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Background: Digital twin technology heralds a transformative era in Otorhinolaryngology (ORL), merging the physical and digital worlds to offer dynamic, virtual models of physical entities or processes., Purpose: These models, capable of simulating, predicting, and optimizing real-world counterparts, are evolving from static replicas to intelligent, adaptive systems., Methods: Fueled by advancements in communication, sensor technology, big data analytics, Internet of Things (IoT), and simulation technologies, artificial intelligence (AI), digital twins in ORL promise personalized treatment planning, virtual experimentation, and therapeutic intervention optimization. Despite their potential, the integration of digital twins in ORL faces challenges including data privacy and security, data integration and interoperability, computational demands, model validation and accuracy, ethical and regulatory considerations, patient engagement, and cost and accessibility issues., Results: Overcoming these challenges requires robust data protection measures, seamless data integration, substantial computational resources, rigorous validation studies, ethical transparency, patient education, and making the technology accessible and affordable. Looking ahead, the future of digital twins in ORL is bright, with advancements in AI and machine learning, omics data integration, real-time monitoring, virtual clinical trials, patient empowerment, seamless healthcare integration, longitudinal data analysis, and collaborative research., Conclusion: These developments promise to refine diagnostic and treatment strategies, enhance patient care, and facilitate more efficient and tailored ORL research, ultimately leading to more effective and personalized ORL management., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The widespread diffusion of Artificial Intelligence (AI) platforms is revolutionizing how health-related information is disseminated, thereby highlighting the need for tools to evaluate the quality of such information. This study aimed to propose and validate the Quality Assessment of Medical Artificial Intelligence (QAMAI), a tool specifically designed to assess the quality of health information provided by AI platforms., Methods: The QAMAI tool has been developed by a panel of experts following guidelines for the development of new questionnaires. A total of 30 responses from ChatGPT4, addressing patient queries, theoretical questions, and clinical head and neck surgery scenarios were assessed by 27 reviewers from 25 academic centers worldwide. Construct validity, internal consistency, inter-rater and test-retest reliability were assessed to validate the tool., Results: The validation was conducted on the basis of 792 assessments for the 30 responses given by ChatGPT4. The results of the exploratory factor analysis revealed a unidimensional structure of the QAMAI with a single factor comprising all the items that explained 51.1% of the variance with factor loadings ranging from 0.449 to 0.856. Overall internal consistency was high (Cronbach's alpha = 0.837). The Interclass Correlation Coefficient was 0.983 (95% CI 0.973-0.991; F (29,542) = 68.3; p < 0.001), indicating excellent reliability. Test-retest reliability analysis revealed a moderate-to-strong correlation with a Pearson's coefficient of 0.876 (95% CI 0.859-0.891; p < 0.001)., Conclusions: The QAMAI tool demonstrated significant reliability and validity in assessing the quality of health information provided by AI platforms. Such a tool might become particularly important/useful for physicians as patients increasingly seek medical information on AI platforms., (© 2024. The Author(s).)

Objective: Large language models (LLMs) are used in various fields for their ability to produce human-like text. They are particularly useful in medical education, aiding clinical management skills and exam preparation for residents. To evaluate and compare the performance of ChatGPT (GPT-4), Gemini, and Bing with each other and with otorhinolaryngology residents in answering in-service training exam questions and provide insights into the usefulness of these models in medical education and healthcare., Methods: Eight otorhinolaryngology in-service training exams were used for comparison. 316 questions were prepared from the Resident Training Textbook of the Turkish Society of Otorhinolaryngology Head and Neck Surgery. These questions were presented to the three artificial intelligence models. The exam results were evaluated to determine the accuracy of both models and residents., Results: GPT-4 achieved the highest accuracy among the LLMs at 54.75% (GPT-4 vs. Gemini p=0.002, GPT-4 vs. Bing p<0.001), followed by Gemini at 40.50% and Bing at 37.00% (Gemini vs. Bing p=0.327). However, senior residents outperformed all LLMs and other residents with an accuracy rate of 75.5% (p<0.001). The LLMs could only compete with junior residents. GPT- 4 and Gemini performed similarly to juniors, whose accuracy level was 46.90% (p=0.058 and p=0.120, respectively). However, juniors still outperformed Bing (p=0.019)., Conclusion: The LLMs currently have limitations in achieving the same medical accuracy as senior and mid-level residents. However, they outperform in specific subspecialties, indicating the potential usefulness in certain medical fields., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare., (©Copyright 2024 by Turkish Otorhinolaryngology- Head and Neck Surgery Society / Turkish Archives of Otorhinolaryngology is published by Galenos Publishing House.)

Purpose: This study was conducted to determine the relationship between preoperative fear and postoperative comfort in otolaryngology patients., Design: This is a descriptive study., Methods: The sample consisted of 282 patients undergoing otolaryngology surgery. Participants scheduled for surgery were administered the Patient Information Form and the Surgical Fear Scale in the preoperative period. In the postoperative period, the Perianesthesia Comfort Scale was administered after leaving the intensive care. Data were analyzed using t test, Mann-Whitney U test, and Kruskal-Wallis tests., Findings: We found that if patients' preoperative fear was low, their postoperative comfort was high. A positive linear relationship was found between surgical fear and comfort (P < .05)., Conclusions: The study revealed a positive relationship between the postoperative comfort experienced by the patients and preoperative fear in that patients who had a low level of preoperative fear experienced less postoperative pain., Competing Interests: Declaration of Competing Interest None to report., (Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the association between laryngopharyngeal reflux disease (LPRD) and Empty Nose Syndrome (ENS)., Methods: Nasal and laryngopharyngeal reflux symptoms were investigated in patients with ENS. Symptoms were evaluated with reflux symptom score-12 (RSS-12), nasal obstruction symptom evaluation (NOSE), empty nose syndrome 6-item questionnaire (ENS6Q), empty nose syndrome index (ENSI), and sinonasal outcome tool-22 (SNOT-22). The anxiety and depression were assessed with the general anxiety disorder-7 (GAD-7), and patient health questionnaire-9 (PHQ-9). A study of association was conducted between demographics and patient-reported outcome questionnaires., Results: Forty-one ENS patients were included (20 females (48.8%)). The control groups included 27 patients with rhinitis/rhinosinusitis and 36 asymptomatic individuals. The ENSI and ENS6Q detected ENS in 97.6% and 90.2% of cases, respectively. The mean scores of ENSI, ENS6Q, RSS-12, NOSE, and SNOT-22 were significantly higher in the ENS group compared to controls. The prevalence of suspected LPRD was 90.2% in the ENS group, which was significantly higher compared to controls. The prevalence of mild, moderate, moderately severe, and severe depression in ENS patients was 7.3% (n = 3), 4.9% (n = 2), 39.0% (n = 16), and 46.3% (n = 19), respectively. RSS-12 reported significant and high associations with the ENS6Q (r s =0.939; p = .001) and ENSI (r s =0.699; p = .001)., Conclusion: LPRD symptoms and prevalence were significantly higher in ENS patients compared to controls. Future controlled studies are needed to investigate the prevalence of LPRD in ENS patients through objective approaches (impedance-pH monitoring, nasal digestive enzyme measurements)., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The purpose of this work is to synthesize the latest developments in diagnosis and management of acute and late dysphagia and dysphonia in oral cavity cancer., Methods: A literature search was conducted using PubMed, Web of Science, Embase and Google Scholar in May 2024 of articles published between 2021 and 2024. Keywords in the search terms included oral cavity cancer, dysphagia, dysphonia, deglutition, swallowing, voice, oral cavity cancer treatment, oral cavity radiation, chemotherapy, dysgeusia, xerostomia, swallow preservation., Results: Twenty-seven pertinent studies fit the inclusion criteria. The most common dysphagic complaints following head and neck cancer are trismus, xerostomia, mucositis and dysphagia. Dysphonia, change in voice is reported by half of head and neck cancer survivors. Fibrosis and neuropathy following radiation therapy to the oral cavity, tongue, oropharynx and its surrounding structures is the most common etiology of post-treatment dysphonia., Conclusions: Oral cavity cancers cause speech and swallowing dysfunction due to both anatomic and post-treatment changes. These sequalae can be detrimental to the quality of life of the head and neck cancer survivor. For both dysphagia and dysphonia after head and neck cancer early speech and swallow therapy with a Speech Language Pathologist are essential to restoring and maintaining function., (© 2024 John Wiley & Sons Ltd.)

