Moshtaghi Omid, Sahyouni Ronald, Haidar Yarah M, Huang Melissa, Moshtaghi Afsheen, Ghavami Yaser, Lin Harrison W, Djalilian Hamid R
1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head & Neck Surgery, University of California, Irvine, Irvine, California, USA.
2 Division of Neurotology and Skull Base Surgery, Department of Biomedical Engineering, University of California, Irvine, Irvine, California, USA.
Otolaryngol Head Neck Surg. 2017 Mar;156(3):554-558. doi: 10.1177/0194599816687740. Epub 2017 Jan 24.
Objective A smartphone-enabled otoscope (SEO) can capture tympanic membrane (TM) images. We sought to compare a SEO to microscopic otoscopy in the detection and evaluation of TM pathology in an otology/neurotology practice. Study Design Prospective single-site study in adults presenting over a 3-month period. Setting Neurotology clinic within a tertiary care academic medical center. Subjects and Methods Following consent, 57 patients underwent a medical and microscopic ear examination. Afterward, clinicians photographed bilateral TMs using a SEO. A second "blinded" neurotologist received a SEO-acquired image of each TM and a brief patient history. Our primary end point was identification of TM pathology (or lack thereof) and the blinded neurotologists' corresponding diagnosis. Secondary end points included patient-reported SEO comfort levels. Results A single SEO-acquired TM image and brief patient history resulted in correct diagnosis of 96% (23/24) of normal TMs and identification of 100% (33/33) of microscope-confirmed abnormal TMs. When pathology was identified by the "blinded" physician, the diagnosis was identical to that made by the primary treating physician 82% (27/33) of the time. On patient surveys, 93% (53/57) of patients felt "very comfortable" with SEO utilization, and 88% (50/57) reported viewing acquired images was "very useful" in understanding their condition. Conclusion A SEO is 96% specific in identifying normal TMs and 100% sensitive in identifying pathology. Its 97% positive predictive value and small false-positive rate makes it a useful screening tool. Furthermore, patients are receptive to this technology and felt comfortable with its utilization in a health care or possible telemedicine setting.
目的 一款具备智能手机功能的耳镜（SEO）能够采集鼓膜（TM）图像。我们试图在耳科学/神经耳科学实践中，比较SEO与显微镜耳镜检查在检测和评估TM病变方面的效果。研究设计 对3个月内前来就诊的成年人进行前瞻性单中心研究。研究地点 一家三级医疗学术医学中心的神经耳科诊所。研究对象与方法 获得患者同意后，57例患者接受了耳部医学检查和显微镜检查。之后，临床医生使用SEO拍摄双侧TM的照片。另一位“不知情”的神经耳科医生收到了每张TM的SEO采集图像以及简短的患者病史。我们的主要终点是确定TM病变（或无病变）情况以及这位不知情的神经耳科医生的相应诊断。次要终点包括患者报告的使用SEO的舒适度。结果 一张SEO采集的TM图像和简短的患者病史能够正确诊断96%（23/24）的正常TM，并且能够识别100%（33/33）经显微镜确认的异常TM。当“不知情”的医生识别出病变时，其诊断与主治医生的诊断在82%（27/33）的情况下是一致的。在患者调查中，93%（53/57）的患者对使用SEO“非常满意”，88%（50/57）的患者表示查看采集的图像“非常有助于”了解自身病情。结论 SEO在识别正常TM方面的特异性为96%，在识别病变方面的敏感性为100%。其97%的阳性预测值和较低的假阳性率使其成为一种有用的筛查工具。此外患者接受这项技术，并且对在医疗保健或可能的远程医疗环境中使用它感到满意。
