Pub Date : 2025-03-01DOI: 10.1001/jamaoto.2024.4572
Peter R Dixon, Elizabeth Camposeo, Theodore R McRackan
{"title":"The End of Medicare Telehealth Coverage for Audiology.","authors":"Peter R Dixon, Elizabeth Camposeo, Theodore R McRackan","doi":"10.1001/jamaoto.2024.4572","DOIUrl":"10.1001/jamaoto.2024.4572","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"185-186"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893713","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 : 2025-03-01DOI: 10.1001/jamaoto.2024.4671
Uchechukwu C Megwalu, Yifei Ma
{"title":"Clarification Regarding Insurance Disparities Among Patients With Head and Neck Cancer-Reply.","authors":"Uchechukwu C Megwalu, Yifei Ma","doi":"10.1001/jamaoto.2024.4671","DOIUrl":"10.1001/jamaoto.2024.4671","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"282"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914790","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 : 2025-03-01DOI: 10.1001/jamaoto.2024.4859
Dmitry Tretiakow, Katarzyna Zyzynska, Agnieszka Kasprzyk-Tryk
{"title":"Tympanostomy Tube With or Without Adenoidectomy.","authors":"Dmitry Tretiakow, Katarzyna Zyzynska, Agnieszka Kasprzyk-Tryk","doi":"10.1001/jamaoto.2024.4859","DOIUrl":"10.1001/jamaoto.2024.4859","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"284"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023447","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 : 2025-03-01DOI: 10.1001/jamaoto.2025.0010
{"title":"Errors in Table and Figures.","authors":"","doi":"10.1001/jamaoto.2025.0010","DOIUrl":"10.1001/jamaoto.2025.0010","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"285"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255678","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 : 2025-03-01DOI: 10.1001/jamaoto.2024.4453
Phillip Staibano, Michael Au, Han Zhang, Sheila Yu, Winnie Liu, Jesse D Pasternak, Xing Xing, Carolyn D Seib, Lisa Orloff, Nhu-Tram Nguyen, Michael K Gupta, Eric Monteiro, Sameer Parpia, Tyler McKechnie, Alex Thabane, J E M Ted Young, Mohit Bhandari
<p><strong>Importance: </strong>Intraoperative parathyroid hormone (IOPTH) monitoring is recommended by the American Association of Endocrine Surgeons for use during parathyroidectomy for patients with primary hyperparathyroidism (PHPT), but there is no clinician consensus regarding the IOPTH monitoring criteria that optimize diagnostic accuracy.</p><p><strong>Objective: </strong>To evaluate and rank the diagnostic properties of IOPTH monitoring criteria used during surgery for patients with PHPT.</p><p><strong>Data sources: </strong>A bayesian diagnostic test accuracy network meta-analysis (DTA-NMA) was performed, in which peer-reviewed citations from January 1, 1990, to July 22, 2023, were searched for in MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL.</p><p><strong>Study selection: </strong>All full-text study designs that evaluated any IOPTH monitoring criteria as a diagnostic test were included in this meta-analysis. Any studies evaluating adult patients diagnosed with PHPT undergoing parathyroidectomy were also included. The reference standard used in this study was normalization of calcium and/or parathyroid hormone levels within 1 year of surgery.</p><p><strong>Data extraction and synthesis: </strong>This DTA-NMA was reported in accordance with the applicable Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Two reviewers evaluated all abstracts and full-text articles using a piloted extraction form. A third author resolved any conflicts. There are no published Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) resources for DTA-NMA. The following conventional monitoring criteria were included: Halle, Miami, Rome, Vienna, and PTH normalization, and the following modified criteria were included: Miami and PTH normalization, modified Miami, and modified Vienna. A bayesian hierarchical DTA-NMA model with corresponding 95% credible intervals (CrIs) was used to describe the pooled diagnostic characteristics of the evaluated IOPTH monitoring criteria.