JAMA otolaryngology-- head & neck surgery最新文献

{"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":"https://doi.org/10.1001/jamaoto.2025.0596","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-05-08","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":"Intersystem Medical Error Discovery in Otolaryngology-Head and Neck Surgery.","authors":"Ruby J Kazemi, Alexis G Antunez, Nicholas R Lenze, Norman D Hogikyan, Andrew G Shuman, Lesly Dossett, Michael J Brenner","doi":"10.1001/jamaoto.2025.0541","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0541","url":null,"abstract":"<p><strong>Importance: </strong>Intersystem medical error discovery (IMED) involves clinicians identifying errors that occurred outside of their facility while a patient was under another clinician's care. Despite its major implications for safety and quality of care, explicit guidance is limited. Given the complexity of disorders and specialization within otolaryngology, IMED is a considerable concern, yet little is known about current practices or management strategies.</p><p><strong>Objective: </strong>To explore otolaryngologists' perceptions and practices around feedback and reporting of IMED and to identify strategies for preventing or responding to these errors.</p><p><strong>Design, setting, and participants: </strong>This qualitative study used semistructured, virtual interviews of 24 otolaryngologists with expertise in patient safety and quality improvement across the US from July to October of 2023. Purposive sampling ensured diversity in subspecialty, career stage, geography, practice context, and demographics.</p><p><strong>Main outcomes and measures: </strong>Otolaryngologist perceptions of IMED, encompassing barriers and facilitators to providing feedback or reporting IMED, and strategies for improving practices. Analysis followed an iterative inductive approach of interpretive description.</p><p><strong>Results: </strong>Among the 24 participants (median [IQR] age, 51 [43-59] years; 13 [54%] female), several barriers, facilitators, and strategies emerged. Barriers included logistical (eg, lack of proximity, unavailable contact information, time constraints), psychosocial (eg, interpersonal discomfort, fear of retaliation, burnout), and structural factors (eg, fragmented systems, lack of incentives, leadership modeling, perceived conflict of interest). Facilitators that were associated with increased feedback or reporting included severe, egregious, fraudulent, or repetitive errors and preexisting relationships with the involved clinician. Most participants believed that IMED was inadequately addressed, with proposed strategies encompassing feedback training, standardized guidelines, interoperable medical records, oversight by national or state bodies, and intersystem safety reporting mechanisms.</p><p><strong>Conclusions and relevance: </strong>This qualitative study shows that the absence of standardized processes and resources hampers effective responses to IMED, such as feedback and reporting. While egregious errors or preexisting relationships may trigger action, opportunities exist to enhance clinical practice and policies across health systems.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005626","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":"Presbycusis and Age-Related Hearing Loss are Really Sociocusis and Noise-Induced Hearing Loss in Elderly Individuals.","authors":"Daniel Fink","doi":"10.1001/jamaoto.2025.0784","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0784","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025013","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":"10.1001/jamaoto.2025.0102","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"532"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","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":"A Framework for Clinical Trials in Hereditary Hemorrhagic Telangiectasia-Associated Epistaxis-Navigating the PATH.","authors":"Andrew M Peterson, Murali M Chakinala, Jay F Piccirillo","doi":"10.1001/jamaoto.2025.0017","DOIUrl":"10.1001/jamaoto.2025.0017","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"425-426"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624616","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":"Retractions in Otolaryngology Publications.","authors":"Shaun Edalati, Tony Chung, Maya Govindaraj, Daniel Kraft, David K Lerner, Anthony Del Signore, Alfred Marc Iloreta","doi":"10.1001/jamaoto.2025.0018","DOIUrl":"10.1001/jamaoto.2025.0018","url":null,"abstract":"<p><strong>Objective: </strong>To characterize trends in otolaryngology (ear, nose, and throat [ENT]) retractions, identify underlying causes, and compare retraction rates with similar specialties.</p><p><strong>Design, setting, and participants: </strong>A scoping review of retracted articles published from January 1, 1974, through December 31, 2023, was carried out. Retraction data were obtained from the Crossref/Retraction Watch database and corresponding abstracts were retrieved from PubMed. Publication data were obtained from Scopus. All retracted articles related to ENT were identified. Articles from neurosurgery and ophthalmology were similarly retrieved for comparison. Articles withdrawn for routine updates, expressions of concern, reinstatements, and corrections were excluded. The data were obtained on December 3, 2024.