JAMA otolaryngology-- head & neck surgery最新文献

{"title":"Updated Thresholds of Basal Calcitonin Level and Extent of Lymph Node Metastasis in Initially Treated Medullary Thyroid Cancer.","authors":"Yuxin Du, Cenkai Shen, Kehan Song, Chuqiao Liu, Zimeng Li, Zhiyan Liu, Yijun Wu, Liang Guo, Yan Zhang, Hao Zhang, Chuang Chen, Min Yin, Haitao Tang, Qinghai Ji, Wenjun Wei, Xiao Shi, Yu Wang","doi":"10.1001/jamaoto.2025.0542","DOIUrl":"10.1001/jamaoto.2025.0542","url":null,"abstract":"<p><strong>Importance: </strong>Calcitonin is the most sensitive and specific biomarker for medullary thyroid cancer (MTC). Basal serum calcitonin levels are strongly associated with the burden of lymph node metastasis (LNM) and can help guide the extent of neck dissection. However, the predictive thresholds for varying degrees of LNM are based on laboratory testing methods no longer in use.</p><p><strong>Objective: </strong>To update the optimal thresholds of basal serum calcitonin levels for predicting the extent of LNM.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included initially treated patients with MTC who had their preoperative basal calcitonin levels tested using electrochemiluminescence or chemiluminescence from a Chinese multicenter cohort of 13 hospitals between 2011 and 2024. The patients were randomly divided into a training and a validation cohort in a 2:1 ratio. The data were analyzed between June 2024 and September 2024.</p><p><strong>Exposures: </strong>Preoperative basal serum calcitonin using electrochemiluminescence or chemiluminescence.</p><p><strong>Main outcomes and measures: </strong>The main outcome is Structural recurrence-free survival (SRFS) based on the group partitioned by the proposed thresholds predicting different LNMs.</p><p><strong>Results: </strong>A total of 509 patients were included in the study with a median (interquartile range [IQR]) follow-up of 52 (27-84) months. The median (IQR) age at diagnosis was 50 (40-59) years, and 279 patients (54.8%) were female individuals. Patients were categorized into 4 groups based on the extent of LNM: no LNM, central LNM, lateral LNM, and upper mediastinal LNM. A positive correlation was found between preoperative calcitonin levels and the extent of LNM (η2 = 0.28). Using the training cohort, preoperative basal calcitonin thresholds associated with different extents of LNM were identified as follows: 241.9 pg/mL for central LNM, 693.9 pg/mL for ipsilateral lateral LNM, 2787.1 pg/mL for upper mediastinal LNM, and 2378.5 pg/mL for bilateral and/or contralateral lateral LNM. In both the training and validation cohorts, the proposed thresholds outperformed those recommended by the American Thyroid Association guidelines not only in the prediction of LNM, but also in the discrimination of SRFS.</p><p><strong>Conclusions: </strong>In this cohort study, updated threshold values of preoperative serum calcitonin predicted different extents of LNM, which may provide optimal cutoffs for future prospective studies on biomarker-guided selective neck dissection in patients with MTC.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"761-767"},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144496683","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":"Hypothermia in Microvascular Head and Neck Reconstruction-Risk of Venous Thromboembolism and Flap Pedicle Thrombosis-Reply.","authors":"Rakan Saadoun, Mario G Solari","doi":"10.1001/jamaoto.2025.1501","DOIUrl":"10.1001/jamaoto.2025.1501","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"825-826"},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325727","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":"Error in Text.","authors":"","doi":"10.1001/jamaoto.2025.2378","DOIUrl":"10.1001/jamaoto.2025.2378","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"827"},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600438","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":"Longitudinal Financial Toxicity and Quality of Life in Head and Neck Cancer.","authors":"Leila J Mady, Khalil Baddour, Maryanna S Owoc, Lauren D Kudrick, Alexzandra T Gentsch, David Ebbott, Benjamin Skalla, Maria Amache, Wassim Najjar, Sudip Gupta, Seema Kacker, Angela L Mazul, Carole Fakhry, Kristin L Rising, Richard Hass, Laila A Gharzai","doi":"10.1001/jamaoto.2025.1313","DOIUrl":"10.1001/jamaoto.2025.1313","url":null,"abstract":"<p><strong>Importance: </strong>Patients with head and neck cancer (HNC) are disproportionately affected by financial toxicity (FT). Most research has evaluated FT at a single point.</p><p><strong>Objective: </strong>To evaluate longitudinal factors associated with FT and health-related quality of life in patients and caregivers to understand its progression and effect.</p><p><strong>Design, setting, and participants: </strong>This prospective cohort study was conducted at a single tertiary care center from October 2018 to December 2020. Data were analyzed from December 2020 to December 2024. Eligible participants included adult patients with HNC undergoing definitive treatment and their primary caregivers.</p><p><strong>Exposures: </strong>Surveys conducted at diagnosis, 3 months, and 6 months postdiagnosis. Instruments included the Comprehensive Score for Financial Toxicity, version 1, Financial Distress Questionnaire, University of Washington Quality of Life Scale (UWQOL), version 4 (with physical [PQOL] and social [SQOL] subscales), 19-Item Social Support Survey, and Three-Item Loneliness Scale. Semistructured qualitative interviews were performed at 6 months.