OBJECTIVE:The video ocular counter-roll (vOCR) test is a novel method that uses video-oculography (VOG) goggles to detect vestibular dysfunction, potentially offering a simpler alternative to current vestibular function tests. In this study, we aim to compare the vOCR test with the caloric test for diagnosing vestibular dysfunction and to assess its clinical applicability. STUDY DESIGN:A retrospective cohort study. SETTING:A tertiary academic referral center. METHODS:This retrospective study included all patients who underwent both vOCR and caloric tests during the same visit between 2021 and 2023. The patients were divided into 3 groups based upon caloric response: unilateral vestibular hypofunction (UVH), bilateral vestibular hypofunction (BVH), and normal. The vOCR test was performed with a 30° head tilt to both sides. Sensitivity, specificity, and area under the curve (AUC) were calculated for vOCR performance. The 2-step approach employed for utilizing the vOCR test included the average vOCR measurement for diagnosing BVH followed by the vOCR asymmetry ratio (AR) to UVH. RESULTS:In total, 134 patients were included in the study, with 14 (10.5%) diagnosed with bilateral vestibular hypofunction (BVH), 44 (32.8%) with unilateral vestibular hypofunction (UVH), and 76 (56.7%) exhibiting normal vestibular function based on caloric testing. A vOCR cutoff value of 3.2° demonstrated sensitivity and specificity of 92.5% and 85.7%, respectively, for detecting BVH (AUC 95.1%, P < .001). An AR of 0.12 showed sensitivity and specificity of 97.7% and 63.2%, respectively, for detecting UVH (AUC 79.2%, P < .001). vOCR measurements differed significantly across all 3 groups (P < .001). In the UVH group, the vOCR angles were consistently smaller on the hypofunction side, suggesting laterality. CONCLUSION:vOCR diagnoses vestibular dysfunction with high sensitivity and specificity compared to the caloric test. Incorporating vOCR into the vestibular testing battery could enhance diagnostic efficiency and patient comfort.

Objectives With smartphones and wearable devices becoming ubiquitous, they offer an opportunity for large-scale voice sampling. This systematic review explores the application of deep learning models for the automated analysis of voice samples to detect vocal cord pathologies. Methods We conducted a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. We searched MEDLINE and Embase databases for original publications on deep learning applications for diagnosing vocal cord pathologies between 2002 and 2022. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Results Out of the 14 studies that met the inclusion criteria, data from a total of 3037 patients were analyzed. All studies were retrospective. Deep learning applications targeted Reinke's edema, nodules, polyps, cysts, unilateral cord paralysis, and vocal fold cancer detection. Most pathologies had detection accuracy above 90%. Thirteen studies (93%) exhibited a high risk of bias and concerns about applicability. Conclusions Technology holds promise for enhancing the screening and diagnosis of vocal cord pathologies. While current research is limited, the presented studies offer proof of concept for developing larger-scale solutions.

BACKGROUND:Advancements in artificial intelligence (AI) and natural language processing (NLP) have led to the development of language models such as ChatGPT. These models have the potential to transform healthcare and medical research. However, understanding their applications and limitations is essential. OBJECTIVES:To present a view of ChatGPT research and to critically assess ChatGPT's role in medical writing and clinical environments. METHODS:We performed a literature review via the PubMed search engine from 20 November 2022, to 23 April 2023. The search terms included ChatGPT, OpenAI, and large language models. We included studies that focused on ChatGPT, explored its use or implications in medicine, and were original research articles. The selected studies were analyzed considering study design, NLP tasks, main findings, and limitations. RESULTS:Our study included 27 articles that examined ChatGPT's performance in various tasks and medical fields. These studies covered knowledge assessment, writing, and analysis tasks. While ChatGPT was found to be useful in tasks such as generating research ideas, aiding clinical reasoning, and streamlining workflows, limitations were also identified. These limitations included inaccuracies, inconsistencies, fictitious information, and limited knowledge, highlighting the need for further improvements. CONCLUSIONS:The review underscores ChatGPT's potential in various medical applications. Yet, it also points to limitations that require careful human oversight and responsible use to improve patient care, education, and decision-making.

ObjectivesLarge language models, including ChatGPT, has the potential to transform the way we approach medical knowledge, yet accuracy in clinical topics is critical. Here we assessed ChatGPT's performance in adhering to the American Academy of Otolaryngology-Head and Neck Surgery guidelines.MethodsWe presented ChatGPT with 24 clinical otolaryngology questions based on the guidelines of the American Academy of Otolaryngology. This was done three times (N = 72) to test the model's consistency. Two otolaryngologists evaluated the responses for accuracy and relevance to the guidelines. Cohen's Kappa was used to measure evaluator agreement, and Cronbach's alpha assessed the consistency of ChatGPT's responses.ResultsThe study revealed mixed results; 59.7% (43/72) of ChatGPT's responses were highly accurate, while only 2.8% (2/72) directly contradicted the guidelines. The model showed 100% accuracy in Head and Neck, but lower accuracy in Rhinology and Otology/Neurotology (66%), Laryngology (50%), and Pediatrics (8%). The model's responses were consistent in 17/24 (70.8%), with a Cronbach's alpha value of 0.87, indicating a reasonable consistency across tests.ConclusionsUsing a guideline-based set of structured questions, ChatGPT demonstrates consistency but variable accuracy in otolaryngology. Its lower performance in some areas, especially Pediatrics, suggests that further rigorous evaluation is needed before considering real-world clinical use.

