A nebulised tranexamic acid protocol was followed by far fewer returns to theatre for tonsil bleeds

The edition in brief

A US quality-improvement project in 501 children presenting with post-tonsillectomy haemorrhage found the share needing surgical control of bleeding fell from 43.9% before nebulised tranexamic acid, to 29.8% with ad hoc use, to 15.2% after a standardised protocol, with no change in length of stay, transfusion, readmission or drug-related complications. The design is a before-and-after comparison, not a trial, and the paper was published in July. In 70 children referred for recurrent croup, household tobacco exposure and reflux were associated with earlier onset, and a shorter interval from first emergency visit to ENT review correlated with shorter disease duration. In 461 children with obstructive sleep apnoea, higher obesity classes were associated with less total sleep, lower efficiency and less REM sleep independent of OSA severity. A Finnish series of 20 laryngeal chondrosarcomas found that after larynx-preserving surgery, reoperation for recurrence and transformation to higher-grade histology were associated with permanent tracheostomy, and two patients died of the disease. Today's pearl covers button batteries in the nose and ear.