The reliability of video otoscopy recordings and still images in the asynchronous diagnosis of middle-ear disease

Abstract

Objective

To compare the asynchronous assessment of video otoscopic still images to recordings by an audiologist and ear, nose and throat surgeon (ENT) for diagnostic reliability and agreement in identifying middle-ear disease.

Design

A prospective cross-sectional study, asynchronously assessing video otoscopy, tympanometry and case history (Dx1). A subset was re-diagnosed (Dx2).

Study sample

Video otoscopy and data from 146 children recruited at two public community events; a sub-set of 47 were re-assessed.

Results

The intra-rater diagnostic agreement between Dx1 and Dx2 was moderate (k = 0.445–0.552) for the ENT surgeon, and almost-perfect (k = 0.928) for the audiologist, in both procedures. The agreement between the two procedures was substantial (k = 0.624) and moderate (k = 0.416) for the ENT surgeon in Dx1 and Dx2 respectively, and almost-perfect for the audiologist (k = 0.854–0.978) in both rounds. In Dx1, the inter-rater agreement between the clinicians was substantial using still images (k = 0.672) and moderate using recordings (k = 0.593); in Dx2 it was moderate using both procedures (k = 0.477–0.488).

Conclusion

Both video otoscopic procedures, in addition to tympanometry and case history information, can be reliably used for asynchronous diagnosis of childhood middle-ear disease. An audiologist has a potential role in triaging children with middle-ear abnormalities and, therefore, improving access to ear-health services.

Keywords:

• Middle Ear
• paediatric
• tele-audiology/tele-health
• video otoscopy

Acknowledgments

This research was supported by the Telethon Kids Institute. We thank Ana Rakonjac, Bek Groom, Beth Arrowsmith, Courtney McMahen, Danielle Darragh, Eleanor Disselkoen, Holly Richmond, Jessica Ramsay, June Doyle, Kylie Sullivan, Narelle Mullan, Natasha Morrison, Nelly Newall, Rosie Barnes, Sarah Brazier, Sharon Weeks, Sonia McAllister, Stacey Campbell, and Valerie Swift for helping during the Telethon Weekend Expo and NAIDOC. We also thank all the children and their parents/guardians who took part in this study. The authors thank the two anonymous reviewers for their comments and suggestions.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This project was funded by the Telethon Kids Institute and the WA Department of Health.