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    Video otoscopy: See what I see

    In my experience, parents and patients are more compliant with treatment recommendations regarding otitis media when you actually can show parents the appearance of their child's tympanic membrane. To accomplish this, I have parents look over my shoulder as I try to hold the otoscope still. This process can be made much easier when you use current technology to perform your "show and tell."

    Firefly Global is marketing new digital video otoscopes that are not only extremely well constructed with superb optics but also are extremely affordable as well. Two versions, wired and wireless, are available, and both use LED lighting and multilayered glass lenses to produce either images or videos of the ear canal and tympanic membrane.

    The $300 wired version, called the model DE500 Digital Video Otoscope, connects the handheld device to a Windows notebook computer's USB port via a 4-foot cord. The included software facilitates the capture of images with the click of a button, and dials on the unit adjust brightness and focus. Once captured, the image can be stored on the computer and incorporated into your patient's EHR. The device can be used for 3 hours continuously before recharging is required.

    The DE500 boasts 150-times magnification and produces 12801024 pixel high-resolution images and records videos at 30 frames per second.



    If you would prefer a wireless model, the $350 DE550 Video Otoscope uses proprietary wireless technology that won't interfere with nearby Bluetooth devices or with your office wireless network. A small video receiver is plugged into a laptop, and the image or video is transmitted to the Firefly software.

    Maximum image resolution with the wireless unit is 720480, slightly less than with the wired unit but still high quality. The wireless model has 4-channel wireless operation, so you can use the video otoscope with up to 4 separate computers.

    Patients really appreciate their pediatrician demonstrating the anatomy of otitis media or otitis externa when presented on a video screen. Both units attach to disposable speculums in 3-mm, 4-mm, and 5-mm sizes and sell for about $35 per box of 192.

    Another nice feature of these digital images is that you can show patients the progress you are making at subsequent visits, and if you see a curious finding, you can email an image to your friendly ear, nose, and throat consultant to ask for advice.

    Advances in pulse oximeter technology

    Last year I described the Masimo Pronto-7 device as a game-changing technology that can measure a child's hemoglobin level transcutaneously without the trauma of a needlestick or venipuncture. Because it is based on pulse oximetry technology, the device provides accurate oxygen saturation as well.

    The Pronto-7 performs hemoglobin measurements on children aged 3 years and older. I've been using the device for more than a year and have found the device's hemoglobin measurements correlate very well with those obtained by my clinic laboratory by venipuncture, usually with less than a 1-gm/dL difference between the 2 methods. By using the device, I identified a teenager with profound iron deficiency anemia and have used the Pronto-7 to monitor her response to iron therapy over the course of several months.

    Recently, the AAP and the Secretary of Health and Human Services issued new guidelines for screening newborns for critical congenital heart disease (CCHD) using pulse oximeters that have been engineered to reduce or eliminate motion effects.5 To date, Masimo is the only company that has received FDA clearance to market their product as fulfilling this requirement for CCHD screening. They have even created a program in which community hospitals can receive a free pulse oximeter to start a CCHD program.



    New this year is Masimo's next-generation hospital, clinic, or bedside pulse oximeter called the Radical-7 that can display simultaneous pulse oximeter and total hemoglobin measurements continuously (unlike the Pronto-7 that can only provide spot measurements).

    Additionally, the Radical-7 can display respiratory rate by using an additional sensor placed on the neck near the cricoid cartridge. The Radical-7 is also capable of displaying carboxyhemoglobin and methemoglobin levels when fitted with the proper sensors.


    Andrew J Schuman, MD, FAAP
    Dr Schuman, section editor for Peds v2.0, is clinical assistant professor of Pediatrics, Geisel School of Medicine at Dartmouth, ...

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