JAMA otolaryngology-- head & neck surgery最新文献

Importance: Allergic contact reactions to medical implants are underrecognized and incompletely understood, particularly in hypoglossal nerve stimulation (HGNS), an increasingly popular and effective alternative to positive airway pressure therapy for patients with obstructive sleep apnea (OSA).

Objective: To document a rare case of allergic contact reaction in a patient following implantation of an HGNS device for OSA.

Design, setting, and participant: In this case report, the patient presented to a quaternary care academic medical center with localized erythema, swelling, and pustular drainage at the right neck incision site approximately 2 months following HGNS device implantation.

Exposure: This patient underwent serial, bilateral HGNS device implantation and subsequent explantation.

Main outcome and measure: The main outcomes were the findings from symptom monitoring and allergy patch testing.

Results: A 64-year-old male patient with severe OSA (Apnea-Hypopnea Index, 54 events/h) underwent implantation of an HGNS device. His recovery was uneventful for 2 months until he reported localized erythema, swelling, and pustular drainage at the right neck incision site. HGNS device extrusion at the neck was noted approximately 3 months postoperatively, prompting device explantation. The patient underwent subsequent HGNS reimplantation in the left neck and chest 3 months after right-sided explantation. At postoperative day 10, swelling, erythema, and purulence were noted from neck and chest incisions. The device was re-explanted with odorless purulence noted in the chest and neck. The wound cultures were negative for infection, and at this time, the patient underwent allergy patch testing, which demonstrated a strong positive reaction to isophorone diisocyanate. Patch testing confirmed an allergy to isocyanates, evidenced by a strong positive reaction to isophorone diisocyanate, 1.0%, in petrolatum. This finding was further validated by the manufacturer, which confirmed isocyanates were used in the polyurethane components of the HGNS device.

Conclusions and relevance: Isocyanates are low-molecular weight compounds used in the production of polyurethanes, which are commonly found in medical devices. HGNS is a widely available implantable medical device for treatment of patients with OSA. The literature regarding isocyanate allergies with medical implants is limited, and this may be the first confirmed case with an HGNS device. This case report highlights the importance of noninfectious causes of device reactions, especially when occurring outside of the postoperative wound infection window. Patch testing for isocyanate and other components can inform both patient and clinician regarding the cause of device implantation failure and have implications for future implantable devices.

Importance: The internet has changed the way that medical information by journals is disseminated, with a shift toward online distribution. Given this, it is important to include alternative metrics that measure online attention when determining the influence of otolaryngology journals.

Objective: To describe a ranking system for otolaryngology journals that reflects the amount of publicity received online and to determine factors associated with these rankings.

Design and setting: In this cross-sectional study, online attention was measured using Altmetric Attention Scores obtained for all 26 112 articles published by the 43 journals classified under the Journal Citation Reports category of otorhinolaryngology from 2018 to 2022. Data were analyzed from January to June 2023.

Main outcomes and measures: Altmetric journal rankings were created from the top 500 articles with the highest Altmetric Attention Scores, using a rank sum weight-based method to assign credit for an article's attention online to its respective journal. The association of article content, study design and type, and social media presence on X (formerly Twitter) with ranking was examined. Comparisons between Altmetric journal rankings and bibliometric rankings (5-year Impact Factor) were also performed.

Results: Of 43 otolaryngology journals, JAMA Otolaryngology-Head & Neck Surgery had the highest Altmetric journal ranking. Most articles in the Altmetric top 500 were nonoperative clinical studies (220 articles [43.5%]) or described the natural history of disease (176 articles [34.9%]) and involved otology/neurotology (158 articles [29.9%]) or rhinology/allergy (134 articles [25.4%]). The COVID-19 pandemic was a common topic (169 articles [33.5%]). The presence of an active X account for the entire 5-year period was associated with a higher Altmetric total rank sum score for journals (η2 = 0.07; 95% CI, 0.02-0.13 [moderate effect size]). There was a moderate statistically significant correlation between Altmetric journal rankings and 5-year Impact Factor rankings (r = 0.5; 95% CI, 0.2-0.7).

Conclusions and relevance: This cross-sectional study demonstrates that metrics based on online attention provide an alternative way to assess the reach and influence of medical journals. Journals seeking to expand their influence online may benefit from a presence on social media.

Importance: Evidence on the associations of taste function changes from early adulthood to mid to late adulthood with all-cause mortality is limited.

Objective: To investigate the associations between subjective perception of taste loss from early adulthood to mid to late adulthood and all-cause mortality.

