JMIR Publications

ABSTRACT

Background:

Otitis media (OM) is one of the most common pediatric infections worldwide. Conventionally, accurate diagnosis depends on in-person pneumatic otoscopy, which is not always accessible, contributing to delayed care and inappropriate prescribing, especially in underserved settings. Rapid advances in telemedicine and digital tool have accelerated the development of remote approaches for assessing pediatric ear diseases, while maintaining diagnostic quality, care models, and real-world outcomes have not been comprehensively mapped in children.

Objective:

To map existing technologies and operational models employed in telehealth for pediatric OM and report their diagnostic and implementation outcomes to guide practice and further research.

Methods:

Between January 1, 2010, and August 31, 2025, a scoping review guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was performed (protocol not registered). PubMed, MEDLINE, Web of Science, and Cochrane CENTRAL were systematically searched for studies that reported on the clinical implementation of telemedicine or digital health in children (<18 years) with suspected or confirmed OM. Two reviewers independently extracted and charted the following study characteristics: telemedicine model, technology, users, comparators, outcomes, and limitations.

Results:

Of the 805 records searched, 46 met the inclusion criteria. These studies have been performed in diverse countries and settings. Asynchronous store-and-forward tele-otoscopy was the most frequently used approach. The rest used either synchronous or hybrid models. When images were captured by trained personnel and reviewed by experienced clinicians, diagnostic consistency with in-person microscopy was substantial. However, the diagnostic yield was highly dependent on the level of training: structured instruction improved video capture by parents and nonspecialists, whereas brief or written-only guidance resulted in low rates of diagnostically useful videos. Telemedicine approaches improved access, supported perioperative follow-up, and, in some contexts, reduced re-examinations and promoted more judicious antibiotic use. However, televisits without otoscopy were associated with lower confirmation rates of middle-ear effusion during tympanostomy tube placement.

Conclusions:

Tele-otoscopy and adjunct digital tools have been demonstrated to be feasible, achieving diagnostic accuracy comparable to in-person assessments, while enhancing access and service efficiency. However, important evidence gaps remain, including the need for large multisite trials, evaluation of long-term child outcomes, economic evaluations, and robust external validation of artificial intelligence (AI)-based diagnostic tools. Standardization of image capture protocols and integration into hybrid care models should be prioritized for scaling up.