Table III.
Summary of Articles in Qualitative Review for Otology/Neurotology.
| Author (year) | Discipline | Level of evidence | Country of origin | Study design and methods | Number of participants/sample size | Outcome measured | Key findings | Common themes |
|---|---|---|---|---|---|---|---|---|
| Arriaga (2010) | Otology/Neurotology | 4 | United States | Retrospective case series and feasibility study | 450 | Breakdown of procedures and diagnoses performed, patient satisfaction ratings | A telemedicine‐assisted neurotology clinic was successfully implemented in post‐Hurricane Katrina Louisiana. Patient satisfaction was equivalent between on‐site and telemedicine evaluations | Improved access to care; Feasibility; Patient satisfaction |
| Biagio (2014) | Otology/Neurotology | 4 | South Africa | Prospective case series | 140 | Patient demographics, independent ratings of video‐otoscopy quality, patient outcomes | Substantial agreement between diagnoses made from video‐otoscopy recordings and those from onsite evaluations. Quality of the video‐otoscopy recordings rated as acceptable or better in 87% of cases. | Improved access to care; Equivalency of diagnosis or outcomes; Importance of image or video quality |
| Bush (2016) | Otology/Neurotology | 2 | United States | Systematic review | 12 | Type of service offered, assessment of electrode‐specific measures and speech recognition, remote gain assessments, patient satisfaction ratings | Auditory rehabilitation services with hearing aids and cochlear implants may be offered via telemedicine. A significant concern is internet bandwidth limitations of remote clinics | Applicability of telemedicine |
| Erkkola‐Anttinen (2018) | Otology/Neurotology | 1 | Finland | Prospective, randomized control trial | 699 | Diagnostic quality of tympanic membrane measured with a structured video analysis independently by three physicians, parent's experience questionnaire, comparing teaching schedules for smartphone otoscopy performed by parents | After instruction, parents were able to perform smartphone otoscopy, however videos of sufficient technical quality for diagnosis were only obtained in 67% of cases | Equivalency or diagnosis or outcomes; Importance of image or video quality |
| Fletcher (2019) | Otology/Neurotology | 2 | United States | Prospective comparative within‐subject control study. | 13 | Routine audiometry, word recognition testing, AzBio and CNC testing | Cochlear implant evaluation testing results were comparable across remote and in‐person conditions | Equivalency of diagnosis or outcomes |
| Gupta (2017) | Otology/Neurotology | 4 | India | Case series, feasibility study | 3000 | Practice patterns, type of service offered, practice costs | Remote screening of otologic pathologies by trained technicians with a telemedicine device is feasible and cost‐effective in a rural area | Feasibility |
| Henry (2017) | Otology/Neurotology | 1 | United States | Prospective randomized control trial | 300 | Tinnitus Functional Index scores, to measure effectiveness of coping skills education provided with progressive tinnitus management | The group which underwent a telephone‐based skills education program showed far greater improvement in symptoms management than the in‐person wait‐list group | Patient satisfaction; Applicability of telemedicine |
| Hofstetter (2010) | Otology/Neurotology | 3 | United States | 16‐year retrospective analysis | 3000 | Time in months to obtain in‐person appointment after initial consultation, before and after implementation of telemedicine | Average wait time for an in‐person appointment dropped dramatically after store‐and‐forward telemedicine was incorporated into practice | Patient satisfaction |
| Kokesh (2008) | Otology/Neurotology | 4 | United States | Case series, prospective study | 70 | Intraprovider comparative concordance ratings, interprovider diagnostic concordance | Video‐otoscopy images of the tympanic membrane are comparable to an in‐person examination for assessment and treatment of patients following tympanostomy tubes. | Equivalency of diagnosis or outcomes |
| Kokesh (2009) | Otology/Neurotology | 3 | United States | Retrospective chart review | 1458 | Number and type of encounters, referrals patterns, travel costs | Travel costs and burdens to the patient were significantly reduced in a store‐and‐forward model where an audiologist communicates with an otolaryngologist | Feasibility; Decreased costs |
