JAMA otolaryngology-- head & neck surgery最新文献

{"title":"Lung Cancer Surveillance for Patients With Head and Neck Cancer.","authors":"Naif Fnais, Francisco Laxague, Marco A Mascarella, Raisa Chowdhury, Hedi Zhao, Sukhdeep Jatana, Abrar Aljassim, Catherine F Roy, Abdulaziz S Alrasheed, David S Chan, Jason Agulnik, Reza Forghani, Khalil Sultanem, Alex Mlynarek, Michael P Hier","doi":"10.1001/jamaoto.2024.3738","DOIUrl":"10.1001/jamaoto.2024.3738","url":null,"abstract":"<p><strong>Importance: </strong>Patients with head and neck squamous cell cancer (HNSCC) are at a greater risk of developing pulmonary metastases and/or second primary lung cancer. However, it remains uncertain whether lung screening in these patients, when the initial staging studies are negative, confers any survival benefit.</p><p><strong>Objective: </strong>To evaluate long-term cancer survival outcomes in patients with HNSCC undergoing chest radiography vs low-dose computed tomography screening for pulmonary metastasis and/or second primary lung cancer.</p><p><strong>Design, setting, and participants: </strong>This randomized parallel trial was conducted at a large academic hospital in Canada enrolling treatment-naive patients with de novo HNSCC from September 2015 to December 2022. Eligible patients did not meet the criteria for lung screening established by the US National Comprehensive Cancer Network guidelines. Participants were randomized to chest radiography or low-dose computed tomography screening groups. Data were analyzed from March to August 2024.</p><p><strong>Intervention or exposure: </strong>Comparison of chest radiography vs low-dose computed tomography screening methods.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes were the lung cancer detection rate measured by comparing the sensitivity and specificity of low-dose computed tomography with chest radiography. Secondary outcomes were overall survival and disease-free survival.</p><p><strong>Results: </strong>A total of 137 patients (mean [SD] age, 65.1 [14.1] years; 34 [24.8%] females and 103 [75.2%] males) were included and randomized, 68 (49.6%) to chest radiography and 69 (50.4%) to low-dose computed tomography. Nine of 137 patients (6.5%) developed a second primary lung cancer (6 patients) or lung metastases (3 patients). There were no clinically meaningful differences in survival outcomes between the 2 groups (hazard ratio, 1.2; 95% CI, 0.4-3.9). Chest radiography exhibited a relatively low sensitivity of 66.7% but a specificity of 100%. Low-dose computed tomography demonstrated both high sensitivity (100%) and specificity (100%), for an overall accuracy of 100%.</p><p><strong>Conclusions and relevance: </strong>The findings of this randomized parallel trial indicate that low-dose computed tomography exhibits statistically significant superior sensitivity compared with chest radiography for diagnosing lung metastases and second primary lung cancer. However, there were no important differences in survival rates. These results hold practical significance, offering valuable insights to clinicians who are guiding decisions regarding lung screening protocols.</p><p><strong>Trial registration: </strong>ISRCTN10954990.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567099","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":"https://doi.org/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":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-06","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":"Gene Therapy for Hearing Loss-Will the Price be Right?","authors":"Lauren E Miller, Oliver F Adunka, Vinay K Rathi","doi":"10.1001/jamaoto.2024.5189","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.5189","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567097","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":"Vitamin D Deficiency With Pediatric Obstructive Sleep Apnea-Reply.","authors":"Andrew E Bluher, Turaj Vazifedan, Cristina M Baldassari","doi":"10.1001/jamaoto.2025.0007","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0007","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567101","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":"Vitamin D Deficiency With Pediatric Obstructive Sleep Apnea.","authors":"Hujun Wang, Chenye Qiao, Congxiao Wang","doi":"10.1001/jamaoto.2025.0004","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0004","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567100","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":"Progress and Outcomes of Intraoperative Nerve Monitoring During Thyroidectomy.","authors":"Madison Hearn, Bin You, Leila J Mady, Kaitlyn M Frazier, Lilah Morris-Wiseman, Aarti Mathur","doi":"10.1001/jamaoto.2024.4452","DOIUrl":"10.1001/jamaoto.2024.4452","url":null,"abstract":"<p><strong>Importance: </strong>Intraoperative nerve monitoring (IONM) is not considered standard of care during thyroidectomy, and guidelines are vague about its use in the absence of strong evidence of superiority over visualization of the recurrent laryngeal nerve (RLN) alone.