Pub Date : 2024-09-01DOI: 10.1001/jamaoto.2024.2157
Wen-Chun Lin, En-Su Chang, James Cheng-Chung Wei
{"title":"Exogenous Estrogen and Head and Neck Cancer.","authors":"Wen-Chun Lin, En-Su Chang, James Cheng-Chung Wei","doi":"10.1001/jamaoto.2024.2157","DOIUrl":"10.1001/jamaoto.2024.2157","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"835"},"PeriodicalIF":6.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758793","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}
Pub Date : 2024-09-01DOI: 10.1001/jamaoto.2024.2260
Betty Ben Dor, Alessandro Villa, Catherine Hayes, Elizabeth Alpert, Donald S Shepard, Stephen T Sonis
Importance: Patients undergoing treatment for head and neck cancer (HNC) experience oral complications requiring substantial dental treatment. This treatment is commonly not reimbursed by medical insurers, presenting a potential financial burden for patients.
Objective: To characterize the dental care needs and associated cost burden for patients with HNC.
Design, setting, and participants: This survey study included Head and Neck Cancer Alliance (HNCA) members who were surveyed from March 23 to October 27, 2023, using Qualtrics. The survey was promoted using the HNCA's social media and email list. Data analysis was performed between October 2023 and May 2024.
Main outcomes and measures: Main outcomes were oral and dental complications of cancer treatment among patients with HNC, the association of cancer treatment with dental care use, and costs of associated dental treatment.
Results: Of 100 individuals administered the survey, 85 (85%) completed all required questions and were included in the analysis. Of 84 participants with age and sex data, 51 (61%) were aged 65 years or older and 45 (54%) were female. Of 85 respondents, 59 (70%) indicated that their current oral health was worse than before cancer treatment. Most respondents (73 of 85 [86%]) endorsed oral complications from cancer treatment, including xerostomia (66 of 73 [90%]), caries (35 of 73 [48%]), and oral mucositis (29 of 73 [40%]); 64 of 73 respondents (88%) required follow-up dental treatment. Overall, 4 of 28 (14%) before HNC treatment and 17 of 53 (32%) after treatment reported finances as the reason that not all recommended dental care was received. A total of 33 of the 85 respondents (39%) said that their postcancer dental care had caused them financial hardship. Individuals who were less likely to endorse financial hardship were more likely to have greater educational attainment (odds ratio [OR], 0.20; 95% CI, 0.06-0.58), higher income (OR, 0.33; 95% CI, 0.11-0.94), increased pre-HNC dental visit frequency (OR, 0.30; 95% CI, 0.10-0.86), same or better oral health after HNC (OR, 0.13; 95% CI, 0.02-0.50), and lower out-of-pocket dental expenses after HNC (OR, 0.09; 95% CI, 0.03-0.29).
Conclusions and relevance: In this survey study, most patients undergoing treatment for HNC required extensive dental treatment throughout cancer treatment; this treatment presented a financial burden for 39% of patients that was a limiting barrier to care. Since most private medical insurers do not reimburse for dental treatment, more comprehensive coverage deserves policy attention.
{"title":"Financial Burden of Dental Care Among Patients With Head and Neck Cancer.","authors":"Betty Ben Dor, Alessandro Villa, Catherine Hayes, Elizabeth Alpert, Donald S Shepard, Stephen T Sonis","doi":"10.1001/jamaoto.2024.2260","DOIUrl":"10.1001/jamaoto.2024.2260","url":null,"abstract":"<p><strong>Importance: </strong>Patients undergoing treatment for head and neck cancer (HNC) experience oral complications requiring substantial dental treatment. This treatment is commonly not reimbursed by medical insurers, presenting a potential financial burden for patients.</p><p><strong>Objective: </strong>To characterize the dental care needs and associated cost burden for patients with HNC.</p><p><strong>Design, setting, and participants: </strong>This survey study included Head and Neck Cancer Alliance (HNCA) members who were surveyed from March 23 to October 27, 2023, using Qualtrics. The survey was promoted using the HNCA's social media and email list. Data analysis was performed between October 2023 and May 2024.