JAMA otolaryngology-- head & neck surgery最新文献

Importance: Recurrence rates for locally advanced human papillomavirus (HPV)-independent head and neck squamous cell carcinoma (HNSCC) are high. Circulating tumor DNA (ctDNA)-based minimal residual disease (MRD) assays have shown promise to improve management and surveillance in several tumor types, but their clinical utility in HPV-independent HNSCC remains understudied.

Objective: To evaluate the performance of a tumor-informed ctDNA-based MRD assay in patients with newly diagnosed locally advanced HNSCC.

Design, setting, and participants: Between December 2020 and March 2022, among patients newly diagnosed with locally advanced HNSCC treated with surgery followed by risk-adjusted adjuvant treatment at a large referral center specializing in treatment of HNSCC, ctDNA was assessed before surgery, before the start of adjuvant treatment, within 6 weeks of completion of treatment, and during surveillance. Patients were followed up for at least 12 months after treatment completion. Kaplan-Meier survival analyses were used to compare recurrence-free survival (RFS) and overall survival (OS) between patients who were MRD positive and those who were MRD negative during each time window. Multivariable Cox hazard regressions were used to assess the association between MRD status and outcomes while controlling for established risk factors. Data were analyzed from August 2024 to March 2025.

Intervention: Tumor-informed ctDNA-based MRD testing.

Main outcomes and measures: RFS and OS.

Results: Of 40 included patients, 29 (73%) were male, 38 (95%) had HPV-independent disease, and the median (IQR) age at diagnosis was 63 (28-85) years. A total of 142 samples from 40 patients. A total of 20 patients (50%) experienced recurrence. The presurgery ctDNA detection rate was 97% (35 of 36). MRD positivity within 6 weeks of completion of treatment was associated with worse OS (hazard ratio [HR], 7.15; 95% CI, 1.44-35.34) and RFS (HR, 5.39; 95% CI, 1.98-21.07). MRD positivity during surveillance was associated with worse RFS (HR, 8.27; 95% CI, 2.03-33.64). The median (range) time from first MRD detection to clinical detection of recurrence was 5 (0.2-21.6) months. In multivariable analyses, MRD positivity was associated with worse RFS (HR, 13.84; 95% CI, 2.92-65.68) and worse OS (HR, 18.93; 95% CI, 2.27-157.70).

Conclusions and relevance: In this study, tumor-informed ctDNA MRD positivity was associated with worse RFS and OS in patients with HNSCC. MRD testing could serve as a noninvasive, prognostic biomarker in patients with HPV-independent HNSCC.

Importance: Acute invasive fungal rhinosinusitis (AIFRS) is a rapidly progressive and potentially life-threatening infection that predominantly affects immunocompromised patients. Recent advances in diagnostic imaging, antifungal therapy, and surgical techniques may have altered its incidence, morbidity, and mortality.

Objective: To evaluate temporal trends in the pooled proportion, morbidity, and mortality of AIFRS in immunocompromised patients and assess the association of diagnostic and therapeutic advances.

Data sources: Systematic searches of Ovid MEDLINE, Ovid Embase, PubMed, Scopus, Web of Science, Cochrane, and Google Scholar from 1977 through October 20, 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Study selection: Prospective, retrospective, and cross-sectional studies and case series reporting pooled proportion, morbidity, or mortality of AIFRS in immunocompromised patients were included. Non-English articles, reviews, editorials, and studies with fewer than 10 patients were excluded.

Data extraction and synthesis: Two independent reviewers extracted data using standardized templates; disagreements were resolved by consensus. Risk of bias was assessed using the Newcastle-Ottawa Scale and Murad tool for case series. Random-effects meta-analysis generated pooled proportion, morbidity, and mortality rates with 95% CIs. Heterogeneity was quantified using I2 statistics. Meta-regression and sensitivity analyses evaluated temporal trends and study-level effects.

Main outcomes and measures: Pooled proportion, morbidity, and mortality rates of AIFRS stratified by publication period (1983-2012 vs 2013-2025).

Results: A total of 205 studies comprising 48 437 immunocompromised patients (median [range] age, 49.4 [5.2-68.8] years), including 10 311 (21.3%) with AIFRS, were analyzed. The pooled proportion was 11.8% (95% CI, 7.9%-17.2%), rising to 16.6% (95% CI, 8.7%-29.2%) in studies from 2013 to 2025. Overall mortality was 31.2% (95% CI, 28.3%-34.3%), declining from 41.9% (95% CI, 35.0%-49.1%) before 2013 to 28.2% (95% CI, 25.1%-31.4%) after 2013. Morbidity was 37.0% (95% CI, 32.9%-41.4%), with similar rates across periods (39.3% before 2013 vs 36.4% after 2013). The most common complications were vision loss, exophthalmos/proptosis, and orbital exenteration.

