Digital Otoscopy in the Pediatric Emergency Department

BACKGROUND/OBJECTIVES: Otoscopy is a fundamental yet challenging skill for pediatric trainees. Otoscopy can be uncomfortable for children, particularly if repeat examinations are required. Digital otoscopy (DO) allows clinicians to record and review otoscopic images. This study evaluated whether trainees' use of DO could reduce repeat examinations by supervisors, and its perceived educational value to trainees. METHODS: We conducted a prospective observational study in a pediatric emergency department in New York City. Pediatric, emergency medicine, and pediatric nurse practitioner trainees used DO to record ear exams in children presenting with fever, upper respiratory symptoms, or otalgia. Trainees presented all cases to a pediatric emergency medicine attendings or fellows who served as supervisors. Trainees completed pre- and postrotation surveys assessing confidence in otoscopy, ability to diagnose acute otitis media (AOM), and satisfaction with otoscopy education. The primary outcome was "first examine success" defined as the supervisor not needing to repeat the examination of the patient's tympanic membranes (TM). Logistic regression was used to identify factors associated with first-exam success. Ratings of DO's value as a diagnostic and teaching tool were also collected. RESULTS: Sixty-seven trainees and 368 patients were included. In 276 (75%) encounters, no repeat exam by the supervisor was needed. First-exam success was independently associated with age ≥2 years, higher training level, and >50% TM visualization. Trainee confidence in performing otoscopy, diagnosing AOM, and educational satisfaction increased significantly postrotation. Of all trainees, 66 (97%) and 57 (85%) agreed that DO was a superior teaching and diagnostic tool, respectively. CONCLUSION: DO eliminated the need for repeated exams in the majority of patients. Trainees considered it a superior teaching and diagnostic tool compared with conventional otoscopy.