JAMA otolaryngology-- head & neck surgery最新文献

Introduction: Mild sleep-disordered breathing (mSDB) in children is associated with both neurobehavioral morbidity and reduced quality of life (QOL). However, the association between symptom burden and QOL with executive function is not well understood, and it is not known whether QOL and symptom burden may help identify children with neurocognitive dysfunction.

Objective: To assess associations among executive function, QOL, and symptom burden in children with mSDB.

Design, setting, and participants: This cross-sectional study was a secondary analysis of the multicenter Pediatric Adenotonsillectomy Trial for Snoring, which included children aged 3 to 12 years randomized to watchful waiting or adenotonsillectomy for mSDB (snoring and an obstructive apnea-hypopnea index <3) between June 29, 2016, and February 1, 2021. The data for this report were analyzed between December 22, 2020, and October 3, 2024.

Exposure: Pediatric mSDB.

Main outcomes and measures: Quality of life was assessed using the Obstructive Sleep Apnea-18 (OSA-18), and symptom burden was assessed using the Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder Scale (PSQ-SRBD). Executive function, including self-control and working memory, was measured using the Behavior Rating Inventory of Executive Function Global Executive Composite (BRIEF GEC), and inhibitory control and sustained attention were measured by the GoNoGo vigilance test. Partial Pearson correlations and multiple linear regression models were used to assess the associations among QOL, symptoms, and executive function.

Results: The sample included 459 children (mean [SD] age, 6.1 [2.3] years; 230 female [50.1%]). Moderate correlations were found between the BRIEF GEC and the PSQ-SRBD and OSA-18 (r = 0.58 [95% CI, 0.51-0.64] and 0.59 [95% CI, 0.52-0.64], respectively). After adjusting for age, sex, race and ethnicity, body mass index percentile, household income, maternal education, attention-deficit/hyperactivity disorder, test characteristics, and disease severity, both OSA-18 and PSQ-SRBD scores were associated with the BRIEF GEC (β = 0.41 [95% CI, 0.36-0.47] and 3.66 [95% CI, 3.17-4.15], respectively). In the fully adjusted model, PSQ-SRBD was also associated with GoNoGo inhibitory control (β = -0.04 [95% CI, -0.08 to -0.01]) and sustained attention (β = -0.05 [95% CI, -0.10 to -0.01]).

Conclusions and relevance: In this study, disease-specific QOL and symptom burden were associated with executive function in children with mSDB. These findings may be useful in identifying those children who are at risk for neurocognitive dysfunction.

Importance: Diagnosis of pediatric ankyloglossia and other oral ties is increasing in part due to social media, leading to more frenotomies and excess medicalization of often normal anatomy.

Objective: To assess the accuracy and readability of social media content on pediatric ankyloglossia and other oral ties.

Design, setting, and participants: In this cross-sectional study, the top 200 posts on an image-based social media platform tagged with #tonguetie, #liptie, or #buccaltie were collected using a de novo account on March 27, 2023. Post metadata and caption and content text were extracted.

Main outcomes and measures: Misinformation was judged by a 30-point scoring sheet based on clinical practice guidelines and expert consensus that was developed by 3 fellowship-trained pediatric otolaryngologist-head and neck surgeons. Readability was assessed using the Flesch-Kincaid Grade Level, Flesch Reading Ease, and Simple Measure of Gobbledygook scales. Quality was scored using the JAMA Benchmark Criteria.

Results: After removing duplicates and irrelevant content, 71 unique posts from 68 unique accounts were included in the analysis. Business and practice accounts made up most of the account types (60 [84.5%]) compared with individual and personal accounts (11 [15.5%]). Most accounts (49 [69.0%]) were run by individuals who self-identified as health care practitioners, and 21 posts (29.6%) originated from accounts of individuals who self-identified as International Board Certified Lactation Consultants (IBCLCs). On average, the content corresponded to a ninth-grade reading level per Flesch-Kincaid Grade Level. Quality of posts as rated by the JAMA Benchmark Criteria corresponded to a median score of 3.0 (IQR, 2.0-4.0). Of the 71 posts, only 8 (11.3%) contained no misinformation. There was a significant difference in misinformation prevalence between accounts run by IBCLCs vs non-IBCLCs, with posts from IBCLCs less likely to contain over 50% misinformation (odds ratio, 0.22; 95% CI, 0.06-0.81), compared with posts from non-IBCLCs.

Conclusions and relevance: This study found a high frequency of misinformation in social media content on ankyloglossia. Most content was generated by self-identified health care practitioners but not physicians. Furthermore, the grade level of the content reviewed was above that recommended for the public. As the public increasingly looks to social media for medical information, health care practitioners should correct medical misinformation.

Importance: Venous thromboembolism (VTE) is a severe complication after microsurgical free tissue transfer (FTT) to the head and neck. Hypothermia during surgery is a modifiable risk factor, and avoiding it may reduce the postoperative VTE rate.

Objective: To assess the association between hypothermia (temperature <36 °C) and postoperative VTE and free flap pedicle thrombosis rates after head and neck reconstruction with FTT.

Design, setting, and participants: This retrospective cohort study in a tertiary academic referral center used prospective and retrospective database and medical record data collected for patients who underwent head and neck reconstruction with FTT between January 1, 2012, and August 31, 2023. Temperature over time was classified as normothermia (temperature ≥36 °C), hypothermia (<36 °C) for more than 30 minutes and less than 120 minutes, and hypothermia for 120 minutes or more.

Exposure: Venous thromboembolism.

Main outcomes and measures: The study outcomes were VTE events and thrombosis of the free flap pedicle that required revision surgery. Univariable and multivariable regressions were used to test the association between the outcomes and clinical factors.

Results: A total of 1078 patients (mean [SD] age, 61.3 [12.6] years; 724 males [67.2%]; mean [SD] Caprini score, 6.4 [2.1]) were included. The VTE and pedicle thrombosis rates were 3.2% (35 patients) and 2.2% (24 patients), respectively. In a multivariable model controlled for Caprini score and chemoprophylaxis, VTE was associated with hypothermia of more than 30 minutes and less than 120 minutes (odds ratio [OR], 3.82; 95% CI, 0.99-14.07) and hypothermia of 120 minutes or longer (OR, 3.55; 95% CI, 1.05-11.95). Free flap pedicle thrombosis was not associated with hypothermia (OR, 0.61; 95% CI, 0.26-1.43).

Conclusions and relevance: These findings suggest that preventing hypothermia during microsurgical FTT to the head and neck may decrease the postoperative rate of VTE. Future studies should explore the optimal intraoperative body temperature range that may prevent the development of VTE without compromising patient safety.