</p><p><strong>Main outcomes and measures: </strong>Main outcomes were oral and dental complications of cancer treatment among patients with HNC, the association of cancer treatment with dental care use, and costs of associated dental treatment.</p><p><strong>Results: </strong>Of 100 individuals administered the survey, 85 (85%) completed all required questions and were included in the analysis. Of 84 participants with age and sex data, 51 (61%) were aged 65 years or older and 45 (54%) were female. Of 85 respondents, 59 (70%) indicated that their current oral health was worse than before cancer treatment. Most respondents (73 of 85 [86%]) endorsed oral complications from cancer treatment, including xerostomia (66 of 73 [90%]), caries (35 of 73 [48%]), and oral mucositis (29 of 73 [40%]); 64 of 73 respondents (88%) required follow-up dental treatment. Overall, 4 of 28 (14%) before HNC treatment and 17 of 53 (32%) after treatment reported finances as the reason that not all recommended dental care was received. A total of 33 of the 85 respondents (39%) said that their postcancer dental care had caused them financial hardship. Individuals who were less likely to endorse financial hardship were more likely to have greater educational attainment (odds ratio [OR], 0.20; 95% CI, 0.06-0.58), higher income (OR, 0.33; 95% CI, 0.11-0.94), increased pre-HNC dental visit frequency (OR, 0.30; 95% CI, 0.10-0.86), same or better oral health after HNC (OR, 0.13; 95% CI, 0.02-0.50), and lower out-of-pocket dental expenses after HNC (OR, 0.09; 95% CI, 0.03-0.29).</p><p><strong>Conclusions and relevance: </strong>In this survey study, most patients undergoing treatment for HNC required extensive dental treatment throughout cancer treatment; this treatment presented a financial burden for 39% of patients that was a limiting barrier to care. Since most private medical insurers do not reimburse for dental treatment, more comprehensive coverage deserves policy attention.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"811-818"},"PeriodicalIF":6.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11295059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859797","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}
Pub Date : 2024-08-29DOI: 10.1001/jamaoto.2024.2556
Michael F Armstrong, Brian J Burkett, Thomas J O'Byrne, Harrison C Gottlich, Linda X Yin, Kendall K Tasche, Daniel L Price, Eric J Moore, David M Routman, Mauricio Gamez, Scott C Lester, Michelle A Neben-Wittich, Daniel J Ma, Katharine A Price, Val J Lowe, Kathryn M Van Abel
<p><strong>Importance: </strong>Asymmetric oropharynx uptake on positron emission tomography (PET)/computed tomography (CT) is a common incidental finding and often prompts otolaryngology referral to rule out malignancy; however, the true risk of malignancy based on this finding is unknown.</p><p><strong>Objective: </strong>To identify the incidence of oropharynx cancer in patients with incidental asymmetric oropharynx PET uptake.</p><p><strong>Design, setting, and participants: </strong>In this retrospective cohort study, patients 18 years and older undergoing PET/CT scans at Mayo Clinic between January 2001 and December 2018 were included. Patients with a history or pretest suspicion of oropharynx cancer were excluded. Data were analyzed from March 2021 to December 2023.</p><p><strong>Exposure: </strong>Blinded radiologic review of imaging studies, including measurement of maximum standardized uptake values (SUVmax) of the ipsilateral side of concern and contralateral side. Retrospective medical record review for associated clinical data.</p><p><strong>Main outcomes and measures: </strong>The primary study outcome was the incidence of oropharynx cancer diagnosis in patients with asymmetric oropharynx PET uptake. The primary outcome was formulated before data collection.