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The CellScope Oto® is a smartphone otoscope attachment allowing physicians to share diagnostic-quality images of the ears. Our primary objective was to evaluate the residents' accuracy in diagnosing acute otitis media in children using the CellScope Oto® attachment compared to traditional otoscope. A randomized crossover controlled trial was performed at a single, tertiary care, pediatric emergency department. Participants were a convenience sample of preschool children, consulting for fever and respiratory symptoms. All children were evaluated by two residents randomized to use the CellScope Oto® smartphone device or a traditional otoscope. The primary outcome was the diagnostic accuracy of residents in ear evaluation compared to pediatric otolaryngologist's using binocular microscopy. Secondary outcomes included the need for a second ear exam by the treating physician and parental preference. Between August 2015 and June 2016, 90 residents examined 100 patients. Six patients were excluded, leaving 94 children evaluated twice. Diagnostic accuracies were 0.69 (95% CI: 0.52 to 0.75) for the residents using a traditional otoscope and 0.74 (95% CI: 0.68 to 0.80) for those using the CellScope Oto® for an absolute difference of 0.06 (95% CI: −0.03 to 0.15). The emergency physicians reported no need for a control exam in 49/91 (54%) situations. Finally, 44 (47%) families preferred the CellScope Oto®, 26 (28%) the traditional otoscope and 23 (25%) had no preference. Residents using the CellScope Oto® had accuracies as good as those using the traditional otoscope to evaluate the ears of young children at risk of acute otitis media. www.clinicaltrials.gov: Identifier NCT02521597.

Background Despite a high prevalence of chronic otitis media and related complications, many African dispensaries and clinics lack microscopes or fiberoptic equipment for examining external ear ducts and tympanic membranes. Method An alternative, inexpensive, and readily available device designed for ear wax removal is presented as a clinical ear and anterior nasal cavity examination tool. The device connects to Wi-Fi or cellular networks, providing high-definition images of the ear and anterior nasal cavity through a smartphone interface. Its use, utility, strengths, and limitations are discussed. Conclusion This paper describes a novel, cost-effective, and user-friendly device for examining the external ear, tympanic membrane, and anterior nasal cavity of patients throughout humanitarian missions.

Purpose To present the utility of a smartphone-enabled otoscope as a teaching adjunct in pre-clinical otoscopy training. Methods 60 pre-clinical medical students were randomized into either a control group using a conventional otoscope or an experimental group using a smartphone-enabled otoscope. Participants in each group were trained to use their assigned device and were given time to practice on a colleague’s ear. Participants then completed a questionnaire indicating their ability to visualize anatomical landmarks of the middle ear as well as their confidence in performing a middle ear examination using their device. Results Compared to participants using the conventional otoscope, significantly more students using the smartphone-enabled otoscope identified the umbo (93% versus 63%, P  = 0.005), the short process of the malleus (67% versus 33%, P  = 0.008), the cone of light (100% versus 70%, P  = 0.001), and the pars flaccida (60% versus 33%, P  = 0.03). Furthermore, participants who used the smartphone-enabled otoscope reported significantly increased confidence in performing otoscopy compared to those who used a conventional otoscope (4.1 ± 0.7 versus 2.8 ± 0.9, P  < 0.001). Finally, participants rated the smartphone-enabled otoscope as an excellent teaching aid for otoscopy training. Conclusion The smartphone-enabled otoscope serves as a valuable teaching tool for pre-clinical otoscopy education. After using the device, pre-clinical students were more confident in performing a middle ear examination and in identifying important anatomical landmarks of the middle ear.

Earwax (cerumen), a normal bodily secretion, can become a problem when it obstructs the ear canal. Earwax removal is a difficult task for specialists because of the ear's unique location and the ear canal's intricate structure. Using ear scoops or cotton swabs to dig out ear wax in daily life is like “a blind man walking on a cliff.” Improper operation may damage the ear canal or the eardrum. Thus, we need a pair of visible “eyes,” otoscopes, to help us see earwax intuitively. As opposed to traditional otoscopes, which only serve as a visual aid, the endoscopic ear pick allows us to not only view the ear canal but also remove wax or other obstructions from the ear. In this review, we discussed endoscope ear pick pros and cons and discussed their future role.

Otitis media (OM), a middle-ear infection, is the most common childhood illness treated by pediatricians. If inadequately treated, OM can result in long-term chronic problems persisting into adulthood. Children with chronic OM or recurrent OM often have conductive hearing loss and communication difficulties and require surgical treatment. Tympanostomy tube insertion, the placement of a small drainage tube in the tympanic membrane (TM), is the most common surgical procedure performed in children under general anesthesia. Recent clinical studies have shown evidence of a direct correspondence between chronic OM and the presence of a bacterial biofilm within the middle ear. Biofilms are typically very thin and cannot be recognized using a regular otoscope. Here we report the use of optical coherent ranging techniques to noninvasively assess the middle ear to detect and quantify biofilm microstructure. This study involves adults with chronic OM, which is generally accepted as a biofilm-related disease. Based on more than 18,537 optical ranging scans and 742 images from 13 clinically infected patients and 7 normal controls using clinical findings as the gold standard, all middle ears with chronic OM showed evidence of biofilms, and all normal ears did not. Information on the presence of a biofilm, along with its structure and response to antibiotic treatment, will not only provide a better fundamental understanding of biofilm formation, growth, and eradication in the middle ear, but also may provide much-needed quantifiable data to enable early detection and quantitative longitudinal treatment monitoring of middle-ear biofilms responsible for chronic OM.

