Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco.
University of California School of Medicine, San Francisco.
JAMA Otolaryngol Head Neck Surg. 2021 Apr 1;147(4):336-342. doi: 10.1001/jamaoto.2020.5223.
During the novel coronavirus disease 2019 pandemic, telehealth has become a vital component of health care delivery. For otolaryngology evaluations, examination of the ear and oropharynx is important but difficult to achieve remotely.
To assess the feasibility of patient use of low-cost digital videoscopes and smartphones for examination of the ear and oropharynx.
DESIGN, SETTING, AND PARTICIPANTS: A prospective quality improvement study was conducted in an academic adult otolaryngology clinic including 23 patients who presented for an in-person appointment and owned a smartphone device. The study was conducted from July 1 to 15, 2020.
Participants were asked to capture pictures and videos of their ear canals and oropharynx with digital videoscopes and their smartphones under real-time guidance over a telehealth platform. They were then surveyed about their experience.
The primary outcomes were ratings by health care clinicians and a blinded otolaryngologist reviewer of image acceptability. Secondary outcomes included participant time to image acquisition and willingness to purchase digital videoscopes for telehealth use.
Of the 23 participants included, 14 were women (61%); mean age was 50 years (range, 21 to 80 years). Of the images obtained using the digital otoscope ear examination, 95% were considered acceptable by the health care clinicians and 91% were considered acceptable by the blinded reviewer; 16 participants (70%) reported that the otoscope was easy to use. The mean time to acquire images for both ears was 114 seconds (95% CI, 84-145 seconds). Twenty-one participants (91%) were willing to pay for a digital otoscope for telehealth use. For the oropharyngeal examination, a greater proportion of smartphone video examinations were considered acceptable by clinicians (63% acceptability) and the blinded reviewer (55%) compared with the digital endoscope (clinicians, 40%; blinded reviewer, 14%). The mean time required for the oropharyngeal examination smartphone video capture was shorter at 35 seconds compared with both the digital endoscope (difference, -27 seconds; 95% CI, -7 to -47 seconds) and smartphone photo capture (difference, -53 seconds; 95% CI, -20 to -87 seconds).
Digital otoscopes and smartphones apparently can facilitate remote head and neck physical examination in telehealth. Digital otoscopes were useful for ear examinations, and smartphone videos appeared to be the most useful for oropharyngeal examinations. Further studies are required to determine specific diagnostic capabilities in various telehealth practice settings.
在 2019 年新型冠状病毒病大流行期间，远程医疗已成为医疗保健服务的重要组成部分。对于耳鼻喉科评估，检查耳朵和口咽很重要，但远程实现起来很困难。
评估患者使用低成本数字内镜和智能手机进行耳部和口咽检查的可行性。
设计、设置和参与者：这是一项在学术成人耳鼻喉科诊所进行的前瞻性质量改进研究，包括 23 名因个人预约就诊并拥有智能手机设备的患者。该研究于 2020 年 7 月 1 日至 15 日进行。
参与者被要求在远程医疗平台上实时指导下使用数字内镜和智能手机拍摄他们的耳道和口咽的照片和视频。然后他们接受了关于他们体验的调查。
主要结果是医疗保健临床医生和盲法耳鼻喉科审查员对图像可接受性的评分。次要结果包括参与者获取图像的时间以及他们是否愿意为远程医疗使用购买数字内镜。
在纳入的 23 名参与者中，有 14 名女性（61%）；平均年龄为 50 岁（范围，21 至 80 岁）。使用数字耳镜进行耳部检查获得的图像中，有 95%被临床医生认为是可接受的，有 91%被盲法审查员认为是可接受的；16 名参与者（70%）表示耳镜易于使用。双耳采集图像的平均时间为 114 秒（95%置信区间，84-145 秒）。21 名参与者（91%）愿意为远程医疗使用付费购买数字耳镜。对于口咽检查，智能手机视频检查的可接受性被临床医生（63%）和盲法审查员（55%）认为高于数字内镜（临床医生，40%；盲法审查员，14%）。与数字内镜（差异，-27 秒；95%置信区间，-7 至-47 秒）和智能手机照片采集（差异，-53 秒；95%置信区间，-20 至-87 秒）相比，智能手机视频采集口咽检查的平均时间更短，为 35 秒。
数字耳镜和智能手机显然可以促进远程头部和颈部体检在远程医疗中的应用。数字耳镜对耳部检查有用，而智能手机视频似乎对口咽检查最有用。还需要进一步的研究来确定在各种远程医疗实践环境中的特定诊断能力。
