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Feasibility of Low-Cost Smartphone Endoscopy for Laryngeal Imaging
Roxanne Malan1, Maria du Toit1, Rita Patel2
1Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.
Background:
Access to laryngeal endoscopy remains limited in many low-resource settings, constraining timely voice assessment and diagnosis.
Aim:
To evaluate the feasibility of affordable, commercially available smartphone-compatible endoscopes for laryngeal imaging in under-resourced settings.
Method:
This feasibility study evaluated low-cost, commercially available smartphone-compatible endoscopes for laryngeal imaging. Eight scopes were screened based on technical specifications (including focal range and resolution), followed by staged preclinical and mannequin testing assessing usability, image quality, and safety. Two scopes progressed to initial human testing in three participants. The highest-performing device, combined with a custom 3D-printed sleeve, was then used to record 35 laryngeal videos in adult participants. Three otolaryngologists independently rated recordings for visualization of laryngeal structures. Inter- and intra-rater reliability of video ratings were also determined. Feasibility was predefined as passable usability (System Usability Scale ≥ 52), successful visualization of laryngeal structures, and substantial inter-rater agreement.
Results:
Predefined feasibility criteria relating to usability, laryngeal visualization, and inter-rater agreement were met. Overall visualization of laryngeal structures was high (91.6%). Arytenoids, aryepiglottic folds, vocal fold movement, and supraglottic compression demonstrated consistently high (94.3%-100%) with perfect consensus agreement (100%). Lower visualization of true vocal folds and vocal fold edges was found (82.9% each), with wider confidence intervals noted, indicating greater variability. Inter-rater agreement was almost perfect for most structures (Gwet AC1: 0.87-1.00) and substantial for true vocal folds, false vocal folds, and vocal fold edges (AC1: 0.71-0.72). Intra-rater reliability was also high (85%-100%).
Conclusion:
An affordable smartphone-compatible endoscope demonstrated feasibility for laryngeal imaging, supporting its potential role as an adjunct tool for expanding access to voice assessment in under-resourced settings.
