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

2008; Wiley; Volume: 139; Issue: 1 Linguagem: Inglês

10.1016/j.otohns.2008.04.008

1097-6817

John Kokesh, A. Stewart Ferguson, Chris Patricoski, Kathryn R. Koller, Greg Zwack, Ellen Provost, Peter Holck,

Sinusitis and nasal conditions

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.Comparative concordance, diagnostic reliability.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.Intraprovider concordance for physical examination findings was: "Tube in," 94 percent -97 percent (kappa = 0.89-0.94); "Tube patent," 94 percent -97 percent (kappa = 0.89-0.94); "Drainage," 90 percent -96 percent (kappa = -0.04-0.38); "Perforation," 90 percent -96 percent (kappa = 0.61-0.82); "Granulation," 97 percent -100 percent (kappa = 0.49-1.0); "Middle ear fluid," 88 percent -96 percent (kappa = 0.28-0.71); "Retracted," 83 percent -91 percent (kappa = 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 (kappa = 0.64-0.71) and 77 percent -88 percent (kappa = 0.66-0.81) when poor images were excluded. Interprovider diagnostic concordance for the in-person exam was 89 percent (kappa = 0.83).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.