A medical student-run newsletter showcasing the latest cutting edge research in otolaryngology
Issue #100
30 November 2025
Educational Pearl
Laryngeal Papillomatosis
Overview: Laryngeal papillomatosis, also known as recurrent respiratory papillomatosis (RRP), is an otolaryngologic manifestation of human papillomavirus (HPV) infection characterized by papillomatous growths of the larynx that typically involve the true vocal cords. Juvenile-onset RRP (JoRRP) classically presents with the triad of dysphonia, stridor, and dyspnea, and onset in early children is often associated with more aggressive disease than adult-onset RRP (AoRRP). RRP can significantly affect a patient’s voice and breathing, and treatment remains challenging due to high recurrence rates.
Epidemiology:
HPV: most common sexually transmitted infection in the United States (US) and worldwide
RRP: most common benign laryngeal disease in both children and adults
US RRP Incidence: 4.3 per 100,000 children; 1.8 per 100,000 adults
Currently declining, likely secondary to HPV vaccine development and its widespread administration
Etiology:
Infection with HPV subtypes 6 and 11 is associated with greater risk of RRP development and worse disease severity
JoRRP Cause: vertical transmission from HPV-6/11+ mother to child
AoRRP Causes: oral sex, laser smoke, immunosuppression
Diagnosis:
Cough, dysphonia, shortness of breath, snoring, and/or dysphagia should prompt an RRP work-up
Laryngoscopy: diagnostic technique that reveals multiple pink, white, or gray exophytic, wart-like lesions
Lesions usually have a cauliflower- or grape-like appearance
Narrow-Band Imaging: diagnostic technique that highlights a papilloma’s vascular core as a soft tissue lesion surrounding blue foci
Definitive diagnosis requires lesion biopsy with HPV typing
Management:
Goals: maintain airway patency, preserve voice quality, minimize disease recurrence
Surgery: first-line treatment
CO2 Laser-Assisted Lesion Debulking: conventional approach
Possible Complications: respiratory tract burns, laryngeal scarring, tracheoesophageal fistulae, anterior commissure synechiae, glottic stenosis
Microdebridement: less damaging to tissue with greater epithelium preservation
Possible Complications: laryngeal scarring, anterior commissure synechiae
Tracheostomy: reserved for aggressive cases with impending airway compromise after multiple failed debulking surgeries
20% of RRP patients require further adjuvant therapy to control their disease
Bevacizumab: anti-VEGF monoclonal antibody, reduces angiogenesis
Cidofovir: antiviral agent, inhibits viral replication
Further Readings:
[1] StatPearls - Laryngeal Papillomas
[2] RRP - Current & Future Perspectives
Source:
[1] Laryngeal Papillomatosis Review
Educational Pearl written by Gina Spencer
Queen's University School of Medicine
Question of the Week
A full-term male neonate is born via spontaneous vaginal delivery without complications. Apgar scores are 8 and 9 at 1 and 5 minutes, respectively. Within minutes of birth, he develops tachypnea and perioral cyanosis. Pulse oximetry reveals an oxygen saturation in the mid-70s on room air. The nurse notes that his color improves with vigorous crying but worsens when quiet or attempting to feed. During bottle feeding, he experiences recurrent desaturation and brief apneic episodes. Physical examination reveals mild intercostal retractions without stridor, normal heart sounds, and no murmurs. The oral cavity appears normal. Attempts to pass a 6 French suction catheter through either naris meet resistance about 2 cm from the vestibule. After gentle oropharyngeal suctioning, oxygen saturation improves into the low 90s while the infant is crying but declines again when he becomes quiet.
Which of the following is the most appropriate next step in management?
(A) Place a McGovern (Montgomery) nipple or oral airway to bypass the nasal obstruction and plan for operative repair
(B) Proceed with endotracheal intubation and schedule emergent tracheotomy
(C) Initiate topical oxymetazoline and observe in the nursery
(D) Schedule elective endoscopic repair in two to four weeks if weight gain is adequate
(E) Initiate prone positioning with humidified oxygen and arrange outpatient follow-up
Question of the Week written by Luke Reardon
Lincoln Memorial University DeBusk College of Osteopathic Medicine
Looking for the Question of the Week answer?
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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 / Basic Science Spotlight
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
Sleep Surgery
Dr. Kevin Motz, MD
Johns Hopkins Medicine
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.
