JAMA otolaryngology-- head & neck surgery最新文献

{"title":"Communication With Families of Children With Overweight Status or Obesity During Consultation for Tonsillectomy.","authors":"Ashwin Ram Reddy, Serin Baek, Anne R Links, Liliana Rodriguez, Mary Catherine Beach, Emily F Boss, Chenery Lowe","doi":"10.1001/jamaoto.2025.1518","DOIUrl":"10.1001/jamaoto.2025.1518","url":null,"abstract":"<p><strong>Importance: </strong>Children with overweight or obesity experience greater prevalence, severity, and perioperative risk of obstructive sleep-disordered breathing and persistent sleep apnea after tonsillectomy. Yet, little is known about how weight status influences communication between surgeons and families in presurgical consultations.</p><p><strong>Objectives: </strong>To evaluate the association between patient weight status with (1) clinician-parent communication and (2) parent ratings of care experience during tonsillectomy consultations.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study examined encounters occurring between April 2016 and September 2023 at outpatient otolaryngology clinics among English-speaking parents of children aged 2 to 17 years undergoing initial evaluation for tonsillectomy and clinicians (surgeons and advanced practice medical professionals) evaluating patients for tonsillectomy. Data were analyzed from September 2023 to May 2024.</p><p><strong>Main outcomes and measures: </strong>Consultations were audio recorded and coded using the Roter Interaction Analysis System to identify verbal and nonverbal communication behaviors. After consultations, clinicians rated child weight status and parents rated care experiences using items modified from the Consumer Assessment of Healthcare Providers & Systems.</p><p><strong>Results: </strong>Of 231 encounters in this study, 50 (22%) were with children with overweight. Most children were male (n = 130 [57%]). Children and adolescents were aged 2 to 17 years (hereafter referred to as children; mean [SD] age: no overweight, 5.0 [2.6] years; overweight or obesity, 8.1 [3.3] years). There were no differences between the groups with and without overweight in verbal dominance, patient centeredness, clinician facilitation or activation statements, clinician chit-chat statements, or clinician emotional statements. After adjusting for child's race, parents' education level, and annual household income, the child overweight status was associated with a decrease in cumulative clinician positive global affect levels by standardized β = -0.18 SDs (95% CI, -0.65 to 0.00 SDs). The small effect size observed may have limited the strength of this association. Furthermore, parents of children with overweight were less likely to report that their clinician definitively demonstrated respect relative to parents of children without overweight (odds ratio, 4.56 [95% CI, 1.06-19.99]).</p><p><strong>Conclusion and relevance: </strong>These findings suggest that child weight status was not associated with measured verbal communication behaviors but was associated with lower parent ratings and observer ratings of clinician respectfulness. The small effect size and potential bias from clinician race and ethnicity and sex may have limited this association. These results indicate the need to elucidate and mitigate multilevel determinants that negatively affect ","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"777-784"},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325725","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":"Progressive Tongue Root Mass in a 32-Year-Old Woman.","authors":"Rinor Ajeti, Afrim Ajeti, Jeton Maxharraj","doi":"10.1001/jamaoto.2025.1708","DOIUrl":"10.1001/jamaoto.2025.1708","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"821-822"},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600439","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":"Updated Calcitonin Values for Prediction of Lymph Node Metastasis in Medullary Thyroid Cancer.","authors":"Ashok R Shaha, Ian Ganly, Louise Davies","doi":"10.1001/jamaoto.2025.0598","DOIUrl":"10.1001/jamaoto.2025.0598","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"767-768"},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144496682","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":"Hypothermia in Microvascular Head and Neck Reconstruction-Risk of Venous Thromboembolism and Flap Pedicle Thrombosis.","authors":"John D Cramer, Trinitia Y Cannon, Michael J