Maie A. St. John

Objective: To characterize synchronous and metachronous contralateral second primary malignancy (SPM) rates across preoperatively defined risk strata in patients with HPV‐positive tonsillar squamous cell carcinoma (TSCC) undergoing unilateral versus bilateral tonsillectomy and to evaluate associated postoperative morbidity and functional outcomes. Methods: All patients with HPV‐positive TSCC who underwent surgery between 2000 and 2023 were retrospectively reviewed. Fisher's exact test, Kaplan–Meier analysis, and log‐rank tests were used to compare morbidity and survival, and multivariable regression models were employed to control for confounders, including patient demographics, substance use, tumor staging, and adjuvant therapy. Results: From 163 patients, 123 (75.5%) underwent unilateral tonsillectomy, 30 (18.4%) low‐risk bilateral tonsillectomy, and 10 (6.1%) high‐risk bilateral tonsillectomy. Across all patients undergoing bilateral tonsillectomy, synchronous tonsillar SPMs were identified in 10.0%, with rates of 6.7% in the low‐risk bilateral group and 20.0% in the high‐risk bilateral group. Of the 123 patients who underwent unilateral tonsillectomy, 0.8% developed a metachronous contralateral TSCC at 181.6 months. Among low‐risk bilateral patients undergoing prophylactic contralateral tonsillectomy, the NNT for identification of one occult synchronous SPM was 14 (95% CI: 5–50). Bilateral tonsillectomy did not significantly alter discharge diet, postoperative length of stay, hemorrhage rates, return to the operating room, or 30‐day emergency department visits. Disease‐free survival did not differ significantly across risk‐stratified groups. Conclusion: Contralateral second primary TSCC clustered disproportionately among high‐risk patients. Bilateral tonsillectomy was not associated with significantly increased postoperative morbidity. These findings support a selective, risk‐stratified approach to bilateral tonsillectomy in HPV‐associated TSCC, balancing the potential benefit of occult contralateral disease detection against procedure‐related morbidity through shared decision‐making. Level of Evidence: III.

Objectives: Head and neck cancer (HNC) patients have high palliative care (PC) needs. We reviewed our initial experience with a novel subspecialty HNC outpatient PC clinic, led by a Hospice and Palliative Medicine fellowship‐trained HNC surgeon. Methods: We retrospectively reviewed 142 patients referred to a novel subspecialty HNC PC clinic between July 2023 and March 2025. Symptom evaluation included the revised Edmonton Symptom Assessment System (ESAS‐r), Patient Health Questionnaire‐9 (PHQ‐9) for Depression, Generalized Anxiety Disorder‐7 (GAD‐7), and frailty. Data were analyzed using cross‐tabulations, multivariable linear regression, and multivariable survival analysis. Results: Most patients had incurable disease (73.9%), with significant improvement in ESAS‐r shortness of breath, ESAS‐r tiredness, GAD‐7, and PHQ‐9 scores at follow‐up. Mortality was 40.1%, and 84.2% of deaths occurred at home or in hospice. Aggressive end‐of‐life care occurred in 57.9% of patients and was associated with continued cancer‐directed treatment (79.4% vs. 26.1%), lower hospice use (55.9% vs. 82.6%), and death in an acute‐care facility (27.3% vs. 0%). Palliative immunotherapy was associated with reduced hospice duration (median = 15 days [IQR = 4–63]) compared to other cancer‐directed treatment (median = 27 days [23–63]) or supportive care (median = 68 days [26–162]). On multivariable analysis, surgery (HR = 0.08 [95% CI = 0.01–0.39]) and ≥ 3 PC visits (HR = 0.24 [0.08–0.73]) were independent prognostic indicators of survival. Conclusions: Patients seen in a surgeon‐led subspecialty HNC PC clinic demonstrated observed longitudinal improvement in symptom scores, improved survival in patients receiving longitudinal PC, and a high rate of home or hospice deaths. These data suggest that subspecialist HNC PC adds value to multidisciplinary HNC care. Level of Evidence: 4.