</p><p><strong>Results: </strong>Of the 1854 patients identified with asymmetric oropharynx PET uptake, 327 (17.6%) met inclusion criteria. Of these, 173 (52.9%) were male, and the median (range) age was 65.0 (24.8-90.7) years. The mean (SD) follow-up interval was 52.1 (43.4) months. A total of 18 of 327 patients (5.5%) were newly diagnosed with oropharynx cancer. The most common diagnosis was squamous cell carcinoma (n = 9), followed by lymphoma (n = 8), and sarcoma (n = 1). Patients with an incidental diagnosis of oropharynx cancer had higher mean (SD) ipsilateral SUVmax (8.7 [3.7] vs 5.3 [1.9]) and SUVmax ratio (3.0 [1.6] vs 1.6 [0.6]) compared with patients with normal examination findings. SUVmax ratio and difference were found to be good discriminators of oropharynx cancer, with areas under the receiver operating characteristic curve of 86.3% (95% CI, 76.4-94.6) and 85.8% (95% CI, 74.8-94.6), respectively. Patients with a new diagnosis of oropharynx cancer were more likely to have a corresponding CT abnormality than those with normal examination findings (6 of 18 [33%] vs 24 of 295 [8.1%]). Patients with concerning lesions on oropharynx palpation by an otolaryngology health care professional were significantly more likely to be diagnosed with oropharynx cancer compared with patients with normal examination findings (odds ratio, 28.4; 95% CI, 6.6-145.8).</p><p><strong>Conclusions and relevance: </strong>In this cohort study, while incidental asymmetric oropharynx PET uptake was common, a new diagnosis of oropharynx cancer was not and potentially results in a large volume of unnecessary referrals and work-up. Using SUVmax ratio, SUVmax difference, and CT correlation may incre
重要性：正电子发射计算机断层扫描（PET）/计算机断层扫描（CT）的非对称口咽摄取是一种常见的偶然发现，通常会促使耳鼻喉科转诊以排除恶性肿瘤；然而，基于这一发现的真正恶性肿瘤风险尚不清楚：目的：确定意外非对称口咽部 PET 摄取患者的口咽癌发病率：在这项回顾性队列研究中，纳入了 2001 年 1 月至 2018 年 12 月期间在梅奥诊所接受 PET/CT 扫描的 18 岁及以上患者。排除了有口咽癌病史或检测前怀疑口咽癌的患者。数据分析时间为2021年3月至2023年12月。暴露：对影像学研究进行盲法放射学审查，包括测量同侧和对侧最大标准化摄取值（SUVmax）。对相关临床数据进行回顾性病历审查：主要研究结果是口咽 PET 摄取不对称患者的口咽癌诊断率。主要结果在数据收集前已制定：在 1854 名口腔咽部 PET 摄取不对称的患者中，有 327 人（17.6%）符合纳入标准。其中，173人（52.9%）为男性，年龄中位数（范围）为65.0（24.8-90.7）岁。平均（标清）随访间隔为 52.1（43.4）个月。327 名患者中，共有 18 人（5.5%）是新确诊的口咽癌症患者。最常见的诊断结果是鳞状细胞癌（9 例），其次是淋巴瘤（8 例）和肉瘤（1 例）。与检查结果正常的患者相比，偶然诊断出口咽癌的患者同侧SUVmax平均值（标度）（8.7 [3.7] vs 5.3 [1.9]）和SUVmax比值（3.0 [1.6] vs 1.6 [0.6]）较高。研究发现，SUVmax 比值和差异是口咽癌的良好鉴别指标，接收者操作特征曲线下的面积分别为 86.3%（95% CI，76.4-94.6）和 85.8%（95% CI，74.8-94.6）。与检查结果正常的患者相比，新诊断出口咽癌的患者更有可能出现相应的 CT 异常（18 例中的 6 例 [33%] 与 295 例中的 24 例 [8.1%]）。与检查结果正常的患者相比，耳鼻喉科医护人员触诊口咽部时发现可疑病变的患者被诊断为口咽癌的几率明显更高（几率比，28.4；95% CI，6.6-145.8）：在这项队列研究中，虽然口咽部 PET 意外非对称摄取很常见，但口咽癌的新诊断并不常见，这可能导致大量不必要的转诊和检查。使用 SUVmax 比值、SUVmax 差值和 CT 相关性可能会增加转诊的益处。口咽部可触及病变和不对称口咽部 PET 摄取的患者应进行确诊活检。
{"title":"Cancer in Patients With Incidental Asymmetric Oropharynx Positron Emission Tomography Uptake.","authors":"Michael F Armstrong, Brian J Burkett, Thomas J O'Byrne, Harrison C Gottlich, Linda X Yin, Kendall K Tasche, Daniel L Price, Eric J Moore, David M Routman, Mauricio Gamez, Scott C Lester, Michelle A Neben-Wittich, Daniel J Ma, Katharine A Price, Val J Lowe, Kathryn M Van Abel","doi":"10.1001/jamaoto.2024.2556","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.2556","url":null,"abstract":"<p><strong>Importance: </strong>Asymmetric oropharynx uptake on positron emission tomography (PET)/computed tomography (CT) is a common incidental finding and often prompts otolaryngology referral to rule out malignancy; however, the true risk of malignancy based on this finding is unknown.</p><p><strong>Objective: </strong>To identify the incidence of oropharynx cancer in patients with incidental asymmetric oropharynx PET uptake.</p><p><strong>Design, setting, and participants: </strong>In this retrospective cohort study, patients 18 years and older undergoing PET/CT scans at Mayo Clinic between January 2001 and December 2018 were included. Patients with a history or pretest suspicion of oropharynx cancer were excluded. Data were analyzed from March 2021 to December 2023.</p><p><strong>Exposure: </strong>Blinded radiologic review of imaging studies, including measurement of maximum standardized uptake values (SUVmax) of the ipsilateral side of concern and contralateral side. Retrospective medical record review for associated clinical data.