Background: Atelectasis and attic retraction pocket are two common tympanic membranes changes. However, general practitioners, pediatricians and otolaryngologists showed low diagnostic accuracy for these ear diseases. Therefore, there is a need to develop a deep learning model to detect atelectasis and attic retraction pocket automatically. Method: 6393 OME otoscopic images from 3 centers were used to develop and validate a deep learning model to detect atelectasis and attic retraction pocket. 3-fold random cross validation was adopted to divided dataset into training set and validation set. A team of otologists were assigned to diagnose and label. Receiver operating characteristic (ROC) curve, 3-fold average classification accuracy, sensitivity and specificity were used to assess the performance of deep learning model. Class Activation Mapping (CAM) was applied to show the discriminative region in the otoscopic images. Result: Among all the otoscopic images, 3564 (55.74%) images were identified with attic retraction pocket, and 2460 (38.48%) images were identified with atelectasis. The automatically diagnostic model of attic retraction pocket and atelectasis achieved 3-fold cross validation accuracy of 89% and 79%, AUC of 0.89 and 0.87, sensitivity of 0.93 and 0.71, and specificity of 0.62 and 0.84 respectively. Bigger and deeper atelectasis and attic retraction pocket showed more weight with red color in the heat map of CAM. Conclusion: Deep learning algorithm could be used to identify atelectasis and attic retraction pocket, which could be used as a tool to assist general practitioners, pediatricians and otolaryngologists. Key words: deep learning, otoscopic images, atelectasis, attic retraction pocket

Background and Objectives Granular myringitis is troublesome for otologist because uncertain etiology and often been overlooked due to vague clinical symptoms and signs. The ideal treatment is elusive. Our study was to investigate the clinical characteristics of granular myringitis and analyzing the effect of the two different strategies, including carbon dioxide laser (CO2 laser) and caustic agent cauterization to manage granular myringitis. Study Design: Retrospective review Subjects and Methods One hundred and thirty patients with granular myringitis receiving treatment at a single medical center from July 2009 to January 2018 were enrolled. We retrospectively reviewed the charts and surgical records. The main two different strategies to manage focal refractory granular myringitis were analyzed, including carbon dioxide laser and caustic solution. We also recorded the clinical course and determine which strategy is better. Results One hundred and thirty patients with granular myringitis were enrolled. 47/130 (36.1%) had previous otologic procedures. Frequent ototrrhea is the most common symptom (66.1%). Posterior-inferior quadrant is the most common site of involvement (58%). The successful rate of CO2 laser, caustic agent were 94.9% and 79.2%. The recurrence rate was comparable between CO2 laser and caustic agent. No major complication was found in either individual group. Conclusion: Otologic procedure may be a predisposing factor of focal chronic myringitis. Ear drops had poor efficacy compared to other treatments. It can be apply only on minor and fresh symptom cases. In this study, we suggest CO2 laser can be the first line treatment, especially for the troublesome or refractory GM cases, which had the higher successful rate and less complication comparing to caustic agent cauterization.

Introduction Silver nitrate is commonly used within otolaryngology to treat granulation tissue in severe otitis externa. It appears radio-opaque on CT (computed tomography) imaging and therefore can mimic bony fragments and foreign bodies. This is particularly cumbersome when the phenomena correlates to the clinical complaint. Discussion We report two cases of 73-year-old and 75-year-old males who presented with chronic otalgia and discharge. Granulation tissue in the external auditory canal was identified and chemically cauterised with silver nitrate. Subsequent CT petrous bones demonstrated an unidentified foreign body in the canal with extensive soft tissue swelling giving an impression of a wick in situ and “minor bony erosion in the left external acoustic canal” respectively. An additional CT of a 57-year-old female who had been treated with silver nitrate for granulomatous tissue reported “multiple highly radiopaque foci in the external auditory canal, suggestive of foreign body”. Though relatively unknown, this phenomenon has been reported in literature. However, there are few reports of silver nitrate artefacts in CT images of the head no cases in the context of otitis externa. Our patients avoided further imaging or surgery following clarification with the radiologists and symptomatic improvement with long-term intravenous antibiotics. Conclusion Given the prevalence of CT imaging and cauterization in otolaryngology, we recommend contemporaneously documenting the use of silver nitrate and highlighting this on request forms to avoid alarming erroneous reports, unnecessary investigation and surgical procedures. We also recommend, where clinically acceptable, to use silver nitrate prior to imaging.

