The edition · ENT & Head and Neck Surgery
No intratympanic drug has reliably prevented cisplatin hearing loss; sucralfate after tonsillectomy looks promising
A meta-analysis of 284 patients finds no consistent otoprotection from intratympanic dexamethasone or N-acetylcysteine, CT osteitis may flag eosinophilic nasal polyps, and a pooled analysis suggests intraoral sucralfate eases pain after tonsillectomy.
The edition in brief
A systematic review and meta-analysis of ten studies (284 patients) found that intratympanic dexamethasone, N-acetylcysteine or sodium thiosulfate has not consistently prevented cisplatin-induced hearing loss; pooled threshold differences were not significant, and a single study of sodium thiosulfate reported less ototoxicity (40% versus 85%). In 154 patients with chronic rhinosinusitis with nasal polyps, CT osteitis severity discriminated eosinophilic disease better than Lund-Mackay scoring (AUC 0.777 versus 0.661). A 40-patient randomised trial found supervised exercise before chemoradiotherapy for head and neck cancer increased six-minute walk distance by 28.6 m. A single-centre review of 41 cochlear implant recipients found slower early speech improvement with 20 or more years of deafness but no difference at 12 months. A meta-analysis of 13 studies suggested perioperative intraoral sucralfate reduced throat pain and analgesic use after tonsillectomy without more bleeding.
Intratympanic drugs to prevent cisplatin hearing loss: no agent has consistently worked
Do not offer intratympanic injections to prevent cisplatin hearing loss outside a trial; keep baseline and serial audiometry.
CT osteitis severity may flag the eosinophilic endotype in nasal polyps
Note osteitis on preoperative CT in nasal polyps as a possible hint of eosinophilic disease, and confirm with histology where it would change management.
Exercise before chemoradiotherapy for head and neck cancer improved walking capacity in a small trial
Consider referring patients awaiting definitive chemoradiotherapy to a supervised exercise programme where one exists.
Long deafness before cochlear implantation: slower early gains, similar results at 12 months
Counsel adults with long-standing deafness that early progress may be slower and that a lack of measurable residual hearing carries a higher risk of limited benefit.
Ask about hearing and ringing before and during cisplatin
Get a baseline audiogram before cisplatin and ask about ringing and hearing change at every cycle.
Intraoral sucralfate after tonsillectomy: less pain and analgesic use without more bleeding
Consider intraoral sucralfate as an adjunct to standard analgesia after tonsillectomy, checking dose and formulation locally, while recognising the pooled effect sizes are not stated in the abstract.
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