Tyto Insights for Eardrum Bulging Detection
DEN250014Tyto Care , Ltd. · granted 2026-03-17 · product code SHL · Ear Nose & Throat
Premarket evidence — what FDA accepted
source quote (p.1)
“Tyto Insights for Eardrum Bulging Detection is an over-the-counter web-based AI-enabled software analytics device intended to automatically detect the bulging of the eardrum in Otoscopic video recordings acquired by the compatible electronic otoscope, as identified in the product labeling, in patients aged 6 months and older.”
source quote (p.4)
“The ALS sub-system is composed of the artificial intelligence-enabled bulging detection algorithm, eardrum quality filter and logic wrapper and interface. The artificial intelligence-enabled Eardrum Quality Filter Algorithm outputs a classification of: Positive: Eardrum with sufficient quality to determine ear drum position was detected in video Negative: Eardrum with sufficient quality to determine ear drum position was not detected in video”
source quote (p.13)
“Re-training of the machine learning model with additional data to increase the sensitivity or specificity compared to the most recently validated and released device while the same type and range of input signal is used.”
source quote (p.14)
“This PCCP was reviewed and authorized by FDA.”
source quote (p.8)
“Regarding the cybersecurity, the documentation included all the information recommended by the FDA Guidance "Cybersecurity in Medical Devices: Quality Management System Considerations and Content of Premarket Submissions.” This includes a Risk Management Report, Threat Model, Risk Assessment, Software Bill of Materials (SBOM), Assessment of Unresolved Anomalies for cybersecurity impact, Metrics, Controls, Architecture Views, Testing, and Management Plan.”
Validation studies (2)
Retrospective clinical
n=857 patients
endpoints: Sensitivity; Specificity; Positive Predictive Value (PPV); Negative Predictive Value (NPV)
Reader study (MRMC)
n=857 cases
endpoints: Sensitivity; Specificity
Reported performance (4 observations)
source quote (p.9)
“The device demonstrated a sensitivity of 0.9231 (95% CI: 0.8902-0.9443)”
source quote (p.9)
“and a specificity of 0.9463 (95% CI: 0.9227-0.9656)”
source quote (p.9)
“corresponding to a PPV of 0.6009 (95% CI: 0.5097-0.7025)”
source quote (p.9)
“and a NPV of 0.9929 (95% CI: 0.9900-0.9948).”
Each value carries its own analysis unit and task — never compare or pool across devices. Source: De Novo decision summary PDF.
Predicate network
Postmarket — what happened after clearance
Not yet tracked — the weekly postmarket refresh hasn't snapshotted this device.
Reimbursement — how devices like this got paid
Not yet tracked — no payment pathway indexed for this clearance (the reimbursement corpus is a growing seed set).
Applicable FDA guidance — what the submission is measured against
FDA guidance documents and guiding principles applicable to De Novo AI/ML devices in the Ear Nose & Throat panel. A curated reference index, not legal or regulatory advice — each item states its own status, and a draft is never binding.
- Final guidance2021-10De Novo Classification Process (Evaluation of Automatic Class III Designation)
De Novo pathway
Final (Oct 2021), issued with the De Novo final rule. Most relevant to first-of-a-kind devices without a predicate (DEN-numbered clearances).
- Final guidance2026-01Clinical Decision Support Software
Clinical decision support · SaMD (general)
New final guidance issued Jan 2026, superseding the Sept 2022 version; narrows the device-CDS scope. Applies to software that informs clinical management.
- Final guidance2026-01General Wellness: Policy for Low Risk Devices
SaMD (general) · Clinical decision support
Revised final (Jan 2026); now addresses noninvasive products estimating physiologic parameters (SpO2, BP, glucose). Reshapes the device / non-device line for AI wellness features.
- Final guidance2025-09Computer Software Assurance for Production and Quality Management System Software
SaMD (general) · Postmarket
Final (Sept 2025). Covers software used in production/QMS (incl. ML development-pipeline tooling), superseding Section 6 of the 2002 GPSV — not device software functions themselves.
- Final guidance2025-06Cybersecurity in Medical Devices: Quality Management System Considerations and Content of Premarket Submissions
Cybersecurity · Software premarket content
Reissued June 2025 (retitled 'Quality Management System', was Sept 2023 'Quality System'); adds coverage of FD&C Act §524B cyber devices.
- Final guidance2024-12Marketing Submission Recommendations for a Predetermined Change Control Plan for Artificial Intelligence-Enabled Device Software Functions
Predetermined Change Control Plan · AI/ML lifecycle · Software premarket content
Final (Dec 2024). Supersedes the April 2023 AI/ML PCCP draft.
- Final guidance2023-10Electronic Submission Template for Medical Device 510(k) Submissions
Software premarket content
eSTAR has been mandatory for 510(k)s since Oct 2023 — operationally unavoidable, though not AI-specific.
- Final guidance2023-08Off-The-Shelf Software Use in Medical Devices
Software premarket content · SaMD (general)
Final (Aug 2023). Applies when a device incorporates off-the-shelf software components (common in ML stacks).
- Final guidance2023-06Content of Premarket Submissions for Device Software Functions
Software premarket content · SaMD (general)
Final (June 2023); replaced the May 2005 'Software Contained in Medical Devices' guidance. Documentation level drives the software content of the submission.
- Final guidance2022-09Policy for Device Software Functions and Mobile Medical Applications
SaMD (general) · Clinical decision support
Current version Sept 2022. Frames which software functions FDA regulates as devices.
- Final guidance2016-12Postmarket Management of Cybersecurity in Medical Devices
Cybersecurity · Postmarket
- Final guidance2002-01General Principles of Software Validation
SaMD (general) · Software premarket content
Still active except Section 6 (superseded Sept 2025 by the Computer Software Assurance final guidance).
- Draft guidance2025-01Artificial Intelligence-Enabled Device Software Functions: Lifecycle Management and Marketing Submission Recommendations
AI/ML lifecycle · Software premarket content · Transparency
Draft as of July 2026 (published Jan 2025); finalization is on CDRH's FY2026 agenda but not yet published. Treat as FDA's stated direction, not a binding expectation.
- Draft guidance2024-08Predetermined Change Control Plans for Medical Devices
Predetermined Change Control Plan · Postmarket
Draft (Aug 2024) extending PCCPs beyond AI to all devices under FD&C §515C; not final as of July 2026.
- Guiding principles2024-06Transparency for Machine Learning-Enabled Medical Devices: Guiding Principles
Transparency · AI/ML lifecycle
- Guiding principles2023-10Predetermined Change Control Plans for Machine Learning-Enabled Medical Devices: Guiding Principles
Predetermined Change Control Plan · AI/ML lifecycle
FDA/Health Canada/MHRA joint principles (Oct 2023); companion to the GMLP and Transparency principles.
- Guiding principles2021-10Good Machine Learning Practice for Medical Device Development: Guiding Principles
AI/ML lifecycle · SaMD (general)
FDA/Health Canada/MHRA joint principles (Oct 2021). Foundational, not a binding guidance; IMDRF issued a related GMLP document Jan 2025.
Applicability is derived from the device's FDA advisory panel and pathway — cross-cutting guidances apply to every AI/ML device; panel-specific ones are flagged. Titles, dates, and links verified against fda.gov as of July 2026.