This systematic literature review aims to study the role and impact of artificial intelligence (AI) in transforming Ear, Nose, and Throat (ENT) healthcare. It aims to compare and analyse literature that applied AI algorithms for ENT disease prediction and detection based on their effectiveness, methods, dataset, and performance. We have also discussed ENT specialists' challenges and AI's role in solving them. This review also discusses the challenges faced by AI researchers. This systematic review was completed using PRISMA guidelines. Data was extracted from several reputable digital databases, including PubMed, Medline, SpringerLink, Elsevier, Google Scholar, ScienceDirect, and IEEExplore. The search criteria included studies recently published between 2018 and 2024 related to the application of AI for ENT healthcare. After removing duplicate studies and quality assessments, we reviewed eligible articles and responded to the research questions. This review aims to provide a comprehensive overview of the current state of AI applications in ENT healthcare. Among the 3257 unique studies, 27 were selected as primary studies. About 62.5% of the included studies were effective in providing disease predictions. We found that Pretrained DL models are more in application than CNN algorithms when employed for ENT disease predictions. The accuracy of models ranged between 75 and 97%. We also observed the effectiveness of conversational AI models such as ChatGPT in the ENT discipline. The research in AI for ENT is advancing rapidly. Most of the models have achieved accuracy above 90%. However, the lack of good-quality data and data variability limits the overall ability of AI models to perform better for ENT disease prediction. Further research needs to be conducted while considering factors such as external validation and the issue of class imbalance., Competing Interests: Conflict of interestThe authors have no conflict of interest to declare relevant to this article’s content., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

The increasing development of artificial intelligence (AI) generative models in otolaryngology-head and neck surgery will progressively change our practice. Practitioners and patients have access to AI resources, improving information, knowledge, and practice of patient care. This article summarizes the currently investigated applications of AI generative models, particularly Chatbot Generative Pre-trained Transformer, in otolaryngology-head and neck surgery., Competing Interests: Disclosure Competing interest: None. Sponsorships: None. Funding source: None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Learning how to use barbed sutures and perform Barbed Pharyngoplasty (BP) is challenging due to limited surgical training opportunities. This work aims to design, develop, and validate a new 3D surgical simulator to train ENT residents and specialists in performing BP., Methods: The Barbed Pharyngoplasty Simulator (BPS) was designed using diagnostic images of the facial mass and testing different materials to replicate the mucosal and bony tissues. ENT specialists with experience in BP and ENT residents were included in the validation study and were asked to perform the Alianza BP. After the simulation, they compiled the Face and Content Validity Questionnaires., Results: The BPS consists of a reusable cranial structure that contains the disposable palatopharyngeal structure, replicating the palatal structures and the tongue. Fifteen experienced ENT specialists and nine residents were included in the study. Findings demonstrated that the BPS faithfully replicated the muscular and fibrous-bony palatopharyngeal structures, with only 11% of residents having a negative opinion of the mucosal tissue. All the participants positively rated the sensation of using surgical instruments on the simulator. Also, ENT residents rated all aspects of the content validity test from normal to excellent, while specialists rated the BPS as a general training tool from normal to excellent; for lateral pharyngoplasty, BP, and Alianza, only 6.7% of participants disagreed with its usefulness, and 13.3% disagreed with it for anterior pharyngoplasty., Conclusion: The BPS proposed in this preliminary study can potentially be a valuable tool in BP surgical training for residents and young otolaryngologists., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Otorhinolaryngology is a medical specialty that focuses on the clinical study and treatments of diseases within head and neck regions, specifically including the ear, nose, and throat (ENT), but excluding eyes and brain. These anatomical structures play significant roles in a person's daily life, including eating, speaking as well as facial appearance and expression, thus greatly impacting one's overall satisfaction and quality of life. Consequently, injuries to these regions can significantly impact a person's well-being, leading to extensive research in the field of tissue engineering and regenerative medicine over many years., Methods: This chapter provides an overview of the anatomical characteristics of otorhinolaryngologic tissues and explores the tissue engineering and regenerative medicine research in otology (ear), rhinology (nose), facial bone, larynx, and trachea., Results and Conclusion: The integration of tissue engineering and regenerative medicine in otorhinolaryngology holds the promise of broadening the therapeutic choices for a wide range of conditions, ultimately improving quality of a patient's life., (© 2024. Korean Tissue Engineering and Regenerative Medicine Society.)

Introduction: COVID-19 has led to delays in providing healthcare in both emergency and non-emergency settings, especially in surgical subspecialties which rely heavily on referrals and in-person visits. Without an established telehealth infrastructure, many otorhinolaryngological departments experienced decreases in consultations. Telemedicine has attempted to bridge the gap between pre- and post-pandemic periods by creating a safe avenue of communication between otorhinolaryngologists and patients. This review hopes to address the accuracy of telemedicine in patient diagnosis and management., Methods: Searches were conducted since study conception until June 30, 2022, on multiple databases including PubMed, SCOPUS, and CINAHL for this systematic review and meta-analysis. Diagnostic accuracy, management accuracy, kappa, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were meta-analyzed by comparing virtual visits to in-person visits (gold standard)., Results: Nineteen studies were included in this review. A total of 1518 patients were included across all studies. When comparing virtual visits against in-person visits, accurate diagnosis was made in 86.2% [82.1,89.9, I 2  = 73.5%, P  < 0.0001] of patients and management accuracy was 91.5% [86.1,95.7, I 2  = 81.8%, P  < 0.0001] when treating patients. Kappa value determining interrater reliability was 0.8 [0.7,0.9, I 2  = 81.8%, P  < 0.0001]., Conclusion: Our data suggest that diagnostic and management concordance is above 80% when comparing diagnosis and management strategies in patients who underwent both telehealth and in-person visits with an otorhinolaryngologist. In uncomplicated patients, telehealth might be a reliable source for diagnosis and management however, in-person consultation is likely still required for pathologies in which physical exam, imaging or procedural elements represent a vital component of the work-up., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

