Introduction Video otoscopy plays an important role in improving access to ear health services. This study investigated the clinician-rated quality of video otoscopy recordings and still images, and compared their suitability for asynchronous diagnosis of middle-ear disease. Methods Two hundred and eighty video otoscopy image–recording pairs were collected from 150 children (aged six months to 15 years) by an ear, nose, and throat (ENT) specialist, audiologists, and trained research assistants, and independently rated by an audiologist and ENT surgeon. On a five-point scale, clinicians rated the cerumen amount, field of view, quality, focus, light, and gave an overall rating, and asked whether they could make an accurate diagnosis for both still images and recordings. Results More video otoscopy recordings were rated as ‘good’ or ‘excellent’ compared to still images across all domains. The mean difference between the two otoscopic procedures ratings was significant across almost all domains ( p < 0.05), except ‘cerumen amount’. The suitability to make a diagnosis significantly improved when using recordings (p<0.05). Younger participant age was found to have a significant, negative impact on the ratings across all domains ( p < 0.03). The role of the tester conducting video otoscopy did not have a significant impact on the ratings. Discussion Video otoscopy recordings were found to provide clearer views of the tympanic membrane and increase the ability to make diagnoses, compared to still images, for both audiologists and ENT surgeons. Research assistants with limited practice were able to obtain video otoscopy images and recordings that were comparable to the ones obtained by clinicians.

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Objective: To compare the asynchronous assessment of video otoscopic still images to recordings by an audiologist and ear, nose and throat surgeon (ENT) for diagnostic reliability and agreement in identifying middle-ear disease. Design:A prospective cross-sectional study, asynchronously assessing video otoscopy, tympanometry and case history (Dx1). A subset was re-diagnosed (Dx2). Study sample:Video otoscopy and data from 146 children recruited at two public community events; a sub-set of 47 were re-assessed. Results:The intra-rater diagnostic agreement between Dx1 and Dx2 was moderate (k=0.445-0.552) for the ENT surgeon, and almost-perfect (k=0.928) for the audiologist, in both procedures. The agreement between the two procedures was substantial (k= 0.624) and moderate (k=0.416) for the ENT surgeon in Dx1 and Dx2 respectively, and almost-perfect for the audiologist (k=0.854-0.978) in both rounds. In Dx1, the inter-rater agreement between the clinicians was substantial using still images (k=0.672) and moderate using recordings (k=0.593); in Dx2 it was moderate using both procedures (k=0.477-0.488). Conclusion:Both video otoscopic procedures, in addition to tympanometry and case history information, can be reliably used for asynchronous diagnosis of childhood middle-ear disease. An audiologist has a potential role in triaging children with middle-ear abnormalities and, therefore, improving access to earhealth services.