</p><p><strong>Main outcomes and measures: </strong>Linear mixed-effects modeling assessed trends in FT (Comprehensive Score for Financial Toxicity), PQOL, and SQOL longitudinally. The McNemar tests compared Financial Distress Questionnaire score among dyads. Qualitative interviews were analyzed using a conventional content analysis.</p><p><strong>Results: </strong>Of 74 enrolled patients (median [range] age, 60 [32-81] years; 12 female individuals [19%]), 64 (86%) completed at least 1 survey, and 41 (64%) participated in interviews. Patients and caregivers reported similar support and loneliness. FT decreased over time (β = 2.77; 95% CI, 1.60-4.33) and older age (β = 0.37; 95% CI, 0.05-0.68) and higher education (β = 13.43; 95% CI, 7.76-18.43) were associated with lower FT, while not working (β = -6.77; 95% CI, -10.31 to -2.96) was associated with worse FT over time. Mixed-effects logistic modeling showed similar odds of high FT over time for patients and caregivers (odds ratio, 1.66; 95% CI, 0.11-273.14). PQOL declined, while SQOL improved longitudinally. Insurance type was the only sociodemographic variable associated with health-related quality of life at diagnosis. Qualitative findings highlighted gaps in treatment expectations, lack of preparedness for financial demands, and the association of FT with employment and caregiving.</p><p><strong>Conclusions and relevance: </strong>The results of this cohort study suggest that age, education level, and employment are associated with FT and its progression. FT is dynamically associated with PQOL and SQOL over time. These findings highlight treatment expectations as a theme contributing to unpreparedness for FT. Interventions to manage physical symptoms, return patients and caregivers to work, and alleviate lower educational attainment an","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"750-760"},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274911","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":"Social Outcomes Among Adults With Hearing Aids and Cochlear Implants: A Systematic Review and Meta-Analysis.","authors":"Kaitlin Hori, Rishabh Shah, Akhil Paladugu, Tyler J Gallagher, Sophie S Jang, Elizabeth V Weinfurter, Choo Phei Wee, Janet S Choi","doi":"10.1001/jamaoto.2025.1777","DOIUrl":"10.1001/jamaoto.2025.1777","url":null,"abstract":"<p><strong>Importance: </strong>Hearing loss is associated with social isolation and loneliness, which are known to negatively impact mental and cognitive health. However, high-quality evidence on the impact of hearing rehabilitation devices on social outcomes remains limited.</p><p><strong>Objective: </strong>To assess the impact of hearing rehabilitation device use on social outcomes in adults with hearing loss.</p><p><strong>Data sources: </strong>Embase, MEDLINE, Linguistics and Language Behavior Abstracts, CINAHL, and PsycINFO were searched from database inception to March 13, 2024.</p><p><strong>Study selection: </strong>Included studies used a hearing rehabilitation device and compared a validated social outcome score to a baseline or control. Studies with baseline and follow-up scores, including variability measures, were eligible for meta-analysis. Risk of bias was assessed using the Newcastle-Ottawa Scale.</p><p><strong>Data extraction and synthesis: </strong>This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Two independent reviewers screened studies and extracted data using a standardized template. The meta-analysis used restricted maximum likelihood-based random-effects models to estimate effect sizes.</p><p><strong>Main outcomes and measures: </strong>Hearing rehabilitation devices included hearing aids, cochlear implants, bone conduction hearing aids, and personal sound amplification. The main outcomes included quality of life, isolation, loneliness, and social engagement using the following validated measures: the UCLA Loneliness Scale, Short Form 36, Nijmegen Cochlear Implant Questionnaire, Hearing Handicap Index for the Elderly, Hearing Handicap Index for Adults-Short, Cochlear Implant Quality of Life-35 Profile, Glasgow Benefit Inventory, and World Health Organization Quality of Life.</p><p><strong>Results: </strong>Of 5847 studies screened, 295 underwent full-text review, 65 were included in the systematic review, and 35 in meta-analysis. A total of 5911 participants (weighted mean [SD] age, 64.1 [6.3] years; weighted mean [SD] percentage female, 49.4% [13.9%]) were included among the studies in the systematic review, and 2664 participants (mean age [SD] age, 65.9 [8.3] years; weighted mean [SD] percentage female, 46.3% [13.6%] female) among the studies in the meta-analysis. Hearing rehabilitation with hearing aids or cochlear implants was generally associated with improved social outcomes, including higher social quality of life (QoL) and decreased perceived social handicap and loneliness. The meta-analysis revealed that both hearing aid and cochlear implant use were associated with higher social QoL scores compared to baseline or control groups (SMD, 1.22; 95% CI, 0.88-1.57). Hearing aid use was linked to a