With the increase in life expectancy and awareness, more otorhinolaryngologic surgeries are being performed in the elderly population. Otorhinolaryngologic surgeries like septoplasty, tympanoplasty, and dacryocystorhinostomy (DCR) surgeries are elective surgeries for improving the quality of life. However, post-operative medication can entail a risk to life or serious side effects in elderly patients. It is seen that before any surgery, the patients have undergone various tests and investigations to monitor the nephrotoxicity and hepatotoxicity primarily to gauge medication clearance and organ damage. However, the effects of various post-operative medications on the central nervous system and cardiovascular system are less well-discussed. Harmful effects of various drugs especially antibiotics given post-operatively in otorhinolaryngology on the central nervous and cardiovascular system are not frequently reported, and the underlying mechanisms may be unclear or conflicting. Older individuals have a greater chance of experiencing serious drug reactions due to physiologic changes affecting pharmacokinetic processes. Some frailty risk indices can be used to determine the cognitive and physiological conditions in geriatric patients so that the outcome of using antibiotics in the post-operative period on the neuropsychiatric and cardiovascular systems can be predicted. This review aims to summarise the research on the neurotoxic and cardiac effects of antibiotics used in otorhinolaryngology practice in the post-operative period in elderly patients, with a focus on signs of psychosis, delirium, cognitive impairment, syncope, cardiac arrest, angina-like symptoms, etc. This review also studies some frailty risk indices that can be used to predict the neuropsychiatric and cardiac side effects due to polypharmacy, especially antibiotics. Hence, post-operative risks can be predetermined and a protocol for further management can be established., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Jain et al.)

Behind the retro auricular groove, hidden by the pinna, on the surface of the mastoid, there is, a bony outgrowth, known by any otorhinolaryngologist worthy of the name, located above and behind the entrance to the external auditory canal in front of the supra meatic fossa: Henle's spine. In this historical note the authors retrace the moment of the dicovery of this primordial relief of otological surgery and the life of its discoverer, the German anatomis Jakob Henle, a true malesrtom which mixes science, art politics, and love., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background/objectives: New teaching methods are warranted to meet the demand for increased flexibility in medical education while making optimal use of the limited resources of educators. The COVID-19 pandemic forced universities to resort to online-only teaching, even for training of psychomotor skills. The objectives of this study were: (I) to investigate the performance of students without previous experience in ear, nose and throat (ENT) examination after completing an asynchronous online teaching course in an objective standardized clinical examination (OSCE) and (II) to evaluate the degree of over- and underestimation of their abilities., Methods: The study was designed as a prospective, single-institution medical education cohort study. Medical students (n = 54; 3rd/4th year, no previous head and neck examination skills) completed a comprehensive online training for basic head and neck examination skills 1-14 days before undergoing an OSCE on 5 different examination items (cervical lymph node examination, oral/oropharyngeal examination, otoscopy, Weber/Rinne hearing test, anterior rhinoscopy). Expert-evaluated theoretical knowledge and practical abilities were measured using Likert scales (1 = high proficiency to 5 = low proficiency). Participants self-evaluated their own skills before and after the OSCE (5-point Likert scales)., Results: Students achieved an overall good to medium skill level in basic head and neck examination after online training. Increased psychomotor complexity of tasks contributed to worse performance. Expert evaluation of practical skills was better in male participants and those who rated their preparation as thorough. Low/no misjudgment (discrepancy between self- and expert-evaluation) was observed in most participants, while high discrepancy levels (strong misjudgment) were mainly attributable to the students' underestimation of their own abilities., Conclusions: Online training of head and neck examination skills is a cost- and resource-efficient introduction to skill training and was inevitable during the pandemic. However, it cannot replace practical hands-on training, especially in tasks with high psychomotor requirements. Refresher-courses could compensate for cancelled skill training during the pandemic., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Objective: Otolaryngologists are at a significantly greater risk of being sued than most other physicians. To date, there is a lack of studies characterizing trends in otolaryngology malpractice claims. To assess these trends and risk variables, this study examined malpractice claims against otolaryngologists., Study Design: Retrospective database review., Setting: LexisNexis Jury Verdicts and Settlements., Methods: The LexisNexis legal database was used to locate jury verdicts and settlements related to medical malpractice in otolaryngology, from 2018 to 2024. The study did not include any claims covered by the Social Security Disability Insurance, Workers' Compensation, Healthcare Law, or Criminal Law and Procedure categories. Temporal trends were evaluated, and logistic regression was used to identify independent risk factors., Results: Out of 903 items, 79 reported malpractice cases were included (mean age 44.5; 60.3% female). The most sued subspecialty was head and neck oncology (32.5%). Negligence (93.7%) was the primary cause of action. Of cases sent to the jury, 87.7% of them resulted in a verdict in favor of the defendant. The mean plaintiff verdict payout was $7,432,508.06 and the mean identified settlement amount was $1,562,500.00. Physical injury (62.0%) was the highest type of harm. Regional analysis indicated a higher percentage of cases from New York favored the defendant (21.1% vs 13.6%; P = .034)., Conclusion: This study highlights key trends in otolaryngology malpractice claims, emphasizing the prevalence in cases of head and neck surgery, primarily attributed to negligence. By identifying trends and risk factors, otolaryngologists can get a better understanding of the dynamics surrounding malpractice., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Objective: To review the current literature on the application, accuracy, and performance of Chatbot Generative Pre-Trained Transformer (ChatGPT) in Otolaryngology-Head and Neck Surgery., Data Sources: PubMED, Cochrane Library, and Scopus., Review Methods: A comprehensive review of the literature on the applications of ChatGPT in otolaryngology was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses statement., Conclusions: ChatGPT provides imperfect patient information or general knowledge related to diseases found in Otolaryngology-Head and Neck Surgery. In clinical practice, despite suboptimal performance, studies reported that the model is more accurate in providing diagnoses, than in suggesting the most adequate additional examinations and treatments related to clinical vignettes or real clinical cases. ChatGPT has been used as an adjunct tool to improve scientific reports (referencing, spelling correction), to elaborate study protocols, or to take student or resident exams reporting several levels of accuracy. The stability of ChatGPT responses throughout repeated questions appeared high but many studies reported some hallucination events, particularly in providing scientific references., Implications for Practice: To date, most applications of ChatGPT are limited in generating disease or treatment information, and in the improvement of the management of clinical cases. The lack of comparison of ChatGPT performance with other large language models is the main limitation of the current research. Its ability to analyze clinical images has not yet been investigated in otolaryngology although upper airway tract or ear images are an important step in the diagnosis of most common ear, nose, and throat conditions. This review may help otolaryngologists to conceive new applications in further research., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Adenocarcinoma of the frontal sinus is extremely rare. We present a primary frontal sinus adenocarcinoma masquerading as an inverted papilloma (IP). Here, we reviewed various clinical presentations, investigations, and management of frontal sinus adenocarcinoma. A 48-year-old male presented with nasal bridge swelling one month following endoscopic sinus surgery for frontal sinus inverted papilloma. Progressively enlarging swelling with persistent pressure symptoms drew doubts regarding previously proven diagnosis. Imaging studies put us at the management crossroads of malignancy versus infection (osteomyelitis). The complexity of this case prompted a multidisciplinary team approach, eventually leading to a revision surgery for re-evaluation. Re-excision of the frontal sinus tumor was later proven to be adenocarcinoma of the frontal sinus. This case underscores the importance of thorough follow-up and investigation in patients presenting with recurrent or persistent symptoms following sinus surgery. This case highlighted the need for a high index of suspicion and comprehensive diagnostic workup., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Chu et al.)