Brenner","doi":"10.1001/jamaoto.2025.1498","DOIUrl":"10.1001/jamaoto.2025.1498","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"825"},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325726","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":"Emerging Role of Pathologic Response in Head and Neck Squamous Cell Carcinoma Immunotherapy.","authors":"Ashish Dahal, Ravindra Uppaluri, Trisha M Wise-Draper","doi":"10.1001/jamaoto.2025.2111","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2111","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753365","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":"Pathologic Treatment Effect and Survival in HPV-Negative HNSCC Following Neoadjuvant Nivolumab.","authors":"Annie E Moroco, Kathryn Nunes, Angela Alnemri, Kelly Bridgham, Pablo Llerena, Madalina Tuluc, Stacey Gargano, Tingting Zhan, Arielle G Thal, David M Cognetti, Joseph M Curry, Jennifer M Johnson, Adam J Luginbuhl","doi":"10.1001/jamaoto.2025.1707","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.1707","url":null,"abstract":"<p><strong>Importance: </strong>Neoadjuvant immunotherapy shows promise in the treatment of head and neck squamous cell carcinoma (HNSCC). Pathologic treatment effect (pTE) is one way to assess response to treatment; however, the association of this response with survival outcomes is not yet clear. The current study sought to determine whether treatment response to neoadjuvant nivolumab, as measured by pTE, correlates with survival outcomes.</p><p><strong>Objective: </strong>To determine whether patients with HNSCC with pathologic response to neoadjuvant nivolumab have improved survival outcomes.</p><p><strong>Design, setting, and participants: </strong>A cohort study performing a pooled analysis of 2 multi-institutional neoadjuvant clinical trials (NCT03238365, NCT03854032) enrolling patients from July 2017 to January 2022, was performed. Patients with resectable HNSCC enrolled in 1 of 2 clinical trials and treated with neoadjuvant immunotherapy and surgical resection were included in the analysis. Patients were followed up for a median (range) of 36 (4-72) months. Analysis took place on April 15, 2024.</p><p><strong>Intervention: </strong>Patients were treated with neoadjuvant nivolumab with or without the addition of immunomodulating medications (tadalafil or indoleamine 2,3 dioxygenase inhibitor).</p><p><strong>Main outcome and measure: </strong>Pooled analysis was performed to plot Kaplan-Meier 3-year survival outcomes for pTE responders and low or nonresponders. A pTE response threshold was determined using recursive partitioning analysis.</p><p><strong>Results: </strong>Seventy-nine patients were included in the analysis, of whom 40 (51%) had human papillomavirus (HPV)-negative disease. Recursive partitioning analysis identified a pTE threshold of 57%, which was used to define pathologic responders vs low or nonresponders. Pathologic responders with HPV-negative disease had significantly improved disease-free survival (100% for responders vs 66.8% for low or nonresponders; 95% CI, 46.1%-80.6%) and overall survival (100% for responders vs 73.3% for low or nonresponders; 95% CI, 53.4%-85.7%). In patients with HPV-positive disease, disease-free survival was high for both responders (90%; 95% CI, 47.3%-98.5%) and low or nonresponders (92.4%; 95% CI, 72.8%-98.1%).</p><p><strong>Conclusion and relevance: </strong>This cohort study found that patients with HPV-negative disease who are deemed pathologic responders (pTE >57%) to neoadjuvant nivolumab may have improved survival outcomes compared with those who are low or nonresponders. Not only does this suggest a role for using pathologic response as a surrogate marker, but it further highlights the neoadjuvant strategy in HNSCC as associated with improved survival.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753366","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":"Risk Factors for Airway Complications After Thyroplasty and Arytenoid Adduction.","authors":"Keisuke Kondo, Ryuhei Okada, Keiji Honda, Takahiro Asakage, Takeshi Tsutsumi, Kiyohide Fushimi, Daisuke Shinjo","doi":"10.1001/jamaoto.2025.2050","DOIUrl":"10.1001/jamaoto.2025.2050","url":null,"abstract":"<p><strong>Importance: </strong>Thyroplasty and arytenoid adduction are common phonosurgical procedures that generally have low complication rates. However, although rare, airway complications can be life-threatening, and the risk factors remain unclear.