Importance Exposure to fine particulate matter with an aerodynamic diameter of 2.5 µm or less (PM 2.5 ) has been associated with multiple malignant neoplasms, but its relationship with sinonasal malignant neoplasm (SNM) remains poorly characterized. Objective To evaluate the association between regional PM 2.5 exposure and first observed SNM diagnosis. Design, Setting, and Participants This national case-control study used commercial outpatient claims with eligible index dates from January 2007 to December 2020. Cases were defined by the first eligible SNM diagnosis after a 1-year enrollment washout period. Controls without any SNM diagnosis throughout claims history were randomly sampled at an approximate 1:5 case to control ratio. Regional PM 2.5 exposure was derived from NASA 1-km gridded models integrating satellite, meteorologic, land-use, and atmospheric data, aggregated to each participant’s residential metropolitan statistical area and index date. Associations were evaluated using mixed-effects logistic regression with a metropolitan statistical area–level random intercept, adjusted for demographic characteristics, comorbidities, regional smoking prevalence, and socioeconomic deprivation. The analysis was conducted from March 2025 to August 2026. Exposures Mean regional PM 2.5 exposure during the 6-month, 1-year, and 5-year periods preceding the index date. Main Outcome and Measure First observed SNM diagnosis after a 1-year enrollment washout period. Results The analytic cohort included 21 295 individuals: 3600 patients with SNM (mean [SD] age, 51.5 [10.6] years; 1656 [46.0%] female and 1944 [54.0%] male participants) and 17 695 controls (41.5 [14.0] years; 9663[54.6%] female and 8032 [45.39%] male participants). Mean (SD) PM 2.5 concentrations were higher among cases than controls across the 6-month (8.57 [2.52] vs 8.36 [2.50] μg/m 3 ), 1-year (8.69 [2.45] vs 8.45 [2.43] μg/m 3 ), and 5-year (9.36 [2.67] vs 9.08 [2.67] μg/m 3 ) windows. In fully adjusted models, each SD increase in PM 2.5 was associated with higher odds of first observed SNM diagnosis (adjusted odds ratio, 1.25 [95% CI, 1.05-1.49] for 6-month average exposure, 1.31 [95% CI, 1.08-1.59] for 1-year average exposure, and 1.36 [95% CI, 1.11-1.66] for 5-year average exposure). Conclusions and Relevance In this case-control study, greater regional PM 2.5 exposure was associated with higher odds of a first observed SNM diagnosis, with larger estimates for longer averaging windows. Further epidemiologic and mechanistic investigation is warranted.
This Viewpoint evaluates the revised methods for rating otolaryngology care in the 2026-2027 US News & World Report Otolaryngology Best Hospitals rankings.
Importance Activation of the prefrontal cortex during attention and executive-function tasks can moderate associations between sleep-disordered breathing (SDB) symptoms and parent-reported behavior. However, conventional severity measures do not explain why cognitive outcomes vary among children with SDB. Objective To assess whether prefrontal cortex (PFC) activity, reflecting attention and impulse control, is associated with SDB severity and cognition, and whether it distinguishes children whose cognition diverges from their SDB severity. Design, Setting, and Participants This cross-sectional study included patients aged 5 to 11 years who were referred for evaluation of SDB at 2 academic pediatric otolaryngology centers from January 2024 to March 2026. Patients with neuromuscular disorders, prior airway surgery, continuous positive airway pressure treatment, sickle cell disease, stimulant use, or developmental delay were excluded. Exposures SDB severity measured by the Pediatric Sleep-Related Breathing Disorders Questionnaire, Apnea-Hypopnea Index (AHI), and oxygen saturation (SpO 2 ) nadir. PFC activation measured by functional near-infrared spectroscopy (fNIRS) during a computer-based go or no-go task in which children respond to frequent cues and withhold responses to infrequent ones. Main Outcomes and Measures Parent-reported executive function (Behavior Rating Inventory of Executive Function) and cognition (US National Institutes of Health [NIH] Toolbox Cognition Battery), and their associations with PFC activation. Linear mixed-effects models with false discovery rate (FDR) correction tested associations and moderation effects. Results Among 284 children (mean [SD] age, 7.9 [1.8] years; 130 [45.8%] female), 237 (83.5%) were at high risk for SDB. The mean (SD) AHI was 11.7 (14.5) events per hour and SpO 2 nadir was 86.4% (8.2%). Higher AHI was associated with greater left dorsolateral PFC activation (oxyhemoglobin: β, 0.08; 95% CI, 0.03 to 0.12; deoxyhemoglobin: β, −0.07; 95% CI, −0.11 to −0.03), and lower SpO 2 nadir was associated with greater activation (β, 0.14; 95% CI, 0.06 to 0.23). Greater activation in the right dorsolateral PFC was associated with worse parent-reported executive function after FDR correction. No severity measure was directly associated with NIH Toolbox performance after correction. However, PFC activation moderated the SDB severity-cognition association: children with greater activation maintained comparable performance despite more severe SDB. Conclusions and Relevance In this cross-sectional study, task-related PFC activation was associated with SDB severity and moderated the severity-cognition association. fNIRS may help identify children whose cognitive profiles deviate from conventional severity metrics, thereby supporting individualized cognitive risk assessment.
