Current Utilizations and Limitations of Augmented Reality in Otolaryngology-Head and Neck Surgery: A Scoping Review

OBJECTIVE: Interactive technologies are evolving along with their applications in medicine. Under this umbrella lie both augmented reality (AR), the process of visually overlaying digital information on top of the physical world, and mixed reality (MR), which builds upon AR with the inclusion of interactions between the digital display and the physical world. Previous reviews of AR and MR in OHNS have been limited in their scope and do not address underlying technological shortcomings. METHODS: A scoping review of relevant literature was conducted using PRISMA methodology. Electronic databases were screened using keywords including "augmented reality," "mixed reality," "ENT, "OHNS," and "otolaryngology." Editorials, reviews, meta-analyses, unpublished, and -only articles were all excluded. Studies were individually assessed for quality using technological usability heuristics. RESULTS: A total of 107 studies were reviewed with 46 studies meeting our inclusion criteria. Of the included studies, there were 4 (8.7%) studies on preoperative surgical planning, 37 (80.4%) on intraoperative surgical guidance, and 5 (10.9%) on surgical education. The majority of studies on AR or MR in OHNS were in subspecialty Otology/Neurotology with 19 studies, while 10 were in Rhinology, and 7 were in Head and Neck Surgery. The majority have been on intraoperative usage. However, almost all of these were preclinical studies (84.8%). Commonly cited challenges limiting the transition of intraoperative guidance from models to the OR include accuracy of registration and ease-of-use. CONCLUSION: Current studies in this field have focused on intraoperative guidance and were predominantly in the preclinical phase. The limitations in current AR/MR technology have prevented a greater level of evidence in studies and advancements in AR/MR implementation.