Laryngology Literature — May 2026

Dear Reader

You can find first issue of The Laryngology Brief. This is the first issue that curated selection from the laryngology literature published in May 2026 across 9 core journals. Please let me know if you liked it or how can I imporove it. It takes 5 min to finish all of them. I hope you enjoy!

Featured Article

Suresh & Mau. The Impact of Etiology on Time to Vocal Fold Motion Recovery in Unilateral Vocal Fold Paralysis. Laryngoscope. 2026. DOI​

Retrospective, 16-year dataset, n=1,425 UVFP patients; 736 with VF motion recovery included. Three etiology groups: surgically induced (n=487), idiopathic (n=187), intubation-related (n=62). Surgically induced UVFP: bimodal recovery distribution, consistent with prior two-phase model. Idiopathic and intubation-related UVFP: both unimodal, but with distinct time courses. Median time to recovery: intubation-related 91 days, surgically induced 107 days, idiopathic 153 days. Among surgically induced cases, recovery curves for thyroid/parathyroid and cardiothoracic surgeries were essentially identical despite the anatomically different injury sites along the RLN. directly challenging the long-held assumption that distance from larynx determines recovery time.

Why it matters: This paper does something deceptively simple but clinically important: it gives us etiology-specific recovery probability tables we can actually use at the bedside. When a post-thyroidectomy patient asks "when will I recover?", I now have a number, 81% of those who will recover will have done so by 6 months. For intubation-related UVFP, that threshold is reached faster. For idiopathic UVFP, the curve is slower and I should counsel accordingly. Also intubation-related UVFP has most chance to recover. Check the Kaplan Myers graphic!

The finding I find most compelling, and most practice-relevant, is the injury location result. The cardiothoracic and thyroid/parathyroid recovery curves essentially overlap. The RLN from the aortic arch to the larynx is a long nerve, yet where you injure it does not predict when it recovers. This, combined with the bimodal model, shifts our mechanistic thinking entirely: it is the grade of injury at the site, not the distance to the larynx, that drives the time course. This directly informs how I counsel patients before and after reinnervation procedures. The clinical implication is that waiting 12 months to declare a case "permanent" is too conservative. The data across this group's body of work consistently show that the vast majority of recoverable UVFP declares itself well within 9 months.

The limitation to keep in mind: recovery timing was captured at clinic visits, not prospectively at fixed intervals, so all reported times are ceiling estimates, not precise recovery dates. The intubation group is also the smallest (n=62). But the qualitative conclusions are robust to these constraints.

By the way, if you are interested with UNVFP please read Ted Mau and his teams paper about this topic. They are worth knowing for your practice.

Also Notable

Aljohani et al. Botulinum Toxin A for Vocal Fold Granuloma: A Systematic Review and Meta-Analysis. Eur Arch Otorhinolaryngol. 2026. DOI​

18 studies, 1,146 patients. Overall complete remission with BTX-A: 87.6%. Recurrence: 6.9%. Subgroup — primary contact granuloma: 91.1%; refractory contact granuloma: 87.4%; refractory intubation-related granuloma: 70.2%(recurrence 19.8%). Adverse events transient in most cases. Hoarseness was the most frequently reported (19.5%), typically resolving by 1 month.

Why it matters: Botulinum toxin injection for granuloma has been part of my practice for years, but the question of "how well does it work and for whom?" always the issue.Also does it really worth the the Hoarseness risk we have after injection. And This meta-analysis gives a partial answer. The most critical finding is the lower remission rate in refractory intubation-related granulomas and their higher recurrence. Which is not surprising because intubation granulomas and contact granulomas are different lesions. That means I can confidently recommend BTX-A for contact granulomas while calibrating expectations downward for intubation-related ones and perhaps consider alternative strategies earlier like surgery. What the study cannot tell us is dosing standardization and optimal injection technique. Objective voice quality data was also largely absent. This meta-analysis answers "does it work?"; the question of "how best to do it?" remains open.

