An introduction to machine learning and generative artificial intelligence for otolaryngologists-head and neck surgeons: a narrative review.

PURPOSE: Despite the robust expansion of research surrounding artificial intelligence (AI) and machine learning (ML) and their applications to medicine, these methodologies often remain opaque and inaccessible to many otolaryngologists. Especially, with the increasing ubiquity of large-language models (LLMs), such as ChatGPT and their potential implementation in clinical practice, clinicians may benefit from a baseline understanding of some aspects of AI. In this narrative review, we seek to clarify underlying concepts, illustrate applications to otolaryngology, and highlight future directions and limitations of these tools. METHODS: Recent literature regarding AI principles and otolaryngologic applications of ML and LLMs was reviewed via search in PubMed and Google Scholar. RESULTS: Significant recent strides have been made in otolaryngology research utilizing AI and ML, across all subspecialties, including neurotology, head and neck oncology, laryngology, rhinology, and sleep surgery. Potential applications suggested by recent publications include screening and diagnosis, predictive tools, clinical decision support, and clinical workflow improvement via LLMs. Ongoing concerns regarding AI in medicine include ethical concerns around bias and data sharing, as well as the "black box" problem and limitations in explainability. CONCLUSIONS: Potential implementations of AI in otolaryngology are rapidly expanding. While implementation in clinical practice remains theoretical for most of these tools, their potential power to influence the practice of otolaryngology is substantial.

An Evaluation of Quality, Reliability, and Accuracy of Vocal Health Content on TikTok.

OBJECTIVES: Social media plays an ever-growing part in modern life and is a frequent source of health information for patients. Singers are particularly likely to receive health information solely from fellow musicians and may experience barriers to seeking vocal healthcare. However, there have been no studies to date evaluating vocal health information on social media. Our study aimed to assess the quality, reliability, and accuracy of vocal health content on TikTok. STUDY DESIGN: Cross-sectional analysis. METHODS: Three searches were carried out on Tiktok, using the terms "vocal health," "vocal injury," and "voice tips." The top 50 videos in each category were cataloged for extraction of data and for analysis on three discrete scales. Two independent reviewers rated each video using the Global Quality Scale (GQS), modified DISCERN scale, and Accuracy in Digital-health Instrument (ANDI). RESULTS: After the removal of duplicates and unavailable content, 146 videos were analyzed. The mean (range) length was 59.8 seconds (5-239), and number of views per video was 886,265 (432-36,700,000). The vast majority of videos (94.5%) were created by non-clinicians; only two videos (1.37%) were posted by otolaryngologists. The mean (SD) GQS score was 2.34 (0.75) out of a maximum of five, the DISCERN score was 0.97 (0.56) out of five, and the ANDI score was 2.85 (0.87) out of four. Video length was positively correlated with GQS and DISCERN scores, but views, likes, and shares were either not associated or negatively associated with GQS, DISCERN, and ANDI. CONCLUSIONS: Most videos were of low quality and reliability and moderate accuracy. Measures of popularity were either uncorrelated or negatively correlated with quality, reliability, and accuracy, suggesting that TikTok users are more likely to engage with lower-quality content online. This implies a potential role for vocal health professionals to fill a crucial gap with reliable information on social media.

Speech Quality Perception in Unilateral Cochlear Implant Users With Single-Sided Deafness.

