JAMA otolaryngology-- head & neck surgery最新文献

{"title":"Tympanostomy Tube With or Without Adenoidectomy-Reply.","authors":"Z Jason Qian, Mai Thy Truong, Kay W Chang","doi":"10.1001/jamaoto.2024.4862","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.4862","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023386","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":"GLP-1RA Use and Thyroid Cancer Risk.","authors":"Juan P Brito, Jeph Herrin, Kavya Sindhu Swarna, Naykky M Singh Ospina, Victor M Montori, David Toro-Tobon, Guillermo E Umpierrez, Rodolfo J Galindo, Yihong Deng, Mindy M Mickelson, Hui Shao, Eric C Polley, Rozalina G McCoy","doi":"10.1001/jamaoto.2024.4852","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.4852","url":null,"abstract":"<p><strong>Importance: </strong>The increasing use of glucagon-like peptide-1 receptor agonists (GLP-1RA) demands a better understanding of their association with thyroid cancer.</p><p><strong>Objective: </strong>To estimate the risk of incident thyroid cancer among adults with type 2 diabetes being treated with GLP-1RA vs other common glucose-lowering medications.</p><p><strong>Design, setting, and participants: </strong>This was a prespecified secondary analysis of a target trial emulation of a comparative effectiveness study using claims data for enrollees in commercial, Medicare Advantage, and Medicare fee-for-service plans across the US. Eligible participants were adults with type 2 diabetes at moderate risk for cardiovascular disease and without history of thyroid cancer who had newly filled prescriptions for GLP-1RA, sodium-glucose cotransporter 2 inhibitor (SGLT2i), dipeptidyl peptidase-4 inhibitor (DPP4i), or sulfonylurea from January 1, 2014, to December 31, 2021. Data were analyzed February 1 to October 31, 2024.</p><p><strong>Main outcomes and measures: </strong>Overall and piecewise (<1, 1-2, and ≥2 years since treatment initiation) hazard ratios (HRs) for thyroid cancer with use of GLP-1RA vs the other 3 drug classes were estimated using inverse propensity score weighted Cox proportional hazards models. Modified intention-to-treat (mITT) (primary) and as-treated (sensitivity) analyses were performed.</p><p><strong>Results: </strong>Of 351 913 patients (mean [SD] age, 65.3 [8.5] years; 173 391 [49.3%] females and 178 522 [50.7%] males), 41 112 started treatment with GLP-1RA; 76 093, with DPP4i; 43 499, with SGLT2i; and 191 209, with sulfonylurea therapy. The numbers of patients diagnosed with thyroid cancer were 69 (0.17%) in the GLP-1RA group, 172 (0.23%) in the DPP4i group, 72 (0.17%) in the SGLT2i group, and 381 (0.20%) in the sulfonylurea group. In the mITT analysis, GLP-1RA initiation was not significantly associated with increased overall risk for thyroid cancer compared to the other 3 diabetes drugs (HR, 1.24; 95% CI, 0.88-1.76). However, the risk for thyroid cancer was significantly higher within the first year after GLP-1RA initiation (HR, 1.85; 95% CI, 1.11-3.08) and was amplified in the overall as-treated analysis that censored patients when therapy was discontinued or another medication was added (HR, 2.07; 95% CI, 1.10-3.95).</p><p><strong>Conclusions and relevance: </strong>This secondary analysis of a target trial emulation of a comparative effectiveness study found that despite the low absolute risk of thyroid cancer among patients receiving GLP-1RA therapy, there was an increased risk of new thyroid cancer diagnoses within the first year of GLP-1RA initiation compared to 3 other diabetes drugs. This finding may have been due to enhanced early detection; therefore, further research is necessary to understand the underlying causes of this association.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023423","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":"Not Enough Dentistry.","authors":"Leila J Mady, Wassim Najjar, Catherine Hayes, Rabie M Shanti","doi":"10.1001/jamaoto.2024.4851","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.4851","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023432","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":"Tympanostomy Tube With or Without Adenoidectomy.","authors":"Dmitry Tretiakow, Katarzyna Zyzynska, Agnieszka Kasprzyk-Tryk","doi":"10.1001/jamaoto.2024.4859","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.4859","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023447","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":"https://doi.org/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":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Speech Perception in Noise After Cochlear Implantation for Single-Sided Deafness: A Randomized Clinical Trial.","authors":"Jan A A van Heteren, Anne W Wendrich, Jeroen P M Peters, Wilko Grolman, Robert J Stokroos, Adriana L Smit","doi":"10.1001/jamaoto.2024.4760","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.4760","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;There is a lack of high level of evidence