Transoral robotic surgery (TORS) provides a minimally invasive approach to address tumors in selected and challenging anatomical locations. Among the critical areas where TORS demonstrates its prowess is the oropharynx. Oropharyngeal tumors can invade parapharyngeal space (PPS) which contains vital structures such as the carotid artery, internal jugular vein, and cranial nerves IX-XII. A deeper understanding of the endoscopic anatomy of the parapharyngeal space could reduce the morbidity associated with tumor resection in this dense neurovascular area. This video-article provides a step-by-step cadaveric dissection of the lower PPS though a transoral robotic approach., (© 2024 Wiley Periodicals LLC.)

Introduction Ear, nose, and throat (ENT), often known as otorhinolaryngology (ORL), is a subspecialty within medicine that specializes in diagnosing and treating conditions affecting the head, neck, and ears. Understanding ORL is essential for treating common ENT issues, avoiding complications, and preserving quality of life. These diseases can affect numerous physiological processes, including taste, smell, speaking, breathing, swallowing, hearing, and secretion clearance. In order to guide interventions for improved ENT health, our study sought to evaluate university students' degree of ORL-related knowledge. Methodology It is a cross-sectional study conducted among students at King Khalid University in Saudi Arabia. Validated surveys are used to collect data via the Internet, including online and email-based data collecting. Data are cleaned in Excel and analyzed by IBM SPSS (IBM Corp., Armonk, NY). Results Our study included 131 Saudi university students in Abha City, revealing significant knowledge gaps and misconceptions regarding ENT issues. Despite high awareness of certain topics like flu vaccination (87.8%) and the association between hearing loss and social life (95.4%), misconceptions persisted, such as the belief in vitamin C's efficacy against influenza (51.9%). Notably, 47.3% displayed good knowledge, 26.7% showed moderate knowledge, and 26% demonstrated poor knowledge about ENT issues. Significant associations were found between knowledge levels and age (p<0.001), academic level (p<0.001), and previous surgery related to ENT issues (p=0.014). Conclusion Our study revealed that 47.3% of participants have good levels of knowledge regarding ENT problems, with significant associations found with age, academic level, previous ENT surgery, and diagnoses of throat issues. Education campaigns should target specific demographics to improve the overall understanding of ENT health., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Research Board of King Khalid University, Abha, Saudi Arabia issued approval ECM#2024-1405. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Al Sulaiman et al.)

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by a type 2 pattern of inflammation. Mepolizumab was approved for the treatment of CRSwNP in 2021, it may be useful to evaluate its safety profile in a real-world setting., Aim: This work aimed to prospectively highlight the effectiveness and safety profile of Mepolizumab in patients with CRSwNP enrolled in the Otorhinolaryngology Unit of the University Hospital of Messina., Methods: An observational cohort study was carried out considering all patients treated with Mepolizumab. A descriptive analysis was conducted reporting all demographic characteristics, endoscopic evaluations, and symptom conditions., Results: A total of 30 patients were treated with Mepolizumab, one patient discontinued the treatment. A statistically significant reduction in the Sino-Nasal Outcome Tests-22 (SNOT-22) and nasal polyp score (NPS) was shown at the 6th and 12th months compared to baseline values (SNOT-22, -33 and - 43, p < 0.001 for both comparisons; NPS, 0 and - 1, p < 0.001 for both comparisons). The median (Q1-Q3) sniffin' sticks test score increased from 7 (6-8) at the 6th month to 11 (10-13) at the 12th month. Seven patients (24.1 %) reported pain at the injection site, accompanied by redness, warmth, and tenderness within the first 24 h post-injection with a median duration of three days from the onset., Conclusions: Given the optimal treatment response and the minimal adverse effects observed, clinicians should consider Mepolizumab a safe and effective treatment in CRSwNP patients. Further studies in real-life setting are necessary to better understand the long-term effects., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

We report a rare case involving improved hearing after surgery for a jugular foramen schwannoma despite the lack of response during the preoperative auditory brainstem response (ABR) test. A left jugular foramen tumor was diagnosed in a 79-year-old man with hearing loss. No response was observed during the preoperative ABR test. However, his hearing improved after surgery using the lateral suboccipital approach. Following Gamma Knife radiation to the residual tumor post-surgery, the ABR test detected V waves. The hearing of patients with cerebellopontine angle tumors can improve even when there is no response during the preoperative ABR test., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Morisaki et al.)

Diagnostic accuracy is vital in otorhinolaryngology for effective patient care, yet diagnostic mismatches between non-otorhinolaryngology clinicians and ENT specialists can occur. However, studies investigating such mismatches in low-resource healthcare environments are limited. This study aims to analyze diagnostic mismatches in otorhinolaryngology within a low-resource healthcare environment. A publicly available dataset assessing diagnostic outcomes from non-otorhinolaryngology clinicians and ENT specialists was analyzed. The dataset included demographic characteristics, referral diagnoses, and final ENT specialist diagnoses. Descriptive statistics and appropriate statistical tests were employed to assess the prevalence of diagnostic mismatches and associated factors. The analysis comprised 1544 cases. The prevalence of diagnostic mismatches between non-otorhinolaryngology clinicians and ENT specialists was 67.4%. Certain specific ENT diseases demonstrated higher frequencies of diagnostic mismatches. Factors such as mismatch in the diagnosis and compliance of patient were found to influence the occurrence of diagnostic mismatches. This study highlights the presence of diagnostic mismatches in otorhinolaryngology within a low-resource healthcare environment. The prevalence of these mismatches underscores the need for improved diagnostic practices in such settings. Factors contributing to diagnostic mismatches should be further explored to develop strategies for enhancing diagnostic accuracy and reducing diagnostic errors in otorhinolaryngology., Competing Interests: Conflict of interestThe authors assert that there are no conflicts of interest to disclose., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Pharyngitis is an inflammation of the mucous membranes of the oropharynx. Pharyngitis may be caused by an infectious or noninfectious disease. Noninfectious diseases of pharynx include allergies, trauma, cancer, reflux and certain toxins. Infection with H. Pylori is associated with developing chronic sore throat, gastritis, gastric or duodenal ulcer, gastric cancer and MALT lymphoma. There are many different investigations to diagnose H pylori as H pylori antigen in blood and stool, urea breath test but, H. Pylori line is a new test for detection of the virulent strains. There are many lines of H pylori therapy in the form of PPIs and antibiotics for about two weeks. This study aimed to detect role of H pylori in chronic pharyngitis. 85 patients who had chronic pharyngitis with normal CBC, WBCS, lymphocyte, monocyte and eosinophils with negative ASO titer and throat swab. These patients did H pylori line to detect H pylori virulent antigen. 77 patients with chronic pharyngitis are positive H pylori and after medical treatment 68 patients became negative. H. Pylori line is a new test for detection of the virulent strains and screening H pylori carrier at risk of developing gastric and duodenal ulcers as well as cancer., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objective: To investigate the accuracy of Chat-Based Generative Pre-trained Transformer (ChatGPT) in answering questions and solving clinical scenarios of head and neck surgery., Study Design: Observational and valuative study., Setting: Eighteen surgeons from 14 Italian head and neck surgery units., Methods: A total of 144 clinical questions encompassing different subspecialities of head and neck surgery and 15 comprehensive clinical scenarios were developed. Questions and scenarios were inputted into ChatGPT4, and the resulting answers were evaluated by the researchers using accuracy (range 1-6), completeness (range 1-3), and references' quality Likert scales., Results: The overall median score of open-ended questions was 6 (interquartile range[IQR]: 5-6) for accuracy and 3 (IQR: 2-3) for completeness. Overall, the reviewers rated the answer as entirely or nearly entirely correct in 87.2% of cases and as comprehensive and covering all aspects of the question in 73% of cases. The artificial intelligence (AI) model achieved a correct response in 84.7% of the closed-ended questions (11 wrong answers). As for the clinical scenarios, ChatGPT provided a fully or nearly fully correct diagnosis in 81.7% of cases. The proposed diagnostic or therapeutic procedure was judged to be complete in 56.7% of cases. The overall quality of the bibliographic references was poor, and sources were nonexistent in 46.4% of the cases., Conclusion: The results generally demonstrate a good level of accuracy in the AI's answers. The AI's ability to resolve complex clinical scenarios is promising, but it still falls short of being considered a reliable support for the decision-making process of specialists in head-neck surgery., (© 2023 The Authors. Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

