The edition · ENT & Head and Neck Surgery
Obesity raised respiratory risk after tonsillectomy, but the excess showed up in recovery, not on the ward
A meta-analysis of 60,044 children found nearly double the odds of respiratory complications with obesity, concentrated in the recovery room. Plus VTE rates across ENT operations, coblation versus microdebrider tonsillotomy, what treats radiation fibrosis, and how well a hearing screener matches audiometry.
The edition in brief
A meta-analysis of 18 studies and 60,044 children found respiratory complications after tonsillectomy in 12.2% of children with obesity and 7.6% without (OR 1.86), with high heterogeneity. The excess appeared only in studies that counted recovery-room events; in studies limited to the ward, obesity did not raise the odds, suggesting children with obesity who are well in recovery may not all need admission. In 277,187 US adults after ENT surgery, 90-day venous thromboembolism was 0.63% overall but 6.1% after free flap reconstruction and 4.4% after lateral skull base surgery; prior VTE carried an odds ratio of 12. In 1,734 children, coblation and microdebrider tonsillotomy had similar bleeding (1% vs 0.9%) and revision rates, with younger age linked to revision. A systematic review found only eight small studies of treatments for radiation fibrosis after head and neck cancer. A hearing screening device gave the same hearing loss prevalence (about 55% at 55 and over) as audiometry.
VTE after ENT surgery: low overall, but 6% after free flaps
Match thromboprophylaxis to the operation: consider it seriously after free flap and skull base surgery, and ask everyone about previous VTE.
Coblation and microdebrider tonsillotomy bled and needed revision at similar rates
Use whichever tonsillotomy technique you know best; warn parents of younger children about a higher chance of revision.
Radiation fibrosis after head and neck cancer: eight small studies, no clear winner
Keep physiotherapy as the first step for radiation fibrosis; other treatments rest on small uncontrolled studies.
A hearing screener matched audiometry for population hearing loss
Screen older adults for hearing loss, and confirm positive screens with audiometry.
Secondary bleeding after tonsillectomy peaks around days 5 to 10
Warn families that bleeding risk peaks in the second week, and assess any bleed in hospital the same day.
Children with obesity: tonsillectomy risk sat in the recovery room
Consider using recovery-room events, rather than obesity alone, to decide whether a child needs overnight admission after tonsillectomy.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for ent & head and neck surgery, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free