JAMA otolaryngology-- head & neck surgery最新文献

{"title":"Factors and Outcomes of Inappropriate Thyroid Ultrasonography.","authors":"Felipe Larios, David Toro-Tobon, Cristian Soto Jacome, Oscar J Ponce-Ponte, Kerly Guevara Maldonado, Luis Vilatuna Andrango, Ana Cristina Proano, Jungwei W Fan, Ricardo Loor-Torres, Misk Al Zahidy, Ana Gabriela Claros, Katerina Mulanovich, Esteban Cabezas, Yuqi Wu, Megan E Branda, Lindsay Bischoff, Naykky Singh Ospina, Juan P Brito","doi":"10.1001/jamaoto.2025.2049","DOIUrl":"10.1001/jamaoto.2025.2049","url":null,"abstract":"<p><strong>Importance: </strong>Thyroid cancer incidence has tripled in the past 3 decades, largely driven by increased detection of small, indolent papillary thyroid cancers. Overuse of thyroid ultrasonography (TUS) contributes to overdiagnosis, leading to unnecessary biopsies, procedures, and potential patient harm.</p><p><strong>Objective: </strong>To evaluate the frequency of and factors associated with inappropriate TUS (iTUS) orders and assess related clinical outcomes.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study analyzed adult patients 18 years and older who underwent their first TUS from January 1, 2017, to December 30, 2021, at 4 Mayo Clinic sites. Patients with previous thyroid nodule, thyroid cancer, thyroid surgery, or TUS were excluded. Based on documented clinical indications, a validated natural language processing model classified TUS orders as appropriate or inappropriate. Data were analyzed from April 2024 to May 2025.</p><p><strong>Exposures: </strong>Baseline characteristics of patients, clinicians, and clinical encounters investigated for their association with an iTUS order.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the proportion of iTUS orders. Secondary outcomes included factors associated with iTUS (sociodemographic, clinical, order-specific, and clinician-related factors) and clinical outcomes following iTUS, including the detection of thyroid nodules, thyroid procedures, and thyroid cancer diagnoses.</p><p><strong>Results: </strong>Of 11 442 included patients, 8422 (73.6%) were female, and the mean (SD) age was 57.3 (15.8) years with a mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) of 29.7 (7.0). Among 11 442 TUS orders, 866 (7.6%) were classified as inappropriate. In multivariable analysis, younger age (age of 18 to 54 years vs older than 65 years; odds ratio [OR], 1.86; 95% CI, 1.56-2.22), hyperthyroidism (OR, 9.04; 95% CI, 6.75-12.11), ordering by nonendocrinology specialties (eg, oncology/hematology; OR, 3.43; 95% CI, 2.47-4.76), and orders not linked to an in-person appointment (eg, portal messages; OR, 2.42; 95% CI, 2.08-2.82) were strongly associated with increased odds of iTUS. Compared with appropriate TUS, iTUS led to lower rates of thyroid nodule detection (202 of 866 [23.3%] vs 6885 of 10 576 [65.1%]; OR, 0.16; 95% CI, 0.14-0.19), biopsies (89 [10.3%] vs 2647 [25.0%]; OR, 0.34; 95% CI, 0.27-0.43), partial thyroidectomies (14 [1.6%] vs 424 [4.0%]; OR, 0.39; 95% CI, 0.23-0.67), and confirmed thyroid cancer cases (16 [1.8%] vs 425 [4.0%]; OR, 0.45; 95% CI, 0.27-0.74).</p><p><strong>Conclusions and relevance: </strong>In this cohort study, approximately 1 in 13 TUS orders were inappropriate. iTUS was more common in younger patients, those with thyroid dysfunction, those not seen in person, and in those referred by nonendocrinology specialties. These findings highlight the need for ta","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"843-852"},"PeriodicalIF":5.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12332758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794459","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":"Skull Base Osteomyelitis Due to Enterococcus raffinosus.","authors":"Shiori Kitaya, Hisashi Sugimoto, Hajime Kanamori","doi":"10.1001/jamaoto.2025.2119","DOIUrl":"10.1001/jamaoto.2025.2119","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"901-903"},"PeriodicalIF":5.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760077","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":"Oral Corticosteroids in Vocal Fold Paralysis After Thyroid Surgery: A Randomized Clinical Trial.","authors":"Eleonor Carvajal-Alegria, Nathalie Girault, Gianluca Donatini, Denis Frasca, Denis Tonnerre, Tom Cosset, Anne Rullière, Jean-Pascal Lebreton, Xavier Dufour, Florent Carsuzaa","doi":"10.1001/jamaoto.2025.2169","DOIUrl":"10.1001/jamaoto.2025.2169","url":null,"abstract":"<p><strong>Importance: </strong>There is no consensus in the field for the management of postthyroidectomy unilateral vocal fold paralysis (VFP). In cases where recurrent laryngeal nerve transection is not present, a local inflammatory process is thought to cause VFP. The findings suggest that corticosteroids may have a beneficial effect in managing this phenomenon.