The edition · ENT & Head and Neck Surgery
Hearing that can still be recovered, a larynx that does not settle, and steroids after tonsillectomy
Pooled data suggest antivirals started after the neonatal period still improve hearing in congenital CMV; a 180-million-record cohort finds laryngeal symptoms peaking one to two years after COVID-19; and a quadruple-blind trial cuts opioid prescriptions after paediatric adenotonsillectomy.
The edition in brief
A single-arm meta-analysis of eight studies and 192 children found that valganciclovir or ganciclovir started after the first month of life in congenital cytomegalovirus reduced urine viral load at two months (pooled mean difference -3.67 log, 95% CI -4.33 to -3.02) and, among ears with hearing loss, was followed by normalisation in 42.3% (13.5-77.5) and improvement in 38.5% (16.8-66.0), with deterioration in 5.5% and grade 3-4 neutropenia in 3.7% - all with very high heterogeneity and no control arm. A retrospective cohort in a global electronic health record network found COVID-19 associated with higher odds of chronic cough (peak odds ratio 7.12), dysphagia (2.71), voice disorders (3.25), vocal fold paralysis (2.17) and laryngeal spasm (2.79), peaking one to two years after infection, though absolute risk differences were well under half a percentage point. An American Head and Neck Society review sets out where circulating tumour DNA stands in head and neck cancer - promising for HPV-associated oropharyngeal and Epstein-Barr virus-associated nasopharyngeal disease, but with test variability and the consequences of false results still unresolved. A retrospective series of 48 emergency cricothyrotomies reports 20.8% in-hospital and 29.2% ninety-day mortality, dysphagia in 35.4%, later subglottic stenosis in 12.5%, and pneumonia associated with delayed conversion to tracheostomy (3.9 against 1.4 days). And a quadruple-blinded randomised trial of oral dexamethasone on postoperative days 2, 4 and 6 after paediatric adenotonsillectomy reduced opioid prescribing (odds ratio 0.23, 95% CI 0.06-0.84) with no increase in bleeding.
Antivirals started after the neonatal window still improved hearing in congenital CMV
A child with congenital CMV and hearing loss diagnosed after the neonatal period is still worth discussing for antiviral treatment - but confirm the diagnosis first, and describe the benefit as uncertain rather than established.
Laryngeal symptoms after COVID-19 peaked one to two years later, not in the acute phase
New dysphonia or chronic cough one to two years after COVID-19 fits a recognised timing pattern - but investigate it exactly as you would any new laryngeal symptom.
Where circulating tumour DNA actually stands in head and neck cancer
Circulating tumour DNA is a test to follow, not yet to act on - keep surveillance clinical and radiological, and do not treat on a liquid biopsy result alone.
After an emergency cricothyrotomy, the complications are mostly swallowing and voice
Book ENT follow-up for every cricothyrotomy survivor before they leave the trauma service - one in eight developed subglottic stenosis and one in five persistent dysphagia.
A failed newborn hearing screen has a clock on it
When a newborn hearing screen refers, book the diagnostic appointment before the family leaves and send the CMV PCR within three weeks - after that, the test cannot tell you when the infection happened.
A short course of oral dexamethasone after paediatric adenotonsillectomy cut opioid prescriptions
Consider a three-dose oral dexamethasone course after paediatric adenotonsillectomy and audit bleeding alongside it - the pain benefit was modest and imprecise, but unplanned returns for pain fell and haemorrhage did not rise.
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