JAMA Otolaryngology Head and Neck Surgery 2020-11-01

JAMA Otolaryngology–Head & Neck Surgery

Publicatie 01-11-2020


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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Otolaryngologic Management of Chronic Cough in School-aged Children

Kennedy AA, Anne S, Hart CK.

Publicatie 01-11-2020


This review discusses common otolaryngologic causes of chronic cough in children and an algorithm for evaluation and treatment.

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Perspective From a COVID-19 Intensive Care Unit Run by Otolaryngology Residents

Badhey AK, Laitman BM.

Publicatie 01-11-2020


This essay details the emotional and physical challenges of transforming from an otolaryngology resident to an ICU physician during the worst of COVID-19 outbreak in New York City.

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Nasal Outcome Score for Epistaxis in Hereditary Hemorrhagic Telangiectasia

Peterson AM, Kallogjeri D, Spitznagel E, et al.

Publicatie 01-11-2020


This survey study uses data from a tertiary care center and online patient community to develop and assess the Nasal Outcome Score for Epistaxis in Hereditary Hemorrhagic Telangiectasia outcome measure of epistaxis in patients with hereditary hemorrhagic telangiectasia.

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Association Between Hearing Impairment and Postural Instability—Reply

Bang S, Kim A, Chae S.

Publicatie 01-11-2020


In Reply The prevalence of postural instability was found to be 3.3% in this article. Our primary method of determining dizziness was via an objective measurement of postural instability through performing the foam balance test. In fact, Korea National Health and Nutrition Examination Survey 2008 data reported that a mean (SD) 23.3% (1.29%) of responders older than 40 years reported symptoms of dizziness or imbalance, whereas only 3.9% (0.74%) failed the foam balance test. Using the dizziness questionnaire, there was no difference in prevalence of dizziness in Korean and Taiwan data.

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Association Between Hearing Impairment and Postural Instability

Chang N, Dai C.

Publicatie 01-11-2020


To the Editor We read with great interest the article published by Bang et al recently reporting the association of hearing impairment with postural instability. The authors concluded that moderate or worse hearing loss (HL) was associated with increased odds of postural instability (PI), and aging and female sex were also related to PI. It sounds reasonable, and can be explained by the coexistence of vestibular function impairment with hearing loss due to the anatomical cochlea-vestibule relationship.

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The 2009 ATA Guidelines and De-escalation of Treatment for Low-risk PTC

Lohia S, Morris LT, Roman BR.

Publicatie 01-11-2020


This quality improvement study assesses the association between the implementation American Thyroid Association guidelines and de-escalation of thereapy for patients with low-risk papillary thyroid carcinoma.

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Thyroid Cancer Clinical Guidelines and the De-escalation of Care

Haymart MR, Goldner WS.

Publicatie 01-11-2020


In the past 2 decades there has been greater interest in tailoring thyroid cancer care to the patient. Specifically, given the low-risk nature of most thyroid cancers, the more recent thyroid cancer guidelines emphasize de-escalating care when appropriate. In the Research Letter by Lohia et al, the authors found that between 2009 and 2016 there was only a small-to-moderate decrease in the use of more intensive management (ie, a decrease in more extensive surgery and use of radioactive iodine) in low-risk patients with tumor sizes of 2 cm or less, despite recommendations for less use of both. They noted that stronger 2009 American Thyroid Association (ATA) guideline recommendations were associated with a larger effect. The findings by Lohia et al are supported by prior studies evaluating the clinical guidelines and trends in surgery for thyroid cancer and use of radioactive iodine.

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Physical Therapy for Iatrogenic Facial Paralysis

Wamkpah NS, Jeanpierre L, Lieu JC, et al.

Publicatie 01-11-2020


This systematic review investigates whether noninvasive physical therapy compared with no physical therapy or other intervention improves facial nerve outcomes in adults with iatrogenic facial paralysis.

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Comparison of Parotidectomy With Observation for Treatment of Pleomorphic Adenoma in Adults

Kligerman MP, Jin M, Ayoub N, et al.

Publicatie 01-11-2020


This decision analytical model compares parotidectomy with observation for the management of pleomorphic adenoma of the parotid gland in adults 50 years or older by age.

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Novel Risk Loci in Tinnitus and Causal Inference With Neuropsychiatric Disorders

Clifford RE, Maihofer AX, Stein MB, et al.

Publicatie 01-11-2020


This genome-wide association study with mendelian randomization identifies genetic risk loci associated with tinnitus, determines genetic correlations, and infers relationships of tinnitus with hearing loss and neuropsychiatric disorders and traits.