</p><p><strong>Objective: </strong>To evaluate the efficacy of a 7-day oral corticosteroid treatment on vocal cord remobilization in patients with unilateral VFP after thyroidectomy or parathyroid surgery.</p><p><strong>Design, setting, and participants: </strong>This prospective randomized double-blind placebo-controlled trial was conducted between September 2018 and May 2023 at a tertiary referral hospital. Patients who underwent partial or total thyroidectomy or parathyroid surgery were included. Exclusion criteria included corticosteroid intolerance, prior cervical surgery or radiotherapy, surgery performed for a malignant tumor and multinodular intrathoracic goiters.</p><p><strong>Interventions: </strong>At baseline, an inclusion visit assessed vocal cord mobility via nasofibroscopy and voice quality using the GRBAS (grade, roughness, breathiness, asthenia, strain) scale. Postoperative assessments were performed the day after surgery to identify unilateral VFP. Patients with unilateral VFP were randomized to receive either a 7-day course of oral corticosteroids or a placebo.</p><p><strong>Main outcomes and measures: </strong>At 7 days, 1 month, and 3 months, nasofibroscopic evaluation and GRBAS scale assessment were performed to monitor vocal fold remobilization and voice quality. All analyses were intention to treat.</p><p><strong>Results: </strong>Of the 468 patients included, 26 (5.6%) developed unilateral VFP and were randomized (19.2% male; 80.8% female; median age, 68 [IQR, 62.5-73.0] years in corticosteroid group and 59 [IQR, 52.5-73.0] years in placebo group). By day 7, vocal cord remobilization occurred in 42.8% (6 of 14) of the corticosteroid group and 41.6% (5 of 12) of the placebo group (proportion difference, 1.2%; 95% CI -32.8% to 34.4%). GRBAS results showed no meaningful difference in pathological items between groups at any time point.</p><p><strong>Conclusion and relevance: </strong>Results of this randomized clinical trial suggest that oral corticosteroids do not enhance vocal cord remobilization or improve voice quality in patients with postoperative unilateral VFP. Speech therapy remains essential in the management of postoperative VFP.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT03553342.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"874-880"},"PeriodicalIF":5.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12332756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794471","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":"Caution in Interpretation of Population Attributable Fractions-Reply.","authors":"Jason R Smith, Nicholas S Reed, Jennifer A Deal","doi":"10.1001/jamaoto.2025.2474","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2474","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954648","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":"Contributing Factors to the Nonpublication of Head and Neck Cancer Clinical Trials.","authors":"Ethan Lewis, Paul Zolkind, Dorina Kallogjeri, Jay F Piccirillo","doi":"10.1001/jamaoto.2025.2549","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2549","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12395354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954639","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":"Executive Summary of the American Radium Society Appropriate Use Criteria for Management of Early Glottic Cancer: A Review.","authors":"Monica E Shukla, Stephanie Misono, Arya Amini, Rita Sieracki, Vinita Takiar, Matthew C Ward, Richard Bakst, Ravi A Chandra, Steven Shih-Wei Chang, Karen Choi, Thomas Galloway, Kenneth S Hu, Jared R Robbins, Farzan Siddiqui, Gary Walker, Matthew E Witek, Danielle N Margalit","doi":"10.1001/jamaoto.2025.2580","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2580","url":null,"abstract":"<p><strong>Importance: </strong>Stage I squamous cell carcinoma (SCC) of the glottic larynx carries a favorable prognosis after treatment with endoscopic surgery or radiation therapy (RT). In addition to tumor control, goals of therapy include preservation of voice quality, swallow function, and breathing. Multidisciplinary consensus guidelines are needed to assist clinicians in treatment selection and the appropriate use of both surgical and radiation-based techniques.