Is generative pre-trained transformer artificial intelligence (Chat-GPT) a reliable tool for guidelines synthesis? A preliminary evaluation for biologic CRSwNP therapy.

INTRODUCTION: Biologic therapies for Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) have emerged as an auspicious treatment alternative. However, the ideal patient population, dosage, and treatment duration are yet to be well-defined. Moreover, biologic therapy has disadvantages, such as high costs and limited access. The proposal of a novel Artificial Intelligence (AI) algorithm offers an intriguing solution for optimizing decision-making protocols. METHODS: The AI algorithm was initially programmed to conduct a systematic literature review searching for the current primary guidelines on biologics' clinical efficacy and safety in treating CRSwNP. The review included a total of 12 studies: 6 systematic reviews, 4 expert consensus guidelines, and 2 surveys. Simultaneously, two independent human researchers conducted a literature search to compare the results. Subsequently, the AI was tasked to critically analyze the identified papers, highlighting strengths and weaknesses, thereby creating a decision-making algorithm and pyramid flow chart. RESULTS: The studies evaluated various biologics, including monoclonal antibodies targeting Interleukin-5 (IL-5), IL-4, IL-13, and Immunoglobulin E (IgE), assessing their effectiveness in different patient populations, such as those with comorbid asthma or refractory CRSwNP. Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha subunit, demonstrated significant improvement in nasal symptoms and quality of life in patients with CRSwNP in several randomized controlled trials and systematic reviews. Similarly, mepolizumab and reslizumab, which target IL-5, have also shown efficacy in reducing nasal polyp burden and improving symptoms in patients with CRSwNP, particularly those with comorbid asthma. However, additional studies are required to confirm the long-term efficacy and safety of these biologics in treating CRSwNP. CONCLUSIONS: Biologic therapies have surfaced as a promising treatment option for patients with severe or refractory CRSwNP; however, the optimal patient population, dosage, and treatment duration are yet to be defined. The application of AI in decision-making protocols and the creation of therapeutic algorithms for biologic drug selection, could offer fascinating future prospects in the management of CRSwNP.

Pediatric Inferior Turbinate Hypertrophy: Diagnosis and Management. A YO-IFOS Consensus Statement.

OBJECTIVE: Pediatric inferior turbinate hypertrophy (PedTH) is a frequent and often overlooked cause or associated cause of nasal breathing difficulties. This clinical consensus statement (CCS) aims to provide a diagnosis and management framework covering the lack of specific guidelines for this condition and addressing the existing controversies. METHODS: A clinical consensus statement (CCS) was developed by a panel of 20 contributors from 7 different European and North American countries using the modified Delphi method. The aim of the CCS was to offer a multidisciplinary reference framework for the management of PedTH on the basis of shared clinical experience and analysis of the strongest evidence currently available. RESULTS: A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria was performed. From the initial 96 items identified, 7 articles were selected based on higher-evidence items such as randomized-controlled trials, guidelines, and systematic reviews. A 34-statement survey was developed, and after three rounds of voting, 2 items reached strong consensus, 17 reached consensus or near consensus, and 15 had no consensus. CONCLUSIONS: Until further prospective data are available, our CCS should provide a useful reference for PedTH management. PedTH should be considered a nasal obstructive disease not necessarily related to an adult condition but frequently associated with other nasal or craniofacial disorders. Diagnosis requires clinical examination and endoscopy, whereas rhinomanometry, nasal cytology, and questionnaires have little clinical role. Treatment choice should consider the specific indications and features of the available options, with a preference for less invasive procedures. LEVEL OF EVIDENCE: 5 Laryngoscope, 134:1437-1444, 2024.

Comprehensive management of paranasal sinus fungus balls: A Young-IFOS consensus statement.

