JAMA otolaryngology-- head & neck surgery最新文献

{"title":"Fusion of Middle Ear Optical Coherence Tomography and Computed Tomography.","authors":"Junzhe Wang, Floor Couvreur, Joshua D Farrell, Reshma Ghedia, Nael Shoman, David P Morris, Robert B A Adamson","doi":"10.1001/jamaoto.2025.0043","DOIUrl":"10.1001/jamaoto.2025.0043","url":null,"abstract":"<p><strong>Importance: </strong>Middle ear optical coherence tomography (OCT) imaging in patients has not previously been directly compared with a standard of care clinical 3-dimensional imaging technology, such as computed tomography (CT).</p><p><strong>Objective: </strong>To qualitatively compare the capabilities of middle ear OCT with CT in normal and pathological ears on representative slices in coregistered OCT and CT datasets.</p><p><strong>Design, setting, and participants: </strong>This case series included 3 patients and 3 ears: 1 normal middle ear, 1 ear affected by traumatic injury, and 1 ear with cholesteatoma. The ears were imaged with both OCT and high-resolution clinical temporal bone CT. Participants were drawn from the patient population of a tertiary otology clinic. CT and OCT images were aligned using rigid coregistration with manual landmark selection. Data were collected from January 2022 to April 2023, and data were analyzed from February 2022 to December 2023.</p><p><strong>Main outcomes and measures: </strong>Images were analyzed qualitatively for field of view (FOV), resolution, shadowing, artifacts, soft tissue and bony tissue contrast, and presentation of diagnostically important features.</p><p><strong>Results: </strong>In the 3 imaged ears, OCT was capable of visualizing many of the important features indicative of middle ear pathology. Compared with CT, OCT exhibited a limited FOV largely confined to the mesotympanum and subject to shadowing from bony structures. However, OCT could resolve soft tissue features that were not readily apparent in the CT images to have a higher resolution than CT and to provide excellent anatomical fidelity with CT, which allowed OCT images to be accurately coregistered with CT images.</p><p><strong>Conclusions and relevance: </strong>In this case series, while OCT was not capable of replacing CT due to its limited FOV and inability to image through thick bony tissues, it visualized signs of pathology, including some soft tissue features, that are difficult to visualize with CT. Given OCT's ability to image in real time, its compatibility with in-office imaging, and its lack of ionizing radiation, it may, despite its limitations compared with CT, be an appealing imaging modality for many applications in middle ear diagnostics.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"476-484"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772204","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":"Further Clarifications for Interpretation of Study of Lobectomy vs Total Thyroidectomy With Ipsilateral Lateral Neck Dissection.","authors":"Keyu Shen, Xiequn Xu","doi":"10.1001/jamaoto.2025.0158","DOIUrl":"10.1001/jamaoto.2025.0158","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"534"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719378","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":"JAMA Otolaryngology-Head & Neck Surgery-The Year in Review, 2024.","authors":"Jay F Piccirillo","doi":"10.1001/jamaoto.2025.0365","DOIUrl":"10.1001/jamaoto.2025.0365","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"429-431"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663423","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 Neoadjuvant Immunotherapy vs Up-Front Surgery in Cutaneous Squamous Cell Carcinoma: A Post Hoc Analysis of a Nonrandomized Clinical Trial.","authors":"Shannon S Wu, A Dimitrios Colevas, Luis Martinez Ramirez, Uchechukwu C Megwalu, Michelle M Chen, Aronpreet Atwell, Vasu Divi","doi":"10.1001/jamaoto.2025.0001","DOIUrl":"10.1001/jamaoto.2025.0001","url":null,"abstract":"<p><strong>Importance: </strong>There is increasing interest in use of neoadjuvant immunotherapy (NAT) in advanced cutaneous squamous cell carcinoma (cSCC) to reduce surgical morbidity and forego adjuvant therapy, while potentially improving survival outcomes.</p><p><strong>Objective: </strong>To assess the cost to Medicare of NAT compared with up-front surgery.</p><p><strong>Design, setting, and participants: </strong>This cohort study was a post hoc analysis of a phase 2 clinical trial evaluating the feasibility of neoadjuvant atezolizumab. The study was conducted from June 2021 to December 2023 at a tertiary-level academic institution among 20 patients with advanced stage II-IV cSCC.</p><p><strong>Interventions: </strong>Up to 3 doses of neoadjuvant atezolizumab, followed by surgical resection with or without adjuvant radiation therapy.</p><p><strong>Main outcomes and measures: </strong>Direct medical costs in US dollars of care received on trial were compared with baseline treatment plans of up-front surgery developed a priori from a Medicare payer perspective.</p><p><strong>Results: </strong>Of 20 patients with advanced cSCC enrolled (median [range] age, 71.5 [53-88] years; 17 male [85.0%]), most individuals had stage III (12 patients [60.0%]) or IV (5 patients [25.0%]) disease. The median (range) follow-up was 14.2 (3.5-28.7) months. Compared with $26 602.67 for up-front surgery, NAT was associated with mean overall costs of $51 561.02, or a 93.8% increase, equivalent to $24 958.36 (95% CI, $22 057.95 to $24 692.43) per patient, which was primarily associated with the drug acquisition costs of atezolizumab ($30 603.96). NAT was associated with mean cost reductions from $12 707.07 to $10 543.71 (17.0%) in surgery and $11 711.97 to $7157.32 (38.9%) in radiation across all patients compared with up-front surgery. Adjuvant radiation therapy was obviated in 5 of 17 patients not previously irradiated (29.4%), reducing costs of radiation. Mean (SD) surgical complexity was reduced from 63.81 (30.55) to 44.71 (32.49) work relative value units (wRVUs; difference, 19.10 wRVU; 95% CI, 5.00 to 33.20 wRVU). NAT was associated with 5 fewer free flaps, 4 fewer neck dissections, 5 more organ-preserving resections, and 3 conversions from inpatient to outpatient surgery.