30-Second Takeaway
- A working definition of acute CRS exacerbations can sharpen diagnosis and limit reflex antibiotics and steroids.
- OSA care is shifting toward endotype-based pharmacotherapy alongside CPAP, surgery, and weight-loss drugs.
- Fine-particulate and NO2 exposure measurably worsen AHI, supporting environmental counseling in sleep clinics.
- Red rubber catheter sheathing reduces epistaxis during nasotracheal intubation at the cost of longer intubation time.
- ctDNA and jaw-in-a-day approaches show promise but still require careful selection, standardization, and longer-term data.
Week ending December 27, 2025
Grand Rounds in Otolaryngology: CRS Exacerbations, OSA Endotypes, Neurotology, and Oncologic Reconstruction
Toward a standardized, stewardship-friendly definition of acute CRS exacerbations
This review focuses on acute exacerbations of chronic rhinosinusitis (AECRS) and their implications for diagnosis and treatment decisions. A recent regulatory definition requires symptom worsening for more than 3 days plus escalation of treatment to qualify as AECRS. Rescue medication use is unreliable, documented in only about one-third of patient-reported AECRS episodes, limiting its value for event definition. The authors emphasize viral and other irritant-triggered dysbiosis with secondary bacterial infection as key pathophysiologic drivers. Patients with asthma or allergic rhinitis appear at increased risk, and many AECRS episodes are likely overtreated with antibiotics and corticosteroids.
OSA pharmacotherapy is moving toward endotype-driven, non-CPAP strategies
This review outlines emerging pharmacologic options for obstructive sleep apnea (OSA) grounded in specific pathophysiologic endotypes. Non-CPAP anatomical therapies, including oral appliances and upper airway surgery, typically reduce OSA severity by about 50%. Weight-loss drugs can reduce OSA severity in the large proportion of patients whose disease is obesity-related. New agents target pharyngeal dilator activation, ventilatory control stability, and sleep depth to address non-anatomical traits. The authors describe practical tools for OSA endotyping that may guide tailored combinations of pharmacologic and non-pharmacologic therapies.
ctDNA in HNSCC: strongest near-term role in monitoring and surveillance
This literature review synthesizes a decade of data on circulating tumour DNA (ctDNA) in head and neck squamous-cell carcinomas. ctDNA has been studied for screening, diagnosis, prognostic stratification, minimal residual disease assessment, and relapse detection. Evidence is strongest for treatment-response assessment and post-treatment monitoring, particularly using ctHPV-DNA in HPV-associated disease. Test performance varies substantially across studies because of assay differences, targets, sampling strategies, and tumor biology. The authors call for large, prospective, standardized studies before routine clinical adoption of ctDNA in head and neck oncology.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.