The edition · ENT & Head and Neck Surgery
In very severe childhood sleep apnoea, tonsillectomy cured fewer than half
Each extra apnoea event per hour was linked to lower odds of cure, and children above an AHI of 30 succeeded only 42% of the time. Plus one hearing aid or two, and parent-filmed tonsils.
The edition in brief
In a weighted analysis of 174 children with polysomnography before and after tonsillectomy for obstructive sleep apnoea, 70% reached an AHI below 5; each additional event per hour beforehand lowered the odds of success (OR 0.96), and children with an AHI above 30 succeeded only 42% of the time. A randomised trial of 275 adults aged 50 and over with age-related hearing loss found two hearing aids gave more self-reported benefit than one (difference about 5 points on the APHAB), though the authors are unsure the difference is clinically meaningful and both groups improved. In 169 children with sleep-disordered breathing, parent-captured oropharyngeal videos graded tonsil size with 70% sensitivity and 86% specificity against examination, but 12% of videos were unusable. A systematic review of 69 ears found cochlear implantation after radiotherapy for nasopharyngeal cancer was generally safe and improved hearing in about 91%. The pearl covers hearing surveillance after head and neck radiotherapy.
Two hearing aids gave somewhat more benefit than one in age-related hearing loss
Offer two aids for symmetrical age-related loss where affordable, but one is far better than none.
Parent-filmed videos graded tonsil size reasonably, but not reliably enough to operate on
Consider parent videos to triage tonsil size remotely, but examine the child before deciding on surgery.
Cochlear implants worked after radiotherapy for nasopharyngeal cancer
Refer patients with profound hearing loss after nasopharyngeal radiotherapy for cochlear implant assessment.
Hearing after head and neck radiotherapy needs a plan
Get a baseline audiogram before head and neck chemoradiotherapy and keep testing afterwards.
In severe childhood sleep apnoea, tonsillectomy alone often did not cure
Counsel families that tonsillectomy is unlikely to cure very severe OSA, and plan a post-operative sleep study.
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