Table 1 Studies reporting risk of otolaryngology-related side effects following cannabis exposure
From: Cannabis related side effects in otolaryngology: a scoping review
Study | Study type | Level of evidence | Subspeciality | No. of participants | Sex | Tobacco use | Cannabis use | Main findings |
|---|---|---|---|---|---|---|---|---|
Ahrens and Bressi [16] | Case series | 4 | Head and neck | 5 | 60% M | 80% | 100% | 5/5 marijuana users developed an erythroplastic lesion, and 2/5 users were determined to have a malignant lesion |
Ahrens and Bressi [17] | Case series | 4 | Head and neck | 178 | 57% M | 100% | 22% | 10/39 tobacco and marijuana users developed oral cancer |
Aldington et al. [18] | Case–control | 4 | Head and neck | 394 | 51% M | 53% | 14% | The highest tertile of cannabis use (> 8.3 JY) was associated with a nonsignificant increased risk of cancer (RR = 1.6; 95%CI 0.5–52) |
Berthiller et al. [19] | Case–control | 4 | Head and neck | 9044 | 74% M | 74% | 13% | No association with marijuana use and risk of H&N cancer observed (OR = 0.88; 95%CI 0.67–1.16) |
Bhattacharyya et al. [20] | Cross-sectional | 4 | Head and neck | 83 | 100% M | 57% | 30% | Overexpression of EGFR onco-proteins is correlated to cannabis smoking (p < 0.01) |
Bonnet [21] | Cross-sectional | 4 | Head and neck | 39 | 80% M | N/A | 100% | All tested patients were found to have TSH, total T3, and free T4 levels within the normal range |
Brumbach et al. [22] | Cross-sectional | 4 | Otology | 40 | 48% M | 0% | 50% | No significant difference was observed in behavioural hearing thresholds between smokers and nonsmokers (p > 0.05) |
Carley et al. [23] | RCT | 2 | Airway | 73 | 71% M | N/A | 66% | The proportion of adverse events did not differ between the OSA patients in the placebo and treatment groups (p = 0.16) |
Cook et al. [24] | Cross-sectional | 4 | Head and neck | 1, 010 | 100% F | 5% | 4% | Oral HPV infection were associated with smoking marijuana (p = 0.03) |
Darling and Arendorf [25] | Cohort | 3 | Head and neck | 579 | N/A | 71% | 46% | Cannabis users did not show greater prevalence of leukoplakia when compared with control groups |
Darling et al. [26] | Cohort | 3 | Head and neck | 48 | 100% M | 67% | 33% | No significant difference in the effect of cannabis on the epithelial cells of the oral cavity |
Darling et al. [27] | Cross-sectional | 4 | Head and neck | 163 | N/A | 69% | 34% | Cannabis smoking significantly increases the prevalence of oral C. albicans compared to tobacco only smokers and non-smokers (p = 0.022) |
Donald [28] | Case series | 4 | Head and neck | 6 | 100% M | 66% | 100% | Chronic marijuana use may be a contributor to H&N cancer production in young patients |
Feng et al. [29] | Case–control | 4 | Head and neck | 1, 251 | 69% M | 41% | 6% | Ever consumption of cannabis was significantly associated with increased nasopharyngeal carcinoma risk (p < 0.025) |
Gillison et al. [30] | Case–control | 4 | Head and neck | 562 | 79% M | 86% | 18% | Marijuana smoking was strongly associated with HPV-16-positive HNSCC in a dose–response relationship (OR = 4.7; 95%CI 1.3–17) |
Han et al. [31] | Cross-sectional | 4 | OtologyRhinologyAirway | 29, 195 | N/A | 19% | 39% | Marijuana use increases the occurrence of sinusitis (OR = 1.23; 95%CI 0.99–1.28), but has no effect on sleep apnea (OR = 1.20; 95%CI 0.92–1.56) and tinnitus (OR = 1.14; 95%CI 0.77–1.70) |
Hashibe et al. [32] | Case–control | 4 | Head and neck | 2, 252 | 61% M | 65% | 54% | No association observed between marijuana use and oral (OR = 1.1; 95%CI 0.8–1.5), pharyngeal (OR = 0.75; 95%CI 0.37–1.5), or laryngeal (OR = 0.93; 95%CI 0.5–1.7) cancer |
Henderson et al. [33] | Case series | 4 | Rhinology | 200 | 100% M | 90% | 100% | 26/200 patients presented with rhinitis and 150/200 patient had symptoms of pharyngitis |
Herning et al. [34] | Cross-sectional | 4 | Head and neck | 108 | 60% M | N/A | 69% | Marijuana users that used for > 8 years had lower T4 (p < 0.01) and higher T3 uptake (p < 0.05) levels compared to short term marijuana users |
Hess et al. [35] | Case–control | 4 | Head and neck | 162 | 88% M | N/A | 43% | HPV-negative patients has higher rates of marijuana use compared to HPV-positive patients (p = 0.003) |
Kagen et al. [36] | Cross-sectional | 4 | Head and neck | 38 | 43% M | 64% | 74% | Marijuana smoking sensitizes patients to Aspergillus |
Liang et al. [37] | Case–control | 4 | Head and neck | 981 | 73% M | 73% | 27% | Moderate marijuana use (10–20 years) was associated with a reduced risk of HNSCC (OR = 0.52; 95%CI 0.34–0.89) |
Liedgren et al. [38] | RCT | 2 | Otology | 30 | 77% M | N/A | 100% | Marijuana has no effect on hearing acuity as assessed by pure tone threshold, speech reception threshold, speech discrimination, and acoustic impedance measurement |
Llewellyn et al. [39] | Case–control | 4 | Head and neck | 323 | 56% M | 69% | 11% | No significant association between cannabis use and oral cancer (OR = 1.0; 95%CI 0.5–2.2.) |
