Digital Otoscopes and Smartphones Can Facilitate Telehealth Head and Neck Exams

By Lisa Rapaport

January 29, 2021

(Reuters Health) - Smartphones and digital otoscopes may be a feasible way for patients to capture images needed for telehealth otolaryngology evaluations, a small study suggests.

Between July 1 and 15, 2020, researchers asked 23 patients who came to in-person visits to try using their smartphones and digital videoscopes to capture images of their oropharynx and ear canal. Participants received real-time guidance over a telehealth portal, and then image acceptability was reviewed by clinicians and by a blinded otolaryngologist reviewer.

Digital otoscope images were considered acceptable for ear exams by clinicians in 95% of cases and by the blinded reviewer in 91% of cases.

With oropharyngeal video exams, however, both clinicians and the blinded reviewer were less likely to consider digital endoscope acceptable (40% and 14%, respectively) than was the case for smartphones (63% and 55%, respectively), according to the results in JAMA Otolaryngology-Head & Neck Surgery.

"We found that patient-obtained physical examination images of the ears using a digital otoscope and of the oropharynx using a smartphone provided useful clinical images, as rated by otolaryngologists," said lead study author Dr. Yi Cai of the University of California, San Francisco.

"These strategies thus expand the breadth and quality of achievable remote physical examination during telehealth for patients at home," Dr. Cai said by email.

While the study was conducted in a clinic setting, where digital videoscopes were provided, researchers did ask participants whether they would be willing to pay for a $35 home-version of this device to use for future telehealth visits - and 91% of the patients were willing to make this purchase. In addition, 70% of patients said the digital otoscope was easy to use.

Overall, 87% of the patients reported satisfaction with the experience of using a digital otoscope, and 65% said they would prefer to do telehealth visits instead of reporting to a clinic in person if they could achieve the same visit objectives remotely.

One limitation of this feasibility study is that smartphone ownership was part of the inclusion criteria, and it's possible results from this patient population may not be representative of all patients who might benefit from telehealth visits.

Because the study was conducted in person at a clinic, researchers were also unable to assess how internet speed or bandwidth might impact the quality of the digital photos and videos.

However, as the COVID-19 pandemic limits access to in-person care, the results do suggest it may be possible to offer care for some patients remotely with good quality images, Dr. Cai said.

"Technology that can facilitate difficult exams in telehealth visits is constantly evolving, becoming higher-quality and less expensive," said Dr. Nicholas Dewyer, an assistant professor at the University of Arizona College of Medicine and director of Otology, Neurotology, and Skull Base Surgery at Banner University Medical Center in Tucson.

"While this technology isn't yet as available, cheap, and easy to use as needed to make ENT telehealth visits ready for primetime, it may be sometime in the near future, and that would be a good thing for expanding access to care," Dr. Dewyer, who wasn't involved in the study, said by email.

SOURCE: JAMA Otolaryngology-Head & Neck Surgery, online January 21, 2021.