JAMA Otolaryngology–Head & Neck Surgery
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.
Discontinuation and Nonpublication of Head and Neck Cancer Randomized Clinical Trials
01-02-2020 – Johnson AL, Fladie I, Anderson J, et al.
This systematic review assesses the rate of discontinuation or nonpublication of phase 3 and 4 randomized clinical trials involving patients with head and neck cancer.
Association Between Microvascular Retinal Signs and Age-Related Hearing Loss in the ARIC-NCS
01-02-2020 – Kim S, Reed N, Betz JF, et al.
This cohort study investigates whether microvascular retinal signs are associated with age-related hearing loss among patients in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS).
Association of Weekly Protected Nonclinical Time With Resident Physician Burnout and Well-being
01-02-2020 – Stevens K, Davey C, Lassig A.
This nonrandomized crossover study describes the design of a departmental-level burnout intervention, evaluates the intervention’s association with otolaryngology residents’ burnout and well-being, and describes how residents used and perceived the intervention.
Prescribing Time to Temporize Burnout
01-02-2020 – Thompson DM, Brenner MJ.
Burnout is harming our medical students, residents, fellows, and colleagues. What is at stake is not only our professional well-being but also the safety of our patients. A 1-point increase in a surgeon’s self-reported emotional exhaustion score is associated with a 5-point increase in errors; this negative association is doubled for a 1-point increase in depersonalization scores. Burnout exacts a staggering toll in safety and quality of care, lost productivity, diminished patient satisfaction, and turnover. This cost is compounded by the mental and physical fatigue experienced by clinicians and their families. We are at an inflection point. Most physicians now report symptoms of burnout, and the moral imperative to address physician wellness is nowhere more poignant than in physician suicide—estimated at 1 physician per day—including our trainees, with their whole careers ahead of them.
Unilateral Vocal Fold Immobility After Prolonged Endotracheal Intubation
01-02-2020 – Campbell BR, Shinn JR, Kimura KS, et al.
This subgroup analysis of a cohort study examines the incidence of and risk factors for unilateral vocal fold immobility after more than 12 hours of mechanical ventilation in a medical intensive care unit.
Clinician Use and Payments for Audiometric and Vestibular Testing Among US Medicare Beneficiaries
01-02-2020 – Adams ME, Yueh B, Marmor S.
This cross-sectional study evaluates the variation in clinician use and payments for audiograms and vestibular tests across all regions of the United States and by specialty practice.
Permanent Facial Paralysis and Hearing Loss After Aural Irrigation
01-02-2020 – Ahmed M, Shetty P, Saunders N, et al.
This case report describes a woman in her 70s who presented with impacted cerumen in the right ear and underwent bilateral irrigation, which resulted in tympanic membrane perforation and infection, with subsequent permanent facial palsy and mixed hearing loss.
Geographic Variation in the Use of Audiovestibular Testing—Too Much or Too Little?
01-02-2020 – Kerber KA.
Clinical epidemiology aims to better understand health care delivery. It can identify potential problems with underutilization or overutilization of services and can be used to establish priorities for future studies or interventional trials. Defining geographic variation of utilization is an important part of clinical epidemiology. Theoretically, the care delivered to patients should be similar in different regions. However, regions can also have important differences in population characteristics that justify variation. Differences in supply may also contribute to variation, ie, supply sensitive variation. Services with a low level of evidence are also expected to have geographic variation based on patient and clinician preferences, ie, preference sensitive variation. Overall, variation is sometimes warranted and other times unwarranted.
An Enlarging Right Neck Mass in a 25-Year-Old Woman
01-02-2020 – Doré KJ, Divakar P, Linos K.
A 25-year-old woman with a history of polycystic ovarian syndrome and a migraine disorder presented with a right neck mass that had enlarged over the course of 6 months. What is your diagnosis?
Implications of Private Equity Acquisition of Otolaryngology Physician Practices
01-02-2020 – Miller LE, Rathi VK, Naunheim MR.
This Viewpoint discusses the risks and benefits of acquisition of otolaryngology physician practices by private equity firms.
Audiology Practices in the Evaluation and Management of Adult Cochlear Implant Candidates
01-02-2020 – Prentiss S, Snapp H, Zwolan T.
This survey study describes the testing methods and practices used by a sample of US audiologists when evaluating adults with severe hearing loss who are being considered for cochlear implant.
The Threshold of Clinical Significance
01-02-2020 – Yueh B.
This Viewpoint assesses the role of clinical significance in the evaluation of statistically significant data.
Immunosuppression and Outcomes of Patients With Cutaneous SCC of the Head and Neck
01-02-2020 – Tam S, Yao CK, Amit M, et al.
This cohort study assesses the association between the presence of immunosuppression and disease-specific outcome in patients with cutaneous squamous cell carcinoma.
