More and more, otolaryngologists are using newer technologies, software, and devices to elevate their surgical or clinical practices, streamline their administrative tasks and business responsibilities, and improve their research and education. Here’s a look at some emerging technologies that are taking the ENT field by storm.
Ambient AI Documentation
Also known as ambient scribes, this technology captures clinician–patient conversations during exams and generates a structured draft note that is posted into an electronic health record (EHR). Ambient scribes can also draft after-visit summaries and patient-facing instructions as well as generate referral letters; increasingly, they may integrate with order workflows and support diagnosis-aware clinical notes.
Ambient AI documentation works by having a clinician open an application on a mobile device (typically an iPhone running Epic Haiku, a mobile application for smartphones), obtain patient consent, and start an encounter. The audio is streamed to cloud infrastructure, where speech recognition and large language models trained on clinical language produce a structured draft mapped to relevant EHR note fields.
“The system differentiates speakers, handles medical terminology reasonably well, and allows users to pick note styles and templates,” said Anaïs Rameau, MDCM, MSc, MPhil, MS, director of new technologies and chief of dysphagia, and associate professor of otolaryngology–head and neck surgery at Weill Cornell Medicine in New York, an urban, academic tertiary center with more than 800 beds. Current examples of ambient scribes include Abridge, Suki, Microsoft Dragon Copilot, and Nabla.
A draft appears in a clinician’s Epic inbox within minutes. Nothing is filed into the chart until a clinician reviews, edits, and signs off on it.
“For a specialty like ours, where so much of an encounter is either highly technical (e.g., a description of endoscopic findings, a review of radiology imaging, or audiogram interpretation) or deeply narrative (e.g., symptom history in dysphonia, globus, chronic cough, or swallowing concerns), the combination is unusually well suited to ambient capture,” Dr. Rameau said.
Ambient AI documentation addresses one of the most significant pain points in ENT practices, documentation burden, said Martin J. Citardi, MD, vice dean of clinical technology and chair of otorhinolaryngology–head and neck surgery at the McGovern Medical School, part of The University of Texas Health Science Center at Houston.
From a clinician’s perspective, key benefits include reduced time spent on charting, improved eye contact and patient engagement, more complete, clinically accurate notes, lower cognitive load during complex visits, and improved clinician satisfaction and reduced burnout, Dr. Citardi said.
Clinic flow improves because documentation no longer competes with patient care, and notes are often more comprehensive and of higher quality—supporting coding accuracy and compliance, he said. In academic settings, ambient AI documentation benefits faculty who balance clinical care with teaching, research, and leadership responsibilities.
ENT practices benefit by having improved documentation completeness supporting appropriate coding, reduced dependence on human scribes, faster note finalization, improved clinician retention and recruitment, and better alignment with value‑based care and quality reporting initiatives.
Patients feel better heard and understood during visits because physicians can be more present, Dr. Citardi said.
In addition, ambient AI documentation contributes to clinical decision support, Dr. Rameau said. Abridge, a generative AI healthcare platform, has a multi-year content partnership with digital journal NEJM Group and peer-reviewed medical journal JAMA Network, which will expand the evidence base feeding its clinical decision support system. Microsoft Dragon Copilot, an AI-powered clinical assistant designed for healthcare professionals, will now include UpToDate, a clinical decision support resource associated with improved patient outcomes.
Some challenges exist, however. In otolaryngology, ambient AI documentation needs more scrutiny because patients are disproportionately likely to have communication disorders, such as dysphonia, hearing loss, or articulation issues in the setting of head and neck cancer, which can limit how well ambient AI documentation works with their datasets, Dr. Rameau said.
Otolaryngologists need to ensure that there aren’t more errors in the EHR for this patient group. Dr. Rameau and colleagues found that speech-to-text algorithms work 10 times worse in patients who are deaf or hard of hearing (Laryngoscope. doi.org/10.1002/lary.31713). “This could hurt them down the line—especially as AI will be increasingly integrated into EHRs and may make erroneous predictions based on mistakes in clinical notes,” she said.
With the rise of ambient AI documentation, Dr. Rameau said that there’s a unique opportunity to help improve speech-to-text recognition of non-standard speech in patients with communication disorders and to analyze patients’ voices for voice biomarkers of disease. Audio data is the ground truth for AI-generated transcripts, which often contain hallucinations and errors impacting the AI summary.
This is particularly the case for patients with communication disorders, non-native English speakers, and individuals from underrepresented groups. Further, voice, speech, and paralinguistic features may contain important biomarkers for disease detection, prediction, and monitoring, Dr. Rameau said. Ambient AI documentation has the potential to scale access to audio data for these two purposes.
