Cerumen Research Articles

Quality Improvement in Otolaryngology-Head and Neck Surgery: Developing Registry-Enabled Quality Measures From Guidelines for Cerumen Impaction and Allergic Rhinitis Through a Transparent and Systematic Process.

Quality measurement can drive improvement in clinical care and allow for easy reporting of quality care by clinicians, but creating quality measures is a time-consuming and costly process. ECRI (formerly Emergency Care Research Institute) has pioneered a process to support systematic translation of clinical practice guidelines into electronic quality measures using a transparent and reproducible pathway. This process could be used to augment or support the development of electronic quality measures of the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) and others as the Centers for Medicare and Medicaid Services transitions from the Merit-Based Incentive Payment System (MIPS) to the MIPS Value Pathways for quality reporting. We used a transparent and reproducible process to create electronic quality measures based on recommendations from 2 AAO-HNSF clinical practice guidelines (cerumen impaction and allergic rhinitis). Steps of this process include source material review, electronic content extraction, logic development, implementation barrier analysis, content encoding and structuring, and measure formalization. Proposed measures then go through the standard publication process for AAO-HNSF measures. The 2 guidelines contained 29 recommendation statements, of which 7 were translated into electronic quality measures and published. Intermediate products of the guideline conversion process facilitated development and were retained to support review, updating, and transparency. Of the 7 initially published quality measures, 6 were approved as 2018 MIPS measures, and 2 continued to demonstrate a gap in care after a year of data collection. Developing high-quality, registry-enabled measures from guidelines via a rigorous reproducible process is feasible. The streamlined process was effective in producing quality measures for publication in a timely fashion. Efforts to better identify gaps in care and more quickly recognize recommendations that would not translate well into quality measures could further streamline this process.

Auditory exostosis in Australian warm water surfers: a cross-sectional study

BackgroundSurfing is a popular sport in Australia, accounting for nearly 10% of the population. External auditory exostosis (EAE), also referred to as surfer’s ear, is recognized as a potentially serious complication of surfing. Cold water (water temperature below 19 °C) is a commonly cited risk factor, with prevalence of EAE in cold water surfers ranging from 61 to 80%.However, there is a paucity of studies reporting the prevalence of EAE in surfers exposed to water temperatures above 19 °C. With mean water temperature ranging from 19 °C to 28 °C, the Gold Coast region of Australia provides the ideal environment to assess the main goal of this study: to assess the prevalence and severity of EAE in warm water surfers.MethodsEligible participants were surfers living and surfing on the Gold Coast (Queensland, Australia). Currently active surfers over 18 years of age, surfing year-round, with a minimum of five consecutive years of surfing experience were recruited to participate. Included individuals were asked to complete a questionnaire and underwent bilateral otoscopy.ResultsA total of 85 surfers were included, with mean age 52.1 years (standard deviation [SD] ±12.6 years) and mean surfing experience of 35.5 years (SD ±14.7 years). Nearly two-thirds of participants (65.9%) had regular otological symptoms, most commonly water trapping (66%), hearing loss (48.2%), and cerumen impaction (35.7%). Less than one-fifth of the surfers (17.7%) reported regular use of protective equipment for EAE. The overall prevalence of exostosis was 71.8%, with most of the individuals having bilateral lesions (59%) and a mild grade (grade 1, 47.5%). There was insufficient evidence for any significant associations between the main outcomes (presence and severity of EAE) and factors related to age, surfing experience, winter exposure, surfing ability, symptoms, and use of protective equipment.ConclusionTo the best of our knowledge, this is the first study assessing EAE in surfers exposed to warm waters (above 19 °C). The prevalence of 71.8% highlights the high prevalence of the condition in the surfing population, regardless of water temperature. Future research should focus on ways to prevent EAE.

Pre-operative and post-operative audiological assessment in cleft lip and palate patients-a prospective study

