The edition · ENT & Head and Neck Surgery
Fewer cervical fusions, more dysphagia after them
Across nearly half a million admissions, ACDF volume fell by 57% while the odds of postoperative dysphagia rose 11% a year — the operations left are the harder ones. Also: what temporal bone histopathology says about implanting after otogenic meningitis, voice fatigue in vapers, and a hoarseness guideline that changed nothing.
The edition in brief
A Nationwide Inpatient Sample analysis of 496,425 elective anterior cervical discectomy and fusion hospitalisations from 2016 to 2022 found dysphagia in 7.7%. Inpatient ACDF volume fell 57.3% while the odds of dysphagia rose an estimated 11.4% annually (OR 1.11, 95% CI 1.09-1.13). Independent predictors were cervical diffuse idiopathic skeletal hyperostosis (OR 5.41, 3.81-7.67), cervical spine fracture (1.73, 1.31-2.30) and pseudarthrosis (1.36, 1.15-1.61), along with higher comorbidity burden, racial minority status and care at urban teaching hospitals. Dysphagia was associated with more aspiration pneumonia, gastrostomy and tracheostomy. A study of 36 archival human temporal bones compared cochlear and vestibular cell loss after otogenic and meningogenic meningitis against age-matched controls. Outer hair cell loss occurred in both groups but was worse after otogenic infection (p = 0.01). Inner hair cell loss occurred only in the otogenic group (p = 0.019 versus meningogenic, p < 0.001 versus controls). Spiral ganglion and Scarpa's ganglion neurons were reduced in both meningitis groups with no difference between routes. A survey of 130 e-cigarette users and 130 age- and gender-matched non-smokers found higher voice fatigue on a visual analogue scale (2.01 versus 0.53, p < 0.001) and more running out of air when speaking (0.72 versus 0.34, p < 0.001). In an 80-participant subgroup, Xerostomia Inventory scores were 22.35 versus 15.95, and correlated with voice fatigue (beta 0.656, adjusted p < 0.001). A retrospective cohort of 528 dysphonia referrals to an academic otolaryngology department found adherence to the 2018 hoarseness guideline did not improve after publication and fell for timely referral, avoiding pre-laryngoscopy imaging and avoiding antibiotics.
ACDF volumes are falling and dysphagia rates are climbing
Inpatient ACDF fell 57% while dysphagia odds rose about 11% a year to a 7.7% rate — most likely because the remaining inpatient cases are the hard ones, with cervical DISH the strongest predictor to identify before surgery.
The route the meningitis took decides how much cochlea is left
After otogenic meningitis both inner and outer hair cells were more severely lost than after meningogenic infection, though spiral ganglion neuron loss was equal — so the route predicts residual natural hearing, not implant substrate.
Vapers report voice fatigue, and it tracks with a dry mouth
E-cigarette users reported substantially more voice fatigue than matched non-smokers, and it correlated with xerostomia — enough to ask about vaping and check for dry mouth in any voice fatigue presentation.
Hoarseness in a smoker is a scope, not a trial of treatment
Look at the larynx before you treat a hoarse voice — beyond four weeks in anyone, and immediately with tobacco, alcohol, a neck lump, referred otalgia, dysphagia or stridor.
Publishing a hoarseness guideline changed referral behaviour — slightly for the worse
Four years after the hoarseness guideline, referral adherence had not improved on any measure and had fallen on three — build the recommendations into the referral pathway, because publishing them achieved nothing.
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