</p><p><strong>Main outcomes and measures: </strong>Main outcomes included pooled diagnostic test properties, including sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio.</p><p><strong>Results: </strong>A total of 72 studies, which included 19 072 patients, met the inclusion criteria. Sixty-nine studies (95.8%) investigated classic PHPT. In PHPT, the Miami criteria were investigated most often and had the best diagnostic properties (diagnostic odds ratio, 60.00 [95% CrI, 32.00-145.00]) when compared to other conventional criteria. Moreover, the modified Miami criteria, which measures a postexcision IOPTH level 15 minutes or more postexcision of all hyperfunctioning parathyroid tissue, were the overall best criteria (diagnostic odds ratio, 79.71 [95% CrI, 22.46-816.67]). There was a low risk of study bias and no publication bias.</p><p><strong>Conclusions and relevan
重要性：美国内分泌外科医生协会推荐在原发性甲状旁腺功能亢进（PHPT）患者进行甲状旁腺切除术时使用术中甲状旁腺激素（IOPTH）监测，但临床医生对优化诊断准确性的IOPTH监测标准尚无共识。目的：对PHPT患者手术中使用的IOPTH监测标准的诊断特性进行评价和排序。数据来源：在MEDLINE、Embase、Web of Science、CENTRAL和CINAHL中检索1990年1月1日至2023年7月22日的同行评审引文，进行贝叶斯诊断测试准确性网络元分析（DTA-NMA）。研究选择：所有评估任何IOPTH监测标准作为诊断测试的全文研究设计都包括在本荟萃分析中。任何评估诊断为PHPT并行甲状旁腺切除术的成年患者的研究也被纳入。本研究使用的参考标准是手术后1年内钙和/或甲状旁腺激素水平的正常化。数据提取和综合：本DTA-NMA按照适用的系统评价和荟萃分析（PRISMA）报告指南的首选报告项目进行报告。两名审稿人评估了所有的摘要和全文文章使用试点提取形式。第三位作者解决了任何冲突。DTA-NMA没有公开的推荐、评估、发展和评估分级（GRADE）资源。包括以下常规监测标准：Halle、Miami、Rome、Vienna和PTH正常化；包括以下修改标准：Miami和PTH正常化、修改Miami和修改Vienna。采用具有相应95%可信区间（CrIs）的贝叶斯分层DTA-NMA模型来描述所评估的IOPTH监测标准的汇总诊断特征。主要结局和测量指标：主要结局包括合并诊断试验特性，包括敏感性、特异性、阳性似然比、阴性似然比和诊断优势比。结果：共有72项研究，19 072例患者符合纳入标准。69项研究（95.8%）调查经典PHPT。在PHPT中，与其他常规标准相比，Miami标准被研究得最多，并且具有最好的诊断特性（诊断优势比为60.00 [95% CrI, 32.00-145.00]）。此外，改良后的Miami标准是总体最佳标准（诊断优势比为79.71 [95% CrI, 22.46-816.67]），该标准测量切除后所有功能异常的甲状旁腺组织在切除后15分钟或更长时间内的IOPTH水平。研究偏倚风险低，无发表偏倚。结论和相关性：本荟萃分析的结果表明，外科医生在对PHPT患者进行iopth引导手术时应使用改良的Miami标准，因为这些标准通过减少不必要的颈部探查和翻修手术率来优化术中诊断的准确性。
{"title":"Intraoperative Parathyroid Hormone Monitoring Criteria in Primary Hyperparathyroidism: A Network Meta-Analysis of Diagnostic Test Accuracy.","authors":"Phillip Staibano, Michael Au, Han Zhang, Sheila Yu, Winnie Liu, Jesse D Pasternak, Xing Xing, Carolyn D Seib, Lisa Orloff, Nhu-Tram Nguyen, Michael K Gupta, Eric Monteiro, Sameer Parpia, Tyler McKechnie, Alex Thabane, J E M Ted Young, Mohit Bhandari","doi":"10.1001/jamaoto.2024.4453","DOIUrl":"10.1001/jamaoto.2024.4453","url":null,"abstract":"<p><strong>Importance: </strong>Intraoperative parathyroid hormone (IOPTH) monitoring is recommended by the American Association of Endocrine Surgeons for use during parathyroidectomy for patients with primary hyperparathyroidism (PHPT), but there is no clinician consensus regarding the IOPTH monitoring criteria that optimize diagnostic accuracy.</p><p><strong>Objective: </strong>To evaluate and rank the diagnostic properties of IOPTH monitoring criteria used during surgery for patients with PHPT.</p><p><strong>Data sources: </strong>A bayesian diagnostic test accuracy network meta-analysis (DTA-NMA) was performed, in which peer-reviewed citations from January 1, 1990, to July 22, 2023, were searched for in MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL.</p><p><strong>Study selection: </strong>All full-text study designs that evaluated any IOPTH monitoring criteria as a diagnostic test were included in this meta-analysis. Any studies evaluating adult patients diagnosed with PHPT undergoing parathyroidectomy were also included. The reference standard used in this study was normalization of calcium and/or parathyroid hormone levels within 1 year of surgery.</p><p><strong>Data extraction and synthesis: </strong>This DTA-NMA was reported in accordance with the applicable Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Two reviewers evaluated all abstracts and full-text articles using a piloted extraction form. A third author resolved any conflicts. There are no published Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) resources for DTA-NMA. The following conventional monitoring criteria were included: Halle, Miami, Rome, Vienna, and PTH normalization, and the following modified criteria were included: Miami and PTH normalization, modified Miami, and modified Vienna. A bayesian hierarchical DTA-NMA model with corresponding 95% credible intervals (CrIs) was used to describe the pooled diagnostic characteristics of the evaluated IOPTH monitoring criteria.