PurposeTo assess association of audiological defects in cleft lip and palate (CLP) following two stage cheiloplasty and palatoplasty using clinical evaluation and otoscopy and effect of the surgical repair at an interval of one year. Materials and methodsA pilot research study was performed on sixty CLP patients of 1–6 years of age reporting at Craniofacial & Research Centre, Dharwad, India between October 2016 to October 2018.Subjects were assessed based on history, clinical examination and otoscopy for audiometric defects including Serous otitis media (SOM), retraction pockets, impacted wax pre-palatoplasty and findings were compared with control group. Study group were followed up postoperatively at 1, 3, 6 and 12 months and statistical analysis was carried. ResultsHigher incidence of conductive audiological defects were noted in study group (96.6%) to control group (8.33%). Of the sixty cleft patients subjected to screening otoscopy, 58 subjects had significant findings like serous otitis media(12.07%), retraction pockets(23.14%), impacted wax(62.04%), bulging of tympanic membrane(3.45%) which were clinically unnoticed. Post palatoplasty no changes were noted at 1 and 3 months, however at 6- and 12months significant improvement was noted (55.17%), with three subjects lost to follow up (6.90%) and none presenting with permanent deafness.results. ConclusionCleft anomalies occur in different degrees of severity and configuration with greater incidence of conductive hearing defects of 97%. Positive correlation was noted in cleft palate cases with significant improvement after palatoplasty at an earlier age. However, future long term studies are warranted for long term assessment of Eustachian tube function.conclusion.

Comparison of prevalence of various ENT diseases and hearing impairment among children of government schools versus private schools of Mardan

Background: School children are frequently afflicted with ENT diseases. The diseases and their associated complications, especially hearing impairment, can be devastating to the children and families alike. Socioeconomic status of children can have strong effect on frequency of various ENT diseases. The objective of this study is to compare the frequency of various ENT diseases among children studying in government schools versus those in private schools of district Mardan.
 Subjects and methods: A cross-sectional descriptive study was carried out at Mardan from July to December 2019. The researchers visited four schools (two government and two private schools) in Mardan district. Relevant history was obtained and physical examination was done to find out the frequency of various ENT diseases. The data variables (age, gender, ENT diseases, hearing impairment) were noted in research Performa and data was entered and analysed in SPSS 21 software. Frequencies were determine for age, gender and ENT diseases. Independent t-test was used to analyze quantitative variables, while Chi-square was used to analyze qualitative variables. A p-value less than 0.05 was taken as significant.
 Results: Total 2986 children were examined in 4 schools. The mean age of the children was 11 years. There were 56% boys and 44% girls. Total 2106 children were examined in two government schools and 880 children were examined in two private schools. The frequency of impacted cerumen was 18.4% (21.2% of government school children versus 11.4% of private school children; p<0.05). Frequency of allergic rhinitis was 9.7% (9.5% of government school children versus 10.1% of private school children; p=0.635). The frequency of chronic suppurative otitis media (CSOM) in government school children was 4.9% versus 2.5% among those in private schools (p<0.05). In this study cumulative prevalence of hearing impairment was 26.8%, where prevalence in government school children was 30.9% versus 17.2% in private schools (p-value<0.001). The causes of hearing impairment were impacted ear cerumen (68.3%), CSOM (15.7%), otitis externa (6.2%), OME (4.1%), otitis media (2.8%), congenital ear deformities (1.6%) and foreign bodies in ear (1.2%). The main causes of hearing impairment in majority of children were impacted cerumen and CSOM in 84% children.
 Conclusion: Various ENT diseases like impacted cerumen, rhinosinusitis, allergic rhinitis, pharyngitis, tonsillitis and CSOM are common in school going children. Impacted cerumen and CSOM are significantly more prevalent in government school children as compared to private schools which are primary cause of hearing impairment in children leading to significantly high prevalence of hearing impairment in government school children

Cross-Sectional Study of Cerumen Impaction Among Inmates of a Nigerian Correctional Facility

In this study which was achieved at Izmir Bozyaka Teaching and Research Hospital, identifying the sensitivity and reliability of round window electrocochleographic records on children during cochlear implantation and investigating the applicability of the method on particularly problematic patient groups was aimed

Audiologic Screening of People with Down Syndrome in Special Schools in Surulere Lagos, Nigeria.

Down syndrome (DS) is associated with a high incidence of ear pathologies and hearing loss. There is a paucity of information on the audiology of people with DS particularly those in special schools in Nigeria. This study aimed to compare pneumatic otoscopy with tympanometry for middle ear screening and pure tone audiometry (PTA) with distortion product otoacoustic emission (DPOAE) for hearing screening in the different age groups of people with people DS. People with DS in two special schools for people with intellectual disability in Surulere, Lagos state were selected based on the schools' record and their phenotype. Otoscopy, pneumatic otoscopy, tympanometry, screening PTA and screening DPOAE were performed on the subjects. 52 subjects aged 6 to 36years and an M: F ratio of 1.5:1 were studied. 82.7% of subjects had wax impaction. The prevalence of otitis media with effusion (OME) by pneumatic otoscopy was 57.8% and 40.2% by tympanometry and the same number of subjects performed both tests successfully. Screening PTA and DPOAE were successfully performed on 32.7% and 94.2% of the subjects respectively. Fail rate of 29.4% by PTA and 65.3% by DPOAE were recorded. Regular ear check-up in people with DS is essential for the detection and treatment of ear wax, OME and hearing impairment which is highly prevalent in them. Pneumatic otoscopy is recommended for the detection of OME in all the age groups. Screening PTA and OAE are recommended for adults and children and non-cooperative adults hearing screening respectively.

