Head and Neck Medicine by Alexandros G.Sfakianakis

Effectiveness of Guided Internet-Based Cognitive Behavioral Therapy vs Face-to-Face Clinical Care for Treatment of Tinnitus: A Randomized Clinical Trial.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 04;:

Authors: Beukes EW, Andersson G, Allen PM, Manchaiah V, Baguley DM

Abstract
Importance: Accessible clinical care is not always available to individuals with distressing tinnitus. Internet-based cognitive behavioral therapy has the potential to increase access to evidence-based services that manage tinnitus. Research comparing the effectiveness of this internet-based intervention with face-to-face care is required.
Objective: To evaluate whether an internet-based cognitive behavioral therapy intervention is at least as effective as established individualized face-to-face clinical care in reducing tinnitus distress and tinnitus-related difficulties.
Design, Setting, and Participants: A randomized, multicenter, 2-arm parallel group, noninferiority trial with 2-month follow-up was performed between October 4, 2016, and July 14, 2017. Invited to participate were 374 adults based in the United Kingdom who had been referred to their local tinnitus clinics because of bothersome tinnitus. The experimental group received the internet-based intervention online, and the active control group underwent the usual face-to-face tinnitus care at 1 of 3 UK-based National Health Service hospitals. Participants were randomly assigned (1:1) to either intervention using variable permuted block sizes of 4 and 6. Of 92 participants who were randomized (46 each in the experimental and control groups), 88 participants completed the assessment immediately after intervention and 74 participants completed the follow-up assessment.
Interventions: Participants were randomized to receive either 8 weeks of guided internet-based cognitive behavioral therapy or a mean of 2 to 3 individualized face-to-face appointments in a tinnitus clinic.
Main Outcomes and Measures: The primary outcome was a change in tinnitus distress (assessed by the Tinnitus Functional Index). Secondary assessment measures were included for insomnia, anxiety, depression, hearing disability, hyperacusis, cognitive failures, and satisfaction with life.
Results: Of 92 patients overall, 55 (60%) were men with a mean (SD) age of 52.96 (12.07) years and mean (SD) tinnitus duration of 6.54 (9.25) years. The between-group difference in the Tinnitus Functional Index scores after intervention were 5.18 (95% CI, -4.17 to 14.53) at the initial assessment and 5.52 (95% CI, -4.60 to 15.61) at follow-up; both differences were within the noninferiority margin of 13 points for the lower 95% CI. For the secondary outcomes, only outcomes for insomnia fell outside the noninferiority margin, both after intervention and at follow-up, favoring internet-based cognitive behavioral therapy.
Conclusions and Relevance: This is the first trial, to our knowledge, to compare an internet-based intervention with standard individualized face-to-face care for tinnitus. It revealed that both interventions are equally effective for reducing tinnitus distress and most tinnitus-related difficulties.
Trial Registration: ClinicalTrials.gov identifier: NCT02665975.

PMID: 30286238 [PubMed - as supplied by publisher]

https://ift.tt/2zT75eS

Cognitive Behavioral Therapy for Tinnitus Unbound.

Cognitive Behavioral Therapy for Tinnitus Unbound.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 04;:

Authors: Rodebaugh TL

PMID: 30286237 [PubMed - as supplied by publisher]

https://ift.tt/2QxNFC2

Identification of Baseline Characteristics Associated With Development of Depression Among Patients With Head and Neck Cancer: A Secondary Analysis of a Randomized Clinical Trial.

Identification of Baseline Characteristics Associated With Development of Depression Among Patients With Head and Neck Cancer: A Secondary Analysis of a Randomized Clinical Trial.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 04;:

Authors: Panwar A, Rieke K, Burke WJ, Sayles H, Lydiatt WM, Prevention of Depression in Patients Being Treated for Head and Neck Cancer Trial (PROTECT) study group

Abstract
Importance: Patients with head and neck cancer (HNC) experience increased risk of depression and compromised quality of life. Identifying patients with HNC at risk of depression can help establish targeted interventions.
Objective: To identify factors that may be associated with the development of moderate or severe depression during treatment of HNC.
Design, Setting, and Participants: This is a retrospective, ad hoc, secondary analysis of prospectively collected data from a randomized, double-blind, placebo-controlled clinical trial. Patients were screened at academic- and community-based tertiary care HNC centers from January 2008 to December 2011. Of the 125 evaluable patients with stages II through IV HNC but without baseline depression, 60 were randomized to prophylactic antidepressant escitalopram oxalate and 65 to placebo at the time of the initial diagnosis. Data analyses were conducted from May 2016 to April 2017.
Main Outcomes and Measures: Depression outcomes were measured using Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) scores (range, 0-27 with a score of 11 or higher indicative of moderate or greater depression). Factors that may be associated with development of moderate or severe depression were assessed, including patient demographics; cancer site and stage; primary treatment modality (surgery or radiotherapy); history of depression or other psychiatric diagnosis; previous treatment of depression or suicide attempt, family history of depression, suicide, or suicide attempt; and baseline score on the QIDS-SR and clinician-rated QIDS instruments. Participants were stratified by study site, sex, cancer stage (early [stage II] vs advanced [stage III or IV]), primary modality of treatment (radiotherapy with or without chemotherapy vs surgery with or without radiotherapy), and randomization to placebo or escitalopram and balanced within these strata.
Results: The mean (SD) age of the 148 patients in the study population was 63.0 (11.9) years; 118 (79.7%) were men, and 143 (96.6%) were white. In the evaluable population of 125 patients, receiver operating characteristic analyses assessing the area under the curve for baseline QIDS-SR score (0.816; 95% CI, 0.696-0.935) and for initial radiotherapy-based treatment (0.681, 95% CI, 0.552-0.811) suggested that these 2 variables were associated with the likelihood of developing moderate or greater depression during the study period among patients who did not receive prophylactic antidepressants. The diagnostic sensitivity for identifying patients at risk of depression using the baseline QIDS-SR score improved to 100% at a threshold of 2 from 94% at a threshold of 4.
Conclusions and Relevance: Baseline symptoms and initial radiotherapy-based treatment may be associated with development of moderate or greater depression in patients with HNC. Patients with QIDS-SR baseline scores of 2 or higher may benefit the most from pharmacologic prophylaxis of depression.

PMID: 30286230 [PubMed - as supplied by publisher]

https://ift.tt/2Pe1WDB

The Role of Otolaryngologists in Eradicating Human Papillomavirus-Reply.

The Role of Otolaryngologists in Eradicating Human Papillomavirus-Reply.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 04;:

Authors: Todd C, Brody-Camp S, Friedlander P

PMID: 30286221 [PubMed - as supplied by publisher]

https://ift.tt/2y4li7q

The 2018 American Head and Neck Society Presidential Address-Reflections.

The 2018 American Head and Neck Society Presidential Address-Reflections.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 04;:

Authors: Irish JC

Abstract
Jonathan C. Irish, President of the American Head and Neck Society (AHNS) for 2017 to 2018, in his Presidential Address highlights the challenges and opportunities of the Society's reorganization in the rapidly changing field of head and neck surgery and details how AHNS members can harness this change to direct the future of their field. Specifically, AHNS members' vital roles as technically proficient surgeons, surgical team members, researchers, teachers, and leaders within an evolving medical system are explored.

PMID: 30286218 [PubMed - as supplied by publisher]

https://ift.tt/2PcxbPf