Hydrops grade tracks hearing in Meniere's, and a better opioid for tonsillectomy

The edition in brief

Today's ENT edition leads on prognosis in Meniere's disease. In 455 patients with MRI-confirmed disease, higher endolymphatic hydrops grade was consistently linked to worse hearing, while age influenced hearing mainly at mild-to-moderate hydrops and faded at advanced grades; age itself was not associated with hydrops severity. A machine-learning model using sustained-vowel voice parameters distinguished early glottic carcinoma from unilateral laryngeal immobility with 72% accuracy, a proof of concept for non-invasive triage where specialist access is limited, though trained on a small augmented dataset. A ten-year single-centre review of 945 tonsillectomies found post-tonsillectomy haemorrhage in 2.65%, mostly secondary around day 7, with adults bleeding far more than children (7.4% vs 1.9%; adjusted odds ratio 2.93), supporting closer counselling and surveillance in adults. A clinic pearl restates that sudden sensorineural hearing loss is an emergency. The practice-changer is a triple-blind randomised trial in 180 children undergoing tonsillectomy: intraoperative hydromorphone cut the need for rescue opioids after extubation compared with fentanyl (53% vs 73%), with similar adverse events.