Telemedicine

Telemedicine is the utilisation of telecommunication technologies to provide medical services. This can range from a doctor using a telephone or fax to discuss a patient with a colleague, to the use of video-conferencing equipment to speak to a patient many thousands of kilometres away, to the use of a small electronic device to continually monitor the heart condition of a patient.

The vast distances in Australia, the high incidences of ear diseases in rural and remote areas, and the difficulties in providing specialist medical services to people in these areas demands some new solutions to overcome these problems.

Ear Science Institute Australia's Tele-Otology Programme

Ear Science Institute Australia has developed a tele-otology programme that provides specialist advice to hearing impaired patients who have difficulty accessing local specialists.

Tele-otology includes the three important elements in all medical consultations: what can be seen (images of the ear canal and eardrum), what has been tested (e.g. hearing test, speech test, tympanometry), and the clinical history of the patient. 

Ear specialists use an otoscope to view the inside of the ear - the ear canal and ear drum - to make an assessment and diagnosis. Through the tele-otology programme, primary care providers, such as GPs, nurses, and aboriginal health care workers, can use a video-otoscope to collect digital images of the eardrum. These images, together with a clinical history of the patient, and audiology (an assessment of the hearing) and tympanometry (measuring the mobility of the ear drum) test results, can be stored on computer and transmitted to a regional centre or city for assessment by an ear specialist. The specialist will be able to view the images and data and transmit advice back to the primary care provider once an assessment has been made.

Ear Science Institute Australia's has:

• Developed protocols for tele-otology assessment
• Written user-friendly software to record and transmit images and data, and for specialists to provide diagnostic and management advice - AurisView
• Identified and tested safe and high quality equipment (video-otoscopes, digitising equipment, computers, audiology and tympanometry equipment
• Developed and conducted a training course for primary care providers in video-otoscopy and tele-otology

Basic Research

• Formulation of telemedicine protocols
• The validation of remote assessment of ear disease using images and other clinical data
• Determination of compression limits for still images and image sequences
• Image processing for automatic detection of ear pathology and disorders

Applied Research

• Existing computing, imaging and telecommunications technologies must be adapted to work with each other
• Development of new devices for telehealth and tele-otology

Training

Ear Science Institute Australia has developed a course to teach rural and remote area health workers the background and skills for video-otoscopy and telehealth. The course covers a wide range of topics, and can be tailored to the needs of a group. Topics include:

• How we hear and how hearing is lost (anatomy and physiology of the ear)
• Recognition of ear diseases
• Taking a clinical history
• Management of ear disease - ear cleaning, when to refer to a specialist
• Use of video-otoscopes
• Use of screening audiometers and tympanometers
• Use of telehealth software