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.
October Issue Highlights
Errors in Abstract and Results
In the Original Investigation titled “Anatomic Distribution of the Morphologic Variation of the Upper Lip Frenulum Among Healthy Newborns,” published online August 22, 2019, there were errors in the Results paragraph of the abstract and the Results section of the text. The mean (SD) birth weight and range of birth weights of 150 newborns should be 3180 (570) g (range, 1850-4480 g). This article was corrected online.
Variation in Surgical Practice for Differentiated Thyroid Cancer
01-10-2019 – Hall SF, Irish JC, Griffiths RJ, et al.
This population-based study evaluates nearly 16 years of clinical and administrative data to understand the differences in surgical treatments, the incidence of thyroid cancer, and the role of region-based surgeons in provincewide practice variations in Ontario, Canada.
Association Between Hospital Market Concentration and Costs of Laryngectomy
01-10-2019 – Gourin CG, Vosler PS, Mandal R, et al.
This cross-sectional analysis uses the Nationwide Inpatient Sample to examine the association between regional hospital market concentration, hospital charges, and costs for laryngectomy.
Redirecting, Without Dampening, the Enthusiasm of Surgeons
01-10-2019 – Chen AY.
It was J. Alison Glover who first noted variation in rates of tonsillectomy across Britain more than 75 years ago. He noted that the variation was because of the school health officers who would refer (or not refer) students for tonsillectomy. Fast forward to Wennberg and Gittelsohn’s article 35 years later that again documented variation in rates of tonsillectomy, this time across Vermont. In this issue of JAMA Otolaryngology–Head & Neck Surgery, Hall and colleagues report on high variability in rates of thyroidectomy within the province of Ontario, Canada. They propose that Chassin’s enthusiasm hypothesis may help explain high rates of thyroidectomy in certain geographic regions of Ontario.
Using Laryngectomies to Help Voice Concerns About Health Care Databases
01-10-2019 – Vorwald KM.
In this month’s issue of JAMA Otolaryngology–Head & Neck Surgery, Gourin et al deliver a comprehensive analysis of the medical marketplace using the National Inpatient Sample (NIS) health care database, focusing on the associations between hospital market concentration, competition, and surgical volumes as they relate to charges, costs, and care in patients undergoing laryngectomy for treatment of malignant disease.
Solitary Mucus Cast at the Wharton Duct Orifice
01-10-2019 – Dokania V, Kacker A.
A woman presents with recurring left submandibular gland swelling and pain, and a sialoendoscopy shows a mucus cast, which has extensive eosinophil infiltrate seen on histologic examination. What is your diagnosis?
Anatomic Distribution of the Morphologic Variation of the Upper Lip Frenulum Among Healthy Newborns
01-10-2019 – Ray S, Golden W, Walsh J.
This cross-sectional study examines the variations in morphology of the maxillary labial frenulum in healthy newborns to identify which anatomic measurements may be associated with neonatal breastfeeding difficulty.
Transnasal-Transpterygoid Endoscopic Removal of an 18 F–Choline-Avid Parathyroid Carcinoma in the Skull Base
01-10-2019 – Morand GB, Rupp NJ, Huellner MW, et al.
This case report describes a patient with a medical history of symptomatic primary hyperparathyroidism who was found to have an atypical parathyroid neoplasm at the right skull base with an infiltrating pattern, which was treated by transnasal-transpterygoid endoscopic removal.
Use and Cost of a Hypoglossal Nerve Stimulator Device for Obstructive Sleep Apnea
01-10-2019 – Rathi VK, Kondamuri NS, Naunheim MR, et al.
This economic evaluation based on publicly available data assesses the use and cost of an implantable device, approved by the US Food and Drug Administration in 2014, that offers a unique alternative to patients with moderate to severe obstructive sleep apnea and poor response to continuous positive airway pressure.
Vaping Among Adolescents in the United States
01-10-2019 – Farzal Z, Perry MF, Yarbrough WG, et al.
On December 18, 2018, the US Surgeon General declared e-cigarette vaping among adolescents an “epidemic.” This declaration coincided with a report in The New England Journal of Medicine highlighting a 10% increase in youth vaping between 2017 and 2018, the equivalent of an additional estimated 1.3 million teenagers. In a public hearing in January 2019, the former US Food and Drug Administration (FDA) Commissioner, Scott Gottlieb, stated that e-cigarettes pose an “existential threat” to youth, and called for exploration of drug therapies to help adolescents overcome addiction. In February 2019, the Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC) declared that the e-cigarette surge has erased recent progress in preventing tobacco use among youth. These statements summarize the current story of how loosely regulated products intended to help individuals quit traditional combustible cigarettes became the fastest growing abused substance and the Achilles’ heel of our youngest generation.
