JAMA otolaryngology-- head & neck surgery最新文献

{"title":"Two Brothers With 1 Diagnosis.","authors":"Dario Ebode, Thomas Radulesco, Justin Michel","doi":"10.1001/jamaoto.2025.0118","DOIUrl":"10.1001/jamaoto.2025.0118","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"529-530"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719386","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":"The Butterfly Effect of Adenotonsillectomy.","authors":"Derek J Lam","doi":"10.1001/jamaoto.2025.0117","DOIUrl":"10.1001/jamaoto.2025.0117","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"431-432"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648208","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.","authors":"","doi":"10.1001/jamaoto.2024.3441","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.3441","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":"151 5","pages":"422"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991826","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":"Further Clarifications for Interpretation of Study of Lobectomy vs Total Thyroidectomy With Ipsilateral Lateral Neck Dissection-Reply.","authors":"Yoshiyuki Saito, Kosuke Inoue, Koichi Ito","doi":"10.1001/jamaoto.2025.0157","DOIUrl":"10.1001/jamaoto.2025.0157","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"534-535"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719380","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":"Patient-Reported Quality-of-Life Outcome Measure After Parotidectomy.","authors":"Linda X Yin, Christine M Lohse, Kathleen J Yost, Amy M Tuchscherer, Eliot J Martin, Heidi Semann, Gabriela A Calcano, Daniel L Price, Kendall K Tasche, Kathryn M Van Abel, Eric J Moore","doi":"10.1001/jamaoto.2024.5253","DOIUrl":"10.1001/jamaoto.2024.5253","url":null,"abstract":"<p><strong>Importance: </strong>There is a lack of reliable, patient-reported quality-of-life (QOL) instruments to address the multidimensional nature of patient-centered outcomes for patients undergoing parotidectomy. The Parotidectomy Quality of Life Index is a new 35-item validated patient-reported outcome instrument specific to recovery after parotidectomy.</p><p><strong>Objective: </strong>To establish and validate a comprehensive English-language patient-reported QOL instrument specific to parotidectomy.</p><p><strong>Design, setting, and participants: </strong>This survey study was conducted in 2 phases: first, in a single-institution cohort (October 12, 2021, to March 7, 2022), and second, as an anonymous web-based survey enrolled via printed promotional brochures and social media platforms (March 13 to July 31, 2023). Inclusion criteria were age at least 18 years and parotidectomy within the last year. For test-retest reliability, a subset of phase II participants volunteered to answer the survey a second time within 2 weeks. Data were analyzed from March 8, 2022, to November 3, 2023.</p><p><strong>Main outcomes and measures: </strong>Item rankings from phase I participants were used to narrow the original 61-item survey down to 45 items in the phase II survey. To assess construct validity, an exploratory factor analysis was performed. Cronbach α and pairwise Pearson correlation coefficients were used to measure internal consistency, reliability, and redundancy. Test-retest reliability was evaluated using intraclass correlation coefficients.</p><p><strong>Results: </strong>Phase I enrolled 38 individuals, of whom 30 completed the survey (15 women [60%]; 21 participants [84%] aged >40 years). Phase II enrolled 342 participants, of whom 317 completed the survey (305 women [89%]; 284 participants [83%] aged >40 years). A total of 42 items across 7 domains were selected based on exploratory factor analysis. After Cronbach α and pairwise correlation analysis, 33 items across 6 multi-item domains and 2 standalone items were incorporated into the final QOL instrument. Cronbach αs for each of the final 6 domains were at least 0.77, suggesting excellent internal validity. Pairwise correlations did not show strong correlations (ie, none ≥0.80), suggesting minimal redundancy between domains. Younger age was significantly associated with a lower global score. Participants with malignant tumors scored lower on 4 of the 6 multi-item domains. Test-retest reliability coefficients for the domains ranged from 0.82 to 0.93, indicating very good reproducibility over a 2-week interval.</p><p><strong>Conclusions and relevance: </strong>These findings suggest the Parotidectomy Quality of Life Index demonstrated excellent internal validity and test-retest reliability. With further external validation, this instrument may provide opportunity for quality improvement in clinical practice and has potential as a key patient-reported outcome in future parotidectomy c","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"441-449"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772311","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":"Pretreatment Liquid Biopsy and Clinicopathologic Features in HPV-Associated Oropharyngeal Squamous Cell Carcinoma.","authors":"Peter V Cooke, Susmita Chennareddy, Daniel O Kraft, Catharine Kappauf, Austin S Lam, Sida Chen, Kunal K Sindhu, Michael H Berger, Rocco M Ferrandino, Raksha Kulkarni, Megan Tang, Nasrin Ghesani, Krzysztof Misiukiewicz, Richard L Bakst, Marshall R Posner, Eric M Genden, Raymond L Chai, Scott A Roof","doi":"10.1001/jamaoto.2024.5549","DOIUrl":"10.1001/jamaoto.2024.5549","url":null,"abstract":"<p><strong>Importance: </strong>Despite the favorable prognosis for HPV-positive oropharyngeal squamous cell carcinoma (HPV+ OPSCC), efforts to de-escalate treatment intensity, while maintaining low recurrence and mortality rates, have proven challenging. Identifying appropriate prognostic factors remains elusive; however, the association of pretreatment circulating tumor tissue viral-modified HPV (TTMV-HPV) DNA level with known characteristics of disease burden-clinical staging, characteristics of pretreatment imaging, and aggressive histopathologic features of surgical specimen-may offer insights that could shift treatment paradigms for HPV+ OPSCC.