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Tapering Biologic Therapy in Chronic Rhinosinusitis With Nasal Polyps. 慢性鼻窦炎伴鼻息肉的减量生物治疗。
IF 5.6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2026-02-01 DOI: 10.1001/jamaoto.2025.4675
Jonathan Liang, Sandra Y Lin
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引用次数: 0
Reframing Head and Neck Cancer Costs-Insights from Screening in Taiwan. 头颈部癌症成本重整:来自台湾筛查的见解。
IF 5.6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2026-02-01 DOI: 10.1001/jamaoto.2025.4133
Ching-Nung Wu, Wei-Chih Chen, Sheng-Dean Luo
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引用次数: 0
Vertebral Lesions in a Patient With Salivary Duct Carcinoma. 1例涎腺导管癌患者的椎体病变。
IF 5.6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2026-02-01 DOI: 10.1001/jamaoto.2025.4121
Takeshi Takahashi, Yushi Ueki, Arata Horii
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引用次数: 0
Peripheral Neural Plasticity in Cochlear Implant Users Across the Lifespan. 人工耳蜗使用者一生中周围神经的可塑性。
IF 5.6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2026-02-01 DOI: 10.1001/jamaoto.2025.4050
Erik Larsen, Leonid M Litvak, M Charles Liberman, Stéphane F Maison

Importance: Neural recordings from cochlear implant users provide a valuable, noninvasive measure of auditory nerve function. However, inconsistent methods for acquiring and analyzing these recordings limit their clinical application.

Objective: To develop and validate an automated method for standardizing the analysis of electrically evoked compound action potentials in cochlear implant users, and to characterize longitudinal changes in auditory nerve function across the largest cohort studied to date.

Design, settings, and participants: This multicenter cohort study used nonlinear curve-fitting models to analyze electrically evoked compound action potentials acquired during clinical programming and follow-up at multiple US centers from July 28, 2002, to August 13, 2017. Data were analyzed from October 8, 2024 to May 6, 2025.

Main outcomes and measures: Model fit success rates; variation in auditory nerve response parameters with age, sex, electrode location, and duration of implant use; and identification of age-related periods of peripheral neural plasticity.

Results: The analysis included 1 145 323 electrically evoked compound action potential recordings comprising 169 159 growth functions from 10 111 cochlear implants in 7416 patients (3560 [48%] female and 3856 [52%] male individuals). Both models successfully fit approximately 80% of auditory-nerve growth functions. Thresholds increased from apex to base along the cochlear array, paralleled by a decline in response slope and plateau. Latencies remained stable across electrode locations. Age at implantation significantly predicted nerve response slope, with younger recipients showing steeper slopes that declined with increasing age, particularly after adolescence. In infants and toddlers, slopes continued to increase over 5 years of implant use, suggesting peripheral neural plasticity early in life. Older recipients showed minimal slope change over time. Although thresholds rose modestly with prolonged device use, slope and plateau stabilized after age 30 years, indicating that age at implantation, rather than stimulation duration, was the primary determinant of auditory nerve responsiveness.

Conclusions and relevance: This cohort study introduces a robust and scalable framework for in vivo assessment of auditory nerve function and monitoring of peripheral plasticity across the lifespan. The findings highlight the critical importance of early cochlear implantation for preserving neural health and optimizing long-term outcomes.

