JAMA otolaryngology-- head & neck surgery最新文献

{"title":"Patient-Reported Symptoms and Direct Health Care Costs in Head and Neck Cancer.","authors":"Kennedy Ayoo, Rinku Sutradhar, Qing Li, Noémie Villemure-Poliquin, Rui Fu, Kelvin K W Chan, Irene Karam, Frances Wright, Natalie G Coburn, Julie Hallet, Antoine Eskander","doi":"10.1001/jamaoto.2025.2641","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2641","url":null,"abstract":"<p><strong>Importance: </strong>Head and neck cancer (HNC) and its associated treatments are associated with substantial functional, psychological, and financial consequences. Patient-reported outcome measures (PROMs) play a crucial role in capturing the full impact of disease. Understanding how PROMs are associated with health care costs is critical for cancer care planning; however, the association of health care expenditure and PROMs is yet to be clarified.</p><p><strong>Objective: </strong>To assess the association between Edmonton Symptom Assessment System (ESAS) scores and direct health care costs incurred in 30 days for adult patients with HNC.</p><p><strong>Design, setting, and participants: </strong>This cohort study used linked administrative datasets from Ontario, Canada, of adult patients who received a diagnosis of HNC between January 1, 2007, and December 31, 2022. Included patients had at least 1 ESAS assessment completed from the date of diagnosis to the date of death or January 31, 2023. Coprimary exposures were the highest individual symptom score (h-ESAS, from 0 to 10) and the sum total of the individual scores of the 9 symptoms (t-ESAS, from 0-90). Multivariable negative binomial regression models using a generalized estimating equation approach under an exchangeable correlation structure were used to assess the association between each primary exposure and 30-day costs, accounting for patient age, sex, immigration status, socioeconomic status, cancer type, and recent cancer-directed treatment modality, updated to each ESAS assessment date. Data analysis was performed from September 2024 to February 2025.</p><p><strong>Main outcomes and measures: </strong>A 30-day cost-capturing window was defined around each ESAS assessment date to comprise a 7-day interval before this date and a 22-day interval after this date. Direct health care costs incurred during this 30-day window were estimated using a patient-level case-costing algorithm adjusted to 2023 Canadian dollars.</p><p><strong>Results: </strong>The total sample population was 16 544 adult patients with HNC (mean [SD] age at diagnosis, 63.7 [11.5] y; 12 526 [75.7%] male individuals ) and their 90 025 ESAS assessments completed since the date of diagnosis. Each 1-point increase in h-ESAS was associated with a 22% increase in 30-day costs (rate ratio [RR], 1.22; 95% CI, 1.21-1.22). Likewise, relative costs increased progressively with higher t-ESAS scores, peaking among patients with scores of 71 to 80 (RR, 4.82; 95% CI, 4.32-5.39).</p><p><strong>Conclusions and relevance: </strong>This cohort study found that both h-ESAS and t-ESAS were significantly associated with 30-day costs. These findings highlight the potential role of PROMs in cost-mitigation strategies for HNC care.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992546","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":"Addressing Stakeholder Gaps and Systemic Barriers in Intersystem Medical Error Discovery Reporting-Reply.","authors":"Ruby J Kazemi, Alexis G Antunez, Michael J Brenner","doi":"10.1001/jamaoto.2025.2660","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2660","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992571","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":"What Is Globus?","authors":"Lauren E Schlegel, Stephanie E Teng","doi":"10.1001/jamaoto.2025.2007","DOIUrl":"10.1001/jamaoto.2025.2007","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"906"},"PeriodicalIF":5.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794472","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":"Cannabis Use and Benign Salivary Gland Neoplasms.","authors":"Tyler J Gallagher, Matthew E Lin, Ian Kim, Daniel I Kwon, Niels C Kokot","doi":"10.1001/jamaoto.2025.1955","DOIUrl":"10.1001/jamaoto.2025.1955","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"900-901"},"PeriodicalIF":5.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12272350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649460","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 Young Adult With Aggressive Lesions in the Neck.","authors":"Liu Yang, Wen Li","doi":"10.1001/jamaoto.2025.2079","DOIUrl":"10.1001/jamaoto.2025.2079","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"898-899"},"PeriodicalIF":5.