Head and Neck Injuries Associated With Cell Phone Use
01-02-2020 – Povolotskiy R, Gupta N, Leverant AB, et al.
This cross-sectional study based on national data from 1998 through 2017 assesses the incidence and mechanisms of head and neck injuries associated with cell phone use, especially during activities such as walking and driving.
Importance of Defining and Interpreting a Clinically Meaningful Difference in Clinical Research
01-02-2020 – Kallogjeri D, Spitznagel EL, Jr, Piccirillo JF.
In a previous Editorial, we focused on the value of reporting results based on the effect size or magnitude of the difference or the strength of the association between groups. Examples of effect size metrics include absolute difference; Cohen d; risk, odds, and hazard ratios; correlation coefficients; and the proportion of variance indexes. The importance of reporting the precision of the estimates using confidence intervals was also described. We advocated for avoiding null hypothesis statistical testing, inferential thinking, and the reporting of results with the use of P values. In a subsequent Editorial, we described the use of confidence intervals and how they can improve the quality of research results reporting and the interpretation of results. In this Editorial, we focus on the concept of a clinically meaningful change, which is sometimes referred to as a minimum important difference (MID). The clinically meaningful difference is a threshold value for which any change as large or larger is considered meaningful to patients, clinicians, or both.
Diagnosis and Management of Pediatric Dysphagia
01-02-2020 – Lawlor CM, Choi S.
This narrative review describes the characteristics and management of dysphagia in infants and children.
Association of Slight to Mild Hearing Loss With Behavior and School Performance in Children
01-02-2020 – le Clercq CP, Labuschagne LE, Franken MP, et al.
This cross-sectional study explores the association of slight to mild hearing loss with behavioral problems and school performance in children.
Sudden sensorineural hearing loss—Reply
01-02-2020 – Bayoumy AB, Lammet van der Veen E, de Ru J.
In Reply We thank Ponzetto et al for their positive feedback and their interest in our article.
Sudden Sensorineural Hearing Loss
01-02-2020 – Ponzetto A, Cavallo G, Figura N.
To the Editor We praise the article by Bayoumy et al, who stressed the importance of oxygen supply for the amelioration of sudden sensorineural hearing loss (SSNHL). We reported that of patients with SSNHL attending an otorhinolaryngology clinic in Torino, Italy, 94.4% (odds risk, 13.6%) had an infection by a known ischemia inducing agent (ie, Helicobacter pylori). In addition, this pathogen may cause thrombosis via a number of mechanisms, the best known of which is antigenic mimicry (ie, the production of autoantibodies against a variety of human antigens that share an amino acid linear homology with bacterial epitopes). Particularly worthy of mention are autoantibodies against phospholipids, which will disappear after cure of the infection; against platelets—with the known consequence of autoimmune thrombotic thrombocythemia—and against endothelial cells that are also directly activated by the bacterium. In addition, H pylori elicits neutrophilic infiltration, a cause of neutrophilic extracellular traps because the bacterium secretes a neutrophilic-activating protein. Neutrophilic infiltration of vascular walls may lead to venous thrombosis. Detection and cure of this infection is not expensive and is available worldwide. We propose that the search of H pylori infection and treatment of positive cases could ameliorate SSNHL outcomes in many patients, at least in countries with high circulation of this pathogen.
When Slight Degrees of Hearing Impairment in Children May Actually Matter
01-02-2020 – Jabbour N, Chi D.
In this issue of JAMA Otolaryngology–Head & Neck Surgery, le Clercq et al describe thought-provoking findings that demonstrate associations of slight hearing loss with behavioral problems, as reported on parent questionnaires, and with poorer school performance, as measured by standardized test scores. They analyzed the behavioral questionnaire data and school performance data of 4779 children with slight or mild hearing loss. The authors found an association between increasing pure-tone averages and higher behavioral problem scores on the questionnaire as well as decreased scores on standardized testing, with a linear association for both.
Subcutaneous Nodule of the Midline Anterior Neck in an Infant
01-02-2020 – Miller E, Finn LS, Boos MD.
A 6-month-old infant presented with a congenital superficial papule on the anterior surface of the neck that was not associated with overlying skin changes, pain, or discharge. What is your diagnosis?
An Osseous Destructive Mass of the Infratemporal Fossa
01-02-2020 – Vesole AS, Shibata SB, Hansen MR.
A 69-year-old man had new-onset headaches, left ear pain, and persistent unsteadiness; computed tomographic imaging of the head demonstrated osseous destruction of the left temporal bone extending along the left internal jugular vein. What is your diagnosis?
Opioid Prescriptions and Risk of Complications After Tonsillectomy in Children
01-02-2020 – Chua K, Harbaugh CM, Brenner MJ.
