A dozen JAMA resources for otolaryngologists to share with patients

From relatively simple matters such as nosebleeds and postnasal drip to major issues such as the connection between smoking and head and neck cancer, otolaryngologists cover a lot of ground in talking with patients about ear, nose and throat conditions. Resources from the JAMA Network® can help bring patients up to speed on prevention, diagnosis and treatment of many of the most common ones.

The JAMA Network has published Patient Pages since 1998 to distill high-quality evidence and make it more accessible for patient education and help guide patient decisions. Patient Pages provide a basic definition of the condition or issue, along with symptoms, consequences, diagnosis, treatment and prevention. These resources, illustrated by JAMA medical illustrators, are always freely accessible online.

As part of a series of news articles curating these outstanding resources, the AMA is highlighting free, recently published Patient Page resources of highest relevance to various physician specialties. This article highlights resources relevant to otolaryngology.

AMA members can explore a range of peer-reviewed research and clinical information published by the JAMA Network, which brings JAMA® together with JAMA Network Open and 11 specialty journals. Published continuously since 1883, JAMA is one of the most widely circulated, peer-reviewed, general medical journals in the world. If you are a member or interested in becoming one, learn how to access these educational materials and innovative tools. 

1. “Enlarged Lymph Nodes”

   1. This JAMA Otolaryngology–Head & Neck Surgery Patient Page describes lymph nodes and how they can be treated if they become enlarged. From the Patient Page: “Lymph nodes are small, bean-shaped organs that are part of your immune system. Lymph nodes contain white blood cells, or lymphocytes, to help fight infections and cancers. Lymph nodes are connected by lymph vessels. These are located throughout the body, including your neck, armpits, chest, abdomen and groin.”
   2. The Patient Page lays out when patients should be concerned about enlarged lymph nodes. “In children, enlarged neck lymph nodes are very common after routine illnesses. These usually get better on their own. Worrisome features are constant fevers, night sweats, weight loss not on purpose and enlarged lymph nodes all over. It is concerning if lymph nodes are larger than 2 centimeters after two weeks or if they enlarge at a fast rate. It is not normal if lymph nodes are firm, feel stuck in place or are located lower in the neck. For adults, newly enlarged lymph nodes when not sick or that persist two to four weeks after illness should be checked by a doctor to rule out cancer.”

2. “Lower Blepharoplasty”

   1. This JAMA Otolaryngology–Head & Neck Surgery Patient Page describes the risks and benefits of lower blepharoplasty. From the Patient Page: “Lower blepharoplasty is the surgical removal and/or repositioning of redundant skin, fat and muscle of the lower eyelid and undereye area.”
   2. The Patient Page helps patients understand whether lower blepharoplasty would be right for them. “The first step is meeting with a surgeon to figure out the right treatment. This is different for each patient. The visit starts with discussing the patient’s unique goals. The surgeon then evaluates the eyes, vision and facial skin. Meeting with an eye doctor may also be advised. Sometimes, the eyes look aged because the fat pads under the eyelids droop. Lower blepharoplasty may help in these cases. Reasons not to perform this surgery include excessive dry eyes and laser eye surgery within the past six months. Lower blepharoplasty does not treat discoloration of the skin, fine wrinkles or puffy skin over the cheekbones.”

3. “Nosebleeds in Children”

   1. This JAMA Otolaryngology–Head & Neck Surgery Patient Page describes the symptoms and treatment of nosebleeds. From the Patient Page: “Although annoying, nosebleeds (also called epistaxis) are generally not serious.”
   2. They are very common, the page notes, affecting about 30% of children under 5, and half of children 5 or older. “The bleeding originates in the nose and may come out of one or both sides of the nose or the mouth. Bleeding from the front of the nose is called an anterior nosebleed. Bleeding from the back of the nose is called a posterior nosebleed.”

4. “Pediatric Tracheostomy”

   1. This JAMA Otolaryngology–Head & Neck Surgery Patient Page describes the use of tracheostomy in the pediatric population. From the Patient Page: “A tracheostomy is a surgical opening into the trachea or windpipe. This is kept open with a tracheostomy tube, a short, curved tube made from soft plastic or silicone that is inserted into the windpipe through the front of the neck. This tube is held in place with a soft strap that wraps around the neck.”
   2. This page explains why some children need a tracheostomy. “Pediatric tracheostomy tubes are most commonly placed for three reasons. First, to provide a stable airway for children with an upper airway that is too narrow or prone to collapse. This airway problem can be something they are born with or can occur later due to illness, trauma or abnormal development. Second, to allow long-term breathing support with a ventilator (breathing machine) for children who are unable to breathe on their own due to prematurity, severe illness or trauma. Finally, to make it easier to pass a suction tube into the windpipe to suck out mucus, saliva, food or liquids that may spill into the airway during swallowing.”