BACKGROUND: Paranasal sinus fungus balls (PSFB) are a common form of surgically treatable, noninvasive mycosis. To date, no guidelines have standardized PSFB treatment or management of difficult cases (eg, immunocompromised or fragile patients). The clinical consensus statement presented herein aims to provide a comprehensive management guide to PSFB based on current evidence. METHODS: A multidisciplinary, international panel of 19 specialists judged statements in 3 rounds of a modified Delphi method survey. Statements encompassed the following PSFB management issues: definition, diagnostic workup; treatment indications and modalities; and follow-up. Otolaryngologists, maxillofacial surgeons, infectious disease specialists, and transplant physicians were considered the target audience. RESULTS: Among the 23 statements, 7 reached strong consensus and 16 reached consensus. Consensus was reached on the definition, diagnosis, and treatment modalities for PSFB. Postoperative follow-up modalities and scenarios with bacterial superinfection were the most debated issues. CONCLUSION: Until further data are available, these points provide a framework for the management of PSFB. Moreover, PSFB should be considered a noninvasive mycosis that is not necessarily symptomatic or related to odontogenic conditions. Although diagnosis may be incidental, endoscopy and single imaging (computed tomography or magnetic resonance imaging, with distinctive features) are required for diagnosis, whereas contrast medium would allow for differential diagnosis. Although treatment of PSFB should be considered mandatory before sinus augmentation and is recommended for symptomatic patients, immunosuppressed patients, or patients with planned immunosuppression, watchful waiting could be considered for asymptomatic patients with chronic rhinosinusitis who are provided with appropriate advice and assessment.

Impacto de la pandemia COVID-19 en la formación de los residentes de otorrinolaringología / Impact of the COVID-19 pandemic on the training of otorhinolaryngology residents

Antecedentes y objetivosLa pandemia COVID-19 ha alterado todas las actividades sanitarias, entre ellas la formación especializada de los residentes. Se llevó a cabo un estudio para analizar en profundidad el impacto de la pandemia COVID-19 en aspectos específicos de las actividades clínicas, formativas e investigadoras que realizan los residentes de otorrinolaringología (ORL) en España durante un año completo de formación.MétodosSe realizó un estudio cualitativo transversal durante las últimas dos semanas de febrero de 2021. El estudio consistió en una encuesta en línea realizada por residentes de ORL que habían realizado un año continuado de formación desde el 15 de febrero de 2020 al 15 de febrero de 2021 y consistió en 26 preguntas que exploraban el impacto del COVID-19 en la salud de los residentes de ORL, en su dedicación laboral y en las actividades de formación. Las variables categóricas se informaron como frecuencia y porcentaje. Cuando se indicó, se utilizó la prueba chi-cuadrado de Pearson con la corrección de Yates y el coeficiente de correlación de Pearson (r).ResultadosSe recibieron 143 encuestas cumplimentadas de 264 residentes (54,17%). Treinta y seis residentes (25,2%) habían padecido la enfermedad por SARS-CoV-2. La mayoría de ellos solo desarrollaron síntomas leves (86,1%) y 3 requirieron hospitalización (8,3%). Los residentes encuestados que resultaron positivos para SARS-CoV-2 no fueron capaces de identificar la fuente de su contagio y la necesidad de confinamiento se debió principalmente a la atención de un paciente asintomático en 9 casos (6,3%) o al contacto estrecho con un asintomático en situaciones no identificadas distintas de la atención sanitaria en 22 (15,4%). El 60,1% de los residentes encuestados reportaron haber perdido más de 6meses de su período de formación, y en el 18,8% de los casos llegaron a 10 y 12meses. (AU)

