Search

Recent advances in artificial intelligence (AI) are driving innovative new health care solutions. We aim to review the state of the art of AI in otology and provide a discussion of work underway, current limitations, and future directions.Two comprehensive databases, MEDLINE and EMBASE, were mined using a directed search strategy to identify all articles that applied AI to otology.An initial abstract and title screening was completed. Exclusion criteria included nonavailable abstract and full text, language, and nonrelevance. References of included studies and relevant review articles were cross-checked to identify additional studies.The database search identified 1374 articles. Abstract and title screening resulted in full-text retrieval of 96 articles. A total of N = 38 articles were retained. Applications of AI technologies involved the optimization of hearing aid technology (n = 5; 13% of all articles), speech enhancement technologies (n = 4; 11%), diagnosis and management of vestibular disorders (n = 11; 29%), prediction of sensorineural hearing loss outcomes (n = 9; 24%), interpretation of automatic brainstem responses (n = 5; 13%), and imaging modalities and image-processing techniques (n = 4; 10%). Publication counts of the included articles from each decade demonstrated a marked increase in interest in AI in recent years.This review highlights several applications of AI that otologists and otolaryngologists alike should be aware of given the possibility of implementation in mainstream clinical practice. Although there remain significant ethical and regulatory challenges, AI powered systems offer great potential to shape how healthcare systems of the future operate and clinicians are key stakeholders in this process.

Background There is a prevailing opinion that spinning sensations signify a peripheral vestibular pathology while non-spinning sensations are not of vestibular origin. Objectives 1) Characterize the subjective sensations reported by patients during caloric testing. 2) Assess if the sensation was correlated with the peak slow phase velocity (SPV). Methods Retrospective chart review at a Canadian adult tertiary-quaternary care balance centre for patients undergoing diagnostic caloric testing between December 2014 and September 2015. Results Of 163 patients included, 122 had normal calorics and 41 demonstrated unilateral weakness. Spinning/rotatory movements were the most commonly reported sensations (55-70%). No sensation was reported among 10-20% of patients. Other non-rotatory sensations were reported 20-25% of the time. Both lack of sensation and other sensations were more likely to be correlated with SPVs that were significantly lower than those associated with spinning/rotating sensations. However, 18% of patients with normal calorics and robust SPVs with warm irrigation still reported non-spinning sensations. Conclusions During caloric irrigation, subjective sensations other than spinning and rotating are reported 20-25% of the time and these tend to be associated with lower peak SPV. Non-spinning vertigo is not uncommon as a subjective description of vestibular sensation even in normal patients with strong SPVs.

To determine the effect of current smoking status on 30-day postoperative adverse events in patients undergoing otologic surgery.Retrospective cohort study.Database of the American College of Surgeons National Surgical Quality Improvement Program from 2006 to 2016.Adult patients undergoing middle ear and mastoid surgery were included. Preoperative smoking status was determined, and adverse events within 30 days of surgery were recorded. Descriptive statistics were used to characterize the study sample. Multivariable logistic regression was performed to identify the association between sociodemographic and clinical variables and postoperative adverse events. Population-attributable fractions were then calculated.A total of 10,684 patients who underwent otologic surgery were included, of whom 2036 (19.1%) were smokers. The most commonly performed surgery was tympanoplasty with and without ossicular chain reconstruction, followed by canal wall up tympanomastoidectomy. Adverse events occurred in 221 (2.1%) patients; the most common was superficial wound infections (n = 99, 0.9%). In smokers, the odds ratio for any adverse event was 1.97 (95% CI, 1.42-2.71). The odds ratios (95% CIs) for superficial wound infections, wound dehiscence, and 30-day readmission among smokers were 1.89 (1.32-2.86), 3.92 (1.26-11.60), and 1.84 (1.15-2.87), respectively. The population-attributable fraction for any adverse event in smokers was 15.5%.In patients undergoing otologic surgery, smokers are more likely than nonsmokers to have postoperative adverse events-in particular, wound infections, wound dehiscence, and readmission to hospital.