</p><p><strong>Objective: </strong>To evaluate the short-term risks of airway obstruction and death within 14 days postoperatively associated with thyroplasty and arytenoid adduction, and to identify modifiable risk factors.</p><p><strong>Design, setting, and participants: </strong>This cohort study used data from the Japanese Diagnosis Procedure Combination database to identify eligible participants from among the patients who underwent thyroplasty or arytenoid adduction from July 2010 to December 2021. Multiple regression and time-dependent Cox regression were used to assess risk factors. Data were analyzed from September 2024 to April 2025.</p><p><strong>Exposure: </strong>Thyroplasty and arytenoid adduction and potential risk factors, including antiplatelet use, gastroesophageal reflux disease, chronic pulmonary disease, and surgical procedures.</p><p><strong>Main outcomes and measures: </strong>Tracheostomy, tracheal intubation, or death within 14 days postoperatively.</p><p><strong>Results: </strong>The analysis included 8626 patients (mean [SD] age, 60.2 [16.2] years; 3127 female [36.3%] and 5499 male [63.7%]), among whom the overall complication rate was 2.03% and the mortality rate, 0.13%. Multivariable analysis showed a clinically meaningful increase in the risk of airway complications associated with advanced age; complexity of the surgical procedure (arytenoid adduction and type III and IV thyroplasty); continuous use of antiplatelets (adjusted relative risk [aRR], 3.49; 95% CI, 1.28-9.54); resumption of antiplatelets (aRR, 2.86; 95% CI, 0.89-9.19) or anticoagulants on postoperative day 1 (aRR, 3.20; 95% CI, 0.77-13.25); presence of chronic obstructive pulmonary disease; and metastatic cancer.</p><p><strong>Conclusions and relevance: </strong>These findings indicate that appropriate management of anticoagulant and antiplatelet therapy, as well as preoperative risk assessment and perioperative airway management for patients with chronic pulmonary disease may help reduce the risk of short-term airway complications after thyroplasty and arytenoid adduction. Individualized risk management in patients undergoing thyroplasty and arytenoid adduction is needed.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12290901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698565","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":"Biochemical Profile of and Factors Associated With Recurrence in Primary Hyperparathyroidism.","authors":"Ryan N Hellums, Priscilla F A Pichardo, Randy W Lesh, Madison Wivell, Anas Qatanani, Tian Guo, Nicholas C Purdy, Phillip K Pellitteri","doi":"10.1001/jamaoto.2025.1346","DOIUrl":"10.1001/jamaoto.2025.1346","url":null,"abstract":"<p><strong>Importance: </strong>Using biochemical profiles of patients with primary hyperparathyroidism allows surgeons to preoperatively identify patients who are more likely to have single-gland disease (SGD) vs multigland disease (MGD). Additionally, biochemical profiles may be used to monitor patients who are at increased risk for recalcitrant disease.</p><p><strong>Objective: </strong>To assess the associations of preoperative imaging localization, intraoperative parathyroid hormone (PTH) kinetics, and surgical pathology (SGD vs MGD) relative to baseline intact serum PTH, as well as establish independent risk factors for recalcitrant hyperparathyroidism.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study used data from a rural tertiary care center treating adult patients who underwent elective parathyroidectomy for primary hyperparathyroidism between November 1, 2006, and January 30, 2023.</p><p><strong>Main outcomes and measures: </strong>Baseline serum biochemical profiles were used to stratify patients into 2 cohorts: low PTH (<100 pg/mL) and high PTH (≥100 pg/mL). Preoperative imaging results, surgical pathology results, intraoperative PTH kinetics, and long-term outcomes were compared between the 2 groups. Long-term follow-up revealed parameters of patients with biochemical recurrence.</p><p><strong>Results: </strong>Of 1202 patients in the study, 536 were included in the low-PTH cohort (mean [SD] age at diagnosis, 61.7 [12.7] years; 430 [80.2%] female) and 666 in the high-PTH cohort (mean [SD] age at diagnosis, 61.9 [13.6] years; 501 [75.2%] female), with a median (IQR) follow-up of 4.8 (8.8) years. Preoperative imaging localized more readily in the high-PTH cohort (559 patients [90.8%] vs 441 patients [83.4%]; odds ratio [OR], 1.94; 95% CI, 1.30-2.90). SGD was more likely among patients in the high-PTH group (594 [89.2%] vs 455 [84.9%]; OR, 1.47; 95% CI, 1.05-2.06). Patients with high baseline PTH tended to have more optimal intraoperative PTH kinetics than those with low baseline PTH (intraoperative PTH decline, 70.1% vs 63.6%; difference, 6.5 percentage points; 95% CI, 1.5-11.2 percentage points). Postoperatively, a calcium level of 10.0 mg/dL at 6 months was associated with recurrence (OR, 6.96; 95% CI, 3.24-14.94).