The edition · ENT & Head and Neck Surgery
Before blaming a small thyroid nodule for globus, look for reflux and muscle tension
A 10-year series finds breathlessness, orthopnoea and larger nodules predict relief from thyroidectomy while alternative causes explain many 'compressive' symptoms; depression and anxiety track with septoplasty complications; and single-sided deafness implant users need a different rehabilitation plan.
The edition in brief
Four studies for ENT surgeons and the GPs who refer to them. In 214 patients referred with symptoms attributed to thyroid compression, 38% had surgery and 83% of those improved; orthopnoea predicted the best result (91% resolution) and operated nodules were far larger (median 36.4 vs 6.4 cm³). Among those not operated on, reflux (36%) and laryngeal muscle tension (23%) were the commonest alternative diagnoses. In matched TriNetX cohorts of about 5,000 patients per group, septoplasty with turbinoplasty in patients without depression or anxiety was associated with fewer ED visits (OR 0.52), readmissions (OR 0.55) and epistaxis (OR 0.70). In 360 adult cochlear implant recipients, only 50% with single-sided deafness reached full-time use against 82% with bilateral loss, and one-month scores did not predict their 12-month result. In Japan, paediatric grommet surgery fell sharply during COVID-19 but held steady in children with Down syndrome or cleft palate. The pearl covers a structured history for suspected thyroid compression.
Depression and anxiety linked to more complications after septoplasty with turbinoplasty
Patients with depression or anxiety used more post-operative care after septoplasty; prepare them and give a clear follow-up route.
Cochlear implants for single-sided deafness: lower use, slower gains, less predictable
Plan closer early support for single-sided deafness implant users, and do not judge their outcome at one month.
Grommet surgery fell in the pandemic, except in Down syndrome and cleft palate
Keep up otitis media with effusion surveillance and timely surgery in children with Down syndrome or cleft palate, even when general demand falls.
A structured history for suspected thyroid compression
Ask about orthopnoea and screen for reflux and muscle tension before blaming a nodule.
Thyroid 'compressive' symptoms: surgery helps large nodules with breathlessness, not globus alone
Reserve thyroidectomy for compressive symptoms mostly for large nodules with breathlessness or orthopnoea; look for reflux and muscle tension first when a small nodule is blamed for globus.
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