A cross-sectional comparative study: ChatGPT 3.5 versus diverse levels of medical experts in the diagnosis of ENT diseases

PURPOSE

With recent advances in artificial intelligence (AI), it has become crucial to thoroughly evaluate its applicability in healthcare. This study aimed to assess the accuracy of ChatGPT in diagnosing ear, nose, and throat (ENT) pathology, and comparing its performance to that of medical experts.

METHODS

We conducted a cross-sectional comparative study where 32 ENT cases were presented to ChatGPT 3.5, ENT physicians, ENT residents, family medicine (FM) specialists, second-year medical students (Med2), and third-year medical students (Med3). Each participant provided three differential diagnoses. The study analyzed diagnostic accuracy rates and inter-rater agreement within and between participant groups and ChatGPT.

RESULTS

The accuracy rate of ChatGPT was 70.8%, being not significantly different from ENT physicians or ENT residents. However, a significant difference in correctness rate existed between ChatGPT and FM specialists (49.8%, p < 0.001), and between ChatGPT and medical students (Med2 47.5%, p < 0.001; Med3 47%, p < 0.001). Inter-rater agreement for the differential diagnosis between ChatGPT and each participant group was either poor or fair. In 68.75% of cases, ChatGPT failed to mention the most critical diagnosis.

CONCLUSIONS

ChatGPT demonstrated accuracy comparable to that of ENT physicians and ENT residents in diagnosing ENT pathology, outperforming FM specialists, Med2 and Med3. However, it showed limitations in identifying the most critical diagnosis.

Management of oral feeding following total laryngectomy around the world: A YO-IFOS international study

BACKGROUND

To analyze worldwide practices regarding the initiation of oral feeding after total laryngectomy (TL).

METHODS

Online survey.

RESULTS

Among the 332 responses received, 278 from 59 countries were analyzed. Our results showed that 45.6% of respondents started water and 45.1% started liquid diet between postoperative days 7 and 10. Semi-solid feeds were initiated between days 10 and 14 for 44.9% of respondents and a free diet was allowed after day 15 for 60.8% of respondents. This timing was significantly delayed in cases of laryngo-pharyngectomy and after prior radiotherapy (p < 0.001). A greater proportion of respondents in Africa and Oceania allowed early oral feeding before day 6 as compared with the rest of the world (p < 0.001).

CONCLUSION

Despite increasing number of publications, there is still a lack of evidence to support early oral feeding. The majority of respondents preferred to delay its initiation until at least 7 days after surgery.

Otolaryngologic manifestations of diffuse idiopathic skeletal hyperostosis (Forestier's disease): A systematic review of the literature

OBJECTIVES

Forestier's disease or diffuse idiopathic skeletal hyperostosis (DISH) is a common, yet underreported, disease affecting the elderly population. From an otolaryngologic perspective, DISH may manifest with dysphagia, dysphonia, or even dyspnea. The purpose of this study was to identify all published cases of dysphagia and other associated upper airway symptoms resulting from DISH in the last decade and to establish subsequently a management algorithm.

METHODS

A comprehensive review of the literature was conducted in May 2020 on Medline and Embase databases following the PRISMA statement for systematic reviews and meta-analysis.

RESULTS

Sixty-three articles, consisting of 50 case-reports and 13 case-series, met the inclusion criteria. A total of 236 cases of DISH were reported from 2010 to date. Otolaryngology instrumental evaluation, by fiberoptic laryngoscopy and fiberoptic endoscopic evaluation of swallowing, was frequently reported. Surgery was the most common treatment strategy for the management of dysphagia in 58.9% of patients, while conservative treatment was used in 41.1%. Tracheotomy for acute airway obstruction relief was performed in 6% of patients. No correlation was found between the type of treatment and dysphagia improvement.

CONCLUSIONS

Forestier's disease is currently a growing source of complications in elderly, mostly dysphagia and less commonly upper airway obstruction. The management of these complications requires a multidisciplinary team and a thorough approach, where the otolaryngologist plays a pivotal role.

Surgical, clinical, and functional outcomes of transoral robotic surgery used in sleep surgery for obstructive sleep apnea syndrome: A systematic review and meta-analysis

We investigated safety and efficacy of transoral robotic surgery (TORS) for base of tongue (BOT) reduction in obstructive sleep apnea syndrome (OSAS) patients. PubMed, Cochrane Library, and Scopus were searched. A meta-analysis was performed. Random effects models were used. Thirty-one cohorts met our criteria (1693 patients). The analysis was based mostly on retrospective studies. The summary estimate of the reduction of Apnea-Hypoxia Index (AHI) was 24.25 abnormal events per hour (95% CI: 21.69-26.81) and reduction of Epworth Sleepiness Scale (ESS) was 7.92 (95% CI: 6.50-9.34). The summary estimate of increase in lowest O₂ saturation was 6.04% (95% CI: 3.05-9.03). The success rate of TORS BOT reduction, either alone or combined with other procedures, was 69% (95% CI: 64-79). The majority of studies reported low level of evidence but suggested that TORS BOT reduction may be a safe procedure associated with improvement of AHI, ESS, and lowest O₂ saturation.

