Association of Long-Term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood
Sean G. Byars, PhD1,2; Stephen C. Stearns, PhD3; Jacobus J. Boomsma, PhD2
Author Affiliations Article Information
JAMA Otolaryngol Head Neck Surg. 2018;144(7):594-603. doi:10.1001/jamaoto.2018.0614
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Questions Are there long-term health risks after having adenoids or tonsils removed in childhood?
Findings In this population-based cohort study of almost 1.2 million children, removal of adenoids or tonsils in childhood was associated with significantly increased relative risk of later respiratory, allergic, and infectious diseases. Increases in long-term absolute disease risks were considerably larger than changes in risk for the disorders these surgeries aim to treat.
Meaning The long-term risks of these surgeries deserve careful consideration.
Abstract
Importance Surgical removal of adenoids and tonsils to treat obstructed breathing or recurrent middle-ear infections remain common pediatric procedures; however, little is known about their long-term health consequences despite the fact that these lymphatic organs play important roles in the development and function of the immune system.
Objective To estimate long-term disease risks associated with adenoidectomy, tonsillectomy, and adenotonsillectomy in childhood.
Design, Setting, and Participants A population-based cohort study of up to 1 189 061 children born in Denmark between 1979 and 1999 and evaluated in linked national registers up to 2009, covering at least the first 10 and up to 30 years of their life, was carried out. Participants in the case and control groups were selected such that their health did not differ significantly prior to surgery.
Exposures Participants were classified as exposed if adenoids or tonsils were removed within the first 9 years of life.
Main Outcomes and Measures The incidence of disease (defined by International Classification of Diseases, Eighth Revision [ICD-8] and Tenth Revision [ICD-10] diagnoses) up to age 30 years was examined using stratified Cox proportional hazard regressions that adjusted for 18 covariates, including parental disease history, pregnancy complications, birth weight, Apgar score, sex, socioeconomic markers, and region of Denmark born.
Results A total of up to 1 189 061 children were included in this study (48% female); 17 460 underwent adenoidectomy, 11 830 tonsillectomy, and 31 377 adenotonsillectomy; 1 157 684 were in the control group. Adenoidectomy and tonsillectomy were associated with a 2- to 3-fold increase in diseases of the upper respiratory tract (relative risk [RR], 1.99; 95% CI, 1.51-2.63 and RR, 2.72; 95% CI, 1.54-4.80; respectively). Smaller increases in risks for infectious and allergic diseases were also found: adenotonsillectomy was associated with a 17% increased risk of infectious diseases (RR, 1.17; 95% CI, 1.10-1.25) corresponding to an absolute risk increase of 2.14% because these diseases are relatively common (12%) in the population. In contrast, the long-term risks for conditions that these surgeries aim to treat often did not differ significantly and were sometimes lower or higher.
Conclusions and Relevance In this study of almost 1.2 million children, of whom 17 460 had adenoidectomy, 11 830 tonsillectomy, and 31 377 adenotonsillectomy, surgeries were associated with increased long-term risks of respiratory, infectious, and allergic diseases. Although rigorous controls for confounding were used where such data were available, it is possible these effects could not be fully accounted for. Our results suggest it is important to consider long-term risks when making decisions to perform tonsillectomy or adenoidectomy.
Association of Age-Related Hearing Loss With Cognitive Function, Cognitive Impairment, and Dementia
A Systematic Review and Meta-analysis
David G. Loughrey, BA(Hons)1,2; Michelle E. Kelly, DPsychBAT1,3; George A. Kelley, DA4; et al Sabina Brennan, PhD1; Brian A. Lawlor, MD, FRCPI, FRCPsych1,2,5
Author Affiliations Article Information
1NEIL (Neuro Enhancement for Independent Lives) Programme, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
2School of Medicine, Trinity College Dublin, Dublin, Ireland
3Department of Psychology, National University of Ireland Maynooth, Kildare, Ireland
4Meta-Analytic Research Group, School of Public Health, Department of Biostatistics, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown
5Mercer's Institute for Successful Ageing, St James Hospital, Dublin, Ireland
JAMA Otolaryngol Head Neck Surg. 2018;144(2):115-126. doi:10.1001/jamaoto.2017.2513
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Key Points
Question Is age-related hearing loss associated with an increased risk for cognitive decline, cognitive impairment, and dementia?
Findings In this systematic review and meta-analysis of 36 epidemiologic studies and 20 264 unique participants, age-related hearing loss was significantly associated with decline in all main cognitive domains and with increased risk for cognitive impairment and incident dementia. Increased risks for Alzheimer disease and vascular dementia were nonsignificant.
