Preferred Name

Alexandra Short

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.


Date of Graduation

Spring 2017

Document Type


Degree Name

Doctor of Audiology (AuD)


Department of Communication Sciences and Disorders


Brenda M. Ryals

Christopher G. Clinard

Lincoln C. Gray


With an average of 1 audiologist to every 20,000 people in developed countries and as many as 6.25 million people in developing countries, the need for audiology services in rural or underserved populations is evident (Swanepoel, et al., 2010). Telemedicine offers an affordable solution. Previous studies assessed digital otoscopy images for postsurgical follow-up (Kokesh, et al., 2008) as well as remote video otoscopy by telehealth technicians (Biagio, et al., 2013). These studies used traditional laptop based video otoscopes. The purpose of the present study was to determine whether more portable and less expensive systems, such as the CellScope and OTO App, could be used as effectively for referral and diagnosis of external and middle ear disease off-site (telemedicine). The study accomplished this by comparing diagnostic accuracy of CellScope images, determining rate of agreement for referral and obtaining an estimate of image quality.

Agreement within professional groups (audiologists – AUD, and otolaryngologists –ENT) and between professionals and the ‘gold’ standard were calculated from 195 comparisons. These agreement scores represented the accuracy with which both groups could specify a diagnosis. All groups were significantly different from each other (p The need for medical referral varied within and between professional groups as well as between CellScope images (pathology). However, two general trends were identified: 1.high agreement between ENTs and AUDs when need for referral was high; and 2. low agreement between the ENTs and AUDs when the need to refer was low. In general, the need for medical referral was rated as higher when the question addressed “immediate referral” or “referral prior to hearing aid fitting/earmold impression” as opposed to need for referral before audiometric testing. All CellScope images were scored by both professional groups as having at least the same quality as manual otoscopy.

We conclude that CellScope images can be used effectively for telemedicine with a high degree of accuracy and with good agreement for referral between otolaryngologists and audiologists.

index and abstract SHORT.docx (22 kB)
title page, acknowledgements, table of contents, abstract



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