title: Digital images for postsurgical follow-up of tympanostomy tubes in remote Alaska.
abstract: OBJECTIVE
  To determine if video otoscope still images of the tympanic membrane taken in remote clinics are comparable to an in-person microscopic examination for follow-up care.
  
  
  METHODS
  Comparative concordance, diagnostic reliability.
  
  
  METHODS
  Community health aide/practitioners in remote Alaska imaged 70 ears following tympanostomy tube placement. The patients were then examined in person by two otolaryngologists. Images were later reviewed at 8 and 14 weeks.
  
  
  RESULTS
  Intraprovider concordance for physical examination findings was: "Tube in," 94 percent -97 percent (kappa = 0.89-0.94); "Tube patent," 94 percent -97 percent (kappa = 0.89-0.94); "Drainage," 90 percent -96 percent (kappa = -0.04-0.38); "Perforation," 90 percent -96 percent (kappa = 0.61-0.82); "Granulation," 97 percent -100 percent (kappa = 0.49-1.0); "Middle ear fluid," 88 percent -96 percent (kappa = 0.28-0.71); "Retracted," 83 percent -91 percent (kappa = 0.26-0.58). These agreement rates are similar to interprovider concordance when two otolaryngologists examine the same patient in person. Intraprovider concordance for diagnoses was 76 percent -80 percent (kappa = 0.64-0.71) and 77 percent -88 percent (kappa = 0.66-0.81) when poor images were excluded. Interprovider diagnostic concordance for the in-person exam was 89 percent (kappa = 0.83).
  
  
  CONCLUSIONS
  Video-otoscopy images of the tympanic membrane are comparable to an in-person examination for assessment and treatment of patients following tympanostomy tubes. Store-and-forward telemedicine is an acceptable method of following patients post tympanostomy tube placement.
authors.affiliation: Alaska Native Medical Center, Otolaryngology, Department of ENT, Anchorage, AK 99508-5926, USA. jkokesh@anmc.org
authors.forename: John
authors.initials: J
authors.lastname: Kokesh
authors.forename: A Stewart
authors.initials: AS
authors.lastname: Ferguson
authors.forename: Chris
authors.initials: C
authors.lastname: Patricoski
authors.forename: Kathryn
authors.initials: K
authors.lastname: Koller
authors.forename: Greg
authors.initials: G
authors.lastname: Zwack
authors.forename: Ellen
authors.initials: E
authors.lastname: Provost
authors.forename: Peter
authors.initials: P
authors.lastname: Holck
mesh_terms: D000293:Adolescent; D000413:Alaska; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008876:Middle Ear Ventilation; D015588:Observer Variation; D038781:Otoscopy; D014432:Tympanic Membrane; D014741:Video Recording