Recent Advances in ENT · Archive
Each day, our harvester pulls peer-reviewed articles from 44 whitelisted ENT journals, scores them for clinical relevance with an AI model, and writes a 1–2 sentence summary lead with the clinical bottom line. 95 articles across 30 days so far.
Post-treatment ctDNA testing in HPV-positive OPSCC showed 80% sensitivity and 96% specificity for detecting recurrence, with a negative test yielding a 97.7% NPV at a 9.7% recurrence prevalence. A positive result carried 130-fold higher odds of recurrence, though inconsistent protocols currently limit clinical implementation.
Primary dental implantation at the time of mandibular reconstruction achieved equivalent implant survival, success, and complication rates compared to secondary implantation, while reducing overall rehabilitation time by 3–6 months.
No pharmacologic agent showed consistent, clinically meaningful benefit for HHT-related epistaxis; bevacizumab produced only a modest reduction in bleeding frequency, while tranexamic acid increased diarrhea risk nearly fourfold without improving any efficacy endpoint.
Pentoxifylline-tocopherol, pravastatin, and lipotransfer showed the most promising results for radiation-induced fibrosis in head and neck cancer, but high study heterogeneity prevented definitive conclusions about comparative effectiveness.
The Stretta procedure (radiofrequency energy to the gastroesophageal junction) showed improvement in cough and hoarseness across most studies, with PPI discontinuation rates of 40–80%, but evidence quality was too poor to confirm effectiveness for laryngopharyngeal symptoms due to heterogeneous designs and lack of objective LPRD confirmation.
Posterior nasal nerve ablation carried a delayed epistaxis risk recognised by surveyed otolaryngologists, with responses characterising the typical presentation, management approaches, and perceived incidence of this complication.
Endoscopic marsupialization for congenital vallecular cysts in children showed significantly lower recurrence than non-marsupialization techniques (2.78% vs 10.13%). Most cases presented in early infancy with stridor, and flexible laryngoscopy was the key diagnostic tool.
Dupilumab and tezepelumab showed the largest symptom and polyp score improvements among biologics for CRSwNP, while mepolizumab and omalizumab had intermediate effects and depemokimab fell below clinically meaningful thresholds. ESS outcomes varied widely across trials, and no head-to-head data exist to guide treatment selection between surgery and biologics.
Frailty consistently predicted medical complications, longer hospital stays, non-home discharge, and impaired swallowing recovery after free flap reconstruction for head and neck cancer, though associations with surgical complications and short-term mortality were inconsistent. Nutritional and sarcopenia-based measures outperformed frailty indices alone in predicting postoperative complications.
Neurogenic PVFM occurs across a wide range of central and peripheral disorders—including brainstem malformations, epilepsy, and neurodegenerative disease—and treating the underlying neurological cause resolved or substantially improved symptoms in most reversible cases. Atypical or refractory PVFM warrants early neurological evaluation rather than assumption of a functional diagnosis.
AI and ML models achieved >90% accuracy for general dysphonia detection but failed to reliably differentiate laryngeal dystonia from muscle tension dysphonia, largely because existing datasets underrepresent both conditions. Reliable AI-based differentiation will require etiologically labelled datasets and multimodal acoustic, physiologic, and imaging inputs.
A neonate with an unclassified laryngotracheal agenesis variant and esophageal airway continuity underwent successful primary crico-tracheal anastomosis, demonstrating that primary reconstruction is feasible in atypical cases where existing classification systems do not apply.
Pre-curved cochlear implant arrays produced lower focused-stimulation thresholds than straight arrays, with a distinct apical-basal profile, while autoimmune etiologies (e.g., Ménière's disease) showed an inverse mid-array pattern; duration of deafness had no significant effect on thresholds.
Remote-access thyroidectomy (axillary, transoral, retroauricular, and breast approaches) showed comparable recurrent laryngeal nerve injury and hypoparathyroidism rates to open surgery in selected patients, but carries approach-specific risks, longer operative times, and higher costs. Current guidelines restrict these techniques to low-risk, well-differentiated carcinomas without neck dissection, performed by high-volume surgeons.
Tinnitus impairs attention, working memory, and executive function through maladaptive central auditory and non-auditory network plasticity, with negative cognitive effects in some studies exceeding those of hearing loss or psychological comorbidities. Interdisciplinary management combining neurological, psychological, and audiological interventions is recommended to address both tinnitus perception and associated cognitive deficits.
The flexible fiberoptic laryngoscope was invented in 1967 by Sawashima, Hirose, and Fujimura at the University of Tokyo, inspired by Ikeda's fiberoptic bronchoscope. This foundational contribution to laryngology has been largely unrecognised in English-language literature.
