Design: Evaluation of the diagnostic accuracy of ChatGPT, available to the public and easily accessible tool, in identifying common otological pathologies using standardized otoscopic images. Setting: In this prospective uncontrolled observational study six common otological pathologies—serous otitis media, acute otitis media, bullous myringitis, otitis externa, perforated tympanic membrane, and chronic otitis with cholesteatoma—were selected. Additionally, images of normal tympanic membranes were included. Ten standardized images for each pathology were sourced. These images were analyzed by ChatGPT-4 via its API, which was queried for the most accurate diagnosis. Results: ChatGPT-4 correctly diagnosed normal tympanic membranes in 30% of cases, frequently misidentifying them as serous otitis media. The AI accurately identified serous otitis media in 60% of cases, with the remaining misdiagnosed mainly as normal tympanic membranes. Similarly, acute otitis media was correctly diagnosed 60% of the time, often confused with serous otitis media. Bullous myringitis was correctly identified in 40% of cases, commonly misdiagnosed as acute otitis media. Otitis externa was correctly diagnosed in 40% of cases but was frequently mistaken for cholesteatoma. The AI accurately diagnosed perforated tympanic membrane in 20% of cases, with the majority misidentified as cholesteatoma. Cholesteatoma had the highest accuracy rate at 90%, with few misdiagnoses. Conclusion: ChatGPT-4 demonstrates promise in accurately diagnosing otological conditions such as cholesteatoma but has limitations, particularly in distinguishing between similar pathologies. The findings underscore the potential of AI as a diagnostic aid while highlighting the need for cautious integration into clinical practice to avoid unnecessary tests and misdiagnoses.

Introduction: The purpose of this study was to investigate whether patient, tumor and radiation therapy factors are associated with development of middle ear effusion (MEE) in nasopharyngeal carcinoma (NPC) patients. Methods: A retrospective review of NPC patients treated between January 2000 and June 2018 at Rabin Medical Center. Patient factors, tumor factors, radiation doses and radiation fields were collected and outlined if needed (middle ear, eustachian tube (ET), tensor veli palatini (TVP) and levator palatini (LVP) muscles), then analyzed and compared between patients with MEE and those without and between sides in patients with unilateral MEE. Results: 73 patients were enrolled. Most were males (71.2%) with advanced stage diseases (78%). At the time of diagnosis 14 patients (19.2%) presented with MEE and in 18 (24.6%) patients post radiation MEE was observed (15 ipsilateral to the tumor and 3 bilateral). Tumor stage, histology and laterality were not associated with development of MEE. Comparison of mean radiation field dosages including - gross target volume (GTV), clinical target volume (CTV) and patient target volume (PTV) showed no association with post radiation MEE. In addition, no difference was found in the radiation doses to the middle ear, ET or the LVP nor the TVP between ears with and without MEE. Conclusions: Postirradiation MEE remains a common adverse effect in NPC patients. Surprisingly, tumor stage, tumor laterality and histology were not associated with MEE. Similar findings were observed for total radiation doses and specific doses to the middle ear, ET and ET muscles.

Objective: To describe the occurrence, clinical presentation and management, of pediatric nasal foreign bodies, and to assess various risk factors for complications. Methods: A retrospective analysis of a computerized patient directory of 562 children admitted to the emergency department (ED) in a tertiary pediatric hospital during a 10-year period (Jan 2010-Dec 2019), with a witnessed NFB upon physical examination. Results: Upon admittance to the ED, most of the children (82%) were asymptomatic. Among the symptomatic children (18%), the primary symptoms were nasal discharge (10%), epistaxis (8%) and pain (4%). Younger children (under age 4 years) were more likely to insert organic materials, compared to older children. Younger children were also admitted sooner to the ED and were more likely to present with nasal discharge. The overall complication rate was 5%. None of the children had aspirated the NFB. Complications included infection (2%), necrosis (0.7%), septal perforation (0.5%), deep mucosal laceration (1.5%) and loss of NFB (1.9%). Significantly higher rates of symptoms and complications were associated with button batteries. Increased risk for complications were observed according to NFB-type, multiple attempts to remove NFB, posterior insertion of NFB and left-side insertion. Conclusions: NFB in children are common. Mostly, patients are asymptomatic, therefore a high index of suspicion is required, for quick diagnosis and safe removal, without complications.