Q&A: Videoscopes, smartphones may allow for ear, oropharyngeal exams via telehealth

Using digital videoscopes and smartphones may be a feasible method to conduct head and neck physical examinations during telehealth visits, according to a study recently published in JAMA Otolaryngology – Head & Neck Surgery.

Researchers conducted a pilot prospective quality improvement study at an otolaryngology clinic involving 23 patients who presented for in-person visits and had a smartphone from July 1, 2020, to July 15, 2020.

For the study, clinicians used video conferencing software to direct participants through the process of taking self-examination images and survey them on their experience. Participants were in a separate room from research staff to simulate remote visits with video-based physical exams.

Video recordings of the exams were taken with commercially available digital endoscopes and otoscopes that were connected to computers used by the participants.

Participants first used the digital endoscope to examine their oropharynx and then used the digital otoscope to examine their ears. Then, participants took photos and videos of their oropharynx on their smartphones using the rear-facing camera with flash.

Afterword, participants completed questionnaires on their experience with the digital cameras and their smartphones.

Clinicians and a blinded reviewer who was an otolaryngologist assessed the images taken by patients for their acceptability in clinical examinations.

Of the obtained images, 95% were considered acceptable by clinicians, while 91% were considered acceptable by the reviewer.

Among participants, 70% said that the otoscope was easy to use, and 91% said that they were willing to pay for a digital otoscope for telehealth visits.

In oropharyngeal examinations, 63% of images were considered acceptable by clinicians and 55% were considered acceptable by the blinded reviewer. These images were more acceptable than digital endoscope images, 40% of which were considered acceptable by clinicians and 14% by the reviewer.

Researchers determined that the mean time needed for oropharyngeal captures on smartphones — 35 seconds — was shorter than digital endoscopes (difference = 27 seconds; 95% CI, 7 to 47 seconds) and smartphone videos (53 seconds; 95% CI, 20 to 87 seconds).

Healio Primary Care spoke with study author Yi Cai, MD, an otolaryngology resident in the School of Medicine at the University of California, San Fransisco, to learn more about the findings and how the use of this technology could impact telehealth visits.

Q: What additional research is needed before these methods can be used regularly in telehealth visits?

A: Our study showed that patient-obtained physical examination images of the ears using a digital otoscope and the oropharynx using a smartphone provided useful clinical images for otolaryngology providers. The simulated telehealth encounters were conducted over high-speed internet connections at our clinics. Additional research is needed to assess whether our reported methods would require adaptation for patients using these image capture devices with lower speed internet connectivity at home. Furthermore, our work assessed the usefulness of patient-acquired images rather than diagnostic accuracy for various conditions, which would also be a helpful focus for future work.

Q: How can patients' use of digital videoscopes and smartphones improve telehealth visits?

A: The current coronavirus pandemic has led to an uptake in the practice of patients completing telehealth appointments from their homes. Under these circumstances, examination of the ear and oropharynx are especially challenging due to limited illumination and the small size of these anatomic regions. Our study suggests commercially available digital videoscopes and smartphones provide feasible solutions to this dilemma, thus expanding the comprehensiveness of achievable remote physical examination during telehealth for patients at home.

Q: Is it plausible to expect patients undergoing these exams to purchase digital videoscopes?

A: Given the time and costs (direct or indirect) of attending an in-person appointment, patients who would be able to avoid in-person visits through use of a digital videoscope or otherwise significantly improve their routine at-home telehealth visits could be expected to purchase these devices. In our study, there was a high degree of patient willingness to purchase a digital videoscope if they were able to utilize it during telehealth visits. These commercially available devices are also readily available to consumers for personal use, so some patients may already own these devices.

In addition, provider clinics, emergency departments and inpatient services could feasibly purchase these videoscopes to facilitate specialist referrals or consultations, especially when specialty care is not readily available or needed quickly. Though not directly assessed in our study, provider use of these devices would likely also produce a high yield of clinically useful images.

Q: Which patients would benefit most from the use of smartphones and digital videoscopes for remote exams?

A: Patients with an established diagnosis of an otologic and/or oropharyngeal condition that requires basic, serial examinations (including post-operative patients) would derive the most benefit in potential time and cost savings. For patients without focused otolaryngologic complaints, these devices are also helpful for improving routine physical examination over telehealth. Given the ubiquity of smartphones, patient smartphone use to facilitate more directed examination of the tonsils and throat for a variety of basic exams would be beneficial to a broad population. Lastly, for patients who are seeking an expedited evaluation for otolaryngologic complaints using telehealth, these devices may improve patient triage of patients requiring in-person versus remote appointments.

Q: Will these strategies be evaluated in children?

A: Case reports published during the current pandemic have illustrated successful parental use of self-purchased digital videoscopes in obtaining useful otologic images for pediatric examination purposes. There is a need to evaluate this approach with objective data and clinician ratings as well as strategies for remote pediatric oropharyngeal examination. Future directions for our work include investigating the use of these strategies for parent-assisted image capture in remote pediatric examination.