Augmented Virtual Examination for Cosmetic and Functional Rhinoplasty

Overview

Telemedicine consultations for nasal complaints have not been rigorously tested for how much a doctor can actually see. The authors compared remote endoscopic and external nasal examination against in-person evaluation. Twenty healthy subjects performed a nasal self examination with an endoscope and webcam while guided over videoconference, then underwent an in-person examination and were surveyed about the experience.

Sections of note

• Design: comparison study in 20 healthy volunteers, not patients seeking surgery.
• Median subject age 27.5 years, range 23 to 77.
• Agreement between raters, measured by kappa, was 0.78 for in-person and 0.66 for virtual evaluations.
• Only the internal nasal valve and the inferior turbinate were better visualized in person.
• No differences were found in detecting external nasal features between in-person and virtual examination.
• Subjects rated their average likelihood of recommending the technology at 8.65 out of 10, standard deviation 1.4.
• Statistical comparison used Wilcoxon and chi-square tests.

What it means for a patient

• A guided remote examination captured most of what an in-person visit did, including all the external features that matter for appearance planning.
• The two structures seen worse remotely, the internal valve and the inferior turbinate, are both central to breathing assessment, so a functional evaluation may still need an office visit.
• Subjects were healthy volunteers, not people with nasal deformities or blockage, so detection of actual abnormalities was not tested.
• Limits: 20 subjects, healthy noses only, and the technique requires the patient to have an endoscope at home.

Why this paper matters

Remote consultation expanded rapidly and then persisted, but for nasal surgery it has been used without evidence that the examination is adequate. This study puts a boundary on what can and cannot be seen. Whether the same holds for patients with real pathology is unanswered.

Terms

• Telemedicine: clinical care delivered remotely by video or phone.
• Nasal endoscopy: examining the inside of the nose with a lighted telescope.
• Internal nasal valve: the narrowest part of the nasal airway, just inside the nose.
• Inferior turbinate: the lowest of the shelf like structures inside the nose that humidify air.
• Anterior rhinoscopy: looking into the front of the nose with a speculum and light.
• Kappa coefficient: a statistic measuring rater agreement beyond chance.