A medical student-run newsletter showcasing the latest research in otolaryngology
Issue #101
10 December 2025
Educational Pearl
Thyroid Cancer
Overview: Thyroid cancer arises from thyroid parenchymal cells, most commonly the follicular cells. Differentiated thyroid cancers (DTCs), including papillary (PTC), follicular (FTC), and Hürthle cell types, account for 90-95% of cases and range in behavior from indolent to aggressive. Medullary thyroid cancer (MTC) arises from parafollicular (C) cells and represents approximately 1-2% of cases. Anaplastic thyroid cancer (ATC) is rare at < 1% and highly aggressive.
Epidemiology:
Represents approximately 1-4% of all malignancies
Fifth most common cancer in United States females
Higher detection rates in women, with a 3:1 female predominance
Autopsy studies suggest true incidence may be similar between genders
PTC incidence has increased by nearly 240% in the past 3 decades because of wider use of diagnostic imaging
Risk Factor: Family history, prior head or neck radiation exposure, systemic symptoms (weight loss, fatigue)
Etiology:
MAPK signaling pathway alterations are central to thyroid carcinogenesis
Common Mutations:
PTC: BRAF point mutation
FTC: RAS proto oncogene mutation
ATC: TP53 tumor suppressor inactivation
MTC: Germline RET proto oncogene mutation
Clinical Features:
Most Common DTC Presentations:
Painless neck swelling
Incidental thyroid nodule found on imaging in an asymptomatic patient
Features Suggestive of Malignancy:
Sudden increase in nodule size
Compressive symptoms (hoarseness, dysphagia, dyspnea)
Diagnosis:
Initial Evaluation For Any Thyroid Nodule:
Obtain thyroid function tests (TSH, T3/T4 levels) and thyroid ultrasound (US)
Hyperthyroid Nodules (low TSH with high T3/T4):
Usually benign
Perform radionuclide uptake scan (avoid fine-needle aspiration [FNA] since cytology is unreliable)
Euthyroid or Hypothyroid Nodules (normal or high TSH with low T4):
Perform high resolution thyroid US
FNA: Gold standard for thyroid cancer diagnosis
Indications: Nodule ≥ 1 cm, high risk US features (irregular margins, hypoechoic, taller than wide shape, microcalcifications, central vascularity), high risk clinical features (rapid growth, pain, hoarseness)
Management:
Surgical resection is the gold standard treatment for PTC and FTC
Lobectomy preferred for unilateral tumors < 1 cm without nodal disease
Total thyroidectomy preferred for tumors > 4 cm or for invasive disease
Radioiodine ablation and thyroid hormone suppression are used when indicated
Advanced or refractory disease may require systemic therapy
Prognosis is excellent (> 95% five-year survival)
Poor outcomes occur with large, invasive, metastatic, anaplastic tumors
Further Readings:
[1] StatPearls - Thyroid Cancer
[2] American Thyroid Association - Guidelines + Statements
Educational Pearl written by Wid Alhassani
Morsani College of Medicine
Question of the Week
A 34-year-old man presents with several months of progressively worsening hoarseness and intermittent shortness of breath. He works as a customer service representative and notes that his voice becomes weak and “cuts out” during routine conversations. He also reports noticeable vocal fatigue by the end of most workdays. He denies any recent upper respiratory infections, tobacco or heavy alcohol use, prior intubation, or history of head or neck surgery. He is sexually active with multiple partners and reports inconsistent condom use.
On physical examination, the patient’s voice is breathy and strained. There is no audible stridor at rest, and oral cavity and oropharyngeal examinations are normal. Flexible fiberoptic laryngoscopy reveals numerous discrete, wart-like lesions with pale pink surfaces on both true vocal folds and the anterior commissure. The lesions vary modestly in size but appear similar in overall appearance, and their bulk reduces glottic airway patency. He subsequently undergoes direct microlaryngoscopy with excision of a representative lesion, with histopathology showing squamous papillomas with fibrovascular cores.