重要性:人工耳蜗使用者的神经记录提供了一种有价值的、无创的听神经功能测量方法。然而,获取和分析这些记录的方法不一致,限制了它们的临床应用。目的:开发和验证一种自动化方法,用于标准化分析人工耳蜗使用者的电诱发复合动作电位,并在迄今为止研究的最大队列中表征听神经功能的纵向变化。设计、设置和参与者:这项多中心队列研究使用非线性曲线拟合模型分析2002年7月28日至2017年8月13日期间在美国多个中心的临床规划和随访期间获得的电诱发复合动作电位。数据分析时间为2024年10月8日至2025年5月6日。主要结果和测量:模型拟合成功率;听神经反应参数随年龄、性别、电极位置和植入时间的变化;以及确定周围神经可塑性的年龄相关时期。结果:对7416例患者(女性3560例(48%),男性3856例(52%))中10 111例人工耳蜗的1 145 323条电诱发复合动作电位记录,包括169 159个生长功能。两种模型都成功地拟合了大约80%的听神经生长功能。阈值沿耳蜗阵列从顶点到底部依次升高,与响应斜率和平台的下降平行。潜伏期在不同电极位置保持稳定。植入年龄显著预测神经反应斜率,年轻受者的神经反应斜率随着年龄的增长而下降,尤其是在青春期之后。在婴儿和学步儿童中,植入物使用5年后,斜度继续增加,表明周围神经在生命早期具有可塑性。随着时间的推移,年龄较大的受助者表现出最小的斜率变化。虽然阈值随着设备使用时间的延长而适度上升,但斜率和平台在30岁后趋于稳定,这表明植入时的年龄,而不是刺激时间,是听神经反应性的主要决定因素。结论和相关性:该队列研究引入了一个强大且可扩展的框架,用于听觉神经功能的体内评估和整个生命周期的外周可塑性监测。研究结果强调了早期人工耳蜗植入对保持神经健康和优化长期预后的关键重要性。
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引用次数: 0
Serum Metabolomics for Prognostic Stratification in Resected Advanced-Stage Oral Cavity Cancer. 血清代谢组学在切除的晚期口腔癌预后分层中的应用。
IF 5.6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2026-02-01 DOI: 10.1001/jamaoto.2025.4267
Eric Yi-Liang Shen, Li-Yu Lee, Shu-Hang Ng, Chien-Yu Lin, Hung-Ming Wang, Chia-Hsun Hsieh, Chih-Hua Yeh, Shiang-Fu Huang, Chung-Jan Kang, Tzu-Chen Yen, Nai-Ming Cheng, Chun-Ta Liao
<p><strong>Importance: </strong>Improved methods are needed to predict recurrence in oral cavity squamous cell carcinoma (OCSCC). However, to date, no metabolome studies have fully explored the prediction of OCSCC relapse patterns and survival.</p><p><strong>Objective: </strong>To identify serum metabolites associated with OCSCC recurrence and develop and validate a prognostic scoring system.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study was conducted at a single tertiary academic center and enrolled patients with histologically confirmed, surgically resected first primary advanced-stage OCSCC from betel quid-chewing areas. Patients underwent primary surgery between February 2007 and May 2018, with follow-up data systematically collected through a prospectively maintained institutional registry. Data were analyzed from December 2024 to September 2025.</p><p><strong>Exposures: </strong>Preoperative serum metabolomic profiling was performed using liquid chromatography-mass spectrometry.</p><p><strong>Main outcomes and measures: </strong>Identification of metabolites predictive of relapse and survivals; development and validation of the MetaboScore.</p><p><strong>Results: </strong>Of 228 included patients, 216 (94.7%) were male, and the mean (SD) age at OCSCC onset was 51.9 (10.8) years. A total of 19 metabolites associated with relapse were included in the MetaboScore. A threshold score of 11 or greater was associated with a higher risk of relapse, including local recurrence (22 of 79 [27.8%] vs 5 of 149 [3.4%]), regional recurrence (19 [24.1%] vs 10 [6.7%]), and distant metastasis (29 [36.7%] vs 21 [14.1%]) compared with scores less than 11. Patients with scores of 11 or greater had worse 5-year disease-free survival (38% [95% CI, 28-51] vs 83% [95% CI, 77-89]; difference, 45 percentage points; 95% CI, 32-57) and disease-specific survival (58% [95% CI, 48-70] vs 85% [95% CI, 79-91]; difference, 27 percentage points; 95% CI, 14-40). Multivariable analysis confirmed the independent prognostic value of the MetaboScore (local recurrence: hazard ratio [HR], 14.84; 95% CI, 5.45-40.40; regional recurrence: HR, 4.22; 95% CI, 1.94-9.15; distant metastases: HR, 2.53; 95% CI, 1.42-4.50; disease-free survival: HR, 4.40; 95% CI, 2.71-7.15; disease-specific survival: HR, 3.04; 95% CI, 1.76-5.25). Notably, the MetaboScore provided additional prognostic information beyond pN3b status.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, a high MetaboScore was associated with local recurrence, regional recurrence, and distant metastasis, even after conventional staging was applied, in OCSCC. Its derivation from a cohort predominantly composed of male patients with betel quid exposure and advanced-stage disease warrants caution. Prospective validation in more diverse populations comprising different etiologies, disease stages, and demographic characteristics will be essential before broad clinical imple
重要性:需要改进预测口腔鳞状细胞癌(OCSCC)复发的方法。然而,到目前为止,还没有代谢组学研究充分探讨了OCSCC复发模式和生存的预测。目的:确定与OCSCC复发相关的血清代谢物,并开发和验证预后评分系统。设计、环境和参与者:这项回顾性队列研究在一个单一的三级学术中心进行,招募了组织学证实、手术切除的首次原发性晚期OCSCC患者,这些患者来自槟榔嚼液区。患者在2007年2月至2018年5月期间接受了初次手术,通过前瞻性维护的机构登记处系统地收集了随访数据。数据分析时间为2024年12月至2025年9月。暴露:术前使用液相色谱-质谱法进行血清代谢组学分析。主要结局和指标:鉴定预测复发和生存的代谢物;代谢评分的开发和验证。结果:纳入的228例患者中,216例(94.7%)为男性,OCSCC发病的平均(SD)年龄为51.9(10.8)岁。代谢评分中包括了19种与复发相关的代谢物。阈值评分为11或更高与更高的复发风险相关,包括局部复发(79例中有22例[27.8%]vs 149例中有5例[3.4%])、局部复发(19例[24.1%]vs 10例[6.7%])和远处转移(29例[36.7%]vs 21例[14.1%])。评分为11或更高的患者的5年无病生存率(38% [95% CI, 28-51] vs 83% [95% CI, 77-89];差异45个百分点;95% CI, 32-57)和疾病特异性生存率(58% [95% CI, 48-70] vs 85% [95% CI, 79-91];差异27个百分点;95% CI, 14-40)较差。多变量分析证实了MetaboScore的独立预后价值(局部复发:危险比[HR], 14.84; 95% CI, 5.45-40.40;区域复发:HR, 4.22; 95% CI, 1.94-9.15;远处转移:HR, 2.53; 95% CI, 1.42-4.50;无病生存:HR, 4.40; 95% CI, 2.71-7.15;疾病特异性生存:HR, 3.04; 95% CI, 1.76-5.25)。值得注意的是,MetaboScore提供了pN3b状态之外的其他预后信息。结论和相关性:在这项队列研究中,高代谢评分与OCSCC的局部复发、区域复发和远处转移相关,即使在应用常规分期后也是如此。它的来源是一个主要由男性患者组成的队列,槟榔液暴露和晚期疾病值得谨慎。在广泛的临床应用之前,在包括不同病因、疾病分期和人口学特征的更多样化人群中进行前瞻性验证是必不可少的。
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引用次数: 0
Patient-Reported Outcomes Across Treatment Strategies in Papillary Thyroid Microcarcinoma: A Meta-Analysis. 不同治疗策略的甲状腺乳头状微癌患者报告的结果:一项荟萃分析。
