JAMA otolaryngology-- head & neck surgery最新文献

{"title":"Caution in Interpretation of Population Attributable Fractions.","authors":"Ching-Nung Wu, Wei-Chun Cheng, Chung-Feng Hwang","doi":"10.1001/jamaoto.2025.2477","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2477","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":"144954628","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":"In Defense of Palpation.","authors":"Edward D McCoul","doi":"10.1001/jamaoto.2025.2433","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2433","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954604","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":"Age-Specific Risk of Second Primary Malignant Neoplasm After Radioactive Iodine Treatment for Differentiated Thyroid Cancer.","authors":"Julia J An, Mark S Choi, Chen Yang, Marita S Teng, Maaike van Gerwen","doi":"10.1001/jamaoto.2025.2626","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2626","url":null,"abstract":"<p><strong>Importance: </strong>Radioactive iodine treatment for differentiated thyroid cancer has been associated with second primary malignant neoplasms, but age-specific risks remain poorly understood.</p><p><strong>Objective: </strong>To evaluate the association of age with increased risk of second primary malignant neoplasm after radioactive iodine treatment for differentiated thyroid cancer (DTC).</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study used data from 8 cancer registries in the US National Cancer Institute's Surveillance, Epidemiology, and End Results Program for 1975 to 2021. Patients who received radioactive iodine treatment for DTC were identified; those with fewer than 2 years of follow-up, missing follow-up data, or distant metastases at diagnosis were excluded. Included patients were categorized into 3 age groups: 15 to 44, 45 to 64, and 65 years or older. Among 5-year survivors, median (IQR) follow-up time was 14.7 (8.6-24.0) years in the 15- to 44-year age group; 8.3 (6.4-11.4) years in the 45- to 64-year group; and 9.3 (6.9-12.7) years in the 65 years or older group. Data were analyzed from May to July 2024.</p><p><strong>Exposure: </strong>Radioactive iodine vs no radioactive iodine.</p><p><strong>Main outcomes and measures: </strong>Relative risks (RR) and 95% CIs for solid and hematologic second primary malignant neoplasms, calculated using multivariable Poisson regression models adjusted for age, sex, and latency.</p><p><strong>Results: </strong>The study sample comprised 72 412 patients with nonmetastatic DTC, of whom 28 432 (39%) were age 15 to 44 years; 34 009 (47%), age 45 to 64 years; and 9971 (14%), 65 years or older. In the 15- to 44-year age group, radioactive iodine was associated with an increased risk of hematologic cancers (RR, 1.35; 95% CI, 1.02-1.80), specifically myeloma (RR, 4.22; 95% CI, 1.68-10.62). In the 45- to 64-year age group, the analyses showed increased risks of prostate cancer (RR, 1.61; 95% CI, 1.10-2.37), salivary gland cancer (RR, 10.22; 95% CI, 1.27-82.24), and nodal non-Hodgkin lymphoma (RR, 2.81; 95% CI, 1.34-5.89). The overall risk of a solid second primary malignant neoplasm was not elevated (RR, 0.94; 95% CI, 0.76-1.16), but hematologic second primary malignant neoplasm risk was elevated (RR, 1.73; 95% CI, 1.14-2.60). Patients in the group that was 65 years and older showed elevated risks of stomach (RR, 4.06; 95% CI, 1.05-15.81), esophagus (RR, 11.42; 95% CI, 1.40-93.3), nonepithelial skin cancers (RR, 10.52; 95% CI, 1.09-88.77), and acute myeloid leukemia (RR, 3.26; 95% CI, 1.15-9.24). The overall risk of a solid second primary malignant neoplasm was elevated (RR, 1.88; 95% CI, 1.59-2.21), whereas risk of hematologic malignant neoplasm was not (RR, 1.35; 95% CI, 0.97-1.87).</p><p><strong>Conclusions and relevance: </strong>This cohort study found that the risk of radioactive iodine-associated second primary malignant neoplasm among patients ","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954543","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":"Management of Postthyroidectomy Hypocalcemia Using Intraoperative Parathyroid Hormone Monitoring.","authors":"Anna M Reagan, Marina E Robson Chase, Anthony A Mangino, Cortney Y Lee, David A Sloan","doi":"10.1001/jamaoto.2025.2370","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2370","url":null,"abstract":"<p><strong>Importance: </strong>Postthyroidectomy hypoparathyroidism is typically diagnosed with low serum calcium levels, often requiring patients to remain in the hospital for appropriate treatment. Given the short half-life of parathyroid hormone (PTH), can hypoparathyroidism be diagnosed intraoperatively when re-exploration and autotransplant are still possible?