Which of the following is the most likely etiologic agent responsible for this patient’s condition?
(A) Epstein-Barr virus
(B) Human papillomavirus types 6 or 11
(C) Human papillomavirus types 16 or 18
(D) Cytomegalovirus
(E) Herpes simplex virus type 1
Question of the Week written by Adriana Báez Berríos
Icahn School of Medicine at Mount Sinai
Looking for the answer to this Question of the Week? · · · · · · · · · · · · · · · · · · · · · · Find it at the bottom of this newsletter!
Our national otolaryngology faculty reviewers have been instrumental in ensuring that we continue to share high-quality content. We thank them for their monthly contributions to The Auricle.
Facial Plastic and Reconstructive Surgery
Dr. Scott Owen, MD
University of Iowa Hospitals and Clinics
Head and Neck Surgery
Dr. Katelyn Stepan, MD
Feinberg School of Medicine at Northwestern University
Laryngology
Dr. Ronda Alexander, MD
Montefiore Medical Center
Otology and Neurotology
Dr. Angela Peng, MD
Baylor College of Medicine
Rhinology and Skull Base Surgery
Dr. Christina Fang, MD
Montefiore Medical Center
Med Student Feature Series
The Auricle proudly spotlights med student-led research published in top otolaryngology journals through our Med Student Feature Series. Here we celebrate future otolaryngologists and the evidence-based discoveries they made during medical school.
Carcinoma ex Pleomorphic Adenoma: Multi-Institutional Study
Kassalow B, Prince A, Bullock M, et al. Carcinoma ex Pleomorphic Adenoma: Multi-Institutional Retrospective Cohort Study. OTO Open. 2025;9(3):e70147. [Article Link]
Carcinoma ex pleomorphic adenoma (CXPA) is a rare, aggressive malignancy arising from long-standing benign salivary gland tumors. Despite recognition of CXPA for several decades, its prognosis and predictive factors remain poorly understood. This retrospective cohort study examined 37 surgically treated adult CXPA patients (28/37, 75.7% males; mean age 63 years) from two institutions, with most primary tumors located in the parotid gland (27/37, 73.0%) followed by the parapharyngeal space (7/37, 18.9%). Five-year overall survival was 61.7%, and five-year locoregional recurrence-free survival was 75.0%. In multivariable analyses, only pathologic nodal stage of 1 or greater independently predicted lower overall survival (hazard ratio 9.47, 95% confidence interval 1.2 to 75.4; p = 0.034). The authors concluded that survival in CXPA remains limited and that the presence of neck metastasis is a key indicator of poor outcomes.
Med Student Feature Summary written by Sue Li
Texas Tech University School of Medicine
Bryce Kassalow
University of Michigan Medical School, Class of 2027
Are you a medical student with a recent first-author publication?
Email theauricleotolaryngology@gmail.com to be featured!
Facial Plastic and Reconstructive Surgery
Facial Palsy and Reanimation Surgery on Emotion Recognition
Hervochon R, Dupuch G, Chaumon M, et al. Impact of Facial Palsy and Reanimation Surgery on Emotion Recognition: A Magnetoencephalography Study of Early Face Processing: The M170 Component. Facial Plast Surg Aesthet Med. 2025;27(5):439-446. [Article Link]
Facial palsy has been shown to impair emotional expression and emotion recognition through disrupted sensorimotor feedback, but the neural mechanisms underlying these deficits remain poorly understood. In this cross-sectional observational study, magnetoencephalography was used to measure the M170, an early face-processing signal that peaks approximately 170 ms after viewing a face, to assess whether facial reanimation restores cortical emotion processing. The cohort included 10 controls (33.3%), 5 untreated facial palsy patients (16.7%), 15 post-reanimation patients (50.0%), and 4 temporalis muscle transfer patients (13.3%). Participants viewed emotional facial expressions while M170 latency (processing speed) and amplitude (signal strength) were recorded. The authors found no significant differences in M170 latency or amplitude between untreated facial palsy patients and controls (p = 0.061), suggesting that early cortical processing of emotional processes is not impaired by facial palsy alone. In contrast, patients who underwent hypoglossal-facial nerve transfer exhibited significantly shorter latency (p = 0.02) and reduced amplitude (p = 0.04) compared with untreated facial palsy patients. These findings indicate that hypoglossal-facial nerve transfer may partially normalize early cortical face-processing responses, reflecting adaptive neuroplasticity and suggesting that facial reanimation can meaningfully influence the brain’s processing of emotional facial expressions.