IF 5.6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2026-02-01 DOI: 10.1001/jamaoto.2025.4670
Sam P J van Dijk, Matthew M K Blanco, Jessica Liu McMullin, G Scott Gazelle, Mohammad S Jalali, Jagpreet Chhatwal, Rajshri M Gartland, Olga Husson, Yinin Hu, J Shannon Swan, Tessa M van Ginhoven, Carrie Cunningham
<p><strong>Importance: </strong>Given the favorable prognosis of papillary thyroid microcarcinoma (PTMC), treatment decisions increasingly rely on patient-reported outcomes (PROs), such as health-related quality of life (HRQOL). Comparative HRQOL data between active surveillance, thermal ablation, and surgery remain limited.</p><p><strong>Objective: </strong>To compare HRQOL among adults with PTMC undergoing active surveillance, thermal ablation, or surgery to inform shared decision-making.</p><p><strong>Data sources: </strong>Embase, MEDLINE via Ovid, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and the top 100 references of Google Scholar were searched from inception to June 17, 2025.</p><p><strong>Study selection: </strong>Eligible studies included adult patients with PTMC and compared at least 2 relevant interventions while reporting PROs. Studies restricted to noncomparative designs or non-PTMC populations were excluded. Two reviewers independently screened titles, abstracts, and full texts, resolving discrepancies with a third reviewer.</p><p><strong>Data extraction and synthesis: </strong>This systematic review followed PRISMA 2020 and PRISMA-S guidelines; the meta-analysis adhered to MOOSE guidelines. Data were extracted by 1 reviewer and independently verified by a second. Study quality was assessed using established critical appraisal checklists. Random-effects models were applied to obtain mean differences with 95% CIs.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was domain-specific HRQOL (eg, voice problems, neuromuscular symptoms, psychological distress), as measured using the Thyroid Cancer Quality of Life (THYCA-QOL), Korean Thyroid-specific Quality of Life (KT-QOL), and other validated instruments.</p><p><strong>Results: </strong>Of 988 retrieved records, 13 studies comprising 5793 patients were included: 2356 underwent active surveillance, 242 received thermal ablation (211 radiofrequency, 31 laser), and 3195 underwent surgery (2350 lobectomy, 833 total thyroidectomy, 12 unspecified). Active surveillance was consistently associated with better PROs compared with surgery across thyroid-specific domains, including neuromuscular symptoms, voice problems, concentration issues, psychological distress, sympathetic complaints, feelings of being chilly, and scar-related concerns. Generic instruments (eg, 36-item Short Form Health Survey, version 2) supported these findings. Low-certainty evidence indicated that thermal ablation was associated with better HRQOL than surgery after 3 to 6 months, although these differences diminished by 12 months. Across studies, heterogeneity arose from differences in treatment strategies and comparators, outcome instruments and duration of follow-up.</p><p><strong>Conclusions and relevance: </strong>This systematic review and meta-analysis found that patients whose PTMC was managed with active surveillance reported equal or better HRQOL than th
重要性:鉴于甲状腺乳头状微癌(PTMC)预后良好,治疗决策越来越依赖于患者报告的结局(PROs),如健康相关生活质量(HRQOL)。主动监测、热消融和手术之间HRQOL的比较数据仍然有限。目的:比较PTMC患者接受主动监测、热消融或手术的HRQOL,为共同决策提供信息。数据来源:Embase, MEDLINE via Ovid, Web of Science Core Collection, Cochrane Central Register of Controlled Trials,检索b谷歌Scholar自创刊至2025年6月17日的前100篇参考文献。研究选择:符合条件的研究包括PTMC成年患者,并在报告PROs时比较至少2种相关干预措施。排除了非比较设计或非ptmc人群的研究。两位审稿人独立筛选标题、摘要和全文,解决与第三位审稿人的差异。数据提取和综合:本系统综述遵循PRISMA 2020和PRISMA- s指南;meta分析遵循MOOSE指南。数据由一名审稿人提取,并由另一名审稿人独立验证。使用已建立的关键评估清单评估研究质量。采用随机效应模型获得95% ci的平均差异。主要结局和测量:主要结局是特定领域的HRQOL(如声音问题、神经肌肉症状、心理困扰),使用甲状腺癌生活质量(THYCA-QOL)、韩国甲状腺特异性生活质量(KT-QOL)和其他经过验证的工具测量。结果:在检索到的988份记录中,纳入了13项研究,包括5793例患者:2356例接受主动监测,242例接受热消融(211例射频消融,31例激光消融),3195例接受手术(2350例肺叶切除术,833例甲状腺全切除术,12例未明确)。与手术相比,在甲状腺特异性领域,包括神经肌肉症状、声音问题、注意力问题、心理困扰、交感疾病、感觉寒冷和疤痕相关的担忧,主动监测始终与更好的PROs相关。通用工具(例如,36项简短健康调查,版本2)支持这些发现。低确定性证据表明,3 - 6个月后,热消融与手术相比HRQOL更好,尽管这种差异在12个月后减弱。在所有研究中,异质性源于治疗策略和比较物、结果工具和随访时间的差异。结论和相关性:本系统综述和荟萃分析发现,主动监测PTMC患者的HRQOL与接受手术的患者相同或更好。这些发现支持将PROs纳入低风险甲状腺癌共同决策的重要性。
{"title":"Patient-Reported Outcomes Across Treatment Strategies in Papillary Thyroid Microcarcinoma: A Meta-Analysis.","authors":"Sam P J van Dijk, Matthew M K Blanco, Jessica Liu McMullin, G Scott Gazelle, Mohammad S Jalali, Jagpreet Chhatwal, Rajshri M Gartland, Olga Husson, Yinin Hu, J Shannon Swan, Tessa M van Ginhoven, Carrie Cunningham","doi":"10.1001/jamaoto.2025.4670","DOIUrl":"10.1001/jamaoto.2025.4670","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Given the favorable prognosis of papillary thyroid microcarcinoma (PTMC), treatment decisions increasingly rely on patient-reported outcomes (PROs), such as health-related quality of life (HRQOL). Comparative HRQOL data between active surveillance, thermal ablation, and surgery remain limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare HRQOL among adults with PTMC undergoing active surveillance, thermal ablation, or surgery to inform shared decision-making.