Figure 3: Diagrams displaying symptom-specific algorithms for
(left to right) ear pain, runny ear and hearing loss. Demographic data,
as well as past medical history, drug history and allergies were also
collected by the questionnaire.
Next, the same nurse administering the questionnaire captured brief
otoscopic videos of each ear using the Cupris TYM device (a platform we
have previously shown to be valid for expert
tele-diagnosis5) attached to an Apple iPhone 5S mobile
phone (Apple Inc., Cupertino). Videos were encrypted and stored. Because
nurses were naïve to the device, they were given a short tutorial
(author [removed for blind peer review]) before the study commenced,
and trialled the device on ten consenting individuals.
Finally, each participant underwent assessment by one of two resident
ENT specialists. They took a targeted clinical history (with open
responses) in the Khmer language, performed oto-endoscopy, and recorded
their diagnosis. In cases where wax precluded a full oto-endoscopic
view, data were removed from final analyses. Specialist assessment was
blind to previous assessment, and conducted in a separate area.