@article{AJO5227,
author = {Alexander John Saxby and Daniel Schofield and Fiona Tout and Joseph Gordon and Misha Verkerk and Tim Watson and Natasha Niles and Nicholas Jufas and Jonathan Kong and Nirmal Patel and Katrina Ward and Judith Caswell},
title = {The EarPAD project: a tele-otology study for remote Aboriginal communities},
journal = {Australian Journal of Otolaryngology},
volume = {9},
number = {0},
year = {2026},
keywords = {},
abstract = {Background: The EarPAD project studied how a telehealth tool compared to conventional in-person clinical consultation in diagnosing otological presentations in remote Aboriginal medical clinics in New South Wales, Australia. The study combined a broad spectrum of tele-health tools as a collective method of ear disease analysis. Secondary aims were to analyse the individual tele-otology components in comparison to gold standard alternatives and to assess cultural appropriateness and ease of application in a remote clinic setting.Methods: This was a prospective diagnostic accuracy study. Patients over the age of 4 years with an ear complaint were sequentially examined by the telehealth tools then a clinical examination with an otolaryngologist, who was blinded to the telehealth findings. Telehealth components included a digital patient history questionnaire (PHQ), video otoscopy, tympanometry and automated audiometry. Tele-data was later assessed by two other otolaryngologists independently, blinded to the onsite surgeon’s findings with comparison of the clinical interpretations. Secondary outcomes included (I) comparison of video otoscopy to conventional microscopy; (II) automated audiometry compared to those performed by a qualified audiometrist; (III) patient experience and cultural appropriateness.Results: 51 patients (102 ears) were enrolled, with a mean age of 35.4 years [standard deviation (SD) ±27.7; range 4–92 years]. Automated audiometry correlated well with the audiometrist led audiogram. It successfully diagnosed hearing loss [defined as >25 decibels hearing level (dB HL)] with a sensitivity of 83.7% [95% confidence interval (CI): 79.9–87.5%] and specificity of 56.1% (95% CI: 51.0–61.2%). Tympanometry showed a moderate correlation (Cohen’s Kappa Coefficient of 0.52). Subjective appraisal of video-otoscopy quality by the offsite surgeons was deemed poor in the majority of cases (57.8%) and only a small percentage (3.7%) were categorized as “good”. A definitive clinical diagnosis was only recorded in approximately half of the potential cases (113 of the pooled 204 cases, 55.3%). When given, offsite diagnosis agreed with the gold standard in 92 cases (81.4%). Analysis by age showed an improved diagnostic capability within the adult subgroup. Calculation of diagnostic accuracy, excluding non-diagnosis cases, comparing normal to abnormal ears, showed an overall sensitivity of 88.7% (95% CI: 80.8–96.6%) and specificity of 76.5% (95% CI: 68.6–84.3%). Paediatric (n=50) vs. adult (n=63) subsets showed a sensitivity of 81.5% (95% CI: 66.8–96.1%) vs. 94.3% (95% CI: 86.6–100%) and a specificity of 69.6% (95% CI: 54.9–84.2%) vs. 82.1% (95% CI: 74.5–89.8%) respectively. The most commonly correctly identified diagnoses were tympanic membrane perforation and middle ear effusion.Conclusions: The EarPAD collection of tele-otology tools have clinical relevance but also highlight several challenges that need to be overcome before successful adoption into the health system. Refinements are necessary before wide adoption but in principle, the use of a multi-faceted approach to tele-otology is valid and useful. Six recommendations are presented for more successful future tele-otology projects.},
issn = {2616-2792}, url = {https://www.theajo.com/article/view/5227}
}