JAMA otolaryngology-- head & neck surgery最新文献

{"title":"How Human Factors Programs Transform Team Behavior-Airlines to Airways.","authors":"Alyssa J Smith, Karthik Balakrishnan","doi":"10.1001/jamaoto.2026.2155","DOIUrl":"10.1001/jamaoto.2026.2155","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"903-904"},"PeriodicalIF":7.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678713","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":"Hypoglossal Nerve Stimulation and the Incidence of Cardiovascular Disease.","authors":"Neil Kondamuri, Max J Hyman, Yi Cai, Phillip S LoSavio, Ted A Skolarus","doi":"10.1001/jamaoto.2026.1777","DOIUrl":"10.1001/jamaoto.2026.1777","url":null,"abstract":"<p><strong>Importance: </strong>As hypoglossal nerve stimulation (HGNS) grows as an obstructive sleep apnea (OSA) treatment option, health risk reduction data are needed.</p><p><strong>Objective: </strong>To determine whether HGNS is associated with lower incidence of cardiovascular disease (CVD).</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study was conducted using the Merative MarketScan Commercial Database. Adults undergoing HGNS between 2015 and 2024 were matched to controls meeting HGNS candidacy criteria (ie, diagnosed with OSA, nonadherent to positive airway pressure therapy) who did not undergo implantation.</p><p><strong>Interventions: </strong>Patients undergoing HGNS were matched on propensity scores estimated by baseline covariates, years with confirmed OSA, and index visit year. OSA and CVD severity were not available for matching.</p><p><strong>Main outcome and measures: </strong>For patients without baseline CVD, outcomes were time from index visit to diagnosis of diabetes or hypertension. For patients with baseline diabetes or hypertension, outcomes were time from index visit to diagnosis of a minor or major cardiovascular event. HGNS was modeled with a time-varying covariate because surgery was not expected to affect diagnoses until after 2 years.</p><p><strong>Results: </strong>The population included 3786 patients who underwent HGNS (median [IQR] age, 53.0 [44.0-59.0] years; 2562 [67.7%] male) and 3395 controls. Among patients without baseline CVD, HGNS (1) was not associated with diabetes diagnosis within 2 years (HR, 1.06; 95% CI, 0.61-1.85) but was associated with lower hazard after 2 years (HR, 0.19; 95% CI, 0.09-0.38), and (2) was associated with higher hazard of hypertension diagnosis within 2 years (HR, 1.70; 95% CI, 1.26-2.28) but lower hazard after 2 years (HR, 0.49; 95% CI, 0.33-0.73). Among patients with baseline diabetes or hypertension, HGNS was associated with higher hazard of a minor (HR, 1.44; 95% CI, 1.06-1.95) or major (HR, 1.62; 95% CI, 1.06-2.48) cardiovascular event diagnosis within 2 years but not associated after 2 years (minor: HR, 0.60; 95% CI, 0.35-1.04; major: HR, 0.65; 95% CI, 0.31-1.36), though the hazards after 2 years began decreasing (minor: HR, 0.42; 95% CI, 0.22-0.79; major: HR, 0.40; 95% CI, 0.17-0.93).</p><p><strong>Conclusions and relevance: </strong>The findings of this cohort study indicate variable but potential longer-term cardiovascular benefits of HGNS and motivate research to verify these associations, explore subgroup differences, and investigate mechanisms underlying potential changes in cardiovascular outcomes after HGNS.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"858-867"},"PeriodicalIF":7.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13377459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470650","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":"Patient Perceptions of Telehealth Use in Head and Neck Cancer Surveillance.","authors":"Harleen K Sethi, Nina Diamond, Wassim Najjar, Samuel R Shing, Alexzandra T Gentsch, Nathan R Handley, Adam F Binder, Richard W Hass, Kristin L Rising, Christopher E Fundakowski, Leila J Mady","doi":"10.1001/jamaoto.2026.1784","DOIUrl":"10.1001/jamaoto.2026.1784","url":null,"abstract":"<p><strong>Importance: </strong>Despite demonstration of telehealth feasibility, accessibility, and satisfaction among patients with various chronic diseases, there is low acceptability among patients with head and neck cancer (HNC). A critical gap exists in understanding patients' perceived barriers to telehealth and strategies to address them.</p><p><strong>Objective: </strong>To explore perceptions about telehealth for oncologic HNC surveillance.