The Choosing Wisely Canada Campaign aims to raise awareness amongst physicians and patients regarding unnecessary tests and treatment. The otology/neurotology subspecialty group within the Canadian Society of Otolaryngology – Head & Neck Society developed a list of five common otologic presentations to help physicians deliver high quality effective care: (1) Don’t order specialized audiometric and vestibular testing to screen for peripheral vestibular disease, (2) Don’t perform computed tomography or blood work in the evaluation of sudden sensorineural hearing loss, (3) Don’t perform auditory brain responses (ABR) in patients with asymmetrical hearing loss, (4) Don’t prescribe oral antibiotics as first line treatment for patients with painless otorrhea associated with tympanic membrane perforation or tympanostomy tube, and (5) Don’t perform particle repositioning maneuvers without a clinical diagnosis of posterior canal benign paroxysmal positional vertigo.

With rising global interest in minimally invasive surgical approaches and the cumulative advances in technology, there is a growing population of otolaryngologists incorporating endoscopic ear surgery into clinical practice and residency training. To date, limited data are available on the learning curve and training process involved in this technique. While the endoscopic approach to the ear has several advantages, it carries also unique challenges and risks that one should be aware of as they impact endoscopic skill acquisition. The current practices in endoscopic ear surgery training involve sharing of technical pearls and a graded step-by-step approach to endoscopic skill development through clinical practice and hands-on courses. In the academic environment, the endoscopic approach carries several advantages for the trainees—through improvement in teaching and the relative ease of the technique as compared to the traditional microscopic approach.

Objectives To analyze the characteristics and the associated medical co-morbidities in children with synchronous airway lesions (SALs) found during rigid bronchoscopy. Methods Retrospective case series and chart review of patients who were found to have more than one airway lesion after undergoing airway evaluation via rigid endoscopy at a tertiary care pediatric hospital between 2001 and 2011. Patient demographics, presence of associated non-airway pathologies, and the number and types of airway lesions were collected. For analysis, airway lesions were classified based on the anatomical subsites involved (supraglottic, glottic, subglottic, tracheal and bronchial). Results Out of 592 rigid bronchoscopies performed, there were 73 cases with SALs (12.3%). Of these, only 20% of patients were term infants without associated congenital anomalies. Over 70% of patients with SALs have combinations of lesions involving the trachea, subglottis and supraglottis. Neurological anomalies and GERD were both independently associated with a three-time increase in the odds of having synchronous involvement of these three anatomical subsites (OR 3.15, 95% CI 1.06–9.41; OR 3.0, 95% CI 1.05–8.50, respectively). Glottic lesions were present in 28.7% of patients. Prematurity and cardiac anomalies were both associated with tendency of doubling the odds of glottic lesions (OR 2.34, 95% CI 0.84–6.52; OR 2.0, 95% CI 0.76–5.60, respectively). Overall, almost 10% of newly diagnosed lesions in context of SALs required an additional intervention. Conclusions The majority of patients with SALs are either born prematurely or have associated congenital anomalies. In SAL patients with associated neurological anomalies or GERD, the lesions are more likely to be localized to the supraglottis, subglottis and trachea whereas prematurity and cardiac anomalies could both be increasing the odds of a glottic lesion. High suspicious index should be kept in mind when rigid bronchoscopy is performed to not miss an associated lesion.

Background Endoscopic ear surgery is an emerging technique with recent literature highlighting advantages over the traditional microscopic approach. This study aims to characterize the current status of endoscopic ear surgery in Canada and better understand the beliefs and concerns of the otolaryngology – head & neck surgery community regarding this technique. Methods A cross-sectional survey study of Canadian otolaryngologists was performed. Members of the Canadian Society of Otolaryngology were contacted though an online survey carried out in 2015. Results The majority of participants in this study (70 %) used an endoscope in their practice, with a large proportion utilizing the endoscope for cholesteatoma or tympanoplasty surgery. To date, 38 Canadian otolaryngologists (70 % of respondents) have used an endoscope for at least 1 surgical case, but only 6 (11 %) have performed more than 50 endoscopic cases. Of the otolaryngologists who use endoscopes regularly, the majority still use the microscope as their primary instrument and use the endoscope only as an adjunct during surgery. However, the general attitude surrounding endoscopes is positive; 81 % believe that endoscopes have a role to play in the future of ear surgery and 53 % indicated they were likely to use endoscopes in their future practice. Participants who were earlier in their practice or who had more exposure to endoscopic techniques in their career were more likely to have a positive stance towards endoscopic ear surgery (p

