“… 172 , 173 In the larynx, rats exposed to e‐cig aerosols showed early evidence of hyperplasia and metaplasia of the mucosa, 174 although the results were not statistically significant in this limited study, and increases in IL‐4. 175 In addition, both nicotine‐containing and nicotine‐free e‐juice have been found to cause biologic disruptions including oxidative stress, DNA breakage, metanuclear anomalies, liposomal dysfunction, and solvent and lipid accumulation, and cytotoxicity in human gingival fibroblasts, 67 , 176 , 177 , 178 , 179 , 180 vocal fold epithelial cells and fibroblasts, 181 , 182 head and neck squamous cell carcinoma cell lines, 67 , 183 , 184 , 185 noncancerous oral and oropharyngeal epithelial cells, 139 , 178 , 186 , 187 , 188 , 189 , 190 , 191 , 192 middle ear epithelial cells, 193 , 194 , 195 nasal epithelial cells, 196 , 197 and organotypic cultures/organoids. 178 , 182 , 197 Interestingly, a recent study found that oral cancer cells exposed to e‐cig aerosols increased cell resistance to cisplatin through changes in drug transporters, suggesting a mechanism for e‐cig‐induced chemotherapy resistance.…”