Mucocutaneous Lesions in an Adult Man Who Recently Moved From Mexico
01-10-2019 – Mularczyk C, Moynihan M, Yu J.
A 66-year-old man presented to the emergency department for painful and pruritic ulcerative cutaneous lesions involving his back, nose, lips, and mucosal lesions involving his oral cavity and oropharynx. What is your diagnosis?
Reflections on the Otolaryngologist’s Role in Opioid Stewardship
01-10-2019 – Brenner MJ.
This article examines otolaryngologist contributions to the opioid epidemic and argues on behalf of limiting opioid prescription and working to make prescribing practices more consistent across disciplines.
Association of a Lean Surgical Plan of the Day With Reduced Operating Room Time for Head and Neck Free Flap Reconstruction
01-10-2019 – Ibrahim A, Ndeti K, Bur A, et al.
This quality improvement cohort study used Lean methodology to identify opportunities to reduce operating room inefficiency and, following a retrospective medical record review, implemented a surgical plan of the day and evaluated its association with reduced operation times.
Association of Sinonasal Factors With Chronic Laryngitis in Korean Adults
01-10-2019 – Lee K, Young Kang C, Lee H, et al.
This cross-sectional study estimates the association of chronic laryngitis with various sinonasal symptoms and endoscopic findings to identify what sinonasal factors are associated with allergic cause of chronic laryngitis.
Concurrent Internal Jugular Vein Phlebectasia and Omohyoid Sling Syndrome
01-10-2019 – Zhiyi J, Chengyao A.
This case report describes a woman in her 20s who presented with a right lower neck swelling that appeared intermittently, especially during swallowing and coughing.
Progressive Bilateral Nasal Obstruction Due to Nasopharyngeal Mass
01-10-2019 – Min H, Kim K.
A man in his 20s presented with a progressive bilateral nasal obstruction accompanied by recurrent nosebleeds. Following removal of the obstruction, histopathologic results showed calcification of the mass. What is your diagnosis?
Cannabis Inhalation and Voice Disorders
01-10-2019 – Meehan-Atrash J, Korzun T, Ziegler A.
This systematic review examines data from humans and animals to assess the association of cannabis inhalation with the health and function of the vocal mechanism.
Association of Opioid Prescriptions With Complications After Tonsillectomy in Children
01-10-2019 – Chua K, Harbaugh CM, Brummett CM, et al.
This cohort study evaluates private insurance claims data for perioperative opioid prescribing practice, duration of prescriptions, and possible association with return visits for complications in pediatric tonsillectomy.
NCCN-Recommended Posttreatment Surveillance and Outcomes in Patients With HPV-Associated Oropharyngeal SCC
01-10-2019 – Masroor F, Corpman D, Carpenter DM, et al.
This cohort study evaluates the association between National Comprehensive Cancer Network–recommended posttreatment clinical surveillance adherence and outcomes in a cohort of patients with of human papilloma virus–associated oropharyngeal squamous cell carcinoma.
Defining Exposure and Non-exposure in Observational Studies of Sleep Apnea Treatment—Reply
01-10-2019 – Lisan Q, Empana J.
In Reply Donovan and colleagues raised concerns regarding the definition of the nonexposed group in our study. As they noted, the variable “PAP positive airway pressure prescription” was derived from a set of branched questions, so that the control group may indeed result in a mixed group of individuals. The control group comprised 311 participants, among whom 305 answered “no” to the “sleepapnea” variable and 6 participants were coded “no” to the “sacpap” variable. Hence, the 305 participants either had no access to a physician or were not given information about their obstructive sleep apnea (OSA) by their physician, and the 6 participants probably either declined PAP therapy and/or used other modalities to treat their OSA.
Defining Exposure and Nonexposure in Observational Studies of Sleep Apnea Treatment
01-10-2019 – Donovan LM, Bertisch SM, Patel SR.