</p><p><strong>Objective: </strong>To characterize patterns of IONM use during thyroidectomy in the US and evaluate the association of IONM with postoperative outcomes.</p><p><strong>Design, setting, and participants: </strong>This cohort study used the National Surgical Quality Improvement Program (NSQIP) thyroidectomy data from January 1, 2016, to December 31, 2022. A nationally representative sample included adult patients without poorly differentiated thyroid cancer who underwent thyroidectomy at multiple centers. Data were collected from the time of surgery until 30 postoperative days through January 31, 2023.</p><p><strong>Exposure: </strong>IONM during thyroidectomy.</p><p><strong>Main outcomes and measures: </strong>Prevalence of IONM during thyroidectomy and postoperative outcomes including RLN injury, hypocalcemia, and neck hematoma.</p><p><strong>Results: </strong>A total of 44 265 patients undergoing thyroidectomy were included (77.2% female; mean [SD] age, 51.8 [15.2] years), with 30 633 (69.2%) using IONM. Common indications for surgery in the cohort were goiter (35.3%) and a single nodule or neoplasm (39.2%). The prevalence of IONM increased from 62.5% in 2016 to 75.9% in 2022. RLN injury occurred in 6.0% of cases. On propensity score-matched analyses, IONM was associated with decreased odds of RLN injury overall (adjusted odds ratio [AOR], 0.98; 95% CI, 0.97-0.99) and decreased odds among patients with differentiated thyroid cancer (AOR, 0.96; 95% CI, 0.94-0.99). IONM was not associated with postoperative hypocalcemia (AOR, 0.99; 95% CI, 0.99-1.00) or neck hematoma (AOR, 1.00; 95% CI, 0.99-1.00).</p><p><strong>Conclusions and relevance: </strong>This cohort study found that IONM during thyroidectomy has become routine, and use has increased over the last 7 years. IONM was associated with a slightly decreased odds of RLN injury, but no difference in hypocalcemia or neck hematoma. Although IONM use is widespread, further research is needed to identify patients who would benefit the most from this technology.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"236-242"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005557","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":"Third Proceedings of The North American Airway Collaborative (NoAAC): Consensus Statement on Trial Design for Airway Stenosis.","authors":"Ruth J Davis, Lee M Akst, Clint T Allen, Richard J Battafarano, Hayley L Born, Paul C Bryson, Matthew S Clary, Tyler Crosby, Vaninder K Dhillon, Greg Dion, Hannah Kavookjian, Kevin P Leahy, Ioan Lina, Natasha Mirza, Robert J Morrison, Kevin M Motz, Rebecca C Nelson, Diego Preciado, Kishore Sandu, Joseph R Spiegel, Jonathan Walsh, Alexander T Hillel, Alexander Gelbard","doi":"10.1001/jamaoto.2024.4963","DOIUrl":"10.1001/jamaoto.2024.4963","url":null,"abstract":"<p><strong>Importance: </strong>Airway stenosis is a rare but debilitating disorder that significantly degrades the quality of life in affected patients. Treatments are primarily surgical, and disease management lacks established medical therapies. The North American Airway Collaborative held its third symposium at The Johns Hopkins Hospital in Baltimore, Maryland, on April 15, 2024, focused on strategies to advance the care of these patients. The proceedings summarize the discussion of trial design in airway stenosis and the resulting North American Airway Collaborative consensus regarding clinical end points for rigorous study of novel therapies.</p><p><strong>Observations: </strong>The lectures and panels centered on the translation of a growing body of preclinical data into therapeutic targets. Additionally, detailed discussion explored design of clinical trials to evaluate safety and efficacy of novel therapeutics. The need for a consensus regarding clinically meaningful end points in airway stenosis was identified to facilitate the comparison of outcomes across institutions and future multi-institutional trials.