The COVID-19 pandemic has led to a major public health crisis. Residents entered the frontline in triaging and treating COVID-19 patients, working overtime to meet the growing demand. Surgical practice and educational activities were restricted, thus affecting resident training. There was also a great risk to their mental health. Our study aims to assess the academic impact and quality of life including mental health status among year I, year II and year III otorhinolaryngology residents during the pandemic. A cross-sectional study was conducted among postgraduates and junior residents working in otorhinolaryngology departments in institutions across South India in October 2020. Quality of life, severity of anxiety and depression, and academic impact were assessed using the WHOQOL-BREF, GAD-7, PHQ-8 and Academic impact questionnaires respectively via Google Forms. A total of 303 responses were obtained. Inpatient and outpatient clinical activity were affected irrespective of the year of training. Surgical training was also affected especially among the final-year residents (year III) with a mean score of 4.42. The maximum median WHOQOL-BREF score of 14.66 was found in the social domain and 13.33 in the psychological and social domains in men and women respectively. The majority (43%) of 114 men had mild anxiety, while among women, a slight preponderance (33.9%) of severe anxiety was noted. Most of the residents (75% of men and 66.6% of women) had no symptoms suggestive of depressive disorder, however, 19.3% of the men and 29.6% of the women were found to have major depression. The impact of the pandemic on resident training and mental health has been immense. The study outcome may help residents comprehend and perceive the extent of the same, and explore methods to be equipped and overcome similar circumstances in the future., Competing Interests: Conflict of InterestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Eagle's syndrome is a condition characterized by an elongated styloid process or a calcified stylohyoid ligament, which can lead to a plethora of symptoms, such as neck and facial pain upon movement, dysphagia, pharyngeal foreign body sensation, headache, and vertigo-like sensations. This pathology may affect one or both of a patient's styloid processes (unilateral or bilateral), with most of these cases going undiagnosed due to the vague nature of their symptoms. Nonetheless, the diagnosis of Eagle's syndrome must derive from the combined findings of both clinical examination and radiographic imaging. Symptomatic patients may require conservative or surgical treatment., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Karapepera et al.)

Introduction  The coronavirus disease 2019 (COVID-19) pandemic has prompted a transformation in medical practice, including the adoption of telemedicine in Brazil and globally. Otorhinolaryngology, a field at high risk of viral transmission, has witnessed an increasing use of telemedicine tools. However, the extent and challenges of telemedicine in this field in Brazil are not well understood. In the present study, we applied a questionnaire to Brazilian otorhinolaryngologists during the pandemic to assess telemedicine's advantages and challenges, shedding light on its integration and persistent issues in the field. Objective  To assess the usage profile of telemedicine in the clinical practice of otolaryngology in Brazil. Methods  The present was a cross-sectional observational study with convenience sampling. It was conducted as a web-based questionnaire distributed and advertised to Brazilian otorhinolaryngologists through social media posts on WhatsApp (Meta Platforms, Inc., Menlo Park, CA, USA), Instagram (Meta Platforms, Inc.), Facebook (Meta Platforms, Inc.), as well as direct messaging and email. Results  The sample size was 186 participants. A total of 69% of them had already provided or were currently providing telemedicine services, and 34% considered it a frequent or very frequent form of work at the time of data collection. In total, 90% of the respondents considered the lack of physical examination a problem in otolaryngological teleconsultations, while 64% reported frequently or very frequently resolving patient problems through teleconsultations. Conclusion  Telemedicine emerged in the context of the COVID-19 pandemic as a promising tool for remote patient care. More studies are needed to elucidate its role in the context of limited physical examination., Competing Interests: Conflict of Interests The authors have no conflict of interests to declare., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit ( https://creativecommons.org/licenses/by/4.0/ ).)

Background and Objective: There is great heterogeneity in the methodology and evaluation in specialized health training (SHT) in otorhinolaryngology in our country. The figure of the resident tutor is the cornerstone on which the ESF system is based and the regulation and recognition of this figure varies. This article aims to take a snapshot of the current situation of the ESF in Spain and to describe the activity of tutors., Materials and Methods: During the month of September 2023, a survey was sent in a Google Forms® format through the Spanish Society of Otolaryngology and Head and Neck Surgery. The survey consisted of 8 multiple-choice questions and 4 questions in which they were asked to rank a series of 5 weaknesses, threats, opportunities and strengths selected by the authors, in order to perform a SWOT analysis., Results: A total of 103 responses were obtained, of which 81 corresponded to accredited tutors. 63% of the tutors indicated that they did not have enough time to carry out their teaching work and 48% did not carry out a regular assessment of their residents. 64% of the tutors believe that the quality of otorhinolaryngology training in Spain is good and 61% are satisfied with their job as tutors. The main weakness was the short duration of the training programme, and the pressure of care was found to be the main threat. An experienced training system was considered the main strength and the creation of a national network of tutors was seen as an opportunity for improvement., Conclusions: The creation of a common and transversal otorhinolaryngology training pathway for all accredited centres and the creation of a network of mentors and residents are necessary to address the problems of SHT. The role of the tutor must be recognised and reinforced to improve specialist training., (Copyright © 2024. Published by Elsevier España, S.L.U.)