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;Embase, MEDLINE via Ovid, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and the top 100 references of Google Scholar were searched from inception to June 17, 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study selection: &lt;/strong&gt;Eligible studies included adult patients with PTMC and compared at least 2 relevant interventions while reporting PROs. Studies restricted to noncomparative designs or non-PTMC populations were excluded. Two reviewers independently screened titles, abstracts, and full texts, resolving discrepancies with a third reviewer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data extraction and synthesis: &lt;/strong&gt;This systematic review followed PRISMA 2020 and PRISMA-S guidelines; the meta-analysis adhered to MOOSE guidelines. Data were extracted by 1 reviewer and independently verified by a second. Study quality was assessed using established critical appraisal checklists. Random-effects models were applied to obtain mean differences with 95% CIs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was domain-specific HRQOL (eg, voice problems, neuromuscular symptoms, psychological distress), as measured using the Thyroid Cancer Quality of Life (THYCA-QOL), Korean Thyroid-specific Quality of Life (KT-QOL), and other validated instruments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 988 retrieved records, 13 studies comprising 5793 patients were included: 2356 underwent active surveillance, 242 received thermal ablation (211 radiofrequency, 31 laser), and 3195 underwent surgery (2350 lobectomy, 833 total thyroidectomy, 12 unspecified). Active surveillance was consistently associated with better PROs compared with surgery across thyroid-specific domains, including neuromuscular symptoms, voice problems, concentration issues, psychological distress, sympathetic complaints, feelings of being chilly, and scar-related concerns. Generic instruments (eg, 36-item Short Form Health Survey, version 2) supported these findings. Low-certainty evidence indicated that thermal ablation was associated with better HRQOL than surgery after 3 to 6 months, although these differences diminished by 12 months. Across studies, heterogeneity arose from differences in treatment strategies and comparators, outcome instruments and duration of follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This systematic review and meta-analysis found that patients whose PTMC was managed with active surveillance reported equal or better HRQOL than th","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"154-162"},"PeriodicalIF":5.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12743308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145833816","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}
引用次数: 0
Electrocochleography for Monitoring Hearing Preservation During Cochlear Implantation. 人工耳蜗植入术中监测听力保存的超声心动图。
IF 5.6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2026-02-01 DOI: 10.1001/jamaoto.2025.4044
Raphael R Andonie, Christofer Bester, Sudanthi Wijewickrema, Leanne Sijgers, Marlies Geys, Adrian Dalbert, Marco Caversaccio, Flurin Pfiffner, Stephen O'Leary, Stefan Weder
<p><strong>Importance: </strong>Many cochlear implant candidates retain residual hearing, which can improve speech perception and overall outcomes. However, residual hearing is frequently lost during implantation. Intraoperative electrocochleography may enable monitoring of residual hearing, but its clinical relevance is currently limited due to reliance on expert interpretation, the absence of real-time analysis algorithms, and signal variability.</p><p><strong>Objective: </strong>To assess whether automated analysis of intraoperative cochlear microphonic amplitude decreases (events) is associated with hearing preservation and to evaluate additional electrocochleography features enhancing potential predictive performance.</p><p><strong>Design, setting, and participants: </strong>This multicenter, cross-sectional cohort study included adults receiving a cochlear implant with a preoperative hearing threshold not greater than 85 dB hearing level at 0.5 kHz and cochlear microphonic amplitude of 5 μV or higher across 3 tertiary referral centers in Melbourne, Australia; Bern, Switzerland; and Zurich, Switzerland. Intraoperative real-time electrocochleography and impedance data were collected between 2017 and 2025, with audiometric follow-up 3 months postoperatively.</p><p><strong>Exposures: </strong>Cochlear implantation with the Slim Straight Electrode array (Cochlear Limited).</p><p><strong>Main outcomes and measures: </strong>Primary outcome was binary hearing preservation at 3 months postoperatively, defined as less than 25% loss relative to the preoperative low-frequency pure-tone average at 0.25 to 1 kHz. Primary variables assessed as possible predictors included magnitude, location, and persistence of cochlear microphonic events. Post hoc analysis explored associated changes in the auditory nerve neurophonic:cochlear microphonic amplitude ratio and cochlear microphonic phase.</p><p><strong>Results: </strong>A total of 112 patients met inclusion criteria and were analyzed (median [IQR] age at surgery, 68 [58-75] years; 57 [51%] female and 55 [49%] female). Cochlear microphonic events persisting or occurring near the end of insertion were associated with loss of residual hearing (adjusted odds ratio, 31.58 [95% CI, 6.36-205.36] and 52.96 [95% CI, 8.02-472.63], respectively), independent of age, preoperative hearing, and participating hospital. Events with rising amplitude ratio between auditory nerve neurophonic and cochlear microphonic were associated with better hearing preservation (mean difference in hearing preservation, 24.4% [95% CI, 7.3%-41.5%]). Stable cochlear microphonic phase showed a similar trend (mean difference in hearing preservation, 20.9% [95% CI, 2.9%-38.9%]).</p><p><strong>Conclusions and relevance: </strong>This cross-sectional study demonstrates the feasibility of automated intraoperative electrocochleography for possible prediction of hearing preservation during cochlear implantation. Persistent cochlear microphonic events
