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With technological advancements, artificial intelligence (AI) has progressed to become a ubiquitous part of human life. Its aspects in otorhinolaryngology are varied and are continuously evolving. Currently, AI has applications in hearing aids, imaging technologies, interpretation of auditory brain stem systems, and many more in otology. In rhinology, AI is seen to impact navigation, robotic surgeries, and the determination of various anomalies. Detection of voice pathologies and imaging are some areas of laryngology where AI is being used. This review gives an outlook on the diverse elements, applications, and advancements of AI in otorhinolaryngology. The various subfields of AI including machine learning, neural networks, and deep learning are also discussed. Clinical integration of AI and otorhinolaryngology has immense potential to revolutionize the healthcare system and improve the standards of patient care. The current applications of AI and its future scopes in developing this field are highlighted in this review.
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OBJECTIVES: Chronic rhinosinusitis (CRS) is a widely prevalent condition, however its degree of severity according to sex requires further study. The literature shows that sex-based differences exist in the severity of asthma and allergic airway disease in the population. These findings point to a potential hormonal cause for this difference, but there is no study suggesting the role of sex in CRS with nasal polyps (CRSwNP). The purpose of this study was to examine the association of sex and CRSwNP severity in the United States. METHODS: This study was conducted on data gathered from 181 participants in the NAVIGATE I and NAVIGATE II randomized control trials within the OPTINOSE database. Participants were analyzed based on sex controlling for airway-related comorbidities, including history of asthma, race, and ethnicity. SNOT-22 scores were assessed as a quality-of-life outcome measure for CRS. The association between sex and SNOT-22 scores was determined using multiple linear regression. RESULTS: There were 81 female and 100 male participants. SNOT-22 scores were significantly higher in females. The average reported SNOT-22 score was 53.8 ± 16.5 in females and 46.8 ± 18.8 in males. On adjusted regression, the association of sex and SNOT-22 scores approached but didn't reach significance (ß: -4.97; 95 % CI: -10.68-0.73; p = 0.09). CONCLUSIONS: On average, females had more severe manifestations of CRSwNP in comparison to males, with the adjusted association approaching statistical significance. Further studies, potentially looking at hormones as a cause of pathogenesis, are needed to better elucidate the role of sex in CRSwNP.
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Rhinomanometry is a pivotal diagnostic technique in rhinology, providing a quantitative assessment of nasal airflow and resistance. This review comprehensively examines the historical development, principles and clinical applications of rhinomanometry, emphasising its role in diagnosing nasal obstructions, preoperative evaluations and monitoring therapeutic outcomes. Recent advancements, including the integration with imaging technologies and the application of artificial intelligence (AI), have significantly enhanced the accuracy and utility of rhinomanometry. Despite facing challenges such as technical limitations and the need for standardisation, rhinomanometry remains an invaluable tool in both clinical and research settings. The review also explores future directions, highlighting the potential for device miniaturisation, telemedicine integration, personalised protocols and collaborative research efforts. These advancements will likely expand the accessibility, accuracy and clinical relevance of rhinomanometry, solidifying its importance in the ongoing evolution of rhinology practice.
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OBJECTIVE: To describe and illustrate septal perforation shape through the documentation and analysis of length and height measurements. A secondary objective is to correlate perforation size to surgical and nonsurgical etiologies. STUY DESIGN: Retrospective case series. SETTING: Tertiary academic medical center. METHODS: Length and height of consecutively treated perforations over a 3-year period were measured directly or through computed tomography. Mean differences in length and height measurements were compared and regression analysis used to determine perforation shape and the effect of etiology on perforation size. Perforations were classified by length into small (1-5 mm), medium (6-15 mm), and large (>15 mm) and correlated to shape and etiology. RESULTS: One hundred twenty-four patients (mean age 50.4 years, 60.5% female) met study inclusion criteria. Height was less than length in 93% of perforations 5 mm or greater in length. Mean perforation height was significantly less than length for medium and large perforations (P < .001). Mean length and height measurements of nonsurgical perforations were greater than those for surgical perforations (P < .001). CONCLUSION: Height is less than length in over 90% of septal perforations. Most perforations assume an elliptical shape as they enlarge. Accurate measurement and presentation of length and height is relevant information to perforation management decisions and for the evaluation of treatment outcomes.
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KEY POINTS: This follow-up dual-institutional and longitudinal study further evaluated for underlying gender biases in LORs for rhinology fellowship. Explicit and implicit linguistic gender bias was found, heavily favoring male applicants.
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KEY POINTS: Social determinants of health link to worse quality of life in pediatric chronic rhinosinusitis. The area deprivation index (ADI) may serve to predict health disparities in these patients.
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KEY POINTS: Sham procedures produce a clinically significant impact on patient-reported outcome measures This effect should be considered when designing and interpreting the results of RCTs.
