JAMA Otolaryngology–Head and Neck Surgery contains some of the notable studies which were presented at this year’s Annual Meeting of the American Head and Neck Society (AHNS). While the meeting may have been fairly typical in many respects, it certainly felt atypical (in a good way) in that attendees were able to attend in person en masse for the first time in 2 years following COVID-19–related restrictions. Walking through the meeting hall, it was impossible not to feel the energy of friendly interactions and reconnections.

The discrepancy between this cheerful event and the despair felt during the depths of the pandemic prompted me to reflect. The period since early 2020 when we were first confronted with the COVID-19 pandemic has resulted in previously unseen change and growth. When we think back to the early, harrowing days of the pandemic, it is hard to imagine how rapidly our jobs and environments were changing. It was, in retrospect, an extremely important time for the field of otolaryngology. Early in the pandemic, it became clear that viral transmission was occurring via aerosols generated in the very areas where we spent most of our time performing physical examinations: the nasal cavity, pharynx, and oral cavity. How would we respond to care for patients in this time of so many unknowns while recognizing that one of the biggest unknowns was our own safety? This question was compounded by the lack of personal protective equipment experienced in so many parts of the country.

Looking back now, the response by otolaryngologists, and health care workers in general, was nothing short of astounding. As a profession, we immediately set out to do what we do best: study, learn, and provide the best possible care for patients. Members of our field demonstrated creativity in developing innovative methods to protect ourselves with new draping methods during mastoidectomy, during which virus in the middle ear was possibly aerosolized.1 For tracheostomy, new protocols were proposed and quickly validated to reduce the risk of aerosols during entrance to the airway.2 The latter protocols became particularly important as we came to understand that COVID-19 frequently led to prolonged ventilator dependence such that many patients would need a tracheostomy performed by otolaryngologists.

For head and neck oncologists, the struggle to provide the best possible care for patients while faced with shutdowns in the operating room immediately became apparent. Again, we took action by triaging patients to radiation therapy when appropriate and surgery when and where possible. Members of our field took a data-driven approach to understand the impact of delaying treatment for various forms of head and neck cancer.3 All of these initiatives were done in service of our primary goal: delivering excellent patient care, even when faced with challenging conditions.

As we slowly moved out of crisis mode, head and neck oncologists got back to producing influential, if sometimes controversial, studies pertaining to multiple evolving areas in our field. For example, in the last 2 years we have seen the publication of 2 important studies investigating the management of oropharyngeal cancer. The ORATOR2 study4 reported a randomized comparison of reduced-dose radiation therapy and chemotherapy with surgery with or without reduced-dose irradiation for human papillomavirus (HPV)-positive oropharyngeal cancer. While it represented a step forward in initiating randomized trials with a surgical arm, its impact is limited by early stoppage (due to deaths in the surgical arm, which may not approximate the experience at many centers) after 68 enrollments, the use of tracheostomy in all surgical patients, and mild functional outcome differences between groups that diminished over time. In addition, the ECOG 3311 outcomes were published,5 and the researchers found that patients with intermediate-risk HPV-positive oropharyngeal cancer who received treatment as part of a deintensification strategy had outcomes that compared favorably to historical data while also developing a novel surgeon credentialing system. Furthermore, 2 important studies in The Lancet showed us that cetuximab was inferior to traditional chemoradiotherapy in the management of HPV-positive oropharyngeal cancer.6,7 Lastly, a new surgical trial investigating sentinel node biopsy in oral cancer has been initiated as we continue to push forward.

JAMA Otolaryngology–Head and Neck Surgery has published several studies that were presented at the 2022 AHNS meeting. These include a study examining the relationship between tumor bed–sourced frozen sections and final pathological margins,8 which showed poor correlation between the two. Another study examined the results of checkpoint inhibition outside of clinical trials.9 The latter work is particularly pertinent given the rapid uptake of these agents at many institutions.

The works mentioned and other AHNS studies appearing in JAMA Otolaryngology–Head and Neck Surgery provide ample evidence that our field has continued to push forward both during and after the COVID-19 pandemic. It is indeed an exciting time to practice head and neck oncology. The treatment paradigms for patients continue to evolve through new ideas, technology, and the relentless pursuit of better outcomes. We have learned a great deal over the last 2 ½ years, through the lowest of lows and great highs, and now have every reason to be optimistic as we continue to advance our work.

Corresponding Author: Samir S. Khariwala, MD, MS, Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, MMC 396, 420 Delaware St SE, Minneapolis, MN 55455 (khari001@umn.edu).

Published Online: September 8, 2022. doi:10.1001/jamaoto.2022.2730

Conflict of Interest Disclosures: None reported.

Disclaimer: Dr Khariwala is Deputy Editor of JAMA Otolaryngology–Head & Neck Surgery but was not involved in any of the decisions regarding review of the manuscript or its acceptance.

4.Palma  DA, Prisman  E, Berthelet  E,  et al.  Assessment of toxic effects and survival in treatment deescalation with radiotherapy vs transoral surgery for HPV-associated oropharyngeal squamous cell carcinoma: the ORATOR2 phase 2 randomized clinical trial.   JAMA Oncol. 2022;8(6):1-7. doi:10.1001/jamaoncol.2022.0615PubMedGoogle ScholarCrossref 5.Ferris  RL, Flamand  Y, Weinstein  GS,  et al.  Phase II randomized trial of transoral surgery and low-dose intensity modulated radiation therapy in resectable p16+ locally advanced oropharynx cancer: an ECOG-ACRIN Cancer Research Group trial (E3311).   J Clin Oncol. 2022;40(2):138-149. doi:10.1200/JCO.21.01752PubMedGoogle ScholarCrossref 6.Mehanna  H, Robinson  M, Hartley  A,  et al; De-ESCALaTE HPV Trial Group.  Radiotherapy plus cisplatin or cetuximab in low-risk human papillomavirus-positive oropharyngeal cancer (De-ESCALaTE HPV): an open-label randomised controlled phase 3 trial.   Lancet. 2019;393(10166):51-60. doi:10.1016/S0140-6736(18)32752-1PubMedGoogle ScholarCrossref 7.Gillison  ML, Trotti  AM, Harris  J,  et al.  Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial.   Lancet. 2019;393(10166):40-50. doi:10.1016/S0140-6736(18)32779-XPubMedGoogle ScholarCrossref 8.Long  SM, Mclean  T, Valero Mayor  C,  et al.  Use of intraoperative frozen section to assess final tumor margin status in patients undergoing surgery for oral cavity squamous cell carcinoma.   JAMA Otolaryngol Head Neck Surg. Published online August 4, 2022. doi:10.1001/jamaoto.2022.2131PubMedGoogle ScholarCrossref 9.Hobday  SB, Brody  RM, Kriegsman  B,  et al.  Outcomes among patients with mucosal head and neck squamous cell carcinoma treated with checkpoint inhibitors.   JAMA Otolaryngol Head Neck Surg. Published online August 18, 2022. doi:10.1001/jamaoto.2022.2284Google ScholarCrossref