</p><p><strong>Conclusions and relevance: </strong>This study found that treatment with 3 doses of NAT was associated with an overall cost increase compared with up-front surgery, driven by drug acquisition costs, and cost reductions from less extensive surgical resections and obviated adjuvant radiation. Predictive markers for response to NAT could optimize patient selection and improve cost-effectiveness.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT04710498.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"495-502"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772203","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":"Further Clarifications for Interpretation of Study of Lobectomy vs Total Thyroidectomy With Ipsilateral Lateral Neck Dissection.","authors":"Pierpaolo Trimboli, Gianluca Bottoni, Arnoldo Piccardo","doi":"10.1001/jamaoto.2025.0156","DOIUrl":"10.1001/jamaoto.2025.0156","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"533-534"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719376","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":"Sex- and Race-Specific Prevalence of Hearing Loss Across the Adult Lifespan and Associated Factors.","authors":"Lauren K Dillard, Lois J Matthews, Judy R Dubno","doi":"10.1001/jamaoto.2025.0534","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0534","url":null,"abstract":"<p><strong>Importance: </strong>Current research lacks detail on sex and race differences in the prevalence of hearing loss, including on the degree of hearing loss across the adult lifespan and whether associated risk factors for hearing loss may vary across sex and race groups.</p><p><strong>Objective: </strong>To evaluate the prevalence of hearing loss across the adult lifespan and associated factors and differences across sex-specific and race-specific groups.</p><p><strong>Design, setting, and participants: </strong>This study was conducted in the ongoing community-based Medical University of South Carolina Longitudinal Cohort Study of Age-Related Hearing Loss in Charleston, South Carolina (1988 to present, with the sample based in Charleston, South Carolina, and surrounding area). Data were analyzed between May and October 2024.</p><p><strong>Exposures: </strong>Demographic factors included age, self-reported sex and race, and socioeconomic position, determined by education and occupation. Self-reported hearing-related and health-related factors included a history of noise exposure, diabetes, obesity (defined as a body mass index greater than 30; calculated as weight in kilograms divided by height in meters squared), cardiovascular conditions, smoking pack-years, and number of comorbid conditions.</p><p><strong>Main outcomes and measures: </strong>Hearing loss was defined as a worse-ear pure-tone average of thresholds at frequencies 0.5, 1.0, 2.0, and 4.0 kHz greater than 25 dB hearing level. Age-adjusted and multivariable logistic regression models were used to determine factors associated with hearing loss in the entire sample and across sex and race groups separately.</p><p><strong>Results: </strong>Of 1787 included participants, 1013 (56.7%) were female, 322 (18.0%) were Black, 1439 (80.5%) were White, and 26 (1.5%) were another race (including American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, or another race), and the mean (SD) age was 61.3 (16.4) years. The prevalence of hearing loss was 46.2% (825 of 1787) and was highest among White male and female individuals (male: 396 of 652 [60.7%]; female: 326 of 787 [42.1%]) and lower among Black male and female individuals (male: 38 of 113 [33.6%]; female: 61 of 209 [29.2%]). Prevalence increased with age in the entire sample and for all sex and race groups. In a multivariable model, older age, male sex, lower socioeconomic proxy, and noise exposure were associated with higher odds of hearing loss and Black race was associated with lower odds of hearing loss. The prevalence and degree of hearing loss and some associated factors differed across sex and race groups.</p><p><strong>Conclusions and relevance: </strong>Hearing loss is an important public health concern that could be addressed through tailored interventions to reduce its risk across populations.</p>","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12046519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023810","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":"Additional Considerations Regarding GLP-1RA Use and Thyroid Cancer Risk.","authors":"Elena Gamarra, Lorenzo Scappaticcio, Pierpaolo Trimboli","doi":"10.1001/jamaoto.2025.0599","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0599","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":"143990640","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":"Clinical Practice Guideline for Management of Tinnitus: Recommendations From the US VA/DOD Clinical Practice Guideline Work Group.","authors":"LaGuinn P Sherlock, Jennifer Ballard-Hernandez, Amy Boudin-George, Khaya Clark, Maria Colandrea, Catherine Edmonds, Catherine Kelley, Suheily Lovelace, Sally Mahmood, Idalisse Martinez, Paula Myers, Sara Pulliam, James Sall, Michele Spencer, Sarah M Theodoroff, Anthony M Tolisano, Lisa M Wayman, Tara Zaugg, Robert L Folmer","doi":"10.1001/jamaoto.2025.0052","DOIUrl":"10.1001/jamaoto.2025.0052","url":null,"abstract":"<p><strong>Importance: </strong>The most recent US clinical practice guideline (CPG) for tinnitus was published in 2014. The US Department of Veterans Affairs (VA)/US Department of Defense Tinnitus Clinical Practice Guideline Work Group recently completed a new guideline. The work group consisted of experts across disciplines who were supported by the VA Office of Quality and Patient Safety and the Defense Health Agency Clinical Quality Improvement Program. This article summarizes the first VA/US Department of Defense CPG for tinnitus management.