To the Editor We read with interest the article by Lisan et al, published online on April 11, 2019. The authors analyzed publicly available data from the Sleep Heart Health Study (SHHS) to answer an important question: does prescription of positive airway pressure (PAP) treatment save lives? The authors observed substantially lower mortality risk among those with severe obstructive sleep apnea (OSA) who were prescribed PAP relative to matched controls who were not prescribed PAP (hazard ratio HR, 0.38-0.58). However, we are concerned that the methods used to define PAP exposure led to substantial heterogeneity in these groups—limiting our interpretation.
Factors to Consider When Contemplating Posttreatment Surveillance for Survivors of HPV-Associated Oropharyngeal Squamous Cell Carcinoma
01-10-2019 – Swegal WC, Eisele DW, Fakhry C.
In this issue of JAMA Otolaryngology–Head & Neck Surgery, Masroor at al explore the outcomes associated with adherence to the current National Comprehensive Cancer Network (NCCN) posttreatment surveillance recommendations for patients with human papillomavirus–associated oropharyngeal squamous cell carcinoma (HPV-associated OPSCC). Recognition of the favorable prognosis of HPV-associated OPSCC has led to the issue of whether the current NCCN-guided surveillance recommendations are appropriate for survivors of HPV-associated OPSCC. The goals of a regular surveillance schedule are to identify cancer recurrence and sequelae of therapy. To our knowledge, no study to date has evaluated the benefit of a surveillance schedule specific to HPV-associated OPSCC.
Intraoperative Autofluorescence Parathyroid Identification in Patients With Multiple Endocrine Neoplasia
01-10-2019 – Squires MH, Shirley LA, Shen C, et al.
This cohort study examines the use of real-time near-infrared autofluorescence imaging in the intraoperative setting for identification and localization of the parathyroid gland in patients with multiple endocrine neoplasia type 1.
Geographic Disparities in US Veterans’ Access to Cochlear Implant Care
01-10-2019 – Shayman CS, Ha Y, Raz Y, et al.
This analysis uses census tract–level data from the nationwide American Community Survey to investigate geographic disparities for US veterans in accessing cochlear implant facilities within the Veterans Health Administration system.
Association of Singing With the Development of Pediatric Voice Disorders—Reply
01-10-2019 – Porebska I, Clarós P, Clarós-Pujol A.
In Reply We thank James and Ong and Sataloff for dedicating their time to comment on our article. We are honored by their attention, overall complimentary perspective, and will make our best effort to respond to their comments.
Association of Singing With the Development of Pediatric Voice Disorders
01-10-2019 – Sataloff RT.
To the Editor Clarós et al should be complimented on the article “Association Between the Development of Pediatric Voice Disorders and Singing in Children’s Choir,” published online in March. The study was important. However, the authors might consider another explanation for their findings. Their article suggests an association between good vocal health and choir singing based on attention to healthy singing techniques in the Spanish choir tradition. Although I am a strong advocate of healthy choral singing, one should consider that their findings may have been a result of self-selection rather than vocal education. Voice disorders were twice as common in the nonsinging group; but there is no way to know from this study when those voice problems developed. It is likely that children with poor voices, especially those with pathologic voice disorders, would choose to avoid auditioning for a choir (or might be rejected if they did audition) and would gravitate toward extracurricular activities that are not dependent on good voice quality and endurance. So, although I (as a university choir conductor) would like to believe that there may be a causal relationship between choral singing and good vocal health, I do not believe that the data presented support that conclusion.
Association of Singing With the Development of Pediatric Voice Disorders
01-10-2019 – James NE, Ong S.
To the Editor We thank Clarós et al for their study investigating the association between singing in a children’s choir and the development of voice disorders. The authors reported a significantly greater number of voice disorders in nonsingers compared with singers, thus emphasizing the importance of introducing conscientious voice care in nonsinging children. However, we have identified several notable limitations in this study.
Prevalence of Eustachian Tube Dysfunction in Adults in the United States
01-10-2019 – Shan A, Ward BK, Goman AM, et al.
Using a representative cross-sectional sample combined with census data, this study calculates prevalence and population estimates to approximate the burden of eustachian tube dysfunction among adults in the United States.
Desquamatory Lesions of the Upper Aerodigestive Tract Mucosa
01-10-2019 – Lechien JR, Mouawad F.
A man in his 30s presented with a medical history of severe dysphagia and dysphonia, fever, rhinorrhea, several macules and desquamatory lesions on the mucosa of the oral cavity, lips, penis, and eye sclera. What is your diagnosis?