The edition · ENT & Head and Neck Surgery
The shape of the first audiogram tells you who will recover from sudden deafness
In 487 patients with idiopathic sudden sensorineural hearing loss, complete recovery ran from half of ascending curves to none of the totally deaf ears; a nebulised tranexamic acid protocol cut the need to take children back to theatre for post-tonsillectomy bleeding by two-thirds; and HPV vaccination in the target age group has fallen by nearly half since 2016.
The edition in brief
A single-centre retrospective cohort of 487 adults with unilateral idiopathic sudden sensorineural hearing loss classified the first pure-tone audiogram as ascending, flat, descending or totally deaf. Complete recovery occurred in 16.4 per cent overall but varied from 50.0 per cent of ascending curves and 25.2 per cent of flat ones to 9.8 per cent of descending and none of the totally deaf; descending configuration carried an odds ratio of 0.25 (95 per cent CI 0.15 to 0.42) and total deafness 0.05 (0.01 to 0.22) for complete recovery, with a model area under the curve of 0.78. An analysis of 19.6 million HPV vaccinations recorded in a US national database between 2007 and 2023 found vaccination in those aged 9 to 26 fell by 47.1 per cent between 2016 and 2023 despite broadened indications, with males now half of paediatric vaccinations but a much smaller share among adults. In the All of Us cohort of 338,048 adults, bilateral conductive hearing loss carried 2.05 times the odds of dementia (95 per cent CI 1.18 to 3.32) after adjustment, and adding surgical or device treatment to the model reduced that only marginally. A prospective controlled study of 67 patients with laryngopharyngeal reflux found reduced salivary microbial diversity and raised elastase against 44 controls. A two-cycle quality improvement project in 501 children cut the proportion needing surgical control of post-tonsillectomy haemorrhage from 43.9 to 15.2 per cent after a standardised nebulised tranexamic acid protocol, with no change in transfusions, readmissions or complications.
Audiogram shape is a prognostic marker in sudden sensorineural hearing loss
The shape of the first audiogram in sudden sensorineural hearing loss separates a 50 per cent chance of complete recovery from none, so counsel patients from their own configuration rather than the average.
HPV vaccination is falling in exactly the group head and neck surgeons need it to rise in
HPV vaccination in the 9-to-26 age group fell 47.1 per cent between 2016 and 2023 even as head and neck cancer became a designated indication - name that indication explicitly rather than relying on cervical cancer messaging to reach men.
Conductive hearing loss tracks with dementia, which is an argument about mechanism
Bilateral conductive hearing loss carried double the odds of dementia in a 338,000-person cohort, which strengthens the case that hearing loss itself matters cognitively - but the design cannot show that treating it helps.
Laryngopharyngeal reflux comes with a different salivary microbiome - which is not yet a test
Patients with impedance-proven laryngopharyngeal reflux showed reduced salivary microbial diversity and raised elastase against controls, which is a mechanistic finding rather than the basis for any new test.
Sudden deafness is an emergency, and a tuning fork settles it in a minute
One-sided sudden hearing loss with a normal drum and Weber lateralising to the better ear is sudden sensorineural hearing loss - start steroids the same day and arrange the audiogram and MRI afterwards.
A nebulised tranexamic acid protocol cut returns to theatre for post-tonsillectomy bleeding by two-thirds
Implementing a standardised nebulised tranexamic acid protocol for paediatric post-tonsillectomy haemorrhage cut the need for surgical control from 43.9 to 15.2 per cent with no increase in transfusions, readmissions or complications.
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