重要性:许多人工耳蜗候选人保留了残余听力,这可以改善语言感知和整体预后。然而,在植入过程中,残余听力经常会丧失。术中耳蜗电图可以监测残余听力,但由于依赖专家解释、缺乏实时分析算法和信号可变性,其临床相关性目前受到限制。目的:评估术中人工耳蜗麦克风振幅下降(事件)的自动分析是否与听力保护有关,并评估其他增强潜在预测性能的耳蜗电图特征。设计、环境和参与者:这项多中心、横断面队列研究包括澳大利亚墨尔本3个三级转诊中心接受人工耳蜗的成年人,术前听力阈值不大于85 dB,听力水平为0.5 kHz,耳蜗麦克风振幅为5 μV或更高;瑞士伯尔尼;以及瑞士的苏黎世。2017 - 2025年间采集术中实时耳蜗和阻抗数据,术后3个月进行听力学随访。曝光:使用超薄直电极阵列植入人工耳蜗(耳蜗有限公司)。主要结果和指标:主要结果是术后3个月的二元听力保留,定义为相对于术前0.25至1 kHz的低频纯音平均听力损失小于25%。评估作为可能预测因素的主要变量包括耳蜗麦克风事件的大小、位置和持续时间。事后分析探讨了听神经神经声、耳蜗麦克风振幅比和耳蜗麦克风相位的相关变化。结果:共有112例患者符合纳入标准并进行了分析(手术时中位[IQR]年龄为68[58-75]岁,女性57[51%],女性55[49%])。耳蜗麦克风事件持续存在或发生在植入结束时与残余听力损失相关(调整后的优势比分别为31.58 [95% CI, 6.36-205.36]和52.96 [95% CI, 8.02-472.63]),与年龄、术前听力和参与医院无关。听神经神经声和耳蜗传声器间振幅比升高的事件与更好的听力保存相关(听力保存的平均差异为24.4% [95% CI, 7.3%-41.5%])。稳定的耳蜗麦克风期表现出类似的趋势(听力保存的平均差异为20.9% [95% CI, 2.9%-38.9%])。结论和相关性:本横断面研究证明了自动术中耳蜗电图预测人工耳蜗植入过程中听力保存的可行性。在插入结束时持续的耳蜗麦克风事件与听力损失有关。额外的电子耳蜗特征可能会改善信号的解释。这些发现支持实时反馈系统的发展,以指导人工耳蜗植入。
{"title":"Electrocochleography for Monitoring Hearing Preservation During Cochlear Implantation.","authors":"Raphael R Andonie, Christofer Bester, Sudanthi Wijewickrema, Leanne Sijgers, Marlies Geys, Adrian Dalbert, Marco Caversaccio, Flurin Pfiffner, Stephen O'Leary, Stefan Weder","doi":"10.1001/jamaoto.2025.4044","DOIUrl":"10.1001/jamaoto.2025.4044","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Many cochlear implant candidates retain residual hearing, which can improve speech perception and overall outcomes. However, residual hearing is frequently lost during implantation. Intraoperative electrocochleography may enable monitoring of residual hearing, but its clinical relevance is currently limited due to reliance on expert interpretation, the absence of real-time analysis algorithms, and signal variability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess whether automated analysis of intraoperative cochlear microphonic amplitude decreases (events) is associated with hearing preservation and to evaluate additional electrocochleography features enhancing potential predictive performance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This multicenter, cross-sectional cohort study included adults receiving a cochlear implant with a preoperative hearing threshold not greater than 85 dB hearing level at 0.5 kHz and cochlear microphonic amplitude of 5 μV or higher across 3 tertiary referral centers in Melbourne, Australia; Bern, Switzerland; and Zurich, Switzerland. Intraoperative real-time electrocochleography and impedance data were collected between 2017 and 2025, with audiometric follow-up 3 months postoperatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Cochlear implantation with the Slim Straight Electrode array (Cochlear Limited).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Primary outcome was binary hearing preservation at 3 months postoperatively, defined as less than 25% loss relative to the preoperative low-frequency pure-tone average at 0.25 to 1 kHz. Primary variables assessed as possible predictors included magnitude, location, and persistence of cochlear microphonic events. Post hoc analysis explored associated changes in the auditory nerve neurophonic:cochlear microphonic amplitude ratio and cochlear microphonic phase.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 112 patients met inclusion criteria and were analyzed (median [IQR] age at surgery, 68 [58-75] years; 57 [51%] female and 55 [49%] female). Cochlear microphonic events persisting or occurring near the end of insertion were associated with loss of residual hearing (adjusted odds ratio, 31.58 [95% CI, 6.36-205.36] and 52.96 [95% CI, 8.02-472.63], respectively), independent of age, preoperative hearing, and participating hospital. Events with rising amplitude ratio between auditory nerve neurophonic and cochlear microphonic were associated with better hearing preservation (mean difference in hearing preservation, 24.4% [95% CI, 7.3%-41.5%]). Stable cochlear microphonic phase showed a similar trend (mean difference in hearing preservation, 20.9% [95% CI, 2.9%-38.9%]).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This cross-sectional study demonstrates the feasibility of automated intraoperative electrocochleography for possible prediction of hearing preservation during cochlear implantation. Persistent cochlear microphonic events","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"117-125"},"PeriodicalIF":5.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12635923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563685","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}
引用次数: 0
Hypotensive Agents for Controlled Hypotension in Endoscopic Sinus Surgery: A Systematic Review and Network Meta-Analysis. 内窥镜鼻窦手术控制降压的降压药:系统回顾和网络荟萃分析。
IF 5.6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2026-01-29 DOI: 10.1001/jamaoto.2025.5222
Abdelrahman Saeed, Omar Saeed, Mohamedhen Vall Nounou, Edward D McCoul, Qasi Najah, Sara Saleh, Osama Barakat, Ahmed Wahhab, Longgang Yu, Muhammed Elhadi

