GLP-1 Receptor Agonists in Ear, Nose and Throat: A Review of Clinical Implications, Side Effects and High-Risk Airway Surgery Considerations

OBJECTIVE: Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are a rapidly proliferating class of drugs used for diabetes and obesity management. Their use poses several implications for ear, nose and throat (ENT) surgeons, including high-risk airway surgery considerations. This review highlights pharmacological mechanisms, ENT-specific side effects and perioperative challenges. METHODS: A narrative review was performed with comprehensive literature search across PubMed and Google Scholar (2000-2025). International anaesthetic, surgical and endoscopic guidelines were reviewed and synthesised to compare management strategies. RESULTS: GLP-1 RAs function to regulate glucose, reduce appetite and slow gastric emptying, increasing aspiration risk during airway surgery. ENT clinical implications include patulous eustachian tube dysfunction, nasopharyngitis and improvement in sleep apnoea and emerging sinus surgery outcomes. Pre-clinical data suggest a theoretical medullary thyroid cancer risk. Despite endoscopy data showing increased residual gastric content, no studies specifically address risks in airway surgery. Peri-operative guidelines vary, and this review reports the range of recommendations from major international anaesthetic organisations. CONCLUSION: ENT surgeons must recognise GLP-1 RA associated risks, especially during tubeless airway surgery. An individualised, team-based approach may be necessary for patients, as current guidelines do not reach consensus. ENT side effects of eustachian tube dysfunction, and theoretical risk of medullary thyroid cancer still needs further investigation.