5. “Postnasal Drip”

   1. This JAMA Otolaryngology–Head & Neck Surgery Patient Page describes the symptoms and treatment of postnasal drip. From the Patient Page: “Postnasal drip is when mucus drips down from the back of the nose into the throat. Many things can cause postnasal drip, including allergies, pollution, certain foods or changes in temperature. The mucus can have different colors and thicknesses. This depends on what is causing it.
   2. “A common cause of postnasal drip is swelling of the inner lining of the nose. This is called rhinitis. Sometimes, this is caused by allergies. Discolored, bad-smelling postnasal drip can be caused by disease in the sinuses, called sinusitis. This is sometimes caused by an infection with a virus or bacteria. Sinusitis can be short term (acute) or long term (chronic),” says the Patient Page. “It can cause you to have a stuffy nose, thick mucus, facial pressure and trouble smelling. Reflux of stomach acid can also cause swelling and mucus in the nose and throat. This adds to the feeling of postnasal drip. Postnasal drip may also have other causes or be a result of a combination of issues.”

6. “Smoking and Head and Neck Cancer”

   1. This JAMA Otolaryngology–Head & Neck Surgery Patient Page describes the association of tobacco use with head and neck cancer and provides suggested treatment and prevention measures. From the Patient Page: “Head and neck cancers are the eighth most common group of cancers globally. These include cancers located in the nose, sinuses, mouth, throat, and voice box. There are different types of head and neck cancers. The most common is called squamous cell carcinoma.
   2. “Using tobacco is the biggest risk factor for developing head and neck cancer. In fact, smoking doubles the risk of developing head and neck squamous cell carcinoma. Heavier tobacco use leads to even higher risk. Drinking alcohol also increases the risk.” This resource also advises how to quit or help someone quit smoking.

7. “Understanding Eustachian Tube Dysfunction”

   1. This JAMA Otolaryngology–Head & Neck Surgery Patient Page describes Eustachian tube dysfunction symptoms, causes and treatment. From the Patient Page: “The Eustachian (yoo-stay-shuhn) tubes connect the back of the nose to the middle ear, which is the air-filled space behind the eardrum. The Eustachian tubes open when people yawn or swallow, and they help to equalize pressure behind the ear drum and prevent accumulation of fluid.”
   2. This Patient Page explains that eustachian tube dysfunction (ETD) occurs when a tube is blocked or does not open correctly. “ETD is more common in young children than in adults, as children have underdeveloped Eustachian tubes that can easily become blocked. Chronic ETD can result in fluid buildup in the middle ear, causing temporary hearing loss and increased risk of infection. This is called otitis media with effusion.
   3. “ETD may cause a feeling of ear fullness or blockage, ear pain, ringing in the ears, or popping sounds. Patients may not hear well out of the affected ear. Parents may notice that their children do not hear as well or have ear discomfort.”

8. “What Are Vocal Cord Nodules?”

   1. This JAMA Otolaryngology–Head & Neck Surgery Patient Page describes the symptoms, diagnosis and treatment of vocal cord nodules. From the Patient Page: “Vocal cord nodules are growths that form on the vocal cords,” and they are benign.
   2. This Patient Page describes what patients should do after being diagnosed with vocal nodules, noting that they “should avoid screaming, intense singing, and shouting. Drinking water and use of a humidifier are also ways to keep the vocal folds healthy. Nodules are not usually painful.
   3. “Doctors may suggest voice therapy to rehabilitate the voice. Voice therapy is led by speech language pathologists. In voice therapy sessions, patients are taught how to use their voice in a healthier way through vocal and breathing exercises. Outside of therapy, some patients can increase the amount of water they drink, change their diet or manage their allergies and acid reflux to improve chances of recovery.”

9. “What Is Globus?”

