2 minute read
A Picture Is Worth a Thousand Words: Utilizing Smartphone Technology in the Evaluation of ENT Emergencies
By Seth Lotterman, MD
Telemedicine is not a new tool and has been available and used by emergency physicians for some time. For example, many emergency physicians are familiar with the use of teleneurology during the evaluation of patients with neurologic emergencies. However, the COVID-19 pandemic has sped up the adoption of telemedicine in a variety of other settings. Improved infrastructure, such as the advent of broadband wireless and improvements in smartphone camera and video capabilities, along with HIPAA compliant text messaging applications, have increased the potential capabilities of telemedicine. These innovations allow for transmission of clinically useful images to consultants who are not able to immediately evaluate an emergency department patient at the bedside. Many community emergency departments lack subspecialty coverage and the ability to transmit images with high enough quality to assist in real-time medical decisions can be extremely helpful and may help avoid unnecessary transfers. Recent studies using images obtained with smartphones demonstrated that the image quality was sufficient to allow for remote attending otolaryngologists to assess nystagmus with the performance of the Dix-Hallpike maneuver to facilitate the diagnosis of benign positional peripheral vertigo (BPPV) and to assess for the presence of a retropharyngeal abscess. In one study, by Shah et al, a smartphone was used to record a patient’s eye movements during the performance of the Dix-Hallpike test and the video was later viewed by attending neuro-otologists, who were able to identify BPPV with 85% sensitivity
and 100% specificity. In the other study by Mallen et al. “Utility of Smartphone Telemedical Consultations for Peritonsillar Abscess Diagnosis and Triage” video recordings of patients with suspected peritonsillar abscesses were reviewed by attending otolaryngologists who were able to diagnose PTA with 83% accuracy and moderate agreement between the attending otolaryngologists. All but one of the videos was felt to be of high enough quality to make a diagnosis.
This technology could be also used in the evaluation of a patient with airway obstruction by sending clips of fiberoptic laryngoscopy for otolaryngology review. Invited commentary by Thal and Mehta regarding the retropharyngeal abscess article discussed that potential for improvement in patient care, decreasing wait times and reducing the use of unnecessary radiologic imaging and developing algorithms to manage otolaryngology conditions such as otitis externa, sialadenitis, and neck abscess.
While there have been significant strides and growth in the implementation of telemedicine in the general medical community, the COVID-19 pandemic has accelerated the use of telemedicine in many facets of the medical community. The use of telemedicine has the potential to decrease unnecessary transfers and facilitate timely outpatient follow-up. The author hopes that this will continue to be utilized and result in more efficient and improved patient care.
ABOUT THE AUTHORS
Dr. Lotterman is assistant residency program director and assistant professor of emergency medicine at the University of Connecticut.
