How GLP-1s Are Changing Otolaryngology Practice

GLP-1 drugs (glucagon-like peptide-1 receptor agonists) are everywhere: TV commercials, social media scrolls, casual conversations, and conference presentations.

Approximately one in eight Americans is currently taking a GLP-1 medication, and nearly one in five adults has taken a GLP-1 at some point, according to a November 2025 KFF Health Tracking poll (KFF. https://tinyurl.com/2cjdvc55). By now, that number may be even higher.

Otolaryngologists may not have paid much attention to GLP-1s when they first came on the market, but now they are impossible to ignore. Multiple U.S. Food and Drug Administration-approved (FDA) GLP-1s are currently on the market, including exenatide, liraglutide, dulaglutide, lixisenatide, and semaglutide, with FDA indications for type 2 diabetes treatment, cardiovascular risk management in people with type 2 diabetes or obesity, and weight management. Semaglutide use has skyrocketed, with prescriptions increasing 40-fold over the past five years (Laryngoscope. doi:10.1002/lary.32061). And in late 2024, the dual GIP (glucose-dependent insulinotropic polypeptide) GLP-1 agonist tirzepatide became the first FDA-approved medication for obstructive sleep apnea (FDA. https://tinyurl.com/5ysmazj2).

“Most otolaryngologists seem more focused on the potential side effects of GLP-1 receptor agonists (GLP-1RAs) rather than the potential benefits they may provide for the conditions they treat,” said Mohamad R. Chaaban, MD, MSCR, MBA, associate professor and vice chair of research in the department of otolaryngology at Cleveland Clinic in Cleveland, Ohio. “But I think, overall, these medications will be positive for patients’ overall well-being and comorbidities.”

Otolaryngologists should be aware of the side effects but also think about how they can be used to treat ENT-related issues, including rhinosinusitis and sleep apnea. “If we don’t get on board and look at repurposing these drugs to treat those conditions, we’re going to fall way behind,” Dr. Chaaban added.

Your practice surely includes patients who use GLP-1 medication and likely includes patients who may benefit from them. Understanding the indications, benefits, adverse effects, and perioperative implications of GLP-1 therapies is becoming important for all otolaryngologists.

ENT Impacts: What Should Otolaryngologists Watch For?

Delayed gastric emptying is a physiologic effect of GLP-1 medications. But from an otolaryngologic perspective, this intended effect can be a perioperative nuisance.

GLP-1 drugs reduce gastric motility and slow food digestion, meaning patients who use these medications may still have food in their system even if they fast for eight hours or more before surgery.

In 2024, the American Gastroenterological Association, American Society for Metabolic and Bariatric Surgery, American Society of Anesthesiologists, International Society of Perioperative Care of Patients with Obesity, and the Society of American Gastrointestinal and Endoscopic Surgeons issued nuanced clinical practice guidelines that emphasize shared decision making and the need to balance patients’ metabolic need for GLP-1 treatment with individual patient risk (Surg Obes Relat Dis. doi.org/10.1016/j.soard.2024.08.033). These guidelines also note that delayed gastric emptying—and therefore the risk of aspiration—is more likely among patients who are on a higher GLP-1 dose or increasing their dosage.

“My approach is to identify the medication early and coordinate with anesthesia rather than manage it in isolation,” said Yi Cai, MD, assistant professor and director of sleep surgery at the Columbia University Irving Medical Center in New York.

Nausea and vomiting related to delayed gastric emptying are the most commonly reported—and most widely known—side effects of GLP-1 medications. But because the drugs affect the entire body, patients may experience side effects that affect the ear, nose, and throat as well.

“I’ve had patients come in and ask me, ‘Is this because of my GLP-1?’ And I didn’t know,” said Omar G Ahmed, MD, associate professor in the division of rhinology and skull base surgery at Houston Methodist Hospital in Houston.

So, Dr. Ahmed, in collaboration with others, conducted a retrospective analysis of the FDA’s Adverse Event Reporting System (FAERS) database to determine otolaryngologic side effects of GLP-1s.

Gastroesophageal reflux disease (GERD) is common and may cause throat irritation, dysphonia, and increased postnasal drip, Dr. Ahmed said. Other ENT-related side effects include dysphagia, dysgeusia, anosmia, and tinnitus. GLP-1 medications may also increase the risk of sinonasal pathologies because they have a drying effect and may increase mucous viscosity and decrease mucociliary clearance (Laryngoscope. doi.org/10.1002/lary.32061). “The actual percentage of patients who have these side effects is hard to say from the data alone,” Dr. Ahmed said, as the FAERS database only includes reported side effects.

Having a general understanding of the ENT-related effects of GLPs, however, is helpful because many patients don’t realize that their throat irritation, chronic cough, or altered sense of taste or smell may be related to GLP-1 therapy. Some may seek otolaryngologic care for their symptoms. Asking about GLP-1 use early in the evaluation process may help avoid unnecessary testing and referrals.

Beyond Side Effects: Potential Benefits for ENT Patients

Sleep apnea

The FDA’s approval of tirzepatide to treat sleep apnea could have a tremendous impact on patients and otolaryngologists alike.

