title: Comparison of traditional otoscope to iPhone otoscope in the pediatric ED.
abstract: OBJECTIVE
  Acute otitis media (AOM) is a common diagnosis under age 5 years. The primary objective was to determine if the CellScope Oto (CSO) improves tympanic membrane (TM) visualization and diagnostic precision compared to traditional otoscope. The secondary objective was to determine physician, patient, and parent device preference.
  
  
  METHODS
  This is a prospective cross-sectional study of patients younger than 18 years presenting with ear pain, fever, or upper respiratory infection symptoms. Patients were examined by a resident then attending physician with a traditional wall-mounted otoscope followed by CSO. Each was blinded to the other's findings. Intrarater and interrater diagnostic agreement was compared. Physicians, parents, and patients were surveyed regarding their experience.
  
  
  RESULTS
  A total of 51 patients completed the study. There was substantial intrarater agreement between traditional otoscope and CSO for residents: right ear (κ = 0.74) and left ear (κ = 0.74); CSO use changed reported view for 16 of 102 TM examinations (16%), of which 7 (7%) had clinically relevant change in diagnosis to/from AOM. There was substantial to almost-perfect agreement for attending physicians: right: (κ = 0.86) and left (κ = 0.79); CSO use changed reported view for 12 (12%), with 6 (6%) clinically relevant. Resident/attending physician interrater agreement was moderate for both traditional otoscope (κ = 0.40) and CSO (κ = 0.47). Physicians agreed CSO was easy to use, enhanced TM visualization and diagnostic precision, and was a good teaching tool. Patients and parents also found the CSO images very helpful.
  
  
  CONCLUSIONS
  CellScope Oto was preferred by physicians, patients, and parents. Use of the CSO changed final diagnosis a significant number of times, including clinically relevant changes to/from AOM.
authors.affiliation: Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA. Electronic address: jrrichards@ucdavis.edu.
authors.forename: John R
authors.initials: JR
authors.lastname: Richards
authors.affiliation: Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA.
authors.forename: Kelsey A
authors.initials: KA
authors.lastname: Gaylor
authors.affiliation: Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA.
authors.forename: Ashley J
authors.initials: AJ
authors.lastname: Pilgrim
mesh_terms: D040421:Cell Phone; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005180:Faculty, Medical; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007396:Internship and Residency; D008297:Male; D010033:Otitis Media / Q000175:diagnosis*; D019720:Otoscopes; D038781:Otoscopy / Q000379:methods*; D017060:Patient Satisfaction; D011446:Prospective Studies; D014432:Tympanic Membrane