Phonosurgery & Laryngeal Oncology

Reder et al. Three-Year Oncologic Outcomes of 445-nm TruBlue Laser Ablation for Early Glottic Cancer and Dysplasia. J Voice. 2026. DOI​

Retrospective cohort, n=66 (42 dysplasia, 24 SCC). Initial local control: 66.7%. Iterative local control with TruBlue alone: 92.4% (dysplasia 100%, SCC 79.2%). Laryngeal preservation: 100%.

Why it matters: We are among the few centers in Turkey using TruBlue for early glottic lesions. The value here is three-year oncologic data across a spectrum from dysplasia to SCC. The 100% laryngeal preservation rate is impressive but the picture is incomplete. Initial local control was only 66.7%. "One and done" is not the right expectation. I explain this to patients as follows: photoangiolytic laser gives us a repeatable tool we keep the larynx functional while controlling the disease. The unanswered question is long-term oncologic safety in T2 lesions; and being a single-center series, referral bias is a real concern.

I personally do not use it for the primary cases, I use it for the follow ups.

Levi, Shoffel-Havakuk et al. The Reliability of Intraoperative Frozen Section for Glottic Lesions Suspected of Early Malignancy. Otolaryngol Head Neck Surg. 2026. DOI​

Retrospective, 2 centers, n=91 lesions. Accuracy for invasive carcinoma: 94.5%. Sensitivity 92%, specificity 96%, PPV 95%, NPV 94%. Zero false positives.

Why it matters: Skipping preoperative biopsy and proceeding directly to cordectomy speeds up care but the cost of an incorrect decision is high. My biggest concern is not getting positive pathology result but they shared something interesting. Zero false positives is a strong finding. When adequate sampling is achievable, frozen section can guide the decision to proceed with cordectomy. The key caveat is "adequate sampling" far from guaranteed in every case. Performance in diffuse lesions or previously treated tissue remains unaddressed. My preference is still in-office biopsy before surgery.

Airway

Abdou et al. Slide Tracheoplasty Versus Tracheal Resection Anastomosis: A Prospective Pilot RCT. Eur Arch Otorhinolaryngol. 2026. DOI​

n=30 (1:1), grade II–IV acquired tracheal stenosis. Success rates comparable. Slide group: earlier decannulation (12.3 vs 16.3 days, p=0.013), fewer postoperative dilations (13.3% vs 40%).

Why it matters: The first RCT comparing these two approaches. I want to say this clearly: pilot, n=30, single center. Not practice-changing yet. But the earlier decannulation and reduced dilation burden in the slide group is noteworthy. This is the trial to watch as larger multicenter data develops.

Russo et al. Mitomycin C for Airway Stenosis: Systematic Review /Meta Analysis. Ann Otol Rhinol Laryngol. 2026. DOI​

n=358. Stenosis resolution: 76.4%. Median intervention-free interval: 366 days. Evidence insufficient to draw definitive conclusions on MMC efficacy.

Why it matters: Honestly, reading this meta-analysis was not a relief. I use MMC in stenosis cases and have always questioned whether it truly makes a difference. The paper lands on a gentle "we don't know." The 76% resolution looks good but there is no comparator arm. The takeaway: use MMC selectively and with monitoring, not as a default adjuvant. This doesn't say "stop using it"; it says "don't draw firm conclusions without better data."

Imaging & AI

Cheng, Elkhadrawy, Rameau et al. Evaluating Injection Laryngoplasty Skills Using a Foundation Model (Gemini 2.5 Pro). Laryngoscope. 2026. DOI​

Weill Cornell Medicine. n=30 simulated videos. Zero-shot prompting: failed to discriminate skill levels (ρ=0.12). Few-shot prompting: strong correlation with expertise (ρ=0.66, p=0.0002), 44% reduction in mean absolute error.

