A Comparison of In-Person Examination and Video Otoscope Imaging for Tympanostomy Tube Follow-Up

Abstract

The objective of this study was to determine if video otoscope still images (640 x 480 pixel resolution) of the tympanic membrane following surgical placement of tympanostomy tubes are comparable to an in-person microscopic examination. Forty patients having undergone tympanostomy tube placement in both ears were independently examined in-person by two otolaryngologists and imaged using a video otoscope and telemedicine software package. The two physicians later reviewed images at 6 and 12 weeks. Physical examination findings and diagnosis were documented and compared for their concordance using kappa statistics. For both physicians, the intraprovider concordance between the in-person examination and the corresponding image review was high for each of the physical examination findings: Tube In 93-94% (K 0.85-0.87), Tube Patent 86-93% (K 0.74-0.85), Drainage 94-98% (K 0.42-0.66), Perforation 85-98% (K 0.40-0.84), Granulation 95-99% (K -0.01 to 0.00), Middle Ear Fluid 89-91% (K -0.03 to 0.50), and Retracted 89-94% (K 0.13-0.43). These agreement rates are similar to the normal interprovider concordance observed when two physicians independently examined the same patient in-person for physical exam findings: Tube In 96% (K 0.93), Tube Patent 94% (K 0.88), Drainage 96% (K 0.56), Perforation 90% (K 0.60), Granulation 96% (K 0.39), Middle Ear Fluid 88% (K 0.14), and Retracted 91% (K 0.43). For both physicians, the intraprovider diagnostic concordance between the in-person examination and the corresponding image review was high 79-85% (K 0.67-0.76). The interprovider diagnostic concordance for the in-person exam was 88% (K 0.81). The interprovider diagnostic concordance when two physicians independently reviewed all images was 84% (K 0.74), and 89% (K 0.80) when poor images were excluded. This study demonstrates that physician review of video otoscope images is comparable to an in-person microscopic examination. Store-and-forward video otoscopy may be an acceptable method of following patients post-tympanostomy tube placement.

Asynchronous Video-Otoscopy with a Telehealth Facilitator

“…typically apparent through use of interactive binocular microscope examination 12 or pneumatic otoscopy. Typically, in field face-toface otologic assessment, medical, demographic, and social history, in conjunction with techniques such as tympanometry and pure tone audiometry, would be used in addition to video-otoscopy or conventional otoscopy.…”

“…8,9 Previous studies concluded that video-otoscopic images are equivalent in quality to face-to-face otoscopy. 6,8,[10][11][12] A comparison of four video-otoscopes found that three of the four systems yielded images rated as adequate or better for at least 80% of the images. 8 Previous studies reported 75-82% of video-otoscopic images were judged to be adequate, good, very good, or excellent in quality.…”

“…11,13 It is important that for the purpose of validation of video-otoscopy within a hearing telehealth clinic, studies have demonstrated average to good diagnostic concordance between conventional otoscopy and video-otoscopic images. 12,[14][15][16] Three studies have made use of video-otoscopy for telehealth applications within underserved communities. 12,15,16 Patricoski et al 12 compared the diagnosis made from microscopic examination of ears post-tympanostomy tube placement with that made from asynchronous video-otoscopic images taken by two otolaryngologists; diagnostic concordance between the aforementioned methods indicated substantial agreement with j values ranging from 0.67 to 0.76.…”

“…12,[14][15][16] Three studies have made use of video-otoscopy for telehealth applications within underserved communities. 12,15,16 Patricoski et al 12 compared the diagnosis made from microscopic examination of ears post-tympanostomy tube placement with that made from asynchronous video-otoscopic images taken by two otolaryngologists; diagnostic concordance between the aforementioned methods indicated substantial agreement with j values ranging from 0.67 to 0.76. Using an experienced video-otoscopist to acquire videootoscopic images, Eikelboom et al 15 reported significant correlations between image quality and age of the participant and between clinically important observations of the tympanic membrane during face-to-face otoscopy and asynchronous evaluation of videootoscopic images.…”

“…The study emphasized the importance of the participant's clinical history and audiometric and tympanometric data in order to assist the otolaryngologist in making an asynchronous diagnosis using the images. Kokesh et al 16 evaluated video-otoscopic images taken by a community healthcare worker, but, as with the study of Patricoski et al, 12 the population was limited to children attending follow-up appointments following tympanostomy tube placement. Concordance between the diagnoses of two otolaryngologists based on asynchronous evaluation of video-otoscopic images was substantial (j = 0.70) compared with near perfect concordance during face-toface otoscopy (j = 0.83), which served as the gold standard.…”