JAMA otolaryngology-- head & neck surgery最新文献

Importance: Adjuvant radiotherapy can improve locoregional control and survival in patients with olfactory neuroblastoma (ONB), particularly with advanced-stage and histologic-grade disease. Standard radiotherapy treatment is with intensity-modulated radiotherapy (IMRT). Proton beam radiotherapy (PBRT) provides theoretical advantages in greater sparing of dose to uninvolved organs at risk.

Objective: To investigate if there are differences in the effectiveness and radiation treatment-related adverse events (RTAEs) between adjuvant IMRT and PBRT for patients with ONB.

Design, setting, and participants: This propensity score-matched cohort study included patients with ONB treated between February 2005 and April 2021 with either IMRT or PBRT at 9 academic tertiary care centers in North America. Patients were matched 1:2 based on age, modified Kadish stage, and Hyams grade. Data were analyzed from July 2024 to January 2025.

Exposure: Adjuvant IMRT or adjuvant PBRT.

Main outcomes and measures: Local recurrence-free survival (RFS), any RFS, and overall survival (OS). RTAEs, ie, grade 2 events or higher based on Common Terminology Criteria for Adverse Events, were recorded for both modalities.

Results: Of 54 included patients, 27 (50%) were female, and the mean (SD) age was 46.2 (15.4) years. A total of 18 were treated with PBRT and 36 were treated with IMRT. Most patients had modified Kadish stage C disease (33 of 54 [61%]), and 24 patients (44%) had Hyams grade III or IV disease. The RTAE rate was 20% (8 of 40); IMRT had a rate of 21% (6 of 29), and PBRT had a rate of 18% (2 of 11). The difference in the point estimates for 10-year RFS showed a potential clinical benefit favoring IMRT, although the wide confidence interval indicates uncertainty (10-year RFS: IMRT, 63.3%; 95% CI, 44.6-89.8; PBRT, 37.8%; 95% CI, 14.2-100; difference, 25.5 percentage points; 95% CI, -17.6 to 68.6). There were no clinically meaningful differences in 10-year local RFS (IMRT, 75.6%; 95% CI, 59.8-95.4; PBRT, 72.7%; 95% CI, 45.2-100; difference, 2.9 percentage points; 95% CI, -35.9 to 41.7) or 10-year OS (IMRT, 61.8%; 95% CI, 42.8-89.1; PBRT, 57.1%; 95% CI, 24.3-100; difference, 4.7 percentage points; 95% CI, -49.2 to 58.6), although wide confidence intervals indicate considerable uncertainty.

Conclusions and relevance: Due to the imprecision of estimates, no definitive conclusions can be made regarding the comparative effectiveness of IMRT vs PBRT for patients with ONB. These preliminary data may inform the design of appropriately powered prospective studies evaluating the efficacy of PBRT vs IMRT in this population.

Importance: The inflammation-modulating properties of sex hormones provide a pathophysiological basis for anticipating sex-based differences in chronic rhinosinusitis (CRS), but the role of biological sex has not been thoroughly studied.

Objectives: To investigate sex differences in CRS diagnosis and biomarkers.

Design, setting, and participants: This cross-sectional study used data from the All of Us Research Program, a large national dataset of US adults, collected from partner health care organizations including academic medical centers, Veterans Affairs facilities, and community health centers. From May 2018 to October 2023, a total of 393 596 participants with electronic health records were considered for inclusion; those with incomplete data were excluded. Data analysis was conducted from April to September 2025.

Exposures: Participant sex was the primary exposure, and covariates included demographics, socioeconomic status, risk factors, and comorbidities.

Main outcomes and measures: CRS diagnosis, stratified into CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP), and CRS biomarkers.

Results: The analysis included 258 245 participants, of whom 38.4% were male and 61.6% were female and most (57.3%) were 50 years or older. After controlling for covariates, female sex was associated with an increased odds of CRSsNP among those younger than 60 years (odds ratio [OR], 1.44; CI with Holm-Bonferroni correction [CIH-B], 1.35 to 1.54) and 60 years or older (OR, 1.32; CIH-B, 1.23 to 1.40), but a lower odds of CRSwNP (OR, 0.63; CIH-B, 0.52-0.76) compared to males. Compared to male participants, female participants had a lower concentration of serum eosinophils (β, -0.35; CIH-B, -0.44 to -0.25) and IgE (β, -99.73; CIH-B, -190.49 to -8.96) among participants with CRSsNP after controlling for covariates, as well as lower eosinophils among participants with CRSwNP (β, -0.41; CIH-B, -0.80 to -0.01). Analyzing CRS prevalence by age group revealed a downtrend among female participants 60 years or older, despite an upward trend at younger age groups, with regression analysis demonstrating a negative interaction effect between female sex and age 60 years or older with odds of CRSsNP (OR, 0.91; CIH-B, 0.84 to 0.99).

