Question of the Week

A 6-year-old girl is brought to clinic for a painless midline neck mass that her parents first noticed several months ago. The mass has gradually increased in size. She has no fever, dysphagia, or respiratory distress. On examination, there is a 2-cm, smooth, cystic mass located just inferior to the hyoid bone in the midline. The mass elevates with tongue protrusion and swallowing. There is no overlying erythema or tenderness.

Which of the following is the most appropriate next step in management?

(A) Fine-needle aspiration biopsy
(B) Oral antibiotics
(C) Surgical excision with Sistrunk procedure
(D) Simple cyst excision without removal of surrounding structures
(E) Radioactive iodine ablation

Question of the Week written by Adriana Báez Berríos
Icahn School of Medicine at Mount Sinai
 

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Med Student Feature Series

Our “Med Student Feature Series” spotlights recently published medical student-led research in top otolaryngology journals.

Join us as we celebrate evidence-based discoveries made by aspiring otolaryngologists during medical school.

C. diff Risk With Post-Tonsillectomy Antibiotics

Gawel EM, Varavenkataraman G, Reardon L, Akella DS, Favre NM, Carr MM. Clostridioides difficile Infection Risk in Children Prescribed Antibiotics for Tonsillectomy. Otolaryngol Head Neck Surg. Published online October 31, 2025. [Article Link]

Stewardship matters

Although the Tonsillectomy Clinical Practice Guidelines from the American Academy of Otolaryngology-Head and Neck Surgery strongly recommend against routine antibiotic prophylaxis for uncomplicated pediatric tonsillectomy, adherence remains variable in practice. Antibiotic exposure is a known, modifiable risk factor for Clostridioides difficile infection (CDI), which is associated with significant morbidity in children. However, the risk of CDI in otherwise healthy pediatric patients undergoing elective surgery remains unknown. This multi-institutional, propensity-matched retrospective cohort study used the TriNetX United States Collaborative Network to compare the 90-day incidence of CDI in pediatric patients undergoing tonsillectomy with (N = 58,722) and without (N = 58,722) perioperative antibiotic exposure within seven days of surgery. Although the overall risk of CDI was low in both groups (antibiotics: N = 42, 0.05%; none: N = 10, 0.02%), children who received perioperative antibiotics had a fourfold increased risk of developing CDI (risk ratio = 4.2, 95% confidence interval 2.1 to 8.4; p < 0.001). Amoxicillin was the most frequently prescribed antibiotic (N = 37,217, 63.4%), followed by cefazolin (N = 10,226, 17.4%), ampicillin (N = 6,716, 11.4%), and clindamycin (N = 4,995, 8.5%). These findings suggest that perioperative antibiotic use in otherwise healthy children undergoing tonsillectomy is associated with a significantly increased risk of CDI without clear benefit, reinforcing guideline recommendations and highlighting an important opportunity for antimicrobial stewardship in otolaryngology.

Med Student Feature Series Summary written by Thuyduong (Michelle) Nguyen
Edward Via College of Osteopathic Medicine - Virginia
 

Facial Plastics & Reconstruction

Rhinoplasty Complications by Cartilage Graft Source

Upton MK, Ortiz A, Neal E, et al. Complications in Functional Rhinoplasty Related to Cartilage Graft Source. Facial Plast Surg Aesthet Med. 2025;27(6):551-557. [Article Link]

Autologous cartilage grafts have traditionally been used for structural support in functional rhinoplasty, though fresh frozen cadaveric rib (FFCR) allografts have emerged as a potentially successful alternative graft option. In this retrospective cohort study at a single tertiary care medical center, the authors compared the use of autologous cartilage versus FFCR on postoperative complications in 259 patients (mean age 43.1 years; females: N = 185, 71.4%; males: N = 75, 28.6%) who underwent functional rhinoplasty from November 2017 to January 2022 with six months of follow-up. Outcomes included need for revision rhinoplasty, postoperative infection requiring oral antibiotics, and subjective sensation of persistent nasal obstruction symptoms documented in a postoperative visit note. Among the 5.8% of patients (N = 15) that required revision rhinoplasty, there was a significant association between the use of FFCR with revision rhinoplasty compared to the use of autologous grafts (autologous group: 8/201, 4.0%; FFCR group: 7/58, 12.1%; odds ratio = 4.0, 95% confidence interval 0.17 to 2.61; p = 0.024). Overall, 12 patients (4.6%) developed postoperative infection (autologous group: 7/201, 3.5%; FFCR group: 5/58, 8.6%; p = 0.101) and 17 patients (6.6%) had persistent nasal obstruction (autologous group: 11/201, 5.5%; FFCR group: 6/58, 10.3%; p = 0.187), with no significant differences in these outcomes between the use of FFCR and autologous grafts. This study provides evidence that FFCR can be a suitable graft choice in patients with limited options for autologous grafts, particularly elderly patients, despite increased rates of revision rhinoplasty with use of FFCR.