OBJECTIVE: Cochlear implant (CI) users frequently complain about speech quality perception (SQP). In patients undergoing cochlear implantation for single-sided deafness, there is concern that poor SQP from the implanted ear will negatively impact binaural (CI + normal hearing [NH]) SQP. In this study, we investigate if binaural SQP is measurably different than unimplanted NH alone. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary care center. METHODS: Fifteen unilateral CI users with NH in the contralateral ear completed the validated Columbia Speech Quality Instrument. This instrument consists of 9 audio clips rated across 14 specific speech qualities using a 10-point visual analog scale. SQP was assessed in 3 conditions: CI only, NH only, and CI + NH. RESULTS: Median speech quality scores were worse in the CI only condition compared to the NH only (50.0 vs 72.6, P = .0003) and binaural (50.0 vs 71.0, P = .007) conditions. Median speech quality scores were not significantly different between the NH only and binaural conditions (72.6 vs 71, P = .8). Compared to NH, CI speech quality sounded less clear, less natural, and more mechanical. CONCLUSION: Compared to NH, SQP is poorer with a CI alone. However, in contrast to expectation, there is no significant difference between NH and binaural SQP. This suggests poorer CI speech perception does not negatively impact binaural SQP in patients undergoing cochlear implantation for single-sided deafness.

National Cohort Data Suggests an Association Between Serious Mental Illness and Audiometric Hearing Loss.

OBJECTIVE: To explore whether there is an association between serious mental illness (SMI) and hearing loss (HL) among US Hispanic adults. STUDY DESIGN AND SETTING: Cross-sectional epidemiological study (Hispanic Community Health Study), including multicentered US volunteers. METHODS: Multivariable linear regressions were conducted to study the association between SMI and HL. Adjustments were made for potential confounders including age, sex, education, vascular disease (hypertension or diabetes mellitus), and cognition. SMI was defined by (1) antipsychotic medication classification and (2) the use of at least 1 antipsychotic medication specifically used to treat SMI in clinical psychiatric practice. HL was measured by pure tone audiometry. RESULTS: A total of 7581 subjects had complete data. The mean age was 55.2 years (SD = 7.5 years) and the mean pure tone average in the better ear was 16.8 dB (SD = 10.7 dB). A total of 194 (2.6%) subjects were taking a HCHS-defined antipsychotic and 98 (1.3%) were taking at least 1 antipsychotic specifically used to treat SMI. On multivariable regression, use of HCHS's classified antipsychotics was associated with 3.75 dB worse hearing (95% confidence interval [CI] = 2.36-5.13, P < .001) and use of antipsychotics specific for SMI was associated with 4.49 dB worse hearing (95% CI = 2.56-6.43, P < .001) compared to those not using antipsychotics. CONCLUSION: SMI, as defined by either the use of HCHS-defined antipsychotics or the use of antipsychotic medication specific for SMI, is associated with worse hearing, controlling for potential confounders. Whether SMI contributes to HL, antipsychotic medication (through ototoxicity) contributes to HL, or whether HL contributes to SMI is unknown and warrants further investigation.

Mannose Supplementation Curbs Liver Steatosis and Fibrosis in Murine MASH by Inhibiting Fructose Metabolism.

Metabolic dysfunction-associated steatohepatitis (MASH) can progress to cirrhosis and liver cancer. There are no approved medical therapies to prevent or reverse disease progression. Fructose and its metabolism in the liver play integral roles in MASH pathogenesis and progression. Here we focus on mannose, a simple sugar, which dampens hepatic stellate cell activation and mitigates alcoholic liver disease in vitro and in vivo . In the well-validated FAT-MASH murine model, oral mannose supplementation improved both liver steatosis and fibrosis at low and high doses, whether administered either at the onset of the model ("Prevention") or at week 6 of the 12-week MASH regimen ("Reversal"). The in vivo anti-fibrotic effects of mannose supplementation were validated in a second model of carbon tetrachloride-induced liver fibrosis. In vitro human and mouse primary hepatocytes revealed that the anti-steatotic effects of mannose are dependent on the presence of fructose, which attenuates expression of ketohexokinase (KHK), the main enzyme in fructolysis. KHK is decreased with mannose supplementation in vivo and in vitro, and overexpression of KHK abrogated the anti-steatotic effects of mannose. Our study identifies mannose as a simple, novel therapeutic candidate for MASH that mitigates metabolic dysregulation and exerts anti-fibrotic effects.