JAMA Otolaryngology Head and Neck Surgery 2021-10-01

JAMA Otolaryngology–Head & Neck Surgery

Publication date 01-10-2021


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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Neck Mass in an Adolescent

Gourishetti SC, Hittman J, Pereira KD.

Publication date 01-10-2021


This case report describes a 13-year-old male who presented with a 2-year history of a right neck mass that had slowly increased in size. What is your diagnosis?

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Cribriform Plate Injury After Nasal Swab Testing for COVID-19

Knížek Z, Michálek R, Vodička J, et al.

Publication date 01-10-2021


This case report describes an otherwise healthy man in his 40s who presented with right-sided clear water rhinorrhea after nasal swab testing that was mistakenly diagnosed as allergic rhinitis.

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Shared Decision-making and Decisional Conflict in Otolaryngologic Surgery

Wamkpah NS, Gerndt SP, Kallogjeri D, et al.

Publication date 01-10-2021


This survey study assesses the prevalence of decisional conflict, patient-specific concerns, and the association between patient factors and decisional conflict in patients undergoing otolaryngologic surgery during the COVID-19 pandemic.

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Evaluation of Nocturnal Enuresis After Adenotonsillectomy in Children With Obstructive Sleep Apnea

Snow A, Vazifedan T, Baldassari CM.

Publication date 01-10-2021


This secondary analysis of a randomized clinical trial of children who underwent adenotonsillectomy for nonsevere obstructive sleep apnea evaluates the prevalence of nocturnal enuresis after the operation.

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A Not-So-Simple Thyroid Nodule

Jia L, Day A, Hussain I.

Publication date 01-10-2021


A 50-year-old woman presents with a 2-month history of a neck mass that was associated with hoarseness of voice and globus sensation and thyromegaly with a palpable nodule in the right lobe. What is your diagnosis?

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Symptoms With New Loss of Taste or Smell in Adults With or Without SARS-CoV-2 Infection

Koyama AK, Siegel DA, Oyegun E, et al.

Publication date 01-10-2021


This cross-sectional study uses data from the Centers for Disease Control and Prevention’s Coronavirus Self-checker to assess which symptoms are reported with new loss of taste or smell among individuals with and without SARS-CoV-2.

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The Future of Fluorescent-Guided Surgery

Hom ME, Rosenthal EL, Varvares M.

Publication date 01-10-2021


To the Editor Durham and colleagues conducted one of the first large-scale clinical trials using fluorescence to guide surgical resection. The strong data from this large, multicenter, well-conducted trial clearly demonstrated that autofluorescence imaging can be helpful to identify the extent of the mucosal margin. However, the results of this clinical trial did not find a significant difference in key indicators of clinical benefit.

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Analyzing Charge Data Systematically Overestimates Health Care Costs

Rathi VK, Xiao R, Sethi RV.

Publication date 01-10-2021


To the Editor Nocon et al estimated that the mean total cost associated with imaging surveillance after treatment for head and neck cancer was $36 800 over a median surveillance period of 3.2 years.

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Intraoperative Parathyroid Hormone in Minimally Invasive Parathyroidectomy

Chow T.

Publication date 01-10-2021


To the Editor My attention was arrested by the article by Quinn et al on the use of intraoperative parathyroid hormone (ioPTH) in minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism (PHP). To our knowledge, it is the first meta-analysis on this topic showing a beneficial association of ioPTH with cure rates—98% vs 94.8% without ioPTH. It will have a considerable effect on surgical treatment for PHP. Nonetheless, I have some comments on the methodology, results, and conclusion of the trial.

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The Future of Fluorescent-Guided Surgery—Reply

Poh CF, Durham J.

Publication date 01-10-2021


In Reply We appreciate the comments from Hom et al regarding our recent study. Our previous studies showed that fluorescence visualization (FV) can improve the direct visualization of clinical nonapparent changes that are associated with either high-grade histologic findings or high-risk molecular changes (Figure). Although the so-called “gold standard” phase 3 clinical trial did not find a significant difference in the local recurrence rate between FV-guided and conventional white light (WL)-guided surgeries, using quantitative tissue pathologic analysis we found that FV-guided surgery has the potential to spare more normal tissue at the surgical margins.

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Analyzing Charge Data Systematically Overestimates Health Care Costs—Reply

Nocon CC, Bhayani MK.

Publication date 01-10-2021


In Reply We appreciate the thoughtful response from Rathi et al regarding our study on imaging surveillance costs for patients with head and neck cancer. They appropriately highlight the role of payer mix and service mix in accurately estimating costs. Their review of publicly available information on charge data and insurer-specific rates suggests an overestimation of our study’s potential cost savings.

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Intraoperative Parathyroid Hormone in Minimally Invasive Parathyroidectomy—Reply

Quinn AJ, Ryan ÉJ, Lowery AJ.

Publication date 01-10-2021


In Reply We thank Dr Chow for their careful review of our recent article on the use of intraoperative parathyroid hormone (ioPTH) in minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism (PHP).

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Prophylactic Steroids for Postthyroidectomy Hypocalcemia and Voice Dysfunction

Dhahri A, Ahmad R, Rao A, et al.

Publication date 01-10-2021


This randomized clinical trial investigates the use of dexamethasone to prevent postoperative hypocalcemia and voice dysfunction in patients undergoing thyroidectomy.

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Neoadjuvant PD-1/PD-L1 Inhibitors for Resectable Head and Neck Cancer

Masarwy R, Kampel L, Horowitz G, et al.