</p><p><strong>Objective: </strong>To determine whether intraoperative parathyroid hormone monitoring (ioPTH) permits the stratification of patients into appropriate tiers for postoperative supplementation.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included patients undergoing total or completion thyroidectomy and was conducted at a single academic center from January 2021 and December 2022. Analysis was completed in July 2024. To complete the planned threshold analysis, additional patients who had surgery between January 2020 to December 2020 and January 2023 to June 2023 and were discharged with calcium carbonate and calcitriol supplementation were included. Patients undergoing concomitant parathyroidectomy or lateral neck dissection were excluded.</p><p><strong>Exposures: </strong>All patients had a baseline PTH level drawn in the preoperative area. Additional ioPTH levels were drawn immediately and 10 minutes after thyroid excision. The exposure of interest was the absolute and relative change from baseline to immediate and 10-minute ioPTH.</p><p><strong>Main outcomes and measures: </strong>Outcome groups were determined by supplementation tier. A control group that received no supplementation was compared with the groups that received calcium carbonate only or calcium carbonate plus calcitriol. Logistic regression models were used to analyze the threshold at which ioPTH could predict postoperative supplementation tier.</p><p><strong>Results: </strong>Of the 217 patients included (mean [SD] age, 49.94 [15.56] years; 193 female individuals [89%]; 15 patients [7%] were Black, and 197 patients [91%] were White), 100 (46.1%) received no supplementation, 61 (28.1%) received calcium carbonate, and 56 (25.8%) received calcium carbonate plus calcitriol. Ninety eight (45.2%) experienced temporary hypoparathyroidism, while 2 patients developed permanent hypoparathyroidism. The best model to predict any postoperative supplementation used a 30% decrease from baseline to immediate ioPTH with an overall accuracy rate of 78.20% (sensitivity, 74.78%; specificity, 82.29%). The best model to predict use of calcium carbonate plus calcitriol supplementation corresponded to an immediate ioPTH level of 22 pg/mL, with an overall accuracy rate of 73.91% (sensitivity, 70.00%; specificity, 78.18%).</p><p><strong>Conclusions and relevance: </strong>The results of the threshold analysis demonstrated the utility of ioPTH in guiding postoperative supplementation. ioPTH may also be a useful adjunct in guiding parathyroid autotransplant intraoperatively, potentially","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954646","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":"Incidentally Discovered Neck Mass in a Middle-Aged Woman.","authors":"Katherine L Webb, Sarah Zadeh, David C Shonka","doi":"10.1001/jamaoto.2025.1476","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.1476","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855256","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":"Unilateral vs Bilateral Transoral Surgery for Tonsillar Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis.","authors":"Andrew M Peterson, Lucas Cruz, Michael P Wu, Spencer R Bockover, Dorina Kallogjeri, Lauren H Yaeger, Alex Harbison, Paul Zolkind, Jason T Rich, Patrik Pipkorn, Randal C Paniello, Sidharth V Puram, Ryan S Jackson","doi":"10.1001/jamaoto.2025.2235","DOIUrl":"10.1001/jamaoto.2025.2235","url":null,"abstract":"<p><strong>Importance: </strong>Transoral surgery via a radical tonsillectomy followed by pathology-guided adjuvant therapy is standard of care for tonsillar squamous cell carcinoma (SCCa). There is significant variation in the management of the contralateral tonsil without clinical evidence of disease.</p><p><strong>Objective: </strong>To assess the second primary tumor rates, oncologic survival, functional outcomes, and complications between bilateral and unilateral transoral surgery for tonsillar SCCa.