JAMA otolaryngology-- head & neck surgery
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JAMA Otolaryngol Head Neck Surg · Apr 2014
Comparative StudyA comparison of outcomes using intensity-modulated radiation therapy and 3-dimensional conformal radiation therapy in treatment of oropharyngeal cancer.
Approximately 50% of head and neck cancer survivors experience dysphagia and related morbidity. Intensity-modulated radiation therapy (IMRT) is increasingly used to treat oropharyngeal cancers with excellent oncologic outcomes, but few studies have compared it with conventional 3-dimensional conformal radiation therapy (3D-CRT) to determine whether it can decrease treatment-related toxic and adverse effects. ⋯ The use of IMRT significantly improves PEG tube and toxicity-related outcomes compared with 3D-CRT in the treatment of oropharyngeal primary cancers. Given the association between mucosal toxic effects, PEG tube dependence, and dysphagia, these findings may be an indication of improved swallowing outcomes with IMRT.
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JAMA Otolaryngol Head Neck Surg · Apr 2014
Impact of facial fractures and intracranial injuries on hospitalization outcomes following firearm injuries.
Firearm injuries (FAIs) play a major role in unintentional injuries, suicides, and homicides. It is important that policy makers, public health authorities, physicians, and the public are kept abreast of current trends in FAIs so that preventive programs can be tailored to the needs of cohorts that are at highest risk for such injuries. ⋯ AND RELEVANCE Occurrence of intracranial injuries was an independent risk factor for poor outcomes. Teaching hospitals had higher mortality rates but also treated more complex cases than nonteaching hospitals.
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JAMA Otolaryngol Head Neck Surg · Mar 2014
Multicenter StudyHoarseness and laryngopharyngeal reflux: a survey of primary care physician practice patterns.
Current approaches to the diagnosis and subsequent management of specific voice disorders vary widely among primary care physicians (PCPs). In addition, sparse literature describes current primary care practice patterns concerning empirical treatment for vocal disorders. ⋯ Most PCPs who responded to our survey report empirically treating patients with chronic hoarseness of unknown origin. Many physician respondents were willing to empirically prescribe reflux medication as primary therapy, even when symptoms of gastroesophageal reflux disease were not present. These data suggest that PCPs strongly consider reflux a common cause of dysphonia and may empirically treat patients having dysphonia with reflux medication before referral.
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JAMA Otolaryngol Head Neck Surg · Mar 2014
Multicenter StudySafety of adult tonsillectomy: a population-level analysis of 5968 patients.
Tonsillectomy is one of the most commonly performed otolaryngology procedures. The safety of this procedure in adults is based on small case series. To our knowledge, we report the first population-level analysis of the safety of adult tonsillectomies in the United States. ⋯ In the United States, adult tonsillectomy is a safe procedure with low rates of mortality and morbidity. The most common posttonsillectomy complications were infectious in etiology, and complications were independently associated with the need for reoperation.