Facial Plastic and Reconstructive Surgery Summary written by Nicole Reynoso
University of California, San Francisco School of Medicine
Head and Neck Surgery
Elective Neck Dissection for Early-Stage Oral Cavity Tumors
Calabrese L, Abousiam M, Tagliabue M, et al. When Should Elective Neck Dissection be Considered for Early-Stage Oral Cavity Tumors? Insights From a Multicenter Study of 1109 Patients and Development of a Multiparametric Predictive Model. Head Neck. Published online October 13, 2025. [Article Link]
To dissect or not to dissect? That is the question
Nodal metastases are associated with worse survival in oral cavity squamous cell carcinoma (OCSCC), yet the optimal management of a clinically negative neck (cN0) in early-stage disease remains undefined. Depth of invasion (DOI) has traditionally guided decisions regarding whether to perform elective neck dissection (END) in these early-stage cases, however, the lack of standardized DOI cutoffs and the possibility that additional factors could improve risk prediction make this decision challenging. In this multicenter retrospective study of 1109 cT1 to T2 cN0 OCSCC patients (median age at diagnosis 65 years, interquartile range 55 to 74 years) treated across 30 institutions, the investigators evaluated DOI, lymphovascular invasion (LVI), perineural invasion (PNI), tumor grade, and worst pattern of invasion (WPOI) as predictors of occult lymph node metastases. Among 683 patients (61.6%) who underwent END, 193 (28.3%) had occult nodal metastases, and 27 (4.0%) of these cases exhibited extranodal extension. Univariate logistic regressions identified pathological DOI (odds ratio [OR] = 1.3 per mm, 95% confidence interval [CI] 1.2 to 1.3), LVI (OR = 6.9, 95% CI 4.5 to 10.7), PNI (OR = 5.1, 95% CI 3.6 to 7.2), tumor grade 2 (OR = 3.6, 95% CI 2.2 to 6.0), tumor grade 3 (OR = 8.6, 95% CI 5.0 to 15.4), and high WPOI risk (OR = 4.9, 95% CI 3.0 to 8.1) as significant predictors of metastasis (p < 0.001 for all variables). Given these findings, a multivariable predictive model incorporating DOI, LVI, PNI, and tumor grade was developed and significantly outperformed a standard DOI-only model (area under the curve 0.81 vs. 0.77; p < 0.01). By incorporating multiple histopathologic parameters, the novel predictive model developed in this study offers an individualized, evidence-based approach to selecting patients for END in early OCSCC.
Josh Sorrentino’s Takeaway: What stood out to me in this article was not only the novel findings, but also how much predictive value may still be gained by considering additional histopathologic factors. Given that WPOI, a strong indicator of OCSCC aggressiveness, was excluded from this study’s predictive model due to limited data, standardizing pathology reports could substantially improve risk estimation and enable more personalized surgical and reconstructive planning in head and neck cancer care.