</p><p><strong>Data sources: </strong>A search of Embase, Ovid MEDLINE, Scopus, and Cochrane was performed on September 11, 2024.</p><p><strong>Study selection: </strong>Inclusion criteria were studies with more than 10 adults undergoing transoral surgery for unilateral tonsillar SCCa reporting at least 1 primary or secondary outcome. Screening of abstracts and full texts along with data extraction were performed in duplicate.</p><p><strong>Data extraction and synthesis: </strong>The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline was followed. Data were pooled using a random-effects model.</p><p><strong>Main outcomes and measures: </strong>The primary outcome measure was the synchronous and metachronous contralateral tonsil second primary tumor rates. Secondary outcome measures were between-group differences in oropharyngeal hemorrhage and gastrostomy tube dependence rates and 2-year and 5-year overall survival (OS) and disease-free survival (DFS).</p><p><strong>Results: </strong>Of 136 unique citations identified, 11 studies were included, representing a total of 1486 patients (634 bilateral surgery, 852 unilateral surgery). The synchronous contralateral tonsil second primary tumor rate in the bilateral surgery group was 4.0% (95% CI, 2.0%-5.0%; I2 = 0.05%). The metachronous contralateral tonsil second primary tumor rate in the unilateral surgery group was 0.1% (95% CI, 0%-1%; I2 = 0.04%). There were no between-group differences in oropharyngeal bleeding rate (-0.2% [95% CI, -5.6% to 5.3%]) or gastrostomy tube dependence rate (-0.5% [95% CI, -5.2% to 4.3%]). The 2-year and 5-year pooled OS proportion differences between the bilateral surgery and unilateral surgery groups were 3.6% (95% CI, -2.2% to 9.4%) and 5.3% (95% CI, -3.8% to 14.4%), respectively. The 2-year and 5-year pooled DFS proportion differences between the bilateral surgery and unilateral surgery groups were -0.5% (95% CI, -6.5% to 5.4%) and 11.1% (95% CI, 1.6%-20.5%), respectively.</p><p><strong>Conclusions and relevance: </strong>This systematic review and meta-analysis suggests that omission of contralateral elective extracapsular tonsillectomy in tonsillar SCCa is safe with markedly low metachronous contralateral tonsillar second primary tumor rates and no compromise in survival. The decision to perform a simultaneous contralateral extracapsular tonsillectomy can be addressed via clinician-patient shared decision-making with consideration of i","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855259","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":"Anteroposterior and Lateral Epiglottis-Related Obstruction in Adult Obstructive Sleep Apnea.","authors":"Eric J Kezirian","doi":"10.1001/jamaoto.2025.2051","DOIUrl":"10.1001/jamaoto.2025.2051","url":null,"abstract":"<p><strong>Importance: </strong>Epiglottis-related airway obstruction in obstructive sleep apnea is uniquely identified during drug-induced sleep endoscopy (DISE) and may be associated with poorer treatment outcomes.</p><p><strong>Objective: </strong>To determine whether specific demographic factors, awake physical examination, and DISE findings are associated with anteroposterior and/or lateral configurations of epiglottis-related airway obstruction during DISE.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study including adults with obstructive sleep apnea undergoing DISE with prospective data collection from 2015 to 2025 was performed at 2 academic medical centers. Statistical analyses were performed in November 2024 and May 2025.</p><p><strong>Exposures: </strong>Demographic (age, sex), awake physical examination (body mass index, Modified Mallampati Position, tonsil size, posterior displacement of the epiglottis off the tongue base during awake upright fiberoptic endoscopy), and DISE findings.</p><p><strong>Main outcome and measure: </strong>Presence and degree of anteroposterior or lateral epiglottis-related obstruction in the supine body position during DISE.