ChatGPT performance in laryngology and head and neck surgery: a clinical case-series.

peer reviewed[en] OBJECTIVES: To study the performance of ChatGPT in the management of laryngology and head and neck (LHN) cases. METHODS: History and clinical examination of patients consulting at the Otolaryngology-Head and Neck Surgery department were presented to ChatGPT, which was interrogated for differential diagnosis, management, and treatment. The ChatGPT performance was assessed by two blinded board-certified otolaryngologists using the following items of a composite score and the Ottawa Clinic Assessment Tool: differential diagnosis; additional examination; and treatment options. The complexity of clinical cases was evaluated with the Amsterdam Clinical Challenge Scale test. RESULTS: Forty clinical cases were submitted to ChatGPT, accounting for 14 (35%), 12 (30%), and 14 (35%) easy, moderate and difficult cases, respectively. ChatGPT indicated a significant higher number of additional examinations compared to practitioners (p = 0.001). There was a significant agreement between practitioners and ChatGPT for the indication of some common examinations (audiometry, ultrasonography, biopsy, gastrointestinal endoscopy or videofluoroscopy). ChatGPT never indicated some important additional examinations (PET-CT, voice quality assessment, or impedance-pH monitoring). ChatGPT reported highest performance in the proposition of the primary (90%) or the most plausible differential diagnoses (65%), and the therapeutic options (60-68%). The ChatGPT performance in the indication of additional examinations was lowest. CONCLUSIONS: ChatGPT is a promising adjunctive tool in LHN practice, providing extensive documentation about disease-related additional examinations, differential diagnoses, and treatments. The ChatGPT is more efficient in diagnosis and treatment, rather than in the selection of the most adequate additional examination

Dysphagia after supraglottic laryngeal cancer surgery.

peer reviewe

Correction: Exploring the potential of Chat-GPT as a supportive tool for sialendoscopy clinical decision making and patient information support (European Archives of Oto-Rhino-Laryngology, (2023), 10.1007/s00405-023-08104-8)

peer reviewedIn this article, the ethics declaration statement was missing and it should have been read as “The author Jerome R. Lechien is also guest editor of the special issue on ‘ChatGPT and Artificial Intelligence in Otolaryngology-Head and Neck Surgery’. He was not involved with the peer review process of this article”. The original article was updated

Indications, Efficacy, Safety, and Clinical Outcomes of 585 nm Pulsed Dye Laser in Non-Malignant Laryngeal Lesions: A Systematic Review.

peer reviewedThe objective of this manuscript was to review the indications, efficacy, and safety of a 585 nm pulsed dye laser (PDL) in non-malignant laryngeal lesions. Following the PRISMA statement recommendations, three independent authors searched for articles published in PubMed/MEDLINE, the Cochrane Library, Google Scholar, Scielo, and Web of Science. A bias analysis was performed following NICE guidance tools. From the 506 identified publications, 19 observational studies met the inclusion criteria. The PDL improves vocal quality objectively and subjectively in vascular lesions (p < 0.005) and improves vocal quality in patients with dysplasia/leukoplasia without changing the natural history of the disease compared to other treatments. Reinke's edema and granulomas require an average of 1.5 PDL sessions for resolution. Treatment of recurrent respiratory papillomatosis requires multiple sessions, with complete remission achieved in 50-70% of patients. Regardless of the lesion, the tolerance of the procedure under local anesthesia is exceptional (84-97%), and the results in terms of regression and vocal quality are promising. The complication rate is minimal, and the procedure does not interfere with other treatment alternatives. There is no consensus on laser settings. The lack of consistent use in evaluating vocal outcomes, whether objective or subjective, prevents the comparability between studies. The 585 nm pulsed dye laser appears to be an effective and safe therapeutic option in patients with non-malignant laryngeal pathology. Future controlled studies are needed to compare the 585 nm pulsed dye laser with other lasers or cold instrument procedures

Cost-Effectiveness Study of Double-Flange Voice Prostheses in the Treatment of Periprosthetic Leakage in Laryngectomized Patients.

