Habib AR, Kajbafzadeh M, Hasan Z, Wong E, Gunasekera H, Perry C, Sacks R, Kumar A, Singh N. Artificial intelligence to classify ear disease from otoscopy: A systematic review and meta-analysis.
Clin Otolaryngol 2022;
47:401-413. [PMID:
35253378 PMCID:
PMC9310803 DOI:
10.1111/coa.13925]
[Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/08/2022] [Accepted: 02/27/2022] [Indexed: 11/29/2022]
Abstract
Objectives
To summarise the accuracy of artificial intelligence (AI) computer vision algorithms to classify ear disease from otoscopy.
Design
Systematic review and meta‐analysis.
Methods
Using the PRISMA guidelines, nine online databases were searched for articles that used AI computer vision algorithms developed from various methods (convolutional neural networks, artificial neural networks, support vector machines, decision trees and k‐nearest neighbours) 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 multiclassification algorithm (3 or more diagnostic classes) achieved 97.6% (95%CI: 97.3–97.9%) accuracy to differentiate between normal, AOM and OME in three studies. 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 three 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.
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