</p><p><strong>Main outcomes and measures: </strong>The primary study outcome was the incidence of oropharynx cancer diagnosis in patients with asymmetric oropharynx PET uptake. The primary outcome was formulated before data collection.</p><p><strong>Results: </strong>Of the 1854 patients identified with asymmetric oropharynx PET uptake, 327 (17.6%) met inclusion criteria. Of these, 173 (52.9%) were male, and the median (range) age was 65.0 (24.8-90.7) years. The mean (SD) follow-up interval was 52.1 (43.4) months. A total of 18 of 327 patients (5.5%) were newly diagnosed with oropharynx cancer. The most common diagnosis was squamous cell carcinoma (n = 9), followed by lymphoma (n = 8), and sarcoma (n = 1). Patients with an incidental diagnosis of oropharynx cancer had higher mean (SD) ipsilateral SUVmax (8.7 [3.7] vs 5.3 [1.9]) and SUVmax ratio (3.0 [1.6] vs 1.6 [0.6]) compared with patients with normal examination findings. SUVmax ratio and difference were found to be good discriminators of oropharynx cancer, with areas under the receiver operating characteristic curve of 86.3% (95% CI, 76.4-94.6) and 85.8% (95% CI, 74.8-94.6), respectively. Patients with a new diagnosis of oropharynx cancer were more likely to have a corresponding CT abnormality than those with normal examination findings (6 of 18 [33%] vs 24 of 295 [8.1%]). Patients with concerning lesions on oropharynx palpation by an otolaryngology health care professional were significantly more likely to be diagnosed with oropharynx cancer compared with patients with normal examination findings (odds ratio, 28.4; 95% CI, 6.6-145.8).</p><p><strong>Conclusions and relevance: </strong>In this cohort study, while incidental asymmetric oropharynx PET uptake was common, a new diagnosis of oropharynx cancer was not and potentially results in a large volume of unnecessary referrals and work-up. Using SUVmax ratio, SUVmax difference, and CT correlation may incre","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107463","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}
Pub Date : 2024-08-22DOI: 10.1001/jamaoto.2024.2553
Stephen F Politano, Emily Georgiadi, Alec Bonifer, Richard G Muller, David Ludlow
{"title":"In-Office vs Operating Room Time to Treatment of Oropharyngeal Biopsies.","authors":"Stephen F Politano, Emily Georgiadi, Alec Bonifer, Richard G Muller, David Ludlow","doi":"10.1001/jamaoto.2024.2553","DOIUrl":"10.1001/jamaoto.2024.2553","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11342216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017447","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}
Pub Date : 2024-08-08DOI: 10.1001/jamaoto.2024.2420
Joseph Califano, Prakriti Sen, Chao Liu
{"title":"Cannabis and Head and Neck Cancer-Déjà Vu All Over Again?","authors":"Joseph Califano, Prakriti Sen, Chao Liu","doi":"10.1001/jamaoto.2024.2420","DOIUrl":"https://doi.org/10.1001/jamaoto.2024.2420","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901769","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}
Pub Date : 2024-08-08DOI: 10.1001/jamaoto.2024.2419
Tyler J Gallagher, Ryan S Chung, Matthew E Lin, Ian Kim, Niels C Kokot
Importance: Cannabis is the most commonly used illicit substance worldwide. Whether cannabis use is associated with head and neck cancer (HNC) is unclear.
Objective: To assess the clinical association between cannabis use and HNC.
Design, setting, and participants: This large multicenter cohort study used clinical records from a database that included 20 years of data (through April 2024) from 64 health care organizations. A database was searched for medical records for US adults with and without cannabis-related disorder who had recorded outpatient hospital clinic visits and no prior history of HNC. Propensity score matching was performed for demographic characteristics, alcohol-related disorders, and tobacco use. Subsequently, relative risks (RRs) were calculated to explore risk of HNC, including HNC subsites. This analysis was repeated among those younger than 60 years and 60 years or older.
Exposure: Cannabis-related disorder.
