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J Telemed Telecare. 2014 Sep;20(6):300-6. doi: 10.1177/1357633X14541038. Epub 2014 Jun 23.

Video-otoscopy recordings for diagnosis of childhood ear disease using telehealth at primary health care level.

Author information

  • 1Department of Communication Pathology, University of Pretoria, South Africa leigh.biagio@up.ac.za.
  • 2Department of Communication Pathology, University of Pretoria, South Africa Ear Sciences Centre, School of Surgery, University of Western Australia, Nedlands, Australia Ear Science Institute Australia, Subiaco, Australia.
  • 3Department of Communication Pathology, University of Pretoria, South Africa ENT Unit, Department of Clinical Science, Umeå University, Sweden.
  • 4Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Sweden.


We studied the diagnoses made by an otologist and general practitioner (GP) from video-otoscopy recordings on children made by a telehealth facilitator. The gold standard was otomicroscopy by an experienced otologist. A total of 140 children (mean age 6.4 years; 44% female) were recruited from a primary health care clinic. Otomicroscopic examination was performed by an otologist. Video-otoscopy recordings were assigned random numbers and stored on a server. Four and eight weeks later, an otologist and a GP independently graded and made a diagnosis from each video recording. The otologist rated the quality of the video-otoscopy recordings as acceptable or better in 87% of cases. A diagnosis could not be made from the video-otoscopy recordings in 18% of ears in which successful onsite otomicroscopy was conducted. There was substantial agreement between diagnoses made from video-otoscopy recordings and those from onsite otomicroscopy (first review: otologist κ = 0.70 and GP κ = 0.68; second review: otologist κ = 0.74 and GP κ = 0.75). There was also substantial inter-rater agreement (κ = 0.74 and 0.74 at the two reviews) and intra-rater agreement (κ = 0.77 and 0.74 for otologist and GP, respectively). A telehealth facilitator, with limited training, can acquire video-otoscopy recordings in children for asynchronous diagnosis. Remote diagnosis was similar to face-to-face diagnosis in inter- and intra-rater variability.

© The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

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