JAMA otolaryngology-- head & neck surgery最新文献

{"title":"Otolaryngology and Public Health-Lessons in Hearing and Aging.","authors":"Sarah Y Bessen, Alexander Chern, Umamaheswar Duvvuri, Nicholas S Reed","doi":"10.1001/jamaoto.2025.1410","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.1410","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274913","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":"Nosebleeds in Children.","authors":"Alexandra G Espinel","doi":"10.1001/jamaoto.2025.1252","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.1252","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274912","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":"Stellate Ganglion Block for the Treatment of COVID-19-Induced Parosmia: A Randomized Clinical Trial.","authors":"Nyssa Fox Farrell, Lara W Crock, Aseeyah Islam, Dean Adkins, Andrew M Peterson, Dorina Kallogjeri, Jay F Piccirillo","doi":"10.1001/jamaoto.2025.1304","DOIUrl":"10.1001/jamaoto.2025.1304","url":null,"abstract":"<p><strong>Importance: </strong>Smell distortion (parosmia) is a symptom of post-COVID-19 condition that persists and has immeasurable detriments on quality of life. To date, a standard criterion for treatment of this bothersome condition has not been identified.</p><p><strong>Objective: </strong>To determine whether stellate ganglion block (SGB) is effective and safe in improving olfactory dysfunction in patients with persistent COVID-19-induced parosmia.</p><p><strong>Design, setting, and participants: </strong>This was a randomized, double-blinded, placebo-controlled clinical trial conducted from October 2023 to September 2024 at a single center study (the Washington University in St Louis/Barnes Jewish Hospital). A volunteer sample of 192 individuals were screened; 57 were enrolled after meeting eligibility criteria (age 18-70 years with self-reported parosmia of ≥6 months since COVID-19 infection, and a screening score of ≥40 on the Parosmia Olfactory Dysfunction Outcomes Rating [DisODOR] scale). Of 135 excluded, the most common reasons were prior SGB (n = 42) and parosmia resolution or non-COVID-19-induced parosmia (n = 28). Data were analyzed from September to October 2024.</p><p><strong>Intervention: </strong>Ultrasonography-guided injection of 6 to 8 mL of active mepivacaine, 1%, or saline, 0.9%, at the right or left (randomized 1:1) stellate ganglion was performed by a board-certified anesthesiologist and pain medicine specialist.</p><p><strong>Main outcome and measure: </strong>Between-subject difference of 25% in proportion of responders (defined by a 15-point decrease in DisODOR score) from baseline.</p><p><strong>Results: </strong>The study evaluated 48 participants, 32 randomized to SGB (median [range] age, 45 [19-64] y; 25 [81%] female), and 16 to placebo (median [SD] age, 45 [26-64] y; 13 [81%] female). Time since COVID-19 infection was similar between groups (SGB, 35.3 vs placebo, 30.6 months; MD = -3.1 months; 95% CI, -10.9 to 3.7). Three-month response rate was 43% (n = 13) for SGB and 38% (n = 6) for placebo (difference, -5%; 95% CI, -32% to 33%). There was no between-group difference in clinical global impression of improvement.</p><p><strong>Conclusions and relevance: </strong>This randomized clinical trial found that SGB is not superior to placebo in treating COVID-19-induced parosmia, and thus, should not be recommended as treatment.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT06253806.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274914","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":"Longitudinal Financial Toxicity and Quality of Life in Head and Neck Cancer.","authors":"Leila J Mady, Khalil Baddour, Maryanna S Owoc, Lauren D Kudrick, Alexzandra T Gentsch, David Ebbott, Benjamin Skalla, Maria Amache, Wassim Najjar, Sudip Gupta, Seema Kacker, Angela L Mazul, Carole Fakhry, Kristin L Rising, Richard Hass, Laila A Gharzai","doi":"10.1001/jamaoto.2025.1313","DOIUrl":"10.1001/jamaoto.2025.1313","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Patients with head and neck cancer (HNC) are disproportionately affected by financial toxicity (FT). Most research has evaluated FT at a single point.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate longitudinal factors associated with FT and health-related quality of life in patients and caregivers to understand its progression and effect.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This prospective cohort study was conducted at a single tertiary care center from October 2018 to December 2020. Data were analyzed from December 2020 to December 2024. Eligible participants included adult patients with HNC undergoing definitive treatment and their primary caregivers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Surveys conducted at diagnosis, 3 months, and 6 months postdiagnosis. Instruments included the Comprehensive Score for Financial Toxicity, version 1, Financial Distress Questionnaire, University of Washington Quality of Life Scale (UWQOL), version 4 (with physical [PQOL] and social [SQOL] subscales), 19-Item Social Support Survey, and Three-Item Loneliness Scale. Semistructured qualitative interviews were performed at 6 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Linear mixed-effects modeling assessed trends in FT (Comprehensive Score for Financial Toxicity), PQOL, and SQOL longitudinally. The McNemar tests compared Financial Distress Questionnaire score among dyads. Qualitative interviews were analyzed using a conventional content analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 74 enrolled patients (median [range] age, 60 [32-81] years; 12 female individuals [19%]), 64 (86%) completed at least 1 survey, and 41 (64%) participated in interviews. Patients and caregivers reported similar support and loneliness. FT decreased over time (β = 2.77; 95% CI, 1.60-4.33) and older age (β = 0.37; 95% CI, 0.05-0.68) and higher education (β = 13.43; 95% CI, 7.76-18.43) were associated with lower FT, while not working (β = -6.77; 95% CI, -10.31 to -2.96) was associated with worse FT over time. Mixed-effects logistic modeling showed similar odds of high FT over time for patients and caregivers (odds ratio, 1.66; 95% CI, 0.11-273.14). PQOL declined, while SQOL improved longitudinally. Insurance type was the only sociodemographic variable associated with health-related quality of life at diagnosis. Qualitative findings highlighted gaps in treatment expectations, lack of preparedness for financial demands, and the association of FT with employment and caregiving.