IntroductionThe field of vestibular science, encompassing the study of the vestibular system and associated disorders, has experienced notable growth and evolving trends over the past five decades. Here, we explore the changing landscape in vestibular science, focusing on epidemiology, peripheral pathologies, diagnosis methods, treatment, and technological advancements.MethodsPublication data was obtained from the US National Center for Biotechnology Information (NCBI) PubMed database. The analysis included epidemiological, etiological, diagnostic, and treatment-focused studies on peripheral vestibular disorders, with a particular emphasis on changes in topics and trends of publications over time.ResultsOur dataset of 39,238 publications revealed a rising trend in research across all age groups. Etiologically, benign paroxysmal positional vertigo (BPPV) and Meniere’s disease were the most researched conditions, but the prevalence of studies on vestibular migraine showed a marked increase in recent years. Electronystagmography (ENG)/ Videonystagmography (VNG) and Vestibular Evoked Myogenic Potential (VEMP) were the most commonly discussed diagnostic tools, while physiotherapy stood out as the primary treatment modality.ConclusionOur study presents a unique opportunity and point of view, exploring the evolving landscape of vestibular science publications over the past five decades. The analysis underscored the dynamic nature of the field, highlighting shifts in focus and emerging publication trends in diagnosis and treatment over time.

Although more common in females, thyroid cancer is deemed to be more aggressive in males. The reasons for sex disparities in thyroid cancer are not well understood. We hypothesised that differences in molecular mutations between females and males contribute to this phenomenon.

Abstract Disclosure: I. Tessler: None. N.A. Gecel: None. G. Avior: None. E. Klang: None. E. Alon: None. T. Kolitz: None. Aim: Thyroid cancer prevalence rate continues to increase, being the most common endocrine cancer. During the years, significant progress in methods for diagnosis, risk-stratification and management were developed, with the recent advance of molecular testing. Here we explore the evolution of thyroid cancer management over the past five decades through a text-mining analysis. Materials and methods: We have queried PubMed for all available 'thyroid cancer' related entries published during 1970-2022. The following data were extracted for each entry: year of publication, publishing journal, title, keywords, and abstract text. Search terms belonged to demographics, histology, diagnosis methods, treatment, and follow-up. Annual trends of publications were plotted. The slopes of publication trends were calculated by fitting regression lines to the yearly number of publications. We also retrieved the number of citations per publication and analyzed the most impactful papers on each topic.Results: Our search yielded 95,931 papers published during the study period. Publications regarding diagnosis (39,490) outnumbered all other topics, in which molecular testing has significantly sharpest raise (slope p=34.1±3.3). Most publication focused on females (n=56,198) and differentiated thyroid cancer (n=45,953). Surgery remains the most studied treatment method during the whole study period, with recent raise in studies regarding active-surveillance (slope 14.2±1.3). Studies concerning shared decision-making and patient experience emerged in 2000, with a sharp increase in recent years (slope 3.8±0.3, p < .001).Conclusions: Our study provides an overview of the trends in thyroid cancer research over the past five decades. Publications regarding molecular testing outnumbered all other diagnosis methods, identified as the primary trend of the current era. Publications on active surveillance have rapidly risen in recent years, highlighting this method's role in thyroid cancer. Keywords: Machine learning; artificial intelligence; Thyroid cancer; Molecular-tests Presentation Date: Saturday, June 17, 2023

Background and Objectives: Since its invention in the 1970s, the cochlear implant (CI) has been substantially developed. We aimed to assess the trends in the published literature to characterize CI. Materials and Methods: We queried PubMed for all CI-related entries published during 1970–2022. The following data were extracted: year of publication, publishing journal, title, keywords, and abstract text. Search terms belonged to the patient’s age group, etiology for hearing loss, indications for CI, and surgical methodological advancement. Annual trends of publications were plotted. The slopes of publication trends were calculated by fitting regression lines to the yearly number of publications. Results: Overall, 19,428 CIs articles were identified. Pediatric-related CI was the most dominant sub-population among the age groups, with the highest rate and slope during the years (slope 5.2 ± 0.3, p < 0.001), while elderly-related CIs had significantly fewer publications. Entries concerning hearing preservation showed the sharpest rise among the methods, from no entries in 1980 to 46 entries in 2021 (slope 1.7 ± 0.2, p < 0.001). Entries concerning robotic surgery emerged in 2000, with a sharp increase in recent years (slope 0.5 ± 0.1, p < 0.001). Drug-eluting electrodes and CI under local-anesthesia have been reported only in the past five years, with a gradual rise. Conclusions: Publications regarding CI among pediatrics outnumbered all other indications, supporting the rising, pivotal role of CI in the rehabilitation of children with sensorineural hearing loss. Hearing-preservation publications have recently rapidly risen, identified as the primary trend of the current era, followed by a sharp rise of robotic surgery that is evolving and could define the next revolution.