High-frequency bone-conducted vibration activates irregular otolithic and canal afferents via rapid transient mechanics, explaining why oVEMPs, cVEMPs, and skull vibration-induced nystagmus can remain abnormal or exaggerated even when caloric and vHIT results are near-normal in conditions such as unilateral vestibular loss, Ménière's disease, and third-window syndromes.
Nasoseptal flap transnasal rotation successfully closed a soft palate fistula in a patient who had failed prior transoral repair, resolving nasal regurgitation and partially restoring velopharyngeal function without causing Eustachian tube dysfunction.
Continuous intraoperative monitoring with the Auditory Nerve Test System (ANTS) during simultaneous vestibular schwannoma resection and cochlear implantation successfully preserved acoustic nerve function in three cases, with all patients achieving hearing compensation postoperatively.
Family expectations for paediatric cochlear implantation are high across most domains—55% expected exclusive oral communication and 38% mainstream schooling—but only 14% strongly believed their child would keep pace with hearing peers. Expectations increased significantly after device activation, particularly for auditory and spoken language outcomes.
Laryngopharyngeal malakoplakia presented as a base-of-tongue mass mimicking malignancy in a diabetic, uremic patient; diagnosis required histological identification of Michaelis-Gutmann bodies, and complete surgical excision resulted in no recurrence at 20 months.
TNM-9 refines HPV-positive oropharyngeal carcinoma staging by placing greater weight on nodal extranodal extension to better discriminate prognosis within this subgroup, but therapeutic decisions should not be based on TNM stage alone and require standardised diagnostics with interdisciplinary interpretation.
Expanded CI indications now include single-sided deafness, residual hearing preservation, and electric-acoustic stimulation, with refinements in surgical technique and electrode design driving these changes. Bilateral implantation and remote programming have also gained ground in routine clinical practice.
Twin studies showed OSA heritability estimates of 40–83% for AHI and ODI, but discordant monozygotic twins — including the presented case — demonstrate that anatomical differences and lifestyle factors drive considerable phenotypic variability independent of shared genetics.
Frontal sinus setback in facial feminization surgery carried a 23% rate of delayed sinonasal complications, including mucocele formation and chronic rhinosinusitis, occurring months to years postoperatively; multidisciplinary ENT follow-up is warranted for these patients.
In-office laser marsupialization of vocal fold mucous retention cysts showed durable voice improvement (mean VHI-10 reduced from 21 to 5.5) over mean 19-month follow-up, with mucosal pliability preserved in most patients but one recurrence requiring formal microlaryngeal surgery.
Intraoperative micro-PET/CT in a supraglottic SCC patient who achieved pathologic complete response after neoadjuvant pembrolizumab showed residual tracer uptake at the primary site comparable to the tracheostomy site, suggesting tumour avidity alone may not distinguish responders intraoperatively.
Valganciclovir started after the neonatal period reduced cCMV viral load and normalised or improved hearing in approximately 80% of affected ears, with serious neutropenia (grade 3–4) in only 3.67% of patients, though high heterogeneity and small study numbers limit conclusions.
In an 82-year-old with an incidentally found Glasscock-Jackson type I glomus tympanicum, watchful waiting produced no tumor growth and no new symptoms over 5 years. Conservative surveillance is a reasonable strategy for small, asymptomatic lesions in older patients.
GIC-based incudostapedial rebridging ossiculoplasty achieved a mean ABG reduction of 16.5 dB at 1–3 years, with 77% of patients reaching ABG <20 dB and 53% reaching <10 dB across 749 patients in 24 studies.
Antidepressants reduced dizziness and psychiatric symptoms in 55–84% of PPPD patients across 13 studies, but up to 25% could not tolerate treatment and evidence remains limited to low-quality, heterogeneous trials without placebo controls.
LPR patients showed a consistent pattern of raised UES pressures, reduced LES pressures, and ineffective esophageal motility with impaired bolus clearance, though study quality was low and LPRD diagnosis was objective in only 3 of 24 studies.
PRP showed benefit over controls in 79% of ENT studies reviewed, with the strongest evidence supporting its use in tympanic membrane perforation repair and olfactory dysfunction. Substantial heterogeneity in preparation protocols and poor reporting of platelet concentrations limit clinical standardisation.
Female otolaryngologists took an average of 10–12 weeks of parental leave post-training and earned significantly less than male colleagues, with one study reporting a $35,000 salary gap attributable partly to childbearing. Most respondents across six surveys lacked adequate knowledge of their parental leave policies.