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Novel Decision Support Interventions for Low-risk Thyroid Cancer

Pitt SC, Saucke MC.

Publicatie 01-11-2020


This quality improvement study examines a patient-oriented intervention to support decision-making about low-risk thyroid cancer treatment.

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A New Buzz for Tinnitus—It’s in the Genes!

Cederroth CR, Trpchevska N, Langguth B.

Publicatie 01-11-2020


“Does tinnitus run in your family?” Seldom is that question asked by clinicians to their patients with tinnitus, but why would they ask? Audiologists and ear, nose, and throat specialists see patients with tinnitus in association with either conductive or sensorineural hearing loss, which has led to the clinical dogma that tinnitus is secondary and by definition a symptom arising from the hearing disorder. However, tinnitus may occur in absence of any detectable auditory dysfunction, most particularly in young individuals, which raises the question on the origins of these more sporadic cases of phantom percept. In this issue of JAMA Otolaryngology–Head & Neck Surgery, Clifford et al present the first evidence in a genome-wide association study (GWAS) of 3 loci and 8 genes associated with tinnitus and replicated in 2 independent large cohorts of European ancestry: the UK Biobank and the Million Veterans Program. These findings go against the preconceived notion that tinnitus is purely a symptom and demonstrate that, at least in part, its neurological basis lies in the genes. A GWAS is the primary step in establishing the connection between genes and a trait by investigating the level of genetic variation between cases and controls. Thus, rather than looking at all the sequences from the entire genome, Clifford et al looked at specific sites across the whole genome, termed single-nucleotide variants (SNVs), where variations are expected to happen. A number of variants showed up consistently among individuals with tinnitus but not among those without tinnitus. Heritability of SNVs explained 6.3% of the variation; in other words, the identified SNVs explain nearly 6% of the trait. Including hearing difficulties as a covariate reduced tinnitus heritability by 18.8% to 35.6%, which reinforces the paradigm-shifting concept that not all tinnitus cases depend on hearing loss. With more than 1 gene being significantly associated with tinnitus, tinnitus can be defined as a polygenic disorder. Although these findings clearly demonstrate that tinnitus has a heritable component, they also indicate the importance of environmental factors in determining the full manifestation of tinnitus. Altogether, these features define tinnitus as a complex disorder, as opposed to rare mendelian disorders, wherein multiple genes and environmental factors interact together to generate a phenotype.

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Seemingly Innocuous Sore Throat in a 21-Year-Old Man

Zhiyi J, Chengyao A.

Publicatie 01-11-2020


A 21-year-old Chinese man with no relevant medical history with a recurrent sore throat associated with hoarseness of voice for 3 months’ duration. What is your diagnosis?

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COVID-19 Nasopharyngeal Swab Testing and False-Negative Results From an Anatomical Misconception

Higgins TS, Wu AW, Ting JY.

Publicatie 01-11-2020


This Viewpoint describes how a commonly held false presumption of nasal and nasopharyngeal anatomy may contribute to false-negative results in severe acute respiratory syndrome coronavirus 2 testing.

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In Vitro Efficacy of a Povidone-Iodine Nasal Antiseptic for Rapid Inactivation of SARS-CoV-2

Frank S, Brown SM, Capriotti JA, et al.

Publicatie 01-11-2020


This cross-sectional study assesses the efficacy of nasal povidone-iodine against in vitro transmission of severe acute respiratory syndrome coronavirus 2.

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Efficacy of Intranasal Timolol for Hereditary Hemorrhagic Telangiectasia–Associated Epistaxis

Peterson AM, Lee JJ, Kallogjeri D, et al.

Publicatie 01-11-2020


This randomized clinical trial uses data from existing patients at a tertiary care facility to assess the efficacy of intranasal thermosensitive timolol gel in treating moderate-to-severe recurrent hereditary hemorrhagic telangiectasia–associated epistaxis.

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Noncongenital Pediatric Mature Teratoma of the Mandible

Liu A, Warren M, Wlodarczyk JR, et al.

Publicatie 01-11-2020


This case report describes a young African American girl who presented with a 2-month history of left cheek swelling and pain associated with an enlarging jaw mass that was determined to be a mature teratoma.

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A Radiolucency Associated With an Impacted Mandibular Canine Tooth in an Adult Man

Tailor B, Allen H, Miller K.

Publicatie 01-11-2020


A man in his 40s presented with mobility of the anterior mandibular dentition; clinical examination revealed fullness on the mentolabial fold, but no gross facial asymmetry or mental nerve paresthesia. What is your diagnosis?