</p><p><strong>Methods and observations: </strong>The guideline was based on a systematic review of clinical and epidemiological evidence. Rigorous methods determined the strength of the recommendations. Developed by a panel of multidisciplinary experts, it provides a clear explanation of the logical associations between various care options and health outcomes while rating the quality of the evidence and strength of the recommendations for 20 questions focused on evaluating and managing care for adults with bothersome tinnitus. The guideline provides an evidence-based framework for evaluating and managing care for adults with bothersome tinnitus.</p><p><strong>Conclusions and relevance: </strong>The CPG offers patients with tinnitus and clinicians an overview of evidence-based education and self-management, care options, and recommended outcome measures to monitor effectiveness and potentially improve patient health and well-being. Findings of a lack of sufficient evidence resulted from evaluating the quality of the body of evidence and emphasize the gaps in knowledge that need further study. Addressing these gaps may enable a comprehensive evaluation of the potential benefits and limitations of various tinnitus care options, ultimately improving patient care and clinical practice.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"513-520"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663395","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":"Over-the-Counter Hearing Aid-Enabled Earbuds-Merging Hearing Health and Technology.","authors":"Alexander Chern, Justin S Golub","doi":"10.1001/jamaoto.2025.0095","DOIUrl":"10.1001/jamaoto.2025.0095","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"423-424"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663430","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":"Decision-Making Tool for Planning Camera-Assisted and Awake Intubation in Head and Neck Surgery.","authors":"Zohal Popal, Hans-Heinrich Sieg, Lynn Müller-Wiegand, Philipp Breitfeld, Andre Dankert, Phillip B Sasu, Viktor A Wünsch, Linda Krause, Christian Zöllner, Martin Petzoldt","doi":"10.1001/jamaoto.2025.0538","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0538","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Indication criteria for camera-assisted and awake tracheal intubation are vague. It is unknown if diagnostic and clinical data from multiple sources, such as transnasal videoendoscopy or symptoms for pharyngolaryngeal lesions, might improve preanesthesia airway management planning and decision-making in patients undergoing head and neck surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To develop and validate a new decision-making tool (Evidence-Based Algorithm for the Expected Difficult Intubation [Expect-It]) and show noninferiority to the clinical standard (nonalgorithm-based decision-making).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This single-center study prospectively developed and validated a decision-making tool with a 2-stage design that included anesthetic cases from patients undergoing head and neck surgery between May 1, 2021, and January 29, 2022. Data were analyzed between August 2021 (first stage) and December 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Airway-related risk factors from 4 domains (previous intubation difficulties, physical examination, physician's rating of difficult airway indicators, and pharyngolaryngeal lesions/transnasal videoendoscopy findings) were preoperatively assessed. During airway management planning, physicians proposed a first-line tracheal intubation technique (camera-assisted or direct laryngoscopy) and strategy (awake or asleep tracheal intubation). In the development cohort, these proposals were nonalgorithm-based (clinical standard); in the validation cohort, they relied on the Expect-It decision-making tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Regularized regression was used to select potentially predictive airway-related risk factors (covariables). The final decision-making tool is a combined score originating from 2 multivariable logistic regression models that predict 2 different primary outcomes: the most appropriate (1) tracheal intubation technique (camera-assisted or direct laryngoscopy) and (2) strategy (awake or asleep), as determined by the anesthesiologists after tracheal intubation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 1201 patients (mean [SD] age, 50.3 [19.0] years; 695 [58%] male), 1282 anesthetic cases were included in the analysis: 602 in the development and 680 in the validation cohort. The area under the curve of the decision-making tool was 0.86 (95% CI, 0.81-0.90) to predict appropriate camera-assisted and 0.97 (95% CI, 0.96-0.99) to predict appropriate awake tracheal intubation in the development cohort. The sensitivity of the Expect-It tool to predict both appropriate camera-assisted and awake tracheal intubation was superior compared to the clinical standard (camera-assisted: 88% [95% CI, 81%-93%] vs 35% [95% CI, 27%-44%], respectively; awake tracheal intubation: 97% [95% CI, 81%-100%] vs 29% [95% CI, 15%-50%], respectively), and specificity was noninferior to the clinical standard (camera-assisted: 97% [95% CI, 96%-98%] ","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12046521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019732","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}