</p><p><strong>Conclusions and relevance: </strong>In this cohort study, high baseline PTH levels were associated with improved preoperative image localization and presence of SGD. Furthermore, intraoperative PTH kinetics were more optimal in patients with high baseline PTH levels. Targeted surgical approaches must be considered carefully in patients with low baseline PTH levels. Patients with postoperative calcium of 10 mg/dL at 6 months should warrant consideration of close follow-up, as these patients are more likely to have recalcitrant disease.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12290905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698561","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":"Meclizine Use and Subsequent Falls Among Patients With Dizziness.","authors":"Meredith E Adams, Pinar Karaca-Mandic, Schelomo Marmor","doi":"10.1001/jamaoto.2025.2052","DOIUrl":"10.1001/jamaoto.2025.2052","url":null,"abstract":"<p><strong>Importance: </strong>Among adults who present with dizziness, there is a critical need to identify and deimplement low-value and guideline-discordant care to mitigate the risk of falls over time. Meclizine, an antihistamine with anticholinergic properties, is the most used antiemetic vestibular suppressant in the US.</p><p><strong>Objective: </strong>To determine the factors associated with meclizine use and subsequent falls among patients aged 18 to 64 years and those aged 65 years or older with dizziness.</p><p><strong>Design, setting, and population: </strong>This cohort study assessed US commercial and Medicare Advantage claims among 805 454 adults (aged ≥18 years) with new diagnoses of dizziness between 2006 and 2015. Data were analyzed from July 2024 to February 2025.</p><p><strong>Exposure: </strong>Prescription of meclizine within 30 days of a new dizziness diagnosis.</p><p><strong>Main outcomes and measures: </strong>The main outcome measure was falls resulting in medical evaluation. Fall outcomes were attributed to meclizine use if they occurred within 60 days of a meclizine prescription. Associations of falls and meclizine with presentation setting, diagnoses, and sociodemographic characteristics were estimated with multivariable analyses.</p><p><strong>Results: </strong>Of 805 454 individuals with dizziness (502 055 women [62%]; median age, 52 years [range, 18-87 years]), 8% received a meclizine prescription. Among those prescribed meclizine, 5792 (9% overall; 10% [2189/21 700] aged 18-64 years and 9% [3603/40 138] aged ≥65 years) experienced an injurious fall. When adjusting for sociodemographics and clinical factors, a filled meclizine prescription was associated with subsequent falls in those aged 18 to 64 years (hazard ratio, 2.94; 95% CI, 2.81-3.08) and those aged 65 years or older (hazard ratio, 2.54; 95% CI, 2.42-2.66).</p><p><strong>Conclusions and relevance: </strong>This study found that although meclizine may offer immediate vertigo relief, use is incongruent with guideline-concordant care for common vestibular diagnoses. Receipt of a meclizine prescription was associated with an increased risk of injurious falls among both patients aged 65 years or older and those aged 18 to 64 years with dizziness, who are already fall prone. Future prospective and mechanistic studies may further elucidate the relationship between vestibular suppressants and fall risk, and future guidelines that engage clinicians and patients to deimplement routine vestibular suppressant use for dizziness may be warranted.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12290902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698564","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":"Comparison Between Intraoperative Frozen Sections and Final Tumor Specimen Histopathology in HPV-Related OPSCC-Reply.","authors":"Sidharth V Puram, Ryan S Jackson, Salma Ramadan","doi":"10.1001/jamaoto.2025.2004","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2004","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698563","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}