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Progress and Outcomes of Intraoperative Nerve Monitoring During Thyroidectomy. 甲状腺切除术中术中神经监测的进展与结果。
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-03-01 DOI: 10.1001/jamaoto.2024.4452
Madison Hearn, Bin You, Leila J Mady, Kaitlyn M Frazier, Lilah Morris-Wiseman, Aarti Mathur

Importance: Intraoperative nerve monitoring (IONM) is not considered standard of care during thyroidectomy, and guidelines are vague about its use in the absence of strong evidence of superiority over visualization of the recurrent laryngeal nerve (RLN) alone.

Objective: To characterize patterns of IONM use during thyroidectomy in the US and evaluate the association of IONM with postoperative outcomes.

Design, setting, and participants: This cohort study used the National Surgical Quality Improvement Program (NSQIP) thyroidectomy data from January 1, 2016, to December 31, 2022. A nationally representative sample included adult patients without poorly differentiated thyroid cancer who underwent thyroidectomy at multiple centers. Data were collected from the time of surgery until 30 postoperative days through January 31, 2023.

Exposure: IONM during thyroidectomy.

Main outcomes and measures: Prevalence of IONM during thyroidectomy and postoperative outcomes including RLN injury, hypocalcemia, and neck hematoma.

Results: A total of 44 265 patients undergoing thyroidectomy were included (77.2% female; mean [SD] age, 51.8 [15.2] years), with 30 633 (69.2%) using IONM. Common indications for surgery in the cohort were goiter (35.3%) and a single nodule or neoplasm (39.2%). The prevalence of IONM increased from 62.5% in 2016 to 75.9% in 2022. RLN injury occurred in 6.0% of cases. On propensity score-matched analyses, IONM was associated with decreased odds of RLN injury overall (adjusted odds ratio [AOR], 0.98; 95% CI, 0.97-0.99) and decreased odds among patients with differentiated thyroid cancer (AOR, 0.96; 95% CI, 0.94-0.99). IONM was not associated with postoperative hypocalcemia (AOR, 0.99; 95% CI, 0.99-1.00) or neck hematoma (AOR, 1.00; 95% CI, 0.99-1.00).

Conclusions and relevance: This cohort study found that IONM during thyroidectomy has become routine, and use has increased over the last 7 years. IONM was associated with a slightly decreased odds of RLN injury, but no difference in hypocalcemia or neck hematoma. Although IONM use is widespread, further research is needed to identify patients who would benefit the most from this technology.

重要性:术中神经监测(IONM)不被认为是甲状腺切除术期间的标准护理,在缺乏强有力的证据表明其优于单独观察喉返神经(RLN)的情况下,指南对其使用含糊不清。目的:了解美国甲状腺切除术中离子转移剂的使用模式,并评估离子转移剂与术后预后的关系。设计、环境和参与者:该队列研究使用了2016年1月1日至2022年12月31日期间国家手术质量改进计划(NSQIP)甲状腺切除术的数据。一个具有全国代表性的样本包括在多个中心接受甲状腺切除术的无低分化甲状腺癌的成年患者。数据收集自手术时间至术后30天至2023年1月31日。暴露:碘离子甲状腺切除术期间。主要结局和指标:甲状腺切除术中IONM的发生率和术后结局包括RLN损伤、低钙血症和颈部血肿。结果:共纳入44 265例甲状腺切除术患者(77.2%为女性;平均[SD]年龄为51.8[15.2]岁),使用IONM的患者为30 633(69.2%)。该队列中常见的手术指征是甲状腺肿(35.3%)和单一结节或肿瘤(39.2%)。IONM的患病率从2016年的62.5%上升到2022年的75.9%。RLN损伤发生率为6.0%。在倾向评分匹配分析中,IONM与RLN损伤的总体发生率降低相关(调整优势比[AOR], 0.98;95% CI, 0.97-0.99),分化型甲状腺癌患者的赔率降低(AOR, 0.96;95% ci, 0.94-0.99)。IONM与术后低钙血症无关(AOR, 0.99;95% CI, 0.99-1.00)或颈部血肿(AOR, 1.00;95% ci, 0.99-1.00)。结论及相关性:该队列研究发现,碘化甲状腺素在甲状腺切除术期间已成为常规,并且在过去7年中使用量有所增加。IONM与RLN损伤的几率略有降低有关,但在低钙血症或颈部血肿方面没有差异。虽然IONM的使用很广泛,但需要进一步的研究来确定哪些患者将从这项技术中获益最多。
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引用次数: 0
Third Proceedings of The North American Airway Collaborative (NoAAC): Consensus Statement on Trial Design for Airway Stenosis.
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-03-01 DOI: 10.1001/jamaoto.2024.4963
Ruth J Davis, Lee M Akst, Clint T Allen, Richard J Battafarano, Hayley L Born, Paul C Bryson, Matthew S Clary, Tyler Crosby, Vaninder K Dhillon, Greg Dion, Hannah Kavookjian, Kevin P Leahy, Ioan Lina, Natasha Mirza, Robert J Morrison, Kevin M Motz, Rebecca C Nelson, Diego Preciado, Kishore Sandu, Joseph R Spiegel, Jonathan Walsh, Alexander T Hillel, Alexander Gelbard