Autoimmune and Respiratory Diseases in Children
Sorrentino JM, Boire S, Varavenkataraman G, Patel V, Carr M. The Relationship Between Autoimmune Disease and Respiratory Diseases in a Pediatric Population. Int J Pediatr Otorhinolaryngol. 2025;195:112385. [Article Link]
Autoimmune disease nose no bounds
Autoimmune diseases (ADs) are believed to share inflammatory pathways with chronic respiratory conditions, suggesting that autoimmune dysregulation may predispose pediatric patients to diseases such as acute rhinosinusitis (ARS), chronic rhinosinusitis (CRS), rhinitis, and asthma. This retrospective study used the TriNetX United States Collaborative Network to investigate this relationship using two cohorts consisting of 166,135 children each, aged 2 to 17 years, with and without various ADs, matched by age, race, and ethnicity. Children with a diagnosed AD were more likely to develop ARS (odds ratio [OR] = 1.75; p < 0.001), CRS (OR = 2.09; p < 0.001), rhinitis (OR = 1.86; p < 0.001), and asthma (OR = 1.86; p < 0.001). A reverse analysis showed that children with an established CRS diagnosis were more likely to have necrotizing vasculopathies (OR = 3.93, 95% confidence interval [CI] 2.83 to 5.48; p < 0.001), rheumatoid arthritis (OR = 3.34, 95% CI 2.39 to 4.65; p < 0.001), systemic lupus erythematosus (OR = 3.28, 95% CI 2.21 to 4.88; p < 0.001), connective tissue diseases (OR = 2.92, 95% CI 2.63 to 3.26; p < 0.001), and psoriasis (OR = 2.52, 95% CI 2.22 to 2.87; p < 0.001), while those with ARS were more likely to have rheumatoid arthritis (OR = 2.43, 95% CI 1.86 to 3.17; p < 0.001), psoriasis (OR = 2.26, 95% CI 2.05 to 2.49; p < 0.001), and systemic lupus erythematosus (OR = 2.18, 95% CI 1.59 to 2.99; p < 0.001). These findings demonstrate a strong association between pediatric autoimmune and inflammatory airway diseases and suggest a potential bidirectional relationship between immune dysregulation and chronic airway inflammation. Future studies should explore temporal and mechanistic links between ADs and respiratory disease development to inform earlier intervention and treatment.
Med Student Feature Summary written by Thuyduong (Michelle) Nguyen
Edward Via College of Osteopathic Medicine - Virginia
Joshua Sorrentino
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo,
Class of 2026
Are you a medical student with a recent first-author publication?
Email theauricleotolaryngology@gmail.com to be featured!
Facial Plastic and Reconstructive Surgery
Outcomes of Hypoglossal-Facial Nerve Transfer
Mato-Patino T, Morales-Puebla JM, Sánchez-Cuadrado I, et al. Prognostic Factors of Facial and Tongue Functional Outcomes Following Side-to-End Hypoglossal-Facial Nerve Transfer: A 20-Year Multidisciplinary Experience. Facial Plast Surg Aesthet Med. 2025;27(5):423-430. [Article Link]
Surgeons have increasingly adopted the side-to-end hypoglossal-facial nerve transfer (HFT) technique to preserve tongue function without compromising facial reanimation outcomes, but predictors of success remain insufficiently defined. This single-institution retrospective study reviewed demographic, clinical, and operative data from 64 patients who underwent side-to-end HFT between January 2005 and April 2025. Functional outcomes were evaluated pre- and postoperatively using the House-Brackmann (HB) scale, Sunnybrook Facial Grading System, electronic facial paralysis assessment (eFACE), Martin’s scale, and the Oral and Pharyngeal Disability Index (OPDI), with multivariate regression identifying independent predictors. Postoperatively, the mean eFACE score across all patients was 80 (normal function = 100), with 61 patients (95.3%) achieving an HB grade of III-IV. Tongue morbidity was minimal, with a mean OPDI score of 79.3 (normal function = 100) across all patients and 63 patients (98.4%) demonstrating preserved function on Martin’s scale. Older age predicted worse facial and tongue outcomes, including lower eFACE (linear coefficient [β] = -0.30; p < 0.01) and OPDI scores (β = -0.37; p < 0.01), and delayed initial recovery was associated with poorer facial outcomes (β = -0.32; p < 0.01). These findings demonstrate that side-to-end HFT can result in successful facial reanimation with minimal donor morbidity, albeit with limitations related to patient age and delayed recovery timelines.
