International Rhinologic Society Rhinology 0300-0729 2026 03 17 Regarding “Endoscopic surgery versus conservative treatment in nasopharyngeal carcinoma patients with nasopharyngeal necrosis”: the potential confounding role of nutritional support EN W-Z Hong Department of Otorhinolaryngology Head and Neck Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong, China Journal Article 3437 10.4193/Rhin25.622 We read with great interest the article by Ouyang et al. in a recent issue of Rhinology, which compares the effectiveness of endoscopic surgery and conservative therapy for nasopharyn-geal necrosis (NN) in patients with nasopharyngeal carcinoma (NPC). The authors are to be commended for their rigorous work on a large cohort, employing propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) to balance baseline characteristics. Their conclusion that endo-scopic surgery offers superior overall survival (OS) compared to conservative treatment, particularly for middle necrosis, provi-des a crucial benchmark for managing this severe complication.