The Influence of Chewing Habits on the Degree of Impacted Cerumen

Abstract: Cerumen was glandular secretions at the outer one-third of the ear mixed with exfoliated squamous epithelium. The jaw's movement keeps the cerumen in the ear canal in a state of balance, so it is clean, protects and lubricates the external auditory canal. Impacted cerumen is also caused by excessive production, narrow canal anatomy, viscosity wax, and irritation due to cotton-tipped swabs habits. This study aims to determine whether chewing habits influence the degree of cerumen obstruction in patients with impacted cerumen. The study was a cross-sectional method in impacted cerumen patients at 17-80 years old in the ENT clinic of District Hospital Wates, Kulon Progo, Yogyakarta, Indonesia. Risk factors assessed were education, age, gender, chewing habits, and cotton-tipped swabs habits. The data were then analyzed by chi-square test. Of 80 respondents with the dominant age range 17-38 years (58.8 %), the number of males was 47 (58.8 %), and females were 33 (41.2 %). The significant risk factors comprised the chewing habit and the use of cotton-tipped swabs. Factors affecting the degree of cerumen in patients with impacted cerumen were the chewing habits and cotton-tipped swabs habits.

Update on technologies, medicines and treatments.

An abstract presented at the 2020 European Association for the Study of Diabetes (EASD) suggests that, in future, we might be able to monitor longer term exposure to glucose through our tears. The study measured glycated albumin (GA) in lacrimal fluid and found this to be strongly correlated to glycated albumin in blood, an indicator of glycaemia over a 2 week period.

Cerumenolytics with or without manual extraction for impacted earwax: A network meta-analysis of randomised clinical trials.

Many different substances for cerumenolysis have been evaluated in clinical trials. We carried out a systematic review and network meta-analysis to compare their effectiveness. Electronic databases were searched for randomised clinical trials conducted in patients with impacted cerumen evaluating cerumenolytics. The primary outcome was the proportion of patients with wax clearance using manual techniques. Rankogram plot was used to assess the "best" cerumenolytic. Odds ratio (OR) with 95% confidence intervals (95% CI) was the effect estimate. Twenty-six studies were included in the systematic review and 25 in the meta-analysis. Sodium bicarbonate (OR: 2.68, 95% CI: 1.2, 6.1) and paradichlorobenzene (OR: 30.9, 95% CI: 5.9, 161.3) were associated with significantly greater proportions of patients with wax clearance following syringing compared to normal saline. Rankogram plot revealed paradichlorobenzene to have the highest probability of being the "best" cerumenolytic. Chlorobutanol was observed to be significantly better than normal saline in adults as well as following single application. Following multiple applications, glycerol, docusate sodium, hydrogen peroxide, oil, paradichlorobenzene, hydrogen peroxide/glycerol and arachis oil/chlorobutanol/paradichlorobenzene were observed with significant cerumenolytic activities. Urea/hydrogen peroxide/glycerol was observed with a significant cerumenolytic activity without the need for further interventions such as syringing/aspiration/suction. We observed several cerumenolytics to be effective in the treatment of impacted earwax when accompanied by additional manual techniques such as syringing/aspiration/suction.

Cholesteatoma Masquerading as Cerumen

Cerumen is composed of glandular secretions and desquamated epithelial cells. It protects and lubricates the external auditory canal. Impacted cerumen causes canal occlusion and pressure over the tympanic membrane, causing ear discomfort, conductive hearing loss, itching, etc. Up to 6% of the general population are affected with impacted cerumen, which includes 10% of children, more than 30% of the elderly and people with cognitive impairment. Persistent symptoms despite resolution of impaction and patient repeatedly should raise suspicion of alternative diagnosis and prompt for further evaluation. A 20-year-old female patient came with complaints of decreased hearing and ear discharge. On otoscopic examination of left ear, impacted cerumen was seen in the attic region. On removal of wax with the aid of oto-endoscopy, attic region was found to be filled with cholesteatoma debris. On pure tone audiometry, patient had mild conductive hearing loss of 30 db and computed tomography of left temporal bone revealed ill-defined soft tissue density in the middle ear (epitympanum) with erosion of head of malleus and short process of incus. Blunting of scutum was also seen. Attic reconstruction and type III tympanoplasty was performed. On histopathological examination, the section showed keratin flakes with bacterial colonies which were consistent with cholesteatoma. In conclusion, any case of impacted cerumen should not be ignored by otorhinolaryngologist. Further evaluation with thorough examination under otomicroscope/otoendoscope has to be done which can lead to different diagnosis and treatment plan.