moderate improvement in social QoL (SMD, 0.62; 95% CI, 0.13-1.10). Cochlear implant use, for those with moderate to profo","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"806-816"},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553593","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":"Communication With Families of Children With Overweight Status or Obesity During Consultation for Tonsillectomy.","authors":"Ashwin Ram Reddy, Serin Baek, Anne R Links, Liliana Rodriguez, Mary Catherine Beach, Emily F Boss, Chenery Lowe","doi":"10.1001/jamaoto.2025.1518","DOIUrl":"10.1001/jamaoto.2025.1518","url":null,"abstract":"<p><strong>Importance: </strong>Children with overweight or obesity experience greater prevalence, severity, and perioperative risk of obstructive sleep-disordered breathing and persistent sleep apnea after tonsillectomy. Yet, little is known about how weight status influences communication between surgeons and families in presurgical consultations.</p><p><strong>Objectives: </strong>To evaluate the association between patient weight status with (1) clinician-parent communication and (2) parent ratings of care experience during tonsillectomy consultations.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study examined encounters occurring between April 2016 and September 2023 at outpatient otolaryngology clinics among English-speaking parents of children aged 2 to 17 years undergoing initial evaluation for tonsillectomy and clinicians (surgeons and advanced practice medical professionals) evaluating patients for tonsillectomy. Data were analyzed from September 2023 to May 2024.</p><p><strong>Main outcomes and measures: </strong>Consultations were audio recorded and coded using the Roter Interaction Analysis System to identify verbal and nonverbal communication behaviors. After consultations, clinicians rated child weight status and parents rated care experiences using items modified from the Consumer Assessment of Healthcare Providers & Systems.</p><p><strong>Results: </strong>Of 231 encounters in this study, 50 (22%) were with children with overweight. Most children were male (n = 130 [57%]). Children and adolescents were aged 2 to 17 years (hereafter referred to as children; mean [SD] age: no overweight, 5.0 [2.6] years; overweight or obesity, 8.1 [3.3] years). There were no differences between the groups with and without overweight in verbal dominance, patient centeredness, clinician facilitation or activation statements, clinician chit-chat statements, or clinician emotional statements. After adjusting for child's race, parents' education level, and annual household income, the child overweight status was associated with a decrease in cumulative clinician positive global affect levels by standardized β = -0.18 SDs (95% CI, -0.65 to 0.00 SDs). The small effect size observed may have limited the strength of this association. Furthermore, parents of children with overweight were less likely to report that their clinician definitively demonstrated respect relative to parents of children without overweight (odds ratio, 4.56 [95% CI, 1.06-19.99]).</p><p><strong>Conclusion and relevance: </strong>These findings suggest that child weight status was not associated with measured verbal communication behaviors but was associated with lower parent ratings and observer ratings of clinician respectfulness. The small effect size and potential bias from clinician race and ethnicity and sex may have limited this association. These results indicate the need to elucidate and mitigate multilevel determinants that negatively affect ","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"777-784"},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325725","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":"Progressive Tongue Root Mass in a 32-Year-Old Woman.","authors":"Rinor Ajeti, Afrim Ajeti, Jeton Maxharraj","doi":"10.1001/jamaoto.2025.1708","DOIUrl":"10.1001/jamaoto.2025.1708","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"821-822"},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600439","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":"Updated Calcitonin Values for Prediction of Lymph Node Metastasis in Medullary Thyroid Cancer.","authors":"Ashok R Shaha, Ian Ganly, Louise Davies","doi":"10.1001/jamaoto.2025.0598","DOIUrl":"10.1001/jamaoto.2025.0598","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"767-768"},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144496682","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":"Hypothermia in Microvascular Head and Neck Reconstruction-Risk of Venous Thromboembolism and Flap Pedicle Thrombosis.","authors":"John D Cramer, Trinitia Y Cannon, Michael J Brenner","doi":"10.1001/jamaoto.2025.1498","DOIUrl":"10.1001/jamaoto.2025.1498","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"825"},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325726","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":"Emerging Role of Pathologic Response in Head and Neck Squamous Cell Carcinoma Immunotherapy.","authors":"Ashish Dahal, Ravindra Uppaluri, Trisha M Wise-Draper","doi":"10.1001/jamaoto.2025.2111","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2111","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753365","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}