Reliability and Accuracy of Remote Fiberoptic Nasopharyngolaryngoscopy in the Pediatric Population

Abstract

Introduction: Telemedicine is an increasingly prevalent component of medical practice. In otolaryngology, there is the potential for telemedicine services to be performed in conjunction with device use, such as with a nasolaryngoscope. This study evaluates the reliability of remote examinations of the upper airway through an iPhone recording using a coupling device attached to a nasopharyngolaryngoscope (NPL). Methods: A prospective, blinded study was performed for pediatric patients requiring an NPL during an office visit. The NPL was performed using a coupling device attached to a smartphone to record the examination. A second, remote otolaryngologist then evaluated the recorded examination. Both otolaryngologists evaluated findings of anatomic sites including nasopharynx, oropharynx, base of tongue, larynx including subsites of epiglottis, arytenoids, aryepiglottic folds, false vocal cords, true vocal cords, patency of airway, and diagnostic impression, all of which were documented through a survey. Results of the survey were evaluated through inter-rater agreement using the κ statistic. Results: Forty-five patients underwent an NPL, all of which were included in the study. The average age was 4.9 years. The most common complaint requiring NPL was noisy breathing (n = 16). The inter-rater agreement for overall diagnosis was 0.74 with 80% percent agreement, rated as “good.” Other anatomic subsites with “good” or better inter-rater agreement were nasopharynx (0.75), oropharynx (0.75), and true vocal cords (0.71), with strong percentage agreement of 89%, 91%, and 87%, respectively. Both users of the adaptor found the recording setup to run smoothly. Conclusion: A telemedicine device for NPL use demonstrates strong diagnostic accuracy across providers and good overall evaluation. It holds potential for use in remote settings.

Comparative Evaluation of the Effects of Adenotonsillar Hypertrophy on Oral Health in Children

“…Eighty children who presented to the Near East University Hospital Otorhinolaryngology clinic underwent examination by the same otolaryngologist. Flexible fiberoptic nasopharyngolaryngoscopy (FNFL) was used for direct visualization of the adenoid and tonsils [ 18 , 19 ]. Palatine tonsil hypertrophy was determined according to the Brodsky and Koch criteria [ 20 ].…”

Telemedicine in pediatric otolaryngology: Ready for prime time?

“…Despite many studies demonstrating its potential, telemedicine has not been widely adopted in the specialty of otolaryngology [ 4 ]. This may be attributed to concerns over the diagnostic accuracy of remote evaluations, training requirements, and an uncertainty over which of the many telemedicine approaches yield the best results [ [5] , [6] , [7] ]. Fortunately, multiple studies agree that otolaryngology is a specialty well-suited for telemedicine [ 8 ].…”

“…Otolaryngology is a robust specialty that involves the treatment of a variety of ear, nose, throat, and in some practices, head and neck conditions. Due to this variation, diagnostic exams are not standardized between patients, and the technology needed to accurately assess a patient's condition may vary from case to case [ 6 ]. Ultimately, it is the pertinent anatomy that will determine how a patient is evaluated.…”

“…Another study published in 2020 by Miller and colleagues [ 6 ] evaluated the reliability and accuracy of remote nasopharyngolaryngoscopy (NPL) examinations in pediatric patients. The group conducted a prospective, blinded study in which the NPL was performed by an in-office otolaryngologist using an iPhone attachment to record the examination.…”

“…Interestingly, McCool and colleagues [ 4 ] determined that diagnoses of the oral cavity (75%), nasal passage (75%), sinuses (58%), and pharynx (58%) were the most telemedicine-eligible diagnoses after the ear (middle and inner) and skin. Furthermore, the anatomic subsite with the lowest inter-rater agreement in the study by Miller and colleagues [ 6 ] was the larynx and its components, such as the epiglottis (κ = 0.43), the arytenoids (κ = 0.34), and the aryepiglottic folds (κ = 0.20). Although these sites maintained modest percentage agreements, they were still relatively lower than the values for the nasopharynx and oropharynx.…”