Reliability of a Tailored Tele-Medicine Model for Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) Clinical Practice in Remote Areas of Nepal: A Pilot Study from Tertiary Referral Center.

Abstract

Introduction: Despite the ever-expanding scope of telemedicine, studies regarding its application in the field of otorhinolaryngology-head and neck surgery (ORL-HNS) in remote parts of the world are lacking. This pilot study aims to bridge the research gap and to assess the efficacy of our tailored telemedicine clinic model, operating in an "asynchronous" mode, in diagnosing various ORL-HNS diseases. Methods: This is a cross-sectional study conducted at a tertiary care center of Nepal. An asynchronous telemedicine portal was used with a store and share approach to telecast the pen endoscopic camera findings to the consultant in order to formulate a diagnosis and a management plan. Interobserver reliability was assessed using SPSS version 26 based on Cohen's kappa. The association between the results of the Mimi Hearing App (v. 5.0) and pure tone audiometry were performed using chi-square test. Results: The overall diagnostic agreement in our study was substantial to almost perfect with kappa values of .843, .784, .737, and .764 for rhinology, head and neck, otology, and pediatric cases. Chronic otitis media was the predominant diagnosis across all age groups. Various head and neck swellings, symptomatic deviated nasal septum and chronic rhinosinusitis with polyposis followed closely. Discussion: The future of telemedicine in otorhinolaryngology can be gauged to be effective in reducing cost and human resource use in the limited setting of Nepal with the model allowing for remote but effective communication between the concerned patients and the expert doctor in clarifying doubts and making diagnosis, early recognition of diseases and preventing or decreasing complications of those diseases.