Journal of Otolaryngology - Head & Neck Surgery最新文献

ImportanceClinicians face great challenges in diagnosing dizziness/vertigo disease due to its subjectivity. Currently, there is an absence of machine learning model that could make full use of the information gained from both medical history and physical signs.ObjectiveTo develop and validate a machine learning model based on medical history and physical signs for dizziness/vertigo disease diagnosis, relieving the burden of diagnosis for clinicians.DesignA retrospective cohort study.SettingTertiary referral center.ParticipantsThis study included 1003 patients conformed to the inclusion criteria at the neuro-otologists' clinics.ExposuresThirty-one medical history items, and 9 bedside examination signs recorded by routinely performing a detailed ocular motor examination using video goggles.Main Outcome MeasuresThe accuracy, precision, recall, F1 scores, and Matthews' correlation coefficient of disease diagnosis.ResultsOn the collected dataset of 16 categories of dizziness/vertigo diseases, the proposed model achieved an accuracy of 98.11% and an F1 score of 95.43%. The model demonstrated its optimal robustness when tested with datasets containing added noise. Additionally, an analysis of the correlation between medical history and signs was conducted, along with several case studies.ConclusionsA machine learning-based model was proposed for the diagnosis of dizziness/vertigo, which effectively combined patients' medical history and signs. In terms of diagnostic accuracy, it outperforms models that rely solely on either medical history or signs for diagnosis.RelevanceThe proposed method can effectively combine the patient's medical history and physical sign information to make the diagnosis of dizziness/vertigo disease, which has the potential to relieve the burden of diagnosis for clinicians to a certain extent.

ImportanceChatGPT has emerged as a medical resource through advanced language processing. Patients with thyroid nodules classified under The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) may use it to complement discussions with physicians.ObjectiveWe aimed to determine whether ChatGPT's recommendations on managing thyroid nodules classified by TBSRTC align with those of experienced thyroid specialists.Setting/ParticipantsA multidisciplinary panel of 5 thyroid cancer specialists, including otolaryngologists and endocrinologists, from 3 university-affiliated teaching hospitals in Montreal, Canada, evaluated the responses.Intervention/ExposureChatGPT-3.5 was prompted with 4 questions for each of the 6 Bethesda categories regarding the meaning and management of thyroid nodules, generating 24 responses for evaluation.Main Outcome/MeasuresWe assessed ChatGPT's accuracy against the latest American Thyroid Association (ATA) guidelines using a 4-point Likert scale (<50%, 50-74%, 75-89%, >90%). Additionally, specialists rated their comfort or reluctance in recommending ChatGPT as a complementary tool for patient discussions.ResultsOf the 24 ChatGPT-generated responses, 19 (79.2%) demonstrated moderate to good consistency with the ATA guidelines. The mean consistency score was 3.38/4 and median was 3.5. Consensus (IQR ≤ 1) was achieved in 23 out of 24 responses (95.8%), reflecting strong inter-rater reliability. Consistency scores were highest in Bethesda I-III and declined progressively in higher-risk categories, with the lowest mean score observed in Bethesda VI. Similarly, an upward trend in clinician reluctance was observed from Bethesda I through VI, indicating greater caution in recommending ChatGPT responses for patients suspicious for or diagnosed with malignancy (Bethesda V-VI).Conclusion and RelevanceWhile ChatGPT's responses generally align with specialist recommendations, they are not fully reliable. ChatGPT lacks the ability to serve as an independent or accurate source of medical advice for thyroid nodule management. It remains a useful complement for patient discussions, especially in low-risk scenarios, but further improvements are necessary to make it a safe, reliable component of patient care in complex cases.

Importance: Mentorship is increasingly recognized as a critical part of training across the spectrum of trainees. While explored more in-depth in the literature of other medical specialties, mentorship remains a nascent topic in the Otolaryngology Head and Neck Surgery (OHNS) literature.