Testing of ChatGPT has recently been performed over a diverse range of topics. However, most of these assessments have been based on broad domains of knowledge. Here, we test ChatGPT's knowledge of tinnitus, an important but specialized aspect of audiology and otolaryngology. Testing involved evaluating ChatGPT's answers to a defined set of 10 questions on tinnitus. Furthermore, given the technology is advancing quickly, we re-evaluated the responses to the same 10 questions 3 and 6 months later. The accuracy of the responses was rated by 6 experts (the authors) using a Likert scale ranging from 1 to 5. Most of ChatGPT's responses were rated as satisfactory or better. However, we did detect a few instances where the responses were not accurate and might be considered somewhat misleading. Over the first 3 months, the ratings generally improved, but there was no more significant improvement at 6 months. In our judgment, ChatGPT provided unexpectedly good responses, given that the questions were quite specific. Although no potentially harmful errors were identified, some mistakes could be seen as somewhat misleading. ChatGPT shows great potential if further developed by experts in specific areas, but for now, it is not yet ready for serious application.

Purpose: To investigate the clinical manifestations, management and outcomes of Leishmania lesions in the ear-nose-throat (ENT) region, and its relationship with tumor necrosis factor (TNF)-α blocking drugs., Methods: Single-center retrospective observational study. Patients diagnosed with cutaneous and mucosal leishmaniasis in the otorhinolaryngologic area at a tertiary referral center over a period of 8 years., Results: Three cases of Leishmania lesions in the ear and two in the nose were encountered at our institution. All patients were under treatment with TNF-α blocking drugs. Diagnosis was challenging, and it was important to have a clinical suspicion in order to use accurate detection techniques. All patients received systemic treatment and achieved a complete resolution of the lesions., Conclusions: With the increasing use of biologic treatments like TNF-α blockers, this type of infection will be increasingly frequent in endemic areas and also worldwide. It is important to include leishmaniasis in the differential diagnosis of inflammatory/infectious lesions in the ENT region., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Artificial intelligence (AI) has the potential to improve the surgical treatment of patients with head and neck cancer. AI algorithms can analyse a wide range of data, including images, voice, molecular expression and raw clinical data. In the field of oncology, there are numerous AI practical applications, including diagnostics and treatment. AI can also develop predictive models to assess prognosis, overall survival, the likelihood of occult metastases, risk of complications and hospital length of stay., (© 2024 Wiley Periodicals LLC.)

Background: In the context of contact restrictions, conventional teaching is currently in need of optimization and expansion. The range of digital teaching formats in student training is very heterogeneous and their effectiveness uncertain. This study aims to investigate the extent to which an electronic ward round can be used as an alternative to the conventional ENT attendance practical course, and whether the use of electronic teaching formats has an influence on the quality of teaching., Materials and Methods: Instead of regular attendance practicals, bedside teaching took place once a week in real time as a video stream via tablet. A total of 43 students in the seventh semester (winter semester 2020/2021) were included in the prospective study. Evaluation forms were used to examine the subjective didactic value of different visualization formats for the students. Examination results from previous years were used for comparison., Results: The majority of students reported knowledge gain from the electronic rounds (93.02%) and that they were a good alternative to the traditional attendance clerkship (69.77%). The quality of the video and audio transmission as well as the comprehensibility of the case studies presented were consistently rated as good to very good. The students' examination results tended to be slightly worse in the test group compared to the control students of previous years., Conclusion: Integration of innovative interactive visualization options into teaching shows promising prospects as a supplement to conventional face-to-face teaching. The results of this study can contribute to the further expansion of digital teaching. Scaling up this model could be considered especially in countries with limited availability of face-to-face teaching., (© 2024. The Author(s).)

The discovery of bacterial microcolonies in tonsillar tissue of patients with tonsillar hyperplasia has raised the question of their role in provoking the local immune response. Tonsils collected from patients undergoing tonsillectomy were stained for three clinically relevant bacterial taxa and lymphocytes. The bacterial composition and abundance of microcolonies was investigated using a combination of laser-microdissection, amplicon sequencing and Droplet Digital polymerase chain reaction. Microcolonies were detected in most samples (32/35) with a high prevalence of Haemophilus influenzae (78% of samples). B and T cell lymphocytes were significantly higher in the epithelium adjacent to microcolonies compared to epithelium distal to microcolonies. Furthermore, significant positive and negative correlations were identified between bacterial taxa and lymphocytes. Genus Streptococcus, which includes Group A Streptococcus (traditionally described as the main pathogen of tonsillar hyperplasia), was found in low abundance in this study. These results suggest other potential pathogens may be involved in stimulating the local immune response leading to tonsillar hyperplasia., Competing Interests: Declaration of competing interest All authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

The article analyses level and dynamics of morbidity of diseases of ear and mastoid in the Sakha Republic (Yakutia) in 2020-2021 and availability of otorhinolaryngological care. The methods of comparative statistics and mathematical analysis were applied to analyze official data provided by the Yakut Republic Medical Information and Analytical Center, the specialized Department of Otorhinolaryngology, the Republic Hospital № 2 - Center for Emergency Medical Care and the Federal State Statistics Service of Russia. The study established increasing trend of increasing morbidity of these diseases in both the adult and child population. In 2021, the growth rate of overall morbidity of adult population reached 17.7% and 8.8% in children, as compared to 2020. The primary morbidity of adults made up to 22.3%, in children - 15.7%. The comparative analysis demonstrated higher rates of general morbidity in the Republic: by 0.5% as compared with the Russian Federation and by 14.1% as compared with the Far Eastern Federal Okrug. The level of primary morbidity was lower than similar indicators of the compared territories by 17.1% and 3.0%, respectively. It is worth noting that analyzed morbidity of diseases of ear and mastoid reflects prevalence of ENT diseases in the region only indirectly, as the statistical data do not allow to estimate separately rate of upper respiratory tract lesions. Meanwhile, respiratory diseases rank first in the structure of population diseases in Yakutia. The growth of disability in children due to diseases of ear and mastoid requires attention. Among children of 0-17 years old, the indicator of primary disability increased from 0.38 to 0.8 per 10,000 of children population (increase of 110.5%); in children 0-3 years old - from 0.9 to 2.3 per 10,000 of the child population (an increase of 155.6%). The analysis of the number of beds in otorhinolaryngology wards established that that the bed capacity per 10,000 population was 0.6 that is significantly lower than the established standards. The article emphasizes need to adjust the Federal standards for hospital bed capacity, taking into account climatic and geographical conditions of the region, which contribute to spread and chronization of ENT diseases.

Artificial Intelligence (AI) has become a topic of interest that is frequently debated in all research fields. The medical field is no exception, where several unanswered questions remain. When and how this field can benefit from AI support in daily routines are the most frequently asked questions. The present review aims to present the types of neural networks (NNs) available for development, discussing their advantages, disadvantages and how they can be applied practically. In addition, the present review summarizes how NNs (combined with various other features) have already been applied in studies in the ear nose throat research field, from assisting diagnosis to treatment management. Although the answer to this question regarding AI remains elusive, understanding the basics and types of applicable NNs can lead to future studies possibly using more than one type of NN. This approach may bypass the actual limitations in accuracy and relevance of information generated by AI. The proposed studies, the majority of which used convolutional NNs, obtained accuracies varying 70-98%, with a number of studies having the AI trained on a limited number of cases (<100 patients). The lack of standardization in AI protocols for research negatively affects data homogeneity and transparency of databases., Competing Interests: The authors declare that they have no competing interests., (Copyright: © 2024 Taciuc et al.)