</p><p><strong>Results: </strong>Among 708 study participants, the mean (SD) age was 52.5 (13.5) years, and 109 were female individuals (15%). Epiglottis-related obstruction occurred in 103 (16%), including 100 (14%) and 13 (1.8%) with anteroposterior and lateral configurations, respectively. Multivariable analysis showed that anteroposterior epiglottis-related obstruction was strongly associated with male sex (odds ratio [OR], 2.84; 95% CI, 1.20-6.73), lesser degree of velum-related obstruction (OR, 0.50; 95% CI, 0.29-0.84), and posterior epiglottis displacement (OR, 2.94; 95% CI, 1.73-4.99), and weakly associated with older age (OR, 1.04; 95% CI, 1.01-1.06). Lateral epiglottis-related obstruction was only seen in male individuals and the presence of oropharyngeal lateral-wall related obstruction; it was also associated with posterior epiglottis displacement.</p><p><strong>Conclusions and relevance: </strong>This study found that anteroposterior and lateral epiglottis-related obstruction are distinct, having many different risk factors. However, both configurations were associated with posterior epiglottis displacement during awake examination.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855255","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":"Omitted Author.","authors":"","doi":"10.1001/jamaoto.2025.2804","DOIUrl":"10.1001/jamaoto.2025.2804","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855258","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":"Medical Comorbidities and Behavioral Health in Adolescents With Voice Disorders.","authors":"Robert Brinton Fujiki, Susan L Thibeault","doi":"10.1001/jamaoto.2025.2338","DOIUrl":"10.1001/jamaoto.2025.2338","url":null,"abstract":"<p><strong>Importance: </strong>Voice problems in adolescents detract from quality of life. Yet it is unknown whether medical history or behavioral health profiles are associated with increased voice disorder risk in this population.</p><p><strong>Objective: </strong>To determine the medical comorbidities, behavioral health profiles, and medication use patterns associated with increased risk for voice disorders in adolescents (age 13-17 years) across the US.</p><p><strong>Design, setting, and participants: </strong>A prospectively performed cross-sectional design was utilized in this survey study. A probability sample of adolescents living across the US was recruited between March and June 2023.</p><p><strong>Main outcomes and measures: </strong>Adolescents were surveyed regarding voice status, medical history, behavioral health diagnoses, and medication use. Multivariable logistic regression was used to identify factors associated with increased prevalence of voice problems.</p><p><strong>Results: </strong>Of 988 adolescents invited to complete the survey, 502 participated (mean [SD] age, 15.2 [1.27] years; 254 male [50.6%]). Factors associated with increased voice problem prevalence in adolescents included a family history of voice disorders (odds ratio [OR], 7.3; 95% CI, 3.2-14.7), cancer (OR, 6.5; 95% CI, 2.9-10.9), diabetes (OR, 3.4; 95% CI, 2.1-5.1), neurological disorders (OR, 3.1; 95% CI, 1.9-5.1), gastrointestinal issues (OR, 2.5; 95% CI, 1.8-3.2), and acid reflux (OR, 2.3; 95% CI, 1.5-3.6). Anxiety (OR, 2.2; 95% CI, 1.8-3.7) and depression (OR, 1.9; 95% CI, 1.5-2.9) were associated with increased voice problems, and voice disorder risk was associated with anxiety severity. Additionally, inhaler use (OR, 1.6; 95% CI, 1.2-2.5), depression/anxiety medications (OR, 3.1; 95% CI, 1.9-4.2), and steroids/hormones (OR, 4.05; 95% CI, 1.9-8.2) were associated with voice problems.</p><p><strong>Conclusions and relevance: </strong>Findings of this survey study suggest that voice problem risk is associated with medical history, behavioral health profile, and medicinal intake. Research is needed to further characterize factors that place adolescents at risk for voice disorders, as well as to determine how these factors may affect treatment.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855257","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":"Sensitivity of a Genomic Sequence Classifier for Diagnosing Medullary Thyroid Carcinoma on Thyroid Fine-Needle Aspiration.","authors":"Christine A Tran, Lisa A Friedman, Sara L Zadeh, Philip W Smith, Anna Z Fashandi","doi":"10.1001/jamaoto.2025.1493","DOIUrl":"10.1001/jamaoto.2025.1493","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"823-825"},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325728","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}