This Week in Otolaryngology — Sep 3, 2026

Welcome to This Week in Otolaryngology. This week we're covering 10 notable papers spanning head and neck oncology and molecular surveillance, hearing rehabilitation and implant care, and the evolving pharmacologic and surgical management of airway disease. Let's dive in.

We'll start with head and neck oncology, where two papers in different journals tackle the same question from opposite ends of the human papillomavirus spectrum. In JAMA Otolaryngology–Head and Neck Surgery, Sicard and colleagues report a retrospective cohort using a commercially available tissue-informed circulating tumour DNA assay, which builds a bespoke panel from each patient's own tumour variants and therefore works regardless of viral status [1]. Across 77 pretreatment patients, the assay successfully detected circulating tumour DNA in about 92 percent, and in a surveillance cohort of 107 patients followed a median of roughly eighteen months from the end of treatment, per-test sensitivity was around 95 percent with specificity of 100 percent and a negative predictive value just under 100 percent. Those are strong numbers, but note that the failure to generate or detect a test in nearly one in thirteen pretreatment patients remains unexplained, and this is a single urban tertiary centre over about fifteen months. Alongside it, in Head and Neck, Cooke and colleagues asked whether tumour tissue-modified viral human papillomavirus DNA testing, which is well validated in oropharyngeal cancer, holds up in human papillomavirus-associated cancers arising outside the oropharynx [2]. In a small single-centre cohort of nineteen diagnostic and fifteen surveillance patients, diagnostic sensitivity was about 80 percent with perfect specificity, and surveillance sensitivity was around 86 to 87 percent, again with perfect specificity and positive predictive value. In two patients a positive blood test preceded clinically or radiographically evident recurrence, in one case by roughly three and a half months. The practical message from both is consistent: a positive result is highly trustworthy and should trigger imaging, but a negative result is reassuring rather than definitive, particularly with the smaller non-oropharyngeal series where the numbers are genuinely tiny.

Staying in the neck, JAMA Otolaryngology also published a multicentre retrospective cohort from four academic centres examining compartment-specific recurrence in medullary thyroid carcinoma [3]. Among 235 patients operated on between 1998 and 2021, just under a third developed recurrence, and the dominant sites were the ipsilateral central and ipsilateral lateral neck, at about fifteen percent each. Contralateral central neck recurrence was uncommon, around five percent overall. In the subgroup of 105 patients who were clinically node-negative before surgery, roughly half of whom underwent contralateral prophylactic central neck dissection, the differences in overall and contralateral recurrence were small and, critically, imprecisely estimated. On multivariable analysis, contralateral prophylactic dissection was not associated with a reduction in either overall or contralateral recurrence. Seo and colleagues are appropriately cautious: the confidence around those estimates is wide enough that this does not settle the debate, but it does tell you that the contralateral central compartment is a low-yield battleground compared with the ipsilateral neck.

The oncology theme closes with a long-view survivorship study in Head and Neck from Karlsson and colleagues, who followed 211 irradiated head and neck cancer patients out to ten years [4]. Trismus, defined as a maximal interincisal opening of 35 millimetres or less, was present in about 35 percent of patients at ten years post-radiotherapy. Most quality-of-life scores did not change between the five and ten year marks, meaning that whatever deficit your patient carries at five years is likely the deficit they will carry at ten. On the head and neck specific questionnaire, eleven of fourteen domains and items were worse than baseline. This is a strong argument for building trismus screening and jaw exercise programmes into long-term survivorship clinics rather than treating them as a first-year rehabilitation issue.

Our second theme is hearing rehabilitation, and here three papers in Otology and Neurotology and one in The Laryngoscope map the whole arc from access, through surgery, to device survival. Ayas and colleagues conducted a scoping review of attrition across the adult cochlear implant care pathway, synthesising seventeen studies [5]. Patients drop out at every stage — before referral, between referral and assessment, and most heavily in the post-assessment presurgical window, where ten of the studies clustered. Early loss was driven by under-referral, poor awareness of candidacy, and socioeconomic barriers; later loss by logistics, decisional uncertainty, doubts about benefit, and cumulative care burden. Notably, no study examined the interval from surgery to device activation as a discrete stage. The reframing here is useful: cochlear implant underutilisation is not one patient saying no, it's a cumulative leak across a pipeline, and each leak needs its own fix.

