We propose a novel automated algorithm for classifying diagnostic categories of otitis media: acute otitis media, otitis media with effusion, and no effusion. Acute otitis media represents a bacterial superinfection of the middle ear fluid, while otitis media with effusion represents a sterile effusion that tends to subside spontaneously. Diagnosing children with acute otitis media is difficult, often leading to overprescription of antibiotics as they are beneficial only for children with acute otitis media. This underscores the need for an accurate and automated diagnostic algorithm. To that end, we design a feature set understood by both otoscopists and engineers based on the actual visual cues used by otoscopists; we term this the otitis media vocabulary. We also design a process to combine the vocabulary terms based on the decision process used by otoscopists; we term this the otitis media grammar. The algorithm achieves 89.9% classification accuracy, outperforming both clinicians who did not receive special training and state-of-the-art classifiers. 1. Introduction Otitis media is a general term for middle-ear inflammation and may be classified clinically as either acute otitis media (AOM) or otitis media with effusion (OME); AOM represents a bacterial superinfection of the middle ear fluid and OME represents a sterile effusion that tends to subside spontaneously. Although middle ear effusion is present in both cases, this clinical classification is important because antibiotics are generally beneficial only for AOM [1, 2]. However, proper diagnosis of AOM as well as distinction from both OME and no effusion (NOE) requires considerable training (see Figure 1, e.g., images). Figure 1: Sample (cropped) images from the three diagnostic categories of otitis media. AOM is a frequent condition affecting the majority of the pediatric population for which antibiotics are prescribed. It is the most common childhood infection, representing one of the most frequent reasons for visits to the pediatrician. The number of otitis media episodes has increased substantially in the past two decades, with approximately 25 million visits to office-based physicians in the US and a total of 20 million prescriptions for antimicrobials related to otitis media yearly [3]. This results in significant social burden and indirect costs due to time lost from school and work, with an estimated annual medical expenditure of approximately 2$ billion [4]. The current standard of care in diagnosing AOM includes visual examination of the tympanic membrane with a range of available
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