Abstract Objectives: To assess the impact of risk factors on the disease control among CRS patients, following 1 year of functional endoscopic sinus surgery (FESS), and combining the risk factors to formulate a convenient, visualized prediction model. Design: A retrospective and nonconcurrent cohort study Setting and Participants: A total of 325 patients with Chronic rhinosinusitis (CRS) from June 2018 to July 2020 at the First Affiliated Hospital, the Third Affiliated Hospital, and the Seventh Affiliated Hospital of Sun Yat-sen University. Main Outcomes Measures: Outcomes were time to event measures: the disease control of CRS after surgery 1 year. The presence of nasal polyps, smoking habits, allergic rhinitis (AR), the ratio of tissue eosinophil (TER), and peripheral blood eosinophil count (PBEC)and asthma was assessed. The logistic regression models were used to conduct multivariate and univariate analyses. Asthma, TER, AR, PBEC were also included in the nomogram. The calibration curve and AUC (Area Under Curve) were used to evaluate the forecast performance of the model. Results: In univariate analyses, most of the covariates had significant associations with the endpoints, except for age, gender, and smoking. The nomogram showed the highest accuracy with an AUC of 0.760 (95% CI, 0.688-0.830) in the training cohort. Conclusions: In this cohort study that included the asthma, AR, TER, PBEC had significantly affected the disease control of CRS after surgery. The model provided relatively accurate prediction in the disease control of CRS after FESS and served as a visualized reference for daily diagnosis and treatment.

Objectives: Review of radiological images of the keystone area to assess risk of disruption to the nasal dorsum when separating the osseo-cartilaginous junction in septoplasty. Methods: A Cross sectional radiological study of adults who underwent CT scan of paranasal sinuses. Outcome measures included were: The Length of the keystone area (shorter length implies a higher risk of disruption) and a high-risk shape (high risk shape implies shorter keystone area) that can predispose to disruption of nasal dorsal integrity during septoplasty surgery. Certain nasal dimensions were evaluated to determine if they add risk to the dorsum. Results: CT scans of 343 patients were reviewed. The mean keystone area length was initially 10.42 mm that came down to 7.43 mm after adjustment in patients with high-risk shape. 31.5% of subjects were at risk of disruption to the dorsum due to short keystone area length <5 mm. Relatively shorter nasal bones (nasal bone length: overall dorsal length <0.49%) were associated with a shorter keystone area length (P = 0.004). Age, gender, septal deviation are not risk factors as they did not significantly influence keystone area length. Conclusions: One third of our patients (31.5%) had short KSA length < 5mm which carries higher risk of disruption to the dorsum integrity upon complete detachment of osseo-cartilaginous junction. We recommend preoperative CT imaging for thorough evaluation and precise measurement of KSA. Patients with relatively shorter nasal bones detected on examination (and confirmed radiologically), need to be recognized as they are more likely to have shorter KSA

Because they can experience neutropenia due to bone marrow failure, patients with Shwachman-Diamond syndrome (SDS) carry increased risk for serious infections compared to the general population; however, it has been unknown whether this predisposes them to COVID-19 infection or more significant complications. We compiled results from a survey distributed to participants in the Shwachman-Diamond Syndrome Registry between May and June 2021. In this report we describe the characteristics and outcomes of patients with SDS who had COVID-19. Patients reported a short clinical course without significant complications or severe cytopenias. Additionally, COVID-19 vaccines were well tolerated with only minor side effects.