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were annual retraction rate (proportion of retracted articles per total published articles) and reasons for retraction (categorized as intentional data misconduct, intentional procedural misconduct, unintentional data errors, unintentional procedural errors, or unknown). Secondary measures included time from publication to retraction and comparisons with neurosurgery and ophthalmology retraction rates.</p><p><strong>Results: </strong>Of 481 215 ENT articles, 471 (0.10%) were retracted. Retractions increased over time, peaking in 2022 with a retraction rate of 0.42%. Among retracted ENT articles, the most common reasons were intentional data misconduct (233 [49.50%]) and intentional procedural misconduct (210 [44.60%]). Articles with first authors from China accounted for the largest share (243 [51.60%]) of these retractions. Basic science head and neck cancer research represented the largest subspecialty category (161 [34.20%]). The median (IQR) time to retraction was 21.8 (10.8-55.3) months.</p><p><strong>Conclusions and relevance: </strong>This analysis found that retractions in ENT literature have increased over 5 decades, predominantly driven by intentional misconduct. These findings highlight the need for enhanced oversight, training, and editorial vigilance to maintain the integrity of ENT research and protect patient welfare.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"458-465"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624621","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":"A Mucocele in the Pterygopalatine Fossa.","authors":"Asimakis D Asimakopoulos, Ludovic Word, Alexandre Karkas","doi":"10.1001/jamaoto.2025.0608","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0608","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","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":"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":"485-494"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","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":"Current Progress and Future Directions of Immunotherapy in Head and Neck Squamous Cell Carcinoma: A Narrative Review.","authors":"Edward S Sim, Hoang C B Nguyen, Glenn J Hanna, Ravindra Uppaluri","doi":"10.1001/jamaoto.2024.5254","DOIUrl":"10.1001/jamaoto.2024.5254","url":null,"abstract":"<p><strong>Importance: </strong>For decades, the 3 therapeutic pillars for head and neck squamous cell carcinoma (HNSCC) have been radiation therapy, chemotherapy, and surgery. In recent years, a fourth pillar, immunotherapy, has shifted the existing paradigm of oncologic care by improving survival outcomes. This narrative review highlights key completed and ongoing clinical trials that have led to new therapeutic approaches and are aiming to further alter the current standard of care.</p><p><strong>Observations: </strong>Immunotherapy in HNSCC first saw success in phase 3 clinical trials with immune checkpoint inhibitors (ICIs) for programmed cell death 1 protein in patients with recurrent or metastatic (R/M) disease. However, only approximately 15% to 20% of patients with R/M HNSCC achieve durable responses. Subsequent trials aimed to broaden ICIs to the definitive or curative setting, in combination with established chemoradiation modalities. These studies have yielded disappointing results, raising concerns that concurrent administration of ICI with chemoradiation- or radiation-induced attenuation of immune responses may contribute to lack of efficacy. Therefore, recent studies have attempted to introduce ICI sequentially, either prior to standard of care surgery in the neoadjuvant setting or following definitive treatment in the adjuvant or maintenance setting. These trials have demonstrated mixed results but with promising initial results from early phase neoadjuvant trials demonstrating early signals of response. Further trials are currently underway with various combinatorial approaches in the neoadjuvant and adjuvant settings to assess response rates and survival.</p><p><strong>Conclusions and relevance: </strong>The introduction of ICIs has brought a dramatic shift in the treatment landscape of HNSCC. Completed trials have provided new hope for patients, but failures in several settings suggest that further studies based on a biologic understanding of immune responses are required to expand immunotherapeutic approaches.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"521-528"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567095","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":"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":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To identify preoperative patient and tumor factors associated with receiving AT, either radiation therapy (RT) or chemoradiation therapy (CRT), in patients with OCSCC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;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).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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]).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;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":"466-475"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","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}