JAMA otolaryngology-- head & neck surgery最新文献

{"title":"Preoperative Clinical and Tumor Factors Associated With Adjuvant Therapy for Oral Cavity Cancer.","authors":"Gabriel S Dayan, Houda Bahig, Justine Colivas, Antoine Eskander, Stephanie Johnson-Obaseki, Shamir Chandarana, John R de Almeida, Anthony C Nichols, Michael Hier, Mathieu Belzile, Andrea Avagnina, Xinyuan Hong, Marc Gaudet, T Wayne Matthews, Robert Hart, David P Goldstein, Ali Hosni, Danielle MacNeil, James Fowler, Carlos Khalil, Mark Khoury, Gregoire Morand, Khalil Sultanem, Tareck Ayad, Apostolos Christopoulos","doi":"10.1001/jamaoto.2024.5250","DOIUrl":"10.1001/jamaoto.2024.5250","url":null,"abstract":"<p><strong>Importance: </strong>The standard of care for patients with oral cavity squamous cell carcinoma (OCSCC) is generally primary surgical resection with or without adjuvant therapy (AT), based on pathological factors. Identifying preoperative factors that are associated with the receipt of AT may enhance treatment planning.</p><p><strong>Objective: </strong>To identify preoperative patient and tumor factors associated with receiving AT, either radiation therapy (RT) or chemoradiation therapy (CRT), in patients with OCSCC.</p><p><strong>Design, setting, and participants: </strong>This cohort study, spanning January 2005 to December 2019 at 9 academic centers in Canada, was conducted as part of the Canadian Head & Neck Collaborative Research Initiative, a national network of head and neck surgical oncologists. Participants included patients with oral cavity cancer who underwent surgery. The data analysis was performed in March 2024.</p><p><strong>Exposures: </strong>Preoperative variables, including demographics (age, sex, smoking history, and Charlson Comorbidity Index [CCI]) and tumor characteristics (clinical T and N stage, biopsy grade, tumor size).</p><p><strong>Main outcomes and measures: </strong>The main outcomes were the receipt of AT vs surgery alone; the type of AT, either RT or CRT; and the presence of a strong pathologic indicator for AT.</p><p><strong>Results: </strong>Of the 3980 patients, 2438 underwent surgery alone (61%) and 1542 received AT (39%). Of these, 1907 (48%) had a strong pathologic indicator for AT. The mean (SD) age was 63 (13) years, and 1498 participants (38%) were female. On multivariable analysis, factors independently associated with AT included being older than 65 years (odds ratio [OR], 0.50 [95% CI, 0.38-0.64]), CCI of 4 or higher (OR, 1.83 [95% CI, 1.26-2.65]), previous head and neck cancer (OR, 0.40 [95% CI, 0.26-0.62]), maxillary alveolus (OR, 2.16 [95% CI, 1.11-4.22]) and retromolar trigone (OR, 1.85 [95% CI, 1.04-3.29) subsites, tumor dimension (OR, 1.35 [95% CI, 1.22-1.50] per cm), increasing clinical T and N stages, and worse grade on biopsy (poorly differentiated: OR, 1.89 [95% CI, 1.25-2.84]). Among those receiving AT, poorly differentiated grade (OR, 2.40 [95% CI, 1.34-4.30]) and advanced N stage were associated with CRT rather than RT. Among patients with strong pathologic indicators for AT, factors associated with not receiving AT included age, CCI, grade, stage, and tumor dimension. The prediction model showed good discriminatory power (area under the receiver operating characteristic curve, 0.84 [95% CI, 0.82-0.86]).</p><p><strong>Conclusions and relevance: </strong>The results of this cohort study suggest that preoperative variables can help to identify patients with OCSCC who are more likely to receive AT, despite many factors not being predictable until the postoperative period. Early identification of patients at high risk may improve treatment planning and reduce delays in initiating A","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Further Clarifications for Interpretation of Study of Lobectomy vs Total Thyroidectomy With Ipsilateral Lateral Neck Dissection.","authors":"Keyu Shen, Xiequn Xu","doi":"10.1001/jamaoto.2025.0158","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0158","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Further Clarifications for Interpretation of Study of Lobectomy vs Total Thyroidectomy With Ipsilateral Lateral Neck Dissection.","authors":"Pierpaolo Trimboli, Gianluca Bottoni, Arnoldo Piccardo","doi":"10.1001/jamaoto.2025.0156","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0156","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Factors Associated With Spontaneous Regression in Head and Neck Lymphatic Malformations.","authors":"Juliana Bonilla-Velez, Carrie L Heike, Larry G Kessler, Xing Wang, Tara L Wenger, Bonnie W Ramsey, Jonathan A Perkins","doi":"10.1001/jamaoto.2025.0104","DOIUrl":"10.1001/jamaoto.2025.0104","url":null,"abstract":"<p><strong>Importance: </strong>Head and neck lymphatic malformations (HNLMs) demonstrate considerable variability in their natural history. While some malformations cause chronic severe functional impairment, others are asymptomatic and spontaneously regress. Understanding the frequency and features associated with regression will aid clinicians and families in making informed treatment choices and avoid unnecessary risks of intervention for a subset of patients.