Algorithm-Driven Tele-otoscope for Remote Care for Patients With Otitis Media.

OBJECTIVE: The COVID-19 pandemic has spurred a growing demand for telemedicine. Artificial intelligence and image processing systems with wireless transmission functionalities can facilitate remote care for otitis media (OM). Accordingly, this study developed and validated an algorithm-driven tele-otoscope system equipped with Wi-Fi transmission and a cloud-based automatic OM diagnostic algorithm. STUDY DESIGN: Prospective, cross-sectional, diagnostic study. SETTING: Tertiary Academic Medical Center. METHODS: We designed a tele-otoscope (Otiscan, SyncVision Technology Corp) equipped with digital imaging and processing modules, Wi-Fi transmission capabilities, and an automatic OM diagnostic algorithm. A total of 1137 otoscopic images, comprising 987 images of normal cases and 150 images of cases of acute OM and OM with effusion, were used as the dataset for image classification. Two convolutional neural network models, trained using our dataset, were used for raw image segmentation and OM classification. RESULTS: The tele-otoscope delivered images with a resolution of 1280 × 720 pixels. Our tele-otoscope effectively differentiated OM from normal images, achieving a classification accuracy rate of up to 94% (sensitivity, 80%; specificity, 96%). CONCLUSION: Our study demonstrated that the developed tele-otoscope has acceptable accuracy in diagnosing OM. This system can assist health care professionals in early detection and continuous remote monitoring, thus mitigating the consequences of OM.

Development of a mobile tele-education system to assist remote otolaryngology learning during COVID-19 pandemic.

Background: Developing clinical thinking competence (CTC) is crucial for physicians, but effective methods for cultivation and evaluation are a significant challenge. Classroom teaching and paper-and-pencil tests are insufficient, and clinical field learning is difficult to implement, especially during the COVID-19 pandemic. Simulation learning is a useful alternative, but existing methods, e.g., OSCE, 3D AR/VR, and SimMan, have limitations in terms of time, space, and cost. Objective: This study aims to present the design and development of an Otolaryngology Mobile Tele-education System (OMTS) to facilitate CTC learning, and to evaluate the system's usability with senior otolaryngology experts. Methods: The OMTS system utilizes the convenience of mobile learning and the touch function of mobile devices to assist users (medical students or post-graduate physicians) in learning CTC remotely. Clinical knowledge and system functions in the OMTS system are defined by senior experts based on required CTC learning cases. Through simulated clinical case scenarios, users can engage in interactive clinical inquiry, practice required physical and laboratory examinations, make treatment decisions based on simulated responses, and understand and correct learning problems through a diagnostic report for effective learning. Usability testing of the OMTS system was evaluated by three senior otolaryngology experts using measurements of content validity, system usability, and mental workload during their available time and location. Results: Statistical results of experts' evaluation showed that the OMTS system has good content validity, marginal-to-acceptable system usability, and moderate mental workload. Experts agreed that the system was efficient, professional, and usable for learning, although the practicality of the clinical inquiry and hands-on practice functions could be improved further. Conclusions: Based on the OMTS system, users can efficiently hands-on practice and learn clinical cases in otolaryngology, and understand and correct their problems according to the diagnostic report. Therefore, the OMTS system can be expected to facilitate CTC learning according to experts' evaluation.

National quality evaluation of peri-surgical hearing care for pediatric otitis media with effusion.

