Is artificial intelligence ready to replace specialist doctors entirely? ENT specialists vs ChatGPT: 1-0, ball at the center.

PURPOSE: The purpose of this study is to evaluate ChatGPT's responses to Ear, Nose and Throat (ENT) clinical cases and compare them with the responses of ENT specialists. METHODS: We have hypothesized 10 scenarios, based on ENT daily experience, with the same primary symptom. We have constructed 20 clinical cases, 2 for each scenario. We described them to 3 ENT specialists and ChatGPT. The difficulty of the clinical cases was assessed by the 5 ENT authors of this article. The responses of ChatGPT were evaluated by the 5 ENT authors of this article for correctness and consistency with the responses of the 3 ENT experts. To verify the stability of ChatGPT's responses, we conducted the searches, always from the same account, for 5 consecutive days. RESULTS: Among the 20 cases, 8 were rated as low complexity, 6 as moderate complexity and 6 as high complexity. The overall mean correctness and consistency score of ChatGPT responses was 3.80 (SD 1.02) and 2.89 (SD 1.24), respectively. We did not find a statistically significant difference in the average ChatGPT correctness and coherence score according to case complexity. The total intraclass correlation coefficient (ICC) for the stability of the correctness and consistency of ChatGPT was 0.763 (95% confidence interval [CI] 0.553-0.895) and 0.837 (95% CI 0.689-0.927), respectively. CONCLUSIONS: Our results revealed the potential usefulness of ChatGPT in ENT diagnosis. The instability in responses and the inability to recognise certain clinical elements are its main limitations.

Endoscopic stapler-assisted Zenker's diverticulotomy: The surgical technique with video.

OBJECTIVE: The aim of the present article is to describe step by step the endoscopic stapler-assisted Zenker's diverticulotomy (ESD) and to show in details pre- and post-operative management. STUDY DESIGN: Case study with instructional video. SETTING: Department Of Otolaryngology, San Bortolo Hospital of Vicenza. BACKGROUND: Several comparable surgical approaches have been proposed for the treatment of hypopharyngeal Zenker's diverticulum, however determining the best operative facility in terms of safety, outcomes and hospital stay is still a matter of debate. In this scenario the endoscopic treatment of Zenker's diverticulum using the stapler device permits simultaneous sectioning and suturing of the septum between the pouch and esophagus, creating a more functional common cavity. METHODS: We here present a step by step description of an endoscopic treatment of Zenker's diverticulum using the stapler device. Common referral symptoms are persistent hoarseness and globus sensation associated with transient dysphagia. An endoscopic dynamic examination of upper airway may reveal the presence of a hypopharyngeal pouch, which should be confirmed by a fluoroscopic barium esophageal radiography. If a Zenker's diverticulum is diagnosed, an endoscopic single or multiple diverticulotomy with a stapler device is indicated. The patient may be discharged after 24-48 h without any dietary restrictions, once a post-operative esophageal radiography rules out any sort of perforation. CONCLUSION: It is of relevance to precisely know the Endoscopic Stapler-assisted Zenker's Diverticulotomy as it represents a safe and efficient procedure and ensures good outcomes with the benefit of being performed even on a planned 24-hour-stay basis.

Endoscopic posterior ventricular cordectomy with contact diode laser: how I do it.

BACKGROUND: The treatment of bilateral vocal fold paralysis is mainly surgical and several procedures can be used to guarantee adequate breathing. Furthermore, other causes of the narrowing of the natural airways could coexist and the treatment should consider all of them. METHODS: A supraglottic extension of posterior cordectomy to the false homolateral chord is described, which provides a further widening of the airway while maintaining acceptable voice quality. CONCLUSION: Endoscopic posterior ventricular cordectomy performed by contact diode laser may be a viable and safe option, especially in those patients who present bilateral vocal fold paralysis associated with various degrees of laryngospasm.

Negative Outcome of Temporalis Fascia Graft in Tympanoplasty with Excessive Bleeding: A Retrospective Study.