Llewellyn et al. [40] | Case–control | 4 | Head and neck | 144 | 53% M | 69% | 13% | No significant association between cannabis use and oral cancer (OR = 0.3; 95%CI 0.1–1.8.) |
Malhotra et al. [41] | Cross-sectional | 4 | Head and neck | 5, 280 | 50% | N/A | 55% | Recent marijuana use was not associated with thyroid dysfunction, but was significantly associated with lower levels of TSH (0.344; 95%CI 0.127–0.928) |
Marks et al. [42] | Case–control | 4 | Head and neck | 9, 916 | 71% M | 66% | 16% | Marijuana use was associated with an elevated risk of oropharyngeal cancer (OR = 1.24; 95%CI 1.06–1.47), and a reduced risk of oral tongue cancer (OR = 0.47; 95%CI 0.29–0.75). Possible association with HPV |
Mueller and Wilcox [43] | Cross-sectional | 4 | Laryngology | 35 | 26% M | 29% | 40% | Marijuana users did not differ perceptually from nonsmokers and tobacco smokers in vocal pitch, vocal quality, and fundamental frequency; however, users had darker vocal cords on indirect laryngoscopy |
Mulheran et al. [44] | RCT | 2 | Otology | 8 | 100% M | N/A | 100% | THC does not appear to have a profound effect on the processing of elementary stimuli by the auditory pathway as assessed by pure tone audiometry |
Muller et al. [45] | Case–control | 4 | Head and neck | 289 | 53% M | 70% | 48% | Marijuana use was associated with oral HPV detection in HIV-negative patients (OR = 4.0; 95%CI 1.3–12.4), but not HIV-positive patients |
Newman et al. [46] | Cross-sectional | 4 | Head and neck | 39 | 85% M | N/A | 51% | Marijuana use was associated with a change of the oral microbiota at the oral pharyngeal site that were more consistent with cancer |
Parshad et al. [47] | Case–control | 4 | Head and neck | 56 | 100% M | 0% | 100% | Serum T3 levels were lower in smokers compared to non-smokers (p < 0.05) |
Prasad et al. [48] | Case series | 4 | Airway | 17 | 35% M | N/A | 100% | Dronabinol treatment is safe and significantly reduces the apnea–hypopnea index in patients with sleep apnea (p = 0.003) |
Rosenblatt et al. [49] | Case–control | 4 | Head and neck | 1, 022 | 71% M | 78% | 25% | No association observed between marijuana use and OSCC (OR = 0.9; 95%CI 0.6–1.3) |
Shah et al. [50] | Case–control | 4 | Head and neck | 1, 000 | 80% M | 27% | 1% | Patients with head and neck cancer were more likely to smoke marijuana (OR = 1.6) |
Spector [51] | RCT | 2 | Otology | 72 | N/A | N/A | 100% | No vestibular effect was observed after smoking marijuana |
Spector [52] | Cross-sectional | 4 | Otology | 89 | 56% | N/A | 73% | No auditory differences observed between chronic marijuana users and controls, but significant changes in vestibular function seen in chronic marijuana users as assessed by electronystagmography |
Stokes et al. [53] | Cohort | 3 | Rhinology | 127 | N/A | N/A | N/A | 78/128 patients were skin test positive to cannabis, and 22/30 of the patients with positive skin testing has respiratory symptoms consistent with allergic rhinitis |
Tashkin et al. [54] | Cohort | 3 | Airway | 299 | 67% M | 69% | 93% | Compared to nonsmokers, marijuana smokers did not report a significantly increased percentage of dyspnea |
Taylor [55] | Case series | 4 | Head and neck | 10 | 60% M | 60% | 70% | 7/10 patients with respiratory tract carcinoma were marijuana users |
Tennant et al. [56] | Cohort | 3 | Rhinology | 31 | 100% M | 68% | 100% | 12/31 hashish users presented with symptoms of rhinopharyngitis |
Weich et al. [57] | Cross-sectional | 4 | Otology | 17 | N/A | N/A | 59% | 7/17 users reported hearing loss; 6/17 users reported dizziness; 6/17 users reported tinnitus |
Winton-Brown et al. [58] | RCT | 2 | Otology | 14 | 100% M | N/A | 100% | THC attenuated activation in the primary and secondary auditory regions of the brain bilaterally relative to placebo (p = 0.0006) |
Xie et al. [59] | Case–control | 4 | Head and neck | 879 | 72% M | 52% | 8% | A higher rate of oropharynx cancer was observed within marijuana users (p < 0.0001); marijuana users had a higher rate of HPV-16 positive oropharyngeal cancer (p = 0.002) |
Zhang et al. [60] | Case–control | 4 | Head and neck | 349 | 63% M | 72% | 12% | The risk of HNSCC is increased with marijuana use compared to no use in a dose–response relationship (OR = 2.6; 95%CI 1.1–6.6) |
Zhang et al. [61] | Case–control | 4 | Head and neck | 284 | 64% M | 76% | 11% | Marijuana use combined with environmental tobacco smoke exposure is a potential risk factor for HNSCC (OR = 7.1; 95%CI 1.5–34.5) |
Zhang et al. [62] | Cohort | 3 | Head and neck | 94 | 81% M | 24% | 50% | No survival difference between HPV-related OPSCC marijuana users and non-users in 2-year and 5-year survival (p = 0.400) |
Zuskin et al. [63] | Cross-sectional | 4 | AirwayRhinology | 190 | 24% M | 34% | 100% | Male and female hemp works experienced a significantly higher prevalence of sinusitis compared to controls; female works also experienced a higher prevalence of dyspnea |