JAMA Otolaryngology Head and Neck Surgery 2020-10-01

JAMA Otolaryngology–Head & Neck Surgery

Publicatie 01-10-2020


Mission Statement: JAMA Otolaryngology–Head & Neck Surgery provides timely information for physicians and scientists concerned with diseases of the head and neck. Given the diversity of structure and function based in this anatomic region, JAMA Otolaryngology–Head & Neck Surgery publishes clinical, translational, and population health research from an array of disciplines. We place a high priority on strong study designs that accurately identify etiologies, evaluate diagnostic strategies, and distinguish among treatment options and outcomes. Our objectives are to (1) publish original contributions that will enhance the clinician’s understanding of otolaryngologic disorders, benefit the care of our patients, and stimulate research in our field; (2) forecast important advances within otolaryngology–head and neck surgery, particularly as they relate to the prevention, diagnosis, and treatment of disease through clinical and translational research, including that of the human genome and novel imaging techniques; (3) address questions of clinical outcomes and cost-effectiveness that result from clinical intervention, which grow in importance as health care providers are increasingly challenged to provide evidence of enhanced survival and quality of life; (4) provide expert reviews of topics that keep our readers current with true advances and also to provide a valuable educational resource for trainees in the several disciplines that treat patients with diseases of the head and neck; (5) serve as a forum for the concerns of otolaryngologists such as socioeconomic, legal, ethical, and medical issues; (6) provide helpful critiques that enable contributing authors to improve their submissions. We encourage a concise presentation of information and employ an abstract format that efficiently assesses validity and relevance from a clinical perspective. This approach promotes succinct yet complete presentation for our readers and electronic information resources. We believe this approach typifies the commitment of JAMA Otolaryngology–Head & Neck Surgery to providing important information that is easily interpreted by its diverse readership.

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Spontaneous Cerebrospinal Fluid Leak in a Transgender Man

Lin GC, Paz M, Porrmann J, et al.

Publicatie 01-10-2020


This case report describes a transgender man in his 20s who presented with 9 months of right-sided rhinorrhea and spontaneous drainage of clear, salty nasal discharge consistent with idiopathic intracranial hypertension.

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Tracheostomy Timing for Patients With COVID-19 in the ICU

Schultz MJ, Teng MS, Brenner MJ.

Publicatie 01-10-2020


This Viewpoint examines the timing of performing tracheostomies, which are aerosol-generating procedures that may cause increased risk of COVID-19 transmission to health care workers.

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A Neurotologist’s Reflection From the Front Line

Cosetti MK.

Publicatie 01-10-2020


This essay highlights the lessons to be learned from the COVID-19 pandemic on the importance of recognizing communication difficulties among those with hearing impairment.

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Predictors of Behavioral Changes After Adenotonsillectomy in Pediatric Obstructive Sleep Apnea

Isaiah A, Spanier AJ, Grattan LM, et al.

Publicatie 01-10-2020


This secondary analysis compares the use of objective physiological measures with subjective caregiver symptom reports to identify the association between sleep disruption with or without intermittent hypoxemia and behavior in children who underwent surgical treatment for obstructive sleep apnea.

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Tracheostomy During COVID-19 Pandemic—In Search of Lost Timing—Reply

Tay JK, Khoo M, Loh W.

Publicatie 01-10-2020


In Reply We thank Cazzador et al for their appreciation of the Viewpoint “Surgical Considerations for Tracheostomy During the COVID-19 Pandemic: Lessons Learned From the Severe Acute Respiratory Syndrome Outbreak.” Since the publication, several other groups have also developed guidelines for tracheostomy in the context of coronavirus disease 2019 (COVID-19), with similar goals of minimizing perioperative aerosolization risks.

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Atypical Presentation of Langerhans Cell Histiocytosis of the Skull

Cuoco JA, Guilliams EL, Klein BJ, et al.

Publicatie 01-10-2020


This case report describes a man in his 20s who presented with a 4-week history of progressive swelling of the midline forehead, recurrent headache, and sinus pain, and was subsequently diagnosed with Langerhans cell histiocytosis.

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Tracheostomy During COVID-19 Pandemic

Cazzador D, Franchella S, Navalesi P.

Publicatie 01-10-2020


To the Editor Tay et al should be complimented on their Viewpoint “Surgical Considerations for Tracheostomy During the COVID-19 Pandemic: Lessons Learned From the Severe Acute Respiratory Syndrome Outbreak” highlighting preoperative and perioperative recommendations for tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic. The authors searched the literature for tracheostomies performed during the previous outbreak of severe acute respiratory syndrome (SARS), finding 3 case series and 2 case reports (23 procedures). Lessons learned from those experiences were summarized into 5 points. The need for adequate personal protective equipment in performing surgery, the site to perform surgery to lessen transport of infected patients, the precautions to reduce time of exposure to infective secretions, the establishment of experienced teams, and the caution in postprocedure waste disposal were discussed and translated to the current COVID-19 pandemic.