Importance: Excessive bleeding during endoscopic sinus surgery (ESS) impairs visualization and increases complications. Controlled hypotension is widely used; however, comparative effectiveness of available pharmacological agents remains uncertain.

Objective: To compare the effectiveness and safety of hypotensive drugs for reduced bleeding in ESS.

Data sources: PubMed, Scopus, Web of Science, and Cochrane databases were searched from inception to December 2024, and updated to include studies up to May 2025.

Study selection: Randomized clinical trials of patients undergoing ESS and receiving dexmedetomidine, clonidine, esmolol, labetalol, bisoprolol, metoprolol, diltiazem, nifedipine, or verapamil vs placebo. A total of 1258 records were screened.

Data extraction and synthesis: Data were extracted and assessed using the Cochrane risk of bias tool. Certainty was rated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. A random-effects meta-analysis was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines.

Main outcomes and measures: Surgical bleeding score, intraoperative mean arterial pressure (MAP), and mean intraoperative heart rate. Secondary outcomes included blood loss, surgery duration, and emergence time.

Results: The analysis included 52 randomized clinical trials involving 3526 participants; of these, 43 studies contributed to the network analysis. Several agents were associated with reduced bleeding vs placebo: diltiazem (mean difference [MD], -1.25; 95% CI, -2.13 to -0.37), esmolol (MD, -1.16; 95% CI, -1.80 to -0.51), dexmedetomidine (MD, -1.09; 95% CI, -1.48 to -0.70), labetalol (MD, -1.00; 95% CI, -1.58 to -0.42), and clonidine (MD, -0.69; 95% CI, -1.23 to -0.16). Dexmedetomidine was associated with the most reduced MAP (MD, -30.30 mm Hg; 95% CI, -47.91 to -12.69), followed by clonidine (MD, -28.61; 95% CI, -53.11 to -4.11), esmolol (MD, -27.62; 95% CI, -49.73 to -5.51), and labetalol (MD, -26.54; 95% CI, -47.20 to -5.87). At 60 minutes, bisoprolol (MD, -58.30; 95% CI, -67.50 to -49.10 beats per minute [bpm]), verapamil (MD, -49.90; 95% CI, -58.98 to -40.82 bpm), and labetalol (MD, -43.89; 95% CI, -54.59 to -33.18 bpm) produced the largest heart rate reductions. Esmolol (MD, -3.67; 95% CI, -4.21 to -3.13 minutes) and labetalol (MD, -3.64; 95% CI, -4.79 to -2.49 minutes) shortened emergence time.

Conclusions and relevance: In this systematic review and network meta-analysis, controlled hypotension improved surgical field quality in ESS with comparable safety. Diltiazem, esmolol, dexmedetomidine, labetalol, and clonidine were effective; dexmedetomidine was associated with reduced MAP the most, and esmolol favored recovery.