Background and Objectives: Non-autologous graft materials hold promise for tympanic membrane (TM) perforation closure. In the present manuscript, we aimed to evaluate the influence of clinical and surgical (i.e., graft materials) characteristics on tympanoplasty outcome in chronic otitis media (COM). Materials and Methods: We retrospectively reviewed clinical and surgical characteristics of COM patients with TM perforation treated with tympanoplasty and mastoidectomy. Univariate and multivariate appropriate tests were applied. Results: We used xenograft (porcine submucosal collagen) in 163 patients, and temporalis fascia in 210. The mean follow-up time was 37.2 months. Postoperative TM perforation (i.e., negative outcome) was detected in 11.6% of cases with xenograft, and in 12.8% with temporalis fascia. Performing uni- and multivariate analysis, we determined that large (three or all quadrants) TM perforation (p = 0.04) and moderate-to-severe intraoperative bleeding (p = 0.03) were independent prognostic factors of negative outcome. Considering the 197 patients with moderate-to-severe intraoperative bleeding, we disclosed that the use of temporalis fascia (p = 0.03) was an independent risk factor of postoperative TM perforation. Conclusions: According to our results, large TM perforation and moderate-to-severe intraoperative bleeding were independent prognostic factors of negative outcome in adult COM patients treated with tympanoplasty. In the sub-group of COM patients with excessive intraoperative bleeding, use of temporalis fascia was associated with negative outcome; these patients could benefit from xenograft materials. These findings should be tested in large randomized clinical trials.

Hearing Status and Ventilation Tube at Time of Palatoplasty in Cleft Lip and Palate Patients: A Retrospective Study.

Background and Objectives: There is no consensus regarding the indications for and timing of ventilation tube (VT) insertion in cleft lip and palate (CLP) patients. Our aim was to search for clinical and surgical (i.e., VT insertion) characteristics that influence the hearing status in CLP. Materials and Methods: We reviewed the hearing outcome of consecutive CLP cases operated on at a single referral center. Univariate and multivariate analysis were applied as appropriate. Results: We included 285 consecutive CLP patients, 109 female and 176 male; the mean age at last follow-up was 16.2 years. Unilateral CLP was found in 249 cases and bilateral CLP in 36. Early VTs (i.e., at the time of hard palate surgery) were applied in 75 (26.3%) patients. Late VTs (i.e., after hard palate surgery during follow-up) were applied in 69 (24.2%) children, at a mean age of 6.7 years old. Hearing loss (pure-tone average > 20 dB) was found in 114 (40%) CLP patients at last available follow-up (mild hearing loss in 96 patients, moderate in 18). In univariate and multivariate analyses, we found that only the absence of early VT insertion (p = 0.0003; OR = 18.2) was an independent prognostic factor of hearing loss in CLP patients. Furthermore, when early VTs were not inserted, there was a high risk of late VT (p = 0.002; OR 13.6). Conclusions: According to our results, the absence of VT insertion at the time of hard palate surgery is an independent prognostic risk factor of hearing loss in CLP patients. Early VT placement in CLP patients may prevent hearing loss and related consequences. These findings should be tested in a large, randomized clinical trial.

Transethmoidal encephalocele endoscopically treated in a newborn: a case report.

Congenital encephalocele is a very rare entity, with herniation of normal brain or gliotic tissue through a defect in the skull. The objective is to present a newborn child diagnosed with transethmoidal encephaloceles at birth. She developed respiratory problems, feeding difficulties, and failure to thrive since the first days of life and so required early surgery at her 33th day of life, through an endoscopic nasal approach. Technical difficulties encountered, complications, and management are discussed. To the best of our knowledge, this is the first report of endoscopic treatment of transethmoidal encephalocele in a newborn. Further studies are needed to understand the best way to repair the dural defect in this rare condition.

The role of ultrasonic instruments in pharyngolaryngeal endoscopic surgery.

The purpose of this study was to assess the applicability and efficacy of ultrasonic instruments in laryngeal and pharyngeal endoscopic surgery. This article describes three cases of supraglottic laryngopharyngeal carcinoma transorally treated with the Harmonic forceps, which are indicative of our preliminary experience in this field. Based on our preliminary experience, we believe that the use of the ACE Harmonic forceps opens up very encouraging prospects in transoral endoscopic surgery of pharyngolaryngeal tumors and can potentially become a key instrument in this area. Given their different characteristics, we believe that ultrasonic instruments should be used not so much as an alternative to, but rather in addition to those traditionally used in pharyngolaryngeal endoscopic surgery and laser in particular. Finally, we hope that a more widespread use of these instruments in this surgical field may encourage manufacturers to solve the current technical limitations of miniaturization, thus designing and developing more precise and accurate instruments for this type of surgery.

Neural stem/progenitor cells from olfactory neuroepithelium collected by nasal brushing as a cell model reflecting molecular and cellular dysfunctions in schizophrenia.

