The edition · ENT & Head and Neck Surgery
Seventeen years deaf, and the implant still worked
A five-centre cohort undermines duration of deafness as an exclusion for cochlear implantation; word recognition tracks brain amyloid better than the pure-tone average does; and one in three head and neck cancer survivors has no smoking history recorded at all.
The edition in brief
Today's ENT edition opens with hearing and brain amyloid. In 223 adults averaging 65.6 years, worse word recognition was associated with higher amyloid uptake across temporal, parietal, cingulate and right frontal regions and globally, while the pure-tone average reached significance only in the left temporal region — a hint that speech discrimination carries more information about central change than the audiogram does. A systematic review of eleven studies finds frailty in head and neck cancer patients having microvascular free flap reconstruction consistently associated with medical complications, longer stay, non-home discharge, worse swallowing recovery and longer enteral feeding, while associations with surgical complications and short-term mortality were inconsistent; nutritional and sarcopenia-based measures predicted complications better than frailty indices alone. A five-centre retrospective cohort of 68 adults implanted after more than ten years of unilateral severe-to-profound deafness — median 17 years — found a mean word recognition gain of 28.4%, with 54.5% gaining at least 20 points, daily device use of about eight hours, and duration of deafness not predictive of outcome on multivariable analysis. A small randomised trial of prophylactic home exercise during radiotherapy preserved swallowing quality of life and cervical range of motion without worsening facial oedema. The practice-changer is lung cancer screening in head and neck cancer survivors, where more than a third of survivors in a national survey lacked the smoking history needed even to determine eligibility, and expanding the criteria did not raise scanning proportionally.
Word recognition tracks amyloid where the audiogram does not
Treat a word recognition score that is poorer than the audiogram predicts as worth noting, not as a testing artefact — it tracked brain amyloid where the pure-tone average largely did not.
Frailty predicts the recovery, not the flap
Assess frailty with a nutritional or sarcopenia measure before free flap reconstruction, and use it to plan the admission and the discharge rather than to decide whether to operate.
Long-standing single-sided deafness is not an exclusion
A decade or more of single-sided deafness is not a reason to withhold cochlear implant assessment — refer, and counsel on a wide range of outcomes.
Exercising through radiotherapy held the swallow
Start a home-based swallowing, posture and neck mobility programme when radiotherapy starts — it preserved function in this trial and did not worsen facial oedema.
Look at the other side of the neck before you close the clinic letter
Use a fixed examination sequence for any neck lump — both necks, tongue base and floor of mouth by palpation, then full nasendoscopy — and record the normal findings in the letter.
A third of head and neck cancer survivors have no smoking history on record
Record a structured smoking history at the first survivorship visit and check lung screening eligibility at every review — a third of survivors cannot even be assessed for eligibility because the history was never captured.
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