{"title":"Postnasal Drip.","authors":"Jerlon Chiu, Nicholas R Rowan","doi":"10.1001/jamaoto.2024.5136","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.5136","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407925","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}
Sung Ryul Shim, Jieun Shin, Cheol Mog Hwang, Yong Kyun Kim, Jong Bum Park, Jong-Yeup Kim
{"title":"Reduction of Bleeding From Pterygopalatal Injection: A Systematic Review and Meta-Analysis.","authors":"Sung Ryul Shim, Jieun Shin, Cheol Mog Hwang, Yong Kyun Kim, Jong Bum Park, Jong-Yeup Kim","doi":"10.1001/jamaoto.2024.5047","DOIUrl":"10.1001/jamaoto.2024.5047","url":null,"abstract":"<p><strong>Importance: </strong>Endoscopic sinus surgery (ESS) is a minimally invasive surgical method that is widely used in the treatment of various sinonasal conditions, including chronic sinusitis, nasal polyps, and fungal sinusitis. However, intraoperative bleeding remains a significant challenge.</p><p><strong>Objective: </strong>To evaluate the effects of pterygopalatal injections with lidocaine and adrenaline during sinus surgery.</p><p><strong>Data sources: </strong>PubMed/MEDLINE, the Cochrane Library, and EMBASE were systematically searched from database inception through July 31, 2024. Two authors also manually and independently searched all relevant studies.</p><p><strong>Study selection: </strong>Randomized clinical trials with (1) patients diagnosed with sinusitis; (2) interventions that included pterygopalatal injections with lidocaine and adrenaline; (3) comparisons that were specified as normal saline or no injection; and (4) outcomes that used subjective scores (Boezaart surgical field grading [BSFG]) and objective markers (amount of bleeding, duration of surgery, and mean arterial pressure [MAP]).</p><p><strong>Data extraction and synthesis: </strong>Data extraction was completed independently by 2 extractors and cross-checked for research integrity. The pairwise meta-analysis was performed to compare the treatment group with control used in ESS. Hedges g standardized mean differences (SMDs) and mean differences (MDs) were used for improvement in all outcomes.</p><p><strong>Main outcomes and measures: </strong>Efficacy outcomes included subjective scores, such as BSFG, as well as objective markers measuring amount of bleeding, duration of surgery, and MAP.</p><p><strong>Results: </strong>A comprehensive literature search identified 322 patients from 7 studies. The studies were conducted in Australia, Canada, Egypt, India, and Iran. The mean age range was 30 to 48.8 years, and 36.7% to 66.7% of the study populations were male. In most studies, the observation time of BSFG was measured at 15-minute intervals and measured from a minimum of 15 minutes to a maximum of 150 minutes. The pooled SMD for BSFG between treatments vs the control group was -1.01 (95% CI, -1.72 to -0.30), indicating that pterygopalatal injection with lidocaine and adrenaline was associated with improvement in the surgical field condition. The pooled MD for MAP between treatments vs the control group was -0.49 mm Hg (95% CI, -0.91 to -0.07), indicating that pterygopalatal injection was associated with significantly reduced MAP. The pooled MD for amount of bleeding between treatments vs the control group was -9.47 mL (95% CI, -29.05 to 10.11), and the pooled MD for duration of surgery between treatments vs the control group was -4.28 minutes (95% CI, -12.85 to 4.29), indicating that that this technique was not significantly associated with amount of bleeding or duration of surgery.</p><p><strong>Conclusions and relevance: </strong>The findings of this systemat","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407928","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}
Holly McMillan, Carla L Warneke, Sheila Buoy, Christine Porsche, Kiara Savage, Stephen Y Lai, Clifton D Fuller, Katherine A Hutcheson
