Applications of Augmented Reality in Otolaryngology: A Systematic Review

Objective Augmented reality (AR) is a rapidly developing technology. The aim of this systematic review was to (1) identify and evaluate applications of AR in otolaryngology and (2) examine trends in publication over time. Data Sources PubMed and EMBASE. Review Methods A systematic review was performed according to PRISMA guidelines without temporal limits. Studies were included if they reported otolaryngology-related applications of AR. Exclusion criteria included non-English articles, abstracts, letters/commentaries, and reviews. A linear regression model was used to compare publication trends over time. Results Twenty-three articles representing 18 AR platforms were included. Publications increased between 1997 and 2018 (P < .05). Twelve studies were level 5 evidence; 9 studies, level 4; 1 study, level 2; and 1 study, level 1. There was no trend toward increased level of evidence over time. The most common subspecialties represented were rhinology (52.2%), head and neck (30.4%), and neurotology (26%). The most common purpose of AR was intraoperative guidance (54.5%), followed by surgical planning (24.2%) and procedural simulations (9.1%). The most common source of visual inputs was endoscopes (50%), followed by eyewear (22.2%) and microscopes (4.5%). Computed tomography was the most common virtual input (83.3%). Optical trackers and fiducial markers were the most common forms of tracking and registration, respectively (38.9% and 44.4%). Mean registration error was 2.48 mm. Conclusion AR holds promise in simulation, surgical planning, and perioperative navigation. Although level of evidence remains modest, the role of AR in otolaryngology has grown rapidly and continues to expand.