重要性:内窥镜鼻窦手术(ESS)中出血过多会损害可视化并增加并发症。控制性低血压被广泛应用;然而,现有药物的相对有效性仍然不确定。目的:比较降压药减少ESS出血的有效性和安全性。数据来源:PubMed, Scopus, Web of Science和Cochrane数据库从成立到2024年12月进行了搜索,并更新到2025年5月。研究选择:接受ESS并接受右美托咪定、氯定、艾司洛尔、拉贝他洛尔、比索洛尔、美托洛尔、地尔硫卓、硝苯地平或维拉帕米与安慰剂的随机临床试验。总共筛选了1258条记录。数据提取和综合:使用Cochrane偏倚风险工具提取和评估数据。使用GRADE(建议评估、发展和评估分级)框架对确定性进行评级。随机效应荟萃分析按照PRISMA(系统评价和荟萃分析首选报告项目)声明指南进行。主要观察指标:手术出血评分、术中平均动脉压(MAP)、术中平均心率。次要结局包括出血量、手术时间和急救时间。结果:分析纳入52项随机临床试验,涉及3526名受试者;其中,43项研究对网络分析做出了贡献。与安慰剂相比,几种药物与减少出血相关:地尔硫卓(平均差[MD], -1.25; 95% CI, -2.13至-0.37)、艾司洛尔(MD, -1.16; 95% CI, -1.80至-0.51)、右美托咪定(MD, -1.09; 95% CI, -1.48至-0.70)、拉贝他洛尔(MD, -1.00; 95% CI, -1.58至-0.42)和克拉定(MD, -0.69; 95% CI, -1.23至-0.16)。右美托咪定与MAP降低最多相关(MD, -30.30 mm Hg; 95% CI, -47.91至-12.69),其次是cola (MD, -28.61; 95% CI, -53.11至-4.11)、esmolol (MD, -27.62; 95% CI, -49.73至-5.51)和labetalol (MD, -26.54; 95% CI, -47.20至-5.87)。在60分钟时,比索洛尔(MD, -58.30; 95% CI, -67.50至-49.10次/分钟[bpm])、维拉帕米(MD, -49.90; 95% CI, -58.98至-40.82 bpm)和拉贝他洛尔(MD, -43.89; 95% CI, -54.59至-33.18 bpm)产生最大的心率降低。艾司洛尔(MD, -3.67; 95% CI, -4.21 ~ -3.13分钟)和拉贝洛尔(MD, -3.64; 95% CI, -4.79 ~ -2.49分钟)缩短急救时间。结论和相关性:在本系统综述和网络荟萃分析中,控制性低血压改善了ESS手术野质量,且安全性相当。地尔硫卓、艾司洛尔、右美托咪定、拉贝他洛尔和可乐定有效;右美托咪定与MAP减少相关最多,而艾司洛尔有利于恢复。
{"title":"Hypotensive Agents for Controlled Hypotension in Endoscopic Sinus Surgery: A Systematic Review and Network Meta-Analysis.","authors":"Abdelrahman Saeed, Omar Saeed, Mohamedhen Vall Nounou, Edward D McCoul, Qasi Najah, Sara Saleh, Osama Barakat, Ahmed Wahhab, Longgang Yu, Muhammed Elhadi","doi":"10.1001/jamaoto.2025.5222","DOIUrl":"10.1001/jamaoto.2025.5222","url":null,"abstract":"<p><strong>Importance: </strong>Excessive bleeding during endoscopic sinus surgery (ESS) impairs visualization and increases complications. Controlled hypotension is widely used; however, comparative effectiveness of available pharmacological agents remains uncertain.</p><p><strong>Objective: </strong>To compare the effectiveness and safety of hypotensive drugs for reduced bleeding in ESS.</p><p><strong>Data sources: </strong>PubMed, Scopus, Web of Science, and Cochrane databases were searched from inception to December 2024, and updated to include studies up to May 2025.</p><p><strong>Study selection: </strong>Randomized clinical trials of patients undergoing ESS and receiving dexmedetomidine, clonidine, esmolol, labetalol, bisoprolol, metoprolol, diltiazem, nifedipine, or verapamil vs placebo. A total of 1258 records were screened.</p><p><strong>Data extraction and synthesis: </strong>Data were extracted and assessed using the Cochrane risk of bias tool. Certainty was rated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. A random-effects meta-analysis was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines.</p><p><strong>Main outcomes and measures: </strong>Surgical bleeding score, intraoperative mean arterial pressure (MAP), and mean intraoperative heart rate. Secondary outcomes included blood loss, surgery duration, and emergence time.</p><p><strong>Results: </strong>The analysis included 52 randomized clinical trials involving 3526 participants; of these, 43 studies contributed to the network analysis. Several agents were associated with reduced bleeding vs placebo: diltiazem (mean difference [MD], -1.25; 95% CI, -2.13 to -0.37), esmolol (MD, -1.16; 95% CI, -1.80 to -0.51), dexmedetomidine (MD, -1.09; 95% CI, -1.48 to -0.70), labetalol (MD, -1.00; 95% CI, -1.58 to -0.42), and clonidine (MD, -0.69; 95% CI, -1.23 to -0.16). Dexmedetomidine was associated with the most reduced MAP (MD, -30.30 mm Hg; 95% CI, -47.91 to -12.69), followed by clonidine (MD, -28.61; 95% CI, -53.11 to -4.11), esmolol (MD, -27.62; 95% CI, -49.73 to -5.51), and labetalol (MD, -26.54; 95% CI, -47.20 to -5.87). At 60 minutes, bisoprolol (MD, -58.30; 95% CI, -67.50 to -49.10 beats per minute [bpm]), verapamil (MD, -49.90; 95% CI, -58.98 to -40.82 bpm), and labetalol (MD, -43.89; 95% CI, -54.59 to -33.18 bpm) produced the largest heart rate reductions. Esmolol (MD, -3.67; 95% CI, -4.21 to -3.13 minutes) and labetalol (MD, -3.64; 95% CI, -4.79 to -2.49 minutes) shortened emergence time.</p><p><strong>Conclusions and relevance: </strong>In this systematic review and network meta-analysis, controlled hypotension improved surgical field quality in ESS with comparable safety. Diltiazem, esmolol, dexmedetomidine, labetalol, and clonidine were effective; dexmedetomidine was associated with reduced MAP the most, and esmolol favored recovery.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085895","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}
引用次数: 0
Accuracy of Sentinel Lymph Node Biopsy to Predict Nodal Metastasis in Head and Neck Merkel Cell Carcinoma. 前哨淋巴结活检预测头颈部默克尔细胞癌淋巴结转移的准确性。
IF 5.6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2026-01-29 DOI: 10.1001/jamaoto.2025.5211
Stephanie Y Wang, Gavin Turner, Karla L Valdes-Morales, Emily R Hunter, Mimi Kim, Van Anh Tran, Kyle Polen, Dylan Haynes, Christopher J Miller, Jeremy R Etzkorn, Joseph F Sobanko, Joanna L Walker, Junqian Zhang, Robert M Brody, Steven B Cannady, Karthik Rajasekaran, D Gregory Farwell, John T Miura, Giorgos C Karakousis, John R Lukens, Ravi K Amaravadi, Lynn M Schuchter, Tara C Mitchell, H William Higgins, Ryan M Carey

Importance: Merkel cell carcinoma (MCC) is a rare neuroendocrine malignant neoplasm often affecting the head and neck. Sentinel lymph node biopsy (SLNB) is routinely performed; however, the accuracy and reliability of SLNB for head and neck MCC remains unknown.