</p><p><strong>Main outcomes and measures: </strong>Main outcomes included pooled diagnostic test properties, including sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio.</p><p><strong>Results: </strong>A total of 72 studies, which included 19 072 patients, met the inclusion criteria. Sixty-nine studies (95.8%) investigated classic PHPT. In PHPT, the Miami criteria were investigated most often and had the best diagnostic properties (diagnostic odds ratio, 60.00 [95% CrI, 32.00-145.00]) when compared to other conventional criteria. Moreover, the modified Miami criteria, which measures a postexcision IOPTH level 15 minutes or more postexcision of all hyperfunctioning parathyroid tissue, were the overall best criteria (diagnostic odds ratio, 79.71 [95% CrI, 22.46-816.67]). There was a low risk of study bias and no publication bias.</p><p><strong>Conclusions and relevan","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"190-200"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894757","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 : 2025-02-27DOI: 10.1001/jamaoto.2024.5393
Chad W Wagoner, Abby Thomas, Joseph C Dort, Gregg Nelson, Khara M Sauro
Importance: Few studies have examined the association between enhanced recovery after surgery (ERAS) compliance and postoperative outcomes within head and neck (HN) free flap reconstructive surgery. Doing so may inform future interventions to improve ERAS adoption and improve postoperative outcomes.
Objective: To assess overall compliance with ERAS guidelines and its association with postoperative outcomes among individuals undergoing HN free flap reconstructive surgery.
Design, setting, and participants: This retrospective cohort study included patients who underwent ERAS-guided HN major reconstructive surgery in Alberta, Canada between January 2017 and September 2021. Data analysis occurred from May 2024 until August 2024.
Main outcomes and measures: ERAS compliance was assessed for 17 ERAS care elements, and the total compliance score for each patient was a sum of the compliance for each ERAS care element. Compliance was categorized as low compliance (<53%), moderate compliance (53%-72%), and high compliance (>72%). Postoperative outcomes included hospital length of stay and hospital readmission and emergency department admissions within 30 days, intensive care unit readmission, complications, and severe complications. Unadjusted and adjusted models (using backward stepwise regression) assessed associations between ERAS compliance (exposure) and postoperative outcomes.
Results: Of 257 patients, 90 (35.0%) were female, and the mean (SD) age was 62.4 (13.3) years. Overall, 196 (76.3%) had moderate compliance, 50 (19.5%) had low ERAS compliance, and 11 (4.3%) had high compliance. Preoperative (86%) and intraoperative (73%) ERAS compliance exceeded postoperative compliance (38%). Compliance for ERAS care elements varied widely, with the highest compliance observed for preincision antibiotic prophylaxis (99.6%) and the lowest compliance observed for postoperative early mobilization (10.2%). Postoperative hospital length of stay decreased by 0.71 days (95% CI, -1.34 to -0.08), and the odds of experiencing complications decreased by 28% (odds ratio, 0.72; 95% CI, 0.56-0.90) for each 1-unit increase in the total ERAS compliance score.
Conclusions and relevance: This results of this cohort study suggest that higher overall compliance with ERAS guidelines was associated with improved postoperative outcomes for individuals undergoing major HN free flap reconstructive surgery. There also appeared to be discrepancies in compliance between preoperative and postoperative phases, suggesting areas for interventions designed to improve adherence to ERAS protocols and underscoring the need for proactive compliance monitoring for optimizing patient outcomes in major HN surgery.