{"title":"Manual Therapy for Fibrosis-Related Late Effect Dysphagia in Head and Neck Cancer Survivors: The MANTLE Nonrandomized Clinical Trial.","authors":"Holly McMillan, Carla L Warneke, Sheila Buoy, Christine Porsche, Kiara Savage, Stephen Y Lai, Clifton D Fuller, Katherine A Hutcheson","doi":"10.1001/jamaoto.2024.5157","DOIUrl":"10.1001/jamaoto.2024.5157","url":null,"abstract":"<p><strong>Importance: </strong>Late radiation-associated dysphagia (RAD) after head and neck cancer (HNC) treatment is challenging and commonly treatment refractory, with fibrosis stiffening connective tissues and compressing peripheral nerve tracts, contributing to diminished strength and possibly denervation of swallowing muscles. Manual therapy (MT), while common for cancer-related pain and other indications, remains largely unstudied for fibrosis-related late RAD.</p><p><strong>Objective: </strong>To determine the feasibility and safety of MT, estimate effect size and durability of MT for associated improvements in cervical range of motion (CROM), and examine functional outcomes after MT in survivors of HNC with fibrosis-related late RAD.</p><p><strong>Design, setting, and participants: </strong>This nonrandomized clinical trial, Manual Therapy for Fibrosis-Related Late Effect (MANTLE) Dysphagia in Head and Neck Cancer Survivors, is a prospective, single-institution, pilot, single-arm supportive care trial conducted at a National Comprehensive Cancer Network-designated academic comprehensive cancer center. Participants were adult survivors of HNC who were disease free at 2 or more years after curative-intent radiotherapy with grade 2 or higher fibrosis (per Common Terminology Criteria for Adverse Events version 4.0) and grade 2 or higher dysphagia (per video fluoroscopy Dynamic Imaging Grade of Swallowing Toxicity [DIGEST]). Data were collected June 2018 to July 2021 and analyzed November 2022 to November 2024.</p><p><strong>Intervention: </strong>MANTLE included 10 hourly MT sessions by lymphedema-certified speech-language pathologists over 6 weeks with a home exercise program. During the subsequent 6-week washout period, participants implemented only the home exercise program, without clinician MT.</p><p><strong>Outcomes and measures: </strong>Primary end points were feasibility (per therapy completion rate, with a 75% target) and safety. Secondary end points included functional outcomes per CROM, dysphagia severity (per DIGEST), maximum interincisal opening (MIO), and validated participant-reported outcomes (PROs).</p><p><strong>Results: </strong>Among 24 survivors of HNC (20 male [83.3%]; median [range] age, 68 [53-80] years), there was a median (range) of 8.9 (2.4-30.2) years after curative-intent radiotherapy. A total of 22 participants (91.7%) completed the 10 prescribed therapy sessions, and 1 participant experienced a severe adverse event. Secondary end points improved among participants who completed the therapy: MIO (r = 0.76; 95% CI, 0.66 to 0.94) and all 6 planes of CROM (eg, cervical extension: r = 0.86; 95% CI, 0.83 to 0.93) improved, with large effect sizes from baseline to after MT. Large to moderate effect sizes were achieved in symptom measures per PROs (eg, lymphedema-fibrosis symptom severity after MT: r = 0.74; 95% CI, 0.63 to 0.99). However, effect sizes were small to moderate or null in uncompensated swallowing outcom","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255680","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}
Mark Varvares, Regan Bergmark, Nosayaba Nosa Osazuwa-Peters
{"title":"Back to the Workforce-An Important Marker of Survivorship.","authors":"Mark Varvares, Regan Bergmark, Nosayaba Nosa Osazuwa-Peters","doi":"10.1001/jamaoto.2024.5016","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.5016","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255672","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}
Emmanuel Ribereau-Gayon, François Durupt, Matthieu Godinot