Objective: The objective of this study was to assess the current literature on mentorship in OHNS.

Design: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines was used and the methodology was registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/X5FQ7). The Medline, EMBASE, and Web of Science databases were searched. Two authors independently selected studies, with the senior author resolving discrepancies. Study quality was assessed using the Oxford Centre for Evidence-Based Medicine levels of evidence.

Setting and participants: English language studies employing any methodology that involved mentorship of medical trainees and staff in OHNS were included from the inception of the database up to September 20, 2023.

Intervention or exposures: Any form of mentorship.

Main outcome measure: The primary outcome was the benefits of mentorship afforded to the mentee.

Results: From 415 unique articles identified, 45 studies were included. The median publication year was 2020 (IQR 6.5, range 1999-2023). The major themes of benefits from mentorship include improving residency uptake (n = 22), clinical competency and professionalism (n = 20), diversity and equity (n = 19), research productivity (n = 17), career planning and advancement (n = 17), and quality of life (n = 11). Other common themes included active mentorship (n = 29), near-peer mentorship (n = 13), and utilizing digital tools for mentorship (n = 6).

Conclusion and relevance: Mentorship in OHNS has seen a sharp increase in publications in recent years. There are numerous benefits to mentorship including improving residency uptake, diversity initiatives, clinical competency and professionalism, research productivity, career planning and advancement, as well as quality of life.

ImportanceThere is no antifungal otic drug for the treatment of otomycosis approved in the United States. Some current clotrimazole formulations in the market are used off-label.ObjectiveTo evaluate the efficacy and safety of clotrimazole 1% otic solution compared to placebo in treating otomycosis in adults.DesignTwo independent twin multicenter, randomized (2:1), double-blind, controlled clinical trials with identical designs were conducted from February 2020 to October 2021.SettingFifty-three sites located in the United States, Mexico, and Europe.ParticipantsAdults with uncomplicated otomycosis presented with symptoms, debris, and drainage clinically consistent with fungal infection.InterventionPatients received clotrimazole or placebo twice daily for 14 days and were evaluated on visit 1 (day 1), visit 2 (day 8-10), visit 3 (day 15), and follow-up visit 4 (day 24-26).Main Outcome MeasuresAt each visit, pruritus, otalgia, otorrhea, and ear fullness were assessed. Ear exudate was taken for a mycological and microbiological evaluation at baseline and, if present, at subsequent visits. The primary endpoint was a therapeutic cure (mycological and clinical) at visit 4 in the randomized population with positive fungal culture at baseline [mycological intent-to-treat (MITT)].ResultsThree hundred ninety-three patients received study medication (261 clotrimazole and 132 placebo). Efficacy data from the 228 patients (157 clotrimazole and 71 placebo) included in the MITT were analyzed. The clotrimazole group achieved a higher proportion for the primary endpoint than those with the placebo group (68.2% vs 25.4%; P < .0001), with a 42.8 difference in response rate (95% confidence interval: 30.3, 55.3). The treatment was safe and well tolerated, with 2.7% of related adverse events in the clotrimazole versus 1.5% in the placebo group.ConclusionsClotrimazole 1% otic solution has demonstrated its superiority over the placebo in each study and the pooled analysis. These are the results of the first international, multicenter clinical trials in which clotrimazole 1% otic solution demonstrates efficacy for the treatment of otomycosis.

