Objective: To evaluate the clinical applications and limitations of chat generative pretrained transformer (ChatGPT) in otolaryngology.Study Design: Cross‐sectional survey.Setting: Tertiary academic center.Methods: ChatGPT 4.0 was queried for diagnoses and management plans for 20 physician‐written clinical vignettes in otolaryngology. Attending physicians were then asked to rate the difficulty of the clinical vignettes and agreement with the differential diagnoses and management plans of ChatGPT responses on a 5‐point Likert scale. Summary statistics were calculated. Univariate ordinal regression was then performed between vignette difficulty and quality of the diagnoses and management plans.Results: Eleven attending physicians completed the survey (61% response rate). Overall, vignettes were rated as very easy to neutral difficulty (range of median score: 1.00‐4.00; overall median 2.00). There was a high agreement with the differential diagnosis provided by ChatGPT (range of median score: 3.00‐5.00; overall median: 5.00). There was also high agreement with treatment plans (range of median score: 3.00‐5.00; overall median: 5.00). There was no association between vignette difficulty and agreement with differential diagnosis or treatment. Lower diagnosis scores had greater odds of having lower treatment scores.Conclusion: Generative artificial intelligence models like ChatGPT are being rapidly adopted in medicine. Performance with curated, easy‐to‐moderate difficulty otolaryngology scenarios indicate high agreement with physicians for diagnosis and management. However, a decreased quality in diagnosis is associated with decreased quality in management. Further research is necessary on ChatGPT's ability to handle unstructured clinical information.

Dyskeratosis Congenita (DC) is a heritable multi-system disorder caused by abnormally short telomeres. Clinically diagnosed by the mucocutaneous symptoms, DC patients are at high risk for bone marrow failure, pulmonary fibrosis, and multiple types of cancers. We have recapitulated the most common DC-causing mutation in the shelterin component TIN2 by introducing a TIN2-R282H mutation into cultured telomerase-positive human cells via a knock-in approach. The resulting heterozygous TIN2-R282H mutation does not perturb occupancy of other shelterin components on telomeres, result in activation of telomeric DNA damage signaling or exhibit other characteristics indicative of a telomere deprotection defect. Using a novel assay that monitors the frequency and extension rate of telomerase activity at individual telomeres, we show instead that telomerase elongates telomeres at a reduced frequency in TIN2-R282H heterozygous cells; this recruitment defect is further corroborated by examining the effect of this mutation on telomerase-telomere co-localization. These observations suggest a direct role for TIN2 in mediating telomere length through telomerase, separable from its role in telomere protection. The shelterin complex protects telomeres from being processed by the DNA damage repair machinery, and also regulates telomerase access and activity at telomeres. The only shelterin subunit known to promote telomerase function is TPP1, which mediates telomerase recruitment to telomeres and stimulates telomerase processivity. Mutations in shelterin components cause Dyskeratosis Congenita (DC) and related disease syndromes due to the inability to maintain telomere homeostasis. In this study, we have identified TIN2-R282H, the most common DC-causing mutation in shelterin subunit TIN2, as a separation-of-function mutant which impairs telomerase recruitment to telomeres, but not chromosome end protection. The telomerase recruitment defect conferred by TIN2-R282H is likely through a mechanism independent of TIN2’s role in anchoring TPP1 at telomeres, since TPP1 localization to telomeres is unaffected by the mutation.

Background: While papillary thyroid carcinoma (PTC) is associated with high occult central neck metastasis (CNM) rates, prophylactic central neck dissection (pCND) is controversial. This meta-analysis aims to look at the occult CNM rate according to tumor size. Methods: A literature search was conducted in PubMed from inception to April 2023. Inclusion criteria were primary studies that determined occult CNM rates in cN0 PTC by tumor size. Heterogeneity, influential case diagnostics, and proportion data were evaluated with Cochran’s Q-test, Baujat plots and Forest plots, respectively. Results: Fifty-two studies were included in this meta-analysis. The findings demonstrated an occult CNM rate of 30.3% for tumors ≤ 5 mm, 32.7% for tumors ≤ 1 cm, 46.0% for tumors between 1 and 2 cm, 43.1% for tumors between 2 and 4 cm, and 61.2% for tumors > 4 cm. The heterogeneity of each study group was high, though no publication bias was noted. While there was a trend towards increased occult CNM rates with larger tumors, comparisons between different size cutoffs varied in significance. Conclusion: This comprehensive review affirms that occult CNM is high and that an ipsilateral pCND can be justified in all PTC patients for accurate differentiation between Stage I and Stage II disease and its clinical implications.

Introduction: This systematic review aimed to determine the clinical utility of various physical exam findings in the diagnosis of obstructive sleep apnea (OSA).Methods: A systematic review of English articles identified from PubMed, Embase, CENTRAL, and Web of Science databases. Search terms included “sleep apnea,” “physical exam,” “polysomnography,” and all relevant synonyms. Two reviewers independently screened abstracts, reviewed full texts, and extracted data from all studies that presented associations between physical characteristics and apnea‐hypopnea index (AHI).Results: A total of 35 studies representing 13,854 patients were included in this review. The mean difference between high AHI and low AHI groups was 4.09 kg/m² (95% CI: 2.78–5.39) for BMI, 7.93 cm (3.59–12.28) for waist circumference, and 3.67 cm (2.64–4.71) for neck circumference. The odds ratios for having a high AHI were 2.44 (1.07–5.55) for macroglossia, 2.23 (1.68–2.96) for Mallampati > 2, 1.88 (1.67–2.11) for tonsil grade > 2, 3.99 (1.94–8.21) for pharyngeal grade > 2, and 1.57 (1.48–1.67) for enlarged uvula. Thyromental distance, retrognathia, Friedman grade, septal deviation, and enlarged turbinates were also assessed and were not found to be statistically significant between AHI groups.Discussion: Several physical exams have strong evidence in the literature supporting their strength at differentiating patients with and without OSA. These should be used routinely among providers who treat OSA, regardless of specialty, to help guide decisions about recommending a sleep study and selecting appropriate treatment. Other physical characteristics may be better assessed through advanced exam techniques or require more research and standardization in the way they are assessed by practitioners.

To evaluate surgical outcomes of invasive fungal rhinosinusitis MATERIALS AND METHODS: The National Inpatient Sample Database (2000-2015 Q3) was queried for patients with a diagnosis of aspergillosis and/or mucormycosis and a diagnosis of acute sinusitis using the International Classification of Diseases, Ninth Edition. Factors associated with inpatient mortality were then identified with multivariate logistic regression. 514 adult patients with a median age of 57.0 years were identified, of which 231 (44.9 %) underwent sinus surgery. Surgical patients had a longer length of stay (17.0 vs 9.0 days, p < 0.001) and higher total charges ($139,762.00 vs $57,945.00, p < 0.001). The number of sinus procedures was associated with reduced odds of inpatient mortality (OR 0.69; p < 0.001) in multivariate analysis. Hypertension (OR 0.34, p = 0.002) and chronic kidney disease (OR 0.23, p = 0.034) were associated with reduced odds of inpatient mortality. Total number of procedures (OR 1.24; p = 0.002), mucormycosis (OR 2.75, p = 0.002), age (OR 1.03, p = 0.006) and acid-base disorders (OR 2.85, p = 0.012) were associated with increased odds of inpatient mortality. This represents the first large scale study to evaluate outcomes for invasive fungal rhinosinusitis. These findings suggest the odds of inpatient mortality decrease with greater extent of sinus surgery performed. The potentially protective roles of hypertension and chronic kidney disease should be evaluated in future research.