Background and objectivesTraining in surgical specialties has declined during the COVID-19 pandemic. A study was carried out to further analyze the impact of the COVID-19 pandemic on specific aspects of clinical, training, and research activities performed by the otolaryngology residents in Spain.MethodsA cross-sectional qualitative study was conducted during the last two weeks of February 2021. The study consisted of an online survey taken by otolaryngology residents who had undertaken one-year continuing training from February 15, 2020, to February 15, 2021, and consisted of 26 questions exploring the impact of the COVID-19 on the health of the ENT residents and training activities. Categorical variables were reported as frequency and percentage. When indicated, Pearsońs Chi-square test (χ2) with Yates's correction and Pearson's correlation coefficient (r) were used.Results143 completed surveys were received from 264 residents (54.17%). 36 residents (25.2%) have suffered from the disease due to SARS-CoV-2. Most of them only developed mild symptoms (86.1%), with 3 requiring hospitalization (8.3%). The origin of infection was unknown in all reported cases and the need for confinement was principally due to either attending an asymptomatic patient in 9 cases (6.3%) or to being supposedly in close contact with an asymptomatic person in 22 (15.4%). 60.1% of the residents surveyed reported having lost more than 6months of their training period, and in 18.8% of cases, it was as high as 10 and 12months. There has been a reduction of more than 75% of what was planned in surgical training (P<.05) of tympanoplasty, mastoidectomy, stapedectomy, cochlear implants, endoscopic sinonasal and anterior skull base surgery, septoplasty and turbinoplasty. (AU)

Impact of the COVID-19 pandemic on the training of otorhinolaryngology residents.

BACKGROUND AND OBJECTIVES: Training in surgical specialties has declined during the COVID-19 pandemic. A study was carried out to further analyze the impact of the COVID-19 pandemic on specific aspects of clinical, training, and research activities performed by the otolaryngology residents in Spain. METHODS: A cross-sectional qualitative study was conducted during the last two weeks of February 2021. The study consisted of an online survey taken by otolaryngology residents who had undertaken one-year continuing training from February 15, 2020, to February 15, 2021, and consisted of 26 questions exploring the impact of the COVID-19 on the health of the ENT residents and training activities. Categorical variables were reported as frequency and percentage. When indicated, Pearson's Chi-square test (χ2) with Yates's correction and Pearson's correlation coefficient (r) were used. RESULTS: 143 completed surveys were received from 264 Residents (54.17%). 36 residents (25.2%) have suffered from the disease due to SARS-CoV-2. Most of them only developed mild symptoms (86.1%), with 3 requiring hospitalisation (8.3%). The origin of infection was unknown in all reported cases and the need for confinement was principally due to either attending an asymptomatic patient in 9 cases (6.3%) or to being supposedly in close contact with an asymptomatic person in 22 (15.4%). 60.1% of the residents surveyed reported having lost more than 6 months of their training period, and in 18.8% of cases, it was as high as 10 and 12 months. There has been a reduction of more than 75% of what was planned in surgical training (p<0.05) of tympanoplasty, mastoidectomy, stapedectomy, cochlear implants, endoscopic sinonasal and anterior skull base surgery, septoplasty and turbinoplasty. CONCLUSIONS: The decline in ENT activity and residents having to assist in other COVID-19 units during the most critical moments of the pandemic, has caused the main reduction in their training capacity. Contagion mainly occurred through contact with asymptomatic carriers during patient care and through supposedly close contact with asymptomatic carriers. Virtual activities have been widely accepted, but they have not completely replaced all residents' training needs. Measures should be implemented to recover lost training, especially surgical practical learning in otology and rhinology.

[Impact of the COVID-19 pandemic on the training of otorhinolaryngology residents]. / Impacto de la pandemia COVID-19 en la formación de los residentes de otorrinolaringología.