Facial Plastics & Reconstruction Summary written by Cara Buckley
Creighton University School of Medicine


 

Head & Neck

Rehospitalization Predictors After Oncologic Surgery

Abdul-Rahman NH, Sridharan S, Spector ME, Snyderman CH. Clinical and Socioeconomic Predictors of 60-Day Rehospitalization After Oncologic Head and Neck Surgery. Otolaryngol Head Neck Surg. Published online February 6, 2026. [Article Link]

Why do one in three patients come back after head and neck surgery?

Unplanned return to the hospital after oncologic head and neck surgery remains common despite known clinical predictors. This retrospective cohort study evaluated whether neighborhood socioeconomic disadvantage, measured by the Area Deprivation Index (ADI) with higher scores indicating more deprived neighborhoods, predicts 60-day emergency department (ED) visits or readmissions. The study analyzed 1,088 patients from a prospectively maintained head and neck cancer registry from 2012 to 2024 and assigned state-level ADI using the University of Wisconsin Neighborhood Atlas. Within 60 days of discharge, 370 patients (34.0%) re-presented, including 210 (19.3%) readmissions and 162 (14.9%) ED visits. Early re-presentation within seven days was predominantly due to surgical site complications (37/39, 94.9%; p < 0.001), whereas later returns occurred at a median of 20 days versus 10 days and were more often due to nonsurgical issues. On univariate analysis, re-presentation was associated with stage IV disease (odds ratio [OR] = 1.52, 95% confidence interval [CI] 1.01 to 2.31; p = 0.044), longer primary length of stay (OR = 1.03 per day, 95% CI 1.01 to 1.05; p < 0.001), and the highest ADI quartile (OR = 1.54, 95% CI 1.03 to 2.31; p = 0.037), while multivariable analysis identified laryngeal cancer (OR = 1.60, 95% CI 1.16 to 2.21; p = 0.004) and discharge with home health or another facility (OR = 2.22, 95% CI 1.67 to 2.96; p < 0.001) as independent predictors of rehospitalization. These findings suggest that postoperative risk in head and neck cancer surgery reflects both clinical complexity and neighborhood-level socioeconomic disadvantage, supporting the incorporation of ADI into perioperative risk stratification and discharge planning within otolaryngology.

Josh Sorrentino’s Takeaway: While several predictors reached statistical significance, most odds ratios were modest, suggesting that readmission risk is multifactorial and may already be partially mitigated in contemporary perioperative care. Because the study did not stratify surgical versus nonsurgical returns by ADI, future research could clarify whether neighborhood disadvantage differentially influences the type and timing of postoperative complications in head and neck oncology.

Head & Neck Summary written by Josh Sorrentino
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo


 

Otology & Neurotology

CPA Arachnoid Cysts and Hearing Loss in Kids

Siddiqui T, Desai S, Brooks KA, et al. Investigating the Relationship Between Cerebellopontine Angle Arachnoid Cysts and Sensorineural Hearing Loss in Pediatric Patients. Otol Neurotol. 2026;47(2):251-256. [Article Link]

