{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T19:35:36Z","timestamp":1785699336041,"version":"3.56.0"},"reference-count":22,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sinusitis is a prevalent disease for which nasal endoscopy (NE) is an optimal diagnostic modality. However, NE accuracy is limited by inter\u2010operator variability in landmark identification and localization of mucus that is necessary for sinusitis diagnosis. We sought to develop a novel multi\u2010class machine learning (ML) framework that detects anatomical landmarks and structures for sinusitis assessment as supported by clinical best practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 3513 NE images from 452 patients were manually annotated by four physicians for three classes: middle turbinate (MT), inferior turbinate (IT), and mucus. A YOLOv11\u2010nano model was trained for multi\u2010class detection and segmentation. We developed a rule\u2010based logic for middle meatus localization, implementing a clinical algorithm that applies anatomy Intersection over Union (IoU) and conditional logic for sinusitis diagnosis. The system was validated on 178 images from 50 patients with chronic rhinosinusitis without polyps (CRSsNP) with benchmarking of real\u2010time performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The multi\u2010class detection and segmentation model achieved &gt; 75% F1 score for detecting turbinates with mucus. The clinical algorithm achieved 75.0% sensitivity, 76.0% specificity, and 75.2% accuracy for sinusitis classification, with a F1 score of 81.8%, approaching the accuracy of a trained otolaryngologist. The framework achieved near real\u2010time performance at &gt; 20fps on GPU device, demonstrating suitability for integration into live clinical workflows.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This novel ML\u2010driven diagnostic framework with a rule\u2010based clinical algorithm enhances decision\u2010making for diagnosing sinusitis with NE. By reducing inter\u2010operator variability, achieving performance comparable to otolaryngologists, and enabling real\u2010time processing for non\u2010specialists, this work holds potential for standardizing care and improving patient outcomes. Future research will focus on expanding to different sinusitis phenotypes and prospective real\u2010time implementation in clinical settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alr.70045","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T19:43:01Z","timestamp":1760557381000},"page":"152-161","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Machine Learning\u2010Enhanced Clinical Decision Support for Diagnosing Sinusitis With Nasal Endoscopy"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3734-6000","authenticated-orcid":false,"given":"Dipesh","family":"Gyawali","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology Ochsner Health  New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Mundy","sequence":"additional","affiliation":[{"name":"Ochsner Clinical School University of Queensland  New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majid","family":"Hosseini","sequence":"additional","affiliation":[{"name":"Informatics Research Institute University of Louisiana at Lafayette  Lafayette Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morteza","family":"Bodaghi","sequence":"additional","affiliation":[{"name":"Informatics Research Institute University of Louisiana at Lafayette  Lafayette Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akio","family":"Fujiwara","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Ochsner Health  New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sejal Shyam","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Ochsner Health  New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayla","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Ochsner Health  New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Bartolone","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Ochsner Health  New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhara","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Ochsner Health  New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Chu","sequence":"additional","affiliation":[{"name":"Informatics Research Institute University of Louisiana at Lafayette  Lafayette Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raju","family":"Gottumukkala","sequence":"additional","affiliation":[{"name":"Informatics Research Institute University of Louisiana at Lafayette  Lafayette Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Bidwell","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Ochsner Health  New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1812-2105","authenticated-orcid":false,"given":"Edward D.","family":"McCoul","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Ochsner Health  New Orleans Louisiana USA"},{"name":"Ochsner Clinical School University of Queensland  New Orleans Louisiana USA"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Tulane University School of Medicine  New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,15]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.4065\/74.9.877"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537\u2010199305000\u201000006"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405\u2010004\u20100830\u20100"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12070\u2010015\u20100907\u20107"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599813514510"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wjorl.2016.12.001"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.23394"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp\u2010journals\u201010013\u20101122"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21058"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21009"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22854"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.29894"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmra1814259"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.23458"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/1945892418762891"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/1945892419892157"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp16X686581"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.23384"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.5220\/0012424500003660"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405\u2010024\u201008809\u20104"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0297536"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.70004"}],"container-title":["International Forum of Allergy &amp; Rhinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/alr.70045","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/alr.70045","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/alr.70045","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T12:48:04Z","timestamp":1770036484000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/alr.70045"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,15]]},"references-count":22,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1002\/alr.70045"],"URL":"https:\/\/doi.org\/10.1002\/alr.70045","archive":["Portico"],"relation":{},"ISSN":["2042-6976","2042-6984"],"issn-type":[{"value":"2042-6976","type":"print"},{"value":"2042-6984","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,15]]},"assertion":[{"value":"2025-07-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}