This Week in Otolaryngology — Oct 1, 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 head and neck oncology — from risk factors and survivorship to neoadjuvant therapy — hearing restoration across cochlear implantation, stapes surgery and sudden hearing loss, and a pair of studies on airway and pediatric surgical practice. Let's dive in.

We'll start with head and neck cancer, where two large studies in JAMA Otolaryngology–Head and Neck Surgery approach the disease from opposite ends — why it happens, and what it leaves behind. Gottlieb-Vedi and colleagues used the Swedish Prescribed Drugs and Health Cohort to ask whether androgens help explain why laryngeal and hypopharyngeal squamous cell carcinoma is so predominantly a male disease [1]. They compared roughly 253,000 men dispensed 5-alpha-reductase inhibitors — the drugs used for benign prostatic hyperplasia, which block conversion of testosterone to dihydrotestosterone — against five times as many matched non-users, with adjustment for alcohol, smoking, hypertension, hyperlipidaemia and diabetes. Over a median follow-up of around five to six years, 5-ARI users had about a 17 percent lower relative risk of these cancers. The absolute numbers are small — roughly one in a thousand men in each group developed the tumour — and this is observational, so confounding by indication and by unmeasured behaviour remains possible. The authors frame it as biological support for a partial role of testosterone in male predominance, not as a chemoprevention strategy. On the survivorship side, Desai and colleagues followed 789 patients with non-metastatic head and neck cancer treated with definitive radiation or chemoradiation at a single comprehensive cancer centre [2]. Nearly everyone received opioids at some point, and at three months after finishing radiation, seven in ten patients were still taking them; at six months, just under half were. Even among those who were opioid-naive before radiation, close to six in ten patients were still on opioids at three months. Prior opioid use roughly two and a half times the odds of continued use, as did palliative care referral, which nearly quadrupled the odds — a marker of symptom burden rather than a cause. The authors argue these figures justify targeted opioid stewardship that balances genuine analgesic need against dependency risk; it is single-institution data, but the magnitude is hard to ignore.

Two further head and neck papers in Head and Neck address treatment intensity and risk stratification. Xu and colleagues report a prospective single-arm phase two trial of short-course neoadjuvant anlotinib plus paclitaxel and cisplatin in 21 patients with technically resectable locally advanced disease [9]. Two thirds of patients achieved an objective response, meeting the prespecified activity threshold. Eight patients went on to surgery, all with R0 resection, five with a major pathological response, and four undergoing a less extensive resection than originally planned. Toxicity was mostly grade one. The authors are appropriately restrained: this is a signal-generating study in a very small, single-arm cohort, and it does not establish that anlotinib adds anything beyond chemotherapy alone, nor that organ preservation is achievable. Also in Head and Neck, Savoia and colleagues examined the Cachexia Index — built from skeletal muscle index, serum albumin and the neutrophil-to-lymphocyte ratio — in 353 patients with HPV-negative squamous cell carcinoma undergoing curative-intent surgery across two McGill hospitals [10]. Patients in the lowest fifth of the index had roughly double the odds of severe treatment toxicity, and the two lowest quintiles carried roughly three times the mortality risk. Notably, the index was not independently associated with treatment intolerance or disease-free survival after adjustment, so this looks like a marker of host resilience rather than tumour behaviour. The authors position it as warranting further evaluation as a pretreatment risk stratification tool, not yet as a validated one.

Turning to hearing, three papers tackle restoration in very different populations. In Otology and Neurotology, Zawawi and colleagues compared lateral wall and slim modiolar cochlear implant electrodes in 161 ears in children with normal cochlear anatomy and at least four years of follow-up [6]. The slim modiolar group showed lower intraoperative neural response telemetry thresholds and impedances, speech discrimination scores about seven points higher at four years, and roughly an hour and a half more daily device use. Electrode migration occurred only in the lateral wall group, in about one in twelve ears, and suspected scalar translocation was uncommon overall but more frequent with lateral wall electrodes. This is retrospective single-centre data with all the selection issues that implies, but it is among the longer-term paediatric comparisons available. In The Laryngoscope, Roberts and colleagues systematically reviewed cochlear implantation for radiation-induced hearing loss after nasopharyngeal carcinoma — twelve studies, 69 ears [8]. Complications were uncommon, with about four in five cases free of intraoperative complications and nearly all free of postoperative complications, and audiometric improvement was observed in roughly nine in ten patients. Striking is that the mean duration of profound hearing loss before implantation was six and a half years, suggesting these patients are being referred very late; the authors argue this supports audiologic surveillance after radiation. The evidence base is small, retrospective and heterogeneous, so the pooled proportions carry wide uncertainty. And in the American Journal of Otolaryngology, Yeh and colleagues pooled 19 studies and 1,318 otosclerosis patients with preoperative tinnitus undergoing primary stapes surgery [7]. Tinnitus disappeared in close to half of patients and was alleviated in roughly another quarter, with a meaningful drop in Tinnitus Functional Index scores, while under four percent of patients reported deterioration. Air-bone gap closure to within 20 decibels was achieved in around nine in ten patients. The authors are candid that heterogeneity was substantial and that no study had a non-surgical comparison group, so causality — and the link between tinnitus relief and hearing gain — remains unresolved.