Ear wax and hearing impairment in children in Nepal.

The presence of wax is a common finding during ear examination of children and it is one of the main causes of avoidable hearing impairment in children. The objective of this study was to find out the prevalence of wax in ear and evaluate the hearing loss in school-aged children. This is a cross sectional school-based study conducted over a four-year period. Children aged 5-16 were examined by otoscope and pure tone hearing thresholds were obtained at 0.5, 1, 2, and 4 kHz frequencies. A total of 53,970 children from 312 schools of Kathmandu valley were screened. The prevalence of ear wax was 34.64% (n=18697) and hearing impairment associated with wax was 0.88% (n=475). Ear wax and associated hearing loss is a common problem in Nepalese children. Lack of trained personnel and the costs involved in its treatment makes ear wax a big challenge for Nepal's rudimentary health care system.

The Effects Of Earphone Usage On Ear Wax (Cerumen) Impaction

Aim: To determine whether the use of earphones affects ear wax accumulation, to reveal whether it increases the need to consult a doctor, and to try to understand whether these situations vary according to earphone type.Methods: In this study, patients who applied to Ear Nose and Throat Clinic due to ear congestion between 2020 March and September and who were found to have ear wax in the ear examination were included. Those who do not use headphones are classified as the control group, and those who use headphones are classified as the study group. Earpiece types, frequency of self ear care, frequency of applying to the physician due to earwax removal were noted. Results: A total of 46 patients were included in the study. The control group consists of 16 people, and the study group consists of 30 people. The mean age was 48.5 ± 18.01 for the control group and 40.87 ± 21.28 for the study group. Weekly ear care of the patients was 3.25 in the control group and 2.9 in the study group. (p> 0.05) The groups' period to consult a physician for ear wax removal was 62.63 months in the control group and 60.9 months in the study group. (p> 0.05Conclusion: The use of headphones does not affect the frequency of the patients' self weekly ear care or visiting a physician for ear wax removal. Similarly, no significant relationship was found between earphone types and frequency of self ear care and frequency of visiting a physician.

Cerumen knowledge and ear cleaning practices among medical students in Saudi Arabia: An observational study

Background and Aim: Cerumen (earwax) is naturally secreted in human ears and can cause ear obstruction. When individuals at- tempt to remove cerumen from their own ears with tools, it can cause cerumen impaction, injuries, and otitis externa, which are risk factors for hearing loss. Clinicians need to educate their patients accordingly; thus, medical students should have sufficient knowledge of the topic. Here, we investigated the knowledge، awareness، and practices of cerumen and ear self-cleaning approaches among medical students at Al Imam Mohammad Ibn Saud Islamic University, Saudi Arabia. Methods: This cross-sectional study was conducted between June and July 2020. A questionnaire was distributed to medical students to determine their knowledge and practices of cerumen and ear cleaning. Correlations assessed relationships between demographic factors and knowledge. Results: Of 814 medical students who received the survey, 708 students completed the questionnaire (response rate = 86.9%). Males represented 61% of the sample. Most (73%) were aged 21 to 25 years; of them, 64% had cleaned their own ears, mostly with cotton buds (79%), in order to remove cerumen (30.8%). Overall, 85% of students had good knowledge; this was affected by gender and college years. Predominantly, 81% of students had high-risk practices. Conclusions: Although most medical students had a good level of knowledge about cerumen, many cleansed their own ears using cotton buds, despite knowing that it could harm the ear. As completing an otolaryngology course had marked effects on knowledge levels, we recommend further awareness programs to increase knowledge among preclinical students.