Conclusions and relevance: This systematic review and meta-analysis suggests that the pooled proportion of AIFRS among immunocompromised patients has increased while mortality has declined, reflecting advances in diagnostic and therapeutic approaches. Early detection and aggressive management remain critical to improving outcomes.

Importance: Despite the proven benefits of a cochlear implant, utilization rates remain low. Current screening tools have improved awareness but rely on binary classification (candidate vs noncandidate), limiting individualized counseling and shared decision-making.

Objective: To develop a risk stratification system for cochlear implant candidacy based on routine audiometric data, enabling individualized estimates of cochlear implant candidacy likelihood, supporting improved shared decision-making.

Design, setting, and participants: This retrospective cohort study including adults with hearing loss was conducted at a single tertiary academic center.

Methods: Consonant-nucleus-consonant (CNC) scores of 50% or lower were used as candidacy criteria. A conjunctive consolidation approach was used to classify patients into 4 audiometric severity stages, combining pure tone average (PTA) and word recognition score (WRS) cutoffs. Groups were informed by clinical judgment and statistical isometry. Discriminative power was assessed using the C statistic. A secondary stratification system was developed using AzBio sentences (≤60% in quiet or +10 dB on signal-to-noise ratio examination) to define candidacy.

Results: Among 1312 patients with complete data and PTA below 100 dB, 782 (59.6%) met cochlear implant candidacy criteria based on CNC scores of 50% or lower. The 4-stage classification system showed a clear gradient of candidacy likelihood, ranging from 2.8% in stage 0 to 88.5% in stage 3, with strong discriminative power (C = 0.83; 95% CI, 0.81-0.85). Similar trends were observed when candidacy was defined by AzBio scores, with strong model discrimination (C = 0.80; 95% CI, 0.77-0.83). Demographic factors such as age and duration of hearing loss did not enhance model performance and were excluded.

Conclusion: This cohort study found that patients with hearing loss can be effectively stratified by likelihood of cochlear implant candidacy using routine audiometric data. This 4-level classification system offers a simple, clinically intuitive method to estimate candidacy probability, moving beyond binary screening and supporting personalized, data-driven decision-making between clinicians and patients.

Importance: Olfactory dysfunction (OD) is a common and underdiagnosed condition that is associated with increased morbidity and mortality. However, existing smell tests can be costly and time intensive and can lack scalability.

Objective: To evaluate the performance of a novel, self-administered mobile application-based olfactory screening tool.

Design, setting, and participants: This diagnostic study was conducted at a tertiary academic medical center in the US between June 1 and December 31, 2024, to assess the performance of a novel olfactory test for the detection of OD. English-speaking individuals who were 18 years or older were recruited for the study.

Intervention: Completion of a 5-item, mobile application-based smell identification test. A subset of participants also completed a comparator test.

Main outcomes and measures: Diagnostic performance of a novel smell identification test in detecting OD compared with that of a comparator test. Secondary outcomes included correlation with subjective olfactory function.

Results: The study included 484 participants, 243 (50.2%) of whom were men. The mean (SD) age was 53.4 (18.5) years; 160 participants (33.1%) were 65 years or older. Seventy-four participants (15.3%) reported having subjective OD. Participants with self-reported OD had significantly lower novel test scores than those with normosmia (2.54 vs 3.50; mean difference, -0.96 [95% CI, -1.24 to -0.68]). At a cut point of less than 3, the novel test achieved an area under the curve of 0.87 (95% CI, 0.78-0.96), a sensitivity of 74% (95% CI, 51%-88%), and a specificity of 86% (95% CI, 72%-93%). Novel test scores correlated with comparator test scores (r = 0.74 [95% CI, 0.59-0.83]) as well as self-reported smell (r = 0.34 [95% CI, 0.25-0.41]), with acceptable internal consistency (Cronbach α = 0.70-0.71). Novel test scores declined with age, and women aged 18 to 29 years had higher scores than men in the same age group.

Conclusions and relevance: The findings of this diagnostic study suggest that the novel study test is a rapid and reliable olfactory screening tool that correlates well with validated smell tests and has potential for longitudinal screening of OD in the clinical setting.