OBJECTIVES: Neural stem/progenitor cells derived from olfactory neuroepithelium (hereafter olfactory neural stem/progenitor cells, ONSPCs) are emerging as a potential tool in the exploration of psychiatric disorders. The present study intended to assess whether ONSPCs could help discern individuals with schizophrenia (SZ) from non-schizophrenic (NS) subjects by exploring specific cellular and molecular features. METHODS: ONSPCs were collected from 19 in-patients diagnosed with SZ and 31 NS individuals and propagated in basal medium. Mitochondrial ATP production, expression of ß-catenin and cell proliferation, which are described to be altered in SZ, were examined in freshly isolated or newly thawed ONSPCs after a few culture passages. RESULTS: SZ-ONSPCs exhibited a lower mitochondrial ATP production and insensitivity to agents capable of positively or negatively affecting ß-catenin expression with respect to NS-ONSPCs. As to proliferation, it declined in SZ-ONSPCs as the number of culture passages increased compared to a steady level of growth shown by NS-ONSPCs. CONCLUSIONS: The ease and safety of sample collection as well as the differences observed between NS- and SZ-ONSPCs, may lay the groundwork for a new approach to obtain biological material from a large number of living individuals and gain a better understanding of the mechanisms underlying SZ pathophysiology.

Operative technique: Tracheal resection and anastomosis in a revision surgery.

Tracheal stenosis is an uncommon pathological condition in which the lumen of the trachea is reduced. Within its management an adequate preoperative workup is crucial to determine the most appropriate procedure for each patient. In this scenario tracheal resection and anastomosis is a viable approach, as a procedure in which part of the trachea is removed and then restored with a tension-free anastomosis. It is usually indicated for extensive and high-grade lesions or when previous endoscopic procedures had failed. The patient here presented had already undergone a balloon dilatation twice and a tracheal resection and referred to our clinic with a residual tracheal stenosis graded Myer-Cotton 3 involving three tracheal rings. We here illustrate step-by-step the surgical procedure and highlight a peculiar way to perform the anastomosis, especially in a revision surgery.

Oxidized cellulose-based reaction mimicking thyroidal recurrence of disease: a case report and literature review.

Oxidized cellulose is a hemostatic agent currently used in surgery. Foreign body reactions have been described after its use. This paper describes a foreign body reaction caused by oxidized cellulose in a young woman who underwent thyroid surgery. A patient underwent two thyroid surgeries for treatment of papillary carcinoma. Five years after the last surgery, an asymptomatic mass was detected with a routine ultrasound in the left thyroid cavity. After surgical removal, the mass turned out to be a foreign body granuloma based on oxidized cellulose sheets used in the previous surgery. The patient was discharged from the hospital without complications. The follow-up period was uneventful. Oxidized cellulose is a useful tool in surgery to control and prevent intra and post-operative bleeding. Even if it is a biodegradable material, sometimes it persists in the human body causing foreign body reactions that can be misdiagnosed. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03556-0.

Ethmoid osteoma with frontal and orbital extension: endoscopic removal and reconstruction.

Endoscopy provides a safe and effective way of treating craniofacial bony benign lesions. This approach permits not only complete removal of the tumour, but also reconstruction of the bony boundaries as necessary. Osteoma is a rare, osteogenic tumour that usually grows slowly and asymptomatically. It is the most frequent benign neoplasm of the nose and paranasal sinuses. Orbital extension is a rare event that can give rise to ocular signs and symptoms; in such a case treatment is mandatory, although debate persists regarding the optimal approach. We report the case of a bulky fronto-ethmo-orbital osteoma that was treated using an endoscopic trans-nasal approach. The medial wall of the orbit was repaired by means of an implant of porous polyethylene endoscopically positioned using an "underlay" technique. The surgical technique is described and the reasons for the endoscopic choice are also discussed. Fifteen days after the operation the patient reported complete resolution of craniofacial pain. Nasoendoscopy showed complete integration of the polyethylene implant in the healing tissue 4 weeks after surgery. A CT scan performed 6 months postoperatively showed good ventilation of the sinonasal cavity and effective reconstruction of the medial orbital wall.

Endoscopic treatment of upper airway and digestive tract lesions caused by caustic agents.

