Specialist commentator comments

Comments on this technology were invited from clinical specialists working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Three of the 4 specialist commentators were familiar with this technology and 2 stated they had used it before.

Level of innovation

All 4 specialist commentators thought that the TYM smartphone otoscope was innovative, mainly because the otoscopy can be done using a smartphone instead of having to use a dedicated piece of equipment. None of the commentators thought that the device had yet been superseded or replaced, but all stated they were aware of other competing technologies with a similar function.

Potential patient impact

All commentators thought that using the TYM smartphone otoscope could provide patient benefits, specifically: better care decisions, GPs being able to make faster referrals to ear, nose and throat (ENT) specialists, and an increase in informed decision-making by patients (because they would be able to see the images themselves). The specialists disagreed as to whether the quality of the images when viewed remotely would be as good as seeing them in person. Two also noted that the device may provide an opportunity for remote ENT consultations in the community. One specialist commentator stated that the images could be stored in patients' medical records, which may be more robust documentation than descriptions written by clinicians. They also thought that this would be useful for monitoring symptoms over time.

Three commentators thought that the TYM smartphone otoscope may be particularly useful for people with chronic ear conditions, children, people with learning difficulties, and people who struggle or are unable to attend outpatient appointments.

Potential system impact

Opinion was split on the device's potential effect on the care pathway. Two commentators felt that changes to the pathway were likely if nurses and healthcare assistants could do ear examinations and have expert opinion delivered remotely. However, the other 2 specialists felt that change was unlikely because ENT consultants generally prefer direct clinical observation; that it may be difficult to assess the extent of middle ear problems without the use of sophisticated equipment in the ENT clinic, or having access to detailed patient history. One specialist commentator thought that using the device could lead to an increase in referrals related to unclear images, which might not be offset by the number of referrals prevented through using the device. Another noted that audiology assistants routinely do standard otoscopies in secondary care.

All 4 specialists agreed that adopting the TYM smartphone otoscope would cost more than standard care, especially if compatible smartphones need to be purchased. Other factors may be subscription costs for the platform (if there were an inter-professional use fee) or if a data contract is needed (some NHS sites do not always have access to Wi‑Fi). None of the specialist commentators thought that using the device would lead to a large resource impact in terms of staffing. However, staff training in its use and an update to information governance protocols would be needed to ensure that data transmission was encrypted and confidential.

None of the commentators was aware of any safety concerns or regulatory issues surrounding the device.

General comments

Three specialists thought that the TYM smartphone otoscope would most likely be used in addition to standard care, whereas 1 thought it could replace it. One also had concerns that the specula may not be compatible with those available on NHS supplies, and noted that maintaining charge on a smartphone is more complex than replacing batteries or using chargers for otoscopes. The commentators thought that more research was needed, with 1 suggesting an audit specifically evaluating changes in the level of inappropriate specialist referrals from trusts currently using the device.