Abstract Disclosure: I. Tessler: None. N. Gecel: None. R. Payne: None. G. Avior: None. A. Eran: None. Background: Genetic testing for the diagnosis of thyroid cancer has rapidly evolved in recent years. While commonly applied for diagnosis, its role in predicting genotype-phenotype correlation and guiding management is emerging. Here we evaluate differences in the molecular profile of local vs. regional aggressive disease. Methods: We performed a retrospective multicenter study of patients who underwent molecular profiling for DTC between 2018-2021, dividing them into three groups: low-risk, locally aggressive, and regional aggressive. We analyzed the patients' basic characteristics, disease aggressive features (extranodal extension, perineural invasion), lymphovascular invasion, and extrathyroidal extension), and the mutation distribution according to disease aggressiveness. Genetic variants were stratified by risk levels according to the 2015 ATA guidelines. Results: The study included a total of 652 patients, 414 in the low-risk group, 73 in the locally aggressive group, and 165 in the regional aggressive group. The regional aggressive group had the lowest age at diagnosis (mean age of 44.64±13.78 years vs. 52.52±14.53 and 53.58±14.93 for the low-risk and locally-aggressive, respectively, p>0.001), the highest rate of mutation-positive nodules (86.1% vs. 6.6% and 67.1%), and the highest rate of aggressive mutation (76.4% vs. 17.6 and 39.7). On the contrary, RAS mutations were more common in the low-risk (31.4% vs. 19.2% and 6.1% in the local- and regional aggressiveness groups). Conclusion: This study showed that local and regional aggressive thyroid cancer has a distinct molecular profile, with a higher prevalence of high-risk mutations in the regional group. These findings may enhance the use of genetic testing in predicting disease aggressiveness and guiding management in thyroid cancer. Presentation Date: Saturday, June 17, 2023

Background: Although more common in females, thyroid cancer is deemed to be more aggressive in males. The reasons for sex disparities in thyroid cancer are not well understood. We hypothesised that differences in molecular mutations between females and males contribute to this phenomenon.Methods: Retrospective multicentre multinational study of thyroid nodules that underwent preoperative molecular profiling between 2015 and 2022. The clinical characteristics and mutational profiles of tumours in female and male patients were compared. Collected data included demographics, cytology results, surgical pathology, and molecular alterations.Results: A total of 738 patients were included of which 571 (77.4%) were females. The extrathyroidal extension was more common in malignancies in males (chi-squared, p = 0.028). The rate of point mutations and gene fusions were similar in both sex groups (p > 0.05 for all mutations). Patients with nodules with BRAF(V600E) mutations were significantly younger than BRAF wild-type nodule patients (t-test, p = 0.0001). Conversely, patients with TERT promoter mutations were significantly older than patients with wild-type TERT (t-test, p < 0.0001). For patients harbouring both BRAF(V600E) and TERT mutations, the difference in age at presentation was significantly different in females (t-test, p = 0.009) but not in males (t-test, p = 0.433). Among females, patients with BRAF(V600E) and TERT mutations were significantly older than their wild-type or single-mutation counterpart (t-test, p = 0.003).Conclusion: The absolute rate of molecular mutations was similar in females and males. We found that extrathyroidal extension was more common in males. Moreover, BRAF(V600E) and TERT mutations occur at a younger age in males than in females. These two findings are factors that may explain the tendency of more aggressive disease in males.

Objective Achieving clear surgical margins is one of the primary surgical goals in treating oral squamous cell carcinoma (OSCC) and thus aiming to improve overall and disease‐specific survival. Therefore, we developed the Goal‐Oriented Assessment for Intraoperative Margin (‘GAIM’) protocol, a novel intraoperative approach for margin assessment, and present here our 5‐year experience and outcomes. Methods ‘GAIM’ is a 7‐step procedure comprising systematic ruler‐aided resection of labeled tumor‐bed margins, frozen section (FS) co‐produced by both pathologists and operating surgeons, and immediate extension of resection according to FS findings. Data from all patients operated using the ‘GAIM’ protocol at a single tertiary center between 2018 to 2022 were analyzed, including margin status on FS and final pathology (FP) records, recurrence, and mortality. Results A total of 196 patients were included, 56.6% ( n = 111) stages I‐II, and 43.4% ( n = 85) stages III‐IV. Using the ‘GAIM’ protocol, we achieved an overall 94.4% of clean and revised clean surgical margins. Patients with a 2‐year and longer follow‐up ( n = 141) had local recurrence in 3.5% when both FS and final margins were clean, 8.1% when FP margins were clean, and 16.7% with close/positive final margins. Conclusions The proposed ‘GAIM’ protocol is a novel, effective, reproducible, and safe approach for margin evaluation that can be systematically applied. It can increase the rate of final clean surgical margins and potentially improve patients' outcomes. Level of Evidence 3 Laryngoscope , 134:1725–1732, 2024