Head and Neck Surgery Summary written by Josh Sorrentino
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
Laryngology
Partial Versus Whole Radiotherapy for Laryngeal Carcinoma
Treechairusame T, Dee EC, Cao C, et al. Partial vs Whole Laryngeal Radiotherapy for Clinical Stage T1-2N0M0/Tis Laryngeal Carcinoma. JAMA Otolaryngol Head Neck Surg. 2025;151(11):1071-1079. [Article Link]
Reducing radiation toxicity in laryngeal cancer-a tough pill to swallow
Whole laryngeal radiotherapy (WLRT) is a standard treatment for early stage or in situ laryngeal carcinoma with no evidence of metastasis (T1-2N0M0/Tis). Partial laryngeal radiotherapy (PLRT) reduces radiation to surrounding structures and may lessen toxicity, but clinical outcomes data remain limited. This single-institution retrospective cohort study evaluated outcomes in 233 patients with T1 to T2 or in situ laryngeal carcinoma treated with WLRT (N = 176, 75.5%) or PLRT (N = 57, 24.5%) and assessed three years after treatment completion for regional control, laryngectomy-free survival, metastasis-free survival, and overall survival. The authors found no clinical differences in regional control (rate difference -5.4%, 95% confidence interval [CI] -13.5% to 6.9%), laryngectomy-free survival (rate difference -0.8%, 95% CI -9.1% to 7.5%), metastasis-free survival (rate difference 2.4%, 95% CI -0.3% to 4.9%), or overall survival (rate difference 2.5%, 95% CI -6.8% to 12.8%) between treatment groups. T2 tumors behaved differently from carcinoma in situ and T1 tumors based on three-year locoregional control (rate difference 18.4%, 95% CI -5.8% to 21.3%). PLRT was associated with less acute dysphagia (rate difference 18.9%, 95% CI 6.9% to 30.9%). Although PLRT may reduce acute toxicity without compromising short-term control, primary surgical therapy still achieves excellent outcomes and should remain a therapeutic option when complete endoscopic exposure is achievable with low to moderate anesthetic risk.
Laryngology Summary written by Gabriella Adams
Eastern Virginia Medical School
Otology and Neurotology
Factors Associated With Dizziness in Vestibular Schwannoma
Wilson T, Kallogjeri D, Sinks B, et al. Factors Associated With Dizziness Among Patients With Vestibular Schwannoma. JAMA Otolaryngol Head Neck Surg. 2025;151(11):1057-1062. [Article Link]
Surgical resection of vestibular schwannomas is generally successful, yet factors contributing to long-term symptoms such as vertigo and dizziness remain poorly understood. In this retrospective cohort study, 109 patients with unilateral vestibular schwannoma and pre-treatment vestibular testing completed Dizziness Handicap Inventory (DHI) surveys and Generalized Anxiety Disorder-7 (GAD-7) scales. Univariate analysis showed that each 1 point increase in GAD-7 score corresponded to a 2.6 point increase in DHI score (95% confidence interval [CI] 2.0 to 3.3), and that patients with headache had significantly higher DHI scores than those without headache (β = 20.8, 95% CI 4.9 to 36.8). In multivariate linear regression, GAD-7 scores were associated with DHI (standardized β = 0.463) as well as with a history of anxiety (standardized β = 0.204). Patients with a history of anxiety had higher average DHI scores than those without (adjusted β = 10.6, 95% CI 2.4 to 18.7). Prior research demonstrates the complex psychosocial factors affecting patients with vestibular system disorders, and this study reinforces this relationship in individuals with vestibular schwannoma. The findings presented here support the need for larger studies incorporating anxiety measures and encourage clinicians to assess comorbid anxiety in this population.
Otology and Neurotology Summary written by Emily Chestnut
Indiana University School of Medicine
Rhinology and Skull Base Surgery
Characterization of Self-Administered Olfactory Assessments
Saak TM, Zhang R, Spence MDA, Devanand DP, Motter JN, Overdevest JB. Characterization of Self-Administered Olfactory Assessments Novel Olfactory Sorting Task (NOST) and Odor Dilution Sorting (ODS) in a Community-Based Population. Laryngoscope. Published online October 8, 2025. [Article Link]
Is the future of smell testing at home?
