Frugal tele-otoscopy for low resource settings – an online evaluation study among ENT specialists

The implementation of telemedicine and tele-otoscopy in ear, nose and throat (ENT) medicine has accelerated in recent times. While traditional equipment is frequently subject of published studies, little is known about frugal tele-otoscopy suitable for low- and middle-income countries. Frugal innovations aim to achieve cost reduction while maintaining functionality with a high performance level. This pilot study provides an online survey among ENT specialists (N=10), diagnosing and evaluating the video quality of tele-otoscopy videos. The videos were captured using a smartphone camera attached to the frugal Arclight a low cost otoscope available for about 12€ in low- and middle- income countries. In total, a pre-existing Arclight teaching video (healthy tympanic membrane) and five videos of different tympanic conditions (artificial SimEar trainers) were used. ENT specialists achieved an overall diagnosing accuracy of 79% [95% CI: 68%-90%] on videos obtained by the frugal tele-otoscopy device. Both, the quality of the videos and the confidence of the diagnoses, were rated on a Likert-type scale (1=poor; 7=excellent) by the participants. Altogether, the results show an overall median of 3.5 (range:1-6) for the quality rating and a median of 3 (range:1-6) for the confidence of the diagnoses. The conducted online survey highlights the feasibility of remote ear diagnosis using the frugal Arclight otoscope attached to a smartphone camera. Although previous studies have assessed the Arclight as having equivalent diagnostic performance -when compared to expensive traditional otoscopes- this is the first study in a telemedicine setting. Future studies should assess telemedicine settings at a larger scale. This study is part of Dr Buhr′s Masterthesis (MSc Digital Health St Andrews).