Adults with CRS show measurable cognitive deficits on both subjective and objective assessments that improved after medical therapy or endoscopic sinus surgery, with altered orbitofrontal-precuneus connectivity correlating with sinonasal inflammation. Whether CRS increases dementia risk remains contested across studies.
Airway disease in mucopolysaccharidoses is multilevel and clinically severe across subtypes, with OSA affecting 62–84%, tracheal narrowing up to 92% in MPS II, and respiratory causes accounting for 10% of deaths. Early and systematic longitudinal airway assessment is essential in all MPS subtypes.
TNF-α inhibitors were associated with new-onset or severe/fungal rhinosinusitis (often without hypogammaglobulinemia), while anti-CD20 therapy produced recurrent bacterial rhinosinusitis within a sinopulmonary phenotype driven by secondary hypogammaglobulinemia, with immunoglobulin replacement reducing infection burden in several studies.
Visual signal typing reliably identifies which dysphonic voice samples are unsuitable for conventional perturbation analysis — over half in this review — guiding clinicians toward valid acoustic measurement methods. Inter-rater reliability was acceptable for laryngeal voice (κ ≥ 0.72 with training) but lower for tracheoesophageal speech, and automated classification reached 82–96% accuracy.
RFA of the posterior nasal nerve produced greater TNSS improvement than cryoablation across all follow-up points up to one year and showed lower adverse event rates (5.3% vs 29.4%), with cryoablation associated with higher rates of headache and palatal numbness.
Tonsillectomy reduced symptomatic recurrence by 72% (RR 0.28) in adults with recurrent tonsillitis and cut sore throat episodes by 4.3 per year and absenteeism by 7 days compared with conservative care, though healthcare visit frequency was unchanged and 13% of conservatively managed patients eventually required surgery.
Photoangiolytic lasers (KTP, PDL, TruBlue) consistently improved subjective and objective voice outcomes in professional voice users with benign vocal fold lesions, with minor, temporary complications in 5–10% of cases. KTP was the most studied, and vocal fold polyps the most common lesion treated.
Probiotic supplementation significantly reduced all major allergic rhinitis symptoms and improved quality of life in adults across 68 RCTs, though effect sizes were small and immunological markers were unchanged. Multi-strain formulations and Bifidobacterium species ranked highest, supporting probiotics as a safe adjunct to standard treatment.
Xylitol-containing postoperative nasal irrigation showed no statistically significant benefit over saline on SNOT-22 scores after ESS or airway surgery, with only a modest VAS improvement that was of uncertain clinical importance. GRADE certainty was low to very low, and routine use over standard saline is not supported by current evidence.
Belting is better understood as a family of related vocal behaviours than a single technique, characterised by elevated laryngeal position, high subglottal pressure, closed quotient >50%, and first formant tuned to the second harmonic, but with marked individual variability across all acoustic, physiological, and perceptual measures. The authors recommend standardising belting research using objective terminology and auditory anchors rather than the 100+ descriptive terms currently in use.
Rapidly progressive periodontal-like bone destruction in a patient with Fanconi anemia proved to be aggressive mandibular SCC, with the diagnosis delayed 45 days due to initial misinterpretation as localised periodontal disease; the patient died within 3 months despite surgery.
No topical intranasal agent showed consistent superiority over placebo in RCTs for HHT-associated epistaxis, though bevacizumab produced the largest ESS reduction in case series (mean −3.3). Topical agents remain clinically relevant as adjuncts before systemic therapy, with adverse events limited to mild local irritation.
Prior radiotherapy (OR 3.98), fluid overload (OR 2.57), prolonged operative time (OR 2.14), and low albumin (OR 2.06) were the strongest risk factors for free flap compromise in head and neck reconstruction, which occurred in 8.2% of 30,002 flaps with a 3.9% complete failure rate.
Endoscopic transnasal optic canal decompression improved visual outcomes in 26% of traumatic optic neuropathy cases, with the greatest benefit seen when performed 3–7 days post-injury (SMD 0.45); adding steroid pulse therapy conferred no additional benefit over surgery alone.
Intracapsular tonsillectomy with adenoidectomy reduced AHI from 19.6 to 3.0 events/hour in children with severe OSA, with very low postoperative bleeding rates. The main trade-off is tonsillar regrowth and revision surgery rates of 2–15%, requiring long-term follow-up.
Coblation across 30 studies and 473 patients showed favorable outcomes and low complication rates for diverse laryngotracheal pathologies including stenosis, congenital cysts, and vascular malformations, with reintervention exceeding 20% in only 6 of 20 multi-patient studies. Outcome reporting was inconsistent, with dysphonia and dysphagia unrecorded in most studies.
