title: Remote evaluation of video-otoscopy recordings in an unselected pediatric population with an otitis media scale.
abstract: BACKGROUND
  A recently validated image-based grading scale for acute otitis media (OMGRADE) can be used to assess tympanic membrane (TM) status. The aim of this study was to evaluate the validity and reliability of this scale for remote assessments of TM status using video-otoscopy recordings in an unselected pediatric population.
  
  
  METHODS
  Children 2-16 years attending a South African primary health clinic were offered an ear examination by an otologist using otomicroscopy. An ear and hearing telehealth facilitator then made video-otoscopy recordings (9-33s) of the ears and uptakes were uploaded to a secure server for remote assessments in Sweden by an otologist and general practitioner at four- and eight-weeks post onsite assessment. TM appearance was judged according to the OMGRADE scale. Concordance between onsite otomicroscopy and asynchronous assessments of video-otoscopy recordings was calculated together with intra- and inter-rater agreements.
  
  
  RESULTS
  One hundred and eighty ears were included. Concordance of TM classifications using the OMGRADE scale was found to be substantial (weighted kappa range 0.66-0.79). Intra- and inter-rater agreement (test-retest) was found to be substantial to almost perfect (weighted kappa range 0.85-0.88 and 0.69-0.72, respectively).
  
  
  CONCLUSIONS
  The OMGRADE scale can be used to accurately assess the normal TM and secretory otitis media (SOM) remotely using video-otoscopy recordings in an unselected pediatric population.
authors.affiliation: Department of Public Health and Clinical Medicine, Family medicine, Umeå University, S-901 87 Umea, Sweden. Electronic address: thorbjorn.lundberg@fammed.umu.se.
authors.forename: Thorbjörn
authors.initials: T
authors.lastname: Lundberg
authors.affiliation: Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.
authors.forename: Leigh
authors.initials: L
authors.lastname: Biagio
authors.affiliation: Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa; Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umea, Sweden.
authors.forename: Claude
authors.initials: C
authors.lastname: Laurent
authors.affiliation: Department of Public Health and Clinical Medicine, Family medicine, Umeå University, S-901 87 Umea, Sweden.
authors.forename: Herbert
authors.initials: H
authors.lastname: Sandström
authors.affiliation: Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa; Ear Science Institute Australia, Subiaco, Australia; Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands, Australia.
authors.forename: De Wet
authors.initials: de W
authors.lastname: Swanepoel
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000175:diagnosis*; D038781:Otoscopy / Q000379:methods*; D010372:Pediatrics; D015203:Reproducibility of Results; D013019:South Africa; D017216:Telemedicine / Q000379:methods*; D014432:Tympanic Membrane / Q000473:pathology*; D014741:Video Recording
keywords: Grading; Otitis media; Tympanic membrane; Video-otoscopy