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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
  1. JY, Joint years; EGFR, epidermal growth factor receptor; OSA, obstructive sleep apnea; HPV, human papillomavirus; HNSCC, head and neck squamous cell carcinoma; OSCC, oral squamous cell carcinoma; OPSCC, oropharyngeal squamous cell carcinoma; OR, odds ratio; N/A, not applicable