Introduction: Necrotising otitis externa (NOE) is a serious, progressive infection of the external ear canal. If untreated, it can invade into temporal bone, skull-base and surrounding tissue resulting in cranial nerve palsies, neurological infections and death. Patients present with unremitting, severe otalgia, otorrhoea and oedematous ear canals containing granulation. Surgery has a limited role; the mainstay of treatment involves a long course of intravenous antibiotics. Currently, there is no data on the complications of antibiotic treatment for NOE. This project aims to provide evidence on the nature/frequency of severe treatment-related complications requiring a change in antibiotic regime. Methods: A retrospective 5-year cohort analysis was performed on 64 patients who were treated for confirmed NOE with intravenous antibiotic therapy. Clinical notes, blood results and antibiotic prescriptions were documented and analysed. Results: Average duration of treatment was 11 weeks (range=38 weeks). There was an average of 2.1 antibiotic regimes per patient with 10 cases requiring inpatient admission due to treatment-related complications. 63% of treatment changes were directly related to adverse effects of intravenous antibiotics. Drug allergy/intolerance (n=18) and clinical deterioration i.e. Lack of symptomatic improvement and/or worsening inflammatory markers (n=18), were the most common reasons for antibiotic change. Neutropenia, deranged liver function tests and acute kidney injury were also recognised adverse effects of treatment. Conclusion: This study provides the first evidence on the notable frequency of antibiotic-related complications in NOE patients. Larger, multicentre studies are required in the future to validate our findings and will better inform both clinicians and patients of the risks of treatment.

Objectives: The three dimensional (3D) endoscope is considered as a new surgical tool which used in different approaches in intranasal and anterior skull base surgical procedures. There are many advantages of the 3D endoscopy over the two dimensional (2D) one that have been demonstrated along clinical applications, surgical training and different experimental studies. Our study aimed to show the difference between using the 3D & 2D endoscopes during endonasal and anterior skull base surgery and its importance specially when used by novice users. Design: Our study is divided into two phases (clinical & cadaveric phases).In the clinical study we have done 52 endonasal & anterior skull base surgical procedures (26 study cases and 26 control cases).We recorded accuracy, duration and intraoperative complication for each case. The cadaveric study was performed on three cadavers, difference in accuracy and dissection time were recorded using 3D & 2D endoscopy for each side chosen by randomization. Results: In the clinical study, the cases done by 3D endoscope were significantly faster and more accurate with less intraoperative complications compared to cases done using 2D endoscope. In cadaveric dissection while using 3D endoscope there was better depth of perception regarding the anatomical landmarks compared to 2D endoscope. Conclusion: 3D endoscopy is an advanced instrument that allows better training for the coming generation of ENT surgeons. Both clinical and cadaveric studies offer a promising outcomes in both endonasal and anterior skull base surgery.

- We retrospectively evaluated a large series of patients (n: 15) underwent a modified transmanubrial approach for wide mediastinal resection in case of malignance thyroid mass - In fourteen cases, also with thyroid tumor involving the middle line. A bilateral mTMA was necessary to perform a cava vein resection. - No major postoperative and cutaneous/sternum complications were detected. - mTMA allows an optimal exposure of the upper thoracic inlet achieving a complete radical oncological resection of the tumor/lymph-node and a safety vascular/tracheal control. - As a limitation, the modified mTMA is anatomically more demanding and not familiar for most surgeons in comparison to sternotomy

Background: The role of intra-operative parathyroid hormone (IOPTH) monitoring during parathyroidectomy for primary hyperparathyroidism has long been debated. Objectives: Our main goal was to investigate the cure rates of parathyroidectomy for primary hyperparathyroidism with and without IOPTH monitoring. Our secondary goal was to investigate if operating room time can be saved when not using IOPTH monitoring. Design: A retrospective analysis of patients who underwent parathyroidectomy for PHPT for a single adenoma between 2004-2019 was performed. Cure rates and operating room time were compared. Results: 423 patients were included. IOPTH was used in 248 patients (59%). Four patients were not cured, two from each group, with no significant difference between the groups (98.8% vs. 99.1%, p=0.725). Surgery time was significantly longer in the IOPTH group, p<0.001. Conclusions: There is no advantage for using IOPTH during parathyroidectomy in suitable clinical setting. A focused procedure may be safely performed without IOPTH while achieving non-inferior success rates and reducing operative time.

