Advice
The technology
The technology
The TYM smartphone otoscope (Cupris) uses an iOS smartphone to let users capture images and videos of the external ear canal and eardrum. These can then be reviewed and shared securely with other healthcare professionals through the Cupris app.
The TYM smartphone otoscope package consists of 5 specula (4.25 mm), a proprietary smartphone case and an otoscope attachment.
To use the device, the user places their smartphone in the case and slides the otoscope attachment over the lens of the phone camera. A speculum is then screwed onto the attachment until locked into place. Images and videos are captured using the smartphone's camera linked to the Cupris app.
The Cupris app can be downloaded from the Cupris website. The images and video captured using the device are stored on a secure and encrypted cloud system and can be viewed on the iPhone, Mac or Windows PC computer.
The TYM smartphone otoscope can only be used with compatible Apple iOS devices. Compatibility for Android smartphones is planned by mid‑2018.
Innovations
The TYM smartphone otoscope differs from standard otoscopes by allowing images and videos to be captured and stored in the patient's record, and by allowing these images and videos to be shared securely between healthcare professionals. It also differs from most otoscopes in that it does not need any additional equipment.
Current NHS pathway or current care pathway
Standard, non-digital otoscopes are usually for people presenting to primary care services with difficulty in hearing or other ear-related symptoms. Information from the otoscopy is used to inform decisions about care. The GP may refer the patient to an ear, nose and throat (ENT) consultant or audiologist if appropriate. Referrals usually provide only a written description of the signs and symptoms. The patient must then wait for the ENT or audiology appointment, and it is usually necessary for them to travel to the appointment.
Audiologists and ENT consultants also routinely use digital video otoscopes in secondary care. ENT specialists also do microscope otoscopy.
The NICE guideline on otitis media with effusion in under 12s suggests that assessment should include a clinical examination focusing on otoscopy, upper respiratory health and general developmental status. British Academy of Audiology guidelines for the direct referral of adults with hearing difficulty to audiology services state that a full medical history and a full ear examination must be done before any referral to an audiologist.
Population, setting and intended user
The TYM smartphone otoscope would most likely be used by GP or other health professionals in primary care (instead of standard otoscopes), or by ENT specialists in secondary care (instead of digital otoscopes). It would be used in people of all ages who need an ear examination. The company states that no additional training is needed for staff already familiar with standard otoscopy.
Costs
Technology costs
The device costs £107.50 per unit (excluding VAT), not including a compatible iOS smartphone. A smartphone is needed to use the device. One speculum must be used per patient at a cost of £0.06 each. The Cupris app is free to download.
Table 1 Cost of the TYM smartphone otoscope (excluding VAT)
|
Description |
Cost |
Additional information |
|
TYM smartphone otoscope package |
£107.50 |
This includes 5 specula, the otoscope attachment, a phone case and an instruction manual |
|
4.25 mm speculum (disposable) |
£0.06 |
One used per patient; based on £49.79 for 850 |
|
Refurbished iPhone 5 with 12‑month warranty |
£141.70 |
Distributed by Cupris |
Costs of standard care
A standard, non-digital otoscope with handle and charger costs £53.81. A digital video otoscope costs £333.57 (NHS Supply Chain). One speculum must be used per patient at a cost of £0.06 each.
Resource consequences
Introducing the TYM smartphone otoscope would increase costs, but this may be offset if its use resulted in fewer unnecessary referrals to secondary care. The costs may be further offset if the device enables image and video capture by non-specialist clinicians.
Implementing the device may need some changes to infrastructure because of the use of the Cupris app, the need for Wi‑Fi and charging points for the smartphones.
This device is currently used in 27 NHS organisations.