{"title":"Enhanced Recovery After Surgery Compliance and Outcomes for Head and Neck Reconstructive Surgery.","authors":"Chad W Wagoner, Abby Thomas, Joseph C Dort, Gregg Nelson, Khara M Sauro","doi":"10.1001/jamaoto.2024.5393","DOIUrl":"10.1001/jamaoto.2024.5393","url":null,"abstract":"<p><strong>Importance: </strong>Few studies have examined the association between enhanced recovery after surgery (ERAS) compliance and postoperative outcomes within head and neck (HN) free flap reconstructive surgery. Doing so may inform future interventions to improve ERAS adoption and improve postoperative outcomes.</p><p><strong>Objective: </strong>To assess overall compliance with ERAS guidelines and its association with postoperative outcomes among individuals undergoing HN free flap reconstructive surgery.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included patients who underwent ERAS-guided HN major reconstructive surgery in Alberta, Canada between January 2017 and September 2021. Data analysis occurred from May 2024 until August 2024.</p><p><strong>Main outcomes and measures: </strong>ERAS compliance was assessed for 17 ERAS care elements, and the total compliance score for each patient was a sum of the compliance for each ERAS care element. Compliance was categorized as low compliance (<53%), moderate compliance (53%-72%), and high compliance (>72%). Postoperative outcomes included hospital length of stay and hospital readmission and emergency department admissions within 30 days, intensive care unit readmission, complications, and severe complications. Unadjusted and adjusted models (using backward stepwise regression) assessed associations between ERAS compliance (exposure) and postoperative outcomes.</p><p><strong>Results: </strong>Of 257 patients, 90 (35.0%) were female, and the mean (SD) age was 62.4 (13.3) years. Overall, 196 (76.3%) had moderate compliance, 50 (19.5%) had low ERAS compliance, and 11 (4.3%) had high compliance. Preoperative (86%) and intraoperative (73%) ERAS compliance exceeded postoperative compliance (38%). Compliance for ERAS care elements varied widely, with the highest compliance observed for preincision antibiotic prophylaxis (99.6%) and the lowest compliance observed for postoperative early mobilization (10.2%). Postoperative hospital length of stay decreased by 0.71 days (95% CI, -1.34 to -0.08), and the odds of experiencing complications decreased by 28% (odds ratio, 0.72; 95% CI, 0.56-0.90) for each 1-unit increase in the total ERAS compliance score.</p><p><strong>Conclusions and relevance: </strong>This results of this cohort study suggest that higher overall compliance with ERAS guidelines was associated with improved postoperative outcomes for individuals undergoing major HN free flap reconstructive surgery. There also appeared to be discrepancies in compliance between preoperative and postoperative phases, suggesting areas for interventions designed to improve adherence to ERAS protocols and underscoring the need for proactive compliance monitoring for optimizing patient outcomes in major HN surgery.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515657","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 : 2025-02-27DOI: 10.1001/jamaoto.2025.0242
{"title":"Error in Abstract.","authors":"","doi":"10.1001/jamaoto.2025.0242","DOIUrl":"10.1001/jamaoto.2025.0242","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515660","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 : 2025-02-27DOI: 10.1001/jamaoto.2024.5255
Viann N Nguyen-Feng, Patricia A Frazier, Yuchen Liu, Erin Feddema, Benjamin Wils, Elizabeth Nikcevich, Ali Stockness, Kelvin O Lim, Amanda C Hu, Lisa Butcher, Stephanie Misono
<p><strong>Importance: </strong>Voice-related perceived control is the extent to which a person feels they can control their voice condition and/or their response to it. Given the interaction of psychological factors and voice outcomes, an intervention targeting psychological factors may be a helpful adjunct to clinical voice care.</p><p><strong>Objective: </strong>To investigate the feasibility, acceptability, and potential efficacy of a perceived control intervention adapted for adult patients with muscle tension dysphonia and to compare its outcomes with those of a voice education program.</p><p><strong>Design, settings, and participants: </strong>This was a pilot randomized clinical trial using mixed methods and including adults with muscle tension dysphonia from academic otolaryngology clinics from July 8, 2018, to December 8, 2019. Participants were randomized to the voice education program or the perceived control intervention, and feasibility and acceptability of both were assessed using quantitative and qualitative measures. Data analyses were performed from October 1, 2023, to March 5, 2024.</p><p><strong>Main outcomes and measures: </strong>Voice-related impairment was measured using the Voice Handicap Index-10 (VHI-10). Psychological factors were measured using the voice-related Perceived Present Control Scale, Brief Symptom Inventory-18 (BSI), and Perceived Stress Scale-4. Open-ended participant responses were analyzed following consensual qualitative research methods.