Reimagining otitis media diagnosis: A fusion of nested U-Net segmentation with graph theory-inspired feature set

Otitis media (OM) is a common infection or inflammation of the middle ear causing conductive hearing loss that primarily affects children and may delay speech, language, and cognitive development. OM can manifest itself in different forms, and can be diagnosed using (video) otoscopy (visualizing the tympanic membrane) or (video) pneumatic otoscopy and tympanometry. Accurate diagnosis of OM is challenging due to subtle differences in otoscopic features. This research aims to develop an automated computer-aided design (CAD) system to assist clinicians in diagnosing OM using otoscopy images. The ground truths, generated manually and validated by otolaryngologists, are utilized to train the proposed nested U-Net++ model. Ten clinically relevant gray level co-occurrence matrix (GLCM) and morphological features were extracted from the segmented Region of Interest (ROI) and validated for OM classification based on a statistical significance test. These features serve as input for a Graph Neural Network (GNN) model, the base model in our research. An optimized GNN model is proposed after ablation study of the base model. Three datasets, one private dataset, and two public ones have been used, where the private dataset is utilized for both training and testing, and the public datasets are used to test the robustness of the proposed GNN model only. The proposed GNN model obtained the highest accuracy in diagnosing OM: 99.38 %, 93.51 %, and 91.38 % for the private dataset, public dataset1, and public dataset2, respectively. The proposed methodology and results of this research might enhance clinicians' effectiveness in diagnosing OM.