The edition · ENT & Head and Neck Surgery
A CT clue to nasal-polyp endotype, and hyperbaric oxygen for sudden deafness
Plus what a long duration of deafness means for cochlear implant results, exercise before head and neck chemoradiotherapy, and the manoeuvres that settle most vertigo.
The edition in brief
Today's ENT edition opens on nasal polyps. A prospective study of 154 patients found that CT-based osteitis severity tracked tissue eosinophilia and identified the eosinophilic endotype of chronic rhinosinusitis with nasal polyps better than the conventional Lund-Mackay score (area under the curve 0.78 vs 0.66), offering a preoperative imaging marker to stratify endotype. A retrospective cochlear-implant series found that adults with 20 or more years of deafness improved more slowly early on but caught up by 12 months, while those with no measurable preoperative hearing were at higher risk of limited benefit. A small randomised trial showed supervised exercise before definitive head and neck chemoradiotherapy improved functional capacity and helped preserve quality of life. A clinic pearl reaffirms the Dix-Hallpike and Epley manoeuvres for posterior-canal benign positional vertigo. The practice-changer: a multicentre cohort of 1,309 patients with sudden sensorineural hearing loss found that adding 10 to 20 hyperbaric oxygen sessions to corticosteroids, started early, improved hearing recovery — strongest when begun within two weeks and in severe loss.
CT osteitis severity flags the eosinophilic nasal-polyp endotype
Consider CT-based osteitis severity as a preoperative marker of the eosinophilic nasal-polyp endotype, as an adjunct to histological confirmation.
Long deafness duration slowed, but did not block, cochlear-implant gains
Do not withhold cochlear implantation for long-standing deafness alone; counsel on slower early gains, and flag absent preoperative hearing thresholds as the higher-risk marker.
Exercise before head and neck chemoradiotherapy preserved function
Offer supervised exercise prehabilitation between diagnosis and chemoradiotherapy for head and neck cancer to preserve functional capacity and quality of life.
Diagnose and treat posterior-canal BPPV at the bedside
For positional vertigo, do the Dix-Hallpike test and treat a positive result with the Epley manoeuvre at the bedside rather than imaging or sedating.
Early hyperbaric oxygen added to steroids aided sudden hearing loss
For sudden sensorineural hearing loss, start hyperbaric oxygen early — within two weeks, as a 10-to-20-session course with steroids — prioritising severe losses, where available.
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