-
Journal of Imaging Informatics in... Jun 2024The gold standard for otosclerosis diagnosis, aside from surgery, is high-resolution temporal bone computed tomography (TBCT), but it can be compromised by the small...
The gold standard for otosclerosis diagnosis, aside from surgery, is high-resolution temporal bone computed tomography (TBCT), but it can be compromised by the small size of the lesions. Many artificial intelligence (AI) algorithms exist, but they are not yet used in daily practice for otosclerosis diagnosis. The aim was to evaluate the diagnostic performance of AI in the detection of otosclerosis. This case-control study included patients with otosclerosis surgically confirmed (2010-2020) and control patients who underwent TBCT and for whom radiological data were available. The AI algorithm interpreted the TBCT to assign a positive or negative diagnosis of otosclerosis. A double-blind reading was then performed by two trained radiologists, and the diagnostic performances were compared according to the best combination of sensitivity and specificity (Youden index). A total of 274 TBCT were included (174 TBCT cases and 100 TBCT controls). For the AI algorithm, the best combination of sensitivity and specificity was 79% and 98%, with an ideal diagnostic probability value estimated by the Youden index at 59%. For radiological analysis, sensitivity was 84% and specificity 98%. The diagnostic performance of the AI algorithm was comparable to that of a trained radiologist, although the sensitivity at the estimated ideal threshold was lower.
PubMed: 38926265
DOI: 10.1007/s10278-024-01079-w -
Frontiers in Surgery 2024This study aims to evaluate the effectiveness of ChatGPT-4, an artificial intelligence (AI) chatbot, in providing accurate and comprehensible information to patients...
PURPOSE
This study aims to evaluate the effectiveness of ChatGPT-4, an artificial intelligence (AI) chatbot, in providing accurate and comprehensible information to patients regarding otosclerosis surgery.
METHODS
On October 20, 2023, 15 hypothetical questions were posed to ChatGPT-4 to simulate physician-patient interactions about otosclerosis surgery. Responses were evaluated by three independent ENT specialists using the DISCERN scoring system. The readability was evaluated using multiple indices: Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (Gunning FOG), Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index (CLI), and Automated Readability Index (ARI).
RESULTS
The responses from ChatGPT-4 received DISCERN scores ranging from poor to excellent, with an overall score of 50.7 ± 8.2. The readability analysis indicated that the texts were above the 6th-grade level, suggesting they may not be easily comprehensible to the average reader. There was a significant positive correlation between the referees' scores. Despite providing correct information in over 90% of the cases, the study highlights concerns regarding the potential for incomplete or misleading answers and the high readability level of the responses.
CONCLUSION
While ChatGPT-4 shows potential in delivering health information accurately, its utility is limited by the level of readability of its responses. The study underscores the need for continuous improvement in AI systems to ensure the delivery of information that is both accurate and accessible to patients with varying levels of health literacy. Healthcare professionals should supervise the use of such technologies to enhance patient education and care.
PubMed: 38903865
DOI: 10.3389/fsurg.2024.1373843 -
Ear, Nose, & Throat Journal Jun 2024To analyze the etiology, diagnosis, and treatment of unexplained conductive hearing loss (UCHL) with intact tympanic membrane. A systematic review was conducted based... (Review)
Review
To analyze the etiology, diagnosis, and treatment of unexplained conductive hearing loss (UCHL) with intact tympanic membrane. A systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 642 articles were retrieved from databases such as PubMed, Embase, Web of Science, and Cochrane. Fifty-four research articles and 21 case reports were screened out according to the inclusion and exclusion criteria for analysis of the etiology of UCHL. Seven research articles with UCHL who underwent exploratory tympanotomy were selected for data extraction and analysis of clinical characteristics. UCHL is a common manifestation of various diseases, including congenital ossicular anomalies (COA), otosclerosis (OTS), congenital middle ear cholesteatoma (CMEC), oval window atresia, superior semicircular-canal dehiscence, congenital stapedial footplate fixation, middle ear osteoma or adenoma, congenital ossification of stapedial tendon, and so on. A total of 522 patients were included in the 7 articles; among whom OTS showed a tendency to increase with age. The main symptoms were hearing loss, followed by tinnitus, dizziness, ear fullness, ear pain, facial paralysis. A total of 87.5% to 93.0% patients with COA manifested as nonprogressive deafness that occurred since childhood, with tinnitus incidence of 15.6% to 30.2%, and 86.4% to 96.4% patients with OTS presented with progressive hearing loss, with tinnitus incidence of 60.1% to 90.9%. The diagnosis positive rate of high-resolution computed tomography (HRCT) was 33.8% to 87.1%, and CMEC was higher than that of COA (83.3%-100% vs 28.6%-64%). All the articles reported good hearing recovery. The most common surgical complications included taste abnormalities, tinnitus, and dizziness. UCHL presents with similar clinical manifestations and poses challenges in preoperative diagnosis. Exploratory tympanotomy is the primary method for diagnosis and treatment, with good prognosis after removing the lesion and reconstructing hearing during the operation. Children can also safely undergo the surgery.