studies comparing the effect of different treatment options for single-sided deafness (SSD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine the effect of a cochlear implant (CI), bone conduction device (BCD), contralateral routing of signals hearing aid (CROS), and no treatment on speech perception in noise outcomes in patients with SSD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;In this single-center randomized clinical trial, adult patients with SSD were randomized into 3 groups: CI; a trial period with first a BCD on a headband and then a CROS; or a trial period with first a CROS and then a BCD on a headband. After the trial periods, patients opted for a BCD, CROS, or no treatment. Measurements were completed at baseline and at 3, 6, 12, and 24 months of follow-up. Data were collected from July 2014 to October 2021, and data were analyzed from December 2022 to May 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;CI, BCD then CROS, or CROS then BCD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was the speech reception threshold in noise (SRTn), measured with speech and noise from the front (S0N0), speech directed to the poor ear and noise to the better ear (SpeNbe), and vice versa (SbeNpe). The secondary outcome was disease-specific quality of life (QOL).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 120 included patients, 60 (50.0%) were female, and the mean (SD) age at inclusion was 53.0 (12.1) years. At the start of follow-up, 28 patients received a CI, 25 a BCD, 34 a CROS, and 26 chose no treatment. At 24 months, the CI group had significantly better speech perception in noise scores than the BCD group (difference in SRTn: SbeNpe, -4.7 dB; 95% confidence interval, -6.6 to -3.0; SpeNbe, -2.2 dB; 95% confidence interval, -4.6 to -1.1), the CROS group (difference in SRTn: S0N0, -1.3 dB; 95% confidence interval, -1.7 to -0.2; SbeNpe, -5.3 dB; 95% confidence interval, -6.0 to -3.1), and the no treatment group (difference in SRTn: SpeNbe, -6.3 dB; 95% confidence interval, -7.5 to -4.9). Compared with the no treatment group, the BCD and CROS groups showed significantly better (difference in SRTn for SpeNbe, -4.1 dB [95% confidence interval, -5.2 to -1.5] and -4.1 dB [95% confidence interval, -6.1 to -3.3], respectively) or worse (difference for SbeNpe, 4.0 dB [95% confidence interval, 2.6 to 6.2] and 4.6 dB [95% confidence interval, 2.8 to 5.7], respectively) speech perception in noise. Self-reported speech perception abilities were significantly better for the CI group compared with the BCD, CROS, and no treatment groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this randomized clinical trial, the CI group outperformed the BCD, CROS, and no treatment groups in terms of speech perception in noise and disease-specific QOL in patients with SSD after 24 months of follow-up. These results indicate that patients with SSD can partially regain t","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005558","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":"Approaching Immediate Total Thyroidectomy in First-Side Loss of Neuromonitoring Signal With Caution.","authors":"Charles de Ponthaud, Fabrice Menegaux, Sébastien Gaujoux","doi":"10.1001/jamaoto.2024.4674","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.4674","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949041","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":"Approaching Immediate Total Thyroidectomy in First-Side Loss of Neuromonitoring Signal With Caution-Reply.","authors":"Sruthi Ramesh, Nadia H Van Den Berg, Patrick Sheahan","doi":"10.1001/jamaoto.2024.4677","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.4677","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949047","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":"Cochlear Implant Electrode Placement and Music Perception.","authors":"Katelyn A Berg, Jack H Noble, Benoit M Dawant, Linsey W Sunderhaus, Andrea J DeFreese, Robert F Labadie, René H Gifford","doi":"10.1001/jamaoto.2024.4761","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.4761","url":null,"abstract":"<p><strong>Importance: </strong>Cochlear implants enable improvements in speech perception, but music perception outcomes remain variable. Image-guided cochlear implant programming has emerged as a potential programming strategy for increasing the quality of spectral information delivered through the cochlear implant to improve outcomes.</p><p><strong>Objectives: </strong>To perform 2 experiments, the first of which modeled the variance in music perception scores as a function of electrode positioning factors, and the second of which evaluated image-guided cochlear implant programming as a strategy to improve music perception with a cochlear implant.</p><p><strong>Design, setting, and participants: </strong>This single-center, prospective study recruited 50 adult patients with at least 6 months of cochlear implant listening experience and normal cochlear anatomy to participate in experiment 1 from 2013 to 2023. Data analysis was conducted from January to February 2024. Thirty-four of the 50 patients from experiment 1 also completed experiment 2.