title: Asynchronous video-otoscopy with a telehealth facilitator.
abstract: OBJECTIVE
  The study investigated whether video-otoscopic images taken by a telehealth clinic facilitator are sufficient for accurate asynchronous diagnosis by an otolaryngologist within a heterogeneous population.
  
  
  METHODS
  A within-subject comparative design was used with 61 adults recruited from patients of a primary healthcare clinic. The telehealth clinic facilitator had no formal healthcare training. On-site otoscopic examination performed by the otolaryngologist was considered the gold standard diagnosis. A single video-otoscopic image was recorded by the otolaryngologist and facilitator from each ear, and the images were uploaded to a secure server. Images were assigned random numbers by another investigator, and 6 weeks later the otolaryngologist accessed the server, rated each image, and made a diagnosis without participant demographic or medical history.
  
  
  RESULTS
  A greater percentage of images acquired by the otolaryngologist (83.6%) were graded as acceptable and excellent, compared with images recorded by the facilitator (75.4%). Diagnosis could not be made from 10.0% of the video-otoscopic images recorded by the facilitator compared with 4.2% taken by the otolaryngologist. A moderate concordance was measured between asynchronous diagnosis made from video-otoscopic images acquired by the otolaryngologist and facilitator (κ=0.596). The sensitivity for video-otoscopic images acquired by the otolaryngologist and the facilitator was 0.80 and 0.91, respectively. Specificity for images acquired by the otolaryngologist and the facilitator was 0.85 and 0.89, respectively, with a diagnostic odds ratio of 41.0 using images acquired by the otolaryngologist and 46.0 using images acquired by the facilitator.
  
  
  CONCLUSIONS
  A trained telehealth facilitator can provide a platform for asynchronous diagnosis of otological status using video-otoscopy in underserved primary healthcare settings.
authors: Department of Communication Pathology, University of Pretoria, Pretoria, South Africa.
authors: Leigh
authors: L
authors: Biagio
authors: De Wet
authors: de W
authors: Swanepoel
authors: Adebolajo
authors: A
authors: Adeyemo
authors: James W
authors: JW
authors: Hall
authors: Bart
authors: B
authors: Vinck
mesh_terms: D000293:Adolescent; D000328:Adult; D004427:Ear Diseases / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010036:Otolaryngology / Q000379:methods*; D038781:Otoscopy / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D017216:Telemedicine / Q000379:methods*; D055815:Young Adult