Importance Over-the-counter (OTC) hearing aids often rely on digital technologies that may limit access for older adults with low technology use. Community health worker (CHW)−delivered interventions may help overcome these barriers, but it is unclear whether baseline technology usage modifies intervention efficacy. Objective To evaluate whether an older adult’s baseline technology use modifies the effect of a CHW-delivered hearing care intervention incorporating OTC hearing devices on self-perceived communication function. Design, Setting, and Participants This secondary post hoc subgroup analysis used data from the HEARS (Hearing Health Equity Through Accessible Research & Solutions) study, a parallel-group 1:1 randomized clinical trial with waitlist controls that was conducted between April 2018 and October 2019. HEARS recruited older adults (age ≥ 60 years) with untreated hearing loss and self-reported communication difficulties from 13 community sites, including affordable independent housing complexes and senior centers, in Baltimore, Maryland. The primary end point was assessed at 3 months postrandomization, with additional descriptive follow-up through 12 months postintervention. Data were analyzed from August 2023 to March 2026. Intervention A CHW-delivered hearing care intervention that includes the provision of a low-cost OTC hearing device, device orientation, and navigational support or a wait-list control. Main Outcomes and Measures Change from baseline score on the Hearing Handicap Inventory for the Elderly−Screening Version (HHIE-S) at 3 months postrandomization was the primary outcome. Participants were classified as technology-connected if they reported recent use of a smartphone, computer or tablet, the internet, or email or text messaging. Intervention effects were estimated using doubly robust weighted least squares, stratified by technology use. Results The analysis comprised 151 participants (mean [SD] age, 76.7 [8.0] years; 101 females [67.8%]), of whom 108 (71.5%) were technology-connected. At 3 months postrandomization, HHIE-S scores decreased by a mean of 14.1 (95% CI, −17.6 to −9.9) points among technology-connected participants and by 12.5 (95% CI, −16.2 to −5.2) points among not-connected participants compared with their respective controls. The estimated difference in treatment effect between groups was −1.6 (95% CI, −7.8 to 4.1) points.. Conclusions and Relevance This secondary analysis of a randomized clinical trial found that the estimated treatment effects of a CHW-delivered hearing care intervention were consistent across strata of participants’ baseline technology use. These exploratory findings suggest that navigational support may mitigate technology-related barriers in hearing care interventions for older adults. Trial Registration ClinicalTrials.gov Identifier: NCT03442296
Importance Circulating tumor human papillomavirus DNA (ctHPVDNA) is a potential biomarker for surveillance of HPV-positive oropharyngeal cancer. Despite its growing clinical use, patient experiences are not well characterized, and understanding patient perspectives of ctHPVDNA-guided surveillance is essential to guiding its appropriate use while mitigating potential harms. Objective To characterize patient experiences with ctHPVDNA-guided surveillance. Design, Setting, and Participants A mixed-methods cross-sectional interview study in adults treated for HPV-positive oropharyngeal cancer with 1 or more surveillance ctHPVDNA test 3 or more months before enrollment conducted in June through August 2025 in a single tertiary academic cancer center. Purposive sampling ensured representation of diverse patient experiences. Exposures One semistructured interview regarding experiences with ctHPVDNA-guided surveillance. Willingness to pay (WTP) out of pocket was assessed using iterative bidding. Main Outcomes and Measures Themes and subthemes were derived from coded interview transcripts using a categorical inductive approach. Results Among 20 participants (median age, 58 years [IQR, 55-70 years]; 16 males [80%]), 8 (40%) had true-negative ctHPVDNA test results, 6 had true-positive results (30%), 4 had false-negative results (20%), and 2 had false-positive results (10%). Five major themes emerged: (1) broad enthusiasm and support for ctHPVDNA testing, with a common assumption that more and earlier disease-related information is beneficial, and appreciation for the reassurance of negative test results (discordance between support for testing in general and personal experiences of test accuracy was observed); (2) distress as inherent to the emotional variability of the cancer journey itself, such that anxiety associated with ctHPVDNA testing was considered attributable to cancer survivorship rather than to the test; (3) trust in the oncology team supersedes trust in test itself, whereby clinicians were trusted to appropriately interpret potentially confusing results (this trust was enhanced by clear communication); (4) test as a valuable add-on to standard care, which should enrich, but not replace, standard surveillance; and (5) sensitivity to financial toxicity, with strong support for accessible and equitable testing. The median per-test WTP was $325 (range, $0-$9000). Conclusions and Relevance This study found that participants expressed strong support for ctHPVDNA-guided surveillance. Trust in clinicians appeared to mitigate distress related to confusing or inaccurate test results. Clinicians using ctHPVDNA testing should be familiar with and clearly communicate its strengths and limitations to optimize clinical benefit.