Virtual Surgical Planning
Virtual surgical planning (VSP) for complex craniofacial reconstruction, available from several companies, including KLS Martin and Stryker CMF, is primarily used in complex mandibular or maxillary reconstruction after tumor resection in combination with bony free flap reconstruction. It’s increasingly being used in challenging facial trauma cases, said Andrés M. Bur, MD, professor of head and neck surgical oncology and vice chair for research in the department of otolaryngology–head and neck surgery at the University of Kansas School of Medicine in Kansas City, Mo., an academic hospital with 900 beds.
VSP starts by acquiring a high-resolution CT scan (typically 1 mm cuts) of the facial bones. Software then converts the CT scan into a 3D digital model of a patient’s anatomy, Dr. Bur explained. Surgeons can then participate in a virtual planning session with engineers to define the planned tumor resection, plan flap shape and positioning, and optimize the reconstruction’s geometry.
An engineering team designs patient-specific cutting guides and plates, which are often 3D printed. These guides allow surgeons to select an optimal reconstructive strategy in advance and precisely reconstruct complex bone defects much faster.
Benefits include greater precision compared to freehand reconstructive surgery and reduced operative time and ischemia time for free flaps.
“Improved reconstructive accuracy leads to better facial symmetry and function, and shorter surgery times reduce the risks of general anesthesia,” Dr. Bur said.
Data show that advanced planning of tumor resections may improve margin clearance rates (Front Oncol. doi:10.3389/fonc.2022.960545). Studies found that VSP is cost-saving or cost-neutral compared to traditional reconstructive surgery (Head Neck. doi:10.1002/hed.28035).
The Role of Extended Reality (XR) in Surgery
By using XR in surgery, surgeons can view real-time clinical data, including patient-specific imaging such as CT or MRI, allowing them to see complex anatomy behind surface structures that they couldn’t see otherwise, said Eric Gantwerker, MD, MMSc(MedEd), MAMSE, pediatric otolaryngologist and associate professor of otolaryngology at Northwell Health in Lake Success, New York, an urban academic health system on Long Island/Queens with more than 28 hospitals and sites. Overlays are used in real time using a virtual or augmented reality headset.
“If you have a tumor in a precarious location, XR technology allows you to see structures in three dimensions,” Dr. Gantwerker said. “You can zoom in and out, and you can get a better understanding of very complex anatomy. You can also get a clear sense of areas to avoid and therefore do more complete surgeries.”
“XR helps surgeons with surgical planning and gives them reassurance when performing surgeries,” Dr. Gantwerker continued. Today’s headsets provide a more ergonomic experience with heads-up displays, which help prevent neck strain.
Currently, ENTs are mostly using this technology for sinus surgeries and are starting to use it in otology and head and neck surgery.
Surgical Navigation Systems
Surgical navigation systems continue to improve, said Mark E. Gerber, MD, division chief of otolaryngology, head and neck surgery, at Phoenix Children’s in Phoenix, Ariz., a pediatric health system with more than 580 beds. Today’s navigation tools include 4K visualization and high-resolution camera systems. They feature high-definition endoscopic equipment for minimally invasive surgical procedures and image-guided navigation systems that offer real-time anatomical mapping.
Image navigation, which is not new, helps surgeons know where their tools are during surgery. In pediatrics, surgeons often operate on very small cavities; the new systems provide accuracy within 1 millimeter. “In our work, a few millimeters can matter a lot,” Dr. Gerber said.
Using this advanced technology for complex procedures can potentially improve efficiency, accuracy, and safety when operating in the sinuses and at the skull base, Dr. Gerber said.
Molecular Diagnostics Platforms
Afirma Genomic Sequencing Classifier and ThyroSeq Genomic Classifier are both molecular diagnostics platforms used for fine-needle aspiration (FNA) of the thyroid. These tests are used in patients with thyroid nodules that have indeterminate cytology after FNA, typically Bethesda III or IV nodules, Dr. Bur said.
These platforms better define the risk of malignancy than traditional cytology and can guide decisions to recommend surgery. They are particularly helpful when it’s a priority to avoid unnecessary thyroid surgery, such as in a medically complex patient at high risk for medical complications, Dr. Bur said.
These tests classify nodules as benign (low risk) versus suspicious/malignant (high risk) to risk-stratify a nodule for cancer. They can also provide clinical recommendations, such as to observe or operate.
These platforms work by assigning a pre-operative cancer risk score based on molecular signatures, Dr. Bur explained. First, an FNA biopsy is obtained from a thyroid nodule. A sample is sent for molecular diagnostics, at which point DNA/RNA is extracted from cells and analyzed. Techniques include next-generation sequencing, gene expression profiling, and mutation detection. Proprietary machine learning algorithms are then used to predict malignancy risk.
Major benefits include avoiding unnecessary surgeries for low-risk nodules, improving shared decision-making through better risk stratification, and supporting personalized care for thyroid tumors. The platforms also enable earlier treatment for patients with aggressive mutations (e.g., BRAF-mutated thyroid cancers), Dr. Bur said.
These tests have very high sensitivity (94% to 97%) and negative predictive value (up to 99%).