Background and objectives: Training in surgical specialties has declined during the COVID-19 pandemic. A study was carried out to further analyze the impact of the COVID-19 pandemic on specific aspects of clinical, training, and research activities performed by the otolaryngology residents in Spain. Methods: A cross-sectional qualitative study was conducted during the last two weeks of February 2021. The study consisted of an online survey taken by otolaryngology residents who had undertaken one-year continuing training from February 15, 2020, to February 15, 2021, and consisted of 26 questions exploring the impact of the COVID-19 on the health of the ENT residents and training activities. Categorical variables were reported as frequency and percentage. When indicated, Pearsons Chi-square test (χ2) with Yates's correction and Pearson's correlation coefficient (r) were used. Results: 143 completed surveys were received from 264 residents (54.17%). 36 residents (25.2%) have suffered from the disease due to SARS-CoV-2. Most of them only developed mild symptoms (86.1%), with 3 requiring hospitalization (8.3%). The origin of infection was unknown in all reported cases and the need for confinement was principally due to either attending an asymptomatic patient in 9 cases (6.3%) or to being supposedly in close contact with an asymptomatic person in 22 (15.4%). 60.1% of the residents surveyed reported having lost more than 6 months of their training period, and in 18.8% of cases, it was as high as 10 and 12 months. There has been a reduction of more than 75% of what was planned in surgical training (P < .05) of tympanoplasty, mastoidectomy, stapedectomy, cochlear implants, endoscopic sinonasal and anterior skull base surgery, septoplasty and turbinoplasty. Conclusions: The decline in ENT activity and residents having to assist in other COVID-19 units during the most critical moments of the pandemic, has caused the main reduction in their training capacity. Contagion mainly occurred through contact with asymptomatic carriers during patient care and through supposedly close contact with asymptomatic carriers. Virtual activities have been widely accepted, but they have not completely replaced all residents' training needs. Measures should be implemented to recover lost training, especially surgical practical learning in otology and rhinology.

Enseñanzas de la actividad otorrinolaringológica durante el pico de la pandemia por COVID-19 en España / Lessons learned from ENT activity during the peak of the COVID-19 pandemic in Spain

Introducción: la infección por el coronavirus del síndrome respiratorio agudo grave de tipo 2 (SARS-CoV-2) tiene una elevada incidencia entre profesionales sanitarios, especialmente otorrinolaringólogos (ORL). El objetivo de este estudio fue recoger aspectos organizativos, de seguridad y de protección de los ORL durante el pico de la pandemia por la enfermedad por coronavirus de 2019 (COVID-19) en España. Material y métodos: estudio transversal con una encuesta por correo electrónico a los socios ORL de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC). Resultados: respondieron 408 profesionales. La atención a pacientes con COVID-19 representó más del 25 % de la actividad asistencial para el 24,4 % de los encuestados. 213 encuestados (52,6 %) respondieron que algún compañero había guardado cuarentena o dado positivo en la prueba. La cantidad de facultativos diagnosticados con COVID-19 o que guardó cuarentena por síntomas compatibles osciló entre 1 y 12 por hospital (media 2,2; mediana 2) y se encontró una mayor incidencia en las regiones con mayor incidencia de coronavirus (62,1 % frente a 41,8 %; p < 0,001), atención directa a pacientes con COVID-19 (81 % frente a 46,4 %; p = 0,001) y actividad de guardias (p = 0,01). El 61,5 % de los especialistas en hospitalización y el 40,4 % en consultas no contaron siempre con la protección personal aconsejada. Conclusiones: la pandemia por COVID-19 ha alterado la organización y la actividad asistencial de los servicios de otorrinolaringología. Importancia clínica: los especialistas ORL no han contado siempre con los equipos de protección aconsejados por los protocolos y una cantidad relevante se ha visto afectada por la COVID-19.

Introduction: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has a high incidence among healthcare professionals, especially otorhinolaryngologists (ENT). Study objective: The objective of this study was to collect organizational, safety and protection aspects of otorhinolaryngologists during the peak of the coronavirus disease 2019 (COVID-19) pandemic in Spain. Material and methods: Cross-sectional study with an e-mail survey to the ENT partners of the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC). Results: 408 professionals completed the survey. Care of patients with COVID-19 represented more than 25% of healthcare activity for 24.4% of respondents. 213 respondents (52.6%) answered that a colleague tested positive or had been quarantined. The number of ENT surgeons diagnosed with COVID-19 or who were quarantined for compatible symptoms ranged between 1 and 12 per hospital (mean 2.2; median 2) and was related to regions with the highest incidence of coronavirus (62.1% vs. 41,8%; p <0.001), direct care for patients with COVID-19 (81% vs. 46.4%; p = 0.001) and on call activity (p = 0.01). 61.5% of the specialists attending inpatients and 40.4% attending outpatients did not always have the recommended personal protective equipment (PPE). Conclusions: The COVID-19 pandemic has altered the organization and care activity of the otorhinolaryngology departments. Clinical importance: ENT specialists have not always had the protective equipment recommended by the protocols and a significant number have been affected by COVID-19.