Objectives To determine the value of fine-needle aspiration biopsies (FNABs) of the thyroid and stratify the risk of malignancy within the indeterminate FNAB diagnostic category at our institution. Study design Case series with chart review of preoperative FNABs of consecutive patients who underwent total thyroidectomy between 2005 and 2007. Subjects and Methods A total of 115 cases were reviewed, and FNABs were categorized into four groups: benign, positive or suspicious for malignancy, indeterminate (follicular or Hurthle cell lesions), and nondiagnostic. Cytohistologic correlation was then established. Results The accuracy of FNAB in detecting thyroid malignancy was 88 percent with false-negative and false-positive rates of 13 percent and 7 percent, respectively. Overall, 52 percent of the indeterminate cases were carcinomas (48 percent of follicular lesions and 62 percent of Hurthle cell lesions). In the presence of cytologic atypia, the rate of malignancy increased to 75 percent and 83 percent for the follicular and Hurthle cell lesions, respectively. Conclusions FNAB is an accurate and helpful method for the evaluation of thyroid nodules with results directly correlating with management. Surgery should be considered for FNABs categorized as indeterminate, especially in the presence of cytologic atypia. Because of the high false-negative rate, benign FNABs require close follow-up with ultrasound examination and periodic biopsies.

(1) To determine if head movements in patients with vestibular deficiency differ from those in normal subjects during daily life activities. (2) To assess if these differences can be correlated with patients' perception of dizziness-induced handicap.Prospective matched-pairs studyTertiary referral centerThirty-one vestibular schwannoma patients with documented postoperative unilateral vestibular loss and their age-, gender-, and physical activity level-matched controls with symmetric vestibulo-ocular reflexes.Head movements during 10 tasks from daily life were recorded using body-worn movement sensors.The time to complete the task, the average head velocity and acceleration during each task, and the number of head turns performed were compared between cases and controls. These measures were then correlated with the self-reported Dizziness Handicap Inventory (DHI) scores of the patients.Patients with a unilateral vestibular deficit took significantly longer to perform most daily life activities compared to controls. Their head movements, however, were not always slower. They adopted a different movement strategy, in certain instances less efficient and more disorganized. Dimensions of movement are not all affected equally after a unilateral vestibular loss with evidence of clear clustering of the differences within dimensions across tasks. There was no correlation between the DHI and patients' performance in those tasks.Vestibular loss, even when compensated, affects patients' movements, which can be measured in an ambulatory setting of daily life activities. The differences in movements associated with vestibular loss do not correlate with the degree of self-reported handicap.

To determine whether patients with vitamin D deficiency (VDD) are at increased risk for hypocalcemia following total thyroidectomy.A retrospective study of 246 consecutive patients undergoing thyroidectomy at a McGill University teaching hospital was conducted. Patients who had subtotal thyroidectomy or concomitant parathyroidectomy or whose laboratory tests were incomplete for analysis were excluded, as were pediatric patients. The remaining 139 patients had preoperative 25-hydroxyvitamin D [25(OH)D], corrected calcium, and parathyroid hormone (PTH) measured. Postoperatively, PTH and serum calcium were measured to assess for hypocalcemia. Low vitamin D (LVD) was defined as 25(OH)D ≤ 70 nmol/L (≤ 28 ng/mL), which includes vitamin D insufficiency, 25(OH)D35 nmol/L (14 ng/mL) but ≤ 70 nmol/L (≤ 28 ng/mL), and VDD, 25(OH)D ≤ 35 nmol/L (≤ 14 ng/mL). Adequate vitamin D (AVD) corresponded to levels35 nmol/L (14 ng/mL), whereas optimal vitamin D (OVD) levels corresponded to levels70 nmol/L (28 ng/mL).The rate of postthyroidectomy hypocalcemia in OVD patients was 10.4% (8 of 77) compared to 3.2% (2 of 62) in LVD patients (odds ratio = 0.29, p = .10). There was no hypocalcemia in the 9 VDD patients, meaning that all hypocalcemic episodes occurred in patients with AVD (7.7%; 10 of 130). The mean preoperative PTH levels for LVD patients was 4.65 pmol/L (43 ng/L) compared to 4.18 pmol/L (38.9 ng/L) for OVD patients (p = .073).In this series, preoperative LVD did not predict early postthyroidectomy hypocalcemia. On the contrary, it showed a trend toward protective effect. Adaptive changes in the parathyroid glands, such as hypertrophy, hyperplasia, or the ability to secrete more hormone secondary to prolonged VDD, may contribute to this phenomenon. A large prospective study is needed to better understand the relationship between preoperative vitamin D levels and postoperative hypocalcemia.

