{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T19:54:46Z","timestamp":1787860486306,"version":"build-2784847793"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,5,28]],"date-time":"2017-05-28T00:00:00Z","timestamp":1495929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Cupris\u00a9"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Hearing loss is a neglected international health problem. The greatest burden of ear disease is in low\u2010income countries where there is also a lack of resources. In this context, screening for otological disease may be worthwhile. Cupris\u00a9 has developed an otoscopy device that offers the possibility of low\u2010cost mass screening in remote communities. We evaluated the validity of this device in diagnosing ear disease and in determining whether referral to an <jats:styled-content style=\"fixed-case\">ENT<\/jats:styled-content> centre is warranted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cross\u2010sectional study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Outpatient clinic, Nepal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>All adults and children were invited to take part over a 2\u2010day period. The Cupris\u00a9 device was used to record participants otological history and examination. Stored history and images were assessed in the United Kingdom by a Consultant\u2010grade <jats:styled-content style=\"fixed-case\">ENT<\/jats:styled-content> Surgeon, who provided a diagnosis and decided whether referral to an <jats:styled-content style=\"fixed-case\">ENT<\/jats:styled-content> centre was warranted.<\/jats:p><jats:p>After screening with the Cupris\u00a9 device, participants were immediately assessed by a <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content> trained <jats:styled-content style=\"fixed-case\">ENT<\/jats:styled-content> Consultant Surgeon using a standard otoscope (\u201cstandard assessment\u201d). A diagnosis was recorded for each participant and a decision was made as to whether referral to an <jats:styled-content style=\"fixed-case\">ENT<\/jats:styled-content> centre was warranted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcomes<\/jats:title><jats:p>Concordance in primary diagnosis (analysed per ear) and concordance in the decision to refer (analysed per patient). Cohen's kappa coefficient for inter\u2010rater agreement in diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty\u2010six patients agreed to participate. In four patients, the quality of video recorded precluded a diagnosis or management plan. These patients were excluded from subsequent analysis, leaving 52 patients for analysis. The same diagnosis was reached for 99 of 104 ears when comparing the Cupris\u00a9 device to standard assessment (95% concordance), with Cohen's kappa coefficient of 0.89. The decision as to whether a patient should be referred to an <jats:styled-content style=\"fixed-case\">ENT<\/jats:styled-content> centre for further assessment was the same for all 52 participants when comparing the Cupris\u00a9 device to standard assessment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>When compared to standard assessment, the Cupris\u00a9 device is a valid tool for the diagnosis of ear disease and decision for onward referral. It shows considerable promise for use by trained non\u2010medical workers, as a low\u2010cost and portable tool to screen for ear disease in remote settings, particularly in low\u2010 and middle\u2010income countries.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.12898","type":"journal-article","created":{"date-parts":[[2017,5,9]],"date-time":"2017-05-09T07:06:47Z","timestamp":1494313607000},"page":"31-38","source":"Crossref","is-referenced-by-count":59,"title":["A cross\u2010sectional evaluation of the validity of a smartphone otoscopy device in screening for ear disease in Nepal"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5839-2735","authenticated-orcid":false,"given":"R.","family":"Mandavia","sequence":"first","affiliation":[{"name":"UCL Ear Institute London UK"},{"name":"Royal National Nose Throat and Ear Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Lapa","sequence":"additional","affiliation":[{"name":"Northwest Thames Deanery London School of General Practice London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Smith","sequence":"additional","affiliation":[{"name":"INF Ear Hospital Pokhara Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.F.","family":"Bhutta","sequence":"additional","affiliation":[{"name":"UCL Ear Institute London UK"},{"name":"University of Western Australia Perth Australia"},{"name":"Royal Perth Hospital Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,5,28]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"WHO.Deafness and Hearing loss. Factsheet N 300 2015. Available at:http:\/\/www.who.int\/mediacentre\/factsheets\/fs300\/en\/."},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30777-2"},{"key":"e_1_2_9_4_1","unstructured":"Primary Ear and Hearing Care Training Resource 2016. Available at: httpwww.who.intpbddeafnessactivitieshearingcareadvanced.pdfua."},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0036226"},{"key":"e_1_2_9_6_1","unstructured":"Department of Health.Action Plan on Hearing Loss 2015. 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