Nodules form via cumulative symmetric phonotrauma causing mid-membranous collision stress and ligament stiffening, while polyps result from acute high-magnitude stress transients rupturing lamina propria microvasculature and flooding Reinke's space — a biomechanical distinction that supports voice therapy for nodules and surgical excision for polyps.
Obesity impairs upper aerodigestive function through altered respiratory mechanics, increased reflux burden, reduced esophageal clearance, and systemic inflammation, contributing to voice, swallowing, and airway pathology, with additional perioperative risks that laryngologists should account for in assessment and management.
PSG-confirmed OSA in school-aged children was associated with a moderate neurocognitive deficit versus healthy controls (Hedges' g=0.67), affecting executive function, working memory, intelligence, and phonological processing. These findings support routine neurocognitive screening and early intervention in children with OSA.
Compliance-over-time (COT) testing achieved 96.3% sensitivity for diagnosing patulous Eustachian tube, outperforming otoscopic detection of tympanic membrane respiratory movement (55%). Ipsilateral nostril deep breathing alone closely matched the full COT protocol's accuracy, offering a faster screening option.
rTMS and acoustic/nerve stimulation reduced tinnitus severity on the THI at short-term follow-up (pooled reduction –6.97 points), but effects diminished by 6 months and tDCS showed no significant benefit. Secondary outcomes including TFI, loudness, and mood scales did not improve significantly.
Research quality in dysphagia studies across multiple consistencies (2012–2024) showed poor representation of diverse racial and ethnic groups and inconsistent reporting of dysphagia severity criteria across 465 articles from 32 countries. Future studies need standardised definitions and measurement of dysphagia severity.
Type III thyroplasty reduced fundamental frequency in all 23 transmasculine patients reported across four studies, with one case of transient subcutaneous emphysema; however, the evidence base is too small and heterogeneous to support clinical recommendations on long-term effectiveness or safety.
Radiosurgery achieved 5-year tumor control of 81–85% and hearing preservation of 33–67% in NF2-related schwannomatosis VS, while microsurgery (used for larger tumors) yielded good facial nerve outcomes in 50–83% and bevacizumab produced radiographic response in roughly one-third. Treatment remains individualized, with no modality clearly superior across all outcomes.
No single monogenic cause of familial Ménière's disease was identified across nine studies reporting 29 rare variants in 17 genes from 194 families, with most variants lacking functional validation or complete segregation data. Marked genetic heterogeneity and methodological limitations mean current findings are hypothesis-generating only.
Reverberation in a virtual open-plan office (T30 = 0.5 s and 1.0 s) reduced spoken content recall and increased listening effort compared to free-field conditions, with no significant difference between the two office reverberation levels.
Adenotonsillectomy in children with sickle cell disease reduced AHI by 51–83% and significantly decreased postoperative acute chest syndrome and emergency department visits, though vaso-occlusive crises were not significantly reduced. Surgical complications occurred in 5–11% of cases, and most patients required preoperative transfusion.
Accelerator-based BNCT achieved meaningful antitumor responses in approximately 200 head and neck cancer cases treated at a single Japanese centre, with the hospital-based NeuCure® system enabling routine clinical delivery under insurance reimbursement since 2020.
A subhyoid open approach for deeply infiltrative base of tongue tumors allowed full-thickness resection while preserving lingual neurovascular structures, with thyro-hyoido-pexy restoring hyo-laryngeal suspension without flap reconstruction to maintain swallowing function.
Concurrent laryngologist-SLP clinics were associated with improved therapy initiation, better patient-reported voice outcomes, and reduced ED and primary care utilisation, though access disparities by race and geography persisted. Billing and reimbursement remained the most commonly reported barrier to implementation.
Smartphone-based pure-tone threshold (GRaBr) and categorical loudness scaling (rACALOS) tests showed good test-retest reliability at home (ICC >0.75; across-run bias <5 dB) and produced results comparable to laboratory audiometry, though frequency-specific errors of ±5 dB at 250 Hz and 4 kHz and wide loudness variability warrant caution before clinical adoption.
No single objective biomarker currently supports stand-alone tinnitus diagnosis. Cognitive-behavioural markers (attention-modulated cortical responses) showed the strongest association with tinnitus burden, while molecular markers such as metabolomics showed early promise but lack replication.
Pseudoprogression after immune checkpoint inhibitor therapy is uncommon in HNSCC but carries outsized risk when lesions involve the larynx, hypopharynx, carotid, or skull base; these sites should be managed as true progression until proven otherwise. Clinically stable patients with low-risk anatomy can continue immunotherapy with short-interval reassessment using an HNSCC-modified iRECIST framework.