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;The results of this cohort study suggest that age, education level, and employment are associated with FT and its progression. FT is dynamically associated with PQOL and SQOL over time. These findings highlight treatment expectations as a theme contributing to unpreparedness for FT. Interventions to manage physical symptoms, return patients and caregivers to work, and alleviate lower educational attainment an","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274911","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":"Immunotherapy Utilization Outcomes in Distantly Metastatic Head and Neck Squamous Cell Carcinoma.","authors":"Neel R Sangal, Iulia Tapescu, Praneet Kaki, Robert M Brody, Ryan M Carey","doi":"10.1001/jamaoto.2025.1351","DOIUrl":"10.1001/jamaoto.2025.1351","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Immunotherapy is part of multimodal treatment for distantly metastatic head and neck squamous cell carcinoma (mHNSCC); however, survival outcomes outside of clinical trials have not been systematically assessed. This study used the US National Cancer Database (NCDB) to evaluate the use and outcomes of nonpalliative immunotherapy across various HNSCC primary sites outside of clinical trial settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the routine clinical use of nonpalliative immunotherapy and its survival outcomes for different primary sites of mHNSCC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This was a large population-based cohort study using data from the NCDB, a cancer registry of patients treated at more than 1500 hospitals in the US. Eligible participants were patients with mHNSCC who received immunotherapy from 2013 to 2020. Data analysis was conducted from October 2023 and March 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Receiving immunotherapy or not.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Overall survival (OS) following mHNSCC diagnosis was the primary outcome. The secondary outcome was prognostic factors of OS stratified by primary site. Kaplan-Meier and multivariable Cox regression models were used in the analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 5059 patients with mHNSCC (mean [SD] age at diagnosis, 64.6 [10.6] years; 4074 male [80.5%]; 162 Asian [3.2%], 763 Black [15.1%], 267 Hispanic [5.3%], 19 Native American [0.4%], and 3848 White [76.1%] individuals), there were 1073 (21.3%) who received immunotherapy and 3986 (78.8%) who did not. Immunotherapy use increased year over year from 2013 to 2020 (9.3% vs 33.8%). Immunotherapy recipients were predominantly covered by Medicare (539 patients [22.3%]) or privately insured (310 patients [23.9%]). Patients receiving both chemotherapy and immunotherapy had the longest median survival at 19.1 (95% CI, 17.0-21.5) months, followed by those receiving chemotherapy alone at 17.3 (95% CI, 16.6-18.3) months. Compared to chemotherapy alone, multivariable Cox analysis demonstrated improved OS for the addition of immunotherapy (hazard ratio [HR], 0.81; 95% CI, 0.72-0.91) but worse OS for immunotherapy alone (HR, 1.25; 95% CI, 1.08-1.45) and no chemotherapy or immunotherapy (HR, 2.31; 95% CI, 2.12-2.52). Adding immunotherapy to chemotherapy improved OS in patients with hypopharyngeal (HR, 0.66; 95% CI, 0.50-0.86), oral cavity (HR, 0.76; 95% CI, 0.59-0.98), and laryngeal (HR, 0.81; 95% CI, 0.66-1.00) cancers, but not for p16-positive (HR, 1.05; 95% CI, 0.79-1.39) or p16-negative (HR, 1.33; 95% CI, 0.96-1.86) oropharyngeal cancers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This cohort study found that immunotherapy use increased significantly from 2013 to 2020 for mHNSCC treatment, particularly at academic centers. Immunotherapy use was associated with modest OS improvement in patients with hypopharyngeal, oral cavity, and lar","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225507","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":"Considering Cohort Heterogeneity, Incorporating Frequency-Specific Classifications, and Adopting Longitudinal Designs-Reply.","authors":"Jing Wang, Valerie Sung, Melissa Wake","doi":"10.1001/jamaoto.2025.0188","DOIUrl":"10.1001/jamaoto.2025.0188","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"637-638"},"PeriodicalIF":6.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772110","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":"Determinants to Progression to Cancer of Oral Premalignant Disorders.","authors":"Saverio Caini, Oreste Gallo","doi":"10.1001/jamaoto.2025.0404","DOIUrl":"10.1001/jamaoto.2025.0404","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"639-640"},"PeriodicalIF":6.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013061","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":"A Mucocele in the Pterygopalatine Fossa.","authors":"Asimakis D Asimakopoulos, Ludovic Word, Alexandre Karkas","doi":"10.1001/jamaoto.2025.0608","DOIUrl":"10.1001/jamaoto.2025.0608","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"633-634"},"PeriodicalIF":6.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967110","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":"Moving Intersystem Medical Error Reporting Into a New Era of Accountability and Duty.","authors":"G Richard Holt","doi":"10.1001/jamaoto.2025.0596","DOIUrl":"10.1001/jamaoto.2025.0596","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"602-603"},"PeriodicalIF":6.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967655","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":"Ushering in Neoadjuvant Immune Checkpoint Inhibitors for Mucosal Head and Neck Squamous Cell Carcinoma.","authors":"Melina J Windon, Nabil F Saba, Moran Amit","doi":"10.1001/jamaoto.2025.0540","DOIUrl":"10.1001/jamaoto.2025.0540","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"625-626"},"PeriodicalIF":6.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012864","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}