Meaning Age-related hearing loss is a possible biomarker and modifiable risk factor for cognitive decline, cognitive impairment, and dementia.
Abstract
Importance Epidemiologic research on the possible link between age-related hearing loss (ARHL) and cognitive decline and dementia has produced inconsistent results. Clarifying this association is of interest because ARHL may be a risk factor for outcomes of clinical dementia.
Objectives To examine and estimate the association between ARHL and cognitive function, cognitive impairment, and dementia through a systematic review and meta-analysis.
Data Sources and Study Selection A search of PubMed, the Cochrane Library, EMBASE, and SCOPUS from inception to April 15, 2016, with cross-referencing of retrieved studies and personal files for potentially eligible studies was performed. Keywords included hearing, cognition, dementia, and Alzheimer disease. Cohort and cross-sectional studies published in peer-reviewed literature and using objective outcome measures were included. Case-control studies were excluded.
Data Extraction and Synthesis One reviewer extracted and another verified data. Both reviewers independently assessed study quality. Estimates were pooled using random-effects meta-analysis. Subgroup and meta-regression analyses of study-level characteristics were performed.
Main Outcomes and Measures Hearing loss measured by pure-tone audiometry only and objective assessment measures of cognitive function, cognitive impairment, and dementia. Cognitive function outcomes were converted to correlation coefficients (r value); cognitive impairment and dementia outcomes, to odds ratios (ORs).
Results Forty studies from 12 countries met our inclusion criteria. Of these, 36 unique studies with an estimated 20 264 unique participants were included in the meta-analyses. Based on the pooled maximally adjusted effect sizes using random-effects models, a small but significant association was found for ARHL within all domains of cognitive function. Among cross-sectional studies, a significant association was found for cognitive impairment (OR, 2.00; 95% CI, 1.39-2.89) and dementia (OR, 2.42; 95% CI, 1.24-4.72). Among prospective cohort studies, a significant association was found for cognitive impairment (OR, 1.22; 95% CI, 1.09-1.36) and dementia (OR, 1.28; 95% CI, 1.02-1.59) but not for Alzheimer disease (OR, 1.69; 95% CI, 0.72-4.00). In further analyses, study, demographic, audiometric, and analyses factors were associated with cognitive function. Vascular dysfunction and impaired verbal communication may contribute to the association between hearing loss and cognitive decline.
Conclusions and Relevance Age-related hearing loss is a possible biomarker and modifiable risk factor for cognitive decline, cognitive impairment, and dementia. Additional research and randomized clinical trials are warranted to examine implications of treatment for cognition and to explore possible causal mechanisms underlying this relationship.
Association Between Hearing Aid Use and Health Care Use and Cost Among Older Adults With Hearing Loss
Elham Mahmoudi, PhD1,2; Philip Zazove, MD1,2; Michelle Meade, PhD2,3; et al Michael M. McKee, MD, MPH1,2
Author Affiliations Article Information
1Department of Family Medicine, School of Medicine, University of Michigan, Ann Arbor
2Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
3Department of Physical Medicine & Rehabilitation, School of Medicine, University of Michigan, Ann Arbor
JAMA Otolaryngol Head Neck Surg. 2018;144(6):498-505. doi:10.1001/jamaoto.2018.0273
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Question Is the use of hearing aids associated with the probability of hospitalizations and emergency department visits as well as health care use and spending among older people with self-reported hearing loss?
Findings In this cohort study of nationally representative data from 1336 US Medicare beneficiaries who reported hearing loss, self-reported use of hearing aids was associated with reducing any visits to the emergency department and hospitalizations, both by means of 2 percentage points. Use of hearing aids increased the number of office visits, if any, by 1.40 days and reduced the number of nights in the hospital, if any, by 0.46 nights; hearing aids also increased total health care spending by $1125 and out-of-pocket costs by $325 but decreased Medicare spending by $71.
Meaning This information might be useful for the Centers for Medicare & Medicaid in deciding on insurance coverage of hearing aids for older adults with hearing loss.
Abstract
Importance Hearing loss (HL) is common among older adults and is associated with poorer health and impeded communication. Hearing aids (HAs), while helpful in addressing some of the outcomes of HL, are not covered by Medicare.
Objective To determine whether HA use is associated with health care costs and utilization in older adults.
Design, Setting, and Participants This retrospective cohort study used nationally representative 2013-2014 Medical Expenditure Panel Survey data to evaluate the use of HAs among 1336 adults aged 65 years or older with HL. An inverse propensity score weighting was applied to adjust for potential selection bias between older adults with and without HAs, all of whom reported having HL. The mean treatment outcomes of HA use on health care utilization and costs were estimated.