</p><p><strong>Observations: </strong>Treatment of clinical T1N0 glottic SCC has evolved over time, with advances in both transoral laser microsurgery and RT designed to become more targeted and reduce the overall treatment burden for patients. When selecting a treatment option, consideration should be given to patient-specific factors, including tumor position/extent, age, and medical and psychosocial factors. This 16-member multidisciplinary American Radium Society (ARS) Head and Neck Cancer Appropriate Use Criteria (AUC) expert panel performed a review of the English-language medical literature from 2000 to 2022 to inform consensus guidelines. Clinical case variants were developed to represent commonly encountered clinical scenarios, and the RAND/UCLA appropriateness method was used to rate the appropriate use of various treatments. The modified Delphi method was used to reach consensus recommendations, which were approved by the ARS Executive Committee and subject to public comment per established ARS procedures.</p><p><strong>Conclusions and relevance: </strong>Given the range of treatment options available, early glottic SCC management should be done in a multidisciplinary fashion including otolaryngologists and radiation oncologists. The ARS Head and Neck AUC expert panel created an appropriate-use consensus document by performing a literature review of the current treatment strategies for stage I glottic SCC, providing recommendations regarding the appropriateness of surgery or RT for various clinical scenarios and highlighting areas of controversy and uncertainty.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954600","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":"Caution in Interpretation of Population Attributable Fractions.","authors":"Robert F Labadie","doi":"10.1001/jamaoto.2025.2480","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2480","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954602","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":"Can Chemotherapy Emerge From the Shadows in Resectable Cutaneous Squamous Cell Carcinoma?","authors":"Vasu Divi, A Dimitrios Colevas","doi":"10.1001/jamaoto.2025.2678","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2678","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954518","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":"Prognostic Subgroups for Disease-Free Survival With Cutaneous Squamous Cell Carcinoma of the Head and Neck: A Secondary Analysis of a Randomized Clinical Trial.","authors":"Sandro Virgilio Porceddu, Emma Connolly, Mathias Bressel, Chris Wratten, Howard Yu-Hao Liu, Danny Rischin","doi":"10.1001/jamaoto.2025.2110","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2110","url":null,"abstract":"<p><strong>Importance: </strong>Cutaneous squamous cell carcinoma is a common cancer, and approximately 5% of cases present with high-risk features, such as regional nodal metastases. Postoperative radiotherapy (PORT) improves outcomes in this group, but the TROG 05.01 trial found no added benefit of concurrent chemotherapy. Identification of patients with poor disease-free survival (DFS) is critical to optimize future adjuvant treatment strategies.</p><p><strong>Objective: </strong>To identify a subgroup of patients with poor DFS following PORT with or without concurrent chemotherapy who may be appropriate candidates for future adjuvant trials.</p><p><strong>Design, setting, and participants: </strong>This was a secondary analysis of the prospective, randomized phase 3 TROG 05.01 trial, which enrolled 321 patients with high-risk cutaneous squamous cell carcinoma of the head and neck between April 2005 and July 2014 at multiple centers in Australia. Data were analyzed in January 2025. A recursive partitioning analysis using classification and regression trees was applied to identify prognostic subgroups. Disease-free and overall survival (OS) were measured from randomization until relapse or death, with appropriate censoring.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was DFS; secondary outcomes included OS and identification of prognostic subgroups.