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KEY POINTS: GPT-4 generated moderate quality information in response to questions regarding sinusitis and surgery. GPT-4 generated significantly higher quality responses to questions regarding treatment of sinusitis. Future studies exploring quality of GPT responses should seek to limit bias and use validated instruments.
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Objectives: Applicants for rhinology fellowship often utilize program websites to make informed application decisions. Although the American Rhinologic Society (ARS), the professional organization of rhinologists in the United States, maintains a directory of rhinology fellowships that includes basic information for each program, the ARS discloses that the information is provided directly by program directors and may therefore be inconsistent, inaccurate, or outdated. Methods: Our study evaluates the content and comprehensiveness of rhinology fellowship program websites in 31 areas related to either clinical training, research, application process, incentives, or administrative communications. Results: Of 32 unique rhinology fellowship programs, 29 of 32 (90.6%) had websites. On average program websites included 12.1 of the 31 items analyzed (39.0%). Information related to clinical training (mean 54.2%) and research (mean 60.9%) was included more often than information related to application process (mean 50.6%), and incentives (mean 14.9%). Programs with [Formula: see text] 5 dedicated physician faculty included more items than smaller programs (15.3 vs. 11.7 items, P = 0.015). Conclusion: Websites included information on clinical training and research more often than on incentives, even though these factors are important to many applicants. Few programs detailed past or ongoing research opportunities, which if included could help applicants identify mentors with similar research interests. Most websites had less than half of factors analyzed, emphasizing need for continued improvement.
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Objective: Advances in deep learning and artificial intelligence (AI) have led to the emergence of large language models (LLM) like ChatGPT from OpenAI. The study aimed to evaluate the performance of ChatGPT 3.5 and GPT4 on Otolaryngology (Rhinology) Standardized Board Examination questions in comparison to Otolaryngology residents. Methods: This study selected all 127 rhinology standardized questions from www.boardvitals.com, a commonly used study tool by otolaryngology residents preparing for board exams. Ninety-three text-based questions were administered to ChatGPT 3.5 and GPT4, and their answers were compared with the average results of the question bank (used primarily by otolaryngology residents). Thirty-four image-based questions were provided to GPT4 and underwent the same analysis. Based on the findings of an earlier study, a pass-fail cutoff was set at the 10th percentile. Results: On text-based questions, ChatGPT 3.5 answered correctly 45.2% of the time (8th percentile) (P = .0001), while GPT4 achieved 86.0% (66th percentile) (P = .001). GPT4 answered image-based questions correctly 64.7% of the time. Projections suggest that ChatGPT 3.5 might not pass the American Board of Otolaryngology Written Question Exam (ABOto WQE), whereas GPT4 stands a strong chance of passing. Discussion: The older LLM, ChatGPT 3.5, is unlikely to pass the ABOto WQE. However, the advanced GPT4 model exhibits a much higher likelihood of success. This rapid progression in AI indicates its potential future role in otolaryngology education. Implications for Practice: As AI technology rapidly advances, it may be that AI-assisted medical education, diagnosis, and treatment planning become commonplace in the medical and surgical landscape. Level of Evidence: Level 5.
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This case report describes rare concomitant allergic fungal rhinosinusitis (AFRS) and chronic granulomatous invasive fungal sinusitis (CGIFS) in a 34-year-old woman with acute lymphoblastic leukemia and graft-versus-host disease (GVHD) post bone marrow transplantation. Initially presenting with rhinorrhea and nasal obstruction, the patient was diagnosed with AFRS in the right maxillary sinus, followed by a postoperative course of CGIFS in the left nasal cavity, showcasing the unique occurrence. She was not immunocompromised during diagnosis. CGIFS may have occurred because of surgery; however, voriconazole led to significant improvement. This case highlights noninvasive and invasive fungal infections in patients with chronic rhinosinusitis and a history of GVHD and underscores the complexity of diagnosing and managing such cases.
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OBJECTIVE: This case report presents a unique manifestation of Mucocutaneous Leishmaniasis (MCL) in a 56-year-old woman with chronic nasal symptoms. Initially diagnosed with chronic sinusitis and septal perforation, the patient's history of a childhood sandfly bite and subsequent episodes of Leishmaniasis, revealed after nasal surgery, provided crucial information for accurate diagnosis. METHODS: A retrospective review was conducted on this patient's electronic medical record. RESULTS: The patient's life-long struggle with nasal obstruction, congestion, and a septal perforation initially masked the underlying MCL. Sinus surgery and persistent symptoms further complicated the diagnostic process. Only after postoperative complications, including grainy skin texture extending into the nasal passages, did the patient recall the sandfly bite, prompting reevaluation and diagnosis of MCL. The case highlights the challenges of diagnosing MCL due to its varied presentation and potential mimicry of other chronic nasal conditions. It emphasizes the importance of thorough patient history-taking, especially when symptoms are atypical or persistent. Additionally, the report underscores the potential for unexpected postoperative complications in MCL patients and the need for vigilance in recognizing and assessing them. CONCLUSION: This case contributes to the understanding of MCL's diverse clinical presentation and the importance of early diagnosis and multidisciplinary management for prompt intervention and improved outcomes.