Cerebellopontine angle (CPA) arachnoid cysts are benign cerebrospinal fluid–filled lesions that may affect the cochleovestibular nerve, though clinical predictors of associated sensorineural hearing loss (SNHL) remain unclear. This single-institution retrospective study evaluated pediatric patients with CPA arachnoid cysts and available audiologic testing from 2009 to 2024, identifying 19 patients with 21 cysts categorized by cranial nerve (CN) VII/VIII contact or distortion (N = 11 patients, 57.9%; mean age 8.5 ± 4.9 years) versus no nerve contact (N = 8 patients, 42.1%; mean age 7.5 ± 4.0 years). Radiographic cyst characteristics and audiologic outcomes were compared between groups. Ipsilateral SNHL occurred more frequently in the study group (4/11, 36.4%) compared with controls (relative risk = 2.43, 95% confidence interval [CI] 1.09 to 6.38; p = 0.03), and study group cysts demonstrated significantly larger estimated volumes (95% CI -5.49 to -0.23; p = 0.04). Although cisternal nerve length (95% CI -6.4 to -2.3; p < 0.001), total nerve length (95% CI -6.5 to -1.0; p = 0.01), and midcisternal CN VIII distortion (95% CI -2.4 to -0.6; p < 0.01) were greater ipsilateral to the cyst, these anatomic differences did not predict SNHL. CPA arachnoid cysts contacting the cochleovestibular nerve are associated with increased risk of ipsilateral SNHL, though imaging characteristics alone poorly predict symptom development, and the authors recommend baseline audiologic evaluation with longitudinal auditory monitoring for all pediatric patients diagnosed with CPA arachnoid cysts.

Otology & Neurotology Summary written by Anders Erickson
Des Moines University College of Osteopathic Medicine


 

Pediatric Otolaryngology

Steroids for Orbital Complications of Acute Sinusitis

Wei K, Buzi A, Phung C, Yu Y, Rizzi MD, Binenbaum G. Safety and Efficacy of Systemic Corticosteroids in Children With Orbital Complications of Acute Sinusitis. Otolaryngol Head Neck Surg. 2026;174(3):833-838. [Article Link]

Stop the swell, spare the operating room

Pediatric orbital cellulitis is a serious complication of sinusitis that may require surgical drainage, and the role of adjunct systemic corticosteroids in reducing surgical intervention remains controversial. This retrospective cohort study included 222 pediatric patients (mean age 8.6 years, standard deviation = 4.5; male: N = 149, 67.1%; female: N = 73, 32.9%) admitted to a tertiary children’s hospital and compared those treated with antibiotics alone (no steroid group) to those treated with antibiotics plus systemic corticosteroids (steroid group) prior to any surgical intervention to determine whether corticosteroids reduce the need for surgery and improve clinical outcomes. Primary outcomes included orbital or sinus surgery, length of stay (LOS), readmission, vision loss, and secondary infection. The steroid group consisted of 26 children (11.7%) who more frequently presented with proptosis and orbital abscess on imaging, suggesting greater baseline disease severity. After adjusting for age, proptosis, and abscess size, corticosteroid use was independently associated with a significantly lower rate of surgical intervention (steroid: N = 5, 19.2% vs. no steroid: N = 72, 36.7%, odds ratio =  0.3, 95% confidence interval 0.1 to 0.9; p = 0.03). There was no significant difference in LOS or readmission between groups (p = 0.2 and p = 0.4, respectively), and no cases of vision loss or secondary infection occurred in either cohort. Overall, these findings suggest that adjunct systemic corticosteroids may reduce operative intervention without increasing adverse outcomes, supporting their consideration in the management of pediatric orbital cellulitis.

Pediatric Otolaryngology Summary written by Matthaeus Hendricks
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo


 

Rhinology & Skull Base Surgery

Appropriate Medical Therapy Alters CRS Biomarkers

Park AC, Gleason BN, Stein E, et al. Appropriate Medical Therapy Primarily Modifies Type 2 and Severity Biomarkers in Chronic Rhinosinusitis. Int Forum Allergy Rhinol. Published online January 29, 2026. [Article Link]

Appropriate medical treatment (AMT) is first-line therapy for chronic rhinosinusitis (CRS), yet its biologic effects remain incompletely defined. In this prospective cohort study, 51 CRS patients (CRS without nasal polyposis: 30/51, 58.8%; CRS with nasal polyposis: 21/51, 41.2%) were evaluated before and after a median of 35 days (IQR 30.5 to 43.0) of AMT. Treatment included antibiotics (42/51, 82.4%), oral steroids (34/51, 66.7%), and intranasal steroids (37/51, 72.5%). Statistical analysis grouped biomarkers into two inflammatory patterns: one reflecting overall inflammatory burden (eosinophil cation protein [ECP], macrophage inflammatory protein-1 alpha [MIP1α]) and another distinguishing type 2 (IL-5, IL-13) from type 1/3 (IFN-γ, IL-1β) inflammation. After AMT, Sino-Nasal Outcome Test-22 (SNOT-22) improved from 43 to 20 and Modified Lund-Kennedy from 6 to 2 (p < 0.001 for both). T2 and severity biomarkers declined significantly with IL-5 decreasing from 11.5 to 1.8 pg/mL (p = 0.007), IL-13 from 7.6 to 2.0 pg/mL (p = 0.007), ECP from 1,276.5 to 353.4 ng/mL (p < 0.001), and MIP1α from 11.5 to 4.9 pg/mL (p = 0.034). T1/3 biomarkers did not change significantly (IFN-γ: p = 0.629; IL-1β: p = 0.245). These findings indicate that AMT preferentially reduces T2 and severity biomarkers and improves patient-reported and clinical outcomes, while having minimal impact on T1/3 pathways. This selective response reinforces the concept that CRS inflammatory endotypes are biologically distinct, and highlights the potential role of biomarker profiling in characterizing disease activity and treatment response.