peer reviewed[en] BACKGROUND: Tracheoesophageal speech with a voice prosthesis is considered the rehabilitation treatment of choice in laryngectomized patients. The main reasons for prosthesis failure are endoprosthetic leakage and periprosthetic leakage. The Provox XtraSeal® stent incorporates an additional double flange on the esophageal side to prevent periprosthetic leakage. The objective of this study is to compare the duration and costs of the Provox Vega® and Provox XtraSeal® prostheses used in these patients in a tertiary university hospital. MATERIALS AND METHODS: A prospective crossover case study of laryngectomees with Provox Vega® who underwent Provox XtraSeal® placement due to recurrent periprosthetic leaks and decreased theoretical prosthesis life. The duration and possible factors affecting voice prostheses were studied using Kaplan-Meier curves and Cox regression. A cost-effectiveness analysis was carried out from the perspective of the Spanish National Health System with an incremental cost-effectiveness calculation. RESULTS: A total of 38 patients were recruited, 35 men and 3 women, with a mean age of 66.26 ± 9.36 years old. Information was collected from 551 voice prostheses, 484 Provox Vega® and 68 Provox XtraSeal®. The mean duration of Provox Vega® was 119.75 ± 148.8 days and that of Provox XtraSeal® was 181.99 ± 166.07 days (p = 0.002). The most frequent reason for replacement was endoprosthetic leakage in both groups: 283 (60.86%) in the case of Provox Vega® and 29 (48.33%) in that of XtraSeal® (p < 0.000). To obtain no cost differences (ICE ~ 0) between Provox Vega and Provox XtraSeal, the latter should cost EUR 551.63. CONCLUSIONS: The Provox XtraSeal® is a cost-effective option in patients with increased prosthesis replacements due to periprosthetic leakage, reducing the number of replacements, increasing the duration of the prosthesis, and providing savings compared to Provox Vega®

COVID-19 Pandemic and its Impact on the Management of Head and Neck Cancer in the Spanish Healthcare System

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has represented a major challenge for healthcare systems worldwide, changing the habits of physicians. A reorganization of healthcare activity has been necessary, limiting surgical activity to essential cases (emergencies and oncology), and improving the distribution of health resources. Objective To analyze the impact of the COVID-19 pandemic on head and neck cancer surgery management in Spain. Methods A cross-sectional study, through an anonymous and voluntary online survey distributed to 76 Spanish otorhinolaryngology departments. Results A total of 44 centers completed the survey, 65.9% of which were high-volume. A total of 45.5% of them had to stop high-priority surgery and 54.5% of head and neck surgeons were relocated outside their scope of practice. Surgeons reported not feeling safe during their usual practice, with a decrease to a 25% of airway procedures. A total of 29.5% were "forced" to deviate from the "standard of care" due to the epidemiological situation. Conclusions Approximately half of the departments decreased their activity, not treating their patients on a regular basis, and surgeons were reassigned to other tasks. It seems necessary that the head and neck surgeons balance infection risk with patient care. The consequences of the reported delays and changes in daily practice should be evaluated in the future in order to understand the real impact of the pandemic on the survival of head and neck cancer patients

Facial nerve palsy following parotid gland surgery : A machine learning prediction outcome approach

Machine learning (ML)-based facial nerve injury (FNI) forecasting grounded on multicentric data has not been released up to now. Three distinct ML models, random forest (RF), K-nearest neighbor, and artificial neural network (ANN), for the prediction of FNI were evaluated in this mode. A retrospective, longitudinal, multicentric study was performed, including patients who went through parotid gland surgery for benign tumors at three different university hospitals. Seven hundred and thirty-six patients were included. The most compelling aspects related to risk escalation of FNI were as follows: (1) location, in the mid-portion of the gland, near to or above the main trunk of the facial nerve and at the top part, over the frontal or the orbital branch of the facial nerve; (2) tumor volume in the anteroposterior axis; (3) the necessity to simultaneously dissect more than one level; and (4) the requirement of an extended resection compared to a lesser extended resection. By contrast, in accordance with the ML analysis, the size of the tumor (>3 cm), as well as gender and age did not result in a determining favor in relation to the risk of FNI. The findings of this research conclude that ML models such as RF and ANN may serve evidence-based predictions from multicentric data regarding the risk of FNI. Along with the advent of ML technology, an improvement of the information regarding the potential risks of FNI associated with patients before each procedure may be achieved with the implementation of clinical, radiological, histological, and/or cytological data

Stereotactic Body Radiotherapy as a Curative Treatment for De Novo Mucosal Carcinoma of the Head and Neck: A Feasible Alternative Option for Fragile Patients with Small Lesion: A Systematic Review †

