{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:50:54Z","timestamp":1785768654433,"version":"3.56.0"},"reference-count":34,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,11,20]],"date-time":"2023-11-20T00:00:00Z","timestamp":1700438400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Korea Medical Device Development Fund","award":["KMDF-PR-20200901-0147"],"award-info":[{"award-number":["KMDF-PR-20200901-0147"]}]},{"name":"Korea Medical Device Development Fund","award":["GRRC-Gachon2023(B01)"],"award-info":[{"award-number":["GRRC-Gachon2023(B01)"]}]},{"name":"GRRC program of Gyeonggi province","award":["KMDF-PR-20200901-0147"],"award-info":[{"award-number":["KMDF-PR-20200901-0147"]}]},{"name":"GRRC program of Gyeonggi province","award":["GRRC-Gachon2023(B01)"],"award-info":[{"award-number":["GRRC-Gachon2023(B01)"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Otitis media with effusion (OME), primarily seen in children aged 2 years and younger, is characterized by the presence of fluid in the middle ear, often resulting in hearing loss and aural fullness. While deep learning networks have been explored to aid OME diagnosis, prior work did not often specify if pediatric images were used for training, causing uncertainties about their clinical relevance, especially due to important distinctions between the tympanic membranes of small children and adults. We trained cross-validated ResNet50, DenseNet201, InceptionV3, and InceptionResNetV2 models on 1150 pediatric tympanic membrane images from otoendoscopes to classify OME. When assessed using a separate dataset of 100 pediatric tympanic membrane images, the models achieved mean accuracies of 92.9% (ResNet50), 97.2% (DenseNet201), 96.0% (InceptionV3), and 94.8% (InceptionResNetV2), compared to the seven otolaryngologists that achieved accuracies between 84.0% and 69.0%. The results showed that even the worst-performing model trained on fold 3 of InceptionResNetV2 with an accuracy of 88.0% exceeded the accuracy of the highest-performing otolaryngologist at 84.0%. Our findings suggest that these specifically trained deep learning models can potentially enhance the clinical diagnosis of OME using pediatric otoendoscopic tympanic membrane images.<\/jats:p>","DOI":"10.3390\/bioengineering10111337","type":"journal-article","created":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T01:48:45Z","timestamp":1700531325000},"page":"1337","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Improving the Accuracy of Otitis Media with Effusion Diagnosis in Pediatric Patients Using Deep Learning"],"prefix":"10.3390","volume":"10","author":[{"given":"Jae-Hyuk","family":"Shim","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0259-8654","authenticated-orcid":false,"given":"Woongsang","family":"Sunwoo","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung Yoon","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9714-6038","authenticated-orcid":false,"given":"Kwang Gi","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Jae","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1542\/peds.94.5.766","article-title":"Managing otitis media with effusion in young children","volume":"94","author":"Goertz","year":"1994","journal-title":"Pediatrics"},{"key":"ref_2","first-page":"S1","article-title":"Clinical practice guideline: Otitis media with effusion (update)","volume":"154","author":"Rosenfeld","year":"2016","journal-title":"Otolaryngol. Head Neck Surgery"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.joto.2019.01.005","article-title":"Otitis media with effusion in children: Pathophysiology, diagnosis, and treatment. A review","volume":"14","author":"Vanneste","year":"2019","journal-title":"J. Otol."},{"key":"ref_4","first-page":"459","article-title":"Epidemiology and natural history of secretory otitis","volume":"5","author":"Tos","year":"1984","journal-title":"Otol. Neurotol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1093\/clinids\/19.5.823","article-title":"Otitis media","volume":"19","author":"Klein","year":"1994","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1046\/j.1365-2273.2000.00350.x","article-title":"The aetiology of otitis media with effusion: A review","volume":"25","author":"Kubba","year":"2000","journal-title":"Clin. Otolaryngol. Allied Sci."},{"key":"ref_7","first-page":"Doc11","article-title":"Diseases of the middle ear in childhood","volume":"13","author":"Minovi","year":"2014","journal-title":"GMS Curr. Top. Otorhinolaryngol. Head Neck Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1001\/archotol.1984.00800310005002","article-title":"Spontaneous course of secretory otitis and changes of the eardrum","volume":"110","author":"Tos","year":"1984","journal-title":"Arch. Otolaryngol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/0165-5876(94)90060-4","article-title":"Tympanic membrane atrophy, scarring, atelectasis and attic retraction in persistent, untreated otitis media with effusion and following ventilation tube insertion","volume":"30","author":"Maw","year":"1994","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/S0140-6736(89)91317-2","article-title":"Screening for otitis media with effusion in preschool children","volume":"333","author":"Zielhuis","year":"1989","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1542\/peds.112.3.510","article-title":"How helpful is pneumatic otoscopy in improving diagnostic accuracy?","volume":"112","author":"Jones","year":"2003","journal-title":"Pediatrics"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.jsurg.2015.07.011","article-title":"Objective evaluation of otoscopy skills among family and community medicine, pediatric, and otolaryngology residents","volume":"73","author":"Oyewumi","year":"2016","journal-title":"J. Surg. Educ."