case for testing survivorship care as something that begins during treatment rather than after it. Two papers in Head and Neck address tumour biology and extent.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 05
Recurrence Risk in Lateralized Floor of Mouth Carcinoma: Depth of Invasion Versus Midline Distance.
In lateralized floor of mouth cancer, depth of invasion predicted local and ipsilateral but not contralateral recurrence; all contralateral failures occurred in tumours within 5 millimetres of midline.
Ketschau J et al. · Head & Neck · 2026
From the briefingKetschau and colleagues studied 97 patients with lateralized floor of mouth squamous cell carcinoma [5]. Depth of invasion predicted local and ipsilateral regional recurrence but not contralateral recurrence. Among 68 patients whose tumours did not cross the midline, four developed contralateral nodal recurrence, and all four had tumours within 5 millimetres of the midline on preoperative imaging, meaning roughly one in five patients in that close group recurred versus none of the patients further away. With only four events, the authors explicitly call the 5 millimetre threshold exploratory and in need of external validation before it informs contralateral neck management.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 06
Treatment Outcomes in Osteosarcoma of the Head and Neck: A Systematic Review and Meta-Analysis.
Pooling 31 studies of about two thousand patients, chemotherapy with surgery improved overall and disease-free survival in head and neck osteosarcoma, especially neoadjuvant, while radiotherapy showed no survival benefit.
Magri A et al. · Head & Neck · 2026
From the briefingFor a much rarer tumour, Magri and colleagues pooled 31 studies and about two thousand patients with head and neck osteosarcoma [6]. Jaw tumours fared better than skull base tumours, chemotherapy combined with surgery was associated with roughly a quarter lower risk of death and a fifth lower risk of disease recurrence or death, with the signal strongest for neoadjuvant use, while radiotherapy showed no survival benefit. Because this rests on observational series, selection effects are likely, but it reinforces systemic therapy as part of curative-intent treatment.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 07
Pediatric Obstructive Sleep Apnea: Predictors of Surgical Success via Weighted Analysis.
After correcting for selective follow-up testing, higher preoperative apnea-hypopnea index predicted tonsillectomy failure in children, with only about 42 percent success above 30 events per hour.
Zhang Z et al. · The Laryngoscope · 2026
From the briefingIn The Laryngoscope, Zhang and colleagues revisited pediatric tonsillectomy for obstructive sleep apnea, correcting for the fact that children who get a postoperative sleep study are not a random sample [7]. Among 174 children with sleep studies before and after surgery, about 70 percent achieved an apnea-hypopnea index below five. Each additional event per hour before surgery lowered the odds of success by roughly four percent, and children with very severe disease, above 30 events per hour, succeeded only about 42 percent of the time. Obesity trended toward lower success, but the association did not reach significance, and the authors cannot say whether that reflects no effect or limited power. Their conclusion is that surgery alone is unlikely to be curative in the most severe group.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 08
Hearing Preservation as a Function of Angular Insertion Depth With Manual Versus Robotic-Assisted Insertion Techniques.
In 120 cochlear implant hearing preservation candidates, robotic-assisted insertion was linked to less early low-frequency hearing loss, particularly at angular insertion depths beyond 490 degrees, in retrospective data.
Perez-Heydrich CA et al. · Otology & Neurotology · 2026
From the briefingIn Otology and Neurotology, Perez-Heydrich and colleagues compared manual and robotic-assisted electrode insertion in 120 adult hearing preservation candidates receiving straight arrays [8]. Robotic insertion, younger age and shallower insertion were each linked to less early low-frequency hearing loss, and the robotic advantage was concentrated at insertion depths beyond about 490 degrees. This is a retrospective series with only 28 robotic cases and early follow-up, so it generates a hypothesis about deep insertions rather than proving one.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 09
Comparative Effectiveness and Safety of Energy Devices for Thyroidectomy: An Outcome-Specific Network Meta-Analysis of Randomized Controlled Trials.
A network meta-analysis of thyroidectomy trials ranked Harmonic highest, reducing operative time, bleeding, hypocalcemia and transient nerve palsy versus conventional hemostasis, though overall device superiority was not established.
Kim DH et al. · Head & Neck · 2026
From the briefingIn thyroid surgery, a network meta-analysis of randomized trials from Kim and colleagues in Head and Neck ranked Harmonic highest across most outcomes, with shorter operations, less blood loss and drainage, shorter stays, and roughly 40 to 45 percent lower odds of transient hypocalcemia, transient recurrent laryngeal nerve palsy and postoperative bleeding compared with conventional hemostasis [9]. LigaSure improved efficiency but showed less consistent recovery and safety benefits. The authors themselves caution that relative rankings do not establish overall device superiority and that absolute benefits matter.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 10
NaV1.8 Inhibition and the Future of Nonopioid Analgesia in Otolaryngology: A Narrative Review.
