Discussion
atelectasis, OME
ATELECTASIS, RETRACTION POCKET
In this study, we developed and validated a DL model to get an accurate diagnosis of OME by identifying the presence of attic retraction pocket and atelectasis with multiple centers of OME otoscopic images. The DL model could be used to determine further classification of OME by attic retraction pocket and atelectasis. This CNN algorithm obtained an AUC of 0.89 for the identification of attic retraction pocket and 0.87 for atelectasis in OME otoscopic images. The CAM of the DL model showed a consistent discriminative region of tympanic membranes to otolaryngologists.Attic retraction pocket and atelectasis are the most commonly observed tympanic changes in OME, which currently lacks an auxiliary diagnostic tool. Different types of otoscopes (e.g., smartphone-based imaging otoscopes [When the attic retraction pocket or atelectasis occurs in OME cases, patients should be immediately referred to otolaryngologists for further evaluation. Moreover, for young otolaryngologists and those not specialized in otolaryngology, this model could be used as a study tool to increase their knowledge of attic retraction pocket and atelectasis.Previous studies have established DL models for the diagnosis of tympanic retraction and achieved an average level of accuracy ranging from 85.78 to 88.06% [Our results showed that DL models could identify different regions (pars tensa and pars flaccida) of retraction on the tympanic membrane with varying degrees of performance. Based on clinical experience, it is reasonable to suggest that attic retraction pocket is easier to identify than atelectasis because the normal tympanic membrane shows a mild retraction in the pars tensa without a retraction in the pars flaccida. Thus, in cases of mild retraction, atelectasis may be subtle and difficult to determine, whether it is normal or at stage I atelectasis. Our image dataset was representative and collected from three hospitals with different types of otoscopes, photo conditions, and record systems.Considering our experience [