</p><p><strong>Interventions: </strong>Cochlear implant programming using a computed tomography-guided electrode selection strategy.</p><p><strong>Main outcomes and measures: </strong>University of Washington Clinical Assessment of Music score, including subtests of pitch discrimination thresholds, isochronous familiar melody recognition, and timbre recognition.</p><p><strong>Results: </strong>Of 50 participants, 20 (40%) were female, and the mean (SD) age was 57.7 (16.4) years. Experiment 1 suggested that better music perception abilities in the 50 participants were associated with patients who were younger and had a postlingual onset of deafness, as well as electrode arrays with a full scala tympani insertion, higher modiolar distance, and shallower insertion depth. Experiment 2 suggested improvements in melody recognition in the 34 participants using the image-guided cochlear implant programming strategy. Patients with apical electrodes that were deactivated were more likely to demonstrate an improvement in their pitch perception thresholds with the image-guided strategy, likely due to the low-frequency stimuli used in the University of Washington Clinical Assessment of Music.</p><p><strong>Conclusions and relevance: </strong>This study identified patient and device factors that were associated with music perception outcomes with a cochlear implant. These findings suggest that a personalized, image-guided approach to programming may improve music perception abilities for patients with cochlear implants.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949051","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":"Noise Exposure History and Age-Related Changes to Hearing.","authors":"Lauren K Dillard, Larry E Humes, Lois J Matthews, Judy R Dubno","doi":"10.1001/jamaoto.2024.4768","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.4768","url":null,"abstract":"<p><strong>Importance: </strong>Noise exposure is a major modifiable risk factor for hearing loss, yet it is not known whether it affects the rate of hearing decline in aging.</p><p><strong>Objective: </strong>To determine the association of noise exposure history with the rate of pure-tone threshold change per year.</p><p><strong>Design, setting, and participants: </strong>This longitudinal cohort study was conducted in the ongoing community-based Medical University of South Carolina Longitudinal Cohort Study of Age-Related Hearing Loss (1988 to present with the sample based in Charleston, South Carolina, and surrounding area). Following a comprehensive baseline examination, participants attended annual examinations, during which audiometric data were collected. Participants with audiometric data from at least 2 examinations and noise exposure history data were included in the study. Data were analyzed between September 2023 and July 2024.</p><p><strong>Exposure: </strong>Noise exposure history, determined by a self-reported questionnaire and history of military service, was categorized as no/little, some, or high exposure.</p><p><strong>Main outcomes and measures: </strong>Outcome measures were individual audiometric thresholds (0.25 kHz to 8.0 kHz) and pure-tone average (PTA) of thresholds at frequencies 0.5 kHz, 1.0 kHz, 2.0 kHz, and 4.0 kHz, averaged bilaterally. Linear mixed regression models were used to estimate the association of age (per every 1 additional year) with the rate of threshold change at each frequency and PTA, for each noise exposure category. The association of noise exposure with the rate of annual threshold change was determined by an interaction term of age (longitudinal time variable) and noise exposure in regression models.</p><p><strong>Results: </strong>Of 1347 participants, the mean (SD) baseline age was 63 (14) years, and 772 (57%) were female. The mean (SD) follow-up time was 5.1 (5.7) years. Compared to the no/little noise exposure group, groups with some and high noise exposure had significantly higher baseline thresholds from 2.0 kHz to 8.0 kHz and PTA, and 1.0 kHz to 8.0 kHz and PTA, respectively. Those with high noise exposure (vs no/little) showed higher rates of threshold change per year at 1.0 kHz and 2.0 kHz. Participants with some and high noise exposure showed lower rates of change per year at 3.0 kHz to 8.0 kHz and 4.0 kHz to 8.0 kHz, respectively, where hearing loss had already occurred. The rate of PTA change per year did not differ across noise exposure groups.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, noise exposure was associated with poorer baseline hearing and higher rates of annual decline at some midfrequencies. Noise exposure can have immediate and potentially long-term negative impacts on hearing.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949054","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}