ImportanceThe clinical significance of oncocytes in thyroid aspirate is uncertain, leading to inconsistent and possible over-treatment.ObjectiveTo determine the predictive significance of clinico-radiological parameters and cytologic diagnosis on the risks of malignancy (ROM) and neoplasia.DesignData of thyroid aspirates with the presence of oncocytes were reviewed for outcomes and clinical-radiological-pathological parameters.SettingThree regional institutes performing thyroid surgery and investigations.ParticipantsFrom a population base of 1.3 million across a 9-year period, totaling 371 aspirates with oncocytes with an 85.0-month average follow-up.InterventionFine-needle aspiration of thyroid.ResultsOn clinical follow-up, the ROM for Bethesda categories C1-C6 was 15.4%/2.7%/9.2%/6.9%/37.5%/100%, while the risk of neoplasm (considering thyroidectomy follow-up) was 45.5%/23.8%/56.3%/61.9%/50%/100%, including 52 oncocytic follicular lesions (4 carcinomas and 48 adenomas) and 26 other carcinomas/malignancies. C5+ diagnoses were associated with malignancy (P = .003), and C3+ was associated with neoplasm on thyroidectomy (P = .006). Malignant/neoplastic outcomes did not correlate with sex or age (P > .05). High free triiodothyronine/free thyroxine levels were associated with a benign clinical outcome (P = .001). Cystic change on ultrasound was associated with a lower malignancy (P = .012) and neoplasm risk (P = .041). Lesion size, echogenicity, vascularity, multinodularity, lymphadenopathy, and solid areas on ultrasound were not significant in predicting malignancy or neoplasm (P > .05).ConclusionThe presence of oncocytes in thyroid aspirates does not increase malignancy risk. Most malignant oncocytic thyroid aspirates are not attributable to oncocytic carcinomas but papillary thyroid carcinomas. Ultrasound and thyroid function tests are helpful in the risk assessment of these cases.RelevanceFor treatment or follow-up decisions in patients with oncocytes in thyroid aspirates.

ImportanceThe management of complications following oral cavity squamous cell carcinoma (OCSCC) surgery can be challenging. Previous studies show conflicting results on complication risks after preoperative radiotherapy (RT), necessitating a randomized controlled trial (RCT).ObjectiveTo compare early complications during hospitalization for OCSCC surgery between patients receiving preoperative accelerated fractionated RT and those planned for but not yet exposed to RT.DesignA part of the ARTSCAN 2 RCT comparing preoperative accelerated RT with postoperative conventionally fractionated RT for OCSCC.SettingA multicentre trial in 6 tertiary care hospitals in Sweden.ParticipantsUntreated and resectable OCSCC patients of all stages recommended combination treatment by the local multidisciplinary board.InterventionPreoperative accelerated RT was administered twice daily to a total dose of 68 Gy, completed 4 to 6 weeks before surgery.Main Outcome MeasuresComplications during hospitalization included wound infection, neck flap necrosis, chyle leakage, oro/pharyngocutaneous fistula, free flap necrosis, tracheostomy, revision surgery, and medical complications. Length of surgery, perioperative blood loss, and transfusions were also monitored.ResultsTwo hundred and twenty-one patients were eligible for analysis: 103 in the preoperative RT group and 118 not yet exposed to RT. Complication rates were low, with no statistically significant differences between groups. Patients receiving preoperative RT had similar wound infection rates (12/103; 11.7%) to those not exposed (9/118; 7.6%) (P = .31). Among free flap patients, 1/40 (2.5%) in the preoperative RT group and 3/52 (5.8%) in the unirradiated group had free flap necrosis (P = .63). No differences were found in oro/pharyngocutaneous fistula frequency (3/103; 2.9% vs 3/118; 2.5%) (P = 1.00).Conclusion and RelevancePreoperative accelerated RT at 68 Gy, administered 4 to 6 weeks before surgery, does not increase early complications. Although survival rates, morbidities, quality of life, and societal costs need consideration in the ARTSCAN 2 assessment, our findings show that early postoperative complication risks remain unchanged by preoperative RT.Trial RegistrationISRCTN, ISRCTN00608410, Registered 20 March 2008-Retrospectively registered, https://www.isrctn.com/ISRCTN00608410.