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Omission of Funding Source

Publicatie 01-10-2020


In the Research Letter titled, “SARS-CoV-2 Virus Isolated From the Mastoid and Middle Ear: Implications for COVID-19 Precautions During Ear Surgery,” published on July 23, 2020, funding from the National Institutes of Health was omitted. The funding and role of the funder has been added.

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Understanding Patient Perspectives on Single-Sided Deafness

Yu JW.

Publicatie 01-10-2020


This Viewpoint encourages clinicians to listen to patient concerns regarding the varying treatment options available for single-sided deafness.

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Unilateral Cochlear Implants for Severe, Profound, or Moderate Sloping to Profound Bilateral Sensorineural Hearing Loss

Buchman CA, Gifford RH, Haynes DS, et al.

Publicatie 01-10-2020


This systematic review and consensus study uses a modified Delphi consensus process, informed by a systematic review of the literature and 30 international specialists, to develop 20 evidence-based consensus statements regarding the use of unilateral cochlear implants in adults with severe, profound, or moderate sloping to profound bilateral sensorineural hearing loss.

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Cochlear Implants for Adult Medicare Beneficiaries Who Meet Expanded Indications

Zwolan TA, Kallogjeri D, Firszt JB, et al.

Publicatie 01-10-2020


This multicenter nonrandomized clinical trial examines the effectiveness of cochlear implants, as measured by improvement on the AzBio Sentence Test, for newly implanted Medicare beneficiaries who meet the expanded indications of an AzBio Sentence Test score of 41% to 60% in their best-aided condition.

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Quality of Life in Cochlear Implant Recipients 65 Years or Older

Wick CC, Kallogjeri D, McJunkin JL, et al.

Publicatie 01-10-2020


This secondary analysis of a nonrandomized clinical trial explores the audiometric and holistic effects of cochlear implantation in a group of adults 65 years or older compared with an optimized bilateral hearing aid condition.

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Assessment of Speech Understanding After Cochlear Implantation in Adult Hearing Aid Users

Buchman CA, Herzog JA, McJunkin JL, et al.

Publicatie 01-10-2020


This nonrandomized controlled trial investigates the safety and effectiveness of a single-ear cochlear implant in a group of optimized adult hearing aid users with and without mild cognitive impairment across a variety of outcome domains.

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A Cost-effective Solution to Limit Aerosol Transmission of Infectious Agents During Mastoid Drilling—Reply

Carron JD, Buck LS, Harbarger CF, et al.

Publicatie 01-10-2020


In Reply We thank Thong et al for their letter. We chose our method because it allows easy setup and takedown for continued microscope use after drilling is complete. We have taken to using the Sterile-Z Back Table Drape because it has a perforation down the middle to allow for easy break-away when it is no longer needed. As stated in our original Research Letter, we expect better modifications to come about, and otolaryngologists will always be a creative group.

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Facial Nerve Intraneural Perineurioma Masquerading as a Schwannoma

Manzoor NF, Harmsen H, Perkins EL, et al.

Publicatie 01-10-2020


This case report describes a woman in her 30s who presented with worsening left-sided facial weakness and was diagnosed with a perineurioma.

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A Cost-effective Solution to Limit Aerosol Transmission of Infectious Agents During Mastoid Drilling

Warner E, Seymour K, Wareing M.

Publicatie 01-10-2020


To the Editor We were interested by the recent article by Carron, et al “A Simple Technique for Droplet Control During Mastoid Surgery” because we have also been considering the challenges of performing mastoidectomy in the coronavirus disease 2019 era. Mastoidectomy is an aerosol-generating procedure (AGP) owing to the use of drills and presence of potentially virus-containing respiratory mucosa lining the mastoid air cells. The recommended personal protective equipment for AGPs is a FFP3 mask and a face visor to prevent aerosolized particles coming into contact with mucosal surfaces of the face, including the nose, mouth, and eyes. As the authors point out “using a microscope with a face shield is virtually impossible.” Clamp and Broomfield quantified this, demonstrating that face shields reduced the surgical view to a median of 4%. Although the use of plastic drapes are 1 alternative to a face shield, they are somewhat problematic. Instruments have to be passed beneath the drapes by the scrub nurse, which is slow and cumbersome. The seal is not airtight, and lifting drapes to change instruments releases viral particles into the theater environment. Third, there is the contamination risk to the surgical team and environment when removing the drapes afterwards.

