The edition · ENT & Head and Neck Surgery
Half the patients sent for thyroid compression had something else
In 214 referrals for compressive symptoms, reflux and laryngeal muscle tension were the commonest alternative diagnoses — and orthopnoea, not globus, was the symptom that predicted a good surgical outcome. Plus who actually wears a cochlear implant, what a 3D-printed temporal bone does to a trainee, and a hearing-and-gait signal that vanished on adjustment.
The edition in brief
Today's ENT edition opens with a ten-year single-centre review of 214 patients referred for aerodigestive symptoms attributed to thyroid nodules, goitre or cysts. Eighty-two (38%) had surgery and 83% of those improved. Among the 110 not offered surgery, globus and dysphagia were the commonest complaints, and the commonest alternative diagnoses were gastro-oesophageal reflux (36%) and laryngeal muscle tension (23%). Median nodule volume was 36.41 cm³ in those operated on against 6.38 cm³ in those not. Dyspnoea and orthopnoea both predicted a surgical recommendation, and orthopnoea carried the highest postoperative resolution rate at 91%. A longitudinal cohort of 360 adult cochlear implant recipients classified by contralateral pure-tone average found that single-sided deafness recipients used their device far less: full-time use of eight hours or more daily was reached by 50%, against 82% of those with bilateral non-serviceable hearing loss. Single-sided deafness was the only independent predictor of limited use (OR 4.38, 95% CI 2.03-9.48), and one-month performance predicted twelve-month outcome in the other groups but not in this one. A randomised trial of intraoperative patient-specific 3D-printed temporal bones in 40 cochlear implantations found lower cognitive load for attendings (3.8 versus 5.5) and higher for residents (7.2 versus 4.8). And in 172 cognitively unimpaired adults, the association between worse hearing and poorer gait did not survive adjustment.
Single-sided deafness recipients are the ones who stop wearing the implant
Give single-sided deafness implant recipients configuration-specific counselling and closer surveillance from activation, and read their datalogging rather than their early speech scores.
A 3D-printed temporal bone helps the consultant and loads the trainee
Use patient-specific 3D-printed temporal bones selectively, for experienced surgeons intraoperatively and for trainees outside theatre.
Hearing and gait: an association that did not survive adjustment
Treat the link between hearing loss and gait decline as unproven, and do not offer it as a reason to pursue amplification.
Ask whether they can lie flat before you attribute the symptom to the thyroid
Ask about orthopnoea and screen for reflux before accepting that an aerodigestive symptom is thyroid compression.
Compressive symptoms: nodule size and orthopnoea, not globus, pick the patients who improve
Select thyroid surgery for compression on nodule volume, dyspnoea and orthopnoea — and work up globus and dysphagia for reflux and muscle tension first.
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