Background: The goal was to measure the piriform sinus, epiglottis, and thyroid cartilage in our sample population., Methods: This study included 22 adult embalmed cadavers available in the Department of Anatomy. Dimensions were measured using a digital Vernier caliper., Results: The mean height of the thyroid laminae was 27 ± 1.4 mm at the right side and 25.5 ± 1.4 mm at the left side. Mean width of the thyroid lamina was 27.1 ± 1.3 mm at the right side and 27.4 ± 0.9 mm at the left side. The mean thickness of thyroid cartilage was found to be 4.4 ± 0.4 mm and 3.9 ± 0.5 mm over the right and left sides. The mean length, width and thickness of the epiglottis were 29.1 ± 0.5 mm, 22.2 ± 0.6 mm and 2.6 ± 0.3 mm correspondingly. The height, width and thickness of the right piriform sinus were 25 ± 0.5 mm, 14.2 ± 0.5 mm and 12.6 ± 0.5 mm, the same parameters were 25.3 ± 1.3 mm, 15.1 ± 0.7 mm and 13.3 ± 0.4 mm for the left side., Conclusions: The height and thickness of the thyroid cartilage were greater on the right side than on the left side (p<0.05). It was statistically observed that the width and thickness were greater on the left side than on the right side (p < 0.05). The data about the height, width and thickness of the thyroid cartilage, epiglottis and piriform sinus are essential during the laryngeal and other neck surgeries. They guide in the preoperative positioning, predicting the difficulty of intraoperative exposure and retractor pulling., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Vadgaonkar R et al.)

The field of personalized medicine (PM) has grown rapidly because of the "omics revolution", but PM may be difficult for patients to comprehend. This study sought to explore head and neck cancer (HNC) patients' positions and knowledge of PM, gene tests, and follow-up and to compare HNC patients' positions to a sample from a national Danish questionnaire. To do this, patients with prior HNC were invited to participate in a questionnaire. Initial interviews revealed a heterogenic understanding of PM between patients. A total of 226 patients were included in the survey and 177 patients with complete data were included for analysis. Most patients were more positive than negative towards gene tests and gene research (83% and 93%, respectively), but 72% had little or no knowledge of the subject. Almost all patients, 98%, were satisfied with their follow-up. Significantly more patients with HNC were positive towards gene research compared to a sample from a national Danish questionnaire ( p < 0.001). Patients with HNC were positive towards gene tests and PM, but patients may not understand or comprehend the information given, and it is important to inform and educate patients and health professionals to establish common ground in PM.

Biofilms, structured communities of microorganisms encased in a self-produced matrix, pose significant challenges in otorhinolaryngology due to their role in chronic and recurrent infections affecting the ear, nose, and throat (ENT) region. This review provides an overview of biofilms, emphasizing their formation, pathogenesis, diagnosis, and treatment strategies in otorhinolaryngological disorders. Biofilms are pivotal in chronic rhinosinusitis (CRS), otitis media, laryngopharyngeal reflux (LPR), and tonsillitis, contributing to treatment resistance and disease recurrence. Current diagnostic techniques, including imaging modalities, microbiological cultures, and molecular techniques, are discussed, alongside emerging technologies. Treatment strategies, ranging from conventional antibiotics to alternative therapies, such as biofilm disruptors, phage therapy, and immunomodulation, are evaluated in terms of their efficacy and potential clinical applications. The review underscores the significance of understanding biofilms in otorhinolaryngology and highlights the need for tailored approaches to diagnosis and management to improve patient outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Ghosh Moulic et al.)

High-flow nasal oxygen (HFNO) therapy is extensively used in critical care units for spontaneously breathing patients. Trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) is a method of apnoeic oxygenation with continuous nasal delivery of warmed, humidified oxygen at high-flow rates up to 70L/min. THRIVE extends the apnoeic window before desaturation occurs so that tubeless anaesthesia is possible. The advent of THRIVE has had a monumental impact on anaesthetic practice, with a diverse range of clinical applications and it has been incorporated into difficult airway guidelines. THRIVE has many applications in otolaryngology and head and neck surgery. It is used as a pre-oxygenation tool during induction in both anticipated and unanticipated difficult airway scenarios and as a method of oxygenation for tubeless anaesthesia in elective laryngotracheal and hypopharyngeal surgeries and during emergence from anaesthesia. In this scoping review of the literature, we aim to provide an overview on the utility of THRIVE in otolaryngology, including the underlying physiologic principles, current indications and limitations, and its feasibility and safety in different surgical contexts and specific population groups., Competing Interests: Conflict of interestThe authors have no conflict of interest to declare., (© Crown 2024.)

Purpose: Since the beginning of 2023, ChatGPT emerged as a hot topic in healthcare research. The potential to be a valuable tool in clinical practice is compelling, particularly in improving clinical decision support by helping physicians to make clinical decisions based on the best medical knowledge available. We aim to investigate ChatGPT's ability to identify, diagnose and manage patients with otorhinolaryngology-related symptoms., Methods: A prospective, cross-sectional study was designed based on an idea suggested by ChatGPT to assess the level of agreement between ChatGPT and five otorhinolaryngologists (ENTs) in 20 reality-inspired clinical cases. The clinical cases were presented to the chatbot on two different occasions (ChatGPT-1 and ChatGPT-2) to assess its temporal stability., Results: The mean score of ChatGPT-1 was 4.4 (SD 1.2; min 1, max 5) and of ChatGPT-2 was 4.15 (SD 1.3; min 1, max 5), while the ENTs mean score was 4.91 (SD 0.3; min 3, max 5). The Mann-Whitney U test revealed a statistically significant difference (p < 0.001) between both ChatGPT's and the ENTs's score. ChatGPT-1 and ChatGPT-2 gave different answers in five occasions., Conclusions: Artificial intelligence will be an important instrument in clinical decision-making in the near future and ChatGPT is the most promising chatbot so far. Despite needing further development to be used with safety, there is room for improvement and potential to aid otorhinolaryngology residents and specialists in making the most correct decision for the patient., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To compare visual estimation versus ImageJ calculation of tympanic membrane perforation size in the paediatric population between clinicians of different experience., Methods: Five images of tympanic membrane perforations in children, captured using an otoendoscope, were selected. The gold standard was the ImageJ results by one consultant otologist. Consultants, registrars and Senior House Officers or equivalent were asked to visually estimate and calculate the perforation size using ImageJ software., Results: The mean difference in variation from gold standard between visual estimation and ImageJ calculation was 12.16 per cent, 95 per cent CI (10.55, 13.78) p < 0.05, with ImageJ providing a more accurate estimation of perforation. Registrars were significantly more accurate at visual estimation than senior house officers. There was no statistically significant difference in ImageJ results between the different grades., Conclusion: Using ImageJ software is more accurate at estimating tympanic membrane perforation size than visual assessment for all ENT clinicians regardless of experience.