[Primary tumours of the external auditory canal. Our experience in 34 patients]. / Tumores primarios del conducto auditivo externo. Nuestra experiencia en 34 pacientes.

OBJECTIVES: Malignant neoplasms of the external auditory canal (EAC) and middle ear are rare but have a poor prognosis. The aim of this study is to identify the variables associated with worse prognosis. PATIENTS AND METHOD: Thirty-four patients were treated in our department between 1990 and 2006 for EAC and middle ear tumours. The patients were staged according to the 1990 Pittsburgh classification. In most cases, surgery was followed by post-operative radiotherapy. RESULTS: The overall disease-free survival was 49 % after 5 years. It reached 87 % in stages I and II, whereas the survival for stages III and IV was 21 % (P=.001). Pre-operative facial nerve paralysis (P=.03), lymph node metastasis (P=.01) and dural extension (P=.02) were associated with decreased survival rates. CONCLUSIONS: In carcinomas of the EAC and middle ear, lymph node involvement, facial nerve palsy, and dural extension were associated with a poorer outcome. For tumours in advanced stages, new therapeutic protocols should be evaluated.

Tumores primarios del conducto auditivo externo. Nuestra experiencia en 34 pacientes / Primary tumours of the external auditory canal. Our experience in 34 patients

Objetivo: Los tumores malignos del conducto auditivo externo (CAE) y el oído medio son poco frecuentes, pero se asocian a una alta morbimortalidad. El objetivo de este estudio es identificar los factores que se asocian con un peor pronóstico. Pacientes y método: Presentamos un estudio retrospectivo de 34 pacientes con tumores del CAE y el oído medio tratados en nuestro servicio entre los años 1990 y 2005. Los pacientes fueron clasificados siguiendo el sistema de estadificación de Pittsburgh de 1990. El tratamiento en la mayoría los casos fue quirúrgico con radioterapia postoperatoria. Resultados: La supervivencia libre de enfermedad a los 5 años para la serie total fue del 49 %. Agrupados por estadios, en estadios I y II fue del 87 % y en estadios III y IV del 21 % (p = 0,001). Se asociaron a un peor pronóstico la parálisis facial preoperatoria (p = 0,03), la metástasis ganglionar (p = 0,01) y la invasión de la duramadre (p = 0,02). Conclusiones: En los carcinomas de CAE y oído medio, la enfermedad ganglionar, la parálisis facial y la extensión intracraneal se asocian a un peor pronóstico. Dado que la supervivencia a estos tumores en estadios avanzados es escasa, sería necesario considerar nuevos protocolos terapéuticos

Objectives: Malignant neoplasms of the external auditory canal (EAC) and middle ear are rare but have a poor prognosis. The aim of this study is to identify the variables associated with worse prognosis. Patients and method: Thirty-four patients were treated in our department between 1990 and 2006 for EAC and middle ear tumours. The patients were staged according to the 1990 Pittsburgh classification. In most cases, surgery was followed by post-operative radiotherapy. Results: The overall disease-free survival was 49 % after 5 years. It reached 87 % in stages I and II, whereas the survival for stages III and IV was 21 % (P = .001). Pre-operative facial nerve paralysis (P = .03), lymph node metastasis (P = .01) and dural extension (P = .02) were associated with decreased survival rates. Conclusions: In carcinomas of the EAC and middle ear, lymph node involvement, facial nerve palsy, and dural extension were associated with a poorer outcome. For tumours in advanced stages, new therapeutic protocols should be evaluated