Autoimmune sensorineural hearing loss (SNHL) is a rare clinical entity characterized by a progressive fluctuating bilateral asymmetric SNHL that develops over several weeks to months. Vestibular symptoms, tinnitus and aural fullness are present in up to 50% of patients. Due to the lack of specific diagnostic tests, both clinical suspicion and responsiveness to corticosteroids are the pillars for the diagnosis of autoimmune SNHL. The evaluation of patients in whom this condition is suspected should include a detailed history and physical examination, an audiogram, an MRI and a limited laboratory workup to exclude secondary causes of hearing loss. The low frequency of this condition, the heterogeneity in the designs of the available studies and the absence of randomized trials comparing treatment responses and assessing long-term outcomes are some of the factors accounting for the limited evidence to guide the clinician in the approach to the diagnosis and treatment of autoimmune SNHL.

Objective: 1) Determine if low vitamin D reduces risk of post-thyroidectomy hypocalcemia. 2) Verify if this is an independent effect.Method: Retrospective study of 139 total thyroidectomy patients (October 2009-October 2011) at a McGill University teaching hospital. Preoperative 25-hydroxy-vitamin D (25OHD), calcium, and PTH were measured. Patients were assessed for postoperative hypocalcemia. Low vitamin D (LVD) was defined as 25OHD ≤70 nmol/L (28 ng/mL) and optimal vitamin D (OVD) was defined as 25OHD >70 nmol/L (28 ng/mL).Results: Hypocalcemia occurred in 3.2% (2 of 62) patients with LVD and 10.4% (8 of 77) patients with OVD (OR 0.2875, P = .124). No patients with vitamin D deficiency (VDD), defined as 25OHD ≤35 nmol/L (14 ng/mL), developed hypocalcemia. Univariate analysis did not show age, sex, malignancy, presence of thyroiditis, number of preserved parathyroids, parathyroid autotransplantation, preoperative PTH, or preoperative calcium to be significantly predictive. Multivariate analysis confirmed...

To determine the prevalence of underlying lower airway inflammatory conditions in children who underwent rigid bronchoscopy (RB) for a suspected foreign body aspiration (FBA) in the tracheobronchial tree and to identify the characteristics of patients who could benefit from a trial of antiasthma treatment prior to undergoing a diagnostic bronchoscopy.Retrospective chart review.Children with suspected FBA in the tracheobronchial tree who underwent RB at the Montreal Children's Hospital (2001-2009).Patient characteristics such as clinical, radiologic, and bronchoscopic findings on presentation, as well as prior use of inhaled bronchodilators or corticosteroids, were analyzed. A p value.05 was considered significant.Use of inhaled bronchodilators or corticosteroids, signs, symptoms, and radiologic and bronchoscopic findings on presentation.Fifty-five children underwent an RB for suspected FBA. Foreign bodies were found in 36 subjects. Asthmatics were significantly more likely to have a negative bronchoscopy than nonasthmatics (80.0% vs 30.0%, p.05). Otherwise, clinical and radiologic findings were not significantly different in these two groups. The median time between the suspected choking event and the first otolaryngology evaluation was 14 days in asthmatics (range 5 hours-90 days), whereas it was 16 hours in nonasthmatics (range 0.5 hours-120 days).A conservative approach cannot be justified in suspected asthmatic children with possible FBA, in whom the indications for diagnostic bronchoscopy must be tailored to each patient to ensure a timely diagnosis.