Publication date 01-10-2021


This systematic review and meta-analysis assesses the efficacy and safety of neoadjuvant immunotherapy for resectable head and neck squamous cell carcinoma.

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Olfactory Bulb Volume—A Novel Preclinical Biomarker for Smell Loss and Neurodegenerative Disease

Das S.

Publication date 01-10-2021


Neurodegenerative disorders, such as Alzheimer dementia and Parkinson disease, are disabling diseases that present a burden on society that rivals the costs of cancer and heart disease. Although current therapies are often unsuccessful at reversing the progression of these diseases, early detection in patients who are at risk of neurodegenerative disease could allow for timely interventions to delay and minimize the loss of brain function over time.

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Continuous Local Anesthetic Wound Infusions as Postoperative Standard of Care in Patients With Head and Neck Cancer

Vishnu K. S, Vishnu K. S.

Publication date 01-10-2021


To the Editor We thank Gostian et al for their study demonstrating a reduction in postoperative pain when continuous wound infusion (CWI) was used after head and neck oncological resections. The authors call for CWI to be assimilated into the multimodal postoperative analgesic concept in patients. However, prior to widespread implementation, we find it prudent to draw attention to a few caveats to the study’s conclusions.

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Comments on Use of Diagnostic Testing and Intervention for Sensorineural Hearing Loss in US Children

Fifer RC.

Publication date 01-10-2021


To the Editor The article by Qian et al is interesting and has several valid points. But there are some limitations that can influence the interpretation of the findings. First, the authors based the qualifying patient search on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes of which almost half were listed as “unspecified.” It may well be that these unspecified diagnosis codes represent children who had normal hearing outcomes. When the diagnostic conclusion is normal, we are required to code the type of problem that represents either the chief complaint or the primary concern that caused us to do the diagnostic test. For my part, I will code “sensorineural hearing loss, laterality unspecified” under the ICD-10 system when hearing sensitivity is normal. One of the major drawbacks in the ICD coding system is that no one is allowed to be normal. The working assumption is that a valid health-related complaint caused the individual to seek health care services for which we must document. As a result of using ICD codes for participant selection, the percentages reported for the diagnostics need to be taken with a grain of salt.

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Acute Vision Loss From IgG4-Related and Bacterial Rhinosinusitis After COVID-19

Harb AA, Chen Y, Ben-Ami J, et al.

Publication date 01-10-2021


This case report describes a man in his 70s who presented to the emergency department with a headache for 2 weeks and vision loss in the right eye for 2 days and was subsequently diagnosed with IgG4-related and Streptococcus constellatus rhinosinusitis.

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Local Anesthetic Wound Infusions as Postoperative Standard of Care in Patients With Head and Neck Cancer—Reply

Gostian M, Gostian A.

Publication date 01-10-2021


In Reply We are pleased to respond to the comments by Vishnu K. and Vishnu K. on our article, “Postoperative Pain Treatment With Continuous Local Anesthetic Wound Infusion in Patients With Head and Neck Cancer: A Nonrandomized Clinical Trial.”

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Comments on Use of Diagnostic Testing and Intervention for Sensorineural Hearing Loss in US Children—Reply

Qian Z, Chang KW, Cheng AG.

Publication date 01-10-2021


In Reply In our study, we reported rates of diagnostic workup and intervention of sensorineural hearing loss in a large cohort of children from a commercial insurer identified through insurance claims. We proposed that workup and intervention are underused in this cohort and built predictive models to identify clinical and sociodemographic variables that influence outcomes.

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Evaluation of the Neuroanatomical Basis of Olfactory Dysfunction

Lu R, Aziz N, Reuter M, et al.

Publication date 01-10-2021


This cross-sectional study evaluates the role of the components of the olfactory pathway structures in impaired olfactory function.

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Total Laryngectomy Volume During the COVID-19 Pandemic

Noel CW, Li Q, Sutradhar R, et al.

Publication date 01-10-2021


This cohort study examines the association of the COVID-19 pandemic with total laryngectomy volumes among patients in Ontario, Canada.

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Association of Multifocality With Prognosis of Papillary Thyroid Carcinoma

Kim H, Kwon H, Moon B.

Publication date 01-10-2021


This systematic review with meta-analysis examines 26 studies of nearly 34 000 patients with papillary thyroid carcinoma for a difference between the risk of recurrence and cancer-specific survival rates among those with multifocal vs unifocal tumors.

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Deep Learning for Clinical Image Analyses in Oral Squamous Cell Carcinoma

Chu C, Lee NP, Ho JK, et al.

Publication date 01-10-2021


This review summarizes the use of deep learning models for diagnosis, prognosis, and metastasis detection for oral squamous cell carcinoma by analyzing information from pathological and radiographic images.

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Soft Palate Ulcer—Benign or Malignant?

Wong BK, Kiakou M.

Publication date 01-10-2021


A 71-year-old man with rheumatoid arthritis and diabetes presented with pain and ulcers in the pharynx and a defect involving the entire soft palate on the left. What is your diagnosis?

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The Substantial Omission of Postoperative Radiotherapy in Patients With Advanced-Stage Oral Cancer

Awan M, Akakpo KE, Shukla M, et al.

Publication date 01-10-2021


This cohort study aims to identify factors associated with omission of adjuvant postoperative radiotherapy in patients with advanced-stage oral squamous cell cancers in the US.

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