The edition · ENT & Head and Neck Surgery
Updated US tinnitus guideline: ask about self-harm, skip routine imaging, offer CBT
The AAO-HNS update makes self-harm screening a strong recommendation and advises against drugs, supplements and rTMS. Short-term IV iron was not linked to fewer free flap transfusions, and early speech therapy tracked with faster decannulation.
The edition in brief
Today's ENT edition ends on the American Academy of Otolaryngology–Head and Neck Surgery's updated guideline for adults with persistent, bothersome tinnitus, published on 1 October. Its strong recommendations are to distinguish bothersome from non-bothersome tinnitus, to ask about self-harm, and not to order neuroimaging for tinnitus alone without concerning features. It recommends a targeted history and examination, comprehensive audiology, hearing aid evaluation where hearing is affected, cochlear implant referral when criteria are met, and cognitive behavioural therapy, and it advises against antidepressants, anticonvulsants, anxiolytics, intratympanic drugs, supplements and rTMS as treatment for the tinnitus itself. A Canadian cohort of 324 free flap patients found preoperative IV iron was not associated with fewer transfusions, while higher preoperative haemoglobin was, suggesting anaemia needs addressing earlier. A single-centre review of open tracheostomies found each day earlier that speech and language therapy was involved was associated with a 1.39-day shorter stay and faster decannulation. A US county-level analysis linked wildfire smoke exposure over a decade to higher head and neck cancer incidence, strongest for laryngeal cancer. The pearl covers red flags in tinnitus that do warrant imaging.
Short-term IV iron was not linked to fewer transfusions after head and neck free flaps
Detect and treat anaemia at the first cancer visit, because iron given shortly before free flap surgery was not associated with fewer transfusions.
Earlier speech therapy after tracheostomy tracked with shorter stays
Consider involving speech and language therapy early after open tracheostomy, which was associated with faster decannulation and shorter stay.
Wildfire smoke exposure was linked to more head and neck cancer, especially laryngeal
Treat long-term smoke exposure as a possible head and neck cancer risk worth recording, not an established cause.
When tinnitus does need imaging
Reserve imaging for unilateral, pulsatile or neurologically associated tinnitus, and check for those features at the first visit.
Tinnitus guideline update: screen for self-harm, recommend CBT, avoid drugs and supplements
For persistent, bothersome tinnitus, screen for self-harm, arrange audiology and recommend CBT, and avoid drugs, supplements and routine imaging aimed at the tinnitus.
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