Importance: Airway stenosis is a rare but debilitating disorder that significantly degrades the quality of life in affected patients. Treatments are primarily surgical, and disease management lacks established medical therapies. The North American Airway Collaborative held its third symposium at The Johns Hopkins Hospital in Baltimore, Maryland, on April 15, 2024, focused on strategies to advance the care of these patients. The proceedings summarize the discussion of trial design in airway stenosis and the resulting North American Airway Collaborative consensus regarding clinical end points for rigorous study of novel therapies.

Observations: The lectures and panels centered on the translation of a growing body of preclinical data into therapeutic targets. Additionally, detailed discussion explored design of clinical trials to evaluate safety and efficacy of novel therapeutics. The need for a consensus regarding clinically meaningful end points in airway stenosis was identified to facilitate the comparison of outcomes across institutions and future multi-institutional trials.

Conclusions and relevance: The group achieved consensus regarding change in peak expiratory flow as the primary clinical end point in airway stenosis. Additional clinical measures, such as disease recurrence (identified as time to recurrent intervention), anatomical characterization of subglottic scar via axial computed tomography imaging, and patient-reported outcome measures (Clinical COPD Questionnaire [CCQ], Voice Handicap Index-10 [VHI-10], Eating Assessment Tool-10 [EAT-10], and 12-Item Short-Form Health Survey, version 2 [SF-12]) were identified as essential secondary outcomes.

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引用次数: 0
Neoadjuvant GLP-1 Receptor Agonists in Sleep Surgery. 新辅助GLP-1受体激动剂在睡眠手术中的应用。
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-03-01 DOI: 10.1001/jamaoto.2024.4593
Ryan Chin Taw Cheong, Kenny Peter Pang
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引用次数: 0
Residential Differences and Depression Among Older Adults With Dual Sensory Loss. 老年双重感觉丧失患者的居住差异与抑郁。
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-03-01 DOI: 10.1001/jamaoto.2024.4488
Ethan B Wang, Emmanuel E Garcia Morales, Alden L Gross, Frank R Lin, Nicholas S Reed, Jennifer A Deal

Importance: Investigating rural-urban and regional differences in the association between dual sensory loss (concurrent hearing and vision loss) and depression may highlight gaps in sensory loss research and health care services, and by socioeconomic status. Whether urbanicity and region may modify associations between sensory loss and depression is unknown.

Objective: To describe the rural-urban and regional differences in the association of dual sensory loss with depression among older adults.

Design, setting, and participants: This cross-sectional study used data from wave 1 (April 2017-December 2019) of the population-based Longitudinal Aging Study in India (LASI). Participants were recruited from 35 states and union territories in India. LASI incorporated a multistage stratified area probability cluster sampling design to recruit participants 45 years and older and their spouses; 31 447 eligible participants 60 years of age or older were interviewed. Data analyses were conducted from May 17, 2022, to November 11, 2023.

Exposures: Sensory loss (no sensory loss, hearing loss only, vision loss only, and dual sensory loss) was determined by respondents' self-reported perceived difficulty regarding hearing and vision function.

Main outcomes and measures: The Composite International Diagnostic Interview (CIDI-SF) scale was used to identify major episodic depression. Logistic regression was used to estimate the odds ratios (ORs) and 95% CIs of depression comparing participants with vs without sensory loss, adjusting for demographic and clinical covariates. Rural-urban and regional differences were assessed by including interaction terms between these variables and sensory loss.