“It changes the conversation substantially,” Dr. Cai said. “Historically, we talked about weight loss as general lifestyle advice for patients with obstructive sleep apnea. Now, pharmacologic weight loss therapy is part of the formal OSA treatment conversation.”

Tirzepatide is approved to treat moderate to severe OSA in adults with obesity after clinical trials showed substantial improvements in the apnea–hypopnea index (AHI) compared with placebo. Both patients who used continuous positive airway pressure (CPAP) and those who did not experienced benefit from tirzepatide after 52 weeks of treatment (N Engl J Med. https://doi.org/10.1056/nejmoa2404881).

“It can reduce apnea events by almost 50% or more,” said Ramzi Younis, MD, professor of clinical otolaryngology at the University of Miami Miller School of Medicine. “If a patient is stopping breathing 40 times an hour and you reduce it to 20 times, this is great.”

Clinical trial participants who received tirzepatide experienced a significant decrease in weight compared to those treated with placebo, and the FDA announcement of tirzepatide’s approval for sleep apnea states that “improvement in AHI in participants with OSA is likely related to body weight reduction” (FDA. https://tinyurl.com/5ysmazj2).

Of course, excess weight has long been linked with OSA, and people who are overweight or obese and have sleep apnea are routinely advised that losing weight may improve their symptoms. It’s not clear if the therapeutic effect of tirzepatide for sleep apnea is strictly related to weight loss or if other GLP-1 therapies are similarly effective for overweight patients with OSA.

“The majority of the benefits of tirzepatide are due to weight loss. The more nuanced answer is, it’s complex,” said Atul Malhotra, MD, lead researcher of the SURMOUNT-OSA trials and board-certified pulmonologist, intensivist, and research chief of Pulmonary, Critical Care and Sleep Medicine at UC San Diego Health, and the Peter C. Farrell Presidential Chair and tenured professor of respiratory medicine at University of California San Diego School of Medicine.

“Depending on the outcome of interest, some of the effects are mediated by improvements in body weight and some of the effects are mediated by improvements in sleep apnea. Some are direct effects of the medication.”

A meta-analysis published in April 2026 suggests liraglutide also decreases AHI in adults with obesity and OSA, although tirzepatide was associated with greater reductions (Sleep Breath. doi.org/10.1007/s11325-026-03681-4). And a head-to-head comparison of semaglutide and tirzepatide found that people who took semaglutide lost approximately 14% of their body weight, while those on tirzepatide, a dual GLP-1/GIP receptor agonist, lost about 20% (N Engl J Med. https://doi.org/10.1056/nejmoa2416394). 

Additional research is needed to better understand the physiologic impact of GLP-1 medications on sleep apnea and determine which treatments are most effective. Ongoing multicenter clinical trials are evaluating retatrutide, a triple GLP-1/GIP/glucagon receptor agonist, in patients with obesity and moderate-to-severe OSA (Diabetes Obes Metab. https://doi.org/10.1111/dom.70209).

Meanwhile, only a fraction of people with OSA who might benefit from GLP-1 therapy are taking any of the approved medications.

“In a study of patients in my sleep surgery clinic, 28.1% of patients who met FDA labeling criteria for GLP-1-based medications were using them,” Dr. Cai said.

Utilization was higher than in the general population, although insurance coverage appears to limit access. Patients with Medicaid were significantly less likely to use GLP-1 receptor agonists, and insurance-related issues were the leading reason for discontinuing or switching medications (Otolaryngol Head Neck Surg. https://doi.org/10.1002/ohn.70231). FDA approval of tirzepatide may increase access, as some patients whose insurance refuses to cover GLP-1 therapy for obesity may do so if the drug is prescribed specifically for sleep apnea.

“In some cases, patients come to see me wanting a sleep apnea diagnosis because their insurance doesn’t cover GLP-1s for obesity,” Dr. Malhotra said.

The efficacy of tirzepatide (and, perhaps eventually, other GLP-1 therapies) in treating OSA will vary. Some patients experience satisfactory control or resolution of sleep apnea with GLP-1 therapy. Others continue to have clinically significant OSA despite substantial weight loss; however, they may be good candidates for surgical procedures that were previously deemed too risky due to their excess weight.

“Significant weight loss can affect sleep surgery candidacy,” Dr. Cai said. “Hypoglossal nerve stimulation is an example.”

Chronic rhinosinusitis

A retrospective analysis published in January 2026 found that patients with chronic rhinosinusitis (CRS) with nasal polyps who underwent sinus surgery and were treated with a GLP-1 receptor agonist were significantly less likely to need sinus revision surgery after five years than those who did not take a GLP-1RA (Otolaryngol Head Neck Surg. https://doi.org/10.1002/ohn.70072). Patients receiving GLP-1RAs were also likely to have received a prescription for a biologic.

“When I started looking at the metabolic effects of obesity in patients with chronic sinusitis about 10 years ago, it was a very unconventional idea, and many people were skeptical,” said Dr. Chaaban, lead author of the retrospective analysis.

