Ear-Keeper: A Cross-Platform AI System for Rapid and Accurate Ear Disease Diagnosis

Early and accurate detection systems for ear diseases, powered by deep learning, are essential for preventing hearing impairment and improving population health. However, the limited diversity of existing otoendoscopy datasets and the poor balance between diagnostic accuracy, computational efficiency, and model size have hindered the translation of artificial intelligence (AI) algorithms into healthcare applications. In this study, we constructed a large-scale, multi-center otoendoscopy dataset covering eight common ear diseases and healthy cases. Building upon this resource, we developed Best-EarNet, an ultrafast and lightweight deep learning architecture integrating a novel Local-Global Spatial Feature Fusion Module with a multi-scale supervision strategy, enabling real-time and accurate classification of ear conditions. Leveraging transfer learning, Best-EarNet, with a model size of only 2.94 MB, achieved diagnostic accuracies of 95.23% on an internal test set (22,581 images) and 92.14% on an external test set (1,652 images), while requiring only 0.0125 seconds (80 frames per second) to process a single image on a standard CPU. Further subgroup analysis by gender and age showed consistently excellent performance of Best-EarNet across all demographic groups. To enhance clinical interpretability and user trust, we incorporated Grad-CAM-based visualization, highlighting the specific abnormal ear regions contributing to AI predictions. Most importantly, we developed Ear-Keeper, a cross-platform intelligent diagnosis system built upon Best-EarNet, deployable on smartphones, tablets, and personal computers. Ear-Keeper enables public users and healthcare providers to perform comprehensive real-time video-based ear canal screening, supporting early detection and timely intervention of ear diseases.