AI’s Latest Frontier part 2: AI chatbots and clinical audiology

Publication date 14 February 2023 (writing started 22 January)

Written by Jan-Willem Wasmann & supervised by De Wet Swanepoel. The authors used ChatGPT an AI system that can help write text and code or answer questions, but that cannot take responsibility in a way a human writer can do.

The output from ChatGPT (version January 9, see release notes) is supervised by the authors. Prompts were inspired by dr Tristan Behrens who is an AI music composer and Sam Szuchan, who wrote a beginner’s guide to ChatGPT.

Seeds to replicate the precise ChatGPT were not known to the human writers when starting this blog (January 22 anno 2023) but are stored within our personal accounts. In the likely event you find errors, please send us a message, or respond below via the comments.

How will hearing healthcare transform due to AI systems?

When we started addressing this question in the fall of 2018, little did we know how quickly our philosophical discussions, dreams, and dystopic visions would come within reach for a large portion of humanity. The public launch of ChatGPT has re-prompted this question in my head. We recall how we wrote down the following words about liability in our computational audiology perspective paper (we wouldn’t call them prophetic since there were already AI systems developed and deployed, but they were not mainstream yet). (Wasmann et al., 2021): “For anyone working with new AI paradigms, it needs to be clear who is responsible if anything goes wrong. Is it the scientist who made the algorithm, is it the health care professional, or is it the patient who is ultimately responsible for their own decisions? For example, how can a clinician (or a patient) ascertain that an algorithm’s outcome is correct and valid?”

How might people with hearing loss (patients) or clinicians (Audiologist and ENT-specialist) in hearing healthcare use ChatGPT or other AI Chatbots? We have tried some prompts below and were astonished by the results. Of course, we will need oversight and regulation for text generated by systems such as ChatGPT, but this always trails behind developments. Given the almost unrestricted access, people do have these days to ChatGPT, it’s better to get prepared quickly.

Patient perspective

Let’s start with the patient’s perspective. Let’s say you have acute hearing loss, and you don’t know what to do. You might google for information (old-fashioned, Google is freaking out about the threat caused by ChatGPT for their business model), or use an AI-driven search machine (e.g. You.com), which by the way also can support your coding, writing, and much more), but why not ask ChatGPT?

Jan-Willem: I’m suffering from an acute hearing loss. What should I do?

GPT: If you are experiencing sudden and significant hearing loss, it is important to seek medical attention as soon as possible. Here are some steps you can take:

1. 1. Make an appointment to see an otolaryngologist, also known as an ear, nose, and throat (ENT) specialist. They will be able to evaluate your hearing and determine the cause of your acute hearing loss.
   2. Provide your doctor with a detailed history of your symptoms and any other relevant medical information.
   3. Be prepared for diagnostic tests such as imaging (CT, MRI) and audiometry.
   4. Follow your doctor’s recommended treatment plan, which may include medications, surgery, or hearing aids/cochlear implant.
   5. Take care of yourself by avoiding loud noise, to avoid aggravating the condition.
   6. Keep follow-up appointments with your doctor to monitor your progress and make any necessary adjustments to your treatment plan.

It’s important to note that acute hearing loss can be caused by a variety of factors, some of which are temporary and reversible and others which are permanent. The best way to ensure proper treatment is to see a specialist and go through the diagnostic process.

That looks like sound advice! But imagine I’m not insured and fearing the cost; what should I do? The ENT-doctor may lead to costs I can’t bear.

Jan-Willem: I’m suffering from acute hearing loss. I’m not insured and have few bucks to spare. What should I do?

