The edition · ENT & Head and Neck Surgery
Intracapsular tonsillectomy brought severe paediatric sleep apnoea down to an apnoea index of about 3
Pooled data in severe obstructive sleep apnoea show large polysomnographic gains with low bleeding, at the cost of some regrowth. Plus a null phase 3 trial of preoperative dexamethasone in free-flap surgery, routine tonsil histology, the bacteria behind sinusitis, and intratympanic protection from cisplatin.
The edition in brief
A systematic review of intracapsular tonsillectomy or tonsillotomy with adenoidectomy in children with severe obstructive sleep apnoea found the weighted apnoea-hypopnoea index fell from 19.6 to 3.0 events an hour across 11 studies, with very low bleeding and regrowth or revision rates of about 2% to 15%; the evidence is observational. A phase 3 double-blind trial of 180 adults having head and neck cancer surgery with free-flap reconstruction found a single 8 mg preoperative dose of dexamethasone lowered IL-6 and CRP but did not improve quality of recovery, pain, nausea or length of stay. In 769 tonsillectomy specimens at a US safety-net hospital, no child had a malignancy, and 19 of 20 adult cancers were expected before surgery; one unexpected lymphoma was found among 443 adults without preoperative concern. A meta-analysis of 57 culture studies found Staphylococcus aureus the commonest isolate in acute rhinosinusitis (20.5%), with pneumococcus 16.3% and Haemophilus 12.2%, and staphylococci dominating chronic disease. A meta-analysis of 10 randomised trials found no intratympanic agent consistently prevented cisplatin hearing loss, though one sodium thiosulfate trial was positive. The pearl covers the red flags in a unilateral tonsil.
Preoperative dexamethasone did not improve recovery after free-flap head and neck surgery
A single preoperative dose of dexamethasone lowered inflammatory markers but did not improve recovery after free-flap head and neck surgery.
Routine tonsil histology found no cancers in children and one unexpected lymphoma in 443 adults
Preoperative assessment caught 19 of 20 tonsil cancers; consider risk-based rather than routine tonsil histology.
Staphylococcus aureus topped sinus cultures in acute rhinosinusitis, ahead of pneumococcus
Sinus cultures often grow staphylococci, but this does not change first-line empirical treatment; culture before broadening cover.
No intratympanic agent reliably prevented cisplatin hearing loss
Intratympanic dexamethasone and N-acetylcysteine did not prevent cisplatin hearing loss; monitor with audiometry instead.
A unilaterally enlarged tonsil in an adult needs a reason
In an adult with an asymmetric tonsil, look for red flags and arrange tissue diagnosis if any are present.
Intracapsular tonsillectomy controlled severe paediatric sleep apnoea with low bleeding
For non-syndromic children with severe OSA, consider intracapsular tonsillectomy with adenoidectomy and plan follow-up for residual disease and regrowth.
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