Objective: Access to otolaryngology is limited by lengthy wait lists and lack of specialists, especially in rural and remote areas. The objective of this study was to use an automated machine learning approach to build a computer vision algorithm for otoscopic diagnosis capable of greater accuracy than trained physicians. This algorithm could be used by primary care providers to facilitate timely referral, triage, and effective treatment.

Methods: Otoscopic images were obtained from Google Images (Google Inc., Mountain View, CA), from open access repositories, and within otolaryngology clinics associated with our institution. After preprocessing, 1,366 unique images were uploaded to the Google Cloud Vision AutoML platform (Google Inc.) and annotated with one or more of 14 otologic diagnoses. A consensus set of labels for each otoscopic image was attained, and a multilabel classifier architecture algorithm was trained. The performance of the algorithm on an 89-image test set was compared to the performance of physicians from pediatrics, emergency medicine, otolaryngology, and family medicine.

Results: For all diagnoses combined, the average precision (positive predictive value) of the algorithm was 90.9%, and the average recall (sensitivity) was 86.1%. The algorithm made 79 correct diagnoses with an accuracy of 88.7%. The average physician accuracy was 58.9%.

Conclusion: We have created a computer vision algorithm using automated machine learning that on average rivals the accuracy of the physicians we tested. Fourteen different otologic diagnoses were analyzed. The field of medicine will be changed dramatically by artificial intelligence within the next few decades, and physicians of all specialties must be prepared to guide that process.

Level of evidence: NA Laryngoscope, 130:1408-1413, 2020.