Facial Plastic and Reconstructive Surgery Summary written by Brooke Swain
Vanderbilt University School of Medicine
Head and Neck Surgery
Ultrasound-Guided Sampling of Neck Lesions
Satani AA, Kim J, Flood TF, et al. Percutaneous Ultrasound-Guided Biopsy for Sampling Neck Lesions. JAMA Otolaryngol Head Neck Surg. Published online September 18, 2025. [Article Link]
Ultrasound-guided diagnosis: Precision without excision
Neck lesions are frequently encountered by otolaryngologists, and while ultrasound-guided core-needle biopsy (CNB) and fine-needle aspiration (FNA) are less invasive biopsy techniques than surgical excision, their utility for evaluating suspected lymphoma is not well defined. This prospective cohort study analyzed 158 consecutive ultrasound-guided neck biopsies in adults (mean age 60.0 ± 16.5 years) performed between June 1 and August 31, 2024, at a quaternary care academic medical center to determine whether percutaneous CNB and FNA provide diagnostic sufficiency comparable to excisional biopsy for neck lesions, including lymphoma. The primary outcome was lymphoma-specific diagnostic yield, with secondary outcomes including overall diagnostic yield, complication rates, need for subsequent excisional biopsy, and yield differences by biopsy type, site, and operator. The overall diagnostic yield was 94.3% (149/158), with a yield of 97.4% (74/76) for cases in which lymphoma was a prebiopsy consideration. CNB outperformed FNA (91/93, 97.9% vs. 52/59, 88.5%; difference = 9.4 percentage points; 95% confidence interval [CI] -0.4 to 19.2), and lymph node biopsies had higher yield than salivary gland lesions (99/101, 98.0% vs. 44/50, 88.0%; difference = 10.0 percentage points; 95% CI -0.8 to 20.9). Only two patients (1.3%) required subsequent excisional biopsy, and no major immediate complications occurred aside from one transient infection. These findings demonstrate that percutaneous ultrasound-guided CNB is a safe, reliable, and highly effective alternative to excisional biopsy for diagnosing and subtyping lymphoma and other neck pathologies, supporting broader adoption of image-guided CNB in diagnostic algorithms for neck masses.
Head and Neck Surgery Summary written by Michael Evans
Kansas City University College of Osteopathic Medicine
Laryngology
AI Models for Dysphonia Patient Education
Nudelman CJ, Tardini V, Bottalico P. Artificial Intelligence to Detect Voice Disorders: An AI-Supported Systematic Review of Accuracy Outcomes. J Voice. Published online October 4, 2025. [Article Link]
Smart voices with important cautions
Large language models (LLMs) such as ChatGPT and Google Gemini are increasingly used for health information, which has raised new questions about information accuracy, patient safety, data ethics, and environmental impact. This cross-sectional analysis assessed ChatGPT-4o (GPT) and Google Artificial Intelligence Overview (GAO) in their ability to accurately answer patient questions on spasmodic dysphonia, muscle tension dysphonia, and vocal tremor by comparing their answers to answers from Dysphonia International (DI), a nonprofit global leader on dysphonic conditions. Responses to 16 questions on GPT, GAO, and DI were evaluated based on readability, comprehensiveness, accuracy, appropriateness for patients, and patient safety using a five-point Likert scale. GPT responses were found to be more accurate (GPT 4.40 ± 0.74; GAO 3.56 ± 1.00; DI 3.88 ± 1.27), more comprehensive (GPT 4.63 ± 0.57; GAO 3.63 ± 1.00; DI 2.67 ± 1.2), and more patient appropriate (GPT 4.50 ± 0.62; GAO 3.88 ± 0.84; DI 3.88 ± 1.06) than the other information sources, with all comparisons showing significant differences (p < 0.05). GPT also provided responses with safer patient information and recommendations than GAO, although not safer than DI (GPT 4.83 ± 0.56; GAO 4.13 ± 1.08; DI 4.50 ± 0.68; GPT vs. GAO p < 0.001; GPT vs. DI p < 0.111), and all three sources required reading levels above that of a sixth grade student in the United States. Although ChatGPT-4o performed well in this study, users should remember that the intelligence in artificial intelligence is not true thinking but rather a complex predictive process with limited transparency about data ownership, which creates significant concerns for patient privacy. The substantial energy required to run LLMs also contributes to environmental harm that has been shown to disproportionately affect marginalized communities, reinforcing the need for thoughtful and responsible use.