A Comparative Study of Ear Diseases in School Children from Lower versus Higher Socioeconomic Status

Background: Preventable otologic conditions have been found to be important health issues among paediatric age group. Poor socioeconomic status and inappropriate management services in developing countries lead to various complications despite the fact that most of these diseases are self-limiting. The aim of this study was to determine the prevalence and pattern of ear diseases in school children of high and low socioeconomic status in Yola, Nigeria. Methods: This study was conducted in March 2017 in two primary schools (private and public) in Yola among 6 - 8 years old pupils. Approval for the study was obtained from Federal Medical Centre, Yola and consent was obtained from the parents/guardians and the school authorities. Using a health questionnaire, a brief ENT history was obtained from children in years 1 and 2 of each school. Otoscopic examination, audiometry and tympanometry were then carried out. Data collected was analysed using SPSS version 20. Results: One hundred and three children were studied. The age range was 6 - 8 with mean age of 6.8 ± 0.9 and 53 (51.5%) boys. Fifty-two (50.5%) were from public school (low socio-economic class) and 51 (49.5%) from private (high social class). Wax was the most common ear condition encountered affecting 37 (35.9%) children, and the number was similar in both groups. Otitis media with effusion (OME) was encountered in seven children evenly split between the two groups showing a point incidence of 6.8%. There was hearing loss in 13 (12.6%) children, and this was also similar in the two groups. Conclusion: Wax impaction was the commonest otologic disease encountered. Our study also showed a point incidence of 6.8% for OME, but there was no statistical difference between the two groups, and neither was there any statistically significant difference between the two groups in any of the other diseases encountered.

Speech intelligibility enhancement in elderly with high-frequency hearing loss through visual speech perception

Background: Pathological and physiological disabilities of human auditory receptors reduce speech intelligibility under hearing loss (HL) at high frequencies. Objectives: The objective of the study is to investigate the speech-intelligibility-enhancement (SIE) in elderly with high-frequency HL (HFHL) through visual-speech-perception (VSP). The hypothesis is that the VSP of spondee words (two-syllable words with equal stress on both syllables) is properly recognized and reproduced with HFHL. Also; to decide the statistical relevance of the precise significant difference in speech discrimination (SD) with VSP on the subjected ear. Methods: Observational and descriptive studies of SIE with VSP on 12 elderly listeners (24 clear ears; without wax impaction) with progressive and bilateral HFHL were examined. The entire experimental records were checked for distribution with normal (Gaussian) using the Shapiro–Wilk's and paired Student's t-test (parametric test) had the 5% (0.05) significance level (α). Results: We analyzed, improved, and better performance in SIE with HFHL through VSP. The statistical P (probability) measure was calculated nothing, i.e., 0 (P

Clinical profiles of patients referred to an ear, nose and throat specialist clinic via community mobile hearing clinic in Singapore

Background: Community-based audiology service is new to the Singapore’s health-care landscape. Cases deemed unsuitable to remain under audiologists’ management in the community are referred to ear, nose and throat (ENT) specialists. Objectives: Analysis of the clinical profiles for these referred cases revealed the local community burden of otological and auditory conditions. Methods: This was a retrospective, cross-sectional pilot study. Clinical records of 375 patients who were seen by audiologists at a community-based mobile hearing clinic (MHC) and warranted ENT specialist referrals were extracted for descriptive analysis. Results: A total of 83.73% ( n=314) of patients attended their ENT appointments as advised by audiologists. Most patients (57.07%, n=234) had one condition diagnosed by the ENT specialist. One patient had four ENT conditions. Twenty-two types of otological conditions were diagnosed. Chronic suppurative otitis media, otitis externa, impacted cerumen and otitis media with effusion made up the four most frequently seen conditions in this subgroup. Twelve types of auditory conditions were diagnosed, with asymmetrical hearing loss topping the list. Sixteen types of other ENT conditions were diagnosed. Four incidental findings of vestibular schwannoma were reported. Conclusion: Many of the otological conditions diagnosed were chronic. Auditory conditions were predominantly hearing loss. Yet, they were found unnoticed or untreated by patients at the time of their visit to the MHC. This community-based audiology clinic had a catalytic effect on promoting timely or even early otological/hearing diagnosis and treatment. Understanding the prevailing ENT conditions of our wider population indicates the potential for growing community-based hearing health-care provision.

An ex vivo comparison of over-the-counter cerumenolytics for ear wax

Background: Ear wax (cerumen) impaction is a common reason why patients present to general practitioners (GPs) and ear, nose and throat (ENT) specialists. However, there is no consensus on the effectiveness of the variety of cerumenolytics commonly available. Currently, there are no investigations on the effectiveness of cerumenolytics against cerumen of varying consistencies.