The management of occult cervical lymph node metastasis in well-differentiated thyroid cancer (WDTC) is controversial. Given the risks of hypocalcemia, recurrent laryngeal nerve injury, and increased operative time with a central compartment neck dissection (CCND), a routine adoption of prophylactic lymph node dissection has not been accepted by many as a standard management for occult metastasis (Henry et al., 1998; Pereira et al., 2005; Shen et al., 2010). Conversely, other thyroid surgeons feel that the complication rate is low and that the benefits of CCND outweigh the risks (Anand et al., 2009; Haigh et al., 2000; Keleman et al., 1998; Pelizzo et al., 2001; Pitman et al., 2003; Rettenbacher et al., 2000). As a result, sentinel lymph node biopsy (SLNB) has gained an increase in popularity in recent years.

Objective: Determine the prevalence of asthma in children who underwent rigid bronchoscopy (RB) for a suspected foreign body aspiration (sFBA) in the tracheobronchial tree, and to identify characteristics of patients who could benefit from a trial of anti-asthma treatment prior to undergoing a diagnostic bronchoscopy.Method: Retrospective chart review of children with sFBA in the tracheobronchial tree who underwent RB at the Montreal Children’s Hospital (2001-2009). Patient characteristics such as delay between initial choking episode and first otolaryngology evaluation, clinical findings, radiologic findings, bronchoscopic findings, and history of asthma were analyzed.Results: A total of 55 children underwent a RB for sFBA. Foreign bodies (FB) were found in 36 of these, one of which was asthmatic (2.78%, P < .05). In the 19 children who had a negative bronchoscopy (no FB), four were asthmatics (21.1%, P < .05). The mean time from the suspected initial choking event to the first otolaryngology evaluation ...

To better appreciate perioperative concerns affecting patients considering thyroidectomy and to understand how they may vary according to patient characteristics.Cross-sectional analysis.Tertiary referral center.The authors recruited patients scheduled for thyroid surgery at the McGill University Thyroid Cancer Center. A total of 148 patients completed the 18-item Western Surgical Concern Inventory-Thyroid (WSCI-T) questionnaire. Psychometrics of the WSCI-T were assessed through a principal component analysis with varimax rotation and reliability analyses. Independent-samples t tests and 2-tailed Pearson correlations were ran, identifying areas of elevated concerns and their relationship to gender, age, and surgical procedure (total vs hemithyroidectomy).The principal component analysis revealed the presence of 3 domains of presurgical concerns on the WSCI-T:Surgery-Related Concerns, Psychosocial Concerns, and Daily-Living Concerns. Reliability coefficients for the WSCI-T Total and subscales were satisfactory. Responses on the WSCI-T indicated on average a moderate overall level of concerns before thyroidectomy. Surgery-Related Concerns was the highest domain of concerns, followed by Daily-Living and Psychosocial Concerns, respectively. Patients were mainly worried about the nodule being cancerous, experiencing a change in voice, and surgical complications. Areas of minor concern included being judged or treated differently, becoming depressed, and feeling embarrassed. Women had higher overall levels of concern than men did. Although there were no significant differences in overall levels of concern according to age and surgical procedure, differences were noted at a subscale and item level.This study establishes a mean that will permit adequate physician counseling and a better management of patients' perioperative worries.

With the current trend of alarming rise in obesity rates, the health impacts of excess weight will become more apparent. While an increased incidence of cardiovascular disease and diabetes mellitus has been well documented, the association between obesity and carcinogenesis is just being appreciated and is receiving increasing attention. The current review focuses on the evidence linking thyroid cancer with obesity. We conclude that there is sufficient evidence that obesity can predispose to an increased risk of thyroid cancer in both men and women. This population-based association is mainly explained at a biological level through specific obesity-related endocrinopathies.