   1. This JAMA Otolaryngology–Head & Neck Surgery Patient Page describes causes, workup and treatment for globus. From the Patient Page: “Globus, also referred to as globus sensation or globus pharyngeus, is the painless feeling of a lump or tightness in your throat. It can feel like something is stuck or caught, but when doctors check, they usually do not find anything blocking the throat on examination. It can affect people of any age and is generally not dangerous, although it may be uncomfortable. Globus can also get better or worse with factors such as stress, eating or drinking, or time of day.
   2. “Globus does not cause problems swallowing food or drinking water and is not usually associated with pain. If you do have trouble swallowing or you are losing weight without trying, you should see a doctor.”

10. “What Is Sinus Surgery?”

    1. This JAMA Otolaryngology–Head & Neck Surgery Patient Page describes the risks and benefits of sinus surgery for acute or chronic sinusitis. From the Patient Page: “The sinuses are spaces in your face and head that are filled with air. Sinuses may become blocked due to infection, swelling or polyps. Blockages may lead to acute or chronic sinusitis (sinus infections). Symptoms may include recurrent infections, pain in the face or head, discharge or drainage from the nose, and/or congestion in the nose. Sinus surgery is usually performed to treat chronic sinusitis.”
    2. The Patient Page explains that sinus surgery “is done under general anesthesia, so you will be completely asleep. On the day of your surgery, you will be taken to the operating room. Once you are asleep, your physician will use a camera and instruments in your nose to remove infection, swelling, bony blockage or polyps. There will not be any cuts on your face and you will look the same after surgery as you did before. At the end of surgery, your surgeon might put splints or packing in your nose. This holds everything in place while you heal.”

11. “What Is Snoring?”

    1. This JAMA Otolaryngology–Head & Neck Surgery Patient Page describes the causes, symptoms and treatments for snoring and obstructive sleep apnea. From the Patient Page: “Snoring is the sound that is made when the tissues of the throat vibrate against one another. This occurs because the muscles of the throat relax during sleep allowing the airway to narrow. Snoring occurs in nearly everyone at some point in their life. About 25%–50% of adults have regular (habitual) snoring.”
    2. The Patient Page describes the possible problems with snoring. “Snoring can disrupt your bed partner’s sleep. In worse cases, snoring can even affect the sleep of people outside of your bedroom. This disrupted sleep can have effects on the bed partner’s ability to function during the daytime. For the snorer themself, this can be bad for relationships or be embarrassing. Some people think of snoring as a problem without health concerns. There does seem to be a link between snoring and certain health problems. One example is narrowing of blood vessels in the neck in people who snore. Narrowing of blood vessels can cause problems like a stroke.”
    3. In addition, the page explains when snoring is sleep apnea.

12. “What Is Swimmer’s Ear?”

    1. This JAMA Otolaryngology–Head & Neck Surgery Patient Page describes the causes, symptoms, and treatment of swimmer’s ear. From the Patient Page: “Swimmer’s ear is an infection of the ear canal. The ear canal connects the eardrum to the outer ear. Swimmer’s ear is usually caused by bacteria but may also be from a fungus. Nearly one in 10 people will get swimmer’s ear in their lifetime.”
    2. The Patient Page describes how swimmer’s ear happens. “Swimmer’s ear is common in children but may occur at any age. Swimmers are at highest risk, but anyone can be affected. For example, people who wear hearing aids or ear buds may trap moisture in the ear canal from sweating or showering. When the ear does not dry completely, bacteria and fungi grow more easily. This causes infection and irritation of the ear canal. Cleaning, scratching or putting items in the ear (like Q-tips) can also cause infection. Unlike other ear infections, the space behind the eardrum is usually not involved.”

In addition to the Patient Page feature, here are other ways physicians can leverage resources from the JAMA Network to help them in their clinical practice:

• Take CME courses and earn AMA PRA Category 1 Credit™.
• Fulfill maintenance of licensure (MOL) and CME requirements on JN Learning™, the home for all JAMA Network CME.
• Read concise summaries of clinical guidelines and recommendations in a format designed for today’s busy physicians.

The subscription cost of JAMA is included with your AMA membership, plus unlimited digital access to all JAMA Network journals, including JAMA Otolaryngology–Head and Neck Surgery and these other journals: JAMA Cardiology, JAMA Dermatology, JAMA Internal Medicine, JAMA Network Open, JAMA Neurology, JAMA Oncology, JAMA Ophthalmology, JAMA Pediatrics, JAMA Psychiatry and JAMA Surgery.

The journals include many helpful features for students, residents and fellows, including full-text PDFs, clinical challenges, archived editions, audio and video author interviews where authors give their perspectives on a study’s objectives, findings and implications.