The edition · ENT & Head and Neck Surgery
Free flaps carry a 6% thromboembolism rate — the rest of ENT does not
A 277,187-patient database analysis shows where the clot risk in head and neck surgery actually sits, and where blanket prophylaxis buys nothing. Plus what the evidence supports for radiation fibrosis, and how long a probiotic lozenge stays in the throat.
The edition in brief
Today's ENT desk starts with what the evidence actually supports for radiation-induced fibrosis after head and neck cancer treatment: of 4078 screened records, only eight studies met inclusion. Pentoxifylline-tocopherol, pravastatin, amifostine and topical superoxide dismutase all showed variable improvement — in one uncontrolled trial 83 per cent of patients on pentoxifylline-tocopherol had a 50 per cent or greater reduction in fibrotic surface area, and pravastatin reduced fibrosis thickness by 30 per cent or more in 35.7 per cent — while lipotransfer and microcurrent therapy reported improvement in 97 and 92 per cent of small series. Heterogeneity prevents any comparative conclusion. A feasibility trial randomised 53 adults with recurrent sore throat to Streptococcus salivarius K12 lozenges daily or weekly: colonisation on day 7 was 85.7 per cent with daily dosing against 13.6 per cent weekly, and had disappeared in almost everyone by day 21 after dosing stopped, which settles the regimen for a future efficacy trial without saying anything about efficacy. A lifetime Markov model from six Chinese centres put unilateral cochlear implantation against hearing aids at an incremental cost-effectiveness ratio of 64,794.72 CNY per quality-adjusted life year, around 77 per cent of GDP per capita and comfortably below the WHO threshold. The practice-changer is a national database analysis of 277,187 adults having ENT surgery between 2015 and 2025: 90-day venous thromboembolism occurred in 0.63 per cent overall but 6.1 per cent after free tissue transfer, 4.4 per cent after lateral skull base surgery and 3.1 per cent after cricopharyngeal myotomy and anterior skull base surgery, with prior venous thromboembolism the dominant risk factor (OR 12.3).
Radiation fibrosis: eight studies, four drugs, no comparison
Start pentoxifylline-tocopherol with a measured baseline and a review date, and pair it with physiotherapy — the comparative evidence to do otherwise does not exist.
A throat probiotic that leaves when the lozenges stop
Streptococcus salivarius K12 only colonises the throat with daily dosing, and stops doing so within a week of the last lozenge.
Cochlear implants clear the cost-effectiveness bar in a middle-income system
Unilateral cochlear implantation in adults is cost-effective at a middle-income threshold, which is the argument to take to funders rather than to the clinic.
Measure the neck before the radiotherapy, not after the stiffness
Measure mouth opening and neck rotation before head and neck radiotherapy, and repeat at every visit — a falling trend is the referral trigger.
Where the clot risk actually is in ENT surgery
Decide venous thromboembolism prophylaxis in ENT by the specific procedure and a history of previous clot — free flap, skull base and cricopharyngeal myotomy are the high-risk operations.
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