Developing an Artificial Intelligence Tool to Predict Vocal Cord Pathology in Primary Care Settings

Examining Diagnostic Errors in the Field of Otorhinolaryngology within the Challenging Landscape of Limited-Resource Healthcare

Diagnostic accuracy is vital in otorhinolaryngology for effective patient care, yet diagnostic mismatches between non-otorhinolaryngology clinicians and ENT specialists can occur. However, studies investigating such mismatches in low-resource healthcare environments are limited. This study aims to analyze diagnostic mismatches in otorhinolaryngology within a low-resource healthcare environment. A publicly available dataset assessing diagnostic outcomes from non-otorhinolaryngology clinicians and ENT specialists was analyzed. The dataset included demographic characteristics, referral diagnoses, and final ENT specialist diagnoses. Descriptive statistics and appropriate statistical tests were employed to assess the prevalence of diagnostic mismatches and associated factors. The analysis comprised 1544 cases. The prevalence of diagnostic mismatches between non-otorhinolaryngology clinicians and ENT specialists was 67.4%. Certain specific ENT diseases demonstrated higher frequencies of diagnostic mismatches. Factors such as mismatch in the diagnosis and compliance of patient were found to influence the occurrence of diagnostic mismatches. This study highlights the presence of diagnostic mismatches in otorhinolaryngology within a low-resource healthcare environment. The prevalence of these mismatches underscores the need for improved diagnostic practices in such settings. Factors contributing to diagnostic mismatches should be further explored to develop strategies for enhancing diagnostic accuracy and reducing diagnostic errors in otorhinolaryngology.

An introduction to machine learning and generative artificial intelligence for otolaryngologists-head and neck surgeons: a narrative review

PURPOSE

Despite the robust expansion of research surrounding artificial intelligence (AI) and machine learning (ML) and their applications to medicine, these methodologies often remain opaque and inaccessible to many otolaryngologists. Especially, with the increasing ubiquity of large-language models (LLMs), such as ChatGPT and their potential implementation in clinical practice, clinicians may benefit from a baseline understanding of some aspects of AI. In this narrative review, we seek to clarify underlying concepts, illustrate applications to otolaryngology, and highlight future directions and limitations of these tools.

METHODS

Recent literature regarding AI principles and otolaryngologic applications of ML and LLMs was reviewed via search in PubMed and Google Scholar.

RESULTS

Significant recent strides have been made in otolaryngology research utilizing AI and ML, across all subspecialties, including neurotology, head and neck oncology, laryngology, rhinology, and sleep surgery. Potential applications suggested by recent publications include screening and diagnosis, predictive tools, clinical decision support, and clinical workflow improvement via LLMs. Ongoing concerns regarding AI in medicine include ethical concerns around bias and data sharing, as well as the "black box" problem and limitations in explainability.

CONCLUSIONS

Potential implementations of AI in otolaryngology are rapidly expanding. While implementation in clinical practice remains theoretical for most of these tools, their potential power to influence the practice of otolaryngology is substantial.

LEVEL OF EVIDENCE: 4

Diagnosis of pathological speech with streamlined features for long short-term memory learning

BACKGROUND

Pathological speech diagnosis is crucial for identifying and treating various speech disorders. Accurate diagnosis aids in developing targeted intervention strategies, improving patients' communication abilities, and enhancing their overall quality of life. With the rising incidence of speech-related conditions globally, including oral health, the need for efficient and reliable diagnostic tools has become paramount, emphasizing the significance of advanced research in this field.

METHODS

This paper introduces novel features for deep learning in the analysis of short voice signals. It proposes the incorporation of time-space and time-frequency features to accurately discern between two distinct groups: Individuals exhibiting normal vocal patterns and those manifesting pathological voice conditions. These advancements aim to enhance the precision and reliability of diagnostic procedures, paving the way for more targeted treatment approaches.

RESULTS

Utilizing a publicly available voice database, this study carried out training and validation using long short-term memory (LSTM) networks learning on the combined features, along with a data balancing strategy. The proposed approach yielded promising performance metrics: 90% accuracy, 93% sensitivity, 87% specificity, 88% precision, an F1 score of 0.90, and an area under the receiver operating characteristic curve of 0.96. The results surpassed those obtained by the networks trained using wavelet-time scattering coefficients, as well as several algorithms trained with alternative feature types.

CONCLUSIONS

The incorporation of time-frequency and time-space features extracted from short segments of voice signals for LSTM learning demonstrates significant promise as an AI tool for the diagnosis of speech pathology. The proposed approach has the potential to enhance the accuracy and allow for real-time pathological speech assessment, thereby facilitating more targeted and effective therapeutic interventions.

A Generative Method for a Laryngeal Biosignal

The Glottal Area Waveform (GAW) is an important component in quantitative clinical voice assessment, providing valuable insights into vocal fold function. In this study, we introduce a novel method employing Variational Autoencoders (VAEs) to generate synthetic GAWs. Our approach enables the creation of synthetic GAWs that closely replicate real-world data, offering a versatile tool for researchers and clinicians. We elucidate the process of manipulating the VAE latent space using the Glottal Opening Vector (GlOVe). The GlOVe allows precise control over the synthetic closure and opening of the vocal folds. By utilizing the GlOVe, we generate synthetic laryngeal biosignals. These biosignals accurately reflect vocal fold behavior, allowing for the emulation of realistic glottal opening changes. This manipulation extends to the introduction of arbitrary oscillations in the vocal folds, closely resembling real vocal fold oscillations. The range of factor coefficient values enables the generation of diverse biosignals with varying frequencies and amplitudes. Our results demonstrate that this approach yields highly accurate laryngeal biosignals, with the Normalized Mean Absolute Error values for various frequencies ranging from 9.6 ⋅ 10-3 to 1.20 ⋅ 10-2 for different experimented frequencies, alongside a remarkable training effectiveness, reflected in reductions of up to approximately 89.52% in key loss components. This proposed method may have implications for downstream speech synthesis and phonetics research, offering the potential for advanced and natural-sounding speech technologies.