Design, setting, and participants: This population-based cohort study used data from the US National Health and Nutrition Examination Survey (2011-2014) and linked mortality information from the National Death Index (NDI) and included adults aged 40 years and older. Data analyses were conducted between May 6, 2024, and July 22, 2024.

Exposures: Subjective decline in taste function and ability to detect basic tastes (ie, salt, sourness, sweetness, or bitterness) since the age of 25 years.

Main outcomes and measures: All-cause mortality was ascertained via linkage to the NDI with follow-up until December 31, 2019.

Results: Among 7340 participants (52.8% female), 662 (weighted, 8.9%) reported subjective perception of taste loss from early adulthood to mid to late adulthood. During a median (IQR) follow-up of 6.67 (5.67-7.83) years, 1011 deaths occurred. Subjective perception of taste loss was associated with a 47% higher risk of mortality (multiadjusted hazard ratio [HR], 1.47; 95% CI, 1.06-2.03). Specifically, self-reported loss in ability to taste salt (multivariable adjusted HR [aHR], 1.65; 95% CI, 1.21-2.26) and sourness (aHR, 1.69; 95% CI, 1.19-2.40) was associated with increased mortality. Self-reported decline in ability to taste bitterness was associated with increased mortality only in female participants (aHR, 1.63; 95% CI, 1.05-2.53), whereas decline in ability to taste sourness was associated with increased mortality only in male participants (aHR, 1.69; 95% CI, 1.03-2.75). Moreover, among all and female participants without perceived smell function loss, those with perceived taste function loss still had increased mortality (all participants: aHR, 1.64; 95% CI, 1.12-2.40; female participants: aHR, 1.71; 95% CI, 1.14-2.56; male participants: aHR, 1.44; 95% CI, 0.80-2.59).

Conclusions and relevance: In this population-based cohort study, subjective perception of taste loss from early adulthood to mid to late adulthood, particularly perception of salt and sourness, was associated with increased all-cause mortality. The mortality risk associated with perceived taste loss could not be mitigated by undeteriorated smell function. These findings suggest that subjective perception of taste loss may serve as a simple and valuable indicator for screening high-risk populations in clinic and public health practice.

Importance: Hypoparathyroidism (hypoPT) is the most common complication post-total thyroidectomy and is associated with increased morbidity and mortality when chronic. Conventionally, the prevention of hypoPT has involved visual inspection of parathyroid glands; however, near-infrared autofluorescence detection systems have been recently used as adjuncts. These systems involve significant outlay and ongoing costs.

Objective: To evaluate the cost-effectiveness of autofluorescence for hypoPT prevention and to determine the chronic hypoPT rate at which this technology would become economically feasible.

Design, setting, and participants: In this cost-benefit analysis, a decision tree economic model was developed to compare thyroidectomies performed with autofluorescence to visual inspection only. All costs associated with conventional surgery, autofluorescence, and the costs of managing hypoPT were captured. Morbidity was defined in terms of disutility, quantified as quality-adjusted life-years, determined over a lifetime time horizon. The model was used to calculate the incremental cost-effectiveness ratio for autofluorescence-guided surgery and to identify determinants that influenced this ratio, and hence the economic feasibility of the use of autofluorescence. This study was based on the health care setting in Australia, in which more than 3500 thyroidectomies are performed annually. A probe-based autofluorescence detection system was used for analysis based on its availability in Australia. All costs were quantified in Australian dollars (A$) and were adjusted for 2024. The study data spanned from June 2022 to May 2023, and the data were analyzed in June 2023.

Results: The economic model analysis indicated that autofluorescence involved an additional cost of A $1024 (US $639) per surgery, offset by an increase in quality-adjusted life-years of 0.0080, resulting in an incremental cost-effectiveness ratio of A $128 234 (US $80 060). In Australia, it is generally assumed that interventions with a ratio of up to A $70 000 (US $43 703) may be considered cost-effective. Cost-effectiveness was most sensitive to a change in the overall hypoPT rate, chronic hypoPT rate, and the efficacy of autofluorescence. Autofluorescence-guided surgery achieved the cost-effectiveness threshold at a chronic hypoPT rate of greater than or equal to 5%.

Conclusions and relevance: Although the use of autofluorescence involves significant costs, its economic feasibility for the prevention of postsurgical hypoPT is determined by the underlying chronic and overall hypoPT rate, as well as the efficacy of autofluorescence for the reduction of hypoPT. The findings of this cost-benefit analysis are relevant in determining the prioritization and allocation of finite health care resources.