On the surgical side, The Laryngoscope published a randomised controlled trial from Omari and colleagues testing whether inspecting a patient-specific three-dimensional printed temporal bone during cochlear implantation reduces surgeon cognitive load [6]. Forty consecutive adult primary implantations were randomised, with twelve surgeons involved. The result was not uniform, and that's the interesting part. Attending surgeons reported meaningfully lower overall cognitive load with the model, driven mostly by reduced physical fatigue. Residents reported higher cognitive load, with more mental and physical fatigue. Fellows showed no overall difference, though they rated the cases as less complex while feeling more physically fatigued. Models were judged anatomically accurate and useful, especially for teaching. The authors' conclusion is that these models offload experienced surgeons but add effort for trainees, so deployment should be matched to experience level rather than applied across the board.

Also in Otology and Neurotology, Rak and colleagues report twelve-month outcomes from a prospective multicentre observational study of an active middle ear implant across nine tertiary centres in Germany, Austria, and Poland [7]. Among 67 patients, including children, speech recognition thresholds in quiet improved substantially with every coupling approach — incus long process, short process, round window, and stapes head — with gains in the range of eighteen to twenty-five decibels and large effect sizes. Speech in noise improved by roughly four to nine decibels. There were two explantations and two revision surgeries. Exploratory comparisons found no statistically detectable difference between coupling approaches, though the study was underpowered for that comparison, so coupler choice should stay anatomically driven.

And a cautionary counterpoint on implantable hearing devices: Gathman and colleagues analysed 1,090 primary bone-anchored hearing device implantations over more than two decades, with a median follow-up of about four and a half years [8]. Just under twelve percent were ultimately explanted. Recurrent wound complications — more than three episodes — were associated with roughly a fivefold increase in the hazard of explantation after adjustment. Put in absolute terms, the ten-year cumulative incidence of explantation was about sixty percent in patients with frequent wound complications, versus about sixteen percent in those without. Early complications within sixty days roughly doubled the hazard. If your patient is on their third skin problem, that device is in real jeopardy and warrants aggressive early intervention rather than watchful waiting.

Our final theme is airway. JAMA Otolaryngology published a review by Harris and Kaffenberger on glucagon-like peptide-1 receptor agonists in obstructive sleep apnoea, prompted by the December 2024 United States Food and Drug Administration approval of tirzepatide for moderate to severe apnoea in adults with obesity [9]. Across six meta-analyses, apnoea-hypopnoea index reductions ranged widely, and in the phase three trials tirzepatide reduced the index by roughly twenty to twenty-four events per hour versus placebo, with something close to half of patients reaching disease remission. The mechanism is largely weight loss, including reductions in tongue and parapharyngeal fat, with emerging preclinical signals around chemosensitivity and loop gain. Two caveats matter clinically: these drugs did not match continuous positive airway pressure on apnoea reduction, cardiovascular outcome benefits remain unproven, and weight regain after discontinuation is common. The authors position these agents as a complementary adjunct — for the patient with a body mass index above thirty who is intolerant of positive airway pressure, as preoperative optimisation, or potentially to broaden hypoglossal nerve stimulator candidacy — and not as a substitute in patients with primarily anatomical obstruction.

On the paediatric airway, the International Journal of Pediatric Otorhinolaryngology published a systematic review by Rakkar and colleagues on interventions for primary paediatric tracheomalacia, covering 22 studies and 764 participants [10]. More than four in five studies were retrospective. All thirteen surgical pexy studies reported favourable results, with clinician-defined resolution in seventy-three to one hundred percent of cases, while all four stenting studies achieved immediate patency but were uniformly poor on long-term durability. The honest conclusion is that pexy is the best-studied and only intervention with sustained benefit, but every bit of that evidence comes from uncontrolled observational work with no comparison against conservative management — which means we still cannot say how many of these children would have improved on their own.

If you only have time for one paper this week, make it the tissue-informed circulating tumour DNA study in JAMA Otolaryngology [1]. It extends blood-based surveillance beyond human papillomavirus-positive oropharyngeal cancer to the human papillomavirus-negative patients who make up much of our head and neck practice, and the surveillance performance is strong enough to start reshaping how we plan post-treatment follow-up.

Here are the key takeaways from this week in Otolaryngology. First, blood-based surveillance in head and neck cancer is maturing on both the tissue-informed and viral fronts — treat a positive result as actionable and a negative result as reassuring but not conclusive. Second, in medullary thyroid cancer the ipsilateral neck is where recurrence lives, and contralateral prophylactic central dissection showed no clear benefit, though the estimates were too imprecise to close the question. Third, one in three irradiated head and neck patients still has trismus a decade later, and that burden plateaus rather than resolves after five years. Fourth, recurrent wound complications around a bone-anchored device carry roughly a fivefold hazard of eventual explantation, so escalate early. And fifth, glucagon-like peptide-1 receptor agonists are now a legitimate adjunct in obesity-related sleep apnoea, but they do not match positive airway pressure and the benefit fades with weight regain.

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.