Jay F. Piccirillo

Hypothesis: A dual fiber-based optical coherence tomography (OCT) system can be used for real-time intracochlear navigation and distance computation in the human cochlea. Background: OCT is a contrast- and radiation-free modality that provides real-time 2- and 3-dimensional imaging of tissue microanatomy at higher resolutions than those of conventional MRI or CT. Because the fundamental working principle of OCT is to measure the time delay of backscattered near-infrared light using low-coherence interferometry, OCT functions as an intrinsic light-based distance sensor. Methods: A single- and dual-fiber attached to a custom-built 1310 nm swept-source (SS) OCT system was validated in cochlear phantoms and tested in a human cadaveric cochlea to compute the distance of the fibers from the lateral and medial walls. Curvature and distance of the fibers to the lateral and medial walls of the scala tympani were obtained during insertion and pull-back of the fibers as accessed through a round window approach. Results: Our fiber-based SS-OCT system can detect a maximum distance of 7.10 mm with an axial resolution of 10 µm at an acquisition speed of 8 µs. Using space-division multiplexing (SDM) for our dual fiber, we were able to simultaneously obtain distance measurements from 2 spatially separated locations without the need for mechanical rotation. Furthermore, our custom user interface provided an immediate 3-color-coded warning system, which facilitated real-time microadjustments of fiber trajectory to avoid intracochlear trauma. Conclusion: A dual fiber-based SDM-OCT system can be used to provide real-time spatial navigation and distance calculation to the cochlear walls.

Introducing the JAMA Otolaryngology–Head & Neck Surgery Editorial Fellowship, a 2-year program designed for otolaryngologists. This immersive

Background: Depression is common in spine surgery candidates and may influence postoperative outcomes. Ecological momentary assessments (EMAs) can overcome limitations of existing depression screening methods (e.g., recall bias, inaccuracy of historical diagnoses) by longitudinally monitoring depression symptoms in daily life. In this study, we compared EMA-based depression assessment with retrospective self-report (a 9-item Patient Health Questionnaire [PHQ-9]) and chart-based depression diagnosis in lumbar spine surgery candidates. We further examined the associations of each depression assessment method with surgical outcomes. Methods: Adult patients undergoing lumbar spine surgery (n = 122) completed EMAs quantifying depressive symptoms up to 5 times daily for 3 weeks preoperatively. Correlations (rank-biserial or Spearman) among EMA means, a chart-based depression history, and 1-time preoperative depression surveys (PHQ-9 and Psychache Scale) were analyzed. Confirmatory factor analysis was used to categorize PHQ-9 questions as somatic or non-somatic; subscores were compared with a propensity score-matched general population cohort. The associations of each screening modality with 6-month surgical outcomes (pain, disability, physical function, pain interference) were analyzed with multivariable regression. Results: The association between EMA Depression scores and a depression history was weak (r_rb = 0.34 [95% confidence interval (CI), 0.14 to 0.52]). Moderate correlations with EMA-measured depression symptoms were observed for the PHQ-9 (r_s = 0.51 [95% CI, 0.37 to 0.63]) and the Psychache Scale (r_s = 0.68 [95% CI, 0.57 to 0.76]). Compared with the matched general population cohort, spine surgery candidates endorsed similar non-somatic symptoms but significantly greater somatic symptoms on the PHQ-9. EMA Depression scores had a stronger association with 6-month surgical outcomes than the other depression screening modalities did. Conclusions: A history of depression in the medical record is not a reliable indication of preoperative depression symptom severity. Cross-sectional depression assessments such as PHQ-9 have stronger associations with daily depression symptoms but may conflate somatic depression symptoms with spine-related disability. As an alternative to these methods, mobile health technology and EMAs provide an opportunity to collect real-time, longitudinal data on depression symptom severity, potentially improving prognostic accuracy. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

2023 Brought new challenges and opportunities to medical publishing, JAMA, and the JAMA Network. In January, JAMA and the JAMA Network adopted a new policy for

At the time of this writing, and in lieu of completing the federal budget in the proscribed set of rules and procedures, the US House of Representatives is atte

The SARS-CoV-2 virus has infected an estimated 100 million people in the US, with approximately 85% of patients reporting some degree of olfactory dysfunction (OD)^1-4 Patients with OD frequently suffer impaired quality of life and may have greater rates of depressive symptoms.^5,6 Currently, no interventions with definitive clinical utility exist. Thus, continued effort is needed to better define the etiology of COVID-19–induced OD and develop efficacious therapies for those suffering from it.

Objective: Develop and validate a quality‐of‐life (QoL) outcome measure for patients with dysosmia.Study Design: Cross‐sectional survey study.Setting: Otolaryngology clinics, research registries, and Facebook support groups.Methods: A 59‐item pilot survey with questions addressing parosmia concerns was developed using input from subjects with parosmia and clinical expertise from Otolaryngologists. After item reduction, the Parosmia Olfactory Dysfunction Outcomes Rating (DisODOR) was reduced to its final 29 items. DisODOR maximum score is 116 (each item score 0‐4) with higher scores indicating a higher degree of dysfunction from smell distortion. DisODOR was validated using participants with parosmia persisting >3 months after severe acute respiratory syndrome coronavirus 2 (cases) and healthy controls. Reliability, face and content validity, internal consistency, convergent validity, discriminative validity, sensitivity to change, and the minimal clinically important difference (MCID) were assessed.Results: A total of 134 cases and 20 controls completed DisODOR. The mean (SD) age was 45.9 (12.2) for cases and 29.6 (8.9) for controls. The mean score difference between cases and controls was 45.0 (95% confidence interval, 40.5‐49.5) displaying good discriminative validity. DisODOR showed strong test–retest reliability (r = .942) with high internal consistency (Cronbach's α = .971). DisODOR had a moderate correlation with SNOT‐22 scores (r = .619) indicating good convergent validity. There is an excellent association with the global impression of severity categories (η² = 0.447). Based on the distribution method, the MCID is 15.Conclusion: DisODOR is a valid, reliable QoL instrument for parosmia that can be used to measure the functional impact and QoL impairment for parosmia patients. DisODOR is sensitive to change and thus can be used in studies investigating treatments for parosmia.

In Reply We thank Di Stadio and colleagues for their Letter to the Editor, wherein they addressed our clinical trial “Efficacy of Combined Visual-Olfactory Trai

This past year witnessed the country and the world begin to return to prepandemic normal as the number of people who returned to in-person work and school incre