To determine the value of specific cytopathologic features on fine-needle aspiration biopsies (FNABs) at predicting thyroid malignancy.Retrospective review of consecutive patients undergoing thyroidectomy between 2005 and 2007 following FNAB of thyroid nodules.Two McGill University teaching hospitals in Montreal.One hundred forty-seven patients were reviewed and further categorized into two groups (benign vs malignant) based on the final histopathologic diagnosis. The frequency of specific cytopathologic features from the preoperative FNAB samples was recorded for 106 patients from the first hospital and 41 patients from the second.The presence of atypical cells (30% vs 72%; p = 3.23 x 10(-7)), nuclear grooves (5% vs 23%; p = .002), anisonucleosis (8% vs 36%; p = .00011), variable chromatin staining (10% vs 28%; p = .007), hypochromasia (11% vs 47%; p = 7.19 x 10(-6)), nuclear overlapping/crowding (8% vs 29%; p = .0019), irregular nuclear membranes (15% vs 52%, p = 3.22 x 10(-6)), micronucleoli (15% vs 60%, p = .003), and powdery chromatin (8% vs 47%, p = .004) correlates with an increased risk of malignancy. Alternatively, siderophages (44% vs 23%; p = .007) and honeycomb arrangements (92% vs 60%; p = .012) were more associated with benign processes. HBME-1 staining (n = 53) was positive or focally positive on 61% of the malignant cases (p = .0002), with a specificity of 100%. All biopsies demonstrating intranuclear inclusions, papillary fragments, or atypical architecture were malignant.Some cytopathologic features are more significantly associated with thyroid malignancy. The cytopathologic features listed in FNAB reports and HBME-1 immunoreactivity are, alone or in combination, additional tools available to the physician to guide management of thyroid nodules.

Obesity has been linked to numerous diseases including thyroid cancer, but the exact nature of the relationship, especially with respect to patients with thyroid nodules, remains unclear. The objective of this study was to evaluate the impact of body mass index (BMI) on thyroid cancer risk in a population of patients with indeterminate cytology on fine-needle aspiration biopsy (FNAB).A total of 253 consecutive patients with indeterminate thyroid nodule FNABs who underwent total thyroidectomy in a tertiary care teaching hospital between 2002 and 2007 were reviewed. Height and weight reported on the anesthesia summary were recorded for each patient. Malignancy rates were calculated for the underweight, normal, overweight, and obese groups stratified according to their BMI. Subanalyses according to age and sex were also performed.The risk of malignancy tended to be lower in obese patients compared to patients with BMIs in the underweight, normal, and overweight ranges (52% vs. 61%, p = 0.195). In men, a BMI classified as obese was associated with a significantly lower rate of malignancy (36% vs. 72%, p = 0.003). Women older than 45 years were a subgroup in which higher malignancy rates were associated with obesity (65% vs. 54%, p = 0.293). Conversely, in men over the age of 45 years and women under 45 years, a BMI in the obesity range was linked to a lower incidence of malignancy (20% vs. 68% p = 0.009 and 36% vs. 68% p = 0.043, respectively). When older women were excluded from the population studied, the rate of malignancy in obese patients was 36% versus 70% in nonobese patients (p = 0.002) with an associated reduction of 5% in the risk of malignancy per increased unit of BMI.For patients with FNAB results of indeterminate significance, a higher BMI correlates with lower rates of thyroid malignancy for all patients except women over the age of 45 years.

ObjectiveDetermine the value of fine-needle aspiration biopsies (FNAB), and stratify the risk of malignancy within the indeterminate FNAB diagnostic category at our institution.MethodsThe preoperative FNABs of 115 consecutive patients who underwent thyroidectomy at a teaching hospital between 2005 and 2007 were reviewed and categorized into 4 groups: negative for malignancy, positive or suspicious for malignancy, indeterminate, and nondiagnostic. The final histopathological diagnosis was then compared with the FNAB result. FNABs reported as follicular or Hurthle cell lesions were considered indeterminate diagnoses, and malignancy rates were calculated within this category.ResultsThe FNAB results were as follows: 17% negative for malignancy, 35% positive or suspicious for malignancy, 40% indeterminate, and 8% nondiagnostic. The sensitivity of FNAB in detecting thyroid malignancy was 83%, specificity 92% and accuracy 85%. There were 9 discrepant cases giving a false negative rate of 17% and a false positive...