Main outcomes and measures: Diagnosis of HNC and any HNC subsite.
Results: The cannabis-related disorder cohort included 116 076 individuals (51 646 women [44.5%]) with a mean (SD) age of 46.4 (16.8) years. The non-cannabis-related disorder cohort included 3 985 286 individuals (2 173 684 women [54.5%]) with a mean (SD) age of 60.8 (20.6) years. The rate of new HNC diagnosis in all sites was higher in the cannabis-related disorder cohort. After matching (n = 115 865 per group), patients with cannabis-related disorder had a higher risk of any HNC (RR, 3.49; 95% CI, 2.78-4.39) than those without HNC. A site-specific analysis yielded that those with cannabis-related disorder had a higher risk of oral (RR, 2.51; 95% CI, 1.81-3.47), oropharyngeal (RR, 4.90; 95% CI, 2.99-8.02), and laryngeal (RR, 8.39; 95% CI, 4.72-14.90) cancer. Results were consistent when stratifying by older and younger age group.
Conclusions and relevance: This cohort study highlights an association between cannabis-related disorder and the development of HNC in adult patients. Given the limitations of the database, future research should examine the mechanism of this association and analyze dose response with strong controls to further support evidence of cannabis use as a risk factor for HNCs.
{"title":"Cannabis Use and Head and Neck Cancer.","authors":"Tyler J Gallagher, Ryan S Chung, Matthew E Lin, Ian Kim, Niels C Kokot","doi":"10.1001/jamaoto.2024.2419","DOIUrl":"10.1001/jamaoto.2024.2419","url":null,"abstract":"<p><strong>Importance: </strong>Cannabis is the most commonly used illicit substance worldwide. Whether cannabis use is associated with head and neck cancer (HNC) is unclear.</p><p><strong>Objective: </strong>To assess the clinical association between cannabis use and HNC.</p><p><strong>Design, setting, and participants: </strong>This large multicenter cohort study used clinical records from a database that included 20 years of data (through April 2024) from 64 health care organizations. A database was searched for medical records for US adults with and without cannabis-related disorder who had recorded outpatient hospital clinic visits and no prior history of HNC. Propensity score matching was performed for demographic characteristics, alcohol-related disorders, and tobacco use. Subsequently, relative risks (RRs) were calculated to explore risk of HNC, including HNC subsites. This analysis was repeated among those younger than 60 years and 60 years or older.</p><p><strong>Exposure: </strong>Cannabis-related disorder.</p><p><strong>Main outcomes and measures: </strong>Diagnosis of HNC and any HNC subsite.</p><p><strong>Results: </strong>The cannabis-related disorder cohort included 116 076 individuals (51 646 women [44.5%]) with a mean (SD) age of 46.4 (16.8) years. The non-cannabis-related disorder cohort included 3 985 286 individuals (2 173 684 women [54.5%]) with a mean (SD) age of 60.8 (20.6) years. The rate of new HNC diagnosis in all sites was higher in the cannabis-related disorder cohort. After matching (n = 115 865 per group), patients with cannabis-related disorder had a higher risk of any HNC (RR, 3.49; 95% CI, 2.78-4.39) than those without HNC. A site-specific analysis yielded that those with cannabis-related disorder had a higher risk of oral (RR, 2.51; 95% CI, 1.81-3.47), oropharyngeal (RR, 4.90; 95% CI, 2.99-8.02), and laryngeal (RR, 8.39; 95% CI, 4.72-14.90) cancer. Results were consistent when stratifying by older and younger age group.</p><p><strong>Conclusions and relevance: </strong>This cohort study highlights an association between cannabis-related disorder and the development of HNC in adult patients. Given the limitations of the database, future research should examine the mechanism of this association and analyze dose response with strong controls to further support evidence of cannabis use as a risk factor for HNCs.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11310842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901770","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}
Pub Date : 2024-08-01DOI: 10.1001/jamaoto.2024.1967
{"title":"Errors in Abstract and Table 2.","authors":"","doi":"10.1001/jamaoto.2024.1967","DOIUrl":"10.1001/jamaoto.2024.1967","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"749"},"PeriodicalIF":6.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11190822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141426840","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}
Pub Date : 2024-08-01DOI: 10.1001/jamaoto.2024.1421