GLP-1 receptor agonists (liraglutide and tirzepatide) reduced AHI by 12.4 events/hour more than controls across five RCTs, independent of CPAP use, alongside significant weight loss and blood pressure reductions, though gastrointestinal side effects were more common.
Adenotonsillectomy has lower cure rates in obese children with OSA due to multilevel obstruction, and multidisciplinary management targeting weight reduction improved treatment outcomes.
Sinonasal inflammatory pseudotumour extending into the lacrimal system can mimic malignancy; intraoperative frozen section guided surgical extent, and MDT collaboration with oculoplastics achieved clearance while limiting morbidity.
In-office tympanostomy tube placement in awake children achieved a 97% procedural success rate with mild discomfort (mean FLACC score 1.26) and 95% parental satisfaction, with adverse events comparable to OR-based insertion under general anesthesia.
Isolated adenoidectomy reduced AHI by 11.3 events/hour and achieved symptomatic improvement in 75% of children with sleep-disordered breathing, though 17% required further surgery; children over 3 years showed better outcomes and lower reoperation rates.
Structural proteins (otolin-1, otoconin-90), regulatory peptides (aquaporin-2, vasopressin), and inflammatory cytokines (TNF-α, IL-6) showed promise as diagnostic and pathophysiologic biomarkers in Meniere's disease, but methodological variability across 21 studies prevents clinical application until standardised validation is completed.
Structural racism contributed to worse head and neck cancer outcomes in racial and ethnic minorities through neighborhood disadvantage, socioeconomic deprivation, and insurance gaps, with Black patients disproportionately affected by insurance status on survival and Native Hawaiian/Pacific Islander patients more likely to present with advanced-stage disease.
In a single-participant case report, wildfire smoke exposure (PM2.5 up to 117 µg/m³) reduced speaking fundamental frequency, increased laryngeal mucus on endoscopy, and doubled MMP-1 expression in ventricular fold biopsies compared to clean-air baseline.
PRP injection for vocal fold disorders (atrophy, sulcus, scarring) reduced VHI-10 scores by 8 points and achieved an 80% clinical improvement rate across 350 patients, with no serious adverse events. Evidence is limited by small heterogeneous case series and only two RCTs, so routine adoption is premature.
Microdebrider-assisted turbinoplasty showed the best overall outcomes for chronic rhinitis but carried higher mucosal tearing risk; RFVTR offered shortest operative time with least nasal dryness. SMD and laser ablation showed inferior efficacy and higher adverse effect rates, including revision surgery and atrophic rhinitis respectively.
Endoscopic management of complete tracheal rings was described as a feasible alternative to open surgery, allowing direct visualisation and treatment of the stenotic segment. The technique avoided external incisions while maintaining airway patency in affected patients.
ACDF was associated with new-onset and worsened pre-existing OSA, with affected patients showing higher rates of post-operative respiratory complications, mechanical ventilation need, and longer hospital stays. Evidence on perioperative OSA screening and PAP therapy use remains sparse.
DISE in infants under 12 months with OSA most commonly revealed supraglottic and retrolingual multilevel obstruction, with supraglottoplasty and adenotonsillectomy the most frequent interventions; postoperative AHI improved from ~10.6 to ~3 events/hour across eight small retrospective series with no major DISE-related complications reported.
Bilateral cricoarytenoid arthritis caused acute airway obstruction in a young woman with severe untreated rheumatoid arthritis, requiring emergent airway management. RA should be considered in the differential for unexplained stridor or upper airway obstruction.
Infected aryepiglottic cyst caused persistent sore throat in an adult, with diagnosis confirmed on laryngoscopy and resolved following surgical excision.
Gouty tophus presented as a bulbous nasal tip mass and was successfully excised, confirming gout as a rare differential diagnosis for nasal tip enlargement. Serum uric acid measurement aided diagnosis when rhinophyma and other soft-tissue lesions were suspected.
Nasal saline irrigation significantly reduced nasal symptom scores (SMD -1.29) and rescue antihistamine use (SMD -1.38) in children with allergic rhinitis, with only minor adverse effects, though evidence certainty was low to very low across outcomes.
Riedel's thyroiditis caused thyroid cartilage destruction and laryngeal invasion in a 46-year-old man, mimicking malignancy on imaging. RT should be included in the differential for laryngeal masses with cartilage erosion, confirmed by IgG4 immunohistochemistry when storiform fibrosis is absent.
Low-dose BoNT-A (3 units) administered with a strict risk management protocol produced sustained improvement in synkinesis and facial tightness in a myasthenia gravis patient without systemic exacerbation or respiratory compromise at 2 months.
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