Exposures Encounter with the US health care system.
Main Outcomes and Measures (1) Total health care, Medicare, and out-of-pocket spending; (2) any emergency department (ED), inpatient, and office visit; and (3) number of ED visits, nights in hospital, and office visits.
Results Of the 1336 individuals included in the study, 574 (43.0%) were women; mean (SD) age was 77 (7) years. Adults without HAs (n = 734) were less educated, had lower income, and were more likely to be from minority subpopulations. The mean treatment outcomes of using HAs per participant were (1) higher total annual health care spending by $1125 (95% CI, $1114 to $1137) and higher out-of-pocket spending by $325 (95% CI, $322 to $326) but lower Medicare spending by $71 (95% CI, −$81 to −$62); (2) lower probability of any ED visit by 2 percentage points (PPs) (24% vs 26%; 95% CI, −2% to −2%) and lower probability of any hospitalization by 2 PPs (20% vs 22%; 95% CI, −3% to −1%) but higher probability of any office visit by 4 PPs (96% vs 92%; 95% CI, 4% to 4%); and (3) 1.40 more office visits (95% CI, 1.39 to 1.41) but 0.46 (5%) fewer number of hospital nights (95% CI, −0.47 to −0.44), with no association with the number of ED visits, if any (95% CI, 0.01 to 0).
Conclusions and Relevance This study demonstrates the beneficial outcomes of use of HAs in reducing the probability of any ED visits and any hospitalizations and in reducing the number of nights in the hospital. Although use of HAs reduced total Medicare costs, it significantly increased total and out-of-pocket health care spending. This information may have implications for Medicare regarding covering HAs for patients with HL.
Factors Associated With Phantom Odor Perception Among US Adults
Findings From the National Health and Nutrition Examination Survey
Kathleen E. Bainbridge, PhD, MPH1; Danita Byrd-Clark, BBA2; Donald Leopold, MD3
Author Affiliations Article Information
1National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
2Social & Scientific Systems, Inc, Silver Spring, Maryland
3University of Vermont Medical Center, Burlington
JAMA Otolaryngol Head Neck Surg. 2018;144(9):807-814. doi:10.1001/jamaoto.2018.1446
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Question How does the prevalence of phantom odor perception vary by age, sex, socioeconomic position, health status, health behaviors, smell function, and oral and sinonasal symptoms among US adults?
Findings In this cross-sectional study of 7417 adults, the prevalence of phantom odor perception was 6.5% (n = 534) and was greater among women, younger age groups, and those of lower socioeconomic position. Phantom odor perception was more common among those with poorer health, a history of head injury, or dry mouth symptoms.
Meaning Epidemiologic characterization may provide clues to cause and alert clinicians to the importance of this disorder.
Abstract
Importance Phantom odor perception can be a debilitating condition. Factors associated with phantom odor perception have not been reported using population-based epidemiologic data.
Objective To estimate the prevalence of phantom odor perception among US adults 40 years and older and identify factors associated with this condition.
Design, Setting, and Participants In this cross-sectional study with complex sampling design, 7417 adults 40 years and older made up a nationally representative sample from data collected in 2011 through 2014 as part of the National Health and Nutrition Examination Survey.
Exposures Sociodemographic characteristics, cigarette and alcohol use, head injury, persistent dry mouth, smell function, and general health status.
Main Outcomes and Measures Phantom odor perception ascertained as report of unpleasant, bad, or burning odor when no actual odor exists.
Results Of the 7417 participants in the study, 52.8% (3862) were women, the mean (SD) age was 58 (12) years, and the prevalence of phantom odor perception occurred in 534 participants, which was 6.5% of the population (95% CI, 5.7%-7.5%). Phantom odor prevalence varied considerably by age and sex. Women 60 years and older reported phantom odors less commonly (7.5% [n = 935] and 5.5% [n = 937] among women aged 60-69 years and 70 years and older, respectively) than younger women (9.6% [n = 1028] and 10.1% [n = 962] among those aged 40-49 years and 50-59 years, respectively). The prevalence among men varied from 2.5% (n = 846) among men 70 years and older to 5.3% (n = 913) among men 60 to 69 years old. Phantom odor perception was 60% (n = 1602) to 65% (n = 2521) more likely among those with an income-to-poverty ratio of less than 3 compared with those in the highest income-to-poverty ratio group (odds ratio [OR], 1.65; 95% CI, 1.06-2.56; and OR, 1.60; 95% CI, 1.01-2.54 for income-to-poverty ratio <1.5 and 1.5-2.9, respectively). Health conditions associated with phantom odor perception included persistent dry mouth (OR, 3.03; 95% CI, 2.17-4.24) and history of head injury (OR, 1.74; 95% CI, 1.20-2.51).
