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Augmented Reality of the Middle Ear Combining Otoendoscopy and Temporal Bone Computed Tomography

Marroquin, Roberto*; Lalande, Alain*; Hussain, Raabid*; Guigou, Caroline; Grayeli, Alexis Bozorg*,†

doi: 10.1097/MAO.0000000000001922

Hypothesis: Augmented reality (AR) may enhance otologic procedures by providing sub-millimetric accuracy and allowing the unification of information in a single screen.

Background: Several issues related to otologic procedures can be addressed through an AR system by providing sub-millimetric precision, supplying a global view of the middle ear cleft, and advantageously unifying the information in a single screen. The AR system is obtained by combining otoendoscopy with temporal bone computer tomography (CT).

Methods: Four human temporal bone specimens were explored by high-resolution CT-scan and dynamic otoendoscopy with video recordings. The initialization of the system consisted of a semi-automatic registration between the otoendoscopic video and the 3D CT-scan reconstruction of the middle ear. Endoscope movements were estimated by several computer vision techniques (feature detectors/descriptors and optical flow) and used to warp the CT-scan to keep the correspondence with the otoendoscopic video.

Results: The system maintained synchronization between the CT-scan image and the otoendoscopic video in all experiments during slow and rapid (5–10 mm/s) endoscope movements. Among tested algorithms, two feature-based methods, scale-invariant feature transform (SIFT); and speeded up robust features (SURF), provided sub-millimeter mean tracking errors (0.38 ± 0.53 mm and 0.20 ± 0.16 mm, respectively) and an adequate image refresh rate (11 and 17 frames per second, respectively) after 2 minutes of procedure with continuous endoscope movements.

Conclusion: A precise augmented reality combining video and 3D CT-scan data can be applied to otoendoscopy without the use of conventional neuronavigation tracking thanks to computer vision algorithms.

*Le2i Laboratory, University of Burgundy-Franche Comté

Otolaryngology-Head and Neck Surgery Department, University Hospital of Dijon, Dijon, France

Address correspondence and reprint requests to Roberto Marroquin, M.Sc., Laboratoire Le2i, Université de Bourgogne Franche-Comté, UFR Sciences et Techniques, allée Alain Savary, 21000 Dijon, France; E-mail:

The financial support is from the Oticon Medical, Société ORL de Bourgogne, CNRS, and Collin Medical SA.

The authors disclose no conflicts of interest.

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Copyright © 2018 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company