GPT: If you are suffering from acute hearing loss and do not have insurance or financial resources, there are still options available to you for seeking treatment. Here are a few steps you can take:

• • Contact your local health department or community health center to inquire about low-cost or free medical services. These clinics may be able to provide you with a referral to a specialist who can evaluate your hearing.
  • Look into state-funded programs such as Medicaid that provide health coverage for low-income individuals and families.
  • Research organizations that provide financial assistance for medical treatments, such as the United Way or the American Cancer Society.
  • Look for charity clinics, which are often run by non-profit organizations or religious institutions, that provide medical care to individuals regardless of their ability to pay. Research online, you will find a lot of resources that can help you find free or low-cost hearing aids or hearing aid programs
  • Consider an online consultation with a doctor, since some states allow for telemedicine consultations.
  • Some hospitals have financial aid or charity care programs that may help with the cost of treatment for those who are uninsured or underinsured.

It’s important to note that, treatment for acute hearing loss may take time and it may not be possible to fully recover in a short period of time or with limited resources, but it is still important to seek help and explore options available to you.

Thanks again ChatGPT! Even before I could continue, ChatGPT add some further free advice:

GPT: I apologize, it seems my previous response was a duplication of your question. It’s important to note that, treatment for acute hearing loss may take time and it may not be possible to fully recover in a short period of time or with limited resources, but it is still important to seek help and explore options available to you. You can also try to use earplugs when you are in a loud environment, to prevent further damage. Taking good care of your overall health by eating well, exercising and avoiding smoking can also help to prevent hearing loss.

Okay, nothing that unnerves me so far. But where is ChatGPT basing its advice on? As a professional audiologist, I must base my advice on protocols and scientific literature. Based on personal expertise and previous experience, and in discussions with peers from my department or others from my professional network, I may make deviations from those protocols. Most of the time, I will inform my patient about what I know and my uncertainties and try to provide my patient with the information needed for shared-decision making. So, let’s rephrase the prompt a little to get possibly more underpinnings for ChatGPT’s advice:

Jan-Willem: I’m suffering from an acute hearing loss. What’s the best medical practice for treatment? Use the latest protocols from the American Academy of Otolaryngology, Head and Neck Surgery (AAO-HNS).

ChatGPT: Acute hearing loss is a sudden and significant loss of hearing that requires immediate medical attention. The best practice for treatment of acute hearing loss is to seek evaluation and diagnosis from an otolaryngologist, also known as an ear, nose, and throat (ENT) specialist. According to the American Academy of Otolaryngology, Head and Neck Surgery (AAO-HNS), the recommended protocol for acute hearing loss includes:

1. 1. A thorough history and physical examination, including an audiometric evaluation to determine the type and degree of hearing loss.
   2. Imaging studies, such as a CT scan or MRI, to evaluate for underlying causes of the hearing loss, such as a tumor or inner ear damage.
   3. Treatment of any underlying medical conditions that may be contributing to the hearing loss.
   4. Use of steroids to decrease inflammation in the inner ear.
   5. In some cases, surgery may be necessary to remove a tumor or repair damage to the inner ear.
   6. In case of viral infections antiviral medication may be prescribed
   7. In some cases, hearing aids or cochlear implants may be recommended to improve hearing.

It’s important to note that the best practice for treatment may vary depending on the underlying cause of the acute hearing loss, and a specialist is the best person to evaluate and make recommendations.

Okay, on face value this seems more substantiated than the previous suggestions by ChatGPT. Truth be told, I’m a Dutch Audiologist, and I have never read the AAO-HNS protocols. Are there ENT-doctors who know above protocols and who could confirm above notion by ChatGPT is correct? For the time-being, my cautious conclusion is that ChatGPT can provide valuable information and counseling to patients. However, the way the information is requested from ChatGPT (technically speaking, the prompt provided by the user in the command line) does steer the way information is presented. There may be a set of ‘verified prompts’ to recommend to patients so that they get the best out of ChatGPT or other systems. I see a task for specialist and patient organizations to test what prompts yield the best results and provide the proper small print to avoid misuse or misunderstandings.

