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Remote evaluation of video-otoscopy recordings in an unselected pediatric population with an otitis media scale
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Univ Pretoria, Dept Speech Language Pathol & Audiol, ZA-0002 Pretoria, South Africa.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology. Univ Pretoria, Dept Speech Language Pathol & Audiol, ZA-0002 Pretoria, South Africa.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
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2014 (English)In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 78, no 9, 1489-1495 p.Article in journal (Refereed) Published
Abstract [en]

Background: A recently validated image-based grading scale for acute otitis media (OMGRADE) can be used to assess tympanic membrane (TM) status. The aim of this study was to evaluate the validity and reliability of this scale for remote assessments of TM status using video-otoscopy recordings in an unselected pediatric population.

Method: Children 2-16 years attending a South African primary health clinic were offered an ear examination by an otologist using otomicroscopy. An ear and hearing telehealth facilitator then made video-otoscopy recordings (9 – 33 seconds) of the ears and uptakes were uploaded to a secure server for remote assessments in Sweden by an otologist and general practitioner at four- and eight-weeks post onsite assessment. TM appearance was judged according to the OMGRADE scale. Concordance between onsite otomicroscopy and asynchronous assessments of video-otoscopy recordings was calculated together with intra- and inter-rater agreements.

Results: One hundred and eighty ears were included. Concordance of TM classifications using the OMGRADE scale was found to be substantial (weighted kappa range 0,66-0,79). Intra- and inter-rater agreement (test-retest) was found to be substantial to almost perfect (weighted kappa range 0,85-0,88 and 0,69-0,72, respectively).

Conclusion: The OMGRADE scale can be used to accurately assess the normal TM and secretory otitis media (SOM) remotely using video-otoscopy recordings in an unselected pediatric population.

Place, publisher, year, edition, pages
2014. Vol. 78, no 9, 1489-1495 p.
National Category
Otorhinolaryngology
Research subject
Family Medicine; Oto-Rhino-Laryngology
Identifiers
URN: urn:nbn:se:umu:diva-86947DOI: 10.1016/j.ijporl.2014.06.018ISI: 000340983500016OAI: oai:DiVA.org:umu-86947DiVA: diva2:704999
Available from: 2014-03-13 Created: 2014-03-13 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Assessment of tympanic membrane: a study of children with otitis media in general practice
Open this publication in new window or tab >>Assessment of tympanic membrane: a study of children with otitis media in general practice
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Acute otitis media (AOM) is a common disease in children and is causing great discomfort and disability worldwide but many areas are underserved regarding skilled professional. Tele-otology offers a promising technique to provide ear health globally. Diagnostic accuracy of AOM has regardless of method been found to be low. Grading the severity of AOM my offer a guide in decision on antibiotic treatment, however grading systems need improvement.

Aim To describe and evaluate imaging of the tympanic membrane (TM), develop an image based grading scale for AOM and to study the characteristics and the course of acute otitis media (AOM) episodes in children with the use of telemedicine techniques.

Method This thesis is based on two study populations, 63 children attending with othalgia at four primary health care centers in rural Sweden (papers I, II, IV) and 140 children attending a health clinic from a township in Johannesburg, South Africa, (paper III).

Paper I: Image quality of endoscopic imaging of TM´s, from the Swedish study was assessed by an otologist and two general practitioners together with an evaluation of important characteristics of assessing TM appearance.

Paper II: In development and validation of an image-based grading scale of AOM two expert panels of otologist’s evaluated the proposed grading scale stepwise and in a test and retest validation process.

Paper III: A test of the scale in a clinical situation was set up, an otologist oto-microscopically examined children and used the grading scale, and his diagnoses were set as gold standard. A specially trained ear and hearing facilitator then recorded videos of the TM using video-otoscopy. Videos were remotely assessed by the same otologist and by a general practitioner twice; 4 and 8 weeks after the otologist’s on-site grading.

Paper IV: Children with othalgia were followed with assessments of their symptoms and signs over a period of 3 months. An assessment group of two general practitioners and one otologist evaluated TM images, tympanograms and recorded symptoms and make a diagnose.

Results The results from paper I show that image quality was good and the position and transparency of the TM was found to be the most important characteristics when assessing TM. In paper II the new grading scale (OMGRADE) was developed and validated. The image-based scale focuses on the position and transparency of the TM. The results from paper III showed that the OMGRADE scale could discriminate the normal ear as well as ears with otitis media with effusion (OME) in an unselected pediatric population. Paper IV showed that the bilateral AOM had more severe symptoms. The children with chagrinated TM’s took the longest time to resolve regarding TM appearance and tympanograms. Furthermore, symptoms resolved quicker than TM changes and tympanograms during the first week.

Conclusions TM images or video recordings taken by a trained nurse or facilitator are sufficient for remote evaluation. The new grading scale of TM appearance is valid and reliable and may function as a diagnostic guide together with evaluation of middle ear effusion. TM appearance may be of importance in grading the severity of an AOM episode. 

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2014. 61 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1635
National Category
Otorhinolaryngology
Research subject
Family Medicine; Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:umu:diva-86949 (URN)978-91-7601-027-3 (ISBN)
Public defence
2014-04-04, Sal 135, byggnad 9, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
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Available from: 2014-03-14 Created: 2014-03-13 Last updated: 2014-03-14Bibliographically approved

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