The edition · ENT & Head and Neck Surgery
Two in five head and neck cancer survivors develop chronic rhinosinusitis
Pooled data from 17 studies put the incidence at 37 per cent overall and 45 per cent after nasopharyngeal cancer, with radiotherapy the main driver; single-sided deafness turns out to predict who stops wearing a cochlear implant; and a device that logs under four hours a day is the strongest warning sign in paediatric bone conduction.
The edition in brief
Seventeen studies covering 3685 adults treated for head and neck cancer were pooled to estimate how often chronic rhinosinusitis follows. The overall incidence was 0.37 (95 per cent CI 0.27 to 0.47), rising to 0.45 after nasopharyngeal cancer against 0.18 for other sites. Maxillary sinuses were involved in 0.60 of cases and ethmoids in 0.45. Radiotherapy raised the risk (log odds ratio 1.46, 95 per cent CI 0.76 to 2.16, roughly a fourfold increase in odds), and the effect was stronger in nasopharyngeal disease. A commentary on neoadjuvant immunotherapy for resectable locally advanced mucosal head and neck squamous cell carcinoma argues that heterogeneous tumour regression and unreliable response assessment make it unsafe to de-escalate surgery on the basis of treatment response until prospective evidence exists. A cross-sectional study of 172 cognitively unimpaired adults aged 50 to 80 found worse hearing associated with poorer gait on all three composite measures unadjusted, but the association fell to borderline or non-significant after adjusting for age and sex and correcting for multiple comparisons. A review of 127 children with microtia and aural atresia found unilateral hearing loss, age over 11 and public or absent insurance predicted poor adherence to bone conduction devices, with under four hours of daily datalogged wear the strongest single marker. Among 360 adult cochlear implant recipients, only 50 per cent of those with single-sided deafness reached eight hours of daily use against 82 per cent with bilateral non-serviceable hearing.
Chronic rhinosinusitis follows head and neck cancer treatment in more than a third of patients
More than a third of head and neck cancer patients develop chronic rhinosinusitis after treatment, and nearly half of those treated for nasopharyngeal carcinoma - so ask about sinonasal symptoms at survivorship follow-up instead of attributing them to radiation.
Do not shrink the operation because the tumour shrank
A good radiological response to neoadjuvant immunotherapy is not yet a reason to reduce the resection - regression is heterogeneous and response assessment unreliable, so plan margins to the pre-treatment extent.
Hearing and gait: an association that did not survive its own adjustment
Worse hearing tracked with poorer gait until age and sex were accounted for, at which point the association became borderline or vanished - treat hearing loss and mobility as separately assessed rather than causally linked.
In microtia, the child who hears on one side is the one who stops wearing the device
In children with microtia, under four hours a day of datalogged wear carried 33 times the odds of poor adherence, and unilateral hearing loss and age over 11 were the other main risks - so read the datalog at every visit.
Unilateral means scope it
Unilateral nasal obstruction, unilateral epistaxis or a unilateral middle-ear effusion in an adult requires nasendoscopy of the postnasal space before any treatment - and never a grommet without that look.
Single-sided deafness changes how a cochlear implant is used, and how it should be followed
Cochlear implant recipients with a normal contralateral ear reach full-time use half as often, score lower on word recognition through the first year, and cannot be predicted from one-month performance - counsel and follow them differently from the start.
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