</p><p><strong>Objective: </strong>To investigate the association of pretreatment TTMV-HPV DNA levels with clinical, radiologic, histopathologic, and outcome metrics in patients with HPV+ OPSCC.</p><p><strong>Design, setting, and participants: </strong>This cohort study of patients with HPV+ OPSCC and positive test results for pretreatment TTMV-HPV DNA fragment levels used data from a single tertiary center from April 2020 to September 2023. TTMV-HPV DNA fragments levels were categorized into 3 cohorts: low (≤99 fragments/mL), moderate (100-999/mL), and high (≥1000/mL).</p><p><strong>Main outcomes and measures: </strong>Association of clinical tumor (cT) and nodal (cN) staging with TTMV-HPV DNA fragment level. Secondary outcomes included the association between TTMV-HPV DNA fragment level and positive emission tomography-computed tomography (PET-CT) characteristics as well as histopathologic features of surgical specimen. The association of pretreatment fragment level with receiving adjuvant therapy for surgical patients was also analyzed. Recurrence-free survival and disease-specific survival were also assessed.</p><p><strong>Results: </strong>The study population included 203 patients (mean [SD] age, 62 [10] years; 24 [12%] females and 179 males [88%]), 58 (29%) of whom were in the low, 73 (36%) in the moderate, and 72 (35%) in the high TTMV-HPV DNA fragment-level cohort. Compared to patients with cT0/1 stage, those with cT2 stage and cT3/4 stage had increased odds of higher TTMV-HPV DNA levels, with adjusted odds ratios (aORs) of 2.33 (95% CI, 1.24-4.46) and 2.51 (95% CI, 1.17-5.46), respectively. Compared to patients with cN0 stage, those with cN1 stage and cN2/3 stage also had increased odds of higher TTMV-HPV DNA levels, with aORs of 4.26 (95% CI, 1.82-10.34) and 3.64 (95% CI, 1.46-9.36), respectively. In adjusted analysis of pretreatment PET-CT characteristics, total primary tumor plus nodal volume was associated with higher TTMV-HPV DNA levels, with an aOR of 1.04 (95% CI, 1.02-1.07). Among 94 surgical patients, no significant association was found between pretreatment fragment level and lymphovascular invasion, perineural invasion, pathologic T stage, number of positive nodes, or extranodal extension on pathological analysis of surgical specimen. No significant differences in recurrence-free ","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"433-440"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624619","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":"Ushering in Neoadjuvant Immune Checkpoint Inhibitors for Mucosal Head and Neck Squamous Cell Carcinoma.","authors":"Melina J Windon, Nabil F Saba, Moran Amit","doi":"10.1001/jamaoto.2025.0540","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0540","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012864","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":"Global Barriers to Otolaryngology Care.","authors":"Rolvix H Patterson, Ali Haider Bangash, Nader Zalaquett, Akansha Pandey, Sarah Nuss, David Fei-Zhang, Tarika Srinivasan, Zachary Elwell, Adebolajo Adeyemo, Gabrielle Cahill, Alexander Cherches, Davina Daudu, Carolina Der, Taseer Din, Johan Fagan, Racheal Hapunda, Titus Ibekwe, Aveline Aloyce Kahinga, Ivy Maina, Allan Mukuzi, Doreen Nakku, Beatriz Petrucci, Carolina Pietrobon, Valerie Salano, Amina Seguya, David Shaye, Emily Smith, Holly Sprow, Sharon Ovnat Tamir, Christopher James Waterworth, Christopher Wen, Joshua Wiedermann, Mary Jue Xu, Blake Alkire, Samuel Okerosi","doi":"10.1001/jamaoto.2025.0573","DOIUrl":"10.1001/jamaoto.2025.0573","url":null,"abstract":"<p><strong>Importance: </strong>Understanding the global barriers to otolaryngology-head and neck surgery (OHNS) care is crucial in addressing disparities in access to care, particularly in low-income and middle-income countries (LMICs).</p><p><strong>Objective: </strong>To characterize barriers to comprehensive otolaryngology care across World Bank income groups.</p><p><strong>Design, setting, and participants: </strong>Using an online cross-sectional survey that was administered by the Global OHNS Initiative via international and national professional societies, personal contacts, and social media, this study captured the perceptions of otolaryngologists regarding barriers to OHNS care at the levels of the country, health sector, clinician, and patient. Participants included otolaryngologists from the 194 World Health Organization member states and Taiwan. Eligibility criteria included a medical degree and specialized training in managing conditions of the ear, nose, and throat. The nonresponse rate was not recorded. The data collection period spanned from October 2022 to June 2023.</p><p><strong>Exposures: </strong>Exposures included World Bank income group classification.