Stereotactic body radiotherapy (SBRT) is characterized by a high dose per fraction, well-defined small targets, superior dose conformity, and a steep off-target dose gradient. A literature search was conducted to examine the experience with SBRT as a curative treatment for newly diagnosed mucosal carcinoma of the head and neck (MCHN). Four retrospective case series and one prospective phase I clinical trial published between 2012 and 2020 described 124 patients. SBRT was mainly performed in older patients with different tumor sites. The median size of the planning target volumes ranged from 5.3 to 41 cm3. Different approaches were used to create margins. In two studies, limited elective nodal irradiation was performed. The equivalent doses used were 60–83.33 Gy delivered in five fractions. Considerable heterogeneity was observed in the radiation dose specification. The incidence of grade ≥3 late toxicity was 0–8.3%, with local and regional control ranging from 73% to 100%. Improved or stable quality of life after SBRT was reported in two studies. Curative-intent SBRT for de novo MCHN appears to be an effective and relatively safe treatment for small tumor targets, preferably without concomitant elective tissue irradiation. Standardization of SBRT practice and well-designed prospective clinical trials are needed to better define the role of SBRT in this setting

Relationship between the Superior Attachment of the Uncinate Process and Pneumatization of the Middle Turbinate&mdash;A Radiological Study

Objective: the superior attachment of the uncinate process (SAUP) is highly variable. Lateral types of SAUP are associated with frontal rhinosinusitis. SAUP in the middle turbinate is more common when the middle turbinate is aerated. We aim to refine these findings by studying the relationship between the SAUP type and the different subtypes of pneumatization of the middle turbinate. Methods: 200 CT sinonasal scans were analyzed by an otolaryngologist and a radiologist. All CT scans were analyzed to study the type of the middle turbinate concha bullosa and lamellar cell and the type of SAUP. Results: 379 sides were analyzed. The prevalence of the various types of SAUP were: Type I: 43.80%, Type II: 22.16%, Type III: 16.36%, Type IV: 3.69%, Type V: 9.76%, and Type VI: 4.22%. When studying the pneumatization of the middle turbinate and the SAUP types, we only found a statistically significant association between the lateral attachment of the uncinate process and the presence of a lamellar cell (p = 0.029). Conclusion: lateral types of SAUP are more likely in the presence of a lamellar cell. This finding, therefore, renders checking for lateral SAUP types in the presence of a lamellar cell even more relevant than when studying the pre-surgical CT scan. In those cases, it is advisable to perform a careful and complete uncinectomy

Análisis de la marcha y el equilibrio mediante el uso de sensores inerciales: estudio prospectivo, longitudinal, no aleatorio

Introduction: The world population is aging rapidly. A third of those over 65 years of age falls at least once a year, and this prevalence increases by half when they exceed 69 years. Objective: To determine the sensitivity of the use of inertial sensors to determine the gait and rotations of the trunk in a group of healthy individuals. Materials: We use 3 inertial sensors of 9-axis together with the same number of microcontrollers, that sent the information via bluetooth to the computer, the data processing was carried out through an analysis program developed in MATLAB. To analyze the sensitivity of the sensors we use the protocol of Akram et al,5 modified, which consists of 5 activities. Results: In our study 6 volunteers participated, with an average age of 29 years, with an age range 25 to 33 years. The sensors were able to detect multiple variables, including the maximum and minimum elevation of the legs, number of steps, the degree of inclination of the trunk, rotation, speed and cadence. Conclusion: The results obtained are promising and we believe that the use of multiple inertial sensors to assess gait and balance could result in a new tool for the diagnosis and monitoring of people with gait and balance disorder.Antecedentes: la población mundial envejece de manera acelerada. Una tercera parte de los mayores de 65 años se cae por lo menos una vez al año, y esta prevalencia se incrementan a la mitad cuando se superan los 69 años. Objetivo: establecer la sensibilidad del uso de sensores inerciales para determinar la marcha y las rotaciones del tronco en un grupo de individuos sanos. Materiales: utilizamos tres sensores inerciales de nueve ejes, junto a un mismo número de microcontroladores, los cuales enviaron la información vía bluetooth al ordenador, el procesamiento de los datos fue realizado mediante un programa de análisis desarrollado en MATLAB. Para analizar la sensibilidad de los sensores utilizamos el protocolo de Akram et al.,5 modificado, el cual consta de cinco actividades. Resultados: en nuestro estudio participaron seis voluntarios, con una media de edad de 29 años, con un rango de edad de 25 a 33 años. Los sensores fueron capaces de detectar múltiples variables, entre ellas la elevación máxima y mínima de las piernas, número de pasos, el grado de inclinación del tronco, giro, velocidad y cadencia. Conclusión: los resultados hasta ahora obtenidos son prometedores y consideramos que el uso de múltiples sensores inerciales para valorar la marcha y el equilibrio podrían resultar en una nueva herramienta para el diagnóstico y seguimiento de personas con trastorno de la marcha y equilibrio