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Leishmaniose Mucocutânea , Humanos , Feminino , Pessoa de Meia-Idade , Leishmaniose Mucocutânea/diagnóstico , Leishmaniose Mucocutânea/complicações , Obstrução Nasal/etiologia , Obstrução Nasal/diagnóstico , Obstrução Nasal/cirurgia , Perfuração do Septo Nasal/etiologia , Perfuração do Septo Nasal/diagnóstico , Sinusite/diagnóstico , Sinusite/complicações , Mordeduras e Picadas de Insetos/complicações , Mordeduras e Picadas de Insetos/diagnóstico , Tomografia Computadorizada por Raios X , Doença Crônica , Diagnóstico DiferencialRESUMO
Despite the widespread adoption of nasal endoscopy (NE) in the evaluation of sinonasal disease, its diagnostic potential may still be underutilized. Developments in endoscopic technology have led to significant improvements in video quality and maneuverability. However, there is concern that NE continues to be used primarily for the identification of gross pathology, with relative neglect of more subtle findings such as surface features of inflammation and mucus. With fewer technical limitations to perceive these abnormalities, there is potential to greatly improve the diagnostic value of NE. The reader is herein asked to consider several important visual nuances encountered during NE, with the hope that this engenders an appreciation of the versatility of NE as a diagnostic tool.
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Endoscopia , Humanos , Endoscopia/métodos , Seios Paranasais/diagnóstico por imagem , Doenças dos Seios Paranasais/diagnóstico , Nariz/patologia , Doenças Nasais/diagnósticoRESUMO
INTRODUCTION: Chronic rhinosinusitis is a prevalent condition with significant implications for both patients and society at large. The diagnostic and treatment approaches are primarily guided by the EPOS2020 guidelines in Europe, which increasingly delve into the molecular -mechanism of the disease and its resulting phenotypes. In recent years, biologics have emerged as a promising option, in particular for cases that are refractory to conventional therapies. However, the management landscape has become more intricate, necessitating consideration and potential concurrent treatment of comorbidities. Moreover, the utilization of biologics is accompanied by substantial costs, warranting personalized assessment for each patient. Hence, the establishment of specialized boards comprising clinicians from diverse disciplines to collaborate on treatment recommendations is imperative.
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Rinite , Sinusite , Sinusite/diagnóstico , Sinusite/terapia , Rinite/diagnóstico , Rinite/terapia , Doença Crônica , Humanos , Colaboração Intersetorial , Comunicação Interdisciplinar , Produtos Biológicos/uso terapêutico , RinossinusiteRESUMO
OBJECTIVES: Virtual reality (VR) and augmented reality (AR) are innovative technologies that have a wide range of potential applications in the health care industry. The aim of this study was to investigate the body of research on AR and VR applications in rhinology by performing a scoping review. DATA SOURCES: PubMed, Scopus, and Embase. REVIEW METHODS: According to PRISM-ScR guidelines, a scoping review of literature on the application of AR and/or VR in the context of Rhinology was conducted using PubMed, Scopus, and Embase. RESULTS: Forty-nine articles from 1996 to 2023 met the criteria for review. Five broad types of AR and/or VR applications were found: preoperative, intraoperative, training/education, feasibility, and technical. The subsequent clinical domains were recognized: craniovertebral surgery, nasal endoscopy, transsphenoidal surgery, skull base surgery, endoscopic sinus surgery, and sinonasal malignancies. CONCLUSION: AR and VR have comprehensive applications in Rhinology. AR for surgical navigation may have the most emerging potential in skull base surgery and endoscopic sinus surgery. VR can be utilized as an engaging training tool for surgeons and residents and as a distraction analgesia for patients undergoing office-based procedures. Additional research is essential to further understand the tangible effects of these technologies on measurable clinical results. Laryngoscope, 2024.