Objectives: We aimed to characterise the use of tracheostomy procedures for all COVID-19 critical care patients in England and to understand how patient factors and timing of tracheostomy affected outcomes. Design: A retrospective observational study using exploratory analysis of hospital administrative data. Setting: All 500 National Health Service hospitals in England. Participants: All hospitalised COVID-19 patients aged ≥ 18 years in England between March 1st and October 31st, 2020 were included. Main outcomes and measures: This was a retrospective exploratory analysis using the Hospital Episode Statistics administrative dataset. Multilevel modelling was used to explore the relationship between demographic factors, comorbidity and use of tracheostomy and the association between tracheostomy use, tracheostomy timing and the outcomes. Results: In total, 2,200 hospitalised COVID-19 patients had a tracheostomy. Tracheostomy utilisation varied substantially across the study period, peaking in April-June 2020. In multivariable modelling, for those admitted to critical care, tracheostomy was most common in those aged 40-79 years, in males and in people of Black and Asian ethnic groups and those with a history of cerebrovascular disease. In critical care patients, tracheostomy was associated with lower odds of mortality (OR: 0.514 (95% CI 0.443 to 0.596), but greater length of stay (OR: 41.143 (95% CI 30.979 to 54.642). In patients that survived, earlier timing of tracheostomy (≤ 14 days post admission to critical care) was significantly associated with shorter length of stay. Conclusions: Tracheostomy is safe and advantageous for critical care COVID-19 patients. Early tracheostomy may be associated with better outcomes, such as shorter length of stay, compared to late tracheostomy.

Objectives: Rhinitis affects up to 40% of the population worldwide and can significantly reduce quality of life. Some patients remain symptomatic despite maximal medical therapy. In refractory cases, posterior nasal neurectomy (PNN - the division of the intranasal nerve branches containing postganglionic parasympathetic fibres) is postulated to reduce symptom burden. The objectives of this paper were to review the literature to establish whether the procedure is effective and safe in the management of allergic and non-allergic rhinitis. Design: A systematic review of Pubmed, EMBASE and MEDLINE was undertaken. Studies were excluded if not available in English or undertaken in non-human subjects. Participants: Seventeen articles satisfied the inclusion criteria studying in total 2029 patients. Sample size ranged from 8-1056. Main Outcome Measures: Patient-reported objective and subjective outcomes and post-operative complications were reviewed Results: There were two randomised controlled trials, two case control studies, and the remaining thirteen were case series using both objective and subjective outcome measures. All but one study found improved patient reported outcomes following PNN. Complications were reported in 10 studies - haemorrhage was the most common complication and was observed in 28 patients (1.6% of subjects). Conclusions: Endoscopic posterior nasal neurectomy is safe and appears to be effective in the treatment of intractable rhinitis but the level of the available evidence was generally poor. Larger, well designed studies are needed to clarify its role in the management of difficult-to-treat rhinitis.

Objective: To summarize the accuracy of artificial intelligence (AI) computer vision algorithms to classify ear disease from otoscopy. Methods: Using the PRISMA guidelines, nine online databases were searched for articles that used AI methods (convolutional neural networks, artificial neural networks, support vector machines, decision trees, k-nearest neighbors) to classify otoscopic images. Diagnostic classes of interest: normal tympanic membrane, acute otitis media (AOM), otitis media with effusion (OME), chronic otitis media (COM) with or without perforation, cholesteatoma, and canal obstruction. Main Outcome Measures: Accuracy to correctly classify otoscopic images compared to otolaryngologists (ground-truth). The Quality Assessment of Diagnostic Accuracy Studies Version 2 tool was used to assess the quality of methodology and risk of bias. Results: Thirty-nine articles were included. Algorithms achieved 90.7% (95%CI: 90.1 – 91.3%) accuracy to difference between normal or abnormal otoscopy images in 14 studies. The most common multi-classification algorithm (3 or more diagnostic classes) achieved 97.6% (95%CI: 97.3.- 97.9%) accuracy to differentiate between normal, AOM and OME in 3 studies. Compared to manual classification, AI algorithms outperformed human assessors to classify otoscopy images achieving 93.4% (95%CI: 90.5 – 96.4%) versus 73.2% (95%CI: 67.9 – 78.5%) accuracy in 3 studies. Convolutional neural networks achieved the highest accuracy compared to other classification methods. Conclusion: AI can classify ear disease from otoscopy. A concerted effort is required to establish a comprehensive and reliable otoscopy database for algorithm training. An AI-supported otoscopy system may assist health care workers, trainees, and primary care practitioners with less otology experience identify ear disease.