</p><p><strong>Objective: </strong>To assess the incidence, timing, and factors associated with spontaneous regression of HNLMs.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study across a single regional pediatric tertiary care academic center included patients aged 0 to 21 years with HNLM who were evaluated in the vascular anomalies clinic and prospectively enrolled in an institutional quality improvement database between 2003 and 2022. Observation was offered to patients without symptoms or functional compromise. Treatment decisions were made during routine clinical care.</p><p><strong>Exposures: </strong>Age of HNLM onset and HNLM location, distribution, cystic structure, grade, and de Serres staging.</p><p><strong>Main outcome and measures: </strong>The incidence of complete spontaneous regression was estimated. The strength of the association between exposures and regression was assessed using risk ratios, Cliff Δ, and Cramer V. A Kaplan-Meier curve was used to estimate the probability of spontaneous regression over time. The association of the exposures on the likelihood of spontaneous regression were assessed using 2-sided log-rank tests and Cox proportional hazards models.</p><p><strong>Results: </strong>Of 298 patients with HNLMs, 173 (58.1%) were male, and most HNLMs were diagnosed prenatally or at birth (137 patients [46.0%]). Among HNLMs, 189 (63.4%) had a focal distribution, 228 (76.5%) were de Serres stage I or II, and 128 (43.0%) were macrocystic. Complete spontaneous regression occurred in 27 patients (9.1%) at a median (IQR) time of 12.0 (6.7-27.4) months from onset. Factors associated with a large difference in the rate of complete spontaneous regression included macrocystic structure, neck location, focal distribution, and grade 1 or de Serres I stage. HNLMs of the upper face or midface, with mixed or microcystic composition, or with extensive unilateral or bilateral involvement did not regress.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, HNLMs that were macrocystic, of limited extent, and/or in the neck were more likely to completely spontaneously regress. A 1-year observation period for asymptomatic HNLM, particularly when favorable features are present, should be considered, as nonintervention may be curative. Future studies will examine interaction among these factors. This work contributes to a deeper understanding of HNLM natural history that can directly inform clinical decision-making, decrease","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two Brothers With 1 Diagnosis.","authors":"Dario Ebode, Thomas Radulesco, Justin Michel","doi":"10.1001/jamaoto.2025.0118","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0118","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Further Clarifications for Interpretation of Study of Lobectomy vs Total Thyroidectomy With Ipsilateral Lateral Neck Dissection-Reply.","authors":"Yoshiyuki Saito, Kosuke Inoue, Koichi Ito","doi":"10.1001/jamaoto.2025.0157","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0157","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency-to-Place Mismatch and Cochlear Implant Outcomes-Beyond Electrode Type.","authors":"Xiaohui Zhu, Yuan Ren, Kai Wang","doi":"10.1001/jamaoto.2025.0102","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0102","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hearing Loss and Falls: A Systematic Review and Meta-Analysis.","authors":"Brian Sheng Yep Yeo, Vanessa Yee Jueen Tan, Jia Hui Ng, Joyce Zhi'en Tang, Brenda Ling Hui Sim, Yu Ling Tay, Anupama Roy Chowdhury, Abel P David, Nicole T Jiam, Elliott D Kozin, Steven D Rauch","doi":"10.1001/jamaoto.2025.0056","DOIUrl":"10.1001/jamaoto.2025.0056","url":null,"abstract":"<p><strong>Importance: </strong>Falls constitute a significant public health concern worldwide and have been associated with increased morbidity and mortality across all ages. Identifying potentially modifiable risk factors for falls is a key public health priority. Literature surrounding the association between hearing loss (HL) and falls remains inconclusive.</p><p><strong>Objective: </strong>To conduct a systematic review and meta-analysis to comprehensively synthesize evidence surrounding the impact of HL on falls.</p><p><strong>Data sources: </strong>PubMed, Embase, and Cochrane Library from database inception through April 9, 2024.