Digital images for postsurgical follow-up of tympanostomy tubes in remote Alaska

Abstract

Objective

To determine if video otoscope still images of the tympanic membrane taken in remote clinics are comparable to an in-person microscopic examination for follow-up care.

Design

Comparative concordance, diagnostic reliability.

Methods

Community health aide/practitioners in remote Alaska imaged 70 ears following tympanostomy tube placement. The patients were then examined in person by two otolaryngologists. Images were later reviewed at 8 and 14 weeks.

Results

Intraprovider concordance for physical examination findings was: “Tube in,” 94 percent-97 percent (κ = 0.89-0.94); “Tube patent,” 94 percent −97 percent (κ = 0.89-0.94); “Drainage,” 90 percent-96 percent (κ = –0.04-0.38); “Perforation,” 90 percent −96 percent (κ = 0.61-0.82); “Granulation,” 97 percent −100 percent (κ = 0.49-1.0); “Middle ear fluid,” 88 percent −96 percent (κ = 0.28-0.71); “Retracted,” 83 percent-91 percent (κ = 0.26-0.58). These agreement rates are similar to interprovider concordance when two otolaryngologists examine the same patient in person. Intraprovider concordance for diagnoses was 76 percent −80 percent (κ = 0.64-0.71) and 77 percent −88 percent (κ = 0.66-0.81) when poor images were excluded. Interprovider diagnostic concordance for the in-person exam was 89 percent (κ = 0.83).

Conclusion

Video-otoscopy images of the tympanic membrane are comparable to an in-person examination for assessment and treatment of patients following tympanostomy tubes. Store-and-forward telemedicine is an acceptable method of following patients post tympanostomy tube placement.