“The biologic drugs currently approved to treat CRS with nasal polyps all target type 2 inflammation,” he said. “However, we are increasingly recognizing non-type 2 inflammatory pathways, particularly among patients with obesity. These patients may not respond as well to current biologic therapies, and GLP-1RAs may represent a new therapeutic approach.”

Of course, weight loss is known to decrease inflammation. But Dr. Chaaban—and others—also think that GLP-1RAs may have a direct effect on inflammation.

“Further research is needed, but I believe there may be anti-inflammatory effects of these drugs that contribute to reducing inflammation,” Dr. Chaaban said. “Right now, I’m researching what else is going on in addition to weight loss.”

Dr. Ahmed is also investigating that question.

“I’m doing a prospective study right now where I’m following patients on their weight loss journeys via different mechanisms. GLP-1s, bariatric surgery, and then another group using just diet and exercise. We’re tracking these patients’ inflammatory markers in their sinuses and nose over time, and it looks really promising,” he said. “Inflammation seems to be objectively decreasing over time.”

A paper published in February 2026 further supports the idea that GLP-1 treatment may improve outcomes for patients with chronic sinusitis (Int Forum Allergy Rhinol. https://doi.org/10.1002/alr.70097). The retrospective study examined healthcare utilization among people with CRS and found that patients on GLP-1s “had lower rates of surgery, less antibiotic and steroid use, and decreased healthcare utilization than patients of similar weight who were not on GLP-1s,” Dr. Ahmed said.”

Best Practices in the Age of GLP-1s

As GLP-1 therapies become a staple of 21st-century medical care, otolaryngologists must adapt their clinical practice to account for the powerful impact of these drugs.

Ask every patient about GLP-1 use. “Every patient that comes in, we need to look whether they are on a GLP-1 because there are millions of people on them,” Dr. Younis said.

Don’t rely on the medication list in the electronic health record (EHR). Some patients are getting GLP-1 medication outside of traditional medical channels, so their prescriptions may not automatically appear in the EHR. Some, in fact, may be using compounded versions that are not FDA approved.

Retatrutide, for instance, has not yet undergone FDA evaluation and is still an investigational drug, but a recent investigation by CBS News found dozens of clinics advertising and offering the drug (CBS News. https://tinyurl.com/3ybx5efn).

“Many patients may not think to mention these medications if they obtained them through a subscription service, med spa, or compounding pharmacy,” Dr. Cai said. “We need to document the drug, dose, last dose, dose escalation status, and any GI symptoms. This is especially important with compounded or nontraditional products because there may be more uncertainty around formulation, concentration, dosing schedule, and side effects.”

Otolaryngologists should directly ask patients about GLP-1 use at every appointment, because initiation and discontinuation rates remain high.

Incorporate GLP-1 therapy into treatment planning. Could a GLP-1 medication potentially benefit your patient? Is a patient’s use of GLP-1 medication causing side effects that are contributing to otolaryngologic issues? How does their medication usage affect the feasibility and safety of surgical procedures?

These are questions that otolaryngologists must now consider when creating treatment plans.

“If you’re treating somebody who’s got a disease of excess body weight, addressing the body weight issue, I think, is quite important,” Dr. Malhotra said.

However, it’s equally important not to rely on medication and weight loss to resolve health conditions, even when a GLP-1 medication is explicitly approved for an otolaryngologic indication.

“I try to develop a parallel treatment strategy in case the medication is not accessible, not sustainable, or does not produce the expected response,” Dr. Cai said. “Weight loss takes time, and if someone has clinically significant sleep apnea, we still need to treat the apnea they have now.”

Patients may require additional testing and evaluation after significant weight loss to determine the most appropriate clinical path.

“A patient who initially seemed to need multilevel surgery may have milder disease after weight loss, while another patient may still have severe OSA, for instance, because the dominant issue is anatomy rather than weight,” Dr. Cai said. “As a result, I would not make decisions based on BMI alone.”

Coordinate care with GLP-1 prescribers. Primary care physicians, endocrinologists, obesity medicine specialists, and cardiologists are currently the primary prescribers of GLP-1-related therapies. Whether otolaryngologists eventually join their ranks remains to be seen.

If you have a patient whose otolaryngologic symptoms might reasonably benefit from GLP-1 treatment, you may want to initiate a referral to a physician who has experience managing GLP-1 medications. Patients with obesity, excess weight, or type 2 diabetes who have airway disease may experience improvements in their symptoms with GLP-1 therapy and weight loss, Dr. Ahmed said. Encouraging these patients to discuss GLP-1 treatment with their primary care physician or endocrinologist may ultimately help their airway health.

If you believe a patient’s otolaryngologic symptoms may be related to GLP-1 treatment, and those symptoms are interfering with the patient’s quality of life, a call to the prescribing healthcare provider is in order. Such a conversation with the prescribing clinician may identify dose or medication changes that relieve symptoms while maintaining the patient’s metabolic health.

GLP-1 therapies are changing the management of obesity, diabetes, sleep apnea, and perhaps chronic inflammatory airway disease. As evidence continues to evolve, otolaryngology practice must as well.     

Jennifer Fink is a freelance medical writer based in Wisconsin.