Tympanostomy Tube System
Single-pass devices such as the Hummingbird, Tula, and Solo Tympanostomy Tube Systems are now being used to implant ear tubes in children in an office setting without general anesthesia. “Tube placement is one of the most common procedures we perform in order to drain fluid, ventilate the middle ear, and reduce the risk for ongoing ear infections,” Dr. Gerber said.
One-pass devices allow physicians to safely penetrate the eardrum and place the tube in a single pass, making it easier for procedures to be done under local anesthesia in an office setting, Dr. Gerber continued.
These devices have enabled surgeons to provide ear tubes without the additional risk, time, and cost of general anesthesia, Dr. Gerber said.
Medical Knowledge Platforms
OpenEvidence is an AI-powered application that allows physicians to ask natural language questions and receive immediate answers grounded in peer-reviewed medical evidence from trusted sources such as the New England Journal of Medicine and JAMA network journals. It draws only from vetted medical literature and clinical guidelines that can translate evidence into actionable recommendations at the point of care.
“It’s a valuable tool to have in a clinic when a patient presents with something unusual or has a complicated case, because it can quickly provide options based on verified research and results,” Dr. Gerber said.
He believes these platforms can potentially impact patient outcomes because they provide a broader understanding of the clinical knowledge that exists on a particular condition or disease.
AI Billing and Coding Software
AI billing and coding software is being used to read patient charts, suggest billing codes, pre-screen the need for preauthorization, and perform reviews, audits, and appeals, Dr. Gantwerker said. The intent is to capture and maximize billing processes for providers. EHRs such as Epic already implement this technology.
Just like any AI technology based on natural language processing, the software reads through patient information and makes conclusions based on data. It’s trained to look for certain phrases and keywords.
Although AI has clear benefits from a workflow perspective, potential negatives include incorrect suggestions, cost, hallucinations, and data privacy concerns, Dr. Gantwerker said. Real concerns about job threats among medical billers and coders also exist. Insurance companies are using AI to review claims, putting up more barriers to proper reimbursement.
Generative AI for Clinical and Educational Research
For anyone who plans to give a talk or conduct research, generative AI can improve their workflow. It can take large amounts of written information and create summaries and outlines or even perform statistical analysis and provide feedback on review papers and grants, Dr. Gantwerker said.
“I use the technology to find out how I can strengthen a grant application or if my logic falters in a paper,” Dr. Gantwerker said. It can create presentation materials such as slides, videos, charts, voiceovers, and tables. “It’s great at creating problem/case-based learning materials and virtual patients, as well as learning objectives and board-style questions.”
Dr. Gantwerker uses NotebookLM, a free Google application, as a study tool. For a recent exam, instead of reading 50 papers, he uploaded them to NotebookLM. The software created a study guide, multiple-choice questions, a podcast, and a chatbot interface with direct references. “I could listen to the content while driving,” he said. “This made it 10 times easier to study because I didn’t have to cull through 50 papers; it pulled out the essential elements.”
AI-Enabled Chatbots
AI-enabled chatbots are used to automatically schedule patients, answer patients’ questions, screen for symptoms, provide cognitive behavioral therapy, talk through post-operative complications such as pain, and more.
“Almost every health system is investing in AI-enabled chatbots,” Dr. Gantwerker said. “They work 24/7. They don’t need to be paid or take breaks. As a result, patient access, experience, and satisfaction improve.”
A lot of health systems use AI chatbots to replace human workers. While this unfortunately costs jobs, it creates jobs in new areas.
Telehealth
Telehealth software for otolaryngology care, such as the Doximity dialer, can be used for initial consultations, post-operative follow-ups, chronic disease management, and triage management of urgent ENT complaints to determine whether an in-person visit is needed.
“Telehealth is particularly valuable in rural settings where patients may live far from an otolaryngologist or in underserved areas,” Dr. Bur said.
Telehealth allows for a secure video visit between a patient and an otolaryngologist, where images can be shown and test results reviewed.
The technology works by having a provider’s office initiate a visit, sending a secure video link via text or email. The patient connects via smartphone, tablet, or computer. This enables audio and video interaction for real-time virtual consultation.
Benefits include reducing travel and financial burdens for patients, as well as facilitating continuity of care by reducing geographic barriers, Dr. Bur said.
Further, telehealth can support earlier diagnosis and treatment and improve follow-up adherence as patients may be more likely to attend virtual visits.
Studies show positive patient satisfaction and acceptance in rural telehealth programs (J Med Internet Res. doi.org/10.2196/29575).
As these technologies become more integrated into otolaryngology, the challenge will be not simply adopting what’s new, but identifying which tools truly improve care, efficiency, and decision-making in everyday practice. For ENT physicians, the greatest value will come from using innovation thoughtfully—balancing excitement about what’s possible with careful attention to accuracy, equity, cost, and the patient experience.
Karen Appold is an award-winning journalist based in Lehigh Valley, Pa.
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