Smartphone-based video-otoscopy performed by non-ENT physicians as a complementary tool to conventional otoscopy for tympanic membrane diagnosis

Abstract

ABSTRACT Tympanic membrane (TM) evaluations are frequently accomplished through conventional otoscopy (COt) by non-otorhinolaryngologist (ENT) physicians with several limitations, including low diagnostic accuracy. However, novel smartphone-based video-otoscopy (VOt) include characteristics that can improve otoscopic diagnoses. The objective of this study was to evaluate the usefulness of VOt as a complementary tool for COt in performing otoscopic diagnoses. A diagnostic test study with a cross-over design was conducted using family-community medicine (FCM) residents spending two weeks in an otorhinolaryngology clinic between 2020 and 2021. The diagnostic otoscopic accuracy between the ENT and the FCM-residents, who performed both otoscopic techniques sequentially, was evaluated. A random effect, meta-analysis was conducted to evaluate the sensitivity, specificity and positive predictive values. With the participation of 11 FCM-residents, 292 ears were evaluated. The most frequent otoscopic signs were myringosclerosis (33%), TM atrophy (17.1%), TM-retractions (9.2%), and TM perforations (7.9%). VOt showed ∼40 and 45% sensitivity value increase over COt in identifying atrophy and retraction, respectively. VOt also had a ∼34% more positive predictive value over COt in recognizing retractions. The use of VOt as a complementary tool performed by non-ENT physicians thus significantly increased the diagnostic accuracy for certain tympanic alterations such as atrophies and retractions.