Journal Pre-proof the otoscope to examine the ears by oneself (Figure 2.). The children need their parents' help for examination. The patient sent the images or video taken by the smartphone via WeChat group to doctors. After got the images data, the otolaryngologists made a diagnosis and provided real-time feedback. WeChat, the Journal Pre-proof J o u r n a l P r e -p r o o f most popular social media in China, plays a critical role in telemedicine services.Since February 15, 2020, we have preliminary serviced 12 patients via SEWOAOT.There were 5 males and 7 females, with an average age of 28 years (range 4-58 years).Among them, 3 cases of acute otitis media, 2 cases of traumatic tympanic membrane perforation, 2 cases of mycotic otitis externa, 2 cases of cerumen impaction, 1 case of acute external auditory canalitis, 1 case of external auditory canal trauma, and 1 case of post-operation of external auditory canal cholesteatoma. We ask patients to rate their satisfaction with SEWOAOT ranging from dissatisfied, somewhat satisfied, and very satisfied.They were dissatisfied (0, 0%), somewhat satisfied (2, 16.7%), and very satisfied (10, 83.3%). Overall, we have received excellent feedback for participation. Mandavia et al. performed a cross-sectional study, screening ear disease in Nepal, and concluded that an SEO is a potent tool in the diagnosis of ear disease and the decision for onward referral[11]. Hakimi et al. used SEO for training medical students instead of the traditional otoscope[12]. They found that the students were more confident in identifying the anatomical landmarks of the middle ear. However, a recent study had shown that it had not proved the effectiveness of SEO when local health care workers were examining the children. It potentially relates to insufficient training and education of local medical personnel[13]. SEO in this paper offers a better imaging quality than the previous product. The device also has a directional gyroscope which can keep a constant view angle when the machine body rotates unstably. The technological progress makes it possible to Journal Pre-proof J o u r n a l P r e -p r o o f perform a self-examining. However, SEWOAOT also has disadvantages. In some remote rural areas of China, smartphone and internet use remains restricted. SEO is not convenient enough for older people. Nevertheless, SEWOAOT has great significance for preventing human cross-infection during the infectious disease outbreaks. Journal Pre-proof J o u r n a l P r e -p r o o f
PurposeThis study aimed to evaluate the effectiveness of smartphone otoscope telemedicine in the rural medical consortium in East China in the COVID-19 era.MethodsThis prospective study was conducted within a rural medical consortium that provides health care services by integrating medical resources in the same area. When a patient visited primary health care (PHC) for ear diseases, the PHC provider used a smartphone otoscope to examine the patient's external ear canal and eardrum, and then sent photos or videos of the patient's ear to the otolaryngologist at the lead hospital via WeChat group. The otolaryngologist provided remote diagnosis and management recommendations to the PHC provider. The following data were recorded: age and gender, outpatient diagnosis, disease duration, sides, duration of treatment, telemedicine visits, treatment outcomes, patient satisfaction, and PHC providers' self-evaluation score.ResultsA total of 83 patients were included in the study, including 43 males and 40 females, with a mean age of 44.6 ± 19.7 years (range 3–83 years). The duration of treatment for these patients was 14.0 (7,14) days. PHC visits were 2.2 ± 1.1 times (range: 1–7 times). Telemedicine visits ranged from 1 to 5, with a mean of 1.8 ± 0.9. Among of patients, 62 (74.7%) were cured, 21 (25.3%) improved, and 0 (0%) were ineffective. Sixty-five patients (78.3%) were very satisfied, 16 (19.3%) patients were somewhat satisfied, and two patients (2.4%) were dissatisfied. Based on the self-reported helpfulness, the primary health care providers assessed telemedicine as very helpful (n = 63, 75.9%), helpful (n = 20, 24.1%), and unhelpful (n = 0, 0%).ConclusionsSmartphone otoscope telemedicine in the medical consortium can effectively improve the ability of rural PHC providers to diagnose and treat ear diseases, save time and costs for patients, and improve patient satisfaction.
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