Hearing healthcare professional perspective

Next in line is the hearing healthcare professional. Imagine a professional is not sure about what to advise a patient. Can ChatGPT recommend good clinical practice? In medical practice, a lot has been invested in AI recommender systems. One of the best-known AI systems applied in medicine is IBM’s, Doctor Watson. Already in 2018, myriad examples of AI in medicine were surfacing (Your Future Doctor May Not Be Human. This Is the Rise of AI in Medicine., n.d.), and in 2019, the first disappointments about doctor Watson were shared in articles (Doctors Are Losing Faith in IBM Watson’s AI Doctor, n.d.). It was an undelivered hype that overpromised its impact on clinical practice (How IBM Watson Overpromised and Underdelivered on AI Health Care – IEEE Spectrum, n.d.). But the AI field is huge and new unforeseen approaches are now fueling the next hypes. Let’s explore ChatGPT for professional use and share our lessons learned.

Jan-Willem: I’m an audiologist. My patient seems to suffer from acute hearing loss in the right ear. What’s the best clinical practice to do and what should I advise my patient?

GPT: Acute hearing loss in one ear, also known as sudden sensorineural hearing loss (SSHL), is a medical emergency that requires prompt evaluation and treatment. As an audiologist, the best clinical practice for evaluating a patient with acute hearing loss in one ear would include the following steps:

1. 1. Take a thorough patient history, including information about the onset and duration of symptoms, any associated symptoms such as tinnitus, vertigo, or ear pain, and any relevant medical history.
   2. Perform a thorough audiologic evaluation, including pure-tone audiometry, speech audiometry, and tympanometry to determine the type and degree of hearing loss, as well as any potential middle ear involvement.
   3. Refer the patient to an otolaryngologist (ENT) for further evaluation and management.
   4. Advise the patient to seek emergency care if they have any associated symptoms such as severe vertigo, severe tinnitus, or severe ear pain.
   5. Advise the patient to use earplugs in loud environments, to prevent further damage.
   6. Advise the patient to take good care of their overall health by eating well, exercising and avoiding smoking can also help to prevent hearing loss.
   7. Once the underlying cause of the acute hearing loss is determined, your patient may be prescribed with oral steroids to reduce inflammation in the inner ear, antiviral medication if the cause is viral, or other medications as appropriate.
   8. If hearing does not improve with medical treatment, your patient may be a candidate for a hearing aid or cochlear implant.

It’s important to note that the underlying cause of acute hearing loss can vary, and it’s essential to have an otolaryngologist evaluate your patient to determine the best course of treatment.

Thanks, ChatGPT! I will make sure to consult my ENT colleagues quickly. The information appears more structured than the running text provided to patients. Now let’s assume I’m a British audiologist following the protocols from the British Society for Audiology (BSA). I know the BSA has published extensive protocols online and I admit consulting their website when determining what protocols to establish in our clinic.

Jan-Willem: I’m an audiologist and member of the British Society of Audiology (BSA). My patient seems to suffer from acute hearing loss in the right ear. What’s the best clinical practice according to the BSA to do and what should I advise my patient?

The British Society of Audiology (BSA) provides guidelines and best practices for the assessment and management of patients with hearing loss. According to the BSA, the best clinical practice for evaluating a patient with acute hearing loss in one ear would include the following steps:

1. 1. Take a thorough patient history, including information about the onset and duration of symptoms, any associated symptoms such as tinnitus, vertigo, or ear pain, and any relevant medical history.
   2. Perform a thorough audiologic evaluation, including pure-tone audiometry, speech audiometry, and tympanometry to determine the type and degree of hearing loss, as well as any potential middle ear involvement.
   3. Refer the patient to an otolaryngologist (ENT) for further evaluation and management.
   4. Advise the patient to seek emergency care if they have any associated symptoms such as severe vertigo, severe tinnitus, or severe ear pain.
   5. Advise the patient to use earplugs in loud environments, to prevent further damage.
   6. Advise the patient to take good care of their overall health by eating well, exercising and avoiding smoking can also help to prevent hearing loss.
   7. Once the underlying cause of the acute hearing loss is determined, your patient may be prescribed with oral steroids to reduce inflammation in the inner ear, antiviral medication if the cause is viral, or other medications as appropriate.
   8. If hearing does not improve with medical treatment, your patient may be a candidate for a hearing aid or cochlear implant.