We present our experience in the endoscopic management of upper aerodigestive tract lesions caused by caustic agents. Between 1985 and 2000, 112 patients with upper airway and digestive tract lesions due to caustic agents were treated at the Airways Endoscopic Surgery Unit of Padua Hospital: 44 were male and 68 were female, and the median age was 42.6 years. A retrospective statistical analysis of our case series was made to evaluate the factors that most influenced the severity of injuries and the outcome of treatment. All of the patients underwent videoendoscopic assessment. In 79 cases, the patients came under our observation in the acute phase, whereas 33 presented a picture of chronic lesions. Acute lesions were classified into 3 grades. All acute grade 1 lesions healed spontaneously. In the 32 patients with grade 2 lesions, endoscopic treatment based on removal of necrotic tissue, dilations, and cleansing of abnormal fibrin adhesions resolved the disease in 30 cases (94%). Nine patients (43%) with acute grade 3 lesions developed severe chronic lesions that required subsequent treatments. Rigid endoscopy with diode laser-assisted radial lysis was performed in 32 patients with chronic cicatricial lesions and was successful in 30 cases (94%). We reiterate the need for a standardized multidisciplinary protocol for treating lesions caused by caustic agents and emphasize the essential role of airway and digestive canal videoendoscopy in the diagnosis and treatment of both the acute lesions and chronic cicatricial sequelae.

The new Baha implant: a prospective osseointegration study.

OBJECTIVES: To assess stability of a new-design titanium implant (Cochlear Baha BAI300) in bone-anchored hearing aid (Baha) recipients over time. STUDY DESIGN AND SETTING: Prospective case series with planned data collection at a tertiary care institution. Twelve patients who underwent Baha surgery over 12 months were analyzed. SUBJECTS: All patients (3 children, age range 6-10 years, mean 7.7 years, median 7.3 years; 9 adults, age range 34-73 years, mean 52.8 years, median 48 years) underwent the 1-stage procedure following the standard Brånemark technique. In all procedures, the single-skin incision was applied. METHODS: The stability of the implant was measured with implant stability quotient (ISQ) measurement tests. All patients were tested at surgery and every week after for 1 year. Wound-healing time, degree of soft tissue reactions around the abutment, and need for revision surgery were examined. Two-tailed Student t test and χ(2) for all comparisons were calculated; P < .05 values were considered significant. RESULTS: The new implant showed a steep increase of ISQ values over the first 2 weeks and reached stable ISQ values 3 weeks after surgery. Complete skin healing time was obtained in 8 days on average (range, 7-12 days; median 7.6 days). Neither implant extrusion nor skin revision surgery was observed in our patients during the first year of follow-up. CONCLUSIONS: This new implant revealed stability and fast integration. The data from the present study suggest the new implant may be suitable for early loading protocols.

Surgical management of thyroid orbitopathy.

PURPOSE: To examine the outcomes of orbital surgical decompression in patients affected by thyroid orbitopathy with mild-to-severe proptosis. The surgical procedures included fat removal alone or combined with orbital bone walls fracture. METHODS: An analysis of a retrospective case series of 56 patients (115 orbits) who underwent orbital decompression for Graves' orbitopathy between July 1997 and September 2006 using different surgical techniques: orbital fat decompression alone or combined with bone decompression via coronal, trans-palpebral or trans-nasal access; the endoscopic trans-nasal access for medial orbital wall decompression associated with fat removal has been the procedure of choice in the last 5 years. RESULTS: The mean proptosis reduction was 3.40 mm (0-8 mm) by fat removal and 5.40 mm (1-10 mm) by fat removal and bone decompression combined. The association of both procedures reduces the amount of fat to be removed, avoiding enophthalmos and thus decreasing the number of orbital walls to be fractured. The incidence of new-onset primary-gaze diplopia was 38%. Most of the patients subsequently underwent eyelid surgery to reduce retraction and to achieve symmetry. CONCLUSIONS: Orbital decompression is effective in reducing proptosis, exposure keratopathy and congestive apex symptoms, and in improving cosmesis. Endoscopic nasal decompression combined with orbital fat removal allows a precise and gradual medial and infero-medial wall decompression; it permits a less aggressive approach to the bone orbital decompression on the whole. In any case, surgical procedures need to be tailored to the individual patient, knowing that further operations are essential to improve cosmetic results after proptosis correction.

Combined endoscopic-microsurgical approach for transsphenoidal (sphenopalatine) encephalocele with an intralesional pituitary gland. Case report.