Elske Quak, Audrey Lasne-Cardon, Marie Cavarec, Barbara Lireux, Vianney Bastit, Nathalie Roudaut, Pierre-Yves Salaun, Nathalie Keromnes, Gaël Potard, Patricia Vaduva, Annabelle Esvant, Franck Jegoux, Olivier de Crouy-Chanel, Anne Devillers, Clémence Guery, Charline Lasnon, Renaud Ciappuccini, Bérénice Legrand, Adrien Estienne, François Christy, Jean-Michel Grellard, Stéphane Bardet, Bénédicte Clarisse
<p><strong>Importance: </strong>Whether F18-choline (FCH) positron emission tomographic (PET)/computed tomographic (CT) scan can replace Tc99m-sestaMIBI (MIBI) single-photon emission (SPE)CT/CT as a first-line imaging technique for preoperative localization of parathyroid adenomas (PTA) in patients with primary hyperparathyroidism (PHPT) is unclear.</p><p><strong>Objective: </strong>To compare first-line FCH PET/CT vs MIBI SPECT/CT for optimal care in patients with PHPT needing parathyroidectomy and to compare the proportions of patients in whom the first-line imaging method resulted in successful minimally invasive parathyroidectomy (MIP) and normalization of calcemia 1 month after surgery.</p><p><strong>Design, setting, and participants: </strong>A French multicenter randomized open diagnostic intervention phase 3 trial was conducted. Patients were enrolled from November 2019 to May 2022 and participated up to 6 months after surgery. The study included adults with PHPT and an indication for surgical treatment. Patients with previous parathyroid surgery or multiple endocrine neoplasia type 1 (MEN1) were ineligible.</p><p><strong>Interventions: </strong>Patients were assigned in a 1:1 ratio to receive first-line FCH PET/CT (FCH1) or MIBI SPECT/CT (MIBI1). In the event of negative or inconclusive first-line imaging, they received second-line FCH PET/CT (FCH2) after MIBI1 or MIBI SPECT/CT (MIBI2) after FCH1. All patients underwent surgery under general anesthesia within 12 weeks following the last imaging. Clinical and biologic (serum calcemia and parathyroid hormone levels) assessments were performed 1 and 6 months after surgery.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was a true-positive first-line imaging-guided MIP combined with uncorrected serum calcium levels of 2.55 mmol/l or less 1 month after surgery, corresponding to the local upper limit of normality.</p><p><strong>Results: </strong>Overall, 57 patients received FCH1 (n = 29) or MIBI1 (n = 28). The mean (SD) age of patients was 62.8 (12.5) years with 15 male (26%) and 42 female (74%) patients. Baseline patient characteristics were similar between groups. Normocalcemia at 1 month after positive first-line imaging-guided MIP was observed in 23 of 27 patients (85%) in the FCH1 group and 14 of 25 patients (56%) in the MIBI1 group. Sensitivity was 82% (95% CI, 62%-93%) and 63% (95% CI, 42%-80%) for FCH1 and MIBI1, respectively. Follow-up at 6 months with biochemical measures was available in 43 patients, confirming that all patients with normocalcemia at 1 month after surgery still had it at 6 months. No adverse events related to imaging and 4 adverse events related to surgery were reported.</p><p><strong>Conclusions: </strong>This randomized clinical trial found that first-line FCH PET/CT is a suitable and safe replacement for MIBI SPECT/CT. FCH PET/CT leads more patients with PHPT to correct imaging-guided MIP and normocalcemia than MIBI SPECT/CT thanks to its
{"title":"F18-Choline PET/CT or MIBI SPECT/CT in the Surgical Management of Primary Hyperparathyroidism: A Diagnostic Randomized Clinical Trial.","authors":"Elske Quak, Audrey Lasne-Cardon, Marie Cavarec, Barbara Lireux, Vianney Bastit, Nathalie Roudaut, Pierre-Yves Salaun, Nathalie Keromnes, Gaël Potard, Patricia Vaduva, Annabelle Esvant, Franck Jegoux, Olivier de Crouy-Chanel, Anne Devillers, Clémence Guery, Charline Lasnon, Renaud Ciappuccini, Bérénice Legrand, Adrien Estienne, François Christy, Jean-Michel Grellard, Stéphane Bardet, Bénédicte Clarisse","doi":"10.1001/jamaoto.2024.1421","DOIUrl":"10.1001/jamaoto.2024.1421","url":null,"abstract":"<p><strong>Importance: </strong>Whether F18-choline (FCH) positron emission tomographic (PET)/computed tomographic (CT) scan can replace Tc99m-sestaMIBI (MIBI) single-photon emission (SPE)CT/CT as a first-line imaging technique for preoperative localization of parathyroid adenomas (PTA) in patients with primary hyperparathyroidism (PHPT) is unclear.</p><p><strong>Objective: </strong>To compare first-line FCH PET/CT vs MIBI SPECT/CT for optimal care in patients with PHPT needing parathyroidectomy and to compare the proportions of patients in whom the first-line imaging method resulted in successful minimally invasive parathyroidectomy (MIP) and normalization of calcemia 1 month after surgery.