Priyanka Shah’s Takeaway: This study suggests that LLMs such as ChatGPT-4o can be helpful resources for health professionals and medical students by providing quick and accessible educational support. However, given the concerns related to accuracy, privacy, and environmental impact, they should supplement rather than replace expert clinical guidance.
Laryngology Summary written by Priyanka Shah
Edward Via College of Osteopathic Medicine
Otology and Neurotology
Cochlear Implant Outcomes in Ménière's Disease
Arambula AM, Cabrera CI, Richter JE, et al. Vestibular Symptoms After Cochlear Implantation in Patients With Meniere Disease. Otol Neurotol Open. 2025;5(3):e074. [Article Link]
Ménière’s disease (MD) is a condition of the inner ear, classically characterized by the triad of episodic vertigo, tinnitus, and progressive sensorineural hearing loss. Many patients with MD eventually require traditional amplification or cochlear implantation to allow them to hear better. This retrospective study included 39 MD patients who underwent cochlear implantation in the affected ear and compared pre- and postoperative vestibular symptom severity. The authors reported that overall, 92.3% (36/39) experienced symptom improvement or stability (11/39, 28.2% improved; 25/39, 64.1% remained stable), and 3/39 (7.7%) worsened. When compared to patients with moderate or severe symptoms preoperatively, those with mild or absent symptoms were more likely to have stable symptoms postoperatively (78.9% vs. 50.0%, respectively) and less likely to improve (10.5% vs. 45.0%, respectively; p = 0.038). Among patients with moderate or severe symptoms, those without comorbid migraine were more likely to improve than those with migraine (p = 0.003), as compared to previously published studies (this may be due to variability of severity of the symptoms prior to surgery). The authors concluded that cochlear implantation may offer a dual benefit, improving hearing and stabilizing or improving vestibular symptoms in patients with MD.
Otology and Neurotology Summary written by Maaz Haji
Chicago Medical School, Rosalind Franklin University
Pediatric Otolaryngology
Autologous Incus Interposition vs. TORP in Children
Aliyeva A, Alaskarov E. Ossicular Chain Reconstruction in Children: Outcomes of Autologous Incus Interposition and TORP. Int J Pediatr Otorhinolaryngol. 2025 Sep;196:112473. [Article Link]
Small bones, big impact
Conductive hearing loss in children can impair speech, language, and cognitive development, underscoring the need for effective ossicular reconstruction. This retrospective cohort study of 102 children less than 18 years (mean age 9.7 ± 3.3 years) compared hearing outcomes between autologous incus interposition ([AII]; N = 52, 51.0%) and total ossicular replacement prosthesis ([TORP]; N = 50, 49.0%) in tympanoplasty for chronic otitis media, with cholesteatoma present in 87 of 102 patients (85.3%). Air-conduction (AC) and bone-conduction (BC) thresholds were measured at 0.5, 1, 2, and 4 kHz, with success defined as postoperative air-bone gap (ABG) closure ≤ 20 dB and secondary outcome as AC ≤ 30 dB. At middle-term follow-up (> 12 months), 29 of 40 (72.5%) AII patients achieved an ABG ≤ 20 dB compared to 15 of 38 (39.5%) TORP patients (p = 0.003), and 30 of 40 (75.0%) versus 22 of 38 (57.9%) achieved an AC ≤ 30 dB (p = 0.005). AII patients demonstrated a greater improvement in mean postoperative AC thresholds compared with TORP patients (13.1 ± 3.8 dB vs. 12.2 ± 4.3 dB; p = 0.028), along with smaller postoperative ABG (16.3 ± 5.1 dB vs. 21.4 ± 4.7 dB; p < 0.001). In addition, multivariate analysis showed that undergoing AII and having an intact stapes were independent predictors of successful hearing outcomes, defined as achieving a postoperative ABG closure of ≤ 20 dB (odds ratio = 0.31, 95% confidence interval 0.11 to 0.89; p = 0.029). These findings demonstrate that AII results in superior and more durable hearing outcomes compared to TORP, supporting ossicular and stapes preservation in pediatric middle ear surgery.
