Artificial intelligence and ChatGPT: An otolaryngology patient's ally or foe?

BACKGROUND: As artificial intelligence (AI) is integrating into the healthcare sphere, there is a need to evaluate its effectiveness in the various subspecialties of medicine, including otolaryngology. Our study intends to provide a cursory review of ChatGPT's diagnostic capability, ability to convey pathophysiology in simple terms, accuracy in providing management recommendations, and appropriateness in follow up and post-operative recommendations in common otolaryngologic conditions. METHODS: Adenotonsillectomy (T&A), tympanoplasty (TP), endoscopic sinus surgery (ESS), parotidectomy (PT), and total laryngectomy (TL) were substituted for the word procedure in the following five questions and input into ChatGPT version 3.5: "How do I know if I need (procedure)," "What are treatment alternatives to (procedure)," "What are the risks of (procedure)," "How is a (procedure) performed," and "What is the recovery process for (procedure)?" Two independent study members analyzed the output and discrepancies were reviewed, discussed, and reconciled between study members. RESULTS: In terms of management recommendations, ChatGPT was able to give generalized statements of evaluation, need for intervention, and the basics of the procedure without major aberrant errors or risks of safety. ChatGPT was successful in providing appropriate treatment alternatives in all procedures tested. When queried for methodology, risks, and procedural steps, ChatGPT lacked precision in the description of procedural steps, missed key surgical details, and did not accurately provide all major risks of each procedure. In terms of the recovery process, ChatGPT showed promise in T&A, TP, ESS, and PT but struggled in the complexity of TL, stating the patient could speak immediately after surgery without speech therapy. CONCLUSIONS: ChatGPT accurately demonstrated the need for intervention, management recommendations, and treatment alternatives in common ENT procedures. However, ChatGPT was not able to replace an otolaryngologist's clinical reasoning necessary to discuss procedural methodology, risks, and the recovery process in complex procedures. As AI becomes further integrated into healthcare, there is a need to continue to explore its indications, evaluate its limits, and refine its use to the otolaryngologist's advantage.

Utilization of computed tomography in pediatric temporal fractures: A dose reduction approach.

OBJECTIVES: METHODS: Retrospective chart review was performed of pediatric patients who underwent CT brain as part of a trauma pan-scan and dedicated temporal bone CT in the setting of head trauma. The original CT images were re-reviewed by two board certified Neuroradiologists in a blinded manner to determine the presence or absence of temporal bone fracture and if present, fracture line involvement of the 5 critical temporal bone anatomic structures. The dose length product (DLP), a measure of approximate total radiation dose delivered during CT scan (mGy-cm), was noted from the data available. RESULTS: There were 24 temporal bone fractures in a total of 29 patients (4 with bilateral fractures). There were 21 of 24 fractures that were correctly identified on trauma pan-scan CT with dedicated temporal bone CT considered as the diagnostic gold standard. There was a combined sensitivity and specificity of 91 % and 100 % respectively. The sensitivity and specificity in identifying involvement of critical structures were as follows: carotid canal (100 % and 100 %); ossicular chain (75 % and 100 %); tegmen tympani (60 % and 97.9 %); facial nerve canal (25 % and 100 %); otic capsule (N/A and 98.5 %). The median DLP for trauma pan-scan CT and temporal bone CT were 627 mGy-cm and 267 mGy-cm respectively. CONCLUSION: Dedicated TBCT is not required to accurately diagnose and characterize temporal bone fractures seen on trauma pan-scan CT. The radiation exposure of concurrent or subsequent dedicated temporal bone imaging is equal to approximately one half of the original trauma pan-scan CT.

Tongue symptoms, suspension force and duration during operative laryngoscopy.