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1367\/A03-017R1.1","article-title":"Assessment of pediatric residents\u2019 otoscopic interpretive skills by videotaped examinations","volume":"4","author":"Jones","year":"2004","journal-title":"Ambul. Pediatr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1177\/1357633X17708531","article-title":"Digital otoscopy versus microscopy: How correct and confident are ear experts in their diagnoses?","volume":"24","author":"Moberly","year":"2018","journal-title":"J. Telemed. Telecare"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.otorri.2022.07.002","article-title":"Value of simple otoscopy in diagnosing otitis media with effusion in children","volume":"74","author":"Azevedo","year":"2022","journal-title":"Acta Otorrinolaringol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1002\/lary.30291","article-title":"Machine Learning in Diagnosing Middle Ear Disorders Using Tympanic Membrane Images: A Meta-Analysis","volume":"133","author":"Cao","year":"2022","journal-title":"Laryngoscope"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.ebiom.2019.06.050","article-title":"Automated diagnosis of ear disease using ensemble deep learning with a big otoendoscopy image database","volume":"45","author":"Cha","year":"2019","journal-title":"EBioMedicine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1017\/S0022215120000717","article-title":"Artificial intelligence to detect tympanic membrane perforations","volume":"134","author":"Habib","year":"2020","journal-title":"J. Laryngol. Otol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Byun, H., Yu, S., Oh, J., Bae, J., Yoon, M.S., Lee, S.H., Chung, J.H., and Kim, T.H. (2021). An assistive role of a machine learning network in diagnosis of middle ear diseases. J. Clin. Med., 10.","DOI":"10.3390\/jcm10153198"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e041139","DOI":"10.1136\/bmjopen-2020-041139","article-title":"Investigating the use of a two-stage attention-aware convolutional neural network for the automated diagnosis of otitis media from tympanic membrane images: A prediction model development and validation study","volume":"11","author":"Cai","year":"2021","journal-title":"BMJ Open"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e2020034546","DOI":"10.1542\/peds.2020-034546","article-title":"Machine learning for accurate intraoperative pediatric middle ear effusion diagnosis","volume":"147","author":"Crowson","year":"2021","journal-title":"Pediatrics"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1097\/MAO.0b013e3182544e55","article-title":"A novel method to determine standardized anatomic dimensions of the osseous external auditory canal","volume":"33","author":"Mahboubi","year":"2012","journal-title":"Otol. Neurotol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1177\/0194599813509589","article-title":"Endoscopic anatomy of the pediatric middle ear","volume":"150","author":"Isaacson","year":"2014","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1177\/000348949710600106","article-title":"Postnatal change in angle between the tympanic annulus and surrounding structures. Computer-aided three-dimensional reconstruction study","volume":"106","author":"Ikui","year":"1997","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"835","DOI":"10.3346\/jkms.2012.27.8.835","article-title":"Korean clinical practice guidelines: Otitis media in children","volume":"27","author":"Lee","year":"2012","journal-title":"J. Korean Med. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"He, K., Zhang, X., Ren, S., and Sun, J. (2016, January 27\u201330). Deep residual learning for image recognition. Proceedings of the IEEE Conference on Computer Vision and Pattern Recognition 2016, Las Vegas, NV, USA.","DOI":"10.1109\/CVPR.2016.90"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Huang, G., Liu, Z., Van Der Maaten, L., and Weinberger, K.Q. (2017, January 21\u201326). Densely connected convolutional networks. Proceedings of the IEEE Conference on Computer Vision and Pattern Recognition 2017, Honolulu, HI, USA.","DOI":"10.1109\/CVPR.2017.243"},{"key":"ref_28","unstructured":"Xia, X., Xu, C., and Nan, B. (2017, January 2\u20134). Inception-v3 for flower classification. Proceedings of the 2017 2nd International Conference on Image, Vision and Computing (ICIVC), Chengdu, China."},{"key":"ref_29","unstructured":"Baldassarre, F., Mor\u00edn, D.G., and Rod\u00e9s-Guirao, L. (2007). Deep koalarization: Image colorization using cnns and inception-resnet-v2. arXiv."},{"key":"ref_30","unstructured":"O\u2019Shea, K., and Nash, R. (2015). An introduction to convolutional neural networks. arXiv."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Tan, H.H., and Lim, K.H. (2019, January 28\u201330). Vanishing gradient mitigation with deep learning neural network optimization. Proceedings of the 2019 7th International Conference on Smart Computing & Communications (ICSCC), Miri, Malaysia.","DOI":"10.1109\/ICSCC.2019.8843652"},{"key":"ref_32","first-page":"1097","article-title":"Imagenet classification with deep convolutional neural networks","volume":"25","author":"Krizhevsky","year":"2012","journal-title":"Adv. Neural Inf. Process. Syst."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Selvaraju, R.R., Cogswell, M., Das, A., Vedantam, R., Parikh, D., and Batra, D. (2017, January 22\u201329). Grad-cam: Visual explanations from deep networks via gradient-based localization. Proceedings of the IEEE International Conference on Computer Vision 2017, Venice, Italy.","DOI":"10.1109\/ICCV.2017.74"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.ijporl.2004.10.013","article-title":"Comparison of performance by otolaryngologists, pediatricians, and general practioners on an otoendoscopic diagnostic video examination","volume":"69","author":"Pichichero","year":"2005","journal-title":"Int. J. Pediatr. Otorhinolaryngol."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/10\/11\/1337\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:25:30Z","timestamp":1760131530000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/10\/11\/1337"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,20]]},"references-count":34,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["bioengineering10111337"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering10111337","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,20]]}}}