</p><p><strong>Design, setting, and participants: </strong>This qualitative study using semistructured interviews and surveys was conducted from January 1 to February 28, 2024. Individuals were included if they were 18 years or older, spoke English, and had been treated 3 to 24 months before the study at a tertiary center in Philadelphia, Pennsylvania, for oral cavity, oropharynx, larynx, hypopharynx, nasopharynx, or sinonasal squamous cell carcinomas without recurrence or distant metastasis. Interviews were analyzed from April 1 to August 31, 2024.</p><p><strong>Main outcomes and measures: </strong>Interviews explored patient perceptions of telehealth-delivered surveillance care, including a proposed hybrid surveillance model; were conducted until thematic saturation; and were audio-recorded, transcribed, and analyzed using a conventional content analysis approach. Surveys included demographic questions and the following measures: the BRIEF Health Literacy Screening (BHLS), the Oncology Opportunity Cost Assessment Tool (OOCAT), and the Comprehensive Score for Financial Toxicity (COST).</p><p><strong>Results: </strong>The study included 24 participants (mean [SD] age, 60.2 [8.1] years), of whom 16 (67%) were male. The most common primary site of carcinoma was the oropharynx (12 participants [50%]), with 13 participants (54%) having stage I disease. Mean (SD) BHLS and COST scores were 17.3 (3.8) and 29.4 (11.8), respectively. Mean (SD) OOCAT scores were 4.6 (1.4) for minimizing costs, 2.4 (1.6) for life impact, and 2.5 (1.9) for risk stress. Qualitative interviews revealed 7 themes: perceived benefits of telehealth, barriers to telehealth, technology barriers, opportunity costs of in-person appointments, patient responses to telehealth for surveillance, factors increasing telehealth acceptability, and incongruence between data and perceptions. Patients were more receptive to a hybrid model 2 years after HNC treatment.</p><p><strong>Conclusions and relevance: </strong>In this qualitative study, telehealth was less acceptable than in-person visits for initial surveillance after HNC treatment but a hybrid in-person and telehealth model was more acceptable for remote cancer surveillance 2 years after HNC treatment. Strategies to incorporate telehealth in this population should account for patients' acceptability and preferences.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"868-875"},"PeriodicalIF":7.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13377452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470656","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":"Cost-Effectiveness of Perioperative Pembrolizumab in Locally Advanced Head and Neck Cancer.","authors":"Christopher W Noel, Jennifer Guo, David Forner, Alex O Esemezie, Lauren E Miller, Shao Hui Huang, Jonathan C Irish, John R de Almeida, Ambika Parmar, Rui Fu, Antoine Eskander","doi":"10.1001/jamaoto.2026.1659","DOIUrl":"10.1001/jamaoto.2026.1659","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"914-916"},"PeriodicalIF":7.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13329736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368425","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":"Dried Blood Spot Testing in Confirmed Congenital Cytomegalovirus Discovered by Expanded Targeted Testing.","authors":"Peter Kfoury, Megna Reddy, Mark Blackstad, Stephanie Browning McVicar, Max Sidesinger, Jacinda Merrill, Mack Tempero, Mark R Schleiss, Albert H Park","doi":"10.1001/jamaoto.2026.1767","DOIUrl":"10.1001/jamaoto.2026.1767","url":null,"abstract":"<p><strong>Importance: </strong>It is unclear whether a targeted testing or universal screening approach is preferable for identifying newborns with congenital cytomegalovirus (cCMV) infection.</p><p><strong>Objective: </strong>To determine whether infants with cCMV identified by an expanded targeted approach would have been identified by dried blood spot (DBS) universal screening.</p><p><strong>Design, setting, and participants: </strong>This population-based cohort study included newborns from 26 birth hospitals in Utah who were diagnosed with cCMV via expanded targeted early CMV testing between 2019 and 2024. These newborns had their neonatal DBS tested for CMV DNA at the University of Minnesota laboratory in January 2025.</p><p><strong>Exposures: </strong>Detection of CMV using a polymerase chain reaction (PCR) assay.</p><p><strong>Main outcomes and measures: </strong>The main outcome was the diagnostic sensitivity of DBS PCR with confirmed cCMV infection and cCMV symptomatic disease severity.