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A Cost-effective Solution to Limit Aerosol Transmission of Infectious Agents During Mastoid Drilling

Thong J, Ng J, Ng T.

Publicatie 01-10-2020


To the Editor We read with interest the research letter published online on April 28, 2020, titled “A Simple Technique for Droplet Control During Mastoid Surgery.” Mastoid bone drilling is an aerosol-generating procedure with the potential to transmit infectious agents from the upper aerodigestive tract via the eustachian tube and middle ear. Although there are no coronavirus disease 2019–specific data, other studies have found common viruses in the middle ear and nasopharynx. To continue safely with emergency mastoid surgeries and other time-critical surgeries involving mastoid bone drilling during this period, we have also devised a cost-effective solution to limit aerosol transmission to the surgeon and other personnel in the operating room.

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Cochlear Implant Today…Pill Tomorrow

Lalwani AK.

Publicatie 01-10-2020


Hearing loss is the most common sensory disorder in humans. According to recent estimates by the World Health Organization, disabling hearing loss (>40 dB in the better-hearing ear in adults and >30 dB in the better-hearing ear in children) affects 466 million people worldwide, including 34 million children, and is expected to double to 900 million people by 2050. Left untreated, hearing loss is associated with health issues, deterioration in quality of life, and financial costs; the latter include costs associated with health care, education, loss of productivity, and societal costs, with a global burden estimated to be $750 billion annually. Despite the huge financial burden—as well as demonstration of cost-effectiveness of beneficial interventions to prevent, identify, and address hearing loss—most patients are untreated. For example, it has been estimated that less than 20% of those who could benefit from a hearing aid actually use one.

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The Worst Patient—A Physician With COVID-19

Yueh B.

Publicatie 01-10-2020


This essay describes the author’s experience of having COVID-19.

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Utility of Smartphone Telemedical Consultations for Peritonsillar Abscess Diagnosis and Triage

Mallen JR, Shah M, Drake R, et al.

Publicatie 01-10-2020


This comparative effectiveness research study explores the potential of otolaryngology telemedical consultation in triaging and diagnosing patients with suspected peritonsillar abscess.

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Trying to Define Sinonasal Medications—Reply

McCoul ED.

Publicatie 01-10-2020


In Reply In his Letter to the Editor written in response to my article on over-the-counter (OTC) sinonasal medications, Weinberger succinctly addresses the problem of self-directed symptom relief by asking, what is a sinonasal medication? Consciously or unconsciously, the answer to this question drives countless individuals to local pharmacies in a quest for relief of what are perceived as sinus problems. Whether one actually has sinusitis, allergic rhinitis, or another upper respiratory infection is beside the point for these desperate individuals.

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Trying to Define Sinonasal Medications

Weinberger M.

Publicatie 01-10-2020


To the Editor In his Original Investigation, McCoul expresses concern regarding confusion caused by the panoply of over-the-counter (OTC) sinonasal medications. But a more relevant question might be, what is a sinonasal medication?

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New Practical Telehealth Applications

Thal A, Mehta V.

Publicatie 01-10-2020


The timely article by Mallen et al in this issue of JAMA Otolaryngology–Head & Neck Surgery is a practical application of telehealth to improve access to otolaryngology care. The goal of the study was to assess the reliability of telehealth in the diagnosis and triage of patients with suspected peritonsillar abscess (PTA). The authors tested the accuracy of PTA diagnosis by providing off-site otolaryngologists with a primary symptom and an oropharyngeal examination obtained using smartphone video documentation. They compared the predictions of these off-site otolaryngologists with objective evidence, such as needle aspiration or incision and drainage performed by otolaryngology house staff or findings on computed tomography scans, to determine diagnostic accuracy. This study showed that the remote clinicians could diagnose PTA with comparable accuracy (81%) using telehealth video examination, with minimal clinician variability. In the absence of an otolaryngologist, patients with PTAs often undergo computed tomography and experience prolonged emergency department visit wait times, hospital transfers and, occasionally, hospital admission. This study validates the use of telehealth consultation for one of the most common urgent consultations to otolaryngologists using widely available, low-cost, and easy-to-use technology.

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Enhancing Skull Base Structure Along the Carotid Sheath in a Patient With Oropharyngeal Squamous Cell Carcinoma

Tamaki A, Heilingoetter A, Kang SY.

Publicatie 01-10-2020


A 62-year-old man presents with metastatic p16-positive squamous cell carcinoma and a primary cancer in the right tonsil. What is your diagnosis?

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Combination Antiviral Therapy in Patients With Bell Palsy—Reply

Yoo M, Kim S, Yeo S.

