The edition · ENT & Head and Neck Surgery
After tonsillectomy, the extra respiratory risk in children with obesity showed up in recovery, not on the ward
A meta-analysis of 60,044 children found obesity nearly doubled the odds of respiratory complications, but only in studies that counted events in recovery. Also: lymphoedema in half of irradiated head and neck patients, a model questioning the six-week radiotherapy target, and hearing loss after microvascular decompression.
The edition in brief
Today's ENT edition leads on children with obesity having tonsillectomy. An Otolaryngology–Head and Neck Surgery meta-analysis of 18 studies and 60,044 children found respiratory complications in 12.2% of children with obesity and 7.6% without (OR 1.86, 95% CI 1.38 to 2.49), but the excess appeared only in studies that included recovery-room events; in studies limited to the ward, obesity did not raise the odds. A Laryngoscope meta-analysis of 26 studies (3133 patients) found lymphoedema in 49% after radiotherapy for mucosal head and neck cancer, clinically significant (grade 2 or more) in 32%, with very low certainty. A National Cancer Database model of 58,184 HPV-negative patients predicted no overall survival gain if every patient started postoperative radiotherapy within six weeks (58% observed and predicted). A meta-analysis of 11 studies (4014 patients) estimated permanent hearing loss after microvascular decompression for hemifacial spasm at 2.6%, linked to cerebellar retraction and brainstem auditory evoked response changes. A Korean series found 52% of 84 patients with idiopathic acute unilateral audiovestibulopathy had inner ear signal on 3D-FLAIR MRI. The pearl covers sudden sensorineural hearing loss.
Lymphoedema affects about half of patients after radiotherapy for head and neck cancer
Screen for internal and external lymphoedema at every follow-up after head and neck radiotherapy and refer early.
A model predicted no survival gain from starting postoperative radiotherapy within six weeks for every patient
Keep the six-week radiotherapy target, but focus on the causes of delay rather than the deadline alone.
Permanent hearing loss after microvascular decompression for hemifacial spasm: about 2.6%
Test hearing formally before and after microvascular decompression, and quote a permanent loss risk of about 2–3%.
Half of patients with acute unilateral audiovestibulopathy show inner ear signal on 3D-FLAIR MRI
Ask for a precontrast 3D-FLAIR inner ear sequence when imaging acute combined hearing and vestibular loss.
Sudden sensorineural hearing loss is an emergency for the first two weeks
Treat sudden one-sided hearing loss as urgent: tuning forks today, audiogram within days, steroids discussed early.
Tonsillectomy in children with obesity: the risk window is recovery, not the ward
For children with obesity, extend observation in recovery after tonsillectomy; an uneventful recovery may allow same-day discharge.
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