## 4 Discussion  
To the best of our knowledge, this is a first attempt at representing an otoscope video with a single composite image while preserving its diagnostic capability as much as possible. Three ENT experts evaluated the images in the scale of poor, moderate, and good and the results (see Table 2) show that, on average among experts and evaluation rounds, in 60.3% of the cases the diagnostic quality improved and in 15.3% of the cases this improvement was from poor to good and 18.0% from moderate to good. Only 3.0% of the cases deteriorated: 2.7% from good to moderate and only 0.3% from moderate to poor. There is a statistically significant difference in scoring between the base and proposed methods at \(p\) value of 0.0007. Exemplary composite images for the case of same scoring (score of 2) are shown in Figure 8. In Figure 8, each column illustrates the evaluations from different readers. As can be observed in Figure 8, it is likely that better scores for the proposed images will be obtained in a wider assessment scale (e.g., 1-5). \begin{table}
\begin{tabular}{c c c c} \hline \hline  & **Round** & **Method** & **Kendall’s Coefficient of Concordance** \\ \hline \multirow{4}{*}{Inter ENT Variability} & 1 & Base & 0.848 \\  & 1 & SelectStitch & 0.618 \\  & 2 & Base & 0.846 \\  & 2 & SelectStitch & 0.633 \\ \cline{2-4}  & ENT & & \\ \hline \multirow{4}{*}{Intra ENT Variability} & 1 & Base & 0.926 \\  & 1 & SelectStitch & 0.839 \\ \cline{1-1}  & 2 & Base & 0.912 \\ \cline{1-1}  & 2 & SelectStitch & 0.829 \\ \cline{1-1}  & 3 & Base & 0.862 \\ \cline{1-1}  & 3 & SelectStitch & 0.778 \\ \hline \hline \end{tabular}
\end{table} 
Table 4: Inter- and Intra-ENT Variability. \begin{table}
\begin{tabular}{c c c c c} \hline \hline  & \multicolumn{2}{c}{**Round-1**} & \multicolumn{2}{c}{**Round-2**} \\ \cline{2-5}
**Probability** & **Base** & **SelectStitch** & **Base** & **SelectStitch** \\ \hline \(p\) (score = 1) & 0.43 & 0.10 & 0.52 & 0.14 \\ \(p\) (score \(\leq\) 2) & 0.84 & 0.44 & 0.88 & 0.53 \\ \hline \end{tabular}
\end{table} 
Table 3: Probability on Scoring. The \(p\) (score = 1) shows the probability of scoring 1 and \(p\) (score \(\leq\) 2) shows the probability of scoring below 3. Exemplary composite images for the cases where the results deteriorated after SelectStitch are shown in Figure 9, in which the proposed images were consistently scored as poorer than the base images. The comment noted by the ENT-I for the first column was that the base image looks more natural and the proposed image has an unnatural lighting, making difficult to see the disease, which is retraction. The drawback for the composite image generated by the proposed framework (see the second column of Figure 9) was overexposing, but the base image received the score of 3 although it is also mentioned that it has partial view. For the third column, ENT-III noted that the SelectStitch image has glare. We also noticed a particular SelectStitch composite image (see fourth and fifth column in Figure 9) that was given a score of 2, respectively, by ENT-I and ENT-III in both rounds while the base score was 3. For the fourth column in Figure 9, the sample was having multiple abnormalities, i.e., Perforation, Prosthesis, and Tympanosclerosis; and the reader noted that proposed composite image has \"a little unnatural lighting.\" For the fifth column, the sample was originally labeled as Perforation, Cholesteatoma, and Tympanosclerosis; and the reader evaluated the proposed image as \"a little blurry.\" For these cases, we can conjecture that the calcification and scarring present in Tympanosclerosis made the generation of enhanced composite image with natural looking colors even more difficult. We also observed that there are six, three, and three cases which ENTs give less scores compared to the base composite images in Round-1 and four, zero, and two cases in Round-2. We noticed that  
Figure 8: Examples of the same evaluation score for both composite images.