This Week in Otolaryngology — May 14, 2026

Welcome to This Week in Otolaryngology. This week we're covering 10 notable papers spanning major innovations in otology, new approaches in rhinology and skull base surgery, and a key update in pediatric sleep apnea. Let's dive in.

Innovations in Otology

We begin this week in otology, with several papers pushing the boundaries of how we diagnose and treat hearing loss and related disorders. First, from Otology & Neurotology, a study confirms that older adults are excellent candidates for cochlear implantation [7]. Investigators reviewed outcomes for 66 adults aged 65 or older with single-sided deafness or asymmetric hearing loss. After implantation, patients saw dramatic improvements. Mean sentence understanding in the implanted ear jumped by 58 percentage points for the SSD group and 73 points for the AHL group. Subjective ratings of hearing ability and quality of life also improved significantly, and patients used their devices for a substantial part of the day, averaging over 8 hours for SSD and nearly 11 hours for AHL. Importantly, the amount of preoperative hearing in the poor ear did not impact the magnitude of improvement, reinforcing that older adults with significant hearing asymmetry should be strongly considered for cochlear implantation.

For patients with complex neurotologic conditions, another study in Otology & Neurotology explores surgical strategies for those with medically refractory Meniere's disease who also have severe-to-profound hearing loss qualifying them for a cochlear implant [6]. The paper compares two approaches: simultaneous labyrinthectomy with cochlear implantation versus simultaneous endolymphatic sac decompression, or ESD, with cochlear implantation. In this retrospective series of 19 ears, both procedures were found to be safe and effective. As expected, all patients in the labyrinthectomy group achieved vertigo control. In the ESD group, about 71% of patients saw a decrease in vertigo attacks, suggesting a slightly lower rate of vertigo resolution with this less destructive approach. However, hearing outcomes with the cochlear implant were excellent and comparable between the two groups. This suggests that for select patients, simultaneous ESD with CI is a viable alternative to labyrinthectomy, offering a chance at vertigo control while preserving inner ear structures.

Looking toward the future of diagnostics, a paper in Hearing Research describes a novel, non-invasive test that may help pinpoint the specific cause of age-related hearing loss [1]. Researchers used mouse models with known defects to show that analyzing the coherence of auditory brainstem responses can distinguish dysfunction of the stria vascularis from sensory or neural deficits. Mice with strial dysfunction, which affects the endocochlear potential, showed good inter-trial coherence relative to the amplitude of their ABRs. This is a key step toward a diagnostic tool that could one day stratify human patients for clinical trials and targeted therapies aimed at boosting strial function, a common but currently unmeasurable site of pathology.

Finally, also in Hearing Research, a pharmacovigilance analysis of the United States Food and Drug Administration's adverse event database shines a light on medications associated with hyperacusis [2]. The analysis of over 3,800 case reports identified ten drug classes most frequently linked to this distressing loudness sensitivity. The top three were selective serotonin reuptake inhibitors, fluoroquinolone antibiotics, and serotonin-norepinephrine reuptake inhibitors. While this database analysis cannot prove causation, it provides a valuable list of potential culprits for clinicians to consider when a patient presents with new-onset hyperacusis and establishes a foundation for future research to determine which drugs can definitively induce the condition.

Rethinking Rhinology and Skull Base Practice

Next, we turn to rhinology, where two companion papers in JAMA Otolaryngology–Head & Neck Surgery introduce and validate a significant refinement to how we measure patient symptoms in chronic rhinosinusitis. For years, clinicians have noted a frustrating disconnect between patient scores on the standard 22-item Sino-Nasal Outcome Test, or SNOT-22, and objective findings on CT scans. The first study addresses this directly [4].

The Study

Investigators developed a novel, adaptive version of the SNOT instrument based on item response theory. Unlike the static SNOT-22 where every patient answers every question, the adaptive test selects questions dynamically. In a study of over 400 patients who had both symptom scoring and imaging, the standard SNOT-22 scores showed no measurable association with Lund-Mackay CT scores. In stark contrast, the new adaptive SNOT scores, particularly in the nasal domain, demonstrated a strong association with CT findings. A higher adaptive nasal score gave a patient almost four times the odds of having more significant disease on their CT scan. Furthermore, the adaptive test could help discriminate between CRS and allergic rhinitis, as allergy-focused scores were inversely associated with CT findings.