Conclusions and relevance: This cross-sectional study found that female sex was associated with a higher odds of CRSsNP, but a lower odds of CRSwNP compared to males. Biomarker analysis indicated a possible female disposition for nontype 2 inflammation.

Importance: Poor olfaction may be associated with incident coronary heart disease (CHD) in older adults, but empirical evidence is limited.

Objective: To investigate the association of olfaction with risk of CHD.

Design, setting, and participants: This population-based, retrospective analysis of secondary data from the Atherosclerosis Risk in Communities Study, an ongoing prospective cohort, included 5142 US older adults who did not have CHD and had olfaction as assessed at visit 5. At-risk participants were followed up from visit 5 (June 2011 to September 2013) to the date of the first outcome of interest, death, last contact, or December 31, 2020, whichever came first. Data analysis was conducted from March 2024 to January 2025.

Exposure: Olfaction was measured using a 12-item odor identification test and defined as good (score, 11-12), moderate (score, 9-10), and poor (score, 0-8).

Main outcomes and measures: The primary outcome was incident adjudicated CHD events. The discrete-time subdistribution hazard model was used to estimate the absolute risk of CHD across olfactory statuses and adjusted marginal risk ratio and 95% CI while accounting for covariates and competing risk of death.

Results: Of 5142 older adults (mean [SD] age, 75.4 [5.1] years), 3234 (62.9%) were female, 1230 (23.9%) were Black, and 3912 (76.1%) were White. After 9.6 years of follow-up (median [quartile 1-quartile 3]: 8.4 [7.4-8.9]), 280 incident CHD events (5.4%) were identified. Poor olfaction was associated with a higher risk of CHD risk, although the association was attenuated with extended follow-up. Comparing poor with good olfaction, the adjusted marginal risk ratio of CHD was 2.06 (95% CI, 1.04-4.53) at year 2, 2.02 (95% CI, 1.27-3.29) at year 4, 1.59 (95% CI, 1.13-2.35) at year 6, 1.22 (95% CI, 0.88-1.70) at year 8, and 1.08 (95% CI, 0.78-1.44) at year 9. The time-varying associations were confirmed using the period-specific, cause-specific Cox regression. The findings were robust in subgroup and sensitivity analyses. The association between moderate olfaction and CHD risk was weaker but showed a similar time-varying pattern as that observed for poor olfaction.

Conclusion and relevance: The results of this cohort study suggest that, for older adults, poor olfaction as assessed by a single smell identification test is associated with a higher CHD risk.

Importance: Timely computed tomography (CT) imaging is a requirement before performance of sinus surgery, including balloon sinus dilation (BSD).

Objective: To determine adherence to practice guidelines for use of CT imaging before BSD procedures.

Design, setting, and participants: This cross-sectional study used Medicare claims data to identify and include otolaryngologists who each performed at least 11 BSDs from January 1, 2022, to December 31, 2023. Data were analyzed from April 1 to September 9, 2025. using IBM-SPSS statistics version 29 and R 4.3.2.

Main outcome(s) and measure(s): Percentage of physicians performing BSD without CT imaging available within 1 year of the procedure in greater than 10% of procedures (outliers). Physician variables were explored for potential association with outlier status.

Results: The analysis evaluated 490 otolaryngologists (29 female [5.9%] and 460 male [94.1%] individuals) who performed at least 10 BSD procedures annually in a total of 19 692 patients. Preprocedure CT imaging was not available within 1 year prior of BSD for 2905 patients (15%). In all, 156 otolaryngologist-participants (31.8%) were identified as outliers; notably, 30 of these (6.1%) accounted for more than 50% of cases without preprocedure CT imaging, affecting 1880 patients (9.5%) undergoing BSD. Moreover, 42 participants (8.6%) accounted for 47.5% of all missed CTs.

Conclusion and relevance: This cross-sectional study found that most otolaryngologists adhered to clinical consensus by obtaining CT imaging before performing BSD. However, a substantial portion did not obtain CT imaging before BSD and therefore, did not adhere to standard practice guidelines. These findings demonstrate the need for improved monitoring of adherence to the standard of practice.