It is important to give parents accurate information about complication rates as part of the process of informed consent for surgery.  National, routinely-collected data give an opportunity to estimate the rates of rare adverse events such as bleeding, blood transfusion and death.We reviewed data for all Scottish NHS hospitals over the time period 2000-2018 to identify all children (aged 0-16 years) undergoing tonsillectomy, and to identify adverse events occurring within 30 days of the procedure.Readmission to hospital was required in 2%.Surgical arrest of haemorrhage was required in 1%.Blood transfusion occurred in 0.1% and death occurred in one child out of 50,194.

Objectives : Primary : To determine the rate of occult cervical metastasis in primary temporal bone squamous cell carcinomas (TBSSC). Secondary : to perform a subgroup meta-analysis of the risk of occult metastasis based on the clinical stage of the tumour and its risk based on corresponding levels of the neck Design : A systematic review and meta-analysis of papers searched through Medline, Cochrane, Embase, Scopus and Web of Science up to January 2021 to determine the pooled rate of occult lymph node/parotid metastases. Quality assessment of the included studies was assessed through the Newcastle-Ottawa scale. Setting : Centres around the world that perform surgery for TBSCC Participants : Patients with TBSCC Results : Overall, 9 out of 1034 screened studies met the inclusion criteria, for a total of 907 patients of which 388 had TBSCC. Out of the 191 patients who underwent a neck dissection, 21 had positive lymph nodes giving a pooled rate of occult metastases of 11% (95% CI: 7%-17%). When analysed using the Modified Pittsburg staging system, 21 pT2 cases had a pooled occult metastases rate of 3% (95% CI: 0%-21%), 27 pT3 cases had a pooled occult metastases rate of 12% (95% CI: 1%-60%), and 65 pT4 cases had a pooled occult metastases rate of 14% (95% CI: 7%-25%). Data available showed that most of the positive nodes were in Level II. Conclusion: The rate of occult cervical metastases in TBSCC increases based on the tumour (T) staging of the disease with majority of nodal disease found in level 2 of the neck.

Background: CO2 laser and the 532-nm potassium titanyl phosphate laser (KTP) were developed to treat Laryngeal papillomatosis (LP); however, the difference in their outcomes remains unclear. Methods: A systematic review was conducted through a comprehensive search of three databases. Results: Overall, the cure rates were 87.25% in the KTP group and 75.98% in the CO2 group (p＜0.05). The complications rates were significantly different between the two groups (p<0.0001). In addition, there was no significant difference between the recurrence rates of the CO2 group and the KTP group (10% vs 9.8%). The risks of bias were 13.1±1.45 and 13.6±1.52 for CO2 group and KTP group respectively, which indicated the fair quality of evidence. Conclusions: The available fair-quality evidence suggested that KTP laser excision may be a better choice for LP. Following evaluations on the benefits of the two surgical techniques with more high-quality randomized controlled studies are needed.

•A 28-month retrospective review from February 2019 to April 2021 of penetrating neck injuries (PNIs) at our trauma centre revealed a 48% (n=25 to n=37) increase in PNIs ‘post-lockdown’ (lockdown date = 23rd March 2020). •The aetiology of PNI changed over time, with an increase in the proportion of Deliberate Self Harm’ (DSH) cases from 1/3 to 2/3rds of case (n=9 to n=25), an overall 177.8% increase ‘post-lockdown’. An increase in mortality was also seen with no deaths ‘pre-lockdown’, and 3 deaths ‘post-lockdown’. •‘Accidental Injuries’ (AI) increased from 4% to 10% of cases (n=1 to n=4) post lockdown, with ‘grievous bodily harm (GBH) reducing from half to 1/5th of all cases (n=13 to n=8), and ‘domestic violence’ from 8% of cases to no cases post lockdown (DV) ‘post lockdown’. •‘Pre-lockdown’ 10% of DSH patients (n=1) were noted to have a prior mental health diagnosis or psychiatric care, ‘post-lockdown’ this increased to 61.5% (n=16) of DSH patients. •Data from our tertiary trauma centre in London has shown a change in aetiology, psychiatric co-morbidity and number of PNIs pre and post lockdown.