Results: The study analysis included 27 927 participants (mean [SD] age, 68.0 [7.2] years; 14 477 [51%] females and 13 450 [49%] males). The fully adjusted models showed that the odds of depression with dual sensory loss (vs no loss) was higher in urban (OR, 3.16; 95% CI, 2.00-4.99) vs rural (OR, 1.73; 95% CI, 1.31-2.29) residents and among residents in the West (OR, 5.10; 95% CI, 1.74-14.97) vs North (OR, 1.38; 95% CI, 0.81-2.35) regions.

Conclusions and relevance: These findings indicate that sensory loss is associated with depression in older adults, with differences by urbanicity and region. Adults with sensory loss across multiple systems may be an important group to target for intervention.

重要性:调查双重感觉丧失(同时听力和视力丧失)与抑郁症之间关联的城乡和地区差异,可能会突出感觉丧失研究和卫生保健服务以及社会经济地位方面的差距。城市化和地域是否会改变感觉丧失和抑郁之间的联系尚不清楚。目的:探讨老年人双重感觉丧失与抑郁之间的城乡和地区差异。设计、环境和参与者:本横断面研究使用了印度基于人口的纵向老龄化研究(LASI)第一波(2017年4月- 2019年12月)的数据。参与者来自印度的35个邦和联邦属地。LASI采用多阶段分层区域概率整群抽样设计,招募45岁及以上的参与者及其配偶;31 对447名年龄在60岁及以上的合格参与者进行了访谈。数据分析时间为2022年5月17日至2023年11月11日。暴露:感觉丧失(无感觉丧失、仅听力丧失、仅视力丧失和双感觉丧失)由受访者自我报告的听力和视觉功能感知困难来确定。主要结果和测量方法:采用综合国际诊断访谈(CIDI-SF)量表来识别重度发作性抑郁症。采用Logistic回归来估计有感觉丧失与无感觉丧失的受试者抑郁的比值比(ORs)和95% ci,并对人口统计学和临床协变量进行调整。通过纳入这些变量和感觉丧失之间的相互作用项来评估城乡和区域差异。结果:研究分析纳入27名 927名参与者(平均[SD]年龄68.0[7.2]岁;14 477[51%]女性和13 450[49%]男性)。完全调整后的模型显示,在城市中,抑郁症合并双重感觉丧失(与无感觉丧失相比)的几率更高(OR, 3.16;95% CI, 2.00-4.99) vs农村(OR, 1.73;95% CI, 1.31-2.29)居民和西部居民(OR, 5.10;95% CI, 1.74-14.97) vs North (OR, 1.38;95% CI, 0.81-2.35)。结论和相关性:这些发现表明,老年人的感觉丧失与抑郁症有关,但因城市和地区而异。多系统感觉丧失的成年人可能是干预的重要目标群体。
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引用次数: 0
Bilateral Expansile Perigeniculate Lesions in a Patient With Idiopathic Intracranial Hypertension. 特发性颅内高压患者的双侧扩张性周赘病变。
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-03-01 DOI: 10.1001/jamaoto.2024.4611
Lawrance Lee, Mihai Bentan, Nauman F Manzoor
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引用次数: 0
Approaching Immediate Total Thyroidectomy in First-Side Loss of Neuromonitoring Signal With Caution. 慎行首侧神经监测信号丧失的立即全甲状腺切除术。
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-03-01 DOI: 10.1001/jamaoto.2024.4674
Charles de Ponthaud, Fabrice Menegaux, Sébastien Gaujoux
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引用次数: 0
Approaching Immediate Total Thyroidectomy in First-Side Loss of Neuromonitoring Signal With Caution-Reply. 第一侧神经监测信号丧失的立即全甲状腺切除术
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-03-01 DOI: 10.1001/jamaoto.2024.4677
Sruthi Ramesh, Nadia H Van Den Berg, Patrick Sheahan
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引用次数: 0
Clarification Regarding Insurance Disparities Among Patients With Head and Neck Cancer. 头颈癌患者保险差异的澄清。
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-03-01 DOI: 10.1001/jamaoto.2024.4668
Ching-Nung Wu, Wei-Chun Cheng, James Cheng-Chung Wei
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引用次数: 0
Tympanostomy Tube With or Without Adenoidectomy-Reply.
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-03-01 DOI: 10.1001/jamaoto.2024.4862
Z Jason Qian, Mai Thy Truong, Kay W Chang
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引用次数: 0
Cochlear Implant Electrode Placement and Music Perception. 人工耳蜗电极放置与音乐感知。
IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-03-01 DOI: 10.1001/jamaoto.2024.4761
Katelyn A Berg, Jack H Noble, Benoit M Dawant, Linsey W Sunderhaus, Andrea J DeFreese, Robert F Labadie, René H Gifford

