{"title":"Mobile Application as a Digital Therapeutic for Chronic Tinnitus: A Randomized Clinical Trial.","authors":"Koichiro Wasano, Taiji Kawasaki, Fumiyuki Goto, Yoshihiko Hiraga, Shinji Nagai, Madoka Tominaga, Kaoru Ogawa","doi":"10.1001/jamaoto.2026.0858","DOIUrl":"https://doi.org/10.1001/jamaoto.2026.0858","url":null,"abstract":"<p><strong>Importance: </strong>Tinnitus is a highly prevalent condition that has no cure and can severely impair quality of life. Patients who receive cognitive behavioral therapy (CBT) and hearing aid therapy for chronic tinnitus accompanied by hearing loss have shown some improvement, but access to these interventions is limited.</p><p><strong>Objective: </strong>To develop a prototype digital therapeutic mobile app that provides educational counseling and CBT elements for treating chronic tinnitus symptoms and test its efficacy and safety for 16 weeks in patients reporting distressing chronic tinnitus.</p><p><strong>Design, setting, and participants: </strong>This double-blind, sham-controlled randomized clinical trial was conducted from September 2023 to February 2025 in individuals diagnosed with mild to severe chronic tinnitus. The trial included a 16-week treatment phase followed by an 8-week follow-up phase. Data were analyzed from February to March 2025.</p><p><strong>Intervention: </strong>Participants used either the therapeutic app or a sham control app that lacked the therapeutic functions. During the 8-week follow-up, the app's therapeutic functions were blocked and only the app's recording function was available.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was change from baseline to week 16 in the Tinnitus Handicap Inventory (THI) score, an index of tinnitus-related distress and functional impairment. Secondary outcomes were patient-reported and included THI, Tinnitus Functional Index, tinnitus loudness and control numeric rating scales, Hospital Anxiety and Depression Scale, Athens Insomnia Scale, and Patient Global Impression of Improvement.</p><p><strong>Results: </strong>A total of 60 participants (33 [55%] female; median [IQR] age, 58.5 [52.0-64.0] years) were assessed, including 30 participants in the therapeutic app group and 30 participants in the sham-control app group. The overall mean (SD) baseline THI was 41.3 (16.9). At week 16, the therapeutic app group showed significantly greater improvement in THI scores compared with the sham-control app group (between-group difference in change in THI, -20.4; 95% CI, -28.2 to -12.6). The therapeutic effect was maintained up to week 24 (mean between-group difference, -18.3; 95% CI, -26.4 to -10.1). Tinnitus worsened in 1 patient in the sham-control app group. No serious adverse events or device malfunctions with potential for health hazards were observed.</p><p><strong>Conclusions and relevance: </strong>This randomized clinical trial found that use of a tinnitus therapeutic app resulted in substantial and lasting improvement in tinnitus-related distress and functional impairment. The therapeutic app may serve as an effective and standardized intervention for individuals with chronic tinnitus.</p><p><strong>Trial registration: </strong>jrct.mhlw.go.jp Identifier: 032230359.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838039","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":"Cost-of-Care Conversations-Time to Break the Ice?","authors":"Shannon S Wu, Michelle M Chen","doi":"10.1001/jamaoto.2026.0840","DOIUrl":"https://doi.org/10.1001/jamaoto.2026.0840","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837948","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 Aid Efficacy-Timely Trial Finds Professional Guidance Trumps Costly Tech.","authors":"Jay F Piccirillo","doi":"10.1001/jamaoto.2026.0751","DOIUrl":"https://doi.org/10.1001/jamaoto.2026.0751","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837988","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":"Reconsideration of Methods and Outcomes.","authors":"Krishnakumar Thankappan","doi":"10.1001/jamaoto.2026.0843","DOIUrl":"https://doi.org/10.1001/jamaoto.2026.0843","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837969","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":"Reconsideration of Methods and Outcomes-Reply.","authors":"Alvaro Sanabria","doi":"10.1001/jamaoto.2026.0849","DOIUrl":"https://doi.org/10.1001/jamaoto.2026.0849","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837962","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}
Nadia H Van Den Berg, James Griffin, Patrick Sheahan
{"title":"Systematic Postdissection Vagal Stimulation and Surgical Strategy During Thyroidectomy.","authors":"Nadia H Van Den Berg, James Griffin, Patrick Sheahan","doi":"10.1001/jamaoto.2026.0747","DOIUrl":"https://doi.org/10.1001/jamaoto.2026.0747","url":null,"abstract":"<p><strong>Importance: </strong>Intraoperative neuromonitoring (IONM) may prevent bilateral vocal cord palsy after thyroidectomy by prompting the surgeon to abort planned total thyroidectomy in case of loss of signal from the recurrent laryngeal nerve (RLN) on the first side. The International Nerve Monitoring Study Group recommends stimulation in the sequence V1 (predissection vagus nerve), R1 (predissection RLN), R2 (postdissection RLN), V2 (postdissection vagus nerve).</p><p><strong>Objectives: </strong>To investigate sensitivity of V2 stimulation for identification of postoperative vocal cord palsy vs R2 stimulation only.