PURPOSE: Suspension laryngoscopy is a commonly performed procedure in otolaryngology. During the procedure, the laryngoscope applies direct force to the tongue. Postoperative tongue symptoms include pain, swelling, numbness, taste disturbance, and rarely motor deficits. Duration and magnitude of force applied have previously been associated with post-operative throat and tongue pain, respectively. We sought to correlate postoperative tongue symptoms with magnitude of force applied and/or duration of suspension and investigate any risk factors for tongue morbidity. MATERIALS AND METHODS: A sample of patients undergoing suspension laryngoscopy between 2015 and 2018 were prospectively recruited. Those with preexisting tongue symptoms, disease or surgery were excluded. Patients completed preoperative and postoperative questionnaires evaluating tongue swelling, numbness, motion and taste disturbance. Symptoms were subjectively scored on a visual scale from 0 to 10. Patient demographics, past medical and social history were also recorded. Intraoperative pressures were measured using a spring force scale, positioned between the suspension arm and Mayo stand. Initial and end suspension forces and duration of suspension were recorded. RESULTS: 120 patients met inclusion criteria, of which 63 completed both preoperative and postoperative questionnaires. 6 patients (9.5%) experienced postoperative tongue symptoms. Suspension force and duration of suspension were not significantly predictive of postoperative tongue symptoms. While all symptomatic patients were current or former cigarette smokers, smoking status was not found to be a statistically significant factor. CONCLUSIONS: Neither suspension forces nor duration of suspension were predictive of postoperative tongue morbidity. Further research is needed to evaluate the role of smoking status on postoperative tongue symptoms.

Ergonomics in facial plastic and reconstructive surgery.

PURPOSE OF REVIEW: Understanding effective ergonomic interventions is crucial for enhancing occupational health and career longevity. There is a paucity of clear ergonomics guidelines in facial plastic and reconstructive surgery (FPRS), placing practitioners at high risk of work-related musculoskeletal disorders (WMSDs) and their consequences. RECENT FINDINGS: There is mounting evidence that FPRS specialists are at increased risk of WMSDs as compared with the public and other surgical specialties. Numerous studies have demonstrated that implementation of ergonomics principles in surgery decreases WMSDs. Furthermore, WMSDs are reported as early as the first year of surgical residency, marking the importance of early intervention. SUMMARY: Fatigue and physical injuries among surgeons occur more often than expected, particularly during complex, extended procedures that necessitate maintaining a constant posture. FPRS procedure often place surgeons into procrustean positions. Thus, integrating ergonomic practices into the practice of FPRS is essential for reducing WMSDs.

Cross-sectional Evaluation of Neurotology Fellowship Directors: A Present-day Snapshot of Leadership.

Objective: To identify demographic, training, and career trends of neurotology fellowship directors (FDs). Study Design: Cross-sectional study. Setting: United States. Subjects: All 26 neurotology FDs identified using the American Neurotology Society (ANS) ACGME Accredited Neurotology Fellowship Program Directory, accessed November 2021. Main Outcome Measures: Data were collected via CVs, institutional biographies, and emailed questionnaires. Data collected includes age, gender, race and ethnicity, residency and fellowship training institution, time since training completion until FD, length of time as FD, and Hirsch-index (h-index). Results: Twenty-six FDs were identified, and 17/26 (65.4%) FDs responded to the questionnaire. The majority (23/26; 88.5%) were male. The mean age of male and female FDs was 56 versus 47 years, respectively. Of the 17 that responded to the survey, 82.4% (14/17) self-identified as Caucasian. The mean h-index was 25.4. Older age correlated with a higher h-index (r = 0.46, P = 0.019). The duration (mean ± SD, years) from fellowship graduation to FD appointment was 10.7 ± 8.1 and 6.3 ± 4.8 from institutional hire. Six (23.1%) FDs had secondary graduate degrees, and 9 (34.6%) held a leadership position at a national otolaryngology organization. Conclusion: This observational study assesses demographic data on current neurotology FDs in the United States with an analysis of gender disparities. The objective measures identified can provide a baseline for growth in FD leadership.

Excision of rare adult cervical thymic cyst.

Cervical thymic cysts (CTCs) represent 1% of all cervical cystic masses. A review of the literature found that CTCs are typically asymptomatic, with a propensity to be left sided. CTCs often require histological evaluation for diagnosis. A 27-year-old male patient presented to an outpatient otolaryngology clinic with worsening bilateral jaw and neck pain and an incidental right-sided neck mass found on cervical MRI. Preoperative differential diagnosis included venolymphatic malformation versus branchial cleft cyst. Histological examination of the excised specimen provided diagnosis of a CTC. Postoperatively, the patient reported improvement in cervical pain. CTCs are a rare cause of lateral neck mass in young adults. Typical presentation included neck enlargement with no symptoms or in some cases compressive symptoms. It is important to consider CTCs when formulating a differential for a lateral neck mass.