PubMed: 38895947
DOI: 10.1177/01455613241262129 -
Indian Journal of Otolaryngology and... Jun 2024To assess the post-operative cases of stapes surgery. To determine correction in hearing loss post surgery and changing trends over 50 years. In a retrospective...
UNLABELLED
To assess the post-operative cases of stapes surgery. To determine correction in hearing loss post surgery and changing trends over 50 years. In a retrospective observational study, 234 cases otosclerosis who underwent surgical management between 1973 and 2023 were assessed. A total of 234 cases were seen. Male:female ratio was 0.8:1. Most patients were in the age group 21-30. Left > right ear involvement was seen. Stapedotomy > stapedectomy was the surgical procedure done. More than 50% patients had around 30db improvement in audiometric evaluation post surgery. Most common complications were vertigo and nystagmus which were seen more post stapedectomy as compared to stapedotomy. Sensorineural hearing loss is a rare complication and was seen exclusively post stapedectomy. We conclude that stapes surgery is beneficial in improving hearing capabilities with no difference as per change in surgical approach. Stapedectomy being more radical has more predisposition to vertigo and nystagmus post surgery. Post-operative complications has reduced with course of time due to improvement in surgical equipments and pre-op investigations.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s12070-024-04499-w.
PubMed: 38883466
DOI: 10.1007/s12070-024-04499-w -
Journal of the Chinese Medical... Jun 2024The senior author Shiao, had introduced a modified version of the traditional stapes surgery, called minimally traumatic stapes surgery (MTSS), and explored its...
BACKGROUND
The senior author Shiao, had introduced a modified version of the traditional stapes surgery, called minimally traumatic stapes surgery (MTSS), and explored its effectiveness in reducing postoperative vertigo. However, MTSS exhibited no significant breakthrough in terms of audiometric results. Building upon the original MTSS through slight modifications and the use of the Medtronic Big Easy® Piston as the prosthesis, this study evaluates a refined version of the original MTSS technique. In particular, this research sought to investigate the impact of this refined approach on hearing outcomes and postoperative complications among patients diagnosed with otosclerosis.
METHODS
This research comprehensively examined the medical records of individuals diagnosed with otosclerosis who underwent MTSS. The postoperative outcomes assessed encompassed hearing outcomes and the occurrence of any new complications.
RESULTS
Overall, 95 patients diagnosed with otosclerosis (comprising 106 affected ears) underwent MTSS. Significant improvements in both the average air conduction threshold (40 ± 16.82 dB after vs. 60 ± 14.56 dB before surgery; p < 0.0001) and average air-bone gap (11.99 ± 7.24 dB after vs. 29.65 ± 9.47 dB before surgery; p =0.003) were observed after the surgery. Conversely, no significant change in the average bone conduction threshold was observed after the procedure (28 ± 13.81 dB after vs. 29 ± 12.31 dB before surgery; p = 0.149). Among the 106 affected ears, 102 showed postoperative air-bone gap measurements <20 dB, indicating an impressive 96.2% overall hearing improvement. Notably, only a few postoperative complications were observed, including vertigo, chorda tympani injury, facial weakness, and a slight hearing deterioration.
CONCLUSION
The refined MTSS technique promoted significant postoperative hearing improvements with minimal complications. This approach showed potential for addressing the surgical challenges in Asian patients with otosclerosis, emphasizing the importance of further research on this advanced procedural method.
PubMed: 38869453
DOI: 10.1097/JCMA.0000000000001107 -
Radiology Case Reports Aug 2024Superior semicircular canal (SSC) dehiscence syndrome, also known as Minor syndrome, is a rare condition characterized by vestibular and cochlear symptoms linked to a...
Superior semicircular canal (SSC) dehiscence syndrome, also known as Minor syndrome, is a rare condition characterized by vestibular and cochlear symptoms linked to a defect in the bony roof of the SSC. The prevalence is estimated at 0.5%, with a male predominance. Dehiscence may result from abnormal bone development, becoming symptomatic due to minimal trauma or pressure changes. Clinical presentation varies based on dehiscence size and location, with dizziness and oscillatory movements triggered by pressure changes or loud sounds being common symptoms. Other manifestations include conductive hearing loss due to the formation of a ``third window'' in the inner ear. Diagnosis typically involves computed tomography, distinguishing SSCDS from otosclerosis. Surgical treatment is reserved for cases of disabling vestibular pathology, often involving sealing the dehiscence through various approaches.
PubMed: 38860269
DOI: 10.1016/j.radcr.2024.04.075 -
Current Pain and Headache Reports Jun 2024The purpose of this review is to provide an updated approach to the evaluation and management of pulsatile tinnitus (PT), an uncommon but often treatable subtype of... (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to provide an updated approach to the evaluation and management of pulsatile tinnitus (PT), an uncommon but often treatable subtype of tinnitus.
