The edition · ENT & Head and Neck Surgery
Intracapsular tonsillectomy and a third of the return visits, and cannabis before free flap surgery
One department's move to intracapsular tonsillectomy coincided with emergency returns falling from 10% to 3.1%; cannabis users stayed on opioids longer after head and neck reconstruction.
The edition in brief
A propensity-matched TriNetX study of 1,064 patients having head and neck free flap reconstruction found that cannabis users were more likely to be on opioids three to twelve months after surgery and more often gastrostomy-dependent at three months, independent of behavioural health comorbidity. A comparison of a handheld hearing screener with audiometry found the same prevalence of hearing loss in adults over 55, about 55%, which supports screening where audiometry is not available. The practice-changer is a mixed-methods study of 13,899 children at one US institution: as intracapsular tonsillectomy rose from 2.3% to 80.8% of cases over six years, 30-day emergency returns were 3.1% after intracapsular surgery against 10% after total tonsillectomy, and data transparency within the department drove the change.
Cannabis users stayed on opioids longer after head and neck free flap surgery
Ask about cannabis use before head and neck free flap surgery and plan opioid-sparing analgesia and tapering for regular users.
A handheld hearing screener matched audiometry for population prevalence
A handheld hearing screener estimates population hearing loss as well as audiometry, but screen-positive patients still need formal testing.
Sudden hearing loss is an emergency until proven otherwise
Treat sudden unilateral hearing loss as urgent: confirm it is sensorineural, consider early steroids and arrange MRI.
Intracapsular tonsillectomy: emergency returns 3.1% against 10%
Consider intracapsular tonsillectomy for children with obstructive symptoms, and share outcome data to support the change.
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