Abstract:
OBJECTIVE: The study investigated whether video-otoscopic images
taken by a telehealth clinic facilitator are sufficient for accurate
asynchronous diagnosis by an otolaryngologist within a heterogeneous
population. SUBJECTS AND METHODS: A within-subject comparative
design was used with 61 adults recruited from patients of a
primary healthcare clinic. The telehealth clinic facilitator had no
formal healthcare training. On-site otoscopic examination performed
by the otolaryngologist was considered the gold standard diagnosis.
A single video-otoscopic image was recorded by the otolaryngologist
and facilitator from each ear, and the images were uploaded to a
secure server. Images were assigned random numbers by another
investigator, and 6 weeks later the otolaryngologist accessed the
server, rated each image, and made a diagnosis without participant
demographic or medical history. RESULTS: A greater percentage of
images acquired by the otolaryngologist (83.6%) were graded as
acceptable and excellent, compared with images recorded by the
facilitator (75.4%). Diagnosis could not be made from 10.0% of the
video-otoscopic images recorded by the facilitator compared with
4.2% taken by the otolaryngologist. A moderate concordance was
measured between asynchronous diagnosis made from videootoscopic
images acquired by the otolaryngologist and facilitator
(j = 0.596). The sensitivity for video-otoscopic images acquired by
the otolaryngologist and the facilitator was 0.80 and 0.91, respectively.
Specificity for images acquired by the otolaryngologist and the
facilitator was 0.85 and 0.89, respectively, with a diagnostic odds
ratio of 41.0 using images acquired by the otolaryngologist and 46.0
using images acquired by the facilitator. CONCLUSIONS: A trained
telehealth facilitator can provide a platform for asynchronous diagnosis
of otological status using video-otoscopy in underserved
primary healthcare settings.
