Feasibility of asynchronous and automated telemedicine in otolaryngology: Prospective cross-sectional study

Dongchul Cha, Seung Ho Shin, Jungghi Kim, Tae Seong Eo, Gina Na, Seonghoon Bae, Jinsei Jung, Sung Huhn Kim, In Seok Moon, Jaeyoung Choi, Yu Rang Park

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations


Background: COVID-19 often causes respiratory symptoms, making otolaryngology offices one of the most susceptible places for community transmission of the virus. Thus, telemedicine may benefit both patients and physicians. Objective: This study aims to explore the feasibility of telemedicine for the diagnosis of all otologic disease types. Methods: A total of 177 patients were prospectively enrolled, and the patient’s clinical manifestations with otoendoscopic images were written in the electrical medical records. Asynchronous diagnoses were made for each patient to assess Top-1 and Top-2 accuracy, and we selected 20 cases to conduct a survey among four different otolaryngologists to assess the accuracy, interrater agreement, and diagnostic speed. We also constructed an experimental automated diagnosis system and assessed Top-1 accuracy and diagnostic speed. Results: Asynchronous diagnosis showed Top-1 and Top-2 accuracies of 77.40% and 86.44%, respectively. In the selected 20 cases, the Top-2 accuracy of the four otolaryngologists was on average 91.25% (SD 7.50%), with an almost perfect agreement between them (Cohen kappa=0.91). The automated diagnostic model system showed 69.50% Top-1 accuracy. Otolaryngologists could diagnose an average of 1.55 (SD 0.48) patients per minute, while the machine learning model was capable of diagnosing on average 667.90 (SD 8.3) patients per minute. Conclusions: Asynchronous telemedicine in otology is feasible owing to the reasonable Top-2 accuracy when assessed by experienced otolaryngologists. Moreover, enhanced diagnostic speed while sustaining the accuracy shows the possibility of optimizing medical resources to provide expertise in areas short of physicians.

Original languageEnglish
Article numbere23680
JournalJMIR Medical Informatics
Issue number10
StatePublished - Oct 2020


  • Asynchronous
  • Automated diagnosis
  • COVID-19
  • Cross-sectional
  • Diagnosis
  • Feasibility
  • Otolaryngology
  • Otology
  • Telemedicine


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