OBJECTIVE:To investigate the utility of answers generated by ChatGPT, a large language model, to common questions parents have for their children following tonsillectomy.METHODS:Twenty Otolaryngology residents anonymously submitted common questions asked by parents of pediatric patients following tonsillectomy. After identifying the 16 most common questions via consensus-based approach, we asked ChatGPT to generate responses to these queries. Satisfaction with the AI-generated answers was rated from 1 (Worst) to 5 (Best) by an expert panel of 3 pediatric Otolaryngologists.RESULTS:The distribution of questions across the five most common domains, their mean satisfaction scores, and their Krippendorf's interrater reliability coefficient were: Pain management [6, (3.67), (0.434)], Complications [4, (3.58), (-0.267)], Diet [3, (4.33), (-0.357)], Physical Activity [2, (4.33), (-0.318)], and Follow-up [1, (2.67), (-0.250)]. The panel noted that answers for diet, bleeding complications, and return to school were thorough. Pain management and follow-up recommendations were inaccurate, including a recommendation to prescribe codeine to children despite a black-box warning, and a suggested post-operative follow-up at 1 week, rather than the customary 2-4 weeks for our panel.CONCLUSION:Although ChatGPT can provide accurate answers for common patient questions following tonsillectomy, it sometimes provides eloquently written inaccurate information. This may lead to patients using AI-generated medical advice contrary to physician advice. The inaccuracy in pain management answers likely reflects regional practice variability. If trained appropriately, ChatGPT could be an excellent resource for Otolaryngologists and patients to answer questions in the postoperative period. Future research should investigate if Otolaryngologist-trained models can increase the accuracy of responses.

Pediatric dysphagia is a common condition encountered in clinical practice. We review the physiology and development of swallow, presentation, epidemiology, and etiology of dysphagia. Additionally, comorbidities, associated conditions, and medical management of dysphagia are discussed.

Objective To report brain magnetic resonance imaging (MRI) and ultrasonography findings in pediatric patients with congenital idiopathic bilateral vocal fold dysfunction and analyze factors associated with its etiology and resolution. Study Design Case series with retrospective review. Setting Tertiary care multi-institutional setting: Nationwide Children's Hospital, Indiana University, University of North Carolina, and Cleveland Clinic. Methods Pediatric patients with congenital idiopathic bilateral vocal fold dysfunction were included in this review. Results Congenital idiopathic bilateral vocal fold dysfunction was identified in 74 patients from 2000 to 2018. Brain MRI scans were performed in all patients and ultrasonography in 30 (40.5%). Normal imaging results were most commonly found in patients born full-term (P < .0001) or via vaginal delivery (P < .01). Abnormal brain MRI and ultrasound results were found in 38 of 74 (51.3%) and 16 of 30 (53.3%), respectively. Type I Chiari malformation was not identified in any patient. No specific brain MRI or ultrasound abnormality was associated with patients' bilateral vocal fold dysfunction. Complete/incomplete bilateral vocal fold resolution occurred in 45 of 74 (60.8%) patients over the study interval and was not associated with brain MRI or ultrasound findings or birth complications but was associated with vaginal delivery (P = .02). Resolution rates were highest for patients with bilateral vocal fold paramedian paralysis (P = .05). Conclusions In this multi-institutional study, no specific brain MRI or ultrasound abnormality was associated with patients' bilateral vocal fold dysfunction or subsequent resolution rates. While imaging is often performed to detect and treat any reversible causes of bilateral vocal fold dysfunction, in this series, imaging findings were heterogeneous and did not identify any treatable causes, such as type I Chiari malformation.

Background Extramedullary hematopoiesis (EMH) occurs in patients with hematologic disorders, but rarely within the paranasal sinuses. We report a case of EMH in a 17-year-old male with sickle cell disease (SCD) who presented with occipital pain and sinusitis. A computed tomography (CT) scan demonstrated heterogeneous opacification of the right maxillary sinus concerning for allergic fungal sinusitis or a fungal ball with bony erosion. He was taken to the operating room for endoscopic biopsy and a limited endoscopic sinus surgery. Grossly, his maxillary sinus was filled with spiculated osseous tissue. Final pathology demonstrated active hematopoietic bone marrow filling the sinus. Methods We present a case report and literature review of sinonasal EMH. Results We identified 14 articles with 15 patients. EMH was typically associated with SCD or beta thalassemia. The average age of presentation was 30. There was a male sex predilection with a ratio of 11:15. The most common presenting symptom was a headache and nasal obstruction (33% for both). The most common finding on CT was a soft tissue expansile mass (73%). The most commonly affected location was the maxillary sinus (60%). Conclusions This case report serves as a reminder to consider EMH as an uncommon cause of sinus opacification, particularly in patients with SCD or beta thalassemia. The expansion of hematopoietic tissue may be identified as a sinus mass on CT. By recognizing the potential manifestations of chronic anemia, an accurate and timely diagnosis can be made.