Conclusions and Relevance An age-related decline in the prevalence of phantom odor perception is observed in women but not in men. Only 11% (n = 64) of people who report phantom odor perception have discussed a taste or smell problem with a clinician. Associations of phantom odor perception with poorer health and persistent dry mouth point to medication use as a potential explanation. Prevention of serious head injuries could have the added benefit of reducing phantom odor perception.
Association of Continuous Positive Airway Pressure Treatment With Sexual Quality of Life in Patients With Sleep Apnea
Follow-up Study of a Randomized Clinical Trial
Sebastian M. Jara, MD1; Martin L. Hopp, MD, PhD2; Edward M. Weaver, MD, MPH1,3
Author Affiliations Article Information
1Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle
2Department of Otolaryngology–Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California
3Surgery Service, Department of Veterans Affairs Medical Center, Seattle, Washington
JAMA Otolaryngol Head Neck Surg. 2018;144(7):587-593. doi:10.1001/jamaoto.2018.0485
Key Points
Question What is the association of long-term continuous positive airway pressure with sexual quality of life in patients with sleep apnea?
Findings In a cohort study of 182 patients with sleep apnea, a significant improvement in sexual quality of life measures was observed among patients who used continuous positive airway pressure vs those who did not at long-term follow-up.
Meaning In patients with sleep apnea, successful continuous positive airway pressure use may be associated with better improvements in sexual quality of life.
Abstract
Importance Obstructive sleep apnea reduces sexual quality of life (QOL) as a result of reduced libido and intimacy, erectile dysfunction, and several other mechanisms. Treatment for obstructive sleep apnea may improve sexual QOL.
Objective To test the association of long-term continuous positive airway pressure (CPAP) treatment with sexual QOL for patients with obstructive sleep apnea.
Design, Setting, and Participants Prospective cohort study at a single, tertiary medical center of patients with newly diagnosed obstructive sleep apnea who were prescribed CPAP treatment from September 1, 2007, through June 30, 2010 (follow-up completed June 30, 2011). The statistical analysis was performed from February 1 through December 31, 2017.
Exposures Use of CPAP treatment objectively measured by the number of hours per night. Users of CPAP were defined as patients who used CPAP treatment for more than 4 hours per night, and nonusers were defined as patients who used CPAP treatment for fewer than 0.5 hours per night.
Main Outcomes and Measures Data were collected from eligible patients before CPAP treatment was prescribed and 12 months later by using the validated Symptoms of Nocturnal Obstruction and Related Events–25 (SNORE-25) QOL instrument. The 2 sex-specific items used to create the sexual QOL domain were taken from the SNORE-25. The sexual QOL domain was scored in a range from 0 to 5 (higher score is worse). The difference in sexual QOL between CPAP users and nonusers was analyzed using a paired, 2-tailed t test and multivariable linear regression adjusted for potential confounders.
Results Of the 182 participants in the cohort, 115 (63.2%) were men (mean [SD] age, 47.2 [12.3] years) with severe OSA (mean [SD] apnea-hypopnea index, 32.5 [23.8] events per hour). At the 12-month follow-up, 72 CPAP users (mean [SD] use, 6.4 [1.2] hours per night) had greater improvement than 110 nonusers (0 [0] hours per night) in sexual QOL scores (0.7 [1.2] vs 0.1 [1.1]; difference, 0.54; 95% CI, 0.18-0.90; effect size, 0.47). A moderate treatment association was observed after adjustment for age, sex, race/ethnicity, marital status, income level, educational level, body mass index, apnea-hypopnea index, and the Functional Comorbidity Index (adjusted difference, 0.49; 95% CI, 0.09-0.89; effect size, 0.43). Subgroup analysis revealed a large treatment association for women (adjusted difference, 1.34; 95% CI, 0.50-2.18; effect size, 0.87) but not for men (adjusted difference, 0.16; 95% CI, −0.26 to 0.58; effect size, 0.19).
Conclusions and Relevance Successful CPAP use may be associated with improved sexual QOL. Subgroup analysis revealed a large improvement in women but no improvement in men. Further study is warranted to test other measures of sexual QOL and other treatments.