Importance: Cochlear implants enable improvements in speech perception, but music perception outcomes remain variable. Image-guided cochlear implant programming has emerged as a potential programming strategy for increasing the quality of spectral information delivered through the cochlear implant to improve outcomes.

Objectives: To perform 2 experiments, the first of which modeled the variance in music perception scores as a function of electrode positioning factors, and the second of which evaluated image-guided cochlear implant programming as a strategy to improve music perception with a cochlear implant.

Design, setting, and participants: This single-center, prospective study recruited 50 adult patients with at least 6 months of cochlear implant listening experience and normal cochlear anatomy to participate in experiment 1 from 2013 to 2023. Data analysis was conducted from January to February 2024. Thirty-four of the 50 patients from experiment 1 also completed experiment 2.

Interventions: Cochlear implant programming using a computed tomography-guided electrode selection strategy.

Main outcomes and measures: University of Washington Clinical Assessment of Music score, including subtests of pitch discrimination thresholds, isochronous familiar melody recognition, and timbre recognition.

Results: Of 50 participants, 20 (40%) were female, and the mean (SD) age was 57.7 (16.4) years. Experiment 1 suggested that better music perception abilities in the 50 participants were associated with patients who were younger and had a postlingual onset of deafness, as well as electrode arrays with a full scala tympani insertion, higher modiolar distance, and shallower insertion depth. Experiment 2 suggested improvements in melody recognition in the 34 participants using the image-guided cochlear implant programming strategy. Patients with apical electrodes that were deactivated were more likely to demonstrate an improvement in their pitch perception thresholds with the image-guided strategy, likely due to the low-frequency stimuli used in the University of Washington Clinical Assessment of Music.

Conclusions and relevance: This study identified patient and device factors that were associated with music perception outcomes with a cochlear implant. These findings suggest that a personalized, image-guided approach to programming may improve music perception abilities for patients with cochlear implants.

重要性:人工耳蜗可以改善语音感知,但音乐感知的结果仍然是可变的。图像引导人工耳蜗编程已成为一种潜在的编程策略,用于提高通过人工耳蜗传递的频谱信息的质量,以改善结果。目的:进行两个实验,第一个实验将音乐感知得分的方差建模为电极定位因素的函数,第二个实验评估图像引导人工耳蜗编程作为一种改善人工耳蜗音乐感知的策略。设计、环境和参与者:这项单中心前瞻性研究招募了50名具有至少6个月人工耳蜗听力经验且耳蜗解剖正常的成年患者,于2013年至2023年参加实验1。数据分析时间为2024年1 - 2月。实验1的50名患者中有34人也完成了实验2。干预:人工耳蜗植入程序使用计算机断层扫描引导电极选择策略。主要结果和测量:华盛顿大学音乐评分临床评估,包括音高辨别阈值、等时熟悉旋律识别和音色识别的子测试。结果:50例患者中,女性20例(40%),平均(SD)年龄为57.7(16.4)岁。实验1表明,50名参与者中较好的音乐感知能力与年龄更小、语后耳聋的患者有关,也与全阶鼓室插入、高模摩尔距离和浅插入深度的电极阵列有关。实验2表明,使用图像引导人工耳蜗编程策略,34名参与者的旋律识别能力有所提高。在华盛顿大学临床音乐评估中,使用低频刺激的患者在使用图像引导策略时,顶端电极被停用的患者更有可能在音高感知阈值方面表现出改善。结论和相关性:本研究确定了与人工耳蜗音乐感知结果相关的患者和设备因素。这些发现表明,个性化的、图像引导的编程方法可能会提高人工耳蜗患者的音乐感知能力。
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引用次数: 0
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JAMA otolaryngology-- head & neck surgery
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