Suzetrigine, a selective NaV1.8 inhibitor, beat placebo for acute postoperative pain with placebo-like side effects, but otolaryngology-specific evidence is limited to one retrospective cohort so far.
Tham T et al. · JAMA Otolaryngology-Head & Neck Surgery · 2026
From the briefingFinally, a narrative review by Tham and colleagues in JAMA Otolaryngology-Head and Neck Surgery examines suzetrigine, a first-in-class NaV1.8 sodium channel inhibitor recently approved by the United States Food and Drug Administration [10]. Across more than three thousand patients in abdominoplasty and bunionectomy trials, it beat placebo and showed mixed efficacy against hydrocodone with acetaminophen, with adverse events similar to placebo and no respiratory or sedating effects. Otolaryngology data consist of a single retrospective cohort in free flap and transoral robotic surgery, so its potential role after tonsillectomy, sleep surgery or major head and neck surgery remains untested.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
The full briefing
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 new approaches to nasal obstruction and allergic rhinitis, care delivery and recurrence risk in head and neck cancer, and surgical technique and perioperative care from the cochlea to the thyroid. Let's dive in.
We start in rhinology, where three papers question long-standing assumptions about refractory nasal symptoms. The most provocative is a double-blind randomized trial in JAMA Otolaryngology-Head and Neck Surgery from Cruz and colleagues at Washington University, which tested the idea that an intranasal steroid can protect against the rebound congestion we associate with prolonged oxymetazoline use [1]. Sixty adults with chronic nasal obstruction who had already failed topical steroids, and who did not have chronic sinusitis, used either a combined oxymetazoline and budesonide spray or budesonide alone twice daily for four weeks, followed by a three-week wean. About four in five patients on the combination were responders on a global improvement scale, compared with just over a third of patients on budesonide alone, a gap of roughly 47 percentage points. No participant in the combination arm developed worsening obstruction suggestive of rebound, and every participant weaned off without difficulty. The authors are careful to say that rebound with longer-term use cannot be excluded; this is a single-centre trial of four weeks of active treatment, with turbinate biopsies in only ten participants, so it reopens a question rather than settling it. For patients with truly drug-refractory disease, a randomized trial in Otolaryngology-Head and Neck Surgery from Hu and colleagues compared vidian neurectomy with fluticasone in 220 patients with allergic rhinoconjunctivitis [2]. Neurectomy produced greater and more sustained improvement in both nasal and ocular symptoms, along with lower serum immunoglobulin and inflammatory markers and better tear film measures, whereas the fluticasone group plateaued after the first month. Recurrence at one year was lower after surgery, but complications were more frequent, and the trial was single-centre with short follow-up, so it supports neurectomy as an option under study rather than an established step. Rounding out the theme, a meta-analysis by Almezher and colleagues in the American Journal of Otolaryngology pooled 16 randomized trials of intralymphatic immunotherapy, involving 606 patients [3]. Compared with placebo, the short injection course produced a moderate reduction in combined symptom and medication scores, but no meaningful improvement in quality of life. Against subcutaneous immunotherapy it looked similar out to a year, with trends toward better durability for subcutaneous therapy at two and three years that did not reach significance. Local swelling was about four times more common than with placebo, yet total adverse events were roughly 58 percent lower than with subcutaneous therapy. The evidence base remains small trials, so the durability question is open.
Our second theme is head and neck oncology, where three papers address who recurs and what changes survival. In JAMA Otolaryngology-Head and Neck Surgery, Nilsen and colleagues looked at 471 patients receiving definitive curative-intent radiotherapy at one academic centre, about a third of whom attended a multidisciplinary survivorship clinic before radiotherapy was finished [4]. After adjusting for tumour stage, systemic therapy, insurance, area deprivation and other factors, attendees had roughly half the odds of radiotherapy nonadherence, about a 40 percent lower three-year recurrence risk, and similarly better disease-free survival. This is retrospective, and patients who engage with an early clinic may differ in ways no model captures, but it makes a case for testing survivorship care as something that begins during treatment rather than after it. Two papers in Head and Neck address tumour biology and extent. Ketschau and colleagues studied 97 patients with lateralized floor of mouth squamous cell carcinoma [5]. Depth of invasion predicted local and ipsilateral regional recurrence but not contralateral recurrence. Among 68 patients whose tumours did not cross the midline, four developed contralateral nodal recurrence, and all four had tumours within 5 millimetres of the midline on preoperative imaging, meaning roughly one in five patients in that close group recurred versus none of the patients further away. With only four events, the authors explicitly call the 5 millimetre threshold exploratory and in need of external validation before it informs contralateral neck management. For a much rarer tumour, Magri and colleagues pooled 31 studies and about two thousand patients with head and neck osteosarcoma [6]. Jaw tumours fared better than skull base tumours, chemotherapy combined with surgery was associated with roughly a quarter lower risk of death and a fifth lower risk of disease recurrence or death, with the signal strongest for neoadjuvant use, while radiotherapy showed no survival benefit. Because this rests on observational series, selection effects are likely, but it reinforces systemic therapy as part of curative-intent treatment.