</p><p><strong>Results: </strong>Of 321 patients randomized, 310 (23 female individuals [7%] and 287 male individuals [93%]; median [range] age, 64 [32-85] years) initiated the allocated treatment. The recursive partitioning analysis identified 6 nodes and grouped patients into 3 DFS risk categories. A high-risk group (n = 88) was defined by the presence of extranodal extension and a nodal size of 22 mm or greater. This group had 5-year DFS and OS rates of 56% (95% CI, 45%-66%) and 59% (95% CI, 46%-69%), respectively, compared with 75% (95% CI, 68%-81%) and 85% (95% CI, 79%-90%) in the non-high-risk group. The hazard ratios for high vs non-high risk were 2.0 for DFS (95% CI, 1.3-3.1; P = .001) and 3.2 for OS (95% CI, 1.9-5.3; P < .001).</p><p><strong>Conclusions and relevance: </strong>The results of this secondary analysis suggest that patients with extranodal extension and a nodal size of 22 mm or greater represent a high-risk subgroup with inferior DFS following PORT with or without concurrent chemotherapy. These patients may benefit from future trials that evaluate adjuvant treatment intensification.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT00193895.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12395356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954657","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":"Adenotonsillectomy and Blood Pressure in Children With Mild Obstructive Sleep-Disordered Breathing: An Exploratory Analysis of the PATS Randomized Clinical Trial.","authors":"Agustin J Cabrera, Dongdong Li, Susan Redline, Ronald D Chervin, Stacey L Ishman, Cristina M Baldassari, Ron B Mitchell, Raouf Amin, Fauziya Hassan, Sally Ibrahim, Kristie R Ross, Erin M Kirkham, David A Zopf, Christopher M Cielo, Lisa R Young, Susan L Furth, Susan Garetz, Carol L Rosen, Rui Wang, Ignacio E Tapia","doi":"10.1001/jamaoto.2025.2555","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2555","url":null,"abstract":"<p><strong>Importance: </strong>The impact of adenotonsillectomy on blood pressure (BP) in children with mild obstructive sleep-disordered breathing (oSDB) remains unclear.</p><p><strong>Objective: </strong>To compare BP trajectories in children with mild oSDB randomized to early adenotonsillectomy (eAT) vs watchful waiting with supportive care (WWSC).</p><p><strong>Design, setting, and participants: </strong>This was a secondary outcome exploratory analysis of the Pediatric Adenotonsillectomy Trial for Snoring (PATS), a randomized clinical trial where children aged 3 to 12.9 years with snoring and mild oSDB (Obstructive Apnea-Hypopnea Index <3 with tonsillar hypertrophy [Brodsky scale grade ≥2]) were randomized to eAT vs WWSC and followed up for 12 months. PATS was conducted across 7 tertiary pediatric centers in the US. Participants were recruited from June 29, 2016, to February 1, 2021. Data were analyzed between July and November 2024.</p><p><strong>Interventions: </strong>eAT vs WWSC.</p><p><strong>Main outcomes and measures: </strong>The outcomes of interest were 12-month changes in BP percentiles from baseline and the moderating effect of covariates on these changes. BP was measured with an automated oscillometric BP device at baseline, 6 months, and 12 months after randomization. The treatment effect on BP trajectories was evaluated using mixed-effect models.</p><p><strong>Results: </strong>Of 458 participants included in the analysis, the mean (SD) age was 6.1 (2.3) years, 230 (50.2%) were female, and 169 (36.9%) had overweight/obesity. Mean (SD) baseline systolic BP (SBP) and diastolic BP (DBP) percentiles were 60.62 (25.22) and 53.86 (21.05), respectively, and 231 participants (50.4%) underwent eAT. From baseline to 12 months, SBP and DBP decreased in the eAT group but increased in the WWSC group. The between-group difference in changes from baseline for SBP was -9.02 (95% CI, -14.77 to -3.28) and for DBP was -6.53 (95% CI, -11.02 to -2.03). Moderation analysis showed that the effect of eAT on DBP was greater among children with body mass index higher than the 85th percentile, with an interaction effect estimate of -10.40 (95% CI, -19.69 to -1.12; P = .03).</p><p><strong>Conclusion and relevance: </strong>In this exploratory analysis of the PATS randomized clinical trial, BP trajectories differed by treatment arm. eAT led to decreases in SBP and DBP percentiles, while WWSC led to increases. Children with overweight/obesity benefited more from eAT than children without.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT02562040.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12395361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954426","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}