Vol.:(0123456789) 1 3 European Archives of Oto-Rhino-Laryngology https://doi.org/10.1007/s00405-019-05775-0 LETTER TO THE EDITOR A letter in response to the article entitled ‘Utility of a smartphone‐ enabled otoscope in the instruction of otoscopy and middle ear anatomy’ James Schuster‑Bruce 1  · Angharad Davies 2  · Henry Conchie 3  · Eamon Shamil 1  · Angus Waddell 4 Received: 14 December 2019 / Accepted: 21 December 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2020 Keywords Otoscope · Otoscopy · Education · Technology · Smartphone Dear Editor, It was with interest that we read the short communication entitled ‘Utility of a smartphone-enabled otoscope in the instruction of otoscopy and middle ear anatomy’ by Hakimi et al. published in the European archives of Oto-rhino-lar- yngology on the 17th July 2019 [1]. In 2017, we conducted a similar study in the United King- dom. Sixty-one medical students were randomised into 2 groups. The standard group (26) used a standard otoscope and examined a normal ear, labeling its features on a blank eardrum. The intervention group (35) used a Cupris© smart- phone-connected otoscope and performed the same task. Data were gathered through pre- and post-assessment objec- tive and user-experience questions recorded on fve-point Likert scales. Hakimi et al. found users of the smartphone otoscope to have increased confdence compared to the con- ventional group and that participants rated the smartphone otoscope as an excellent teaching tool. Our research found that students found the smartphone otoscope easy to use (Likert 4). Although the improvement in eardrum labeling from 28.6 to 44.2% (p = 0.121) was not statistically signif- cant, students preferred its use for future teaching (Likert 4). Developing otoscopy skills using traditional otoscopes is largely reliant on the trainee’s interpretation of the view obtained. As teachers cannot see the trainee’s image of the eardrum, it is difcult to highlight pathology, or ofer advice on how to improve. These limitations contribute to an inef- fective learning process and low confdence in otoscopy amongst undergraduates [2]. As demands on an already dense medical school syllabus increase, afording more time to teach otoscopy is unlikely [3]. Therefore, innovative teaching methods and tools are required to increase skill development within these constraints. There is seemingly a possible role for these devices within medical education, although further studies are needed to assess smartphone otoscopy in the context of real pathology. The challenge lies in the adoption of technol- ogy by key stakeholders. Especially as ENT is frequently overlooked by undergraduate educators in comparison to its burden of disease [4, 5]. To do this, successful educational interventions that use these technologies need to be cham- pioned to ultimately improve the quality of undergraduate otoscopy training. Yours Sincerely, Funding No funding. Compliance with ethical standards Conflict of interest No confict of interest. Ethical approval Ethical approval granted from University of Bristol Ethics board. This comment refers to the article available online at https://doi. org/10.1007/s00405-019-05559-6. * James Schuster-Bruce James.schuster.bruce@gmail.com 1 Department of Otolaryngology, St George’s University Hospital NHS Trust, Blackshaw road, London SW17 0QT, UK 2 Department of Renal Transplant Surgery, Imperial College Healthcare NHS Trust, London, UK 3 Department of General Surgery, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK 4 Bristol Medical School, Bristol, UK