Our final theme gathers surgical technique and perioperative care, where the papers sharpen expectations about what surgery delivers. In The Laryngoscope, Zhang and colleagues revisited pediatric tonsillectomy for obstructive sleep apnea, correcting for the fact that children who get a postoperative sleep study are not a random sample [7]. Among 174 children with sleep studies before and after surgery, about 70 percent achieved an apnea-hypopnea index below five. Each additional event per hour before surgery lowered the odds of success by roughly four percent, and children with very severe disease, above 30 events per hour, succeeded only about 42 percent of the time. Obesity trended toward lower success, but the association did not reach significance, and the authors cannot say whether that reflects no effect or limited power. Their conclusion is that surgery alone is unlikely to be curative in the most severe group. In Otology and Neurotology, Perez-Heydrich and colleagues compared manual and robotic-assisted electrode insertion in 120 adult hearing preservation candidates receiving straight arrays [8]. Robotic insertion, younger age and shallower insertion were each linked to less early low-frequency hearing loss, and the robotic advantage was concentrated at insertion depths beyond about 490 degrees. This is a retrospective series with only 28 robotic cases and early follow-up, so it generates a hypothesis about deep insertions rather than proving one. In thyroid surgery, a network meta-analysis of randomized trials from Kim and colleagues in Head and Neck ranked Harmonic highest across most outcomes, with shorter operations, less blood loss and drainage, shorter stays, and roughly 40 to 45 percent lower odds of transient hypocalcemia, transient recurrent laryngeal nerve palsy and postoperative bleeding compared with conventional hemostasis [9]. LigaSure improved efficiency but showed less consistent recovery and safety benefits. The authors themselves caution that relative rankings do not establish overall device superiority and that absolute benefits matter. Finally, a narrative review by Tham and colleagues in JAMA Otolaryngology-Head and Neck Surgery examines suzetrigine, a first-in-class NaV1.8 sodium channel inhibitor recently approved by the United States Food and Drug Administration [10]. Across more than three thousand patients in abdominoplasty and bunionectomy trials, it beat placebo and showed mixed efficacy against hydrocodone with acetaminophen, with adverse events similar to placebo and no respiratory or sedating effects. Otolaryngology data consist of a single retrospective cohort in free flap and transoral robotic surgery, so its potential role after tonsillectomy, sleep surgery or major head and neck surgery remains untested.
If you only have time for one paper this week, make it the oxymetazoline and budesonide trial from Cruz and colleagues [1]. It directly challenges one of the most repeated warnings in rhinology and reopens the question of whether rebound congestion is inevitable when a decongestant is paired with a steroid.
Here is what this week's evidence adds up to in Otolaryngology. First, for chronic nasal obstruction refractory to steroids, randomized data now show a large short-term benefit from combined oxymetazoline and budesonide without rebound over four weeks, though longer-term safety is unknown. Second, for drug-refractory allergic disease, both vidian neurectomy and intralymphatic immunotherapy show symptom benefit in trials, but each has trade-offs, with more surgical complications on one side and uncertain durability and no quality of life gain on the other. Third, in head and neck cancer, observational data link early survivorship care to better radiotherapy adherence and survival, and pooled data support chemotherapy in osteosarcoma, while the floor of mouth midline threshold is still exploratory. Fourth, severity matters for pediatric sleep apnea surgery, with success falling sharply above 30 events per hour. And fifth, robotic cochlear implant insertion, energy device choice in thyroidectomy, and suzetrigine for head and neck pain all have promising signals that rest on retrospective, indirect, or out-of-specialty evidence.
That's your roundup for This Week in Otolaryngology. The full transcript and references are available on the episode page. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.
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