The edition · ENT & Head and Neck Surgery
Tinnitus guideline update: ask about self-harm, skip the routine scan, offer CBT
The updated US tinnitus guideline makes self-harm enquiry a strong recommendation and advises against routine drugs, supplements and rTMS. Plus hyperbaric oxygen for sudden hearing loss and the opioid choice for tonsillectomy.
The edition in brief
Today's ENT edition ends on tinnitus. The updated clinical practice guideline in Otolaryngology–Head and Neck Surgery (1 October) covers adults with persistent, bothersome tinnitus. Its strong recommendations are to separate bothersome from non-bothersome tinnitus, to ask about self-harm, and not to order neuroimaging for tinnitus alone without concerning features. It recommends a comprehensive audiological assessment, education, hearing aid evaluation where hearing is affected, cochlear implant referral where criteria are met, and cognitive behavioural therapy. It advises against routine antidepressants, anticonvulsants, anxiolytics, intratympanic drugs, supplements and rTMS for tinnitus itself. A retrospective study of 1,309 patients with sudden sensorineural hearing loss in Shanghai found that 11 to 20 sessions of hyperbaric oxygen added to steroids were associated with more slight and partial recovery at the end of treatment; it was observational. A triple-blind trial of 180 children having tonsillectomy found that intraoperative hydromorphone reduced the need for rescue opioid in recovery compared with fentanyl (53% vs 73%). A cohort of 223 adults in their mid-sixties linked poorer word recognition with more brain amyloid on PET, a small association that does not show cause. The pearl is treating sudden hearing loss as urgent.
Hyperbaric oxygen with steroids was associated with better recovery from sudden hearing loss
Treat sudden hearing loss early with steroids, and consider hyperbaric oxygen as an adjunct within two weeks where it is accessible.
Hydromorphone instead of fentanyl cut rescue opioid after paediatric tonsillectomy
Intraoperative hydromorphone reduced the need for rescue opioid after paediatric tonsillectomy compared with fentanyl.
Poorer word recognition was linked to more brain amyloid in late middle age
Poorer speech recognition was associated with more brain amyloid, but the link is small and not shown to be causal.
Treat sudden hearing loss as an emergency, and use a tuning fork to tell which kind
When a sudden deaf ear has a normal drum and the Weber lateralises away from it, treat it as sensorineural loss and act within days.
Updated tinnitus guideline: ask about self-harm, image only for red flags, and offer CBT
For persistent, bothersome tinnitus, ask about self-harm, get an audiogram, avoid routine imaging and drugs, and offer CBT and hearing rehabilitation.
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