The edition · ENT & Head and Neck Surgery
A department's switch to intracapsular tonsillectomy came with a third as many emergency returns
Nearly 14,000 children over six years show what changed and what held surgeons back, wildfire smoke is linked to head and neck cancer, and long-deaf adults still gained from cochlear implants, only more slowly.
The edition in brief
One paediatric department moved from total to intracapsular tonsillectomy between 2017 and 2022, rising from 2.3% to 80.8% of 13,899 procedures (Laryngoscope, June 2026); 30-day emergency returns were 10% after total and 3.1% after intracapsular surgery, and interviews identified data transparency and personal experience as the drivers of change. A US SEER analysis (Laryngoscope, 13 October 2026) found county-level wildfire smoke associated with higher head and neck cancer incidence over a 10-year lag, strongest for larynx (cumulative RR 1.13 per exceedance day). In 41 adults deaf for five years or more, cochlear implant word scores were lower at three months with 20 or more years of deafness but caught up by 12 months; absent preoperative thresholds predicted poor benefit. In 154 patients with nasal polyps, CT osteitis score identified eosinophilic disease better than Lund-Mackay (AUC 0.777 vs 0.661). Pearl: warn families about the day 5-10 bleed.
Wildfire smoke exposure was linked to higher head and neck cancer incidence, most for larynx
Add long-term wildfire or biomass smoke to the exposure history in suspected head and neck cancer, but keep tobacco and alcohol as the priority.
Long-deaf adults still gained from cochlear implants, just more slowly
Refer long-deaf adults for cochlear implant assessment; expect slower early gains, and counsel carefully if there is no measurable residual hearing.
CT osteitis scoring flagged eosinophilic nasal polyps better than Lund-Mackay
Score osteitis on preoperative sinus CT as a clue to eosinophilic nasal polyps, then confirm on histology.
Warn families about the day 5-10 bleed after tonsillectomy
Warn every family that any fresh bleeding in the first two weeks after tonsillectomy means coming back the same day.
Switching to intracapsular tonsillectomy: a third as many emergency returns, and what held surgeons back
Consider intracapsular tonsillectomy for suitable children, and use shared outcome data to support the change.
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