Pediatric Otolaryngology Summary written by Anders Erickson
Des Moines University College of Osteopathic Medicine
Rhinology and Skull Base Surgery
Cadherin-26 and Cell Migration in Eosinophilic CRS
Jo YI, Moon JW, Park JH, et al. Cadherin-26 Facilitates Transepithelial Migration of Eosinophils in Eosinophilic Chronic Rhinosinusitis. Int Forum Allergy Rhinol. Published online October 15, 2025. [Article Link]
Can cadherins pave the way for future chronic rhinosinusitis therapies
Eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) is characterized by eosinophilic infiltration and inflammation, but the mechanism of eosinophil migration into nasal tissue remains unclear. This study investigated the role of Cadherin-26 (CDH26), a calcium-dependent cell adhesion protein, in eosinophil transepithelial migration across the nasal mucosa. The study authors analyzed nasal tissue from eCRSwNP patients and controls for eosinophil infiltration and CDH26 expression, cultured human primary nasal epithelial cells (hPNECs) and stimulated them with interleukin-4 (IL-4) and IL-13 to measure CDH26 levels, and assessed eosinophil adhesion and transepithelial migration using differentiated EoL-1 cells on recombinant CDH26-coated wells or Transwell inserts. In nasal tissue samples, subjects with eCRSwNP showed increased epithelial eosinophils (mean 7 per high-power field; p < 0.03) and qualitatively stronger epithelial CDH26 staining by immunohistochemistry and immunofluorescence compared with controls (p < 0.01). In cultured hPNECs, IL-4 and IL-13 stimulation upregulated CDH26 expression (27- and 24-fold increases in mRNA, respectively; p < 0.0001) and was positively associated with IL-4 and IL-13 levels (IL-4: Pearson r = 0.664, p = 0.026; IL-13: Pearson r = 0.720, p = 0.012). Functional assays demonstrated that CDH26 promoted eosinophil adhesion via ITGA4 and enhanced transepithelial migration, which increased 3.8- (p < 0.0001) and 6-fold (p < 0.03) with IL-4 and IL-13 stimulation, respectively, but was reduced by CDH26 knockdown (p < 0.02). These findings suggest that CDH26 contributes to eosinophilic transepithelial migration into nasal mucosa and may represent a therapeutic target in eCRSwNP.
Rhinology and Skull Base Surgery Summary written by Hailey Lewis
Brody School of Medicine
Basic Science Spotlight
Microbiological Changes in Osteoradionecrosis
Longfellow GA, Matthews MR, Adams GJ, et al. Post-Radiation Microbiological Changes in Osteoradionecrosis: Investigating the Microbial Landscape. Otolaryngol Head Neck Surg. Published online October 14, 2025. [Article Link]
When radiation and bacteria collide
Osteoradionecrosis of the jaw (ORNJ) is a debilitating complication of radiotherapy for head and neck cancer, yet the microbiologic factors influencing disease severity remain poorly defined. This retrospective cohort study analyzed 84 adults with a median age of 63.3 years (interquartile range 56.2 to 72.1) who were treated for ORNJ at a single tertiary academic medical center between January 2023 and August 2024 to characterize bacterial species, antibiotic resistance patterns, and predictors of autologous reconstruction in this setting. Among the 62 patients (73.8%) with culture data available, 134 cultures were obtained and 58.2% (78/134) grew bacteria representing 30 unique species, most commonly Actinomyces (32/134, 23.9%) and Streptococcus anginosus (10/134, 7.5%). Gram-negative organisms including Pseudomonas aeruginosa (7/134, 5.2%), Klebsiella spp. (6/134, 4.5%), and Escherichia coli (4/134, 3.0%) were found in 14 patients (22.6%), and their presence independently predicted the need for autologous reconstruction in multivariable analysis (adjusted odds ratio [aOR] = 14.81, 95% confidence interval [CI] 2.6 to 84.7; p = 0.0025). The presence of a fistula was also significantly associated with gram-negative infection (aOR = 6.57, 95% CI 1.8 to 24.5; p = 0.005). Cultures revealed 17 distinct antibiotic resistance events, most commonly resistance to ampicillin (8/17, 47.1%) and cefazolin (6/17, 35.3%), while gentamicin showed the highest susceptibility rate (22/29, 75.9%). These findings suggest that gram-negative infection and antimicrobial resistance may signal more aggressive disease biology and could help guide culture-directed management strategies in ORNJ.
