Author(s)
Andre Shomorony, MD
Rachel Weitzman, MD MPH
Hannah Chen, BS
Anthony Sclafani, MD MBA
Affiliation(s)
New York Presbyterian Hospital - Weill Cornell;
Abstract:
Educational Objective: At the conclusion of this presentation, participants should understand the diagnostic accuracy of an endoscopic otologic and rhinologic exam performed by the patient, using a portable endoscope and interpreted in real time by a remote otolaryngologist, and about the effectiveness of this strategy for examining patients' nasal cavities and ears during a telemedical visit.
Objectives: To determine the diagnostic accuracy of an endoscopic otologic and rhinologic examination performed by a patient and interpreted remotely by an otolaryngologist and to assess the feasibility of this system when conducting telemedical otolaryngology visits.
Study Design: Prospective quality improvement study in academic adult otolaryngology clinic.
Methods: 20 healthy subjects presented to an otolaryngology clinic between February and August 2022. Subjects performed a self-examination of their ears and nasal cavities using a commercially available endoscope under remote guidance by an otolaryngology provider over Zoom and subsequently underwent in-person exams by two providers. Subjects were surveyed about their experience. The providers' interrater reliability was calculated using Cohen's kappa coefficients and the ability to detect different anatomic structures and features by in-person examination vs. virtual examination was compared using Wilcoxon tests.
Results: The subjects' average age was 30 (SD 11.5) years. The interrater reliability between providers was excellent; kappa coefficients were 0.72 and 0.81 (p < 0.001) for virtual and in-person exams, respectively. Of the 3 anatomic structures within the ear exam, none showed a difference in detectability between virtual and in-person exams. Of the 12 structures in the nasal exam, 4 were better visualized in-person, 1 was better visualized by virtual exam, and 7 showed no difference. Subject satisfaction was excellent; the average likelihood of recommending this virtual technology to peers (1-10) was 8.65 (SD 1.4).
Conclusions: Patient self-examination of the ears and nose using a portable endoscope may be a feasible and affordable strategy for obtaining valuable physical exam data during telemedical otolaryngology visits.