</p><p><strong>Design, setting, and participants: </strong>A French multicenter randomized open diagnostic intervention phase 3 trial was conducted. Patients were enrolled from November 2019 to May 2022 and participated up to 6 months after surgery. The study included adults with PHPT and an indication for surgical treatment. Patients with previous parathyroid surgery or multiple endocrine neoplasia type 1 (MEN1) were ineligible.</p><p><strong>Interventions: </strong>Patients were assigned in a 1:1 ratio to receive first-line FCH PET/CT (FCH1) or MIBI SPECT/CT (MIBI1). In the event of negative or inconclusive first-line imaging, they received second-line FCH PET/CT (FCH2) after MIBI1 or MIBI SPECT/CT (MIBI2) after FCH1. All patients underwent surgery under general anesthesia within 12 weeks following the last imaging. Clinical and biologic (serum calcemia and parathyroid hormone levels) assessments were performed 1 and 6 months after surgery.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was a true-positive first-line imaging-guided MIP combined with uncorrected serum calcium levels of 2.55 mmol/l or less 1 month after surgery, corresponding to the local upper limit of normality.</p><p><strong>Results: </strong>Overall, 57 patients received FCH1 (n = 29) or MIBI1 (n = 28). The mean (SD) age of patients was 62.8 (12.5) years with 15 male (26%) and 42 female (74%) patients. Baseline patient characteristics were similar between groups. Normocalcemia at 1 month after positive first-line imaging-guided MIP was observed in 23 of 27 patients (85%) in the FCH1 group and 14 of 25 patients (56%) in the MIBI1 group. Sensitivity was 82% (95% CI, 62%-93%) and 63% (95% CI, 42%-80%) for FCH1 and MIBI1, respectively. Follow-up at 6 months with biochemical measures was available in 43 patients, confirming that all patients with normocalcemia at 1 month after surgery still had it at 6 months. No adverse events related to imaging and 4 adverse events related to surgery were reported.</p><p><strong>Conclusions: </strong>This randomized clinical trial found that first-line FCH PET/CT is a suitable and safe replacement for MIBI SPECT/CT. FCH PET/CT leads more patients with PHPT to correct imaging-guided MIP and normocalcemia than MIBI SPECT/CT thanks to its","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"658-665"},"PeriodicalIF":6.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11190825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141426841","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}
Pub Date : 2024-08-01DOI: 10.1001/jamaoto.2024.1516
Robert Brinton Fujiki, Susan L Thibeault
<p><strong>Importance: </strong>Voice disorders impede communication and limit quality of life for many children. However, research demonstrating the prevalence of pediatric voice problems and associated voice use patterns is scarce. This investigation examined the prevalence of voice problems and vocal health characteristics of school-aged children.</p><p><strong>Objective: </strong>To examine the prevalence of voice problems in school-aged children throughout the US with reference to lifestyle, demographic characteristics, and voice use patterns.</p><p><strong>Design, setting, and participants: </strong>This study used a cross-sectional design to survey a probability sample of caregivers of children aged 4 to 12 years living throughout the US in 2023.</p><p><strong>Main outcomes and measures: </strong>Caregivers were surveyed regarding their children's voice use, voice symptoms, voice problems, extracurricular activities, and demographic information. Caregivers also competed the Pediatric Voice-Related Quality of Life questionnaire. The Fisher exact test, χ2 tests, and logistic regression were used to compare children with and without voice problems.</p><p><strong>Results: </strong>Overall, 6293 panelists were invited to complete screening questions for the survey, and 1789 individuals were screened for eligibility between March and April 2023. Of these, 1175 parents (65.7%) completed the survey. Twenty-one (1.8%) were excluded for a combination of either high refusal rates (n = 16), speeding (n = 2), or straight lining (n = 12). The final number of participants included in analysis was 1154 caregivers of children aged 4 to 12 years (559 female children [48.4%]; 595 male children [51.6%]; mean [SD] age, 8.02 [2.49] years). The prevalence of voice problems in children was 6.7% (n = 78), and the lifetime prevalence was 12% (n = 138). Benign vocal fold lesions was the most common diagnosis