Smoking cessation intervention for patients with head and neck cancer: A prospective randomized controlled trial

AIMS

To evaluate the effectiveness of a brief smoking cessation intervention in head and neck cancer patients (HNCP).

STUDY DESIGN

A prospective randomized controlled trial that randomly assigns participants in two groups: a usual care group (UCG), and a standardized intervention group (SIG).

MATERIAL AND METHODS

Patients with a confirmed diagnosis of head and neck squamous cell carcinoma (HNSCC) and who are active smokers were prospectively approached by one of 4 trained Ear-nose-throat (ENT) residents. Participants were randomized into a UCG, and a SIG consisting of a brief perioperative smoking cessation intervention based on National Institute of Health (NIH) "5A's" model along with an informative motivational document and nicotine patch therapy (NPT) offered for 8 weeks in gradually decreasing doses.

OBJECTIVE

The evaluation of abstinence at 3, 6 and 12 months after enrollment.

RESULTS

56 subjects were randomized into the UCG (N = 29, 52%), and the SIG (N = 27, 48%). The overall smoking cessation rates were not statistically different between the two groups; we observed at 3 months cessation rates of 57.1% vs. 57.7% (p = 0.96); at 6 months, 42.9% vs. 24% (p = 0.148); and at 12 months, 33.3% vs. 20.8% (p = 0.318), for the UCG and the SIG respectively.

CONCLUSION

This study failed to show the effectiveness of a combined brief smoking cessation approach led by and ENT resident in HNSCC patients. A multifaceted approach addressing different pharmacological treatments, factors contributing to smoking maintenance, mainly alcohol dependence and mood disturbances and dealing with relapse risks through close face-to-face or phone call follow-ups may have better outcomes and should be evaluated in upcoming trials.

Multifocal adult rhabdomyoma of the head and neck: case report and systematic review of the literature

Adult-type rhabdomyoma (ARM) is the most frequent extracardiac subtype of rhabdomyoma. In very rare instances ARM presents as multiple cervical lesions, an entity known as multifocal ARM. The aim of this study was to review the clinical characteristics and the best therapeutic options for multifocal ARM. The case of a 73-year-old patient recently diagnosed with multifocal ARM and managed in our institution is reported, followed by a systematic review of the literature. The review was conducted using the PubMed, Scopus, and Google Scholar databases, according to the PRISMA guidelines. All case reports and case series related to multifocal ARM written in English or French were included. A total of 29 cases were included in the qualitative analysis. Mean age at presentation was 65.0 years and the male to female ratio was 13.5:1. Dysphagia was the most common presenting symptom. ARM was most frequently found in the submandibular spaces. In conclusion, multifocal ARM are benign tumours with a predilection for the head and neck region. They become symptomatic with gradual compression of the adjacent structures. No cases of malignant transformation were reported in the literature. We suggest a 'watchful wait' approach for small asymptomatic tumours and excision of large symptomatic ones.

Surgical, clinical and functional outcomes of transoral robotic surgery for supraglottic laryngeal cancers: A systematic review

BACKGROUND

The aim of this systematic review is to shed light the current indications and outcomes of transoral robotic surgery (TORS) supraglottic laryngectomy (SGL) in patients with supraglottic laryngeal cancer.

METHODS

PubMed, Scopus and Cochrane Library were searched by three independent otolaryngologists from the Young Otolaryngologists of IFOS for studies investigating the indications, effectiveness and safety of TORS SGL. Surgical, functional, and survival outcomes have been investigated. Inclusion/exclusion criteria; demographic data; and clinical outcome evaluation of papers were analyzed using PRISMA criteria.

RESULTS

A total of 14 papers met our inclusion criteria, accounting for 422 patients (335 males & 87 females). The tumor location mainly consisted of epiglottis (55.4%), aryepglottic fold (31.2%), and ventricular band (5.1%). The following tumor stages were considered: cT1 (35.8%); cT2 (48.6%) and cT3 (13.9%). Feeding tube and percutaneous endoscopic gastrostomy were used in 62.5% and 8.82% of patients, respectively. The 24-month local & regional control rates ranged from 94.3% to 100% and 87.5% to 94.0%, respectively. The 2-year and 5-year overall survival rates ranged from 66.7% to 88.0% and 78.7% to 80.2%, respectively. There was an important heterogeneity between studies with regard to the inclusion/exclusion criteria, follow-up times, complications analysis; surgical and functional outcomes.