</p><p><strong>Study selection: </strong>Observational studies investigating the association between HL and falls were selected. Only studies reporting covariate-adjusted estimates were included to minimize confounding.</p><p><strong>Data extraction and synthesis: </strong>Two independent reviewers evaluated studies for eligibility, extracted data, and assessed the risk of bias of included studies. Using a random-effects model, adjusted estimates were pooled in meta-analyses. Heterogeneity was evaluated using subgroup and sensitivity analyses, and publication bias was assessed.</p><p><strong>Main outcomes and measures: </strong>The cross-sectional odds and longitudinal risk of falls among patients with HL compared with those without HL.</p><p><strong>Results: </strong>A total of 5 071 935 participants were included from 27 studies; approximately 49.2% of participants were female, and 14 studies were conducted in Asia, 7 in North America, 3 in Europe, and 3 in Oceania, represented by Australia. Patients with HL exhibited an increased cross-sectional odds of falls (odds ratio, 1.51; 95% CI, 1.37-1.67; I2 = 64%) and longitudinal risk of falls (risk ratio, 1.17; 95% CI, 1.06-1.29; I2 = 69%) than those without HL. Further stratification by self-reported or validated hearing assessments, fall reporting duration, continent, community-dwelling adults, and studies adjusting for other sensory deficits identified as fall risk factors by the World Falls Guideline did not change significance. These results remained robust to sensitivity analyses, and publication bias was absent.</p><p><strong>Conclusions and relevance: </strong>This systematic review and meta-analysis found that overall, HL may be a risk factor for falls. With a rapidly aging global population, it is crucial to acknowledge the public health concerns surrounding falls and consider if HL could be a potentially modifiable risk factor. Nonetheless, further randomized clinical trials are needed to elucidate any benefit of treating HL on fall prevention.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"JAMA Otolaryngology-Head & Neck Surgery-The Year in Review, 2024.","authors":"Jay F Piccirillo","doi":"10.1001/jamaoto.2025.0365","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0365","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Practice Guideline for Management of Tinnitus: Recommendations From the US VA/DOD Clinical Practice Guideline Work Group.","authors":"LaGuinn P Sherlock, Jennifer Ballard-Hernandez, Amy Boudin-George, Khaya Clark, Maria Colandrea, Catherine Edmonds, Catherine Kelley, Suheily Lovelace, Sally Mahmood, Idalisse Martinez, Paula Myers, Sara Pulliam, James Sall, Michele Spencer, Sarah M Theodoroff, Anthony M Tolisano, Lisa M Wayman, Tara Zaugg, Robert L Folmer","doi":"10.1001/jamaoto.2025.0052","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0052","url":null,"abstract":"<p><strong>Importance: </strong>The most recent US clinical practice guideline (CPG) for tinnitus was published in 2014. The US Department of Veterans Affairs (VA)/US Department of Defense Tinnitus Clinical Practice Guideline Work Group recently completed a new guideline. The work group consisted of experts across disciplines who were supported by the VA Office of Quality and Patient Safety and the Defense Health Agency Clinical Quality Improvement Program. This article summarizes the first VA/US Department of Defense CPG for tinnitus management.</p><p><strong>Methods and observations: </strong>The guideline was based on a systematic review of clinical and epidemiological evidence. Rigorous methods determined the strength of the recommendations. Developed by a panel of multidisciplinary experts, it provides a clear explanation of the logical associations between various care options and health outcomes while rating the quality of the evidence and strength of the recommendations for 20 questions focused on evaluating and managing care for adults with bothersome tinnitus. The guideline provides an evidence-based framework for evaluating and managing care for adults with bothersome tinnitus.</p><p><strong>Conclusions and relevance: </strong>The CPG offers patients with tinnitus and clinicians an overview of evidence-based education and self-management, care options, and recommended outcome measures to monitor effectiveness and potentially improve patient health and well-being. Findings of a lack of sufficient evidence resulted from evaluating the quality of the body of evidence and emphasize the gaps in knowledge that need further study. Addressing these gaps may enable a comprehensive evaluation of the potential benefits and limitations of various tinnitus care options, ultimately improving patient care and clinical practice.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}