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OBJECTIVE: To propose a novel quality metric tool for retrospectively examining ESS performed on chronic rhinosinusitis (CRS) patients, ultimately to facilitate clinician self-assessment and optimize care provision within this population. DESIGN: Quality improvement study. SETTING: Multi-center. PARTICIPANTS: Observational, prospective research database of adult patients with medically recalcitrant CRS, presenting to seven North-American academic rhinology centers, who underwent ESS between 2011 and 2021. Participant characteristics, comorbidities, and preoperative study measures were collected. MAIN OUTCOMES AND MEASURES: A simple ratio of preoperative Lund-Mackay (LM) score to the number of sinus regions operated on during the course of ESS was determined for each participant and dichotomized into ratios of >1.0 or <1.0. RESULTS: 828 study participants with medically recalcitrant CRS met final study inclusion, of which 47.8 % were male with an average age of 49.0 years. Approximately 50.9 % of participants had a history of previous ESS. Overall mean ratio between preoperative LM scores and numbers of surgically addressed sinuses for all patients with CRS (n = 828) was 1.61 (range: 0.00-6.00), with a minority of subjects (n = 108; 13.0 %) found to have ratios below 1.00. Mean ratios between patients who underwent primary ESS versus revision ESS were not statistically different (2.00 [±0.83] vs 1.98 [±0.88]; 0.02 %, 95 % CI -0.10, 0.14; P = 0.76), whereas differences in mean ratios between CRSsNP patients (without nasal polyposis) and CRSwNP patients (with nasal polyposis) were statistically significant (1.78 [±0.93] vs 2.26 [±0.67]; 0.48 %, 95 % CI 0.37, 0.59; P ≤ 0.001). CONCLUSIONS AND RELEVANCE: This quality metric ratio represents a simple operational means for clinicians to integrate qualitative methodology into self-reflection when evaluating the extent of ESS performed on CRS patients. Its use as a clinical tool for retrospective self-reflection enables the surgeon to identify areas for improvement, assess situational specifics, and hone their craft.
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Endoscopia , Melhoria de Qualidade , Rinossinusite , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Crônica , Endoscopia/métodos , Seios Paranasais/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Rinossinusite/diagnóstico , Rinossinusite/cirurgia , Autoavaliação (Psicologia)RESUMO
Rhinology, allergy, and skull base surgery are fields primed for the integration and implementation of artificial intelligence (AI). The heterogeneity of the disease processes within these fields highlights the opportunity for AI to augment clinical care and promote personalized medicine. Numerous research studies have been published demonstrating the development and clinical potential of AI models within the field. Most describe in silico evaluation models without direct clinical implementation. The major themes of existing studies include diagnostic or clinical decisions support, clustering patients into specific phenotypes or endotypes, predicting post-treatment outcomes, and surgical planning.
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Inteligência Artificial , Otolaringologia , Humanos , Otolaringologia/métodos , Medicina de Precisão/métodosRESUMO
INTRODUCTION: The recent approval of Dupilumab has profoundly revolutionized the management of patients affected by severe and recalcitrant Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). However, a review that summarizes the results of real-life studies and compares them to phase 3 studies SINUS-24 and 52 is still lacking. MATERIALS AND METHODS: A search of all real-life studies published from 2019 to 2023 was performed. Patients characteristics at baseline and 6 and 12 months after starting Dupilumab were extracted and compared to those from phase 3 trials: age, sex, smoking habits, comorbid asthma and aspirin-exacerbated respiratory disease (AERD), previous endoscopic sinus surgery (ESS), hematic eosinophils and total IgE, NasalAQ2 Polyps Score (NPS), smell, SNOT-22, adverse events (AEs), and response to treatment. RESULTS: 15 papers were included with an overall number of 1658 patients. A higher rate of comorbidities and previous ESS was found in patients from real-life studies. In addition, they had worse smell and SNOT-22 at baseline compared to patients from SINUS-24 and 52. Comorbid and post-ESS patients tended to have a faster NPS and SNOT-22 improvement, although the absolute values were not clinically relevant. A more extensive surgery and a number of ESS ≥ 2 were related to worse olfactory outcomes, probably due to iatrogenic damage. No correlation was found between hematic eosinophils and outcomes. AEs were reported by 12.4% of patients and 2.2% had to discontinue dupilumab. Weight gain was an emergent AE (0.8%), probably related to the restored sense of smell and taste. Non-responders were 3.5% and they were switched to systemic steroid, ESS, or another biologic. CONCLUSION: Despite some differences in prescription criteria between countries, dupilumab was demonstrated to be effective even in the real-life scenario. However, emerging AEs and possible unknown long-term AEs of a likely lifelong therapy should be considered.
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Nasal septal abscess (NSA) is considered a rhinologic emergency. Fortunately, the incidence of NSA has markedly reduced due to the introduction of antibiotics and easy access to medical care. NSA commonly results from infection in the space between the nasal septum and the overlying mucoperichondrium and/or mucoperiosteum, typically secondary to nasal septal hematoma, but it can also be idiopathic. Prompt diagnosis and intervention are critical to avoid further complications. This paper reports the case of a 46-year-old man with no known risk factors for NSA. He was treated with broad-spectrum antibiotics, and the surgical treatment involved incision and drainage with the intraoperative placement of a Penrose drain and a silastic sheet on postoperative day five. The patient was discharged without complications such as septal perforation or saddle nose deformity.