The treatment of the transsphenoidal sphenopalatine encephalocele in infants has not been thoroughly described in the literature. Pterional and subfrontal transbasal approaches have been reported as the advised treatment for transethmoidal encephalocele, but their feasibility for transsphenoidal encephalocele remains controversial, particularly in neonates. The potential harm to vital structures within the herniated tissue and intraoperative bleeding have been considered the major cause of poor postoperative results. The authors present the case of a full-term newborn with a cleft palate and a large transsphenoidal sphenopalatine encephalocele, which filled the nasopharyngeal space and provided MR imaging evidence of an intralesional pituitary gland. The lesion is unusual, and the extracranial intraoral endoscopic approach with an optimal outcome and sparing of the pituitary tissue has never been described in detail in an infant of this age.

Treatment of congenital subglottic hemangiomas: our experience compared with reports in the literature.

OBJECTIVE: To evaluate the outcome of our experience in the treatment of congenital subglottic hemangiomas. DESIGN: Retrospective review of records. SETTING: Airway tertiary care service. PATIENTS: From 1986 to 2006 we treated 39 pediatric patients affected by congenital subglottic hemangiomas. INTERVENTION: Therapeutic choice depended on presentation symptoms and grade of respiratory obstruction: 6 patients were primarily treated with only systemic steroids; 11 patients underwent intralesional corticosteroid injections followed by tracheal intubation and systemic steroid support; and 22 patients underwent primary diode laser treatment. MAIN OUTCOME MEASURE: The outcomes were evaluated according to 1 or more of the following criteria: resolution of symptoms, reduction of airway obstruction, the need and duration of intubation, tracheotomy decannulation, need of further treatments, and occurrence of complications. RESULTS: Patients treated with only systemic steroids showed a success rate of 50% (3 of 6); patients who underwent intralesional corticosteroid injections followed by tracheal intubation and systemic steroid support reached a positive result in 73% of cases (8 of 11). On the whole, 18% of patients treated with full-dose systemic steroids developed significant adverse effects (3 of 17). The success rate was 95% among patients treated with diode laser as primary treatment (21 of 22), with a complication rate of 9% (2 of 22). CONCLUSIONS: Endoscopic laser surgery is the therapeutic option that most approaches the objectives of securing the airway while using the least invasive method possible and reducing to a minimum the necessity and duration of intubation. On the basis of our experience, we believe that diode laser, owing to its physical and structural features, is the safest and most effective device for the treatment of congenital subglottic hemangiomas. Treatment with intralesional or systemic corticosteroids could have an adjuvant role.

Laryngeal schwannoma in an 8-year-old boy with inspiratory dyspnea.

BACKGROUND: Schwannomas of the larynx are rare lesions in the pediatric age group. METHODS: In this article, we report on the neuroimaging features of a schwannoma arising from the left aryepiglottic fold in an 8-year-old boy with a 6-month history of inspiratory dyspnea. RESULTS: Neuroimaging showed a well-defined, avoid mass originating from the left aryepiglottic fold. The lesion was removed endoscopically. CONCLUSION: Complete removal of laryngeal schwannomas is curative, and adjuvant treatment is not required.

Endoscopic stapler-assisted Zenker's diverticulotomy: which is the best operative facility?

BACKGROUND: Despite great changes in treatment for Zenker's diverticulum, endoscopic stapler-assisted diverticulotomy (ESD) has not yet been included on the lists of possible day-case procedures, and determining the best operative facility is still a matter of debate. The aim of this article was to evaluate the safety and feasibility of endoscopic treatment for patients with Zenker's diverticulum on a planned 24-hour-stay basis. METHODS: We retrospectively reviewed cases in which patients were admitted to and operated on at the Department of Airway Endoscopic Surgery of the Padua University Hospital over a 5-year period (January 2000 to December 2004). RESULTS: We considered 106 consecutive ESDs performed on 86 patients (1.23 procedures/patient). All procedures were planned on a 24-hour-stay basis ("1-day surgery"). In no case was the endoscopic procedure aborted. The mean operative time was 14 minutes (range, 5-45 minutes). Neither perioperative mortality nor major complications occurred. Minor complications were noted in 3 cases (2.8%). The mean time taken to resume oral intake was 0.83 days (range, 0-1). The mean hospital stay was 1.06 days (range, 0-5). Ninety-nine patients (93.4%) were discharged within the 24 hours after surgery. In no case was readmission necessary. CONCLUSIONS: We believe that ESD is a suitable operation for 1-day surgery. This facility, in fact, ensures the same outcome and safety conditions as with the inpatient procedure, making it possible to rationalize health resource management, reduce hospital costs, and improve patient comfort. In selected cases, ESD could be performed on an outpatient basis.