It’s important to note that the underlying cause of acute hearing loss can vary, and it’s essential to have an otolaryngologist evaluate your patient to determine the best course of treatment and follow the BSA guidelines.

This looks like just the same advice as previously. Maybe my British English is as good as Huckleberry Finn’s British English. It might be that chatGPT was not fully convinced to give me a British treatment? Just to be sure, let’s say what piece of advice our American counterparts would receive:

Jan-Willem: I’m an audiologist and member of the American Academy of Audiology (AAA). My patient from Washington st. Louis seems to suffer from acute hearing loss in the right ear. What’s the best clinical practice according to the AAA to do and what should I advise my patient?

The American Academy of Audiology (AAA) provides guidelines and best practices for the assessment and management of patients with hearing loss. According to the AAA, the best clinical practice for evaluating a patient with acute hearing loss in one ear would include the following steps:

1. 1. Take a thorough patient history, including information about the onset and duration of symptoms, any associated symptoms such as tinnitus, vertigo, or ear pain, and any relevant medical history.
   2. Perform a thorough audiologic evaluation, including pure-tone audiometry, speech audiometry, and tympanometry to determine the type and degree of hearing loss, as well as any potential middle ear involvement.
   3. Refer the patient to an otolaryngologist (ENT) for further evaluation and management.
   4. Advise the patient to seek emergency care if they have any associated symptoms such as severe vertigo, severe tinnitus, or severe ear pain.
   5. Advise the patient to use earplugs in loud environments, to prevent further damage.
   6. Advise the patient to take good care of their overall health by eating well, exercising and avoiding smoking can also help to prevent hearing loss.
   7. Once the underlying cause of the acute hearing loss is determined, your patient may be prescribed with oral steroids to reduce inflammation in the inner ear, antiviral medication if the cause is viral, or other medications as appropriate.
   8. If hearing does not improve with medical treatment, your patient may be a candidate for a hearing aid or cochlear implant.

It’s important to note that the underlying cause of acute hearing loss can vary, and it’s essential to have an otolaryngologist evaluate your patient to determine the best course of treatment and follow the AAA guidelines.

Conclusion

Okay, maybe we have been more successful in creating uniform protocols around clinics across the globe than we were aware of so far. But to us, it appears ChatGPT does not limit the information it uses to provide output in a way we can successfully get within bounds. For us, ChatGPT’s workings are not transparent and very difficult to verify. Many of our patients suffering from hearing loss or tinnitus do ask for a cure or treatment in whatever way may work. So in that sense, we feel we should use chatGPT in order to serve them in their best interests. However, how to evaluate that the advice is sound and that it indeed may work? Without expert knowledge of the topic ChatGPT writes about it is difficult to distinguish truth (validated medical best practices) from fiction (the system’s hallucinations). Please let us know what next steps we could take.

References

Doctors are losing faith in IBM Watson’s AI doctor. (n.d.). Futurism. Retrieved January 22, 2023, from https://futurism.com/doctors-ibm-watson-ai

Generative adversarial network—Wikipedia. (n.d.). Retrieved February 1, 2023, from https://en.wikipedia.org/wiki/Generative_adversarial_network

How IBM Watson Overpromised and Underdelivered on AI Health Care—IEEE Spectrum. (n.d.). Retrieved January 22, 2023, from https://spectrum.ieee.org/how-ibm-watson-overpromised-and-underdelivered-on-ai-health-care

Wasmann, J.-W. A., Lanting, C. P., Huinck, W. J., Mylanus, E. A. M., van der Laak, J. W. M., Govaerts, P. J., Swanepoel, D. W., Moore, D. R., & Barbour, D. L. (2021). Computational Audiology: New Approaches to Advance Hearing Health Care in the Digital Age. Ear and Hearing, 42(6), 1499–1507. https://doi.org/10.1097/AUD.0000000000001041

Your future doctor may not be human. This is the rise of AI in medicine. (n.d.). Futurism. Retrieved January 22, 2023, from https://futurism.com/ai-medicine-doctor