The edition · ENT & Head and Neck Surgery
Recurrent croup gets its first international consensus, and lymphoedema after head and neck radiotherapy is common
An international Delphi panel backs airway endoscopy for atypical recurrent croup and steers away from routine imaging, about half of irradiated head and neck cancer patients develop lymphoedema, and a model questions what faster postoperative radiotherapy would buy.
The edition in brief
Today's ENT edition. The first international multidisciplinary Delphi consensus on recurrent croup in children reached strong agreement on direct laryngoscopy and bronchoscopy for atypical presentations, including subglottic sizing and excluding a laryngeal cleft, and on limiting allergy testing to children with suspected atopy; routine imaging was discouraged and no consensus was reached on empirical inhaled steroids or antireflux therapy. A meta-analysis of 26 studies and 3,133 patients put lymphoedema after radiotherapy for mucosal head and neck cancer at about 49%, with about a third clinically significant, though certainty is very low. A US cancer database model of 58,184 HPV-negative patients predicted no overall survival gain if every patient started postoperative radiotherapy within six weeks. A review of 4,014 patients estimated permanent hearing loss after microvascular decompression for hemifacial spasm at about 2.6%, linked to cerebellar retraction and auditory evoked response changes. The pearl covers what makes croup atypical enough to scope.
About half of irradiated head and neck cancer patients developed lymphoedema
Expect lymphoedema in a large share of patients after head and neck radiotherapy, look for it at follow-up, and refer early.
Starting postoperative radiotherapy within six weeks was not predicted to improve survival
Continue to target postoperative radiotherapy within six weeks, but expect other quality measures to matter as much for survival.
Permanent hearing loss followed about 1 in 40 decompressions for hemifacial spasm
Counsel patients that about 2–3% lose hearing permanently after decompression for hemifacial spasm, and get a baseline audiogram.
When croup is not just croup
Croup that is very early, persistent, recurrent without a cold or steroid-resistant needs an airway assessment.
Recurrent croup: scope the atypical, skip routine imaging, test allergy only when suspected
For atypical recurrent croup, refer for airway endoscopy rather than imaging; the panel found no agreement supporting empirical inhaled steroids or antireflux therapy.
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