underlying voice complaints, and other causes included respiratory illness, allergies, autism-related voice issues, and other neurological conditions. Risk factors for pediatric voice problems included being male (odds ratio [OR], 1.47; 95% CI, 1.0-2.1), having more than 4 individuals living in the household (OR, 2.30; 95% CI, 1.2-4.4), poor speech intelligibility (OR, 2.26; 95% CI, 1.2-4.3), maternal history of voice problems (OR, 4.54; 95% CI, 1.2-16.4), participating in online gaming (OR, 1.56; 95% CI, 1.0-2.3), and secondhand smoke exposure (OR, 1.7; 95% CI, 1.1-2.6). Voice use-related risk factors included frequent talking, coughing, throat clearing, tantrums/crying, and vocal strain. Voice problems were associated with substantially detracted quality of life as measured by the Pediatric Voice-Related Quality of Life questionnaire, limited social/extracurricular interactions, increased school absences, and negative attention from adults.</p><p><strong>Conclusions: </strong>The results of this survey study suggest that pediatric voice problems are relatively
{"title":"Voice Disorder Prevalence and Vocal Health Characteristics in Children.","authors":"Robert Brinton Fujiki, Susan L Thibeault","doi":"10.1001/jamaoto.2024.1516","DOIUrl":"10.1001/jamaoto.2024.1516","url":null,"abstract":"<p><strong>Importance: </strong>Voice disorders impede communication and limit quality of life for many children. However, research demonstrating the prevalence of pediatric voice problems and associated voice use patterns is scarce. This investigation examined the prevalence of voice problems and vocal health characteristics of school-aged children.</p><p><strong>Objective: </strong>To examine the prevalence of voice problems in school-aged children throughout the US with reference to lifestyle, demographic characteristics, and voice use patterns.</p><p><strong>Design, setting, and participants: </strong>This study used a cross-sectional design to survey a probability sample of caregivers of children aged 4 to 12 years living throughout the US in 2023.</p><p><strong>Main outcomes and measures: </strong>Caregivers were surveyed regarding their children's voice use, voice symptoms, voice problems, extracurricular activities, and demographic information. Caregivers also competed the Pediatric Voice-Related Quality of Life questionnaire. The Fisher exact test, χ2 tests, and logistic regression were used to compare children with and without voice problems.</p><p><strong>Results: </strong>Overall, 6293 panelists were invited to complete screening questions for the survey, and 1789 individuals were screened for eligibility between March and April 2023. Of these, 1175 parents (65.7%) completed the survey. Twenty-one (1.8%) were excluded for a combination of either high refusal rates (n = 16), speeding (n = 2), or straight lining (n = 12). The final number of participants included in analysis was 1154 caregivers of children aged 4 to 12 years (559 female children [48.4%]; 595 male children [51.6%]; mean [SD] age, 8.02 [2.49] years). The prevalence of voice problems in children was 6.7% (n = 78), and the lifetime prevalence was 12% (n = 138). Benign vocal fold lesions was the most common diagnosis underlying voice complaints, and other causes included respiratory illness, allergies, autism-related voice issues, and other neurological conditions. Risk factors for pediatric voice problems included being male (odds ratio [OR], 1.47; 95% CI, 1.0-2.1), having more than 4 individuals living in the household (OR, 2.30; 95% CI, 1.2-4.4), poor speech intelligibility (OR, 2.26; 95% CI, 1.2-4.3), maternal history of voice problems (OR, 4.54; 95% CI, 1.2-16.4), participating in online gaming (OR, 1.56; 95% CI, 1.0-2.3), and secondhand smoke exposure (OR, 1.7; 95% CI, 1.1-2.6). Voice use-related risk factors included frequent talking, coughing, throat clearing, tantrums/crying, and vocal strain. Voice problems were associated with substantially detracted quality of life as measured by the Pediatric Voice-Related Quality of Life questionnaire, limited social/extracurricular interactions, increased school absences, and negative attention from adults.</p><p><strong>Conclusions: </strong>The results of this survey study suggest that pediatric voice problems are relatively","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"677-687"},"PeriodicalIF":6.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11190826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141426844","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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