title: Validation of tele-otology to diagnose ear disease in children.
abstract: OBJECTIVE
  To determine if digitised still eardrum images, with a clinical history, and audiometry and tympanometry data provide sufficient information to an ear specialist to make an assessment of a patient.
  
  
  METHODS
  66 children (9 months to 16 years) from remote communities were assessed by an ear specialist by standard otoscopy, using a clinical history, audiometry and tympanometry. Up to five images of each ear were digitised. At a later date, the ear specialist made observations, diagnoses and recommendations for management from the images and clinical data.
  
  
  RESULTS
  There was a significant correlation (p<0.01) between image quality and age of the subject. There were significant agreements for the clinically important observations of otorrhea, perforation, retracted tympanic membrane and atrophy of the tympanic membrane (p<0.05). There were significant agreements for the diagnoses of acute otitis media, chronic suppurative otitis media, otitis media with effusion and Eustachian tube dysfunction. The rate of recommendations for review or referral after a tele-otology assessment were between 4 and 16% higher than those in made in the field. The agreements between the various forms of advice or recommendations made in the field to those made by tele-otology were statistically significant (p<0.01).
  
  
  CONCLUSIONS
  A tele-otology system that incorporates good quality digitised images of the tympanic membrane, audiological and tympanometric data, and a comprehensive clinical history provides the ear specialist with sufficient information to make a confident diagnose of existing middle ear disease, and provide management advice to the patients' primary care provider.
authors.affiliation: Lions Ear and Hearing Institute, Grd Flr E-Block, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia. robeik@cyllene.uwa.edu.au
authors.forename: Robert H
authors.initials: RH
authors.lastname: Eikelboom
authors.forename: Mathew N
authors.initials: MN
authors.lastname: Mbao
authors.forename: Harvey L
authors.initials: HL
authors.lastname: Coates
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Atlas
authors.forename: Mark A
authors.initials: MA
authors.lastname: Gallop
mesh_terms: D000158:Acoustic Impedance Tests; D000293:Adolescent; D001299:Audiometry; D002648:Child; D002675:Child, Preschool; D044962:Data Compression; D004424:Ear Canal / Q000473:pathology; D004427:Ear Diseases / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008487:Medical History Taking; D038781:Otoscopy; D019114:Remote Consultation; D015203:Reproducibility of Results; D014432:Tympanic Membrane / Q000473:pathology; D014741:Video Recording