The Earphone Project pilot: a tele-otology study for remote Aboriginal communities

Background: The Earphone Project aims to create a suite of tele-otology tools that enable an Aboriginal Health Worker in a remote setting to perform an otological assessment of a patient including an automated audiogram, tympanometry, patient history questionnaire and video otoscopy. Methods: This prospective pilot study enrolled patients over four years of age presenting with an ear complaint to Ear, Nose and Throat (ENT) clinics from June 2019 and May 2021. Patients were assessed with three different automated audiometers, two different video otoscopes and one handheld tympanometer plus a tablet based multiple choice medical history questionnaire. Device performance was assessed, and the effectiveness of the study protocol was evaluated. Outcome measures included assessment of image quality, patient experience and audiometry and tympanometry concordance with gold standard audiologist-led assessments as well as concordance of the tele-otology diagnosis with a face-to-face clinical diagnosis by a senior otolaryngologist. This was aimed at creating a robust protocol to take through to a larger study where the primary outcome measure would be diagnostic concordance. Results: Tele-assessment was successful in determining an abnormal from normal ear with an overall accuracy of 78.4% giving it a sensitivity, specificity, positive and negative predictive value of 81.3%, 73.1%, 84.8%, 67.9% respectively. All three automated audiometers met the standard required with a high concordance to gold standard audiometry. The HearTest phone-based audiometer was considered the best performing audiometer with the highest accuracy (89.1%). The HearScope video otoscope produced the best quality of image and had a superior image-capture system. The handheld Amplivox tympanometer had excellent concordance with gold standard tympanometry. The history questionnaire was considered appropriate and adequate to the needs of teleassessment. Patient feedback was overall extremely positive. Conclusions: This pilot study enabled selection of which telehealth tools were the most suitable for use in the future main Aboriginal community study. The study design proved to be robust and fit for purpose. Valuable conclusions were drawn to optimize the main study to follow.