Video otoscopy: Bringing otoscopy out of the "black box"

Background: Several billion dollars are spent each year on otitis media, a diagnosis for which educational approaches and diagnostic skills are suboptimal. The Center for Disease Control has identified improvement in otoscopy skills as a key intervention to curb inappropriate antibiotic usage. Educators are looking for interventions to both improve and assess otoscopy skills. Video otoscopy (VO) uses endoscopic technology to project the image of the ear onto a monitor for all to see, offering unexplored educational opportunity. The objective of this study is to perform an evaluation of VO systems in medical education from a review of the literature and hands-on experience of available technology. Methods: The evaluation will focus on the technical acceptability (user requirements), clinical appropriateness (validity, reliability, feasibility), operational effectiveness (training requirements and implementation), and equipment selection. Results: The technical requirements in pediatric education exceed those available in some VO systems, specifically pneumatic capability, sophisticated cameras and optics, and pediatric-sized ear speculums. VO images are comparable to the conventional otoscopic and otomicroscopic examinations. VO is feasible in a primary care setting and can be integrated into resident and medical student education. The technology in VO systems is changing rapidly, necessitating comparison of systems before equipment is purchased. Conclusions: VO is technically acceptable, clinically appropriate and can be integrated into the otoscopic education of residents and medical students. VO provides an opportunity to bring the pediatric ear examination out of the "black box," potentially improving diagnostic skills, quality of care, and reducing antibiotic overuse.