JAMA otolaryngology-- head & neck surgery最新文献

{"title":"Respectful Communication for Pediatric Patients With Overweight-Insights and Next Steps.","authors":"Sanjeev Yadav","doi":"10.1001/jamaoto.2025.3041","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.3041","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137588","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":"Respectful Communication for Pediatric Patients With Overweight-Insights and Next Steps-Reply.","authors":"Emily F Boss, Ashwin Ram Reddy, Chenery Lowe","doi":"10.1001/jamaoto.2025.3173","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.3173","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137518","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":"Palliative Care With Tracheostomy or Gastrostomy Tube Use and End-of-Life Quality and Costs Among Patients With Head and Neck Cancer.","authors":"Rui Fu, Rinku Sutradhar, Qing Li, Noémie Villemure-Poliquin, Kelvin K W Chan, Irene Karam, Julie Hallet, Antoine Eskander","doi":"10.1001/jamaoto.2025.2687","DOIUrl":"10.1001/jamaoto.2025.2687","url":null,"abstract":"<p><strong>Importance: </strong>Patients with head and neck cancer (HNC) have high utilization rates of tracheostomy or gastrostomy tubes (g-tubes) at the end of life, with accompanying high costs. It is unknown whether the timing of palliative care (PC) initiation may attenuate the cost or be associated with better quality of life during the last year and more home deaths.</p><p><strong>Objective: </strong>To assess the association of palliative care (first exposure) and tracheostomy or g-tube utilization with end-of-life costs among patients with head and neck cancer during the last year of life.</p><p><strong>Design, setting, and population: </strong>This was a population-based cohort study of adults diagnosed with HNC between January 1, 2007, and December 31, 2022, who died before October 1, 2023, in Ontario, Canada. Health administrative data were deterministically linked and analyzed at the ICES (formerly Institute for Clinical Evaluative Sciences). Data analysis was conducted from January 2024 to June 2025.</p><p><strong>Exposures: </strong>Timing of PC, categorized as early (12 to 6 months before death), late (<6 months before death), and none (no PC during last year of life), was combined with tracheostomy tube use (binary) to form a 6-level categorical variable. This procedure was repeated for g-tube.</p><p><strong>Main outcomes: </strong>Mean monthly health care costs in last 6 months of life were estimated using a patient-level case-costing algorithm using 2023 CAD$ (CAD$ 1.00 = US$ 0.74) and evaluated by negative binomial regression.</p><p><strong>Results: </strong>The analysis included 11 135 adults who received a diagnosis of HNC from 2007 to 2022 and died before October 1, 2023. They had a mean (SD) age of 68.4 (12.1) years at diagnosis and 8245 were male (74.0%). Nearly 90% received PC: 5866 (52.6%), late PC; 4093 (36.8%), early PC; and 1176 (10.6%) did not receive PC. Regarding tracheostomy/g-tube use in the last year of life, 1293 (11.6%) used a tracheostomy and 1235 (11.1%), a g-tube. Compared to those who did not receive PC nor use a tracheostomy tube, the cost increase on using a tracheostomy tube (rate ratio [RR] 2.93; 95% CI, 2.32-3.71) was higher than using it with early PC (RR, 2.88; 95% CI, 2.63-3.15) but lower than using it with late PC (RR 4.37; 95% CI, 4.00-4.77); results were similar for g-tube use. A large proportion of the cohort had an emergency department visit (9109 [81%]) or a non-PC hospital admission (5419 [48.7%]) in last 6 months of life, with both proportions being the lowest among nonrecipients of PC. Early PC was associated with a 46.8% lower likelihood (odd ratio, 0.53; 95% CI, 0.45-0.63) of experiencing a home death than no PC.</p><p><strong>Conclusions and relevance: </strong>This cohort study found that receiving a tracheostomy/g-tube in last year of life has pronounced economic implications to the health care system. Early initiation of PC may attenuate this high cost but may not reduce the use of ","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12464848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137508","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":"Refining Evidence for Stellate Ganglion Block in COVID-19-Related Parosmia.","authors":"Mengrong Miao, Mingyang Sun, Jiaqiang Zhang","doi":"10.1001/jamaoto.2025.3035","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.3035","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080717","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":"Adenotonsillectomy vs Watchful Waiting in Pediatric Mild to Moderate Obstructive Sleep Apnea: The KATE Randomized Clinical Trial.","authors":"Isabella Sjölander, Johan Fehrm, Anna Borgström, Pia Nerfeldt, Danielle Friberg","doi":"10.1001/jamaoto.2025.2831","DOIUrl":"10.1001/jamaoto.2025.2831","url":null,"abstract":"<p><strong>Importance: </strong>Adenotonsillectomy (ATE) is the standard procedure to treat children with obstructive sleep apnea (OSA).</p><p><strong>Objective: </strong>To investigate whether ATE is more effective than WW for treating otherwise healthy children with mild to moderate OSA. This randomized clinical trial (RCT) of young children investigated the benefit of ATE compared with watchful waiting (WW) after 3 years.</p><p><strong>Design, setting, and participants: </strong>The Karolinska Adenotonsillectomy (KATE) RCT was conducted between 2014 and 2020 with a 3-year follow-up and included children aged between 2 to 4 years with an Obstructive Apnea-Hypopnea Index (OAHI) score of 2 or greater and less than 10 at the otorhinolaryngology department of the Karolinska University Hospital in Stockholm, Sweden. All children were randomized to ATE (n = 29) or WW (n = 31).</p><p><strong>Interventions: </strong>ATE in children with OSA. Data were collected and analyzed in 2023.</p><p><strong>Main outcomes and measures: </strong>Results from polysomnography (PSG) and OSA-18 questionnaire were compared between the groups with the difference between changes in OAHI as the primary outcome. Children in the WW group underwent surgical treatment (crossovers) if remaining signs of OSA; OAHI score greater than 1 and/or severe symptoms, and were offered follow-ups but excluded from the per protocol analysis.