CONCLUSION

TORS SGL is an effective approach for treating patients with early stages supraglottic cancers. Future controlled studies are needed to compare functional and survival outcomes between TORS SGL and other surgical approaches. Recommendations have been provided for future studies for better inclusion of patients, analysis of complications and functional outcomes.

Barriers to research among residents in Otolaryngology - Head & Neck Surgery around the world

OBJECTIVES

To document the challenges faced by residents in Otolaryngology - Head & Neck Surgery (OTL-HNS) around the world to successfully complete research projects. The second objective is to assess if the challenges are uniform worldwide.

METHODS

A survey was sent to all OTL-HNS under 45 years old from the 2017 IFOS meeting. This survey was conducted by the YO-IFOS group (Young Otolaryngologists of the International Federation of Otolaryngological Societies). Data was collected for a period of 1 month. Demographic characteristics, information regarding research projects conducted and data concerning perceived barriers to completion of research projects were collected.

RESULTS

Among the 2787 attendees, 928 responded to the survey (response rate=33.3%). Of these 928 answers, 267 responses were from residents/interns in OTL-HNS, while 635 responses were from certified otolaryngologists. The three most frequent obstacles to conducting research projects for trainees were limited dedicated time (64%), insufficient financial resources (55%) and lack of education in research (45%). There was no statistical difference in these barriers among the different countries (P>0.05).

CONCLUSION

This is the first international study that provides insight on trainee's challenges to conduct research projects during residency. Despite the notion that research is essential for generating new knowledge to guide patient care, many residents fail to successfully incorporate research in their surgical curriculum. These obstacles must be addressed by Otolaryngology - Head & Neck Surgery programs in order to facilitate and support resident's research.

Intratumoral lymphatic vessel density as a predictor of progression-free and overall survival in locally advanced laryngeal/hypopharyngeal cancer

BACKGROUND

Lymphatic vessel density (LVD) has been shown to be an important predictor of survival in head and neck cancers. We report the predictive value of LVD for progression-free survival (PFS) and overall survival (OS) in laryngeal/hypopharyngeal cancer.

METHODS

Fifty-five untreated patients with T3/T4 laryngeal and T4 hypopharyngeal cancer underwent laryngectomy between 1999 and 2010. Surgical specimens were immunostained with D2-40, a specific lymphatic marker. LVDs were determined in tumor vessel "hot spots." Recursive partitioning analysis identified LVD thresholds for both peritumoral (LVDpt) and intratumoral (LVDit) vessels for association with PFS and OS.

RESULTS

Patients with mean LVDit of <11 vessels/mm(2) had 2-year PFS and OS rates of 58% and 65%, respectively, compared to 13% and 13% for those with LVDit ≥11 vessels/mm(2) (p = .06 and .04, respectively).

CONCLUSION

Intratumoral lymphatic vessel density is predictive of PFS and OS in locally advanced laryngeal/hypopharyngeal cancer. © 2015 Wiley Periodicals, Inc. Head Neck 38: E417-E420, 2016.

MET genetic abnormalities unreliable for patient selection for therapeutic intervention in oropharyngeal squamous cell carcinoma

Background

Identification of MET genetic alteration, mutation, or amplification in oropharyngeal squamous cell carcinoma (OPSCC) could lead to development of MET selective kinase inhibitors. The aim of this study was to assess the frequency and prognostic value of MET gene mutation, amplification, and protein expression in primary OPSCC.

Methods

A retrospective chart review was conducted of patients treated for single primary OPSCC between January 2007 and December 2009. Pre-treatment OPSCC tissue samples were analyzed for MET mutations, gene amplification, and overexpression using Sanger sequencing, FISH analysis, and immunohistochemistry respectively. Univariate and multivariate analyses were used to analyze correlations between molecular abnormalities and patient survival.

Results

143 patients were included in this study. Six cases (4%) were identified that had a genetic variation, but previously described mutations such as p.Tyr1235Asp (Y1235D) or p.Tyr1230Cys (Y1230C) were not detected. There were 15 high polysomy cases, and only 3 cases met the criteria for true MET amplification, with ≥10% amplified cells per case. Immunohistochemistry evaluation showed 43% of cases were c-MET negative and in 57% c-MET was observed at the tumor cell level. Multivariate analysis showed no significant association between MET mutation, amplification, or expression and survival.