Trial Registration ClinicalTrials.gov Identifier: NCT00503802
Traumatic Tympanic Membrane Perforations Diagnosed in Emergency Departments
Eric T. Carniol, MD, MBA1; Amishav Bresler, MD2; Kevin Shaigany, MD3; et al Peter Svider, MD4; Soly Baredes, MD2,5; Jean Anderson Eloy, MD2,5,6,7; Yu-Lan Mary Ying, MD2
Author Affiliations Article Information
1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
2Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
3Department of Otolaryngology–Head and Neck Surgery, University of Maryland, Baltimore
4Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
5Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark
6Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark
7Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark
JAMA Otolaryngol Head Neck Surg. 2018;144(2):136-139. doi:10.1001/jamaoto.2017.2550
Key Points
Question What are the leading causes of traumatic tympanic membrane perforation in the United States?
Findings In this cross-sectional analysis of 949 emergency department visits, foreign body instrumentation (including cotton-tipped applicators) was the most frequent cause of traumatic tympanic membrane perforations.
Meaning The leading cause of traumatic tympanic membrane perforations may be preventable, and patient education may prevent this frequent cause of injury.
Abstract
Importance Tympanic membrane perforations (TMPs) are frequent events leading to evaluation in the primary care and otolaryngology offices or the emergency department (ED). Despite specific warning labels on packaging of cotton-tipped applicators regarding the risk of injury to the ear canal with personal use, these products are commonly used to remove ear cerumen.
Objective To analyze the mechanism of injury for traumatic TMPs among patients presenting to the ED.
Design, Setting, and Participants Cross-sectional analysis of cases from 100 emergency departments in the United States. The National Electronic Injury Surveillance System was searched on April 3, 2015, for ear-related injuries with analysis information regarding patient age, patient sex, time and date of injury, specific injury diagnoses, and specific injury mechanisms that occurred across 5 years, from January 1, 2010, through December 31, 2014.
Main Outcomes and Measures Diagnoses of traumatic TMP documented in the ED visit record as well as patient demographics, diagnoses, and other aspects of the injury, including mechanism of injury.
Results There were 949 case entries in the database for traumatic TMP, which extrapolates to 4852 ED visits nationally. Of 949 patients evaluated, 568 (59.8%) were men and 381 (40.2%) were women resulting in a male to female ratio of 1.49:1. Most injuries occurred in patients 18 years or younger (602 of 949 [63.4%]) with children younger than 6 years most at risk (331 of 949 [34.9%]). Ear canal instrumentation including foreign bodies was noted in 581 of 949 cases (61.2%), with cotton-tipped applicators noted in 261 (44.9%) of these cases. While foreign body instrumentation represented the leading cause of traumatic TMP in patients aged 0 to 5 years (284 of 331 cases [85.8%]), 6 to 12 years (108 of 158 [68.4%]), 19 to 36 years (85 of 223 [38.1%]), 37 to 54 years (48 of 91 [52.7%]), and 55 years or older (22 of 33 [66.7%]), water trauma was the leading cause of TMP in patients aged 13 to 18 years (43 of 113 cases [38.1%]).
Conclusions and Relevance Traumatic TMP represents a common reason for evaluation in the ED. Despite common warnings regarding risk of injury to the tympanic membrane with use of a cotton-tipped applicator, it is still a major cause of traumatic TMPs. Other injury mechanisms also play an important role in the teenage and young adult populations.
Association Between Portable Music Player Use and Hearing Loss Among Children of School Age in the Netherlands
Carlijn M. P. le Clercq, MD1,2; André Goedegebure, PhD1; Vincent W. V. Jaddoe, MD, PhD2,3,4; et al Hein Raat, MD, PhD, MBA2,5; Robert J. Baatenburg de Jong, PhD, MD1; Marc P. van der Schroeff, PhD, MD1,2
Author Affiliations Article Information
1Department of Otolaryngology and Head–Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
2The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands
3Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
4Department of Paediatrics, Erasmus University Medical Center–Sophia Children's Hospital, Rotterdam, the Netherlands
5Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
JAMA Otolaryngol Head Neck Surg. 2018;144(8):668-675. doi:10.1001/jamaoto.2018.0646
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Key Points
Question What is the prevalence of noise-induced hearing loss among children aged 9 to 11 years in the Netherlands?
Findings In this cross-sectional, population-based study among 3316 children with normal middle-ear function, audiometry data showed the prevalence of audiometric notches and high-frequency hearing loss was 14.2%. Portable music players, used by 40.0% of the cohort, were associated with high-frequency hearing loss.
Meaning Signs of noise-induced hearing loss may already be present in children aged 9 to 11 years old and may be associated with portable music player use prior to exposure to known noise hazards, such as club and concert attendance.