Objective: The National Health Service (NHS) recognised the risk to public health brought by climate change by launching the Greener NHS National Programme in 2020. These organisational changes aim to attain net zero direct carbon emissions. This article reviews the literature on initiatives aimed at mitigating the environmental impact of ENT practice., Method: Systematic review of the literature using scientific, healthcare and general interest (public domain) databases., Results: The initiatives reviewed can be broken down into strategies for mitigating the carbon footprint of long patient stay, use of operative theatres and healthcare travel. The carbon footprint of in-patient stay can be mitigated by a shift towards day-case surgery. The ENT community is currently focused on the reduction of theatre waste and the use of disposable instruments. Furthermore, supply chains and healthcare delivery models are being redesigned to reduce travel., Conclusion: Future areas of development include designing waterless theatre scrubs, waste-trapping technologies for anaesthetic gases and a continuing investment in virtual healthcare.

Background: German university otorhinolaryngology has a need for digital teaching content. Case-based e‑learning represents a digital teaching methodology. The data on student use of case-based e‑learning in university teaching of ENT medicine are limited., Objective: The aim of this work was to determine the extent to which voluntary case-based e‑learning is used by otolaryngology students and what influence the quality of the e‑learning has on motivation to use e‑learning and on the interest in otolaryngology., Materials and Methods: Fifteen voluntary e‑learning cases were created based on the content of the ENT lecture in the winter semester 2022/2023. Subsequently, a descriptive evaluation of the usage statistics of the cases of 157 students was conducted. Likewise, an evaluation of the quality of the e‑learning as well as the motivation to complete it and the interest in otorhinolaryngology was carried out using a voluntary questionnaire., Results: Voluntary case-based e‑learning was used to varying degrees by 66% of the students. The quality of e‑learning correlated significantly with the motivation and the interest in otolaryngology., Conclusion: The teaching content of otorhinolaryngology can be implemented sufficiently in case-based e‑learning and is characterized by satisfactory student acceptance. Integration should be accomplished in a high-quality manner to increase motivation and interest in otorhinolaryngology., (© 2024. The Author(s).)

Background: Due to the COVID-19 pandemic, contact restrictions occurred worldwide, which affected medical schools as well. It was not possible to hold classroom lectures. Teaching contents had to be converted to a digital curriculum within a very short time. Conditions for assessments posed an even greater challenge. For example, solutions had to be found for objective structured clinical examinations (OSCE), which were explicitly forbidden in some German states. The aim of this study was to evaluate the feasibility of an OSCE under pandemic conditions., Materials and Methods: At the end of the 2020 summer semester, 170 students completed a combined otolaryngology and ophthalmology OSCE. Examinations were held in small groups over the course of 5 days and complied with strict hygiene regulations. The ophthalmology exam was conducted face to face, and the ENT OSCE virtually. Students were asked to rate the OSCE afterwards., Results: Between 106 and 118 of the students answered the questions. Comparing the face-to-face OSCE with the virtual OSCE, about 49% preferred the face-to-face OSCE and 17% preferred the virtual OSCE; 34% found both variants equally good. Overall, the combination of an ENT and ophthalmology OSCE was rated as positive., Conclusion: It is possible to hold an OSCE even under pandemic conditions. For optimal preparation of the students, among other things, it is necessary to transform teaching contents to a digital curriculum. The combination of an ENT and ophthalmology OSCE was positively evaluated by the students, although the face-to-face OSCE was preferred. The overall high satisfaction of the students confirms the feasibility of a virtual examination with detailed and well-planned preparation., (© 2024. The Author(s).)

Objectives: To evaluate the use of EQUATOR guidelines in scientific articles published in the European Annals of Otorhinolaryngology, Head and Neck Diseases between 2020 and 2022. The aim was also to translate the most widely used guidelines into French, in order to promote their dissemination and use in otorhinolaryngology and head and neck surgery., Method: The SWiM guidelines were used. Articles published in the European Annals of Otorhinolaryngology, Head and Neck Diseases between January 1, 2020 and December 31, 2022 were retrieved from the PubMed bibliographic database. Editorials, Letters to the Editor and "What is your diagnosis" articles that did not meet any EQUATOR guidelines were excluded from the analysis., Results: Of the 149 eligible published articles, 21.5% (n=32/149) mentioned use of such a guideline. Guideline use by the European Annals of Otorhinolaryngology, Head and Neck Diseases author community progressed from 0% in 2020 to 8% in 2021 and 63% in 2022., Conclusion: The analysis carried out in this article and the availability of the French version of the seven EQUATOR guidelines most widely used in the European Annals of Otorhinolaryngology Head & Neck Diseases could stimulate application and compliance by authors who submit their work to the journal of the French and international French-speaking societies of otorhinolaryngology., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: Large Language Models (LLMs) might offer a solution for the lack of trained health personnel, particularly in low- and middle-income countries. However, their strengths and weaknesses remain unclear., Aims/objectives: Here we benchmark different LLMs (Bard 2023.07.13, Claude 2, ChatGPT 4) against six consultants in otorhinolaryngology (ORL)., Material and Methods: Case-based questions were extracted from literature and German state examinations. Answers from Bard 2023.07.13, Claude 2, ChatGPT 4, and six ORL consultants were rated blindly on a 6-point Likert-scale for medical adequacy, comprehensibility, coherence, and conciseness. Given answers were compared to validated answers and evaluated for hazards. A modified Turing test was performed and character counts were compared., Results: LLMs answers ranked inferior to consultants in all categories. Yet, the difference between consultants and LLMs was marginal, with the clearest disparity in conciseness and the smallest in comprehensibility. Among LLMs Claude 2 was rated best in medical adequacy and conciseness. Consultants' answers matched the validated solution in 93% (228/246), ChatGPT 4 in 85% (35/41), Claude 2 in 78% (32/41), and Bard 2023.07.13 in 59% (24/41). Answers were rated as potentially hazardous in 10% (24/246) for ChatGPT 4, 14% (34/246) for Claude 2, 19% (46/264) for Bard 2023.07.13, and 6% (71/1230) for consultants., Conclusions and Significance: Despite consultants superior performance, LLMs show potential for clinical application in ORL. Future studies should assess their performance on larger scale.

Objective: The loss of a scalpel or a needle during surgery can threaten the health of the patient and lead to additional costs, and radiographical assistance during surgery has been the only recovery method. This study evaluates the efficacy of a metal detector compared with conventional radiology for recovering a needle lost in the oropharynx during surgery., Method: Different fragment sizes of needles normally used in pharyngoplasty were embedded at different locations and depths in a lamb's head. Three experienced and three junior otolaryngologists searched for the needle fragments using a metal detector and conventional radiology., Results: All fragments were found with each method, but the mean searching time was 90 per cent shorter with the metal detector., Conclusion: A metal detector can be a useful tool for locating needles that break during ENT surgery, as it requires less time than conventional radiology and avoids exposing patients to radiation.