</p><p><strong>Results: </strong>A total of 48 of 60 children (80%) (ATE n = 23, WW n = 16, crossovers n = 9) completed the study. Thirty-nine of 60 children (65%) were analyzed per protocol, 23 (59%) from the ATE group, 16 (41%) from the WW group. No group difference was seen in changes of OAHI (Cohen d, 0.05; 95% CI, -0.7 to 0.6), but a difference of medium effect size (Cohen d, 0.54; 95% CI, -1.3 to 0.1) when comparing changes in total OSA-18 score, in favor of ATE. Thirteen of 31 children (42%) in the WW group crossed over to surgery, follow-up PSG in 9 showed normalized OAHI after ATE. The crossover group had at baseline more of moderate OSA (Cohen d, 0.8; 95% CI, -1.5 to -0.5), higher total OSA-18 score (Cohen d, 0.8; 95% CI, -1.5 to 0.0), and larger tonsils (Cohen d, 1.3; 95% CI, -2.1 to -0.5) compared with nonoperated.</p><p><strong>Conclusions and relevance: </strong>This small long-term RCT suggests that ATE was not more effective than WW. However, almost half of the children in the WW group had remaining signs of OSA and underwent surgery. Altogether, the results indicate that children with mild signs of OSA and small tonsils could be recommended WW.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT02315911.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12447282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080676","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":"Refining Evidence for Stellate Ganglion Block in COVID-19-Related Parosmia.","authors":"Eugene Lipov","doi":"10.1001/jamaoto.2025.3032","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.3032","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080739","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":"Error in Authors' Affiliation.","authors":"","doi":"10.1001/jamaoto.2025.3401","DOIUrl":"10.1001/jamaoto.2025.3401","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12447279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080703","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":"Percutaneous Ultrasound-Guided Biopsy for Sampling Neck Lesions.","authors":"Amir A Satani, Jisoo Kim, Thomas F Flood, Erik K Loken, Raymond Y Huang, Amy C Bessnow, Philippe Armand, Eleni M Rettig, Rosh V K Sethi, Jeffrey P Guenette","doi":"10.1001/jamaoto.2025.2850","DOIUrl":"10.1001/jamaoto.2025.2850","url":null,"abstract":"<p><strong>Importance: </strong>Studies suggest that percutaneous ultrasound-guided biopsy may be effective for diagnosing lymphoma, but the achievable effectiveness has not been reported. A clinical workflow eliminating percutaneous vs surgical biopsy referral biases and allowing measurement of up-front imaged-guided biopsy effectiveness is needed.</p><p><strong>Objective: </strong>To assess diagnostic sufficiency of core-needle biopsy (CNB) and fine-needle aspiration (FNA) of neck lesions in a setting where all patients are referred for CNB or FNA prior to excisional biopsy.</p><p><strong>Design, setting, and participants: </strong>This prospective cohort study was conduced at a quaternary care academic medical institution. Biopsy results of consecutive patients undergoing percutaneous ultrasound-guided neck biopsies and head/neck surgeon excisional neck biopsies performed from June 1 to August 31, 2024, were analyzed.</p><p><strong>Exposures: </strong>CNB and FNA.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes included diagnostic yield overall and for lymphoma. Secondary outcomes included rate of subsequent excisional biopsy and yield stratified by biopsy type, location, and clinician type.</p><p><strong>Results: </strong>Of 158 biopsies among patients (mean [SD] age, 60.0 [16.5] years; 82 [51.9%] female), which were performed by 7 neuroradiologists and 5 physician assistants, diagnostic yield was 94.3% (149 of 158 biopsies), with CNB yield higher than FNA (97.9% vs 88.5%; difference, 9.4 percentage points [pp]; 95% CI, -0.4 to 19.2 pp) and no missed lymphoma diagnoses. Diagnostic yield in cases with lymphoma as prebiopsy differential diagnosis was 97.4% (74 of 76 biopsies): 20 lymphoma, 27 inflammatory, 17 solid tumors, 10 benign lymphoid tissue, and 2 nondiagnostic. No immediate complications and 1 infection occurred. Only 2 patients underwent subsequent excisional biopsy, 1 due to pending pathology on the surgery date and the other to confirm a negative CNB result. Two additional excisional biopsies were performed during the study period, both by request due to insufficient tissue from outside hospital specimens. Neuroradiologist yield was slightly higher than physician assistant yield, with a wide confidence interval (95.3% vs 92.2%; difference, 3.1 pp; 95% CI, -6.7 to 13.0 pp). Flow cytometry analysis detected lymphoma signatures in 13 of 20 (65.0%) lymphoma specimens.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, up-front percutaneous ultrasound-guided biopsy was shown to be a highly effective and safe method for diagnosing neck lesions, with CNB providing a high diagnostic yield that may generally obviate the need for excisional biopsy, even when lymphoma is a prebiopsy differential diagnosis.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12447280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080737","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":"Refining Evidence for Stellate Ganglion Block in COVID-19-Related Parosmia.","authors":"Luke Liu","doi":"10.1001/jamaoto.2025.3038","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.3038","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080660","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":"Refining Evidence for Stellate Ganglion Block in COVID-19-Related Parosmia-Reply.","authors":"Nyssa Fox Farrell, Lara W Crock, Jay F Piccirillo","doi":"10.1001/jamaoto.2025.2923","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2923","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080715","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}