</p><p><strong>Results: </strong>Among 13 078 tested newborns (48.2% female and 51.8% male), 80 (0.6%) were diagnosed with cCMV following expanded targeted screening. Mean (SD) time from initial diagnosis to most recent hearing assessment was 2.3 (1.6) years. Combined results from detection of either UL83 or IE genes had a sensitivity of 86.3% (69 of 80; 95% CI, 77%-92%), specificity of 99.5% (95% CI, 97.0%-99.9%), positive predictive value of 100% (95% CI, 94.7%-100%), and negative predictive value of 94.3% (95% CI, 90.0%-96.8%). The sensitivity of DBS using either UL83 or IE genes among patients who had moderate to severe symptomatic cCMV disease was 92.7% (38 of 41; 95% CI, 80.6%-97.5%), while the sensitivity for those with mild symptomatic cCMV disease using UL83 and IE combined was 78.1% (95% CI, 61.3%-89.0%).</p><p><strong>Conclusions and relevance: </strong>This cohort study demonstrated a relatively high sensitivity of DBS for diagnosis of cCMV infection and differentiation of the severity of symptomatic disease in a known cCMV-positive cohort identified via expanded targeted early CMV testing. These results should be interpreted with caution given the wide confidence intervals and should not be directly extrapolated to universal DBS screening performance, particularly in asymptomatic infants.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"851-857"},"PeriodicalIF":7.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411792","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":"Novel Areca Nut Products and Emerging Public Health Concerns.","authors":"Po-Yuan Jeng, Jiiang-Huei Jeng","doi":"10.1001/jamaoto.2026.2465","DOIUrl":"https://doi.org/10.1001/jamaoto.2026.2465","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840170","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 Methodological and Clinical Reflections-Reply.","authors":"Eddy P Lincango, Julie A Sosa, Juan P Brito","doi":"10.1001/jamaoto.2026.1412","DOIUrl":"10.1001/jamaoto.2026.1412","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"832-833"},"PeriodicalIF":7.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217902","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":"Progressive Maxillary Hyperplasia With Generalized Cutaneous Lesions.","authors":"Guanru Wang, Jinfeng Liao, Chunjie Li","doi":"10.1001/jamaoto.2026.1476","DOIUrl":"10.1001/jamaoto.2026.1476","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"830-831"},"PeriodicalIF":7.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271548","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":"Dynamic Quality-of-Life Trajectories After Head and Neck Reconstruction.","authors":"Steven J Lo, You-Yan Chen, Fu-Chan Wei","doi":"10.1001/jamaoto.2026.1584","DOIUrl":"10.1001/jamaoto.2026.1584","url":null,"abstract":"<p><strong>Importance: </strong>Quality of life (QOL) is considered the second most important outcome after survival in cancer care. In head and neck reconstruction, QOL has long been assumed to stabilize at 1 year, an assumption that guides clinical follow-up and trial design.</p><p><strong>Objective: </strong>To evaluate QOL beyond 1 year after head and neck reconstruction.</p><p><strong>Design, setting, and participants: </strong>This prospective cohort study of 315 patients with head and neck disease was conducted from 2015 through 2023 at a high-volume tertiary center in Taiwan. Data were analyzed March to August 2025.</p><p><strong>Exposure: </strong>Free flap reconstruction.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the physical domain of the University of Wisconsin QOL questionnaire. The primary end point was QOL time to deterioration (TTD), which accounts for reversibility and patient response shift, and to identify modifiable risk factors for deterioration, defined in TTD as a decline of 5 or more points without subsequent recovery of 5 or more points. For Cox proportional hazards models, statistical analysis included hazard ratios (HRs) with 95% CIs. The secondary end point was a composite of TTD or death.