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were Likert scale responses regarding frequency of barriers to OHNS care. The a priori hypothesis was that LMICs would report more frequent barriers to OHNS care.</p><p><strong>Results: </strong>The study involved 146 otolaryngologists (47 female individuals [32%]), with 69 (47%) from high-income countries and 77 (53%) from LMICs. Male individuals represented 45 high-income country respondents (65%) and 54 LMIC respondents (70%). Barriers were reported across income groups at all levels of the health system, with a higher frequency in LMICs. Several barriers were reported to be more substantial in LMICs, such as the national volume and distribution of otolaryngologists, financial compensation for clinicians, and patient stigma, and others were common across income settings, such as the availability of operating rooms and inflexible working hours. Common concerns included national and health sector barriers: OHNS workforce, referral networks, government support; clinician barriers: excessive clinician workloads, understaffing, poor administration support; patient barriers: distance to health care facilities, financial burdens such as medical costs and foregone wages, stigma, and health literacy.</p><p><strong>Conclusions and relevance: </strong>The results of this cross-sectional study suggest that there are barriers to otolaryngology care globally that affected all levels of the health care system. This work may inform prioritization of otolaryngology within research and policy, and it emphasizes the need for effective strategies to expand access to otolaryngology care, particularly in lower-income settings.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035576","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":"Myocardial Injury After Major Head and Neck Surgery.","authors":"Phillip Staibano, Amit X Garg, Matthew T V Chan, Carisi A Polanczyk, Gareth L Ackland, S Danielle MacNeil, Ashaka Patel, Michael Xie, Han Zhang, Michael Au, Mohit Bhandari, Sameer Parpia, Jason W Busse, Diane M Heels-Ansdell, Benjamin van der Woerd, Michael K Gupta, David L Choi, Egehan Salepci, J E Young, P J Devereaux","doi":"10.1001/jamaoto.2025.0656","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0656","url":null,"abstract":"<p><strong>Importance: </strong>Myocardial injury after noncardiac surgery (MINS) is associated with increased perioperative mortality; however, the incidence and prognostic impact of MINS after major head and neck surgery remains uncertain.</p><p><strong>Objective: </strong>To determine the incidence and clinical implications of MINS in patients after major head and neck surgery.</p><p><strong>Design, setting, and participants: </strong>This cohort study used data from the VISION (Vascular Events in Noncardiac Surgery Patients Cohort Evaluation; 2017) study, an international prospective cohort study that analyzed more than 15 000 patients who had noncardiac surgery. Of those, 648 patients (4.3%) underwent major head and neck surgery requiring at least 1-day hospital admission and screening for MINS via troponin T (TnT) concentrations measured during the first 3 postoperative days. MINS was defined as a high-sensitivity TnT (hsTnT) of 20 to 64 ng/L and absolute change more than 5 ng/L or hsTnT 65 ng/L or greater (ie, fifth-generation assay) and cardiac ischemia. When using fourth-generation assay, MINS was defined as non-hsTNT 0.04 ng/mL or greater and cardiac ischemia. Data analyses were performed from October to December 2024.</p><p><strong>Main outcomes and measures: </strong>MINS incidence and its association with 30-day mortality. All clinical outcomes were analyzed using Cox regression models and length of hospital stay (LOHS) was analyzed using multivariable linear regression.</p><p><strong>Results: </strong>Among 648 patients (265 [40.9%] female and 383 [59.1%] male; 376 [58.0%] aged 45 to 64 years), the incidence of MINS after major head and neck surgery was 11.9% (95% CI, 9.39%-14.4%), rising to 23.8% (95% CI, 15.7%-32%) among those aged 75 years or older. MINS occurred more often in patients with medical comorbidities. The proportion of MINS that would have gone undetected without TnT monitoring was 68.8% (95% CI, 57.3%-78.9%). In this cohort, 30-day and 1-year mortality were 1.9% (95% CI, 0.8%-2.9%) and 13.1% (95% CI, 10.5%-15.7%), respectively. MINS was associated with increased 30-day mortality (hazard ratio, 5.51; 95% CI, 1.75-17.36) and prolonged LOHS in patients with MINS with at least 1 ischemic feature (adjusted β, 3.15 days; 95% CI, 1.47-6.76 days).</p><p><strong>Conclusions and relevance: </strong>This cohort study found that myocardial injury was common among patients undergoing major head and neck surgery, especially those aged 75 years or older and those with comorbidities. Nearly 70% of MINS cases go undetected without TnT monitoring, and MINS may contribute to worse 30-day postoperative mortality and prolonged LOHS. Further prospective validation is needed to evaluate the role of MINS screening in improving clinical outcomes after major head and neck surgery.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996937","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":"Epistaxis and a Large Nasal Mass in an Adolescent Male.","authors":"Isabella Cano, Su Yeon Yeon, Victoria S Lee","doi":"10.1001/jamaoto.2025.0411","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0411","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967033","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}