5. Devices to improve otitis diagnosis
Pediatricians are extremely facile with otoscopy but sometimes children squirm making visualization of the ear canal difficult, and even small amounts of cerumen can obscure our view of the tympanic membrane. Jim Berbee, an engineer-turned-emergency-department physician, founded and has recently introduced the $1500 Wispr Digital Otoscope. It is a video otoscope unlike any I’ve reviewed before. It can be used with otoscope handles from Welch Allyn and Heine, both battery and wall mounted.
The device features a 1-mm x 1-mm camera with a permanent antifog coating, a 90-degree field of view, and an auto exposure and focus capability between 3.5 mm and 5 cm. This means you can navigate around cerumen in the ear canal and get an extremely clear image of the canal and tympanic membrane. One can switch easily between video and picture mode, and images or videos can be captured with a click of a button. These can then be reviewed with patients and parents, merely by swiping on the device’s touchscreen. In my limited experience with the Wispr, parents and patients are very impressed with the captured images and videos. The first patient I examined with the Wispr had a previously undiagnosed tympanic membrane perforation, resulting from a tympanostomy tube placed years ago!
The device has 64 GB of memory, sufficient for 30 minutes of video at 15 frames per second. It includes a USB port so images or videos can be written to a thumb drive, which can then be used to transfer files to a computer for inclusion in the EHR. I’ve discovered that the Wispr is compatible with my 16-GB SanDisk Connect wireless USB drive, which can expedite data transfer and EHR integration. The device is fun to use, and I believe most pediatricians will be tempted to replace their traditional otoscope with the Wispr. It should be available by the time you read this.
More than 20 years ago, I used a device called the EarCheck Pro to detect middle ear effusions in children. The device was developed by a pediatrician and sonar engineer to analyze the middle ear for presence of fluid. Unlike tympanometry, which requires both a probe seal and a cooperative child to determine if a middle ear effusion is present, the EarCheck Pro required no seal and only took seconds to obtain a reading. It could be used in a screaming child and obtained readings if there was partial obstruction of the ear canal with cerumen.
The device is returning next year as the Acoustic Otoscope–PRO from Check My Ear LLC (Lincoln, Nebraska). The device consists of a handheld probe containing an acoustic speaker that emits sound bursts composed of 44 different frequencies from 1.8 kHz to 4.4 kHz at 80 dB sound level. The Acoustic Otoscope–PRO analyzes the frequency spectra of the reflected sound and presents the output as a “spectral gradient angle,” which corresponds to the probability of middle ear effusion. The device can be therefore used to quantify the middle ear effusion that helps determine if an effusion is resolving when a child returns for subsequent visits. The reimbursement for the procedure is about $20, and it should be available sometime in 2020.
6. Systems to expedite wound closure
Many years ago, Clozex Medical (Wellesley, Massachusetts) produced a wound closure system ideal for use in pediatric patients, as it did not require lidocaine infiltration or suturing—making it truly painless. The company was acquired by 3M, and although the system was always available, it was never marketed, and thus fell out of popularity. Clozex Medical (Wellesley, Massachusetts) reformed, and the Clozex Surgical Skin Closures system is slowly regaining the attention it deserves.
The Clozex system consists of adhesive strips that are applied to the cleaned and dried wound edges. By pulling on opposing adhesive plastic straps, the wound edges are approximated, and finally the straps are released to complete the process. Not only is the process painless, but wounds closed in this way are less likely to produce unsightly scars compared with those closed with sutures or staples. The Clozex closures are inexpensive and come in a variety of sizes. The company has released an over-the-counter (OTC) product, so parents can close simple lacerations without going to the emergency department, urgent care facility, or physician office.
Another painless, suture-free wound closure system comes from ZipLine Medical (Campbell, California). It was developed initially as a surgical incision closure system, but the device has been adopted by primary care providers as a method to close simple lacerations. The Zip Surgical Skin Closures system consists of an adhesive matrix of beaded plastic “zip ties” that are placed over a laceration and secured in place. One pulls on each tie to approximate wound edges then merely removes the excess with scissors—again easy, quick, painless, and less likely to scar compared with traditional suturing or stapling. Zipline Medical also produces a home-care product called ZipStitch intended to be used by patients and parents to close simple lacerations on their own.
7. Rapid diagnostics for consumers
As I’ve frequently discussed in my practice improvement articles, point-of-care rapid diagnostics for a variety of common pediatric infectious diseases are getting more accurate and less expensive. In the United States, patients can purchase home pregnancy tests, drug tests, human immunodeficiency virus (HIV) tests, and sexually transmitted disease (STD) screening tests at local pharmacies. In many parts of the world including Asia and Europe, consumers can purchase the No-Step Strep A Test from an innovative Israel-based company called Novamed Ltd. (Jerusalem, Israel).
The device uses patented technology to make the assay easy to perform as the user never comes in contact with or measures reagents. A pharyngeal swab is obtained and placed in a well in the device. By pressing a button, reagents are released, and the test initiated. The user merely repositions the swab after 1 minute and results are available 4 minutes later. Novamed is seeking FDA approval for this test as well as for a home flu test. Both should be available in US pharmacies in 2020. Both devices may help expedite evaluation and treatment for these all-too-common illnesses by pediatricians.
It really was another great year for medical gadgets and gizmos (and there are many more on the way). As in past years, I’ve posted video reviews of these devices on my Medgizmos.com website along with a webinar to accompany this article. As always, stay tuned!
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