The second paper is a formal validation study of this new adaptive SNOT [5]. It confirms the instrument's psychometric properties across over 1,000 patients. The adaptive SNOT scores could clearly distinguish between patients with significant sinus disease on CT, defined as a Lund-Mackay score of 5 or greater, and those without. The instrument showed substantial reliability and was responsive to change, with scores improving significantly after medical or surgical treatment for CRS. Together, these papers suggest that an adaptive, intelligent approach to patient-reported outcomes can bridge the gap between subjective symptoms and objective disease, potentially reducing patient burden and improving diagnostic accuracy in the rhinology clinic.

Shifting from the sinuses to the skull base, a systematic review in Otolaryngology–Head and Neck Surgery questions a common practice: postoperative management of spontaneous cerebrospinal fluid leaks [10]. After repairing a lateral skull base CSF leak, many surgeons prescribe treatments like acetazolamide or place a lumbar drain to lower intracranial pressure and protect the repair. This review analyzed 36 studies to see if this practice actually reduces the rate of recurrence. The conclusion is clear: the available evidence does not support universal postoperative ICP-lowering therapy. In a pooled analysis of comparative studies, there was no significant difference in recurrence rates between patients who received ICP-lowering therapy and those who did not. The authors note that limited observational data hints that acetazolamide may be associated with lower recurrence, but lumbar drainage has not shown a sustained benefit. The takeaway is that postoperative management should be individualized, as routine pressure management for all patients is not warranted by the current literature.

Pediatric OSA and the Broader Importance of Sleep

In pediatric otolaryngology, a study in The Laryngoscope provides practical guidance on a common clinical dilemma: who needs to stay overnight after a tonsillectomy? [3]. Current guidelines recommend admission for children considered high-risk, such as those with obesity and severe obstructive sleep apnea. However, most of these children have uneventful recoveries. This retrospective study sought to identify a low-risk subgroup within this high-risk population who could be safely discharged on the same day.

Results

Among 304 children with obesity and severe OSA, about 12% experienced a severe perioperative event. The strongest predictor of an event was the nadir oxygen saturation on the preoperative sleep study. Based on their analysis, the investigators developed a simple clinical rule: children with an AHI less than 25 events per hour AND a baseline oxygen nadir greater than 85% were at extremely low risk for a severe event. This rule had a negative predictive value of 99.5%, meaning that for children meeting these criteria, the chance of a severe event was less than one percent. These findings support a more individualized approach to postoperative disposition and suggest that simple polysomnographic data can safely allow for same-day discharge in a significant portion of this high-risk group, pending prospective validation.

Finally, a large-scale study in Nature underscores the profound importance of sleep for long-term health, providing context for why we treat conditions like OSA so aggressively [8]. Using data from the UK Biobank, researchers examined the link between self-reported sleep duration and 23 different biological aging clocks derived from imaging, proteomics, and metabolomics. They found a consistent U-shaped pattern across all systems. The lowest biological age was associated with a sleep duration between 6.4 and 7.8 hours per night. Both short sleep, under 6 hours, and long sleep, over 8 hours, were associated with accelerated biological aging and increased risk for systemic diseases like depression and diabetes. This paper provides powerful, multi-system evidence that optimizing sleep is a cornerstone of healthy aging.

Editor's Pick

If you only have time for one paper this week, make it the study by Ho and colleagues in The Laryngoscope on identifying high-risk children safe for same-day discharge after tonsillectomy [3]. This paper offers a simple, data-driven, and immediately applicable clinical rule based on PSG data that can directly impact patient care, hospital resources, and family experience.

Clinical Bottom Line

Here are the key takeaways from this week in Otolaryngology.

First, older adults with single-sided deafness or asymmetric hearing loss are excellent cochlear implant candidates and achieve substantial improvements in speech understanding and quality of life.

Second, in children with obesity and severe OSA undergoing tonsillectomy, you can use preoperative sleep study data. An AHI below 25 and an oxygen nadir above 85 percent identifies a very low-risk group who may be candidates for same-day discharge.

Third, a new adaptive SNOT instrument demonstrates superior correlation with CT scan findings compared to the standard SNOT-22, and may help differentiate chronic rhinosinusitis from allergic rhinitis in the clinic.

Fourth, the current evidence does not support routine postoperative intracranial pressure-lowering therapy after repair of a spontaneous lateral skull base CSF leak. Management should be individualized rather than universal.

And finally, be mindful of medications commonly associated with patient reports of hyperacusis, particularly certain antidepressants like SSRIs and SNRI's, and fluoroquinolone antibiotics.

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.

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