ObjectiveTo identify reliable clinical, biological, and radiological markers predicting the failure of medical treatment in pediatric patients with acute ethmoidal rhinosinusitis (AERS) and subperiosteal abscess, facilitating informed decisions regarding the need for surgical intervention.DesignRetrospective multicenter cohort study.SettingPediatric otorhinolaryngology departments at a tertiary-care center and a public hospital in France, spanning from January 2014 to January 2024.ParticipantsChildren under 18 years diagnosed with Chandler stage III orbital complication of AERS, confirmed by computed tomography (CT).InterventionsInitial treatment with antibiotics, with surgical intervention as required based on clinical evaluation.Main Outcome MeasuresFactors associated with the need for surgical intervention, including demographic data, clinical examination, C-reactive protein (CRP) levels, leukocyte count, and CT evaluation.ResultsOut of 65 patients, 31 (48%) underwent surgery and 34 (52%) were treated with antibiotics alone. In multivariate analysis adjusted for age, the significant factors associated with surgical intervention included complete eyelid closure (odds ratio (OR) = 7.6; P < .001), ophthalmoplegia (OR = 14.2; P < .001), clinical exophthalmos (OR = 25.0; P < .001), CRP level >60 mg/L (OR = 6.9; P = .006), leukocyte count >15,600 g/L (OR = 7.7; P = .002), radiological exophthalmos (OR = 6.1; P = .001), retro-septal cellulitis (OR = 3.5; P = .02), posterior ethmoid opacification (OR = 6.1; P = .03), and abscess width >4 mm (OR = 8.2; P = .01).Conclusions and RelevanceMany patients can be managed medically. However, complete eyelid closure should prompt a CT scan. Exophthalmos, retro-septal cellulitis, or an abscess wider than 4 mm is an indication for surgical drainage. Ophthalmoplegia should be interpreted in context. CRP level >60 mg/L, a leukocyte count >15,600 g/L, and posterior ethmoid opacification should lead to close monitoring. These findings can aid in developing a clinico-bio-radiological score to guide treatment decisions, potentially improving patient outcomes by standardizing care protocols.

ImportanceMediastinal goiters can complicate anesthetic management, and although awake bronchoscopic intubation is the gold standard, it is resource-intensive and may be unpleasant for patients. In many centers across North America, patients undergoing thyroidectomy for mediastinal goiters are routinely intubated awake.ObjectiveThis study aimed to evaluate the outcomes of intubation in patients selected for awake versus asleep intubation for thyroidectomy of mediastinal goiters.DesignPRISMA 2020 Checklist for systematic reviews was followed. A search was performed in the Medline, Embase, Web of Science, CINAHL, Scopus, and Cochrane databases. Two independent reviewers performed abstract and full-text review. Data were extracted in duplicate. Study quality was assessed using the JBI Critical Appraisal tool. To account for heterogeneity, a 3-level random-effects model was constructed using the Der Simonian and Laird method with an arcsine transformation.Setting and ParticipantsPatients undergoing thyroidectomy for benign mediastinal goiters.Intervention and ExposuresAwake or asleep intubation.Main Outcome(s) and Measure(s)Rate of failed intubations in asleep intubation and proportion of uncomplicated intubations in asleep and awake populations.ResultsTwelve of 490 identified studies, involving 1002 patients, were included. Three cases of failed intubations were found in the asleep intubation group, with an overall incidence of failed intubation of 0.3%. Meta-analysis demonstrated an overall uncomplicated intubation rate of 91% (95% CI 77%-98%, n = 1002). Subgroup analyses showed a 96% success rate (95% CI 73%-100%, n = 60) for awake intubations and 88% (95% CI 69%-98%, n = 942) for asleep intubations. Further refined analyses showed uncomplicated intubation rates of 98% (95% CI 93%-100%, n = 469) for asleep, and 92% (95% CI 78%-99%, n = 48) for awake groups.Conclusions and RelevanceThe risk of failed intubation in patients with mediastinal goiters remains low, and awake intubation may require more attempts than asleep intubation. Further research with standardized definitions of intubation difficulty is needed.