Efficacy of an Asynchronous Tele-Medicine Model in Otorhinolaryngology

Abstract

Introduction: Access to ENT specialists in remote regions is limited in Nepal. The country’s rugged topography is one important cause. Telemedicine may help bridge this gap; however, evidence supporting its effectiveness in low-resource settings is sparse. This study evaluates the diagnostic performance of an asynchronous telemedicine model in Otorhinolaryngology at Tribhuvan University Teaching Hospital.

Methods: A hospital-based analytical cross-sectional study was conducted in a tertiary care center. A convenience sampling method was used with a minimum sample size of 94, which includes patients of all ages. Trained undergraduate medical students recorded the clinical history and examination findings of the participants. Diagnoses made through asynchronous telemedicine using smartphones, endoscopic imaging, and EMR systems by a consultant ENT specialist were compared with standard in-person evaluations in 102 patients by a separate ENT specialist independently. Concordance was assessed using Cohen’s Kappa.

Results: Diagnostic agreement analysis showed high diagnostic concordance across ENT subspecialties; rhinology had the highest concordance (κ = 0.96) followed by pediatric cases (κ = 0.84), ontological cases  (κ = 0.79), and then head and neck cases (κ = 0.79). Diagnostic discrepancies arose mainly due to poor-quality images and the lack of physical examination.

Conclusion: Asynchronous telemedicine is a viable, cost-effective strategy for ENT diagnostics in resource-constrained settings. It holds potential to improve access to specialist care and optimize referral efficiency in Nepal and similar contexts.