Abstract
Importance Portable music player use may have harmful effects on hearing. The magnitude and effect of frequent music exposure, especially at younger ages, on hearing are unclear.
Objectives To examine the prevalence of noise-induced hearing loss in a 9- to 11-year-old population and associations with portable music player use and sociodemographic factors.
Design, Setting, and Participants A cross-sectional study within an ongoing, prospective, birth cohort study within Rotterdam, the Netherlands was conducted. Between ages 9 and 11 years, 5355 children underwent their first audiometric evaluation. Children were excluded if they had missing or failed tympanometry results. The study was conducted from April 16, 2012, to October 25, 2015.
Exposures Portable music player (PMP) use and sociodemographic factors assessed via parental questionnaires.
Main Outcomes and Measures Hearing acuity measured by pure-tone audiometry at 0.5 to 8 kHz. Possible noise-induced hearing loss was contingent on a high-frequency notch and/or high-frequency hearing loss in the audiogram, or reported hearing-related symptoms.
Results The final sample included 3116 participants who were a mean (interquartile range) age of 9.7 (9.6-9.9) years and equally distributed between boys (1550 [49.7%]) and girls (1566 [50.3%]). Of these, 1244 (39.9%) reported no PMP use, 577 (18.5%) reported use 1 or 2 days per week, 254 (8.2%) reported use 3 or more days per week, and for 1041 (33.4%), PMP use was not reported. Audiometric notches and high-frequency hearing loss were present in 443 (14.2%) of all children; 140 (4.5%) fulfilled the criteria of a notch, 238 (7.6%) of high-frequency hearing loss, and 65 (2.1%) of both. Of the cohort, 52 (1.7%) showed bilateral impairment. Hearing-related symptoms were reported for 232 (11.3%) of the respondents, and 831 (40.0%) of the respondents used portable music players. Portable music player use was associated with high-frequency hearing loss (odds ratio [OR], 2.88; 95% CI, 1.36-6.980 for 1 or 2 days per week and OR, 2.74; 95% CI, 1.22-6.96 for ≥3 days per week), but listening time and duration were not. There was no association of music exposure with high-frequency notches.
Conclusions and Relevance In this study, 14.2% of school-aged children showed audiometric notches or high-frequency hearing loss. This hearing impairment is already present prior to exposure to known noise hazards, such as club and concert attendance, and may have lifelong consequences. Repeated measurements are needed to confirm the association of portable music player use with hearing impairment in children.
Association of Gastroesophageal Reflux With Malignancy of the Upper Aerodigestive Tract in Elderly Patients
Charles A. Riley, MD1; Eric L. Wu, MS1; Mei-Chin Hsieh, PhD2; et al Michael J. Marino, MD1; Xiao-Cheng Wu, MD, MPH2; Edward D. McCoul, MD, MPH1,3,4
Author Affiliations Article Information
1Department of Otolaryngology–Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
2Louisiana Tumor Registry, School of Public Health, Louisiana State University Health Sciences Center, New Orleans
3Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana
4Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana
JAMA Otolaryngol Head Neck Surg. 2018;144(2):140-148. doi:10.1001/jamaoto.2017.2561
Key Points
Question Is gastroesophageal reflux disease (GERD) associated with malignancy of the upper aerodigestive tract (UADT)?
Findings A case-control study of individuals in the United States aged 66 years and older was performed with data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. GERD was associated with a greater odds of developing malignancy of the larynx, hypopharynx, oropharynx, nasopharynx, and paranasal sinuses.
Meaning GERD is associated with the presence of malignancy of the UADT in the elderly population of the United States.
Abstract
Importance Chronic inflammatory states have been linked to the development of malignancy. Gastroesophageal reflux disease (GERD) is a known risk factor for esophageal adenocarcinoma as the end result of chronic inflammatory changes.
Objective To investigate the association of GERD with the risk of malignancy in the upper aerodigestive tract (UADT).
Design, Setting, and Participants We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to conduct a case-control study of individuals in the United States who had been added from January 2003 through December 2011 and were 66 years or older. The study included patients diagnosed with malignancy of the larynx, hypopharynx, oropharynx, tonsil, nasopharynx, and paranasal sinuses. GERD was examined as an exposure. Controls were matched from a 5% random sample of Medicare beneficiaries without cancer. Multivariable unconditional logistic regression was performed.
Main Outcomes and Measures Incidence of invasive malignancies of the UADT.