{"title":"Sore Throat and Lymphadenopathy in an Older Man.","authors":"Emmanuel Ribereau-Gayon, François Durupt, Matthieu Godinot","doi":"10.1001/jamaoto.2024.5036","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.5036","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255709","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":"Smell Recovery After Platelet-Rich Plasma After Trauma-Induced Anosmia.","authors":"Esther Wang, Zara M Patel","doi":"10.1001/jamaoto.2024.4992","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.4992","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255707","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":"Concerns Regarding Mouth Closure and Airflow in Obstructive Sleep Apnea-Reply.","authors":"Daniel Vena, Hyung Chae Yang, Scott A Sands","doi":"10.1001/jamaoto.2024.5076","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.5076","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255676","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}
Femke Jansen, Simone E J Eerenstein, Sara Arman, Birgit I Lissenberg-Witte, Jose A Hardillo, Robert P Takes, Ruud H Brakenhoff, Remco de Bree, Femke Lamers, Johannes A Langendijk, C René Leemans, Irma M Verdonck-de Leeuw
{"title":"Return to Work Up to 5 Years After the End of Treatment Among Patients With Head and Neck Cancer.","authors":"Femke Jansen, Simone E J Eerenstein, Sara Arman, Birgit I Lissenberg-Witte, Jose A Hardillo, Robert P Takes, Ruud H Brakenhoff, Remco de Bree, Femke Lamers, Johannes A Langendijk, C René Leemans, Irma M Verdonck-de Leeuw","doi":"10.1001/jamaoto.2024.4991","DOIUrl":"10.1001/jamaoto.2024.4991","url":null,"abstract":"<p><strong>Importance: </strong>Adverse effects of cancer and its treatment may hamper return to work (RTW) among patients with head and neck cancer (HNC).</p><p><strong>Objectives: </strong>To investigate RTW among patients with HNC from end of treatment to 5 years after treatment and associations of RTW with sociodemographic, clinical, work-related, personal, lifestyle, physical, and psychological factors and cancer-related symptoms.</p><p><strong>Design, setting and participants: </strong>This prospective, longitudinal, multicenter cohort study of patients with HNC used data from the Netherlands Quality of Life and Biomedical cohort. This study focused on patients younger than 65 years (with a subanalysis of patients younger than 60 years) from time of cancer diagnosis (March 2014 to June 2018) to 5 years after end of treatment (January 2019 to July 2023). Data analysis occurred from April 2023 to August 2024.</p><p><strong>Exposure: </strong>Standard clinical care.</p><p><strong>Main outcomes and measures: </strong>Work status was measured at 3 and 6 months, and 1, 2, 3, 4, and 5 years after treatment using an adjusted version of the Productivity Cost Questionnaire. Cox regression analyses were performed to investigate factors (baseline, 3 months, and 6 months) associated with time to RTW.</p><p><strong>Results: </strong>A total of 184 patients with HNC younger than 65 years (mean [SD] age, 55.4 [7.0] years; 146 men [79%]) were included and 77 (42%) had oropharyngeal cancer. RTW increased from 26% (42 of 160 individuals) at 3 months to 65% (89 of 137 individuals) at 1 year, after which it reduced to 52% (51 of 98 individuals) at 5 years. At 5 years after treatment, an additional 28 of 98 participants (29%) were retired. Minor surgery (vs major surgery) was associated with faster RTW from end of treatment onwards (hazard ratio [HR], 2.73; 95% CI, 1.17-6.37). Older age (HR, 0.97; 95% CI, 0.94-0.999) and more fatigue at 3 months (HR, 0.99; 95% CI, 0.98-0.995) were associated with slower RTW from 3 months onwards. Older age was also associated with slower RTW from 6 months onwards (HR, 0.96; 95% CI, 0.93-0.998). Among the 127 patients with HNC younger than 60 years, RTW was 72% (47 individuals) at 5 years after treatment. Advanced tumor stage (HR, 0.59; 95% CI, 0.39-0.90) and more fatigue (HR, 0.99; 95% CI, 0.98-0.999) were associated with slower RTW in this group.</p><p><strong>Conclusion and relevance: </strong>This cohort study found that the majority of patients with HNC in the Netherlands returned to work within 1 year and that certain sociodemographic and clinical factors and cancer-related symptoms were associated with time to RTW. These results may inform patients with HNC and provide insight into potential targets, such as fatigue, to improve RTW.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255683","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}
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