Objectives: The aim of this study was to compare the efficacy and side effects of non-dissolvable packing for the management of epistaxis. Design: Prospective, observational cohort study. Setting: A large university teaching hospital with an emergency department. Participants: Consecutive adults requiring non-dissolvable packing for the management of acute epistaxis between March 2020 and March 2021. Main outcome measures: Likert-scale questions based on the SNOT-22 questionnaire to assess side effects associated with non-dissolvable packing; and pain scores on insertion, whilst in-situ and on removal. Results: A total of 80 adults requiring non-dissolvable packing were included. 47% of patients presented following a first episode of epistaxis and 52% required inpatient management. 70% of patients had a Rapid Rhino pack inserted. Rapid Rhino had an increased incidence of patient-perceived embarrassment (30%, n=17) compared to patients packed with Merocel (8%, n=2). Patients packed with Rapid Rhino also had an increased severity of embarrassment (0.46 ±0.11) compared to patients packed with Merocel (0.13 ±0.09). Merocel packs had a higher mean pain score on removal (6.09 ±0.73) compared to Rapid Rhino (4.05 ±0.43). No significant association was noted between rebleed rates and pack type or rebleed rates and inpatient versus outpatient management. Conclusion: Non-dissolvable nasal packs, Rapid Rhino and Merocel, have similar efficacy in controlling epistaxis. Rapid Rhino packs are more embarrassing for patients in comparison to Merocel packs but are less painful to remove. Patients were successfully managed in the outpatient setting without an increased complication rate.

Key Points 1. COVID-19 associated mucormycosis (CAM) is a life-threatening fungal disease that has become an epidemic and notifiable disease after the second wave of COVID-19 in India 2. The target group for CAM includes severely immunocompromised individuals either by COVID-19, or corticosteroid therapy, or uncontrolled glycemic index. 3. With an intention to find out the sensitivity and specificity of diagnostic nasal endoscopy (DNE) and contrast-enhanced magnetic resonance imaging (CEMRI), one hundred two consecutive patients of target group with clinical features of CAM were enrolled in the study. 4. The sensitivity and specificity of DNE as compared to KOH mount were 73.4% and 94.7% respectively. The sensitivity and specificity of CEMRI as compared to KOH mount were 87.5% and 50% respectively. 5. CEMRI misses fewer cases than DNE. In cases of normal endoscopy in the target group, imaging and biopsy should be advised to reduce false-negative results. Nasal endoscopy, biopsy, and imaging can reliably detect the majority of cases of CAM.

Objectives: To assess the efficacy of avoiding mastoid pressure dressing (MPD) on children as a means of preventing discomfort and postoperative pain. Design: A retrospective controlled study. Setting: All operations were carried out by experienced surgeons using standard techniques, whose custom, not the gravity of any individual case, dictated the use of MPD. Participants: children who underwent mastoidectomy for inflammatory middle ear diseases at a tertiary centre from 2010-2020. Main outcome measures: Wound-related complications and visual analog scale (VAS) pain scores at discharge were compared between children who had a MPD applied following surgery and those who did not. Results: 119 cases were included. The demographic characteristics of the patients and surgical techniques employed similar for both groups. There were 91 patients in the MPD group and 28 in the non-mastoid dressing (NMPD) group. In the MPD group, 5 patients developed minor wound dehiscence, 8 experienced surgical site infections (SSI), and one patient developed a keloid. In the NMPD group, one patient had a SSI, while another had a local hematoma. Therefore, there were no differences between the groups in relation to postoperative complications (p = 0.47). Despite these similitudes, the NMPD patients suffered less postoperative pain, as measured by the VAS (p =.02). Conclusions: This study shows that no significant benefit is derived from using a MPD after mastoidectomy in children. Surgeons should adhere to principles of appropriate haemostasis and wound closure to prevent postoperative wound complications. Our study supports the abandonment of routine MPD on children following mastoidectomy.

Objectives: We aim to analyze long-term voice outcomes and Quality of Life (QoL) in patients undergoing Open Partial Horizontal Laryngectomy Type II (OPHL Type II) and to compare them to those obtained by patients undergoing Total Laryngectomy (TL) with voice prosthesis (VP). Design: Cross-sectional cohort study Setting: patients undergoing surgery for advanced laryngeal cancer, assessed during the usual follow-up consultations at the Phoniatric Unit (February 2020-December 2020). Participants: Forty-five patients were enrolled and divided into two groups: OPHL Group and TL Group. Main outcomes measures: Maximum phonation time, INFV0 scale, I-SECEL, UWQoL-V4 and MDADI questionnaires were used to assess the long-term outcomes. Results: Voices of patients undergoing OPHL Type II were worse than those of laryngectomized patients with VP. Nevertheless, scores in voice and dysphagia-related QoL were comparable and scores in the Social domain of QoL were better in OPHL group. Conclusions. OPHL Type II allows an acceptable voice recovery and a satisfactory QoL.

