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Validation of tele-otology to diagnose ear disease in children
Robert H Eikelboom1, Mathew N Mbao, Harvey L Coates
1Lions Ear and Hearing Institute, Grd Flr E-Block, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia. robeik@cyllene.uwa.edu.au
Insights
Digitised eardrum images combined with clinical data enable ear specialists to accurately diagnose middle ear conditions remotely. This tele-otology approach supports confident diagnosis and management advice for primary care providers.
Area of Science:
- Otolaryngology
- Digital Health
- Medical Imaging
Background:
- Remote communities often face challenges accessing specialist ear care.
- Timely diagnosis and management of middle ear diseases are crucial for children's hearing health.
- Telemedicine offers a potential solution to bridge geographical barriers in healthcare.
Purpose of the Study:
- To evaluate the efficacy of a tele-otology system for diagnosing middle ear conditions.
- To determine if digitised eardrum images, clinical history, audiometry, and tympanometry data are sufficient for specialist assessment.
- To assess the diagnostic accuracy and management recommendations provided via tele-otology.
Main Methods:
- 66 children from remote areas underwent standard otoscopy, audiology, and tympanometry.
- Digitised images of eardrums were captured.
- An ear specialist reviewed images and clinical data remotely to provide diagnoses and management plans.
Main Results:
- Significant correlations were found between image quality and patient age.
- High agreement rates were observed for key otological findings like otorrhea and tympanic membrane perforations.
- Tele-otology assessments showed statistically significant agreement with in-field diagnoses and recommendations, with higher referral rates.
Conclusions:
- A well-implemented tele-otology system, integrating high-quality images and comprehensive data, allows for confident diagnosis of middle ear disease.
- This system provides sufficient information for ear specialists to offer effective management advice to primary care providers.
- Tele-otology can improve access to specialist ear care for patients in remote locations.
Objective:
To determine if digitised still eardrum images, with a clinical history, and audiometry and tympanometry data provide sufficient information to an ear specialist to make an assessment of a patient.
Methods:
66 children (9 months to 16 years) from remote communities were assessed by an ear specialist by standard otoscopy, using a clinical history, audiometry and tympanometry. Up to five images of each ear were digitised. At a later date, the ear specialist made observations, diagnoses and recommendations for management from the images and clinical data.
Results:
There was a significant correlation (p<0.01) between image quality and age of the subject. There were significant agreements for the clinically important observations of otorrhea, perforation, retracted tympanic membrane and atrophy of the tympanic membrane (p<0.05). There were significant agreements for the diagnoses of acute otitis media, chronic suppurative otitis media, otitis media with effusion and Eustachian tube dysfunction. The rate of recommendations for review or referral after a tele-otology assessment were between 4 and 16% higher than those in made in the field. The agreements between the various forms of advice or recommendations made in the field to those made by tele-otology were statistically significant (p<0.01).
Conclusions:
A tele-otology system that incorporates good quality digitised images of the tympanic membrane, audiological and tympanometric data, and a comprehensive clinical history provides the ear specialist with sufficient information to make a confident diagnose of existing middle ear disease, and provide management advice to the patients' primary care provider.
