BACKGROUND : A recently validated image-based grading scale for acute otitis media (OMGRADE) can be
used to assess tympanic membrane (TM) status. The aim of this study was to evaluate the validity and
reliability of this scale for remote assessments of TM status using video-otoscopy recordings in an
unselected pediatric population.
METHOD : Children 2–16 years attending a South African primary health clinic were offered an ear
examination by an otologist using otomicroscopy. An ear and hearing telehealth facilitator then made
video-otoscopy recordings (9–33 s) of the ears and uptakes were uploaded to a secure server for remote
assessments in Sweden by an otologist and general practitioner at four- and eight-weeks post onsite
assessment. TM appearance was judged according to the OMGRADE scale. Concordance between onsite
otomicroscopy and asynchronous assessments of video-otoscopy recordings was calculated together
with intra- and inter-rater agreements.
RESULTS : One hundred and eighty ears were included. Concordance of TM classifications using the
OMGRADE scale was found to be substantial (weighted kappa range 0.66–0.79). Intra- and inter-rater
agreement (test–retest) was found to be substantial to almost perfect (weighted kappa range 0.85–0.88
and 0.69–0.72, respectively).
CONCLUSION : The OMGRADE scale can be used to accurately assess the normal TM and secretory otitis
media (SOM) remotely using video-otoscopy recordings in an unselected pediatric population.