Rhinology & Skull Base Surgery Summary written by Grant Primer
Rush University Medical College


 

Basic Science Spotlight

CDK4 Inhibitors as a Target in Mucosal Melanoma

Hattori T, Fujii M, Ueda T, et al. Exploration of Therapeutic Targets Using CDK4 Inhibitors for Head and Neck Mucosal Melanoma. Otolaryngol Head Neck Surg. 2026;00(00):1-8. [Article Link]

Can breast cancer drugs treat one of the most lethal tumors in ENT?

Mucosal melanoma (MM) of the head and neck is a rare and highly aggressive malignancy with a five-year survival rate of approximately 14% and limited response to traditional targeted therapies. This study aimed to evaluate whether cyclin-dependent kinase 4 (CDK4) inhibition represents a viable molecular therapeutic target in MM through laboratory analysis and retrospective cohort study. Using two MM-derived cell lines (HMV-II and GAK), investigators performed MTT cell proliferation assays and western blotting after treatment with abemaciclib and palbociclib, and conducted immunohistochemistry on tumor specimens from 23 patients with head and neck MM. Both abemaciclib and palbociclib demonstrated concentration-dependent cytostatic effects at 72 hours and reduced phosphorylated retinoblastoma (RB) 1 expression at 24 hours, confirming inhibition of the CDK4-RB pathway in vitro. CDK4 immunostaining was positive in 18 patients (78.3%), though CDK4 status was not significantly associated with overall survival or progression-free survival. These findings suggest that while CDK4 expression itself may not be prognostic, the CDK4 signaling pathway represents a promising target and supports further exploration of CDK4 inhibitors as molecular-targeted therapies for head and neck MM.

Basic Science Spotlight Summary written by Rushi Vekariya
University of Central Florida College of Medicine

Question of the Week

Answer and Explanations

Correct Answer: (C) Surgical excision with Sistrunk procedure

Correct Answer Explanation: This patient presents with a thyroglossal duct cyst, the most common congenital neck mass in children. It arises from persistent epithelial remnants of the thyroglossal duct, an embryologic structure formed during migration of the thyroid gland from the foramen cecum at the base of the tongue to its final position in the anterior neck. Failure of complete involution of this tract results in a cystic mass along the midline, typically located near or just inferior to the hyoid bone. A key distinguishing feature is that the mass moves with tongue protrusion and swallowing due to its attachment to the foramen cecum via the persistent tract.

Answer choice (C), surgical excision with the Sistrunk procedure, is the most appropriate next step. The Sistrunk procedure involves removal of the cyst, the central portion of the hyoid bone, and the tract extending toward the base of the tongue. This approach significantly reduces recurrence rates compared to simple excision.

Incorrect Answer Explanations: Fine-needle aspiration biopsy, answer choice (A), is not routinely necessary in children with classic presentation. Oral antibiotics, answer choice (B), are indicated only if the cyst becomes infected but do not provide definitive treatment. Simple cyst excision without removal of surrounding structures, answer choice (D), has a high recurrence rate due to persistent tract remnants. Radioactive iodine ablation, answer choice (E), has no role in management because it is used in the management of differentiated thyroid carcinoma, particularly papillary or follicular thyroid cancer, after thyroidectomy to eliminate residual thyroid tissue or metastatic disease.

Source:
[1] Gallagher TQ, Hartnick CJ. Thyroglossal Duct Cyst Excision. Adv Otorhinolaryngol. 2012;73:66-69. [Article Link]

Question of the Week Answer written by Adriana Báez Berríos
Icahn School of Medicine at Mount Sinai