Staying with the ear briefly, Sun and colleagues report a multicentre retrospective cohort of 1,309 patients with sudden sensorineural hearing loss across four Shanghai hospitals in Otolaryngology–Head and Neck Surgery, comparing hyperbaric oxygen plus corticosteroids against steroids alone [3]. Eleven to twenty hyperbaric sessions roughly doubled the odds of slight and partial recovery at treatment completion, with effects on complete recovery emerging by 90 days, and no serious adverse events. Age, delayed treatment, vertigo and a high initial pure-tone threshold were independent prognostic factors. The authors favour initiating hyperbaric oxygen early, preferably within two weeks. It is worth being clear that this is retrospective and unrandomised, with a group allocation imbalance of roughly three to one, so treatment selection could easily be doing some of the work here.

Two final papers address access and surgical technique. Gouldman and colleagues, in Otolaryngology–Head and Neck Surgery, looked at drug-induced sleep endoscopy findings in 90 adults with obstructive sleep apnea, comparing patients self-identifying as Black and white [4]. Despite similar age, body mass index, apnea-hypopnea index and neck circumference, anterior-posterior velum collapse — the pattern required for hypoglossal nerve stimulation eligibility — was found in 40 percent of Black patients versus 71 percent of white patients, and race remained independently associated after multivariable adjustment. With only 20 Black patients at a single academic centre, the estimate is imprecise, but the authors raise a plausible mechanism by which anatomic phenotype could contribute to documented disparities in access to surgical sleep apnea therapy. Finally, in the International Journal of Pediatric Otorhinolaryngology, Rhee and colleagues describe a quality improvement initiative converting an academic paediatric centre from extracapsular monopolar to radiofrequency ablation intracapsular tonsillectomy across four plan-do-study-act cycles and 474 tonsillectomies [5]. Emergency department visits for haemorrhage fell from about six percent to one percent, and returns to the operating room fell from three percent to near zero, with no intracapsular patient requiring reoperation for secondary bleeding. Operative time was about seven minutes longer, residents participated in over nine in ten cases, and the authors report one intracapsular patient with intraoperative arterial haemorrhage requiring embolization who recovered fully. This is a pre-post design without randomisation, so secular trends cannot be excluded, but the implementation pathway is the real contribution.

If you only have time for one paper this week, make it the opioid study from JAMA Otolaryngology–Head and Neck Surgery [2]. It puts a hard number on something most head and neck clinicians sense but rarely quantify — that the majority of patients remain on opioids months after radiation ends — and it reframes post-treatment analgesia as a survivorship problem rather than a transient one.

Here is what this week's evidence adds up to in Otolaryngology. First, on head and neck cancer, observational Swedish data raise a biologically interesting androgen hypothesis for male predominance in laryngeal and hypopharyngeal cancer, but at this stage it is hypothesis-generating and nowhere near a preventive indication. Second, persistent opioid use after chemoradiation appears to be the rule rather than the exception at three months, which is single-centre evidence but with effect sizes large enough to support stewardship efforts already under discussion. Third, in hearing restoration, slim modiolar electrodes showed better long-term speech and stability outcomes than lateral wall electrodes in children with normal anatomy, though from retrospective data, while cochlear implantation after nasopharyngeal radiation appears safe and effective even after many years of deafness — with late referral the recurring theme. Fourth, stapes surgery is associated with tinnitus relief in most otosclerosis patients with preoperative tinnitus, but without control groups, causality is unproven. And fifth, the sleep endoscopy work and the tonsillectomy quality improvement project both point toward implementation questions — who gets access to which therapy, and how a centre safely changes technique — where the evidence is early and single-site, but the questions are now clearly posed.

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.

If this weekly briefing is useful, follow the show in your podcast app so new episodes arrive automatically. And if it saves you time, a quick rating in your podcast app helps other physicians find the show.

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