Why it matters: Reading this, my time at Weill Cornell came to mind immediately. Injection laryngoplasty training has always relied on observation and subjective feedback there is no standardized assessment tool. That Gemini failed zero-shot but worked with few-shot tells me something important: general-purpose AI has no intrinsic surgical judgment, but it can be calibrated with examples into a scalable assessment tool. The real vision for me: could I use my own clinical videos to calibrate a model and scale resident assessment in my clinic? The limitation is a simulator context and small n. Real operative video validation is required first.

By the way If you are interested in AI and Innovation in laryngology, watch out Anais Rameau and her teams work!

Swallowing

Manduchi, Hutcheson et al. Pharyngeal Dysphagia in Cancer: Swallow Targets Across 12 Cancer Types.Dysphagia. 2026. DOI​

MD Anderson, n=6,423, 10,677 MBS studies. Most frequently impaired physiologic component: laryngeal vestibular closure. Dysphagia burden significant across GI and CNS cancers, not only HN cancer.

Why it matters: Systematically characterized swallowing data at this scale outside of HN cancer was essentially nonexistent. The most frequently impaired physiologic component is laryngeal vestibular closure that sits right in the middle of our domain. Knowing cancer type specific profiles should shape rehabilitation targeting beyond the Head Neck. Single-center referral bias is a real limitation; more severe cases are overrepresented.

From Bench to Clinic

Bang et al. hTMSC-Derived Exosomes Alleviate PM2.5-Induced Pyroptosis in Vocal Fold Fibroblasts. J Voice. 2026. DOI​

Cell culture study. PM2.5 triggers caspase-1-dependent inflammatory cell death (pyroptosis) and impairs mitophagy in vocal fold fibroblasts. hTMSC-derived exosomes reversed this damage via mitophagy restoration.

Why it matters: In cases of chronic laryngitis and unexplained dysphonia, I find myself asking more often: "What is this patient breathing?" This study provides a cellular-level mechanistic answer. We can now talk about air pollution's role in laryngeal inflammation with some biological precision. The translational path is long, in vivo animal validation is the next step but the conceptual door it opens is real.

Brief Notes

• AI-Driven Voice Disorder Detection (n=2,613, 2 Belgian centers). Healthy vs pathological: AUROC 0.993. Subtype discrimination weaker (AUROC 0.67–0.76). Promising screening tool. DOI​
• Age Does Not Influence Cancer-Specific Mortality After TOLMS (n=676, IEO Milan). T category and margin status dominate — not age. No evidence to withhold surgery based on chronological age. DOI​
• MTD Voice Therapy: 24-Month Follow-Up (n=55). Gains maintained. Seven therapy-resistant patients identified early — this subgroup needs a different approach. DOI​
• HPV in HN Papillomas + Novel Swab-Based Detection (n=866). Pediatric cases 89% laryngeal; HPV positivity predicts recurrence. Swab test: 95% sensitivity, 100% specificity. DOI​
• VPN-FLUS: Synchronized Laryngeal Ultrasonography (n=53). Addresses reproducibility of conventional laryngeal US; arytenoid kinematics during phonation. Needs validation. DOI​
• Absent UES Opening After Neurological Injury (n=7). Earlier CP intervention (<6 months) linked to markedly better functional outcomes. Aspiration risk persists despite improved opening. DOI​
• Office-Based TruBlue Laser Excision of Vocal Fold Cysts ("How I Do It," Hong Kong). En bloc excision via transnasal flexible endoscopy under local anesthesia. Evidence level low but an important step for the office-based laryngology vision. DOI​

DO NOT FORGET: These are my personal comments and carefully curated reflections, prepared with the aim of contributing to the field of laryngology. If I have misinterpreted anything, please do let me know.

If you find this bulletin useful or enjoyable, I would be grateful for a brief thank-you reply. Your feedback would be a great motivation for me to continue this curation.

Necati Enver, MD

Istanbul Voice Center

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