mHealth Research Digest by Mohamed Elawad, BS

Nasal fractures are among the most common fractures presenting at the emergency department yet at times can be difