Hoarseness referrals still miss the guideline half the time — look at the larynx before PPIs, steroids or scans

The edition in brief

An audit of 528 adults referred to a US academic ENT department with dysphonia found that full adherence to the 2018 hoarseness guideline did not improve after publication (61.7% before, 52.5% after), and timely referral actually fell. For referring doctors, the guideline asks for laryngoscopy before imaging, before empirical antireflux treatment, steroids or antibiotics, and before voice therapy, with prompt referral when hoarseness persists. Among 41 adults with at least five years of unaided deafness, cochlear implant speech scores were slower to rise when deafness had lasted 20 years or more, but caught up by 12 months; patients with no measurable pre-operative thresholds did worse. In 455 patients with Meniere's disease, higher hydrops grade on gadolinium MRI tracked with worse hearing, and age mattered mostly at lower grades. A phase 2 trial of pembrolizumab plus metformin in 18 evaluable patients with recurrent or metastatic head and neck cancer reported a response rate of 50%, worth a randomised trial and not yet practice. In-situ simulation across 11 children's hospitals found about three latent safety threats per tracheostomy emergency scenario, including attempts to ventilate through a blocked tube.