The edition · ENT & Head and Neck Surgery
Seven in ten still on opioids three months after head and neck radiotherapy
A large cohort maps who stays on opioids after radiotherapy, residual tonsil tissue after tonsillotomy surfaces years later as abscess, and CT-measured muscle tracks survival in a way BMI does not.
The edition in brief
Of 789 patients treated with definitive radiotherapy or chemoradiotherapy for head and neck cancer at one US centre, 95% received opioids and 70% were still taking them three months after treatment, falling to 47% at six months; prior opioid use, former smoking and palliative care referral were associated with ongoing use. A paediatric series from 2010 to 2025 found nine peritonsillar abscesses after 5,576 tonsillotomies (0.16%) against one after 19,834 tonsillectomies, arising a mean eight years later, usually in residual tonsil tissue. In 1,187 patients receiving head and neck radiotherapy, higher skeletal muscle on planning CT was associated with better survival and intermuscular fat with worse, suggesting BMI alone hides what matters. A meta-analysis of 107 adults with acquired velopharyngeal insufficiency found most improved after treatment, mainly injection pharyngoplasty. The pearl covers red flags in the adult sore throat.
Tonsillotomy carried a small, late risk of peritonsillar abscess
Tell families that tonsillotomy carries a small, late risk of abscess from residual tissue, and keep quinsy on the list for children who had one.
Muscle on the planning CT predicted survival in head and neck radiotherapy
Low muscle mass on the planning CT was linked to worse survival in head and neck radiotherapy, whatever the BMI - consider earlier supportive care for these patients.
Acquired velopharyngeal insufficiency in adults usually improved with treatment
Refer adults with acquired velopharyngeal insufficiency for assessment - most improved with treatment, usually injection pharyngoplasty.
Red flags in the adult sore throat
Trismus, a muffled voice or uvular deviation turns a sore throat into a same-day ENT referral.
Seventy per cent still on opioids three months after head and neck radiotherapy
Plan the opioid exit at the start of head and neck radiotherapy; seven in ten were still taking them three months after treatment.
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