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753364","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":"Surgeon-Performed Transoral Ultrasonography for Detection and Staging of Oropharyngeal Cancers.","authors":"Martin Garset-Zamani, Gitte Bjørn Hvilsom, Thomas Kjærgaard, Padraig O'Leary, Kasper Wennervaldt, Mads Bøgh, Christoffer Holst Hahn, Mikkel Kaltoft, Christina Caroline Plaschke, Ronni Mikkelsen, Rikke Norling, Danijela Dejanovic, Johanna Maria Hall, Tina Klitmøller Agander, Irene Wessel, Annette Kjær Ersbøll, Christian von Buchwald, Tobias Todsen","doi":"10.1001/jamaoto.2025.1954","DOIUrl":"10.1001/jamaoto.2025.1954","url":null,"abstract":"<p><strong>Importance: </strong>Early-stage oropharyngeal squamous cell carcinoma (OPSCC) is challenging to diagnose using clinical examination and cross-sectional imaging. Ultrasonography performed transorally can provide high-resolution images of oropharyngeal structures; however, whether it improves diagnostic evaluation of patients with suspected OPSCC is unknown, and yet there is a need for improved early detection and T staging.</p><p><strong>Objectives: </strong>To compare the accuracy of clinical examination, ultrasonography, and magnetic resonance imaging (MRI) in detection of oropharyngeal tumors.</p><p><strong>Design, setting, and participants: </strong>This multicenter diagnostic clinical trial was conducted in the outpatient clinics of 3 tertiary cancer centers. Consecutive patients with suspected OPSCCs or neck metastases (without visible primary tumors) were screened from February 1, 2023, to June 30, 2024, and those eligible after a clinical examination by a head and neck surgeon were included. Exclusion criteria were a prior head and neck cancer diagnosis or a known histopathologically or imaging-verified oropharyngeal tumor present. Data were analyzed from August 1 to October 31, 2024.</p><p><strong>Intervention: </strong>Surgeon-performed transoral and transcervical ultrasonography of the oropharynx during initial clinical examination followed by cross-sectional imaging (MRI) that was evaluated blinded to results of ultrasonography and histopathologic testing.</p><p><strong>Main outcome and measure: </strong>Oropharyngeal tumor detection with reference to final histopathologic results (presence or absence of an oropharyngeal tumor).</p><p><strong>Results: </strong>The study included 162 participants (median [range] age, 63 [32-85] years; 58 female [35%] and 105 male [65%]), of whom 106 (65%) had an oropharyngeal tumor (OPSCC, 95 [59%]; lymphoma, 7 [4%]; other type, 4 [5%]). Ultrasonography had significantly higher overall accuracy (139 patients [86%]) in correctly diagnosing patients compared to clinical examination (110 [68%]; odds ratio [OR], 0.31; 95% CI, 0.18-0.52) and MRI (123 [76%]; OR, 0.48; 95% CI, 0.28-0.82). The sensitivity of the 3 diagnostic methods to detect oropharyngeal tumors was similar (ultrasonography, 95 patients [90%]; clinical examination, 87 [82%]; MRI, 97 [92%]); however, ultrasonography demonstrated nearly twice the level of specificity in the 56 patients without tumors (44 patients [79%] vs 23 [41%] and 26 [46%], respectively).</p><p><strong>Conclusions and relevance: </strong>This diagnostic clinical trial found that surgeon-performed transoral and transcervical ultrasonography in patients with suspected OPSCC provided higher diagnostic accuracy than clinical examination alone or MRI. Ultrasonography improves the clinical evaluation of suspected oropharyngeal cancers by providing higher diagnostic certainty.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"833-842"},"PeriodicalIF":5.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12272358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649464","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":"Using Supply and Demand to Identify Shortages in the Hearing Health Care Professional Workforce.","authors":"Joseph Garuccio, Benjamin Ukert, Michelle Arnold, Serena Phillips, Michael F Pesko","doi":"10.1001/jamaoto.2025.2112","DOIUrl":"10.1001/jamaoto.2025.2112","url":null,"abstract":"<p><strong>Importance: </strong>Hearing loss is a significant public health issue, affecting 23% of individuals 12 years and older in the US. While hearing loss can be efficaciously treated in many cases, shortages in the supply of hearing health care (HHC) professionals may limit uptake.</p><p><strong>Objective: </strong>To quantify the US HHC professional workforce from 2012 to 2022 and identify areas experiencing HHC professional shortages in 2019.</p><p><strong>Design, setting, and participants: </strong>In this quality improvement study, raw data from the National Plan and Provider Enumeration System were transformed to create a state- and county-level database of HHC professionals, including audiologists and hearing instrument specialists from 2012 to 2022, to assess HHC workforce supply. To assess HHC workforce demand, 2019 state- and county-level hearing loss prevalence data from Sound Check and US Census population data were used. Shortage areas were determined by comparing these measures of supply and demand in 2019. The audiologists and hearing instrument specialists included possessed National Provider Identifiers, allowing them to bill public and private insurance in the US. The data were analyzed between August 2022 and December 2024.</p><p><strong>Main outcomes and measures: </strong>Potential-shortage areas were defined using a threshold of 1 or fewer audiologists per 3500 individuals with hearing loss, and shortage areas were defined using a threshold of 1 or fewer HHC professionals per 3500 individuals with hearing loss.