| Kokesh (2010) | Otology/Neurotology | 3 | United States | Case series with retrospective chart review | 90 | Recommended surgery from telemedicine and in‐person evaluation, estimated operative time | SAF telemedicine is as effective as in‐person evaluation for planning elective ear surgery | Equivalency of diagnosis or outcomes |
| Kokesh (2011) | Otology/Neurotology | 2 | United States | Retrospective observational study | 9559 | Technical requirements, clinical outcomes, patient costs and travel times | Similar clinical outcomes, and improved patient wait times and travel costs compared to in‐person specialty visits, for store‐and‐forward electronic consultations made to the Alaska Federal Health Care Access Network (AFHCAN) | Equivalency of diagnosis or outcomes; Patient satisfaction; Improved access to care. |
| Krumm (2011) | Otology/Neurotology | 5 | United States | Expert opinion and literature review | NA | Applications of teleaudiology as demonstrated in the literature | In otology, telehealth has historically been applied to tinnitus rehabilitation, and treatments involving cochlear implants and hearing aids | Applicability of telemedicine; Feasibility |
| Lundberg (2014) | Otology/Neurotology | 2 | South Africa, Sweden | Prospective observational study with matched controls | 180 | Concordance between onsite otomicroscopy and asynchronous assessments of video‐otoscopy recordings, calculated with intra‐ and inter‐rater agreements | The OMGRADE scale (image‐based grading scale for otitis media) accurately assesses for otitis media using video‐otoscopy recordings | Feasibility; Equivalency of diagnosis or outcomes |
| Luryi (2019) | Otology/Neurotology | 3 | United States | Retrospective single‐site study | 20 | AzBio scores, impedances, comfort and threshold levels, survey responses. | Threshold, comfort, and impedance levels not significantly different between telehealth and live sessions; high degree of patient satisfaction | Communication between clinicians; Equivalency of diagnosis or outcomes; Importance of image or video quality; Patient satisfaction |
| Mandavia (2018) | Otology/Neurotology | 4 | Nepal, United Kingdom | Cross‐sectional study; feasibility study | 56 | Concordance in primary diagnosis and decision to refer, determine through inter‐rater agreements | Development of a mobile video‐otoscopy device shows promise for use by trained nonmedical workers to screen for ear disease in remote settings | Improved access to care; Feasibility; Communication between providers |
| McCool (2018) | Otology/Neurotology | 3 | United States | Retrospective chart review | 1385 | telemedicine eligibility based on prespecified criteria, travel time | 62% of otolaryngology encounters in a VA hospital would likely be eligible for telemedicine. Patients with inner and middle ear problems were more likely eligible for telemedicine | Applicability of telemedicine; Patient satisfaction |
| Moberly (2017) | Otology/Neurotology | 4 | United States | Case series, prospective study | 210 | Diagnosis of digital otoscope eardrum images by 12 neurotologists, percentage correct compared to gold standard of diagnosis, level of confidence in diagnosis reported by reviewers | Digital otoscope images provided sufficient information for neurotologists to make correct diagnoses for some pathologies while others were more difficult to diagnose based on a still image | Equivalency of diagnosis or outcomes; Importance of image or video quality |
| Moshtaghi (2017) | Otology/Neurotology | 4 | United States | Prospective blinded observational study | 57 | Diagnostic concordance with classification of TM by blinded neurotologist, patient satisfaction ratings | Diagnosis made using smartphone otoscopy resulted in a concordant diagnosis 96% of the time; high degree of patient satisfaction | Equivalency of diagnosis or outcomes; Importance of image or video quality |
| Shah (2018) | Otology/Neurotology | 4 | United States | Case series, prospective study | 80 | Interrater reliability between video diagnosis and original diagnosis on pneumatic otoscopy | iPhone otoscopy provides reliable images when used by otolaryngologists but images obtained by parents are not suitable for use in diagnosis | Equivalency of diagnosis or outcomes; Importance of image or video quality |