Publicatie 01-10-2020


In Reply We thank de Ru and Bayoumy for their comments regarding our article. We agree that a large proportion of patients with Bell palsy who have mild paralysis recover spontaneously, and that the combination of steroid and antiviral agents is more effective than steroids alone, particularly in patients with severe Bell palsy. Therefore, we appreciate the intention of de Ru and Bayoumy in their response to our article, as they have studied the outcomes of patients with Bell palsy treated with different methods.

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Ultrastructural Evidence of Direct Viral Damage to the Olfactory Complex in Patients Testing Positive for SARS-CoV-2

Morbini P, Benazzo M, Verga L, et al.

Publicatie 01-10-2020


This case report describes clinicopathologic and ultrastructural postmortem findings observed in the olfactory system of 2 patients with SARS-CoV-2.

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Eustachian Tube Rhabdomyomatous Mesenchymal Hamartoma in a Pediatric Patient

Bell R, Marston AP, Discolo CM.

Publicatie 01-10-2020


This case report describes a young girl who presented with a history of chronic, unilateral middle ear effusion that was treated with a pressure equalization tube.

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Combination Antiviral Therapy in Patients With Bell Palsy

de Ru J, Bayoumy A.

Publicatie 01-10-2020


To the Editor We compliment Yoo et al on their impressive cohort study reviewing data on 1364 patients with Bell palsy. However, we need more data to be able to concur with some of their conclusions. Their discussion correctly expresses our view that combination therapy should be used, especially in cases of severe palsy. Unfortunately, the data are not presented in a way that differentiates the severity of the palsy. The most important concern regarding their study is whether the prescription of antivirals was equally distributed over all patients. Consequently, 2 questions follow: (1) How many of the 1053 patients with an initial House-Brackmann (H-B) grade of III to IV were prescribed combination antiviral therapy compared with the 311 in the severe group (H-B grade V to VI)? (2) What was the rate of favorable outcomes (H-B grade ≤II) of the 311 severe cases (H-B grade V to VI) for those patients who were treated with only oral corticosteroids and for the combination therapy patients in that specific group of severe cases?

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Dysphagia and Pharyngeal Cyst

Buck LS, Farmer S, Stringer SP.

Publicatie 01-10-2020


A 73-year-old woman with chronic cervical neck pain presents with complaints of globus sensation, dysphagia, and localized throat swelling. She has a 1.5-cm cystlike mass on her left lateral pharyngeal wall. What is your diagnosis?

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Immunotherapy

Marcus S.

Publicatie 01-10-2020


This Patient Page describes the risks and benefits of immunotherapy for the treatment of common allergies.

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Using Intraoperative Recordings to Evaluate Surgical Technique and Performance in Mastoidectomy

Lee JA, Close MF, Liu YF, et al.

Publicatie 01-10-2020


This quality improvement study examines which techniques used in mastoidectomy can serve as indicators of surgeon level and whether these determinations of technique can be made based solely on the movement of the drill head or suction.

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A Curious Case of Persistent Throat Pain

Azmy MC, Lee AY, Schiff BA.

Publicatie 01-10-2020


This case report describes a man in his 20s who presented with persistent, severe, right-sided, throbbing throat pain and dysphagia and was found to have bony mass in the parapharyngeal space following a tonsillectomy.

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Lymph Node Ratio and Overall Survival in Metastatic Papillary Thyroid Cancer

Smith BD, Oyekunle TO, Thomas SM, et al.

Publicatie 01-10-2020


This cohort study examines the association of the lymph node ratio with overall survival in patients with papillary thyroid cancer.

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Rare Presentation of Progressive Saddle Nose Deformity

Taylor JK, Mady LJ, Lee SE.

Publicatie 01-10-2020


A young woman presents with saddle nose deformity, an unremarkable medical history, and elevated complement C and total hemolytic complement levels. What is your diagnosis?

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SARS-CoV-2 Virus Isolated From the Mastoid and Middle Ear

Frazier KM, Hooper JE, Mostafa HH, et al.

Publicatie 01-10-2020


This cadaver study examines the prevalence of severe acute respiratory syndrome coronavirus 2 colonization of the middle ear and mastoid in a sample of 3 patients.

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SARS-CoV-2 Isolated from the Middle Ear and Mastoid

Kesser BW.

Publicatie 01-10-2020


Otolaryngologists (especially otologists and/or neurotologists) around the globe have been waiting 6 months for this study. Given the anatomic connection from the nasopharynx, site of initial infection and virus isolation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to the tympanic cavity through the eustachian tube, could the virus responsible for the coronavirus disease 2019 (COVID-19) and the current global pandemic gain access to the middle ear space and mastoid cavity, and thus put health care workers at additional risk of contracting the virus?

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