Hybrid oil-in-water emulsions applying wax(lecithin)-based structured oils: Tailoring interface properties

This study addressed the impact of fruit wax(lecithin)-based oleogels as dispersed phase in formation and stability of oil-in-water emulsions. These hybrid emulsions were prepared above the melting point of the oleogels, using Tween 80 (T80) or whey protein isolate (WPI) as emulsifiers. Both mono- and mixed-component oleogels comprised of fruit wax (FW) or FW + lecithin (FWLEC), respectively, were studied as lipid phases. After hot-homogenization, emulsions were submitted to quiescent cooling and stored over 14 days at 5 or 25 °C, in such temperatures supposed to assist or hinder oleogelation, respectively. Time course promoted a slight decrease in zeta potential only for WPI-stabilized emulsions and particle size distribution was shifted to larger size values, but showing a lesser extent to those stored at 5 °C. The presence of oleogels improved kinetic stability of emulsions compared to liquid oil at both temperatures, disclosing the role of the combined effects of the type of emulsifier and oleogelator(s)-emulsifier interactions. These outcomes are associated with the interfacial activity played by both oleogelators, but mainly lecithin that led to lower values of interfacial tension. In addition FWLEC combined with WPI showed the lowest complex modulus from dilational rheology, which can be related with WPI-LEC complex formation. Overall, results suggest that oleogelators migrated to the O/W interface of dispersed droplets, no longer reflecting oleogel bulk properties and showing a more complex behavior. However, the formation of more complex structures at the interface favored greater stability of the emulsions. Thus, the new perspective of oleogel-inspired fat droplets in hybrid systems can expand the conventional approach of oil structuring to create mixed interfaces tailoring oil-in-water emulsions properties.

Assessment of knowledge regarding the consequences of using earphones among higher secondary and non-medical postgraduate students

Background: Due to the incremental scope of using earphones, in today’s world youngsters are susceptible to loud sounds or prolong sounds that may cause negative consequences to them in the later run. Aim of the study was to assess the knowledge regarding the consequences of the use of earphones in terms of basic level and advanced levels of awareness among some high secondary students and non-medical postgraduate students.Methods: A structure questionnaire-based study was done by distributing it among the students of Pondicherry central university, Puducherry, India, and Delhi Public School, Digboi Assam. 18 students from different departments of the Pondicherry central university and 19 students from the high secondary of Delhi Public School, Digboi were selected randomly for the study. A structured questionnaire consisting of questions related to the consequences of using earphones was used as a study tool for observation. Sets of questions related to the awareness were categorized into basic level, advanced level-1, and advanced level-2.Results: Knowledge scores for basic level awareness showed very good results. Knowledge scores for advanced level 1 and 2 awareness showed poor results for both the groups.Conclusions: The study highlights the requirement of developing awareness programs regarding health hazards associated with the use of earphones in terms of parameters like the feeling of ringing like sounds through the ears, ear wax, ear stress, ear pain, and tinnitus. Such awareness needs to be incorporated in textbooks of the school level.

Development of video otoscopy quiz using a smartphone adaptable otoscope

BackgroundOtoscopy examination can be challenging. Traditional teaching uses still image illustrations. Newer attempts use video samples to simulate the otoscopy exam which is a dynamic process.Aims/Objective: To assess whether recorded otoscopy videos from a smartphone adaptable otoscope can be used to develop a video-based otoscopy quiz which may be used for instructing and familiarizing participants to normal anatomy and pathologic ear conditions. To use this quiz to assess current pediatric residents’ competency of common otoscopy diagnosis. Method and materialsThis study was conducted in 2018. Video samples of ear pathology were collected at the Albany Medical Center using a smartphone adaptable otoscope- Cellscope. The videos were used to create a video otoscopy quiz (VOQ) without clinical vignettes. 45 pediatric residents from 3 academic institutions were evaluated with the quiz. ResultsThe weighted mean for the VOQ was 66.90% (95%CI 58.89%–68.42%). The breakdown by questions are: myringosclerosis 72.88%, retraction pocket 80.65%, cholesteatoma 42.22%, hemotympanum 75.04%, tympanic membrane perforation 79.62%, cerumen impaction 95.46%, otitis externa 52.54%, otitis media with effusion 63.30%, acute otitis media 75.55%, normal ear 36.39%. ConclusionWe found that videos of otoscopy exams can be obtained with a smartphone adaptable otoscope and validated to develop a video-based quiz, which may be used to supplement otoscopic instruction. Following our testing process, we found pediatric residents are relatively well equipped to identify ear pathology on VOQ.