In Reply Sun and colleagues raise important points regarding primary hemorrhage, surgical technique, and nonopioid analgesics. Our decision to not examine primary hemorrhage in our study was driven by 2 considerations. First, primary hemorrhage occurs within 24 hours of surgery (eg, on the day of surgery or the day after). Therefore, any putative effect of perioperative opioid prescribing on the risk of primary hemorrhage (eg, by reducing the use of nonsteroidal anti-inflammatory drugs NSAIDs) would have to be strong and immediate. However, prior studies do not suggest that the association between NSAID use and hemorrhage is large, if it exists at all. Given the lack of a reasonable a priori mechanism between perioperative opioid prescribing and primary hemorrhage, any detected association would most likely be incidental or due to confounding. Second, our definition of perioperative opioid prescription included opioid prescriptions filled from a week before surgery to 1 day after surgery. To establish a clear temporal relationship between perioperative opioid prescriptions and primary hemorrhage, we would have needed to exclude prescriptions filled the day after surgery while only analyzing primary hemorrhages that occurred on the day after surgery.
Some Considerations in Treating Malignant Head and Neck Paragangliomas—Reply
01-02-2020 – McCrary HC, Cannon RB, Buchmann LO.
In Reply We appreciate the feedback received from Jha et al regarding our article titled “Characterization of Malignant Head and Neck Paragangliomas at a Single Institution Across Multiple Decades.” This article describes our institutional experience with head and neck paragangliomas, with an emphasis on evaluating clinical outcomes among malignant head and neck paragangliomas. All of these patients with malignant head and neck paragangliomas were considered surgical candidates without known metastatic disease at presentation. Furthermore, all patients were presented at our institutional head and neck treatment planning conference where surgical oncologists, medical oncologists, and radiation oncologists recommend the best treatment option that is catered for each patient. Surgical resection was only offered when the team felt curative resection could be achieved. Furthermore, the most recent data from the National Cancer Database demonstrated 67% to 88% 5-year survival for patients with malignant head and neck paragangliomas who underwent surgery or surgery with adjuvant radiation, which has the best-known survival outcomes offered for patients with this rare disease.
Atypical Spitz Tumor of the Lower Lip in a Pediatric Patient
01-02-2020 – Pham TB, Tucker S, Nation J.
This case report describes a 2-year-old girl who presented with a lower lip mass with intermittent bleeding, but no discharge, lymphadenopathy, or other oral lesions and was diagnosed with an atypical Spitz tumor.
Some Considerations in Treating Malignant Head and Neck Paragangliomas
01-02-2020 – Jha A, Nilubol N, Pacak K.
To the Editor As academic physicians with an interest in pheochromocytoma/paraganglioma, we read with great interest the article by McCrary et al characterizing malignant head and neck paragangliomas (HNPGLs). The authors used the paraganglioma cohort from an academic tertiary cancer center diagnosed between 1963 and 2018. They found that the prevalence of malignant HNPGLs was 6 of 70 (9%), with 5 of 6 patients carrying the succinate dehydrogenase subunit B (SDHB) mutation. They suggested that patients with paragangliomas should undergo genetic testing, and owing to the difficulty in diagnosing malignant HNPGL prior to surgery, selective neck dissection should be performed during an initial resection. The data presented here are informative, and we congratulate the authors on this effort, yet we have a few concerns.
Opioid Prescriptions and Risk of Complications After Tonsillectomy in Children
01-02-2020 – Sun L, Wong RW, Ng ME.
To the Editor Chua et al have put forward compelling evidence to suggest potential risk of constipation in children undergoing tonsillectomy with or without adenoidectomy after being prescribed opioid medications. However, we would like to suggest 2 further considerations that interested readers may find helpful to be included in the study.
Hearing Loss After Radiotherapy and Cisplatin Chemotherapy in Patients With Head and Neck Cancer
01-02-2020 – Schuette A, Lander DP, Kallogjeri D, et al.
This cohort study develops a hearing loss prediction model for patients with head and neck cancer after radiotherapy and/or cisplatin chemotherapy.
Dermatomyositis Induced by Filler Rhinoplasty Using Liquid Silicone
01-02-2020 – Hu H, Cho H, Chiu Y.
This case report describes a woman in her 60s who presented with intermittent edema, intermittent erythema, and mild tenderness around the nose and was diagnosed with dermatomyositis associated with liquid silicone injection.
Variations in Self-reported Hearing Trouble of Older Adults by Audiometric Hearing Loss and Sociodemographics
01-02-2020 – Goman AM, Reed NS, Lin FR, et al.
This cross-sectional study evaluates 2613 participants 60 years or older in the NHANES study (2001-2012) for variations in self-reported hearing trouble by audiometric hearing loss and sociodemographic characteristics.
A Newborn With Stridor and Respiratory Distress
01-02-2020 – Saidha S, Schneider G, Faria J.
A female neonate was born with stridor and respiratory distress, which required intubation. Laryngoscopy and bronchoscopy revealed a large laryngeal mass that was soft and fluctuant on palpation. What is your diagnosis?