OBJECTIVE Little is known about the efficacy of using artificial intelligence to identify laryngeal carcinoma from images of vocal lesions taken in different hospitals with multiple laryngoscope systems. This multicenter study was aimed to establish an artificial intelligence system and provide a reliable auxiliary tool to screen for laryngeal carcinoma. Study Design: Multicentre case-control study Setting: Six tertiary care centers Participants: The laryngoscopy images were collected from 2179 patients with vocal lesions. Outcome Measures: An automatic detection system of laryngeal carcinoma was established based on Faster R-CNN, which was used to distinguish vocal malignant and benign lesions in 2179 laryngoscopy images acquired from 6 hospitals with 5 types of laryngoscopy systems. Pathology was the gold standard to identify malignant and benign vocal lesions. Results: Among 89 cases of the malignant group, the classifier was able to evaluate the laryngeal carcinoma in 66 patients (74.16%, sensitivity), while the classifier was able to assess the benign laryngeal lesion in 503 cases among 640 cases of the benign group (78.59%, specificity). Furthermore, the CNN-based classifier achieved an overall accuracy of 78.05% with a 95.63% negative prediction for the testing dataset. Conclusion: This automatic diagnostic system has the potential to assist clinical laryngeal carcinoma diagnosis, which may improve and standardize the diagnostic capacity of endoscopists using different laryngoscopes.

5 Key Points: Prior studies demonstrated a failure to identify and localize head and neck cancers via near-infrared (NIR) imaging of indocyanine green (ICG) with a robot-integrated platform. However, our group demonstrated success in visualization of neoplasms using a commercially available dedicated NIR camera system and a technique called second window ICG (SWIG), in which ICG is injected 24 hours pre-operatively.We aimed to evaluate the SWIG technique in patients undergoing transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) and compare two NIR camera systems.System 1 showed poor tumor-margin delineation with no fluorescence in 4/6 cases (66.7%) and only minimal fluorescence in the remaining 2 cases (33.3%).System 2 showed marked fluorescence in 5/6 cases (83.3%), with good margin definition in 4 cases (66.7%). In 2 cases (33.3%), System 2 also identified tumor that was not visible under white light.In this preliminary case series, we found that System 2 outperforms System 1 in NIR imaging with SWIG during TORS for oropharyngeal tumor resection.

Objective: Epistaxis is the most common otolaryngological emergency and up to one third of patients in treated on an inpatient basis take oral anticoagulants (OAC). Direct oral anticoagulants (DOAC), an OAC subgroup, have been on the market since 2010 and are being increasingly prescribed due to the cardiologic and hematologic guidelines that favour them over vitamin K antagonists (VKA), the older of the OAC subgroups. The present study aims to investigate which subgroup of epistaxis patients taking OACs has a more favourable outcome. Design/Setting: A systematic review and meta-analysis were performed according to the PRISMA 2020 statement using the PubMed and Cochrane Library databases. Continuous data was analysed and standardized mean difference (SMD) was calculated according to Hedges’ g. Dichotomous data was analysed and the Mantel-Haenszel method was applied to establish the odds ratio (OR). Heterogeneity was assessed according to the I2 statistics. Main Outcome/Results: A total of 8 reports covering 1390 patients were included in the final synthesis. The pooled analysis demonstrated significantly shorter hospital stays in the DOAC group (SMD= -0.22, 95% CI -0.42 to -0.02, P= .03) and a significantly higher rate of posterior bleeding in the VKA group (OR= .39, 95% CI .23 to .68, P= .001). No statistically significant differences with regard to recurrence rates, admission rates, the need for transfusion, or surgical intervention (P= .57, .12, .57 and .38 respectively) were found. Conclusion: According to this meta-analysis, epistaxis patients taking DOACs have a more favourable outcome than patients taking VKAs.