Objectives: To characterize the survival and morbidity associated with immunocompromised status in patients with surgically resected Human Papillomavirus positive oropharyngeal squamous cell carcinoma (HPV + OPSCC). Methods: We reviewed patients with surgically resected HPV + OPSCC at a tertiary institution between 2000 and 2023. The survival and morbidity associated with an immunocompromised status were assessed with multivariable Cox proportional hazards models controlling for patient, tumor, and treatment characteristics. Results: Among 278 patients with HPV+ OPSCC that met inclusion criteria, 14 patients were immunocompromised. Causes of immunocompromise: 4, leukemia or lymphoma; 3, organ transplantation; 3, medically immunosuppressed; 2, HIV; 2, myelodysplastic syndrome and pancytopenia. Adjusting for covariates, the immunocompromised patient group had significantly worse overall survival (64.3% vs. 91.7%; HR 4.12, 95% CI: 1.14–14.90, p < 0.005) compared to the non‐compromised group. The immunocompromised patient group did not have a significantly different postoperative length of stay (3.96 vs. 3.5 days; aβ 0.66, 95% CI: −1.30 to 2.64). Conclusions: In this small, heterogeneous cohort of surgically resected HPV + OPSCC, immunocompromised status was associated with significantly worse overall survival; however, these exploratory findings should be interpreted cautiously. Level of Evidence: 3.

Introduction: A non‐invasive test to accurately diagnose and quantify vocal fold (VF) scarring from other confounding pathologies would be advantageous to reduce the need for operative diagnostic laryngoscopy. Dynamic optical contrast imaging (DOCI) technology uses tissue autofluorescence to obtain real‐time information of tissue composition. In this study, we describe a novel application of DOCI to identify scar tissue formation in rabbit VFs. Methods: Rabbits underwent endoscopic unilateral VF cordectomy to induce scar formation. After 2 months, VFs were excised and a bench‐top DOCI (UCLA) system was employed to capture images from sections. Results were verified with histologic staining for scar tissue. Results: The DOCI system was capable of distinguishing healthy VF from contralateral scarred VF with discriminating power at the 405 low‐pass filter (LPF), 440, 460–532, and 560–580 nm wavelengths ( p < 0.05). All DOCI images of healthy and scarred VF sections correlated with histological assessment. Conclusion: Our study demonstrated that DOCI technology can discriminate between normal and scarred VFs noninvasively and in real time with similar accuracy to that of histological analysis. This work lays the foundation for the development of a DOCI‐based endoscope for diagnosis and quantification of VF scar formation as well as a tool to measure treatment response.

Although patients with head and neck cancer (HND) commonly experience mental health disease (MHD) at rates equal to or greater than those of patients with other types of cancer, HNC patients with MHD are often underdiagnosed and untreated. Thus, validated surveys should be used to screen for MHD, as subjective clinical judgement may underdiagnose MHD. Multidisciplinary treatment through psychosocial interventions and antidepressant medications can lead to lower rates of MHD, improved quality of life, and reduced mortality among HNC patients.

Objective: Patient frailty negatively impacts postsurgical outcomes across multiple specialties. Commonly used frailty scoring systems include the Modified 5‐Item Frailty Index (MFI‐5) and the Clinical Risk Analysis Index (RAI‐C). We compared these frailty indices in predicting postsurgical outcomes in otolaryngology, a comparison that has never been completed to date. Methods: Retrospective chart review of patients undergoing otolaryngologic surgery at a quaternary care medical center (2022–2024) with an RAI‐C score available for analysis. Chi‐square analysis and ROC curves were utilized to determine associations and predictive ability of each scoring system. Results: Among 1209 patients, 21% met MFI‐5 frailty criteria (MFI‐5 score > 1), and 23% met RAI‐C frailty criteria (RAI‐C score > 30). The Pearson correlation coefficient between MFI‐5 and RAI‐C was 0.481 (95% CI [0.43, 0.53]), indicating a moderate correlation between the two metrics. Patients deemed frail by RAI‐C had 5.7 times higher odds of experiencing a postoperative complication than non‐frail counterparts (95% CI [3.51, 9.28], p < 0.0001), but MFI‐5 frailty status was not associated with postoperative complications. Both RAI‐C and MFI‐5 demonstrated significant predictive ability for 30‐day readmission (AUC 0.77, 95% CI [0.64, 0.89] vs. AUC 0.76, 95% CI [0.61, 0.88]), respectively. When compared to MFI‐5, RAI‐C had greater predictive performance for all other postoperative outcomes in this study. Conclusion: RAI‐C outperformed MFI‐5 in predicting postoperative outcomes in patients undergoing otolaryngologic surgeries. RAI‐C assessment should be considered in frailty research, multidisciplinary treatment planning, and managing patient expectations and outcomes.