Olfactory dysfunction can present as an early symptom of neurodegenerative disorders, driving interest in simple, well-tolerated, self-administered olfaction assessments beyond traditional clinical testing. This prospective observational study of 70 community-based individuals with a median age of 27 years (interquartile range [IQR] 25 to 40) sought to characterize the performance of the Novel Olfactory Sorting Task (NOST), which evaluates odor matching, and the Odor Dilution Sorting (ODS) task, which evaluates odor intensity sorting, against the validated Sniffin' Sticks Threshold, Discrimination, and Identification (TDI) test. NOST scores strongly correlated with overall TDI scores (r = 0.640, 95% confidence interval [CI] 0.47 to 0.76; p < 0.001), with the strongest association occurring with the discrimination subdomain (r = 0.556, 95% CI 0.36 to 0.70; p < 0.001). In addition, NOST demonstrated 81% sensitivity and 73% specificity for distinguishing olfactory dysfunction from normosmia using the 5.5 cutoff originally reported for severe hyposmia, and study participants achieved a median NOST score of 6.0 (IQR 4.0 to 9.0). Participants achieved a median total ODS score of 0.8 (IQR 0.7 to 0.9), with a median eugenol score of 0.9 (IQR 0.8 to 1.0) and a median phenyl ethyl alcohol score of 0.7 (IQR 0.5 to 0.8; p < 0.001 between trials). ODS scores did not significantly correlate with TDI (r = 0.096; p = 0.4) or its threshold (p = 0.5), discrimination (p = 0.18), or identification (p = 0.2) subdomains, and ODS showed limited ability to differentiate normosmia from hyposmia with a sensitivity of 65% and specificity of 56% at the 0.75 cutoff. These findings indicate that NOST is a well-tolerated and informative self-administered assessment that may complement traditional olfactory and cognitive evaluation, while ODS may have limited utility for stratifying olfactory status in primarily normosmic young adults.
Rhinology and Skull Base Surgery Summary written by Anuhya Kanchibhatla
Case Western Reserve University School of Medicine
Question of the Week
Answer Reveal and Explanation
Correct Answer: (B) Human papillomavirus types 6 or 11
Answer Explanation: This patient’s presentation is consistent with adult-onset recurrent respiratory papillomatosis (AoRRP), which is characterized by progressive hoarseness, exertional dyspnea, and wart-like lesions on the vocal folds. Histopathology demonstrating squamous papillomas with fibrovascular cores confirms the diagnosis. AoRRP is caused by infection with human papillomavirus (HPV) types 6 or 11, making answer choice (B) correct. These low-risk HPV strains lead to benign epithelial proliferation of the larynx and upper airway. Transmission in adults is typically through sexual contact.
Answer choice (A), Epstein-Barr virus (EBV), is incorrect because EBV is not associated with benign exophytic laryngeal lesions but is primarily associated with nasopharyngeal carcinoma and certain lymphoid malignancies. Answer choice (C), HPV types 16 or 18, are high-risk oncogenic strains associated with oropharyngeal squamous cell carcinoma, cervical cancer, and other anogenital cancers. Infection with these strains does not cause benign papillomas of the larynx. Cytomegalovirus (CMV), answer choice (D), typically causes ulcerative mucosal lesions or inflammation, particularly in immunocompromised patients, and is not associated with the development of wart-like exophytic laryngeal lesions. Infection with herpes simplex virus type 1, answer choice (E), causes production of painful vesicles and ulcers of the oral cavity, lips, and upper aerodigestive tract, not benign squamous papillomas of the larynx.
Source:
[1] Fortes HR, von Ranke FM, Escuissato DL, et al. Recurrent respiratory papillomatosis: A state-of-the-art review. Respir Med. 2017;126:116-121. [Article Link]
Question of the Week Answer written by Adriana Báez Berríos
Icahn School of Medicine at Mount Sinai
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