Clinical OtolaryngologyVolume 43, Issue 5 p. 1402-1406 CORRESPONDENCE: OUR EXPERIENCE Outpatient management and surgeon specialty for thyroglossal duct cyst excision: A retrospective analysis of 377 patients and 30-day outcomes in the American College of Surgeons NSQIP-P Database D.R. Farquhar, Corresponding Author D.R. Farquhar drfarquhar@gmail.com Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA Correspondence D.R. Farquhar, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA. Email: drfarquhar@gmail.comSearch for more papers by this authorR.B. Rawal, R.B. Rawal Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USASearch for more papers by this authorM.M. Masood, M.M. Masood orcid.org/0000-0002-3477-9898 Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USASearch for more papers by this authorW.G. McClain, W.G. McClain Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USASearch for more papers by this authorL.A. Kilpatrick, L.A. Kilpatrick Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USASearch for more papers by this authorA.S. Rose, A.S. Rose Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USASearch for more papers by this authorC.J. Zdanski, C.J. Zdanski Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USASearch for more papers by this author D.R. Farquhar, Corresponding Author D.R. Farquhar drfarquhar@gmail.com Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA Correspondence D.R. Farquhar, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA. Email: drfarquhar@gmail.comSearch for more papers by this authorR.B. Rawal, R.B. Rawal Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USASearch for more papers by this authorM.M. Masood, M.M. Masood orcid.org/0000-0002-3477-9898 Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USASearch for more papers by this authorW.G. McClain, W.G. McClain Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USASearch for more papers by this authorL.A. Kilpatrick, L.A. Kilpatrick Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USASearch for more papers by this authorA.S. Rose, A.S. Rose Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USASearch for more papers by this authorC.J. Zdanski, C.J. Zdanski Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USASearch for more papers by this author First published: 14 June 2018 https://doi.org/10.1111/coa.13170Citations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume43, Issue5October 2018Pages 1402-1406 RelatedInformation

Objective The traditional resident applicant interview involves multiple oral interviews. The implementation of surgical simulations adds an additional dimension of assessment but can be perceived in a stressful way by applicants. The purpose of this project is to describe low‐fidelity simulations that were implemented for the 2016 to 2017 residency interviews and obtain applicant perception of these simulations. Methods Six simulation modules were created, which reflected tasks used in six subspecialties within otolaryngology (pediatrics, otology, laryngology, facial plastics, rhinology, and head/neck). Applicants were guided in the procedures by both an attending and resident. Afterward, applicants were anonymously surveyed on their perception of the tasks using a 5‐point Likert scale (1 = Strongly Disagree, 2 = Somewhat Disagree, 3 = Neutral, 4 = Somewhat Agree, 5 = Strongly Agree). Results A total of 41 applicants were interviewed. The following were measured: enjoyable (98.5% strongly agree, 2.5% somewhat agree; mean: 4.97; 95% confidence interval [CI], 4.92, 5.02), educational (88% strongly agree, 12% somewhat agree; mean: 4.88; 95% CI, 4.78, 4.98), recommended for future use (92.7% strongly agree, 7.3% somewhat agree; mean: 4.93; 95% CI, 4.85, 5.01), and stressful (63.5% strongly disagree, 19.5% somewhat disagree, 17% neutral; mean: 1.54; 95% CI, 1.30, 1.78). Conclusion Implementation of a low‐fidelity multi‐station surgical simulation experience is feasible in an interview day. Majority of applicants viewed the simulations in a positive manner. Surgical simulations may provide a useful holistic evaluation of an applicant in future interviews, especially if done in a setting that minimizes stress and maximizes the educational experience. Level of Evidence 2b. Laryngoscope , 2503–2507, 2018

Obstruction of the upper airway commonly contributes to respiratory distress in the premature neonate. It is a multifactorial problem that can present heterogeneously and requires accurate anatomical and pathophysiological diagnosis for effective treatment. In this chapter, the diagnosis and treatment options, as well as outcomes, of upper airway obstruction in the premature neonate are discussed. As presentation and treatment vary widely based on lesion location, our discussion is organized by anatomical subsite.

Lingual and labial frenulectomy are commonly performed as an outpatient procedure, either in an office setting or under general anesthesia. Frenulectomy is generally regarded by both otolaryngologists and dentists as a straightforward and low-risk procedure with limited evidence-based indications and similarly few contraindications. We describe two cases of hypovolemic shock occurring after outpatient frenulectomy requiring emergent interventions of cardiopulmonary resuscitation and blood transfusion. These rare, but life-threatening outcomes warrant recognition as potential complications for the presumed benign labial and lingual frenulectomy. We additionally briefly review indications for upper labial and lingual frenulectomy.