Conclusions

Our study shows a low frequency of MET mutations and amplification in this cohort of OPSCC. There was no significant correlation between MET mutations, amplification, or expression and patient survival. These results suggest that patient selection based on these MET genetic abnormalities may not be a reliable strategy for therapeutic intervention in OPSCC.

HPV-related oropharyngeal squamous cell carcinomas: a comparison between three diagnostic approaches

PURPOSE

HPV-related oropharyngeal squamous cell carcinomas clearly represent a growing entity in the head and neck with distinct carcinogenesis, clinico-pathological presentation and survival profile. We aimed to compare the HPV prevalence rates and clinico-pathological correlations obtained with three distinct commonly used HPV detection methods.

MATERIALS AND METHODS

p16-immunohistochemistry (IHC), HPV DNA viral load by real-time PCR (qPCR), and HPV genotyping by a reverse hybridization-based line probe assay (INNO-LiPA) were performed on pretreatment formalin-fixed paraffin-embedded tumor samples from 46 patients treated for single primary oropharyngeal carcinomas.

RESULTS

Twenty-eight patients (61%) had a p16 overexpression in IHC. Twenty-nine patients (63%) harbored HPV DNA on qPCR. Thirty-four patients (74%) harbored HPV DNA on INNO-LiPA. The concordance analysis revealed a good agreement between both HPV DNA detection methods (κ=0.65); when both tests were positive, the depicted HPV subtypes were always concordant (HPV16 in 27 cases, HPV18 in 1 case). Agreement was moderate between IHC and qPCR (κ=0.59) and fair between IHC and INNO-LiPA (κ=0.22).

CONCLUSIONS

Certain highly sensitive methods are able to detect the mere presence of HPV without any carcinogenetic involvement while other more specific tests provide proof of viral transcriptional activity and thus evidence of clinically relevant infections. The use of a stepwise approach allows reducing false positives; p16-immunostaining seems to be an excellent screening test and in situ hybridization may overcome some of the PCR limitations.

Human papilloma virus testing in oropharyngeal squamous cell carcinoma: what the clinician should know

High risk Human Papilloma virus (HR-HPV) associated oropharyngeal cancers are on the increase. Although, the scientific community is aware of the importance of Human Papilloma Virus (HPV) testing, there is no consensus on the assays that are required to reliably identify HR-HPV related tumors. A wide range of methods have been developed. The most widely used techniques include viral DNA detection, with polymerase chain reaction (PCR) or In Situ Hybridization, and p16 detected by immunohistochemistry. However, these tests provide different information and have their own specific limitations. In this review, we summarize these different techniques, in light of the recent literature. p16 Overexpression, which is an indirect marker of HPV infection, is considered by many head and neck oncologists to be the most important marker for patient stratification. We describe the frequent lack of concordance of this marker with other assays and the possible reasons for this. The latest developments in HPV testing are also reported, such as the RNAscope™ HPV test, and how they fit into the existing framework of techniques. HPV testing must not be considered in isolation, as there are important interactions with other parameters, such as tobacco exposure. This is an important and rapidly evolving field and is likely to become pivotal to staging and choice of treatment of oropharyngeal carcinoma in the future.

Human papillomavirus prevalence and prognostic implication in oropharyngeal squamous cell carcinomas

BACKGROUND

Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (SCC) is associated with favorable survival. The purpose of this study was to evaluate the prevalence and prognostic significance of the HPV infection through both the p16 expression status and the oncogenic HPV DNA viral load.

METHODS

A retrospective chart review was conducted on all patients treated for oropharyngeal SCC between January 2007 and June 2009. P16 expression status by immunohistochemistry and HPV DNA viral load by quantitative polymerase chain reaction (qPCR) were evaluated on routine pretreatment tumor samples.

RESULTS

One hundred thirty-three patients (94 men and 39 women) were included in the study. Mean age was 59 years. One hundred twenty-two lesions (92%) were localized to lymphoid areas. Sixty-seven patients (50%) were p16+, and 87 patients (65%) harbored HPV DNA. The p16+/HPV DNA+ profile (48%) was associated with the most favorable prognosis. HPV16 was responsible for the majority of the infections (89%).

CONCLUSION

HPV is common among oropharyngeal SCC in France, and acts as an independent prognostic factor.

Lateral sinus thrombosis in the pediatric population: multiple presentations for a potentially lethal disease

Lateral sinus thrombosis complicating head and neck infections is a rare but potentially life-threatening condition.We report 4 pediatric cases of lateral sinus thrombosis occurring in different settings (2 patients with acute otitis media, 1 patient with chronic otitis media, and another with acute tonsillitis) to emphasize the nonspecific clinical presentation of this complication. In all our cases, early diagnosis was missed.Keeping a high index of suspicion when dealing with these infections is a reasonable approach.