Téléconsultation médicale en audiologie. Conseils de bonnes pratiques de la Société française d’audiologie (SFA) et de la Société française d’ORL et de chirurgie cervico-faciale (SFORL)

Résumé Objectifs Durant l’épidémie de Covid-19, l’accès au diagnostic et aux soins des pathologies relevant de l’audiologie médicale a régressé en France, posant un risque de perte de chance pour le patient. Ce guide de conseils de bonne pratique vise à répertorier les solutions techniques existantes permettant d’examiner à distance le patient présentant une plainte en audiologie et à décrire leurs intérêts et, le cas échéant, leurs limites. Méthodes Les conseils ont pu être élaborés à la fois à partir de l’expérience clinique des experts médicaux ayant participé à la rédaction du guide, et d’une revue extensive de la littérature portant sur les recommandations de pratique clinique en télé-audiologie. Les solutions de télé-audiométrie ont été recensées sur la base d’une requête par moteur de recherche effectuée en avril 2020, avant vérification de leur disponibilité sur le marché européen. Résultats Des solutions de vidéo-otoscopie permettent la télé-transmission d’images compatibles avec un diagnostic de qualité soit en se connectant via internet à une plate-forme de télé-soin, soit via un smartphone ou une tablette utilisant un système d’exploitation iOS ou Androïd. Selon les mêmes modalités, il est possible de réaliser à distance un examen audiométrique tonal dans les règles de l’art, une audiométrie vocale dans le silence ou dans le bruit ainsi que des explorations fonctionnelles objectives de l’audition. Les examens cliniques et paracliniques peuvent être consultés par le médecin de façon différée pour être interprétés (télé-audiologie asynchrone). Ils peuvent aussi être réalisés en temps réel chez un patient, à tout âge de la vie, à condition qu’un aidant puisse être présent durant l’installation des transducteurs ou la réalisation de l’acoumétrie (télé-audiologie synchrone). Les solutions de téléaudiologie trouvent également une application dans la formation à distance des futurs professionnels de santé engagés dans la prise en charge des pathologies de l’audition. Conclusion Dans la législation française, la télé-otoscopie est un acte médical qui relève soit de la télé-expertise (avis asynchrone) soit d’un acte de téléconsultation (avis synchrone). L’évaluation subjective et objective de la fonction auditive du patient est aujourd’hui possible à distance à condition de respecter les précautions listées.

Guidelines of the French Society of Otorhinolaryngology (SFORL) for teleconsultation in patients with vertigo during the COVID-19 pandemic.

OBJECTIVES: In the context of the SARS-CoV-2 pandemic, patients may have been dissuaded from seeking consultation, thus exposing themselves to a risk of loss of chance. This guide aims to define how teleconsultation can assist in assessing vertiginous adults or children, and to gather the information needed to provide quick medical care. METHODS: These recommendations rely on the authors' experience as well as on literature. A survey on otoneurologic approach via telemedicine has been conducted based on a literature search until March 2020. RESULTS: The first clinical assessment of the vertiginous patient via teleconsultation can only be successful if the following conditions are met: initial contact to verify the feasibility of the assessment at a distance, the presence of a caregiver in order to assist the patient, the possibility of making video recordings. Medical history via telemedicine, as in a face-to-face assessment, allows to assess the characteristics, duration, frequency, and potential triggering factors of the vertigo, in both children and adults. During teleconsultation, the following tests can be carried out: oculomotricity evaluation, assessment of balance, simple neurological tests, checking for positional vertigo/nystagmus and, eventually to perform canalith-repositioning procedures. In children, the following should be searched for: history of hearing or visual impairment, a context of fever or trauma, otorrhea, signs of meningeal irritation. CONCLUSION: The neurotologic telemedicine relies on the accuracy of the clinical assessment, which is based on history taking and a few simple tests, encouraging the development of a decision-making algorithm adapted for teleconsultation. However, the latter has its limitations during an emergency examination of a new patient presenting vertigo, and, at least in some cases, cannot replace a face-to-face consultation. Teleconsultation is often adapted for follow-up consultations of previously selected vertiginous patients during face-to-face assessment.

Telemedicine in Audiology. Best practice recommendations from the French Society of Audiology (SFA) and the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL).

OBJECTIVES: Access to diagnosis and treatments for auditory disorders and related pathologies has regressed in France during the COVID-19 pandemic, posing a risk to the patient's chance of recovery. This best practice recommendations guide aims to list the existing technological solutions for the remote examination of a patient with hearing complaint, and to outline their benefits and, where applicable, their limitations. METHODS: The recommendations were developed both from the clinical experience of the medical experts who drafted the guide, and from an extensive review of the literature dealing with clinical practice recommendations for tele-audiology. Tele-audiometry solutions were identified on the basis of a search engine query carried out in April 2020, prior to verification of their availability on the European market. RESULTS: Video otoscopy solutions allow for the teletransmission of images compatible with a high-quality diagnosis, either by connecting via internet to a tele-health platform or using a smartphone or a tablet with an iOS or Android operating system. Using the same telecommunication methods, it is possible to remotely conduct a pure-tone audiometry test in accordance with standard practice, a speech-in-quiet or a speech-in-noise audiometry test, as well as objective measures of hearing. Clinical and paraclinical examinations can be accessed by the physician to be interpreted on a deferred basis (asynchronous tele-audiology). Examinations can also be conducted in real time in a patient, at any age of life, as long as a caregiver can be present during the installation of the transducers or the acoumetry. Tele-audiology solutions also find application in the remote training of future healthcare professionals involved in the management of deafness and hearing impairment. CONCLUSION: Under French law, tele-otoscopy is a medical procedure that is either a tele-expertise (asynchronous adive) or a teleconsultation act (synchronous advice). Subjective and objective evaluation of the patient's hearing functions can be done remotely provided that the listed precautions are respected.