Results A total of 13 805 patients (median [range] age, 74 [66-99] years; 3418 women [24.76%] and 10 387 men [75.24%]) with malignancy of the UADT were compared with 13 805 patients without disease and were matched for sex, age group, and year of diagnosis. GERD was associated with a greater odds of developing malignancy of the larynx (adjusted odds ratio [aOR], 2.86; 95% CI, 2.65-3.09), hypopharynx (aOR, 2.54; 95% CI 1.97-3.29), oropharynx (aOR, 2.47; 95% CI, 1.90-3.23), tonsil (aOR, 2.14; 95% CI, 1.82-2.53), nasopharynx (aOR, 2.04; 95% CI, 1.56-2.66), and paranasal sinuses (aOR, 1.40; 95% CI, 1.15-1.70).
Conclusions and Relevance GERD is associated with the presence of malignancy of the UADT in the US elderly population. This epidemiological association requires further examination to determine causality and diagnostic utility.
Association of Tinnitus and Other Cochlear Disorders With a History of Migraines
Juen-Haur Hwang, MD, PhD1,2; Shiang-Jiun Tsai3; Tien-Chen Liu, PhD4; et al Yi-Chun Chen, MD2,5; Jen-Tsung Lai, MD6
Author Affiliations Article Information
1Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
2School of Medicine, Tzu Chi University, Hualien, Taiwan
3Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
4Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
5Department of Nephrology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
6Department of Otolaryngology, Kuang-Tien General Hospital, Shalu, Taichung, Taiwan
JAMA Otolaryngol Head Neck Surg. 2018;144(8):712-717. doi:10.1001/jamaoto.2018.0939
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Key Points
Question Does a history of migraines increase the risk of tinnitus and other cochlear disorders?
Findings In this cohort study of claims data among patients in Taiwan, 1056 patients with a history of migraines and 4224 controls were identified. The cumulative incidence of cochlear disorders, especially tinnitus, was found to be significantly higher among patients with history of migraines than those without a history of migraines.
Meaning A history of migraines may increase the risk of tinnitus and other cochlear disorders.
Abstract
Importance A headache is a symptom of a migraine, but not all patients with migraine have headaches. It is still unclear whether a migraine might increase the risk of cochlear disorders, even though a migraine does not occur concurrently with cochlear disorders.
Objective To investigate the risk of cochlear disorders for patients with a history of migraines.
Design, Setting, and Participants This study used claims data from the Taiwan Longitudinal Health Insurance Database 2005 to identify 1056 patients with migraines diagnosed between January 1, 1996, and December 31, 2012. A total of 4224 controls were also identified from the same database based on propensity score matching. Statistical analysis was performed from January 23, 1996, to December 28, 2012.
Main Outcomes and Measures The incidence rate of cochlear disorders (tinnitus, sensorineural hearing impairment, and/or sudden deafness) was compared between the cohorts by use of the Kaplan-Meier method. The Cox proportional hazards regression model was also used to examine the association of cochlear disorders with migraines.
Results Of the 1056 patients with migraines, 672 were women and 384 were men, and the mean (SD) age was 36.7 (15.3) years. Compared with the nonmigraine cohort, the crude hazard ratio for cochlear disorders in the migraine cohort was 2.83 (95% CI, 2.01-3.99), and the adjusted hazard ratio was 2.71 (95% CI, 1.86-3.93). The incidence rates of cochlear disorders were 81.4 (95% CI, 81.1-81.8) per 1 million person-years for the migraine cohort and 29.4 (95% CI, 29.2-29.7) per 1 million person-years for the nonmigraine cohort. The cumulative incidence of cochlear disorders in the migraine cohort (12.2%) was significantly higher than that in the matched nonmigraine cohort (5.5%). Subgroup analysis showed that, compared with the nonmigraine cohort, the adjusted hazard ratios in the migraine cohort were 3.30 (95% CI, 2.17-5.00) for tinnitus, 1.03 (95% CI, 0.17-6.41) for sensorineural hearing impairment, and 1.22 (95% CI, 0.53-2.83) for sudden deafness.
Conclusions and Relevance In this population-based study, the risk of cochlear disorders, especially for tinnitus, was found to be significantly higher among patients with a history of migraines. This finding may support the presence and/or concept of "cochlear migraine."