</p><p><strong>Design, setting, and participants: </strong>This retrospective cross-sectional study included patients undergoing thyroidectomy from February 2024 to October 2025, using IONM with stimulation in the sequence of V1, R1, R2, V2. The findings were compared with previous cohort of 1159 nerves at risk (NARs) for which vagal nerve stimulation was performed selectively. The study was performed at an academic tertiary referral center for thyroid surgery. Consecutive patients planned for thyroidectomy were included. Inclusion criteria were thyroidectomy performed using intermittent IONM with postoperative laryngoscopy. Exclusion criteria were preoperative vocal cord palsy, deliberate or inadvertent RLN section, or no postoperative laryngoscopy performed.</p><p><strong>Exposures: </strong>V2 stimulation.</p><p><strong>Main outcomes and measures: </strong>The primary outcome measure was vocal mobility on the first postoperative day. The sensitivity, specificity, negative predictive value, and positive predictive value of the 2 strategies were compared.</p><p><strong>Results: </strong>Among 240 patients (mean [SD] age, 50 [15] years; 188 [78.3%] female patients), 43 of 353 NARs (12.2%) had loss of signal (33 [9.3%] persistent). Of these, 9 (27.3%) had V2 loss of signal, with no preceding loss of signal or electrophysiological events on the RLN. Six patients planned for total thyroidectomy had change in operative plan to lobectomy only, including 2 patients with unexpected V2 loss of signal. Impaired vocal mobility was present in 7 of 9 cases with intact R2 and absent V2 response (77.8%). The sensitivity of R2 and V2 stimulation for postoperative vocal cord palsy was 57.9% and 100%, respectively. Among the earlier cohort undergoing selective vagal nerve stimulation, the sensitivity of IONM for impaired vocal cord mobility was 83.3%.</p><p><strong>Conclusion and relevance: </strong>The findings of this cross-sectional study suggest that IONM without systematic V2 stimulation has inferior sensitivity to systematic V2 stimulation. Systematic V2 stimulation should be considered criterion standard to minimize risk of bilateral vocal cord palsy after total thyroidectomy.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837993","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}
Elena Maria Varoni, Sem Decani, Laura Moneghini, Moreno Zagni, Camilla Tincati
{"title":"Undiagnosed Syphilis Presenting as Recurrent Oral Ulcers.","authors":"Elena Maria Varoni, Sem Decani, Laura Moneghini, Moreno Zagni, Camilla Tincati","doi":"10.1001/jamaoto.2026.0676","DOIUrl":"https://doi.org/10.1001/jamaoto.2026.0676","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771581","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}
Rebecca A Zasloff, Alexandra E Hunter, Ayush Khanna, Huda Haque, Elizabeth R Blackwood, Regan W Bergmark, Evan M Graboyes, Nosayaba Osazuwa-Peters
{"title":"Tools for Identifying Social Determinants of Health in Head and Neck Cancer: A Scoping Review.","authors":"Rebecca A Zasloff, Alexandra E Hunter, Ayush Khanna, Huda Haque, Elizabeth R Blackwood, Regan W Bergmark, Evan M Graboyes, Nosayaba Osazuwa-Peters","doi":"10.1001/jamaoto.2026.0681","DOIUrl":"https://doi.org/10.1001/jamaoto.2026.0681","url":null,"abstract":"<p><strong>Importance: </strong>Adverse social determinants of health (SDoH) are associated with disparities in head and neck cancer (HNC) and lead to delayed diagnosis and treatment. Despite this recognized association, there is limited research assessing SDoH identification tools within HNC care.</p><p><strong>Objective: </strong>To summarize existing literature on SDoH identification tools used for patients with HNC in the US and characterize the scope of domains assessed by these tools.</p><p><strong>Evidence review: </strong>A scoping review was conducted using the Medline, Embase, and Web of Science databases through February 9, 2026. Studies were included if they reported on SDoH identification tools studied in HNC care in the US. Inclusion criteria required that tools be applied in clinical settings and include data relevant to patients with HNC. Data were analyzed on September 5, 2024, and February 15, 2026.</p><p><strong>Findings: </strong>Seven studies published between August 2019 and October 2024 met inclusion criteria (512 patients), identifying 5 unique SDoH identification tools (Comprehensive Score for Financial Toxicity, Financial Distress Questionnaire, Patient Satisfaction Questionnaire, and NCCN Distress Thermometer Problem List). These tools were categorized based on the 5 key domains outlined by Healthy People 2030. Among the identified tools, survey items assessed 4 domains: economic stability, social and community context, health care access and quality, and neighborhood and built environment. Four of 5 tools only assessed 2 domains or fewer, and 1 tool assessed 3 domains. Economic stability was the most commonly examined domain across the 4 tools.</p><p><strong>Conclusions and relevance: </strong>This scoping review highlights a substantial lack of validated SDoH identification research within patient populations with HNC. Existing tools capture a limited scope of SDoH domains, which may hinder efforts to address existing disparities in HNC care. Future research should focus on assessing the use of SDoH instruments in guiding the integration of SDoH screening into routine clinical care and targeted follow-up interventions aimed at improving equity in HNC outcomes.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771598","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}
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