Purpose Competent otoscopy is a key otolaryngology skill for a broad range of medical careers, yet undergraduate’s confidence to perform otoscopy is reported as low. Smartphone otoscopes have been suggested to improve undergraduates learning of normal eardrum anatomy because unlike the traditional otoscope, the learner and educator share the same image. This study aimed to evaluate whether a smartphone otoscope could enhance medical undergraduates recognition of common ear pathology. Methods 52 medical students were randomised into a standard group that used a traditional otoscope and an intervention group that used a smartphone otoscope. Both groups received a short didactic presentation on the recognition of common ear pathologies and were asked to diagnose four simulated pathologies. Both groups received feedback and guidance on how to better visualise the tympanic membrane. Force response items and 5-point Likert scales loaded on an electronic platform recorded their diagnosis and their perceptions towards the otoscope. Results The smartphone-group ( n  = 20) had higher overall rates of correct diagnosis compared to control ( n  = 22) (84% vs. 39%, p  = < 0.001). Only the grommet station did not show a significant improvement between the two groups (100% vs. 91%, p  = 0.49). 90% ( n  = 20) of participants felt the smartphone otoscope was preferential for their learning. The same number expressed that they want to use it in future learning. The remainder were indifferent. Conclusions The smartphone otoscope enabled learners to better observe and recognise middle ear pathology. This popular learning tool has the potential to accelerate the learning curve of otoscopy and therefore improve the proficiency of future doctors at recognising middle ear diseases.

The ai/m of this study was to compare the self-reported confidence of novices in using a smartphone-enabled video otoscope, a microscope and loupes for ear examination and external ear canal procedures. Medical students (n = 29) undertook a pre-study questionnaire to ascertain their knowledge of techniques for otoscopy and aural microsuction. Participants underwent teaching on ear anatomy, examination and procedural techniques using a microscope, loupes and smartphone-enabled video otoscopes. Confidence and preference using each modality was rated using a Likert-like questionnaire. After teaching, all modalities demonstrated a significant increase in confidence in ear examination (p < 0.0001). Confidence in using the smartphone-enabled otoscope post-teaching was highest (p = 0.015). Overall, the smartphone-enabled video otoscope was the preferred method in all other parameters assessed including learning anatomy or pathology (51.72 per cent) and learning microsuction (65.51 per cent). Smartphone-enabled video otoscopes provide an alternative approach to ear examination and aural microsuction that can be undertaken outside of a traditional clinical setting and can be used by novices.

With the recent development of deep learning, the supervised learning method has been widely applied in otolaryngology. However, its application in real-world clinical settings is difficult because of the inapplicability outside the learning area of the model and difficulty in data collection due to privacy concerns. To solve these limitations, we studied anomaly detection, the task of identifying sample data that do not match the overall data distribution with the Variational Autoencoder (VAE), an unsupervised learning model. However, the VAE makes it difficult to learn complex data, such as tympanic membrane endoscopic images. Accordingly, we preprocess tympanic membrane images using Adaptive Histogram Equalization (AHE) and Canny edge detection for effective anomaly detection. We then had the VAE learn preprocessed data for only normal tympanic membranes and VAE was used to calculate an abnormality score for those differences between the distribution of the normal and abnormal tympanic membrane images. The abnormality score was applied to the K-nearest Neighbor (K-NN) algorithm to classify normal and abnormal tympanic membranes. As a result, we were obtained a total of 1232 normal and abnormal eardrum images, classified with an accuracy of 94.5% using an algorithm that applied only normal tympanic membrane images. Consequently, we propose that unsupervised-learning-based anomaly detection of the tympanic membrane can solve the limitations of existing supervised learning methods.

To study the clinical effect of lens cleaning paper patching on traumatic eardrum perforations. A total of 122 patients were divided into 2 groups, of which 56 patients were treated with lens cleaning paper patching and 66 acted as controls. The closure rate and healing time were compared between the two groups. The healing rate of small perforations was 96.4 per cent (27 out of 28) in the patching group and 90 per cent (27 out of 30) in the control group. The difference was not statistically significant (p > 0.05). The healing rate of large perforations was 89.3 per cent (25 out of 28) and 80.6 per cent (29 out of 36) in the two groups, respectively. The difference was statistically significant (p < 0.05). The healing time of large perforations was shorter in the patching group than in the control group (p < 0.01). Patching with lens cleaning paper under an endoscope can accelerate the closure of large traumatic eardrum perforations.