</p><p><strong>Results: </strong>From 2012 to 2022, the number of HHC professionals in the US increased from 16 770 to 30 704, or more than 83%. By the end of 2022, 72.4% of the HHC workforce were audiologists, and 27.6% were hearing instrument specialists, compared to 82.6% and 17.4%, respectively, in 2012. In June 2019, 75.0% of US counties were identified as shortage counties, and these counties were disproportionately rural. Ten states, primarily in the South Census region, are identified as shortage states.</p><p><strong>Conclusions and relevance: </strong>This quality improvement study showed that despite workforce growth, many areas of the US continue to experience shortages of HHC professionals, disproportionately affecting rural populations. Addressing these shortages may improve access to care for individuals with hearing loss.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"868-873"},"PeriodicalIF":5.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760078","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":"Error in Methods.","authors":"","doi":"10.1001/jamaoto.2025.2385","DOIUrl":"10.1001/jamaoto.2025.2385","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"905"},"PeriodicalIF":5.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12272351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649461","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":"Painful Oral Ulcer in the Buccal Mucosa of a Healthy Adult.","authors":"Ashim Shrestha, Rodolfo Garza, Madhu Shrestha","doi":"10.1001/jamaoto.2025.1946","DOIUrl":"10.1001/jamaoto.2025.1946","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"896-897"},"PeriodicalIF":5.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649462","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":"Consensus on Sclerotherapy for Patients With Hereditary Hemorrhagic Telangiectasia-Related Epistaxis.","authors":"Paolo Farneti, Sol Marcos-Salazar, Claudia Crocione, Holly Boyer, Roberto Puxeddu, Alan B Whitehouse, Jay F Piccirillo","doi":"10.1001/jamaoto.2025.2296","DOIUrl":"10.1001/jamaoto.2025.2296","url":null,"abstract":"<p><strong>Importance: </strong>Sclerotherapy involves injecting a sclerosing agent into the nasal, oral mucosa, and cutaneous telangiectasias to reduce bleeding, demonstrating both safety and efficacy as a treatment. Despite its proven benefits, few physicians currently offer this therapy to patients with hereditary hemorrhagic telangiectasia (HHT).</p><p><strong>Objective: </strong>To promote the safe use of sclerotherapy among patients with HHT.</p><p><strong>Design, setting, and participants: </strong>In this survey study, a modified Delphi protocol was used to achieve consensus on sclerotherapy among a panel of 6 experts. The Delphi consensus took place through online meetings and surveys sent via Google Forms. Six experts from Italy, Spain, and the US, each with more than 10 years of experience in the use of sclerotherapy for HHT-associated epistaxis and cutaneous telangiectasias, participated in the Delphi protocol.</p><p><strong>Main outcomes and measures: </strong>This approach included 3 rounds of ratings interspersed with an in-person discussion led by an experienced moderator to resolve disagreements. Experts in using specific sclerotherapy agents (sodium tetradecyl sulfate and polidocanol), both in liquid or foam form, participated in surveys. Consensus was defined as agreement among 4 of 6 panelists. After discussions and clarifications, 3 survey rounds were conducted, resulting in consensus on all 30 statements across 7 domains.</p><p><strong>Results: </strong>The consensus among 6 experts indicates that stable patients with HHT are eligible for sclerotherapy, with individualized precautions based on medical history and comorbidities. In-office sclerotherapy provides several advantages, including quick access, high patient satisfaction, and the elimination of general anesthesia risks, despite the occasional occurrence of vasovagal events and moderate bleeding. According to the 2015 European Society of Cardiology guideline, antibiotic prophylaxis is recommended for patient preparation, while fasting is generally not necessary. Specific precautions for preventing complications such as septal perforation and amaurosis were identified. Adverse effects are usually mild to moderate, with severe bleeding being rare. Practitioners should have expertise in endoscopy or rhinoscopy, thorough pathology knowledge, and training from experienced professionals.</p><p><strong>Conclusions and relevance: </strong>In this survey study, the consensus of 6 experts produced 30 statements guiding patient care and safe procedure implementation. While not formal treatment guidelines, these statements offer valuable insights for clinicians seeking to adopt or align with expert recommendations. Further validation and research are encouraged to ensure these consensus statements improve patient care and outcomes.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"881-887"},"PeriodicalIF":5.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12332757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794458","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}