Basic Science Spotlight Summary written by Ashton Huppert Steed
University of Arizona College of Medicine Phoenix
Sleep Surgery
Association of DISE Findings with Surgical Outcomes
Shah SJ, Zhang F, Gibber M. A Retrospective Review on the Association Between Drug-Induced Sleep Endoscopy Findings and Surgical Outcomes. Otolaryngol Head Neck Surg. Published online September 18, 2025. [Article Link]
DISE it before you slice it
Drug-induced sleep endoscopy (DISE) is commonly used to identify and characterize airway obstruction in patients with obstructive sleep apnea (OSA), yet limited evidence links DISE findings to surgical success. This retrospective single-center cohort study at Montefiore Medical Center analyzed adults (mean age 42.9 ± 13.3 years) who underwent DISE, were diagnosed with OSA, and subsequently underwent surgical intervention between January 2017 and June 2023. Among 255 patients, 119 (46.7%) underwent uvulopalatopharyngoplasty (UPPP), 82 (32.2%) underwent tonsillectomy, 44 (17.3%) underwent hypoglossal nerve stimulator (HNS) implantation, and 10 (3.9%) underwent epiglottectomy. The greatest reductions in apnea-hypopnea index (AHI) were observed in patients who underwent HNS (mean -18.5, 95% confidence interval [CI] -24.0 to -12.9) and tonsillectomy (mean -21.1, 95% CI -28.4 to -13.7). UPPP was most effective in patients with moderate (mean -9.8, 95% CI -18.0 to -1.7) or severe (mean -7.6, 95% CI -13.2 to -2.1) velum obstruction, while tonsillectomy benefited those with moderate (mean -17.1, 95% CI -33.1 to -1.1) or severe (mean -19.7, 95% CI -29.0 to -10.3) oropharyngeal obstruction. HNS patients demonstrated improvement regardless of tongue base and epiglottic obstruction. This study showcases the clinical value of DISE in guiding surgical decision-making for OSA and suggests that tailoring interventions to obstruction sites identified during endoscopy can lead to more effective, procedure-specific improvements in AHI.
Sleep Surgery Summary written by Valeria Guerra Navarro
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
Question of the Week
Correct Answer Reveal + Explanations
Correct Answer: (A) Place a McGovern (Montgomery) nipple or oral airway to bypass the nasal obstruction and plan for operative repair
Answer Explanation:
This neonate has classic findings of bilateral choanal atresia, including cyclic cyanosis that improves with crying, feeding-related desaturation, and inability to pass a catheter through either naris. Newborns are obligate nasal breathers, so complete bilateral nasal obstruction causes hypoxia whenever the infant is quiet or feeding. Answer choice (A) is correct because placement of a McGovern nipple or oral airway bypasses the nasal obstruction and provides a reliable airway until definitive surgical repair can be performed safely. This is the recommended initial management.
Answer choice (B), proceed with endotracheal intubation and schedule an emergent tracheotomy, is incorrect because intubation and tracheotomy are overly invasive as first-line interventions and are therefore reserved for cases in which an oral airway fails or another airway anomaly prevents adequate ventilation. Answer choice (C), initiate topical oxymetazoline and observe, is incorrect because topical oxymetazoline may reduce mucosal edema but cannot relieve a fixed bony or membranous obstruction as seen in choanal atresia and may delay necessary airway stabilization. Answer choice (D), delay repair for two to four weeks, is incorrect because postponing surgical repair for weeks without first securing a dependable airway is unsafe and risks prolonged hypoxia in infants with bilateral choanal atresia. Answer choice (E), initiate prone positioning with humidified oxygen, is incorrect because this intervention does not prevent recurrent desaturation and is therefore ineffective in the management of complete bilateral atresia.
Sources:
[1] Pasha R, Golub JS. Otolaryngology Head and Neck Surgery: Clinical Reference Guide. 4th ed. Plural Publishing; 2014.
[2] AAO-HNSF. Primary Care Otolaryngology Handbook. 4th ed. Alexandria, VA: American Academy of Otolaryngology-Head and Neck Surgery Foundation; 2019:70-76.
Question of the Week Answer written by Luke Reardon
Lincoln Memorial University DeBusk College of Osteopathic Medicine
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