Background: Atelectasis and attic retraction pocket are two common tympanic membranes changes. However, general practitioners, pediatricians and otolaryngologists showed low diagnostic accuracy for these ear diseases. Therefore, there is a need to develop a deep learning model to detect atelectasis and attic retraction pocket automatically. Method: 6393 OME otoscopic images from 3 centers were used to develop and validate a deep learning model to detect atelectasis and attic retraction pocket. 3-fold random cross validation was adopted to divided dataset into training set and validation set. A team of otologists were assigned to diagnose and label. Receiver operating characteristic (ROC) curve, 3-fold average classification accuracy, sensitivity and specificity were used to assess the performance of deep learning model. Class Activation Mapping (CAM) was applied to show the discriminative region in the otoscopic images. Result: Among all the otoscopic images, 3564 (55.74%) images were identified with attic retraction pocket, and 2460 (38.48%) images were identified with atelectasis. The automatically diagnostic model of attic retraction pocket and atelectasis achieved 3-fold cross validation accuracy of 89% and 79%, AUC of 0.89 and 0.87, sensitivity of 0.93 and 0.71, and specificity of 0.62 and 0.84 respectively. Bigger and deeper atelectasis and attic retraction pocket showed more weight with red color in the heat map of CAM. Conclusion: Deep learning algorithm could be used to identify atelectasis and attic retraction pocket, which could be used as a tool to assist general practitioners, pediatricians and otolaryngologists. Key words: deep learning, otoscopic images, atelectasis, attic retraction pocket