Objective: To determine the accuracy of SLNB in head and neck MCC and inform pre- and post-SLNB risk stratification.

Design, setting, and participants: This was a single-center cohort study of patients with clinically node-negative head and neck MCC who underwent SLNB from January 2006 to January 2025; median (IQR) follow-up was 1.9 (0.8-4.6) years. Data analysis was conducted from April to November 2025.

Interventions: SLNB outcome and nodal disease status.

Main outcomes and measures: SLNB accuracy measured by sensitivity, negative predictive value (NPV), and false negative (FN) rate. FN SLNB was defined as regional nodal recurrence at the first site of recurrence after a negative SLNB without concurrent local or in-transit recurrence. Factors associated with failed SLNB (defined as nonvisualization on lymphoscintigraphy, inability to identify the sentinel lymph node intraoperatively, or absence of nodal tissue in the pathology specimen) were evaluated using effect-size measures. Cox proportional hazards model identified factors associated with nodal disease, comparing patients who developed nodal disease (identified by SLNB or subsequent clinical and/or imaging evaluation) with those who did not develop nodal disease during follow-up.

Results: Of 86 participants (mean [SD] age, 75.6 [9.6] years; 36 female [41.9%] and 50 male [58.1%] individuals) with clinically node-negative head and neck MCC, 69 (80.2%) underwent SLNB. Occult nodal disease was identified in 19 participants (27.5%). SLNB sensitivity was 52.6% (10 of 19 patients), NPV was 88.6% (31 of 35 patients), and FN rate was 26.7% (4 of 15 patients). SLNB failed in 29.0% (20 of 69 patients), with tumor location, female sex, and older age having medium to large effect on SLNB failure. Lymphovascular invasion, infiltrative growth pattern, and tumor size had the largest effect size on nodal disease with Cox analysis.

Conclusions and relevance: In this large single-site cohort study, SLNB remained a useful tool in head and neck MCC, identifying more than half of occult nodal disease. Given reduced performance in this region, patients with failed SLNB or negative SLNB plus high-risk features may benefit from tailored management, including intensified therapy and surveillance.

重要性:默克尔细胞癌(MCC)是一种罕见的神经内分泌恶性肿瘤,常累及头颈部。前哨淋巴结活检(SLNB)是常规检查;然而,SLNB对头颈部MCC的准确性和可靠性尚不清楚。目的:确定SLNB在头颈部MCC中的准确性,为SLNB前后的风险分层提供依据。设计、环境和参与者:这是一项单中心队列研究,研究对象为2006年1月至2025年1月接受SLNB治疗的临床淋巴结阴性头颈部MCC患者;中位(IQR)随访时间为1.9(0.8-4.6)年。数据分析时间为2025年4月至11月。干预措施:SLNB结果和淋巴结疾病状态。主要结局和测量指标:SLNB准确性(灵敏度)、阴性预测值(NPV)和假阴性(FN)率。FN SLNB被定义为阴性SLNB后第一个复发部位的区域性淋巴结复发,没有并发局部或途中复发。与SLNB失败相关的因素(定义为淋巴显像未显示,术中无法识别前哨淋巴结,或病理标本中没有淋巴结组织)使用效应大小测量进行评估。Cox比例风险模型确定了与淋巴结疾病相关的因素,比较了在随访期间发生淋巴结疾病(通过SLNB或随后的临床和/或影像学评估确定)的患者与未发生淋巴结疾病的患者。结果:86例临床淋巴结阴性头颈部MCC患者(平均[SD]年龄75.6[9.6]岁,女性36例[41.9%],男性50例[58.1%])中,69例(80.2%)接受了SLNB。19名参与者(27.5%)发现隐匿性淋巴结疾病。SLNB敏感性为52.6% (10 / 19),NPV为88.6% (31 / 35),FN率为26.7%(4 / 15)。69例患者中有20例(29.0%)SLNB失败,肿瘤位置、女性、年龄对SLNB失败有中等到较大的影响。经Cox分析,淋巴血管浸润、浸润性生长模式和肿瘤大小对淋巴结疾病的影响最大。结论和相关性:在这项大型单点队列研究中,SLNB仍然是头颈部MCC的有用工具,可识别一半以上的隐匿性淋巴结疾病。鉴于该区域的表现下降,SLNB失败或SLNB阴性加上高风险特征的患者可能受益于量身定制的管理,包括强化治疗和监测。
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引用次数: 0
Beyond the Usual Fashion-Rethinking the Operative Report. 超越常规——对执行报告的反思。
IF 5.6 1区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2026-01-29 DOI: 10.1001/jamaoto.2025.4987
Edward D McCoul
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引用次数: 0
期刊
JAMA otolaryngology-- head & neck surgery
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