RECENT FINDINGS
Secondary PT can be due to either vascular or non-vascular etiologies, including, but not limited to: neoplasm, arteriovenous malformation or fistula, idiopathic intracranial hypertension, dural venous sinus stenosis, otoacoustic etiologies (e.g., otosclerosis, patulous eustachian tube) and bony defects (e.g., superior semicircular canal dehiscence). Computed tomography (CT) and magnetic resonance imaging (MRI) imaging have comparable diagnostic yield, though each may be more sensitive to specific etiologies. If initial vascular imaging is negative and a vascular etiology is strongly suspected, digital subtraction angiography (DSA) may further aid in the diagnosis. Many vascular etiologies of PT can be managed endovascularly, often leading to PT improvement or resolution. Notably, venous sinus stenting is an emerging therapy for PT secondary to idiopathic intracranial hypertension with venous sinus stenosis. Careful history and physical exam can help establish the differential diagnosis for PT and guide subsequent evaluation and management. Additional studies on the efficacy and long-term outcome of venous sinus stenting for venous stenosis are warranted.
PubMed: 38842617
DOI: 10.1007/s11916-024-01263-1 -
European Archives of... Jun 2024Revision stapes surgery is a challenging procedure performed in relatively small numbers compared to other middle ear procedures. Despite numerous data on hearing... (Review)
Review
PURPOSE
Revision stapes surgery is a challenging procedure performed in relatively small numbers compared to other middle ear procedures. Despite numerous data on hearing results of different middle ear surgeries, the audiological standards for successful outcome of this procedure are still not clarified. On the basis of well-documented data, we wanted to determine what the expected audiological results and complications are after revision stapes surgery in order to set a realistic threshold for surgical success.
METHODS
After the protocol registration in the PROSPERO database, a systematic review was performed in multiple databases (PubMed, Cochrane, Web of Science, Scopus, ScienceOpen, ClinicalTrials.gov, Google Scholar) according to PRISMA guidelines. Twelve articles were reviewed according to the inclusion criteria. A total of 1032 cases were obtained for evaluation. A modified version of Newcastle-Ottawa Scale (NOS) was used to assess publication quality.
RESULTS
Average air-bone gap (ABG) gain was 17.3 dB, average air conduction (AC) gain was 17.5 dB. The average postoperative air-bone gap was 11.1 dB. The postoperative ABG distribution was the following 0-10 dB: 53.3%, > 10-20 dB: 28.2%, > 20 dB: 18.5%. SNHL as a surgical complication was described in a total of 17 cases (1.6%), no equilibrium disorder was reported.
CONCLUSION
The pooled data suggest that revision stapes surgery is an effective solution after failure of previous stapes surgery. However, the results are clearly inferior to those of primary stapedotomies. Hence, we need to apply different expectations and use different standards in the indication and evaluation of this type of surgery.
PubMed: 38839701
DOI: 10.1007/s00405-024-08741-7 -
The Laryngoscope Jun 2024Otosclerosis is a poorly understood clinical entity causing progressive conductive hearing loss. Here we present the first known evidence of otosclerosis demonstrating...
Otosclerosis is a poorly understood clinical entity causing progressive conductive hearing loss. Here we present the first known evidence of otosclerosis demonstrating 99mTc-MDP uptake on bone scan. This presents an opportunity to explore the role of nuclear medicine imaging in early detection, staging, and even informing treatment and prognosis of this condition. Laryngoscope, 2024.
PubMed: 38837225
DOI: 10.1002/lary.31552 -
Laryngoscope Investigative... Jun 2024This study aims to evaluate and compare the surgical outcomes of endoscopic malleostapedotomy (EMS) and endoscopic incudostapedotomy (EIS).
OBJECTIVES
This study aims to evaluate and compare the surgical outcomes of endoscopic malleostapedotomy (EMS) and endoscopic incudostapedotomy (EIS).
METHODS
A retrospective analysis was conducted on 36 consecutive ears in 33 patients who underwent stapes surgery using either EMS (EMS group) or EIS (EIS group). Operational practicability across surgical steps, postoperative hearing, operation time, switch of approach, and complications were compared between the two groups.
RESULTS
The EMS and EIS groups comprised seven (19.4%) and 29 ears (80.6%), respectively. The EMS group exhibited a greater proportion of moderate practicability in anchoring site exposure (42.9%, three of seven) and in securing the prosthesis (100%, seven of seven) in comparison to the EIS group, which had 0% (0 out of 29) and 41.4% (12 out of 29), respectively. Postoperative hearing improvements were equivalent between the groups, with EMS achieving a mean air-bone gap improvement of 28.8 dB and EIS of 23.2 dB. The ABG closure rates within 10 dB and 20 dB for the EMS group were 28.6% and 100%, respectively, and not significantly different from the EIS group ( = .103). However, the average surgical duration for EMS was extended by 77.4 min. The rate of complications was comparable between the groups (EMS 14.3%, EIS 10.3%, = 1.000).
CONCLUSION
The findings indicate that while EMS requires a longer operation time because of decreased practicability in specific surgical steps, it provides comparable outcomes to EIS, underscoring the potential of endoscopic techniques to establish malleostapedotomy as a surgical option as it is with traditional incudostapedotomy.
LEVEL OF EVIDENCE
4.
PubMed: 38803459
DOI: 10.1002/lio2.1273