</p><p><strong>Results: </strong>Among 315 patients (mean [SD] age, 53.7 [11.8] years; 283 [89.8%] male; median follow-up, 1155 [95% CI, 1056 to 1254] days), baseline Cox models identified Charlson Comorbidity Index as associated with QOL deterioration (HR, 1.46; 95% CI, 1.22 to 1.74). In 12-month landmark models (N = 272), Charlson Comorbidity Index (HR, 1.70; 95% CI, 1.43 to 2.06), chemotherapy (HR, 1.60; 95% CI, 1.03 to 2.48), and complications (HR 2.01; 1.21 to 3.34) were associated with QOL deterioration. The composite end point showed similar results. QOL remained dynamic beyond 1 year, with 115 of 192 patients (59.9%) having clinically meaningful score changes between years 1 and 2 (58 of 192 [30.2%] improved, 57 of 192 [29.7%] deteriorated) despite stable cohort mean scores. Findings were consistent in analyses restricted to patients with malignant disease (n = 246). Exploratory baseline and 12-month risk scores demonstrated the feasibility of predicting dynamic QOL changes beyond 1 year.</p><p><strong>Conclusions and relevance: </strong>Results of this cohort study question the assumption that QOL stabilizes at 1 year after head and neck reconstruction. More than half of patients continued to experience clinically meaningful changes, with complications at 1 year representing the strongest modifiable risk factor for deterioration. Prognostic QOL risk scores provide an approach for targeting survivorship interventions to patients at highest risk for deterioration, shifting the focus from survival alone to preservation of QOL.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"783-790"},"PeriodicalIF":7.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13306489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317112","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":"Endoscopic Sinus Surgery for Recurrent Acute Rhinosinusitis: A Randomized Clinical Trial.","authors":"Heidi Kaski, Antti Alakärppä, Aleksi Laajala, Paulus Tokola, Tomi Penna, Ulla Lantto, Pasi Ohtonen, Olli-Pekka Alho","doi":"10.1001/jamaoto.2026.1537","DOIUrl":"10.1001/jamaoto.2026.1537","url":null,"abstract":"<p><strong>Importance: </strong>Recurrent acute rhinosinusitis (RARS) decreases quality of life. The effects of endoscopic sinus surgery (ESS) in RARS are understudied.</p><p><strong>Objective: </strong>To compare the quality of life between patients with RARS who had surgery and medical treatment vs medical treatment alone.</p><p><strong>Design, setting, and participants: </strong>This is an open-label randomized clinical trial with 2 parallel groups with a 6-month follow-up. Patients referred to Oulu University Hospital Otolaryngology Clinic between May 2020 and June 2024 were recruited to participate in the trial. Inclusion criteria were adults with physician-diagnosed RARS episodes occurring at least 3 times during the past 6 months, 4 times during the past year, or twice per year for 3 consecutive years. Conservative treatment had been insufficient for symptom relief. Data collection and analyses were planned before commencing recruitment. Data collection was performed from May 2020 to December 2024, and analysis from January 2025 to January 2026.</p><p><strong>Interventions: </strong>The operative group received ESS and medical treatment, and the conservative group received medical treatment alone.</p><p><strong>Main outcomes and measures: </strong>The main outcome was the difference between groups in mean SinoNasal Outcome Test 22 (SNOT-22) score change from baseline to a 6-month follow-up. The SNOT-22 questionnaire measures rhinosinusitis-related quality of life. Sinonasal symptoms, number of health care visits, antibiotic courses, absences from work or study, and the adverse effects of operative treatment were also studied.</p><p><strong>Results: </strong>A total of 59 patients (mean [SD] age, 40 [14] years; 52 women [88%]) were recruited, 30 in the operative and 29 in the conservative group. Intention-to-treat analysis of the primary outcomes was performed. The mean SNOT-22 score change from baseline to 6 months was greater after ESS compared to medical treatment only (difference, 22.41 points (95% CI, 13.67-31.10 points). Per-protocol analyses of secondary outcomes supported the primary findings for the most part. Only 4 patients received intervention for an operative complication (3 infections, 1 synechia with septal perforation).</p><p><strong>Conclusions and relevance: </strong>In this randomized clinical trial, ESS improved patient-related outcomes at a 6-month follow-up in adults with RARS. Conservative treatment had no clinically meaningful effect. These results suggest that ESS is an effective treatment without major problems.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT04241016.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"776-782"},"PeriodicalIF":7.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13280755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271478","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}