Molecular and Cellular Mechanisms of Perineural Invasion in Oral Squamous Cell Carcinoma: Potential Targets for Therapeutic Intervention.

The most common oral cavity cancer is squamous cell carcinoma (SCC), of which perineural invasion (PNI) is a significant prognostic factor associated with decreased survival and an increased rate of locoregional recurrence. In the classical theory of PNI, cancer was believed to invade nerves directly through the path of least resistance in the perineural space; however, more recent evidence suggests that PNI requires reciprocal signaling interactions between tumor cells and nerve components, particularly Schwann cells. Specifically, head and neck SCC can express neurotrophins and neurotrophin receptors that may contribute to cancer migration towards nerves, PNI, and neuritogenesis towards cancer. Through reciprocal signaling, recent studies also suggest that Schwann cells may play an important role in promoting PNI by migrating toward cancer cells, intercalating, and dispersing cancer, and facilitating cancer migration toward nerves. The interactions of neurotrophins with their high affinity receptors is a new area of interest in the development of pharmaceutical therapies for many types of cancer. In this comprehensive review, we discuss diagnosis and treatment of oral cavity SCC, how PNI affects locoregional recurrence and survival, and the impact of adjuvant therapies on tumors with PNI. We also describe the molecular and cellular mechanisms associated with PNI, including the expression of neurotrophins and their receptors, and highlight potential targets for therapeutic intervention for PNI in oral SCC.

Systematic Review of Ossicular Chain Anatomy: Strategic Planning for Development of Novel Middle Ear Prostheses.

Objective To systematically review the anatomy of the ossicular chain. Data Sources Google Scholar, PubMed, and otologic textbooks. Review Methods A systematic literature search was performed on January 26, 2015. Search terms used to discover articles consisted of combinations of 2 keywords. One keyword from both groups was used: [ ossicular, ossicle, malleus, incus, stapes] and [ morphology, morphometric, anatomy, variation, physiology], yielding more than 50,000 hits. Articles were then screened by title and abstract if they did not contain information relevant to human ossicular chain anatomy. In addition to this search, references of selected articles were studied as well as suggested relevant articles from publication databases. Standard otologic textbooks were screened using the search criteria. Results Thirty-three sources were selected for use in this review. From these studies, data on the composition, physiology, morphology, and morphometrics were acquired. In addition, any correlations or lack of correlations between features of the ossicular chain and other features of the ossicular chain or patient were noted, with bilateral symmetry between ossicles being the only important correlation reported. Conclusion There was significant variation in all dimensions of each ossicle between individuals, given that degree of variation, custom fitting, or custom manufacturing of prostheses for each patient could optimize prosthesis fit. From published data, an accurate 3-dimensional model of the malleus, incus, and stapes can be created, which can then be further modified for each patient's individual anatomy.

Preliminary Model for the Design of a Custom Middle Ear Prosthesis.

HYPOTHESIS: Custom prostheses could be used to recreate the ossicular chain and improve hearing. BACKGROUND: Ossicular discontinuity or fixation occurs in 55% of cases of conductive hearing loss, with most cases involving the incus. Reconstruction has been achieved by a variety of methods; however, there has been little improvement in hearing outcomes in decades. METHODS: Precise measurements of anatomic dimensions, weight, and center of gravity were taken from 19 cadaveric incudes. These measurements were combined with measurements from the medical literature and micro-computed tomography (micro-CT) of cadaveric temporal bones to generate a rasterizable incus model. As a proof of concept, incudal replacements including possible anatomic variations were then three-dimensionally (3-D) printed and inserted into a cadaveric temporal bone. RESULTS: Our measurements of cadaveric incudes corresponded well with those from the medical literature. These measurements were combined with anatomical information from micro-CT allowing identification of critical features of the incus, which remained constant. Other model features were modified to increase stability and facilitate synthesis, including broadening and thickening of the lenticular process and the incudomalleolar articulation. 3-D printed incudal replacements based on this model readily fit into a cadaveric temporal bone and successfully bridged the gap between malleus and incus. CONCLUSION: We have generated a model for custom 3-D synthesis of incudal prostheses. While current 3-D printing in biocompatible materials at the size required is limited, the technology is rapidly advancing, and 3-D printing of incudal replacements with polylactic acid (PLA) is of the correct size and shape.