JAMA otolaryngology-- head & neck surgery
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JAMA Otolaryngol Head Neck Surg · Sep 2020
ReviewMolecular Profiling of Thyroid Nodules-Are These Findings Meaningful, or Merely Measurable?: A Review.
Advances in genomic technologies have facilitated the development of sophisticated molecular diagnostic tests for thyroid nodules, in the hopes of better risk stratifying nodules with indeterminate cytopathologic diagnosis. It is unclear whether the widespread, or reflexive, use of these tests will improve outcomes for patients with thyroid nodules. ⋯ Because of variable performance, unclear benefit to patients, and questionable cost-effectiveness, clinical practice guidelines in the US and Europe currently do not recommend the universal, reflexive use of molecular assays for cytologically indeterminate thyroid nodules. These tests might offer value when used in selected scenarios, although this is not well understood. Future research should address whether the routine use of these molecular diagnostic tests leads to superior patient survival or quality-of-life outcomes compared with management based on clinical and radiographic criteria.
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JAMA Otolaryngol Head Neck Surg · Sep 2020
Risk of SARS-CoV-2 Transmission During Flexible Laryngoscopy: A Systematic Review.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reportedly infected otolaryngologists disproportionately in the early parts of the coronavirus disease 2019 pandemic. Recommendations from national and international health organizations suggest minimizing the use of flexible laryngoscopy as a result. ⋯ A substantial lack of research precludes formal conclusions about the safety of flexible laryngoscopy and transmission of SARS-CoV-2 from patients to health care workers. The use of appropriate precautionary measures and personal protective equipment appears to reduce the risk of transmission. Given the uncertainty in transmission and the known benefits of safety precautions, upper airway endoscopy may be reasonable to perform if precautionary steps are taken.
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JAMA Otolaryngol Head Neck Surg · Sep 2020
Meta AnalysisAssociation of Central Noninvasive Brain Stimulation Interventions With Efficacy and Safety in Tinnitus Management: A Meta-analysis.
Tinnitus has a prevalence of 10% to 25% and is frequently associated with numerous complications, such as neuropsychiatric disease. Traditional treatments have failed to meet the needs of patients with tinnitus. Noninvasive brain stimulation (NIBS) can focally modify cortical functioning and has been proposed as a strategy for reducing tinnitus severity. However, the results have been inconclusive. ⋯ This network meta-analysis suggests a potential role of NIBS interventions in tinnitus management. Future large-scale RCTs focusing on longer follow-up and different priming procedure NIBS are warranted to confirm these findings.
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JAMA Otolaryngol Head Neck Surg · Sep 2020
Multicenter StudyTelemedicine Services Provided to Medicare Beneficiaries by Otolaryngologists Between 2010 and 2018.
Clinicians are increasingly adopting telemedicine in an effort to expand patient access and efficiently deliver care. However, the extent to which otolaryngologists provide telemedicine services is unclear. ⋯ This study suggests that the extent to which otolaryngologists used telemedicine to deliver care to Medicare beneficiaries between 2010 and 2018 was rare. Although there was relative growth in the use of telemedicine by otolaryngologists during this period, absolute growth remained low. Policy makers and provider organizations should support otolaryngologists in the adoption of telemedicine technologies, especially while coronavirus disease 2019 (COVID-19) viral suppression efforts necessitate prolonged restriction of physical clinic throughput.