Otolaryngology Experts Share Best Practices in Five Areas

Editor’s note: Due to the COVID-19 pandemic, the 2021 Triological Society Combined Sections Meeting was held virtually on Jan. 29-30. The physical distance didn’t stop otolaryngologists in every specialty area from discussing the latest treatments, techniques, and issues in otolaryngology research and clinical practice.

The Best Practices session, an extension of the popular “Best Practices” feature that runs frequently in The Laryngoscope, was designed to point to evidence found in the literature in a way that clinicians and surgeons can put to use. Here are the questions they tackled:

Should all vocal fold leukoplakia undergo biopsy and resection?

Dinesh Chhetri, MD, a professor of head and neck surgery at the University of California, Los Angeles, said that these lesions pose some uncertainty. “We have essentially two ways of managing. One is to say, ‘I’m going to biopsy and treat everything,’” he said. “The other is to say, ‘I’m going to biopsy and treat only those that look concerning to me.’”

The leukoplakia referred to here are mostly white lesions in patients with normal vocal fold mobility. The bottom line from the literature, Dr. Chhetri said, is that clinicians should consider the look, the voice, and the expectations of patient follow-up (Laryngoscope. 2019;129:429-434).

He noted that lesions that should be most strongly considered for biopsy and treatment are those that are red, raised, and ragged, or that have vascular stippling; those in which the patient has hoarseness that’s out of proportion to the lesion’s appearance or who have poor mucosal waves; patients expected to have poor follow-up; and patients with poor progress, with worsening of the lesion’s size and appearance over time. 

In one study, researchers grouped leukoplakia into six types based on narrow-band imaging, with the worst types having large brown spots (abnormal vascularity) within or on the outside of the lesions. Three types were considered benign, and three were considered malignant; the diagnostic accuracy was 91%. 

Do antivirals improve congenital cytomegalovirus (CMV)-related hearing loss outcomes?

Sanjay Parikh, MD, professor of otolaryngology–head and neck surgery at the University of Washington in Seattle, said that antiviral treatment is associated with improved hearing outcomes in newborns who have CMV and symptomatic central nervous system involvement, or who have moderate to severe CMV.

In one of the largest trials to study this condition, 96 patients were randomized within 30 days of birth and given six weeks or six months of oral ganciclovir. At 12 and 24 months, the six-month treatment group had a higher rate of hearing preservation (N Engl J Med. 2015;372:933-943).

For isolated sensorineural hearing loss with no CNS involvement, the data are more limited, Dr. Parikh said. But early studies suggest that antiviral treatment is associated with hearing improvement or preservation.