Incidence of Thyroid Cancer Among Children and Young Adults in Fukushima, Japan, Screened With 2 Rounds of Ultrasonography Within 5 Years of the 2011 Fukushima Daiichi Nuclear Power Station Accident
Akira Ohtsuru, MD1,2; Sanae Midorikawa, MD1,2; Tetsuya Ohira, MD2,3; et al Satoru Suzuki, MD2; Hideto Takahashi, PhD2; Michio Murakami, PhD2,4; Hiroki Shimura, MD2,5; Takashi Matsuzuka, MD2,6; Seiji Yasumura, MD2,7; Shin-ichi Suzuki, MD8; Susumu Yokoya, MD9; Yuko Hashimoto, MD10; Akira Sakai, MD2,11; Hitoshi Ohto, MD2; Shunichi Yamashita, MD2,12; Koichi Tanigawa, MD2; Kenji Kamiya, MD2,13
Author Affiliations Article Information
1Department of Radiation Health Management, Fukushima Medical University, Fukushima, Japan
2Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
3Department of Epidemiology, Fukushima Medical University, Fukushima, Japan
4Department of Health Risk Communication, Fukushima Medical University, Fukushima, Japan
5Department of Laboratory Medicine, Fukushima Medical University, Fukushima, Japan
6Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
7Department of Public Health, Fukushima Medical University, Fukushima, Japan
8Department of Thyroid and Endocrinology, Fukushima Medical University, Fukushima, Japan
9Thyroid and Endocrine Center, Fukushima Medical University, Fukushima, Japan
10Department of Pathology, Fukushima Medical University, Fukushima, Japan
11Department of Radiation Life Sciences, Fukushima Medical University, Fukushima, Japan
12Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
13Research Institute of Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
JAMA Otolaryngol Head Neck Surg. Published online November 29, 2018. doi:10.1001/jamaoto.2018.3121
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Comment
Key Points
Question What is the pattern by age group of cancer detection via ultrasonographic screening of the thyroid among children and young adults within 5 years of the 2011 Fukushima Daiichi nuclear power station accident?
Findings In this cohort study of 324 301 children and young adults, thyroid cancer was diagnosed in 187 individuals within 5 years when health effects of radiation were hardly conceivable. The distribution pattern of the incidence rate by age group in second-round examinations increased with older age.
Meaning Large-scale mass screening resulted in the diagnosis of many thyroid cancers even in young age; to avoid overdiagnosis, an improvement in screening strategy based on the understanding of the natural history of thyroid cancer will be urgently needed.
Abstract
Importance Ultrasonographic (US) screening for thyroid cancer was performed in the Fukushima Health Management Survey after the 2011 Fukushima Daiichi nuclear power station accident. Clinical characteristics of thyroid cancers screened by US among children and young adults during the first 5 years after the accident were analyzed.
Objectives To evaluate the number of detected thyroid cancers by age group within 5 years of the Fukushima Daiichi nuclear power station accident and to compare the basic clinical characteristics and demographic patterns in first- and second-round examinations.
Design, Setting, and Participants In this observational study, 324 301 individuals 18 years or younger at the time of accident were included. Patients received a cytologic diagnosis of malignant or suspected malignant thyroid cancer during the first (fiscal years 2011-2013) or second round (fiscal years 2014-2015) of screening. Number of detected cases of cancer was evaluated, correcting for the number of examinees by age group at the time of the accident and for the incidence of detected cancers according to age group at the time of the screening (age groups were divided into 3-year intervals). Results were compared using the age-specific incidence of unscreened cancers from a national cancer registry.
Main Outcomes and Measures Clinical baseline characteristics of the patients and the age-specific number and incidence of thyroid cancers detected during the second round.
Results Among 299 905 individuals screened in the first round (50.5% male; mean [SD] age at screening, 14.9 [2.6] years), malignant or suspected thyroid cancer was diagnosed in 116. Among 271 083 individuals screened in the second round (50.4% male; age at screening, 12.6 [3.2] years), malignant or suspected thyroid cancer was diagnosed in 71. The most common pathologic diagnosis in surgical cases was papillary thyroid cancer (149 of 152 [98.0%]). The distribution pattern by age group at the time of the accident, where the number of detected thyroid cancer cases was corrected by the number of examinees, increased with older age in both screening rounds. This demographic pattern was similar between the first and second examinations. The distribution pattern of the incidence rate by age group at the time of screening in the second round also increased with older age. The incidence rate detected by screening was 29 cases per 100 000 person-years for those aged 15 to 17 years, 48 cases per 100 000 person-years for those aged 18 to 20 years, and 64 cases per 100 000 person-years for those aged 21 to 22 years.
Conclusions and Relevance Large-scale mass US screening of young people resulted in the diagnosis of a number of thyroid cancers, with no major changes in overall characteristics within 5 years of the 2011 Fukushima nuclear power station accident. These results suggest that US screening can identify many detectable cancers from a large pool of nonclinical and subclinical thyroid cancers among individuals of a relatively young age, in an age-dependent manner.
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