OBJECTIVE: Otitis media with effusion (OME) is a common disease among children that can lead to grave sequelae with respect to hearing. Thus, when treating OME, appropriate hearing care should be provided; ventilation tube insertion (VTI), a standard approach for treating OME, is no exception. This study examined hearing care for VTI and its associated factors, especially at the national level. DESIGN: Retrospective database analysis. SETTING: Taiwan's National Health Insurance Research Database. PARTICIPANTS: One thousand one hundred and fifty-nine patients who received VTI (age ≤12 years; 2011-12). INTERVENTION: No intervention. MAIN OUTCOME MEASURES: Compliance to guidelines: sufficient observation time (OBS), tympanogram before VTI (TYM-B) and hearing tests before and after VTI (HEAR-B and HEAR-A, respectively). RESULTS: The national proportions of completion for each procedure were 30.1% for OBS, 84.4% for TYM-B, 74.3% for HEAR-B and 36.0% for HEAR-A; those of OBS and HEAR-A were extremely low. Age, nasal allergy and even geographic area were associated with differences across completion patterns. Regression revealed some notable patterns. Compared with non-teaching hospitals, teaching hospitals administered HEAR-B most successfully (odds ratio [OR: 3.20, 95% CI: 1.06-9.63) and the smallest hospital group performed HEAR-B most successfully (OR: 2.92, 95% CI: 1.14-7.46). CONCLUSION: Several findings surfaced concerning VTI-related hearing care and its association with many clinical and socioeconomic factors in this national study. These findings could serve as a map for improving hearing care quality among children with OME.

Three-dimensional, virtual reality vestibular rehabilitation for chronic imbalance problem caused by Ménière's disease: a pilot study.

PURPOSES: The purpose of this study was to evaluate a three-dimensional, virtual reality system for vestibular rehabilitation in patients with intractable Ménière's disease and chronic vestibular dysfunction. METHODS: We included 70 patients (36 for study, 34 as control) with a chronic imbalance problem caused by uncompensated Ménière's disease. The virtual reality vestibular rehabilitation comprised four training tasks (modified Cawthorne-Cooksey exercises: eye, head, extension, and coordination exercises) performed in six training sessions (in 4 weeks). Measurements of the task scores and balance parameters obtained at the baseline and after final training sessions were compared. RESULTS: A significant improvement was observed in extension and coordination scores. Patients in the early stages of Ménière's disease had a significantly greater improvement in the center of gravity sway and trajectory excursion in the mediolateral direction than did patients in the late stages of Ménière's disease. Mild functional disability attributable to Ménière's disease was a predictor of improvement in the statokinesigram and maximum trajectory excursion in the anteroposterior direction after rehabilitation. The control group showed no significant improvement in almost all parameters. CONCLUSION: Virtual reality vestibular rehabilitation may be useful in patients with Ménière's disease, particular those in the early stages or having mild functional disability. Implication for rehabilitation Chronic imbalance caused by uncompensated Ménière's disease is an indication for vestibular rehabilitation. The interactive virtual reality video game, when integrated into vestibular rehabilitation exercise protocol, may assist patients who have mild disability Ménière's disease and who cannot benefit from treatment with drugs or surgery. The initial data from this study support the applicability of three-dimensional virtual reality technology in vestibular rehabilitation programs. The technology gives professionals a new tool to guide patients for vestibular rehabilitation exercises through three-dimensional virtual reality video game playing. The virtual reality vestibular exercise game can provide patients a step-wise, interactive, dynamic, three-dimensional, and interesting rehabilitation environment.

Endoscope-assisted KTP laser sinus clear-out procedure for recurrent ethmoid polyposis.

BACKGROUND DATA AND OBJECTIVE: Surgery for recurrent sinusitis with diffuse polyposis is challenging since tortuous sinus anatomy and bleeding tendency can make revision surgery particularly difficult. We report the efficacy in using KTP laser under the assistance of endoscope to perform sinus clear-out procedure for patients with recurrent ethmoid polyposis. MATERIALS AND METHODS: Thirteen patients with recurrent ethmoid polyposis underwent this procedure between November 1996 and July 2000. All were available for follow-up. Patients all had a KTP sinus clear-out procedure (15-20 W continuous mode, spot size 0.4-0.8 mm, contact or near-contact approaches) assisted by endoscope. Sinus endoscopic findings, CAT scan data, operation records and perioperative courses were retrospectively reviewed. The mean follow-up period was 24.7 +/- 11 months. RESULTS: Surgeries all went smoothly with minimal bleeding incurred. All patients demonstrated significant improvement in their sinonasal symptoms. Two cases (15.4%) had localized recurrent polyps. CONCLUSION: With its excellent capabilities in hemostasis, great intra-nasal maneuverability, and flexible operation modes, KTP laser is an ideal alternative to manage recurrent ethmoid polyposis for selected cases.