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COVID-19, Disparities, and Opportunities for Equity in Otolaryngology—Unequal America

Burks CA, Ortega G, Bergmark RW.

Publicatie 01-11-2020


This Viewpoint discusses the disproportionate burdens related to COVID-19 experienced by minority populations as well as strategies to limit disparities in health care, access, and outcomes.

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Incomplete Picture of Otolaryngologist Performance in the Merit-Based Incentive Payment System—Reply

Xiao R, Varvares MA, Rathi VK.

Publicatie 01-11-2020


In Reply We appreciate Dr Lum’s interest in our work. Based on our understanding of eligibility criteria for the Merit-Based Incentive Payment System (MIPS) and the Physician Compare data sets, we believe her concerns about the generalizability of our findings are overstated. Dr Lum correctly notes that the Individual Eligible Clinician file includes performance scores for approximately 36% of all MIPS-eligible clinicians. However, this statistic is not generalizable to otolaryngologists. In the final rule establishing the MIPS, the Centers for Medicare & Medicaid Services estimated that fewer than 7812 otolaryngologists would be eligible for participation in 2017. Assuming this upper bound, our sample of 6512 otolaryngologists would therefore represent at least 83% of all MIPS-eligible physicians in our field.

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Incomplete Picture of Otolaryngologist Performance in the Merit-Based Incentive Payment System

Lum F.

Publicatie 01-11-2020


To the Editor I appreciate the hard work and excellent analysis of Merit-Based Incentive Payment System (MIPS) performance in the article by Xiao et al, “Otolaryngologist Performance in the Merit-Based Incentive Payment System in 2017.” However, I have 1 major concern with the article’s depiction of otolaryngologists’ performance because it leaves the impression with the readership that this is a complete picture of 2017 MIPS performance. Specifically, the Individual Eligible Clinician File with MIPS scores (both individual and group) has only 376 170 rows, compared with more than 1 000 000 clinicians participating in MIPS. The Centers for Medicare and Medicaid Services described the first year of MIPS as the following: “We calculated that 1 057 824 MIPS eligible clinicians will receive a MIPS payment adjustment, either positive, neutral, or negative. Of that population, 1 006 319 MIPS eligible clinicians reported data as either an individual, as a part of a group, or through an Alternative Payment Model (APM) and received a neutral payment adjustment or better.”

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Association of Poorer Hearing With Longitudinal Change in Cerebral White Matter Microstructure

Armstrong NM, Williams OA, Landman BA, et al.

Publicatie 01-11-2020


This cohort study examines the association of poorer hearing with baseline and change in white matter microstructure among older adults.

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Mapping the Brain Effects of Hearing Loss

Chern A, Irace AL, Golub JS.

Publicatie 01-11-2020


Described as the “greatest global challenge for health and social care in the 21st century,” dementia is a debilitating disease that affects about 50 million individuals worldwide, a number projected to triple by 2050. Given the limited efficacy of current dementia treatments, society stands to benefit tremendously from public health prevention strategies. Hearing loss (HL) has been recently shown to be a treatable risk factor for dementia. In this issue of JAMA Otolaryngology–Head & Neck Surgery, Armstrong et al examine the cross-sectional and longitudinal associations between HL and white matter (WM) microstructure among older adults. This study demonstrates novel longitudinal findings that suggest that structural change in the brain may underlie the association of HL with cognitive decline and dementia.

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Progressive Upper Airway Obstruction and Dysphagia in a Child With Supraglottic Edema

Hong SA, Bell JR.

Publicatie 01-11-2020


A 9-year-old boy presents with progressive dyspnea, snoring, dysphagia, and weight loss; biopsy and culture results revealed diffuse non-necrotizing granulomas and oropharyngeal flora with negative acid-fast bacilli and Grocott methenamine silver stains. What is your diagnosis?

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An Unlikely Cause of Headaches and Temporomandibular Joint Pain in a Young Woman

Tipirneni KE, Grewal JS, Ryan JE, et al.

Publicatie 01-11-2020


This case report describes a woman in her 20s who underwent chemoradiation for cervical carcinoma and subsequently presented with headaches and right-sided temporomandibular joint pain.

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Fundamental Frequency in Postmenopausal Women Who Undergo HRT vs Those Who Do Not

Lin R, Wang T.

Publicatie 01-11-2020


This systematic review and meta-analysis compares the voice frequency of postmenopausal women with normal body mass index (BMI) who used hormone replacement therapy (HRT) and those who did not use HRT.

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