Smartphone-coupled rhinolaryngoscopy at the point of care

Rhinolaryngoscopy remains difficult to perform in resource-limited settings due to the high cost of purchasing and maintaining equipment as well as the need for specialists to interpret exam findings. While the lack of expertise can be obviated by adopting telemedicine-based approaches, the capture, storage, and sharing of images/video is not a common native functionality of medical devices. Most rhinolaryngoscopy systems consist of an endoscope that interfaces with the patient's naso/oropharynx, and a tower of modules that record video/images. However, these expensive and bulky modules can be replaced by a smartphone that can fulfill the same functions but at a lower cost. To demonstrate this, a commercially available rhinolaryngoscope was coupled to a smartphone using a 3D-printed adapter. Software developed for other clinical applications was repurposed for ENT use, including an application that controls image and video capture, a HIPAA-compliant image/video storage and transfer cloud database, and customized software features developed to improve practitioner competency. Audio recording capabilities to assess speech pathology were also integrated into the smartphone rhinolaryngoscope system. The illumination module coupled onto the endoscope remained unchanged. The spatial resolution of the rhinolaryngoscope system was defined by the fiber diameter of endoscope fiber bundle, rather than the smartphone camera. The mobile rhinolaryngoscope system was used with appropriate patients by a general practitioner in an office setting. The general practitioner then consulted with an ENT specialist via the HIPAA compliant cloud database and workflow modules on difficult cases. These results suggest the smartphone-based rhinolaryngoscope holds promise for use in low-resource settings.