</p><p><strong>Conclusions and relevance: </strong>The group achieved consensus regarding change in peak expiratory flow as the primary clinical end point in airway stenosis. Additional clinical measures, such as disease recurrence (identified as time to recurrent intervention), anatomical characterization of subglottic scar via axial computed tomography imaging, and patient-reported outcome measures (Clinical COPD Questionnaire [CCQ], Voice Handicap Index-10 [VHI-10], Eating Assessment Tool-10 [EAT-10], and 12-Item Short-Form Health Survey, version 2 [SF-12]) were identified as essential secondary outcomes.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"263-267"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023445","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":"Neoadjuvant GLP-1 Receptor Agonists in Sleep Surgery.","authors":"Ryan Chin Taw Cheong, Kenny Peter Pang","doi":"10.1001/jamaoto.2024.4593","DOIUrl":"10.1001/jamaoto.2024.4593","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"186-188"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914797","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":"Residential Differences and Depression Among Older Adults With Dual Sensory Loss.","authors":"Ethan B Wang, Emmanuel E Garcia Morales, Alden L Gross, Frank R Lin, Nicholas S Reed, Jennifer A Deal","doi":"10.1001/jamaoto.2024.4488","DOIUrl":"10.1001/jamaoto.2024.4488","url":null,"abstract":"<p><strong>Importance: </strong>Investigating rural-urban and regional differences in the association between dual sensory loss (concurrent hearing and vision loss) and depression may highlight gaps in sensory loss research and health care services, and by socioeconomic status. Whether urbanicity and region may modify associations between sensory loss and depression is unknown.</p><p><strong>Objective: </strong>To describe the rural-urban and regional differences in the association of dual sensory loss with depression among older adults.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used data from wave 1 (April 2017-December 2019) of the population-based Longitudinal Aging Study in India (LASI). Participants were recruited from 35 states and union territories in India. LASI incorporated a multistage stratified area probability cluster sampling design to recruit participants 45 years and older and their spouses; 31 447 eligible participants 60 years of age or older were interviewed. Data analyses were conducted from May 17, 2022, to November 11, 2023.</p><p><strong>Exposures: </strong>Sensory loss (no sensory loss, hearing loss only, vision loss only, and dual sensory loss) was determined by respondents' self-reported perceived difficulty regarding hearing and vision function.</p><p><strong>Main outcomes and measures: </strong>The Composite International Diagnostic Interview (CIDI-SF) scale was used to identify major episodic depression. Logistic regression was used to estimate the odds ratios (ORs) and 95% CIs of depression comparing participants with vs without sensory loss, adjusting for demographic and clinical covariates. Rural-urban and regional differences were assessed by including interaction terms between these variables and sensory loss.</p><p><strong>Results: </strong>The study analysis included 27 927 participants (mean [SD] age, 68.0 [7.2] years; 14 477 [51%] females and 13 450 [49%] males). The fully adjusted models showed that the odds of depression with dual sensory loss (vs no loss) was higher in urban (OR, 3.16; 95% CI, 2.00-4.99) vs rural (OR, 1.73; 95% CI, 1.31-2.29) residents and among residents in the West (OR, 5.10; 95% CI, 1.74-14.97) vs North (OR, 1.38; 95% CI, 0.81-2.35) regions.</p><p><strong>Conclusions and relevance: </strong>These findings indicate that sensory loss is associated with depression in older adults, with differences by urbanicity and region. Adults with sensory loss across multiple systems may be an important group to target for intervention.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"202-210"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914828","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":"Bilateral Expansile Perigeniculate Lesions in a Patient With Idiopathic Intracranial Hypertension.","authors":"Lawrance Lee, Mihai Bentan, Nauman F Manzoor","doi":"10.1001/jamaoto.2024.4611","DOIUrl":"10.1001/jamaoto.2024.4611","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"276-277"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914813","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}