</p><p><strong>Results: </strong>In all, 50 participants (mean [SD] age, 51.0 [15.9] years; 34 women [68%]); 27 were randomly assigned to receive the voice education program and 23 were randomly assigned to the perceived control intervention. Forty participants (80%) completed the study, which demonstrated the feasibility of both options. Outcomes of both the perceived control intervention and the voice education program were acceptable. Change in VHI-10 was heterogeneous, modest overall, and similar in the perceived control (-2.44; 95% CI, -4.25 to -0.63) and education (-2.94; 95% CI, -4.12 to -1.76) arms. Perceived control (secondary outcome) was higher, and exploratory outcomes (ie, somatic concerns, depression, anxiety, and perceived stress) were lower overall between pretest and posttest assessments. Qualitative analyses showed an overall decrease in negative voice-related emotions, fatigue, and negative self-image over the course of the perceived control intervention, and an interest in curated information in the voice education program.</p><p><strong>Conclusions and relevance: </strong>This pilot randomized clinical trial indicates that both the perceived control intervention and voice education program appear promising for further development. Online interventions are of interest to people with voice disorders, and future work may benefit from taking individual differences into account.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NC
{"title":"Online Intervention for Muscle Tension Dysphonia: A Pilot Randomized Clinical Trial.","authors":"Viann N Nguyen-Feng, Patricia A Frazier, Yuchen Liu, Erin Feddema, Benjamin Wils, Elizabeth Nikcevich, Ali Stockness, Kelvin O Lim, Amanda C Hu, Lisa Butcher, Stephanie Misono","doi":"10.1001/jamaoto.2024.5255","DOIUrl":"10.1001/jamaoto.2024.5255","url":null,"abstract":"<p><strong>Importance: </strong>Voice-related perceived control is the extent to which a person feels they can control their voice condition and/or their response to it. Given the interaction of psychological factors and voice outcomes, an intervention targeting psychological factors may be a helpful adjunct to clinical voice care.</p><p><strong>Objective: </strong>To investigate the feasibility, acceptability, and potential efficacy of a perceived control intervention adapted for adult patients with muscle tension dysphonia and to compare its outcomes with those of a voice education program.</p><p><strong>Design, settings, and participants: </strong>This was a pilot randomized clinical trial using mixed methods and including adults with muscle tension dysphonia from academic otolaryngology clinics from July 8, 2018, to December 8, 2019. Participants were randomized to the voice education program or the perceived control intervention, and feasibility and acceptability of both were assessed using quantitative and qualitative measures. Data analyses were performed from October 1, 2023, to March 5, 2024.</p><p><strong>Main outcomes and measures: </strong>Voice-related impairment was measured using the Voice Handicap Index-10 (VHI-10). Psychological factors were measured using the voice-related Perceived Present Control Scale, Brief Symptom Inventory-18 (BSI), and Perceived Stress Scale-4. Open-ended participant responses were analyzed following consensual qualitative research methods.</p><p><strong>Results: </strong>In all, 50 participants (mean [SD] age, 51.0 [15.9] years; 34 women [68%]); 27 were randomly assigned to receive the voice education program and 23 were randomly assigned to the perceived control intervention. Forty participants (80%) completed the study, which demonstrated the feasibility of both options. Outcomes of both the perceived control intervention and the voice education program were acceptable. Change in VHI-10 was heterogeneous, modest overall, and similar in the perceived control (-2.44; 95% CI, -4.25 to -0.63) and education (-2.94; 95% CI, -4.12 to -1.76) arms. Perceived control (secondary outcome) was higher, and exploratory outcomes (ie, somatic concerns, depression, anxiety, and perceived stress) were lower overall between pretest and posttest assessments. Qualitative analyses showed an overall decrease in negative voice-related emotions, fatigue, and negative self-image over the course of the perceived control intervention, and an interest in curated information in the voice education program.</p><p><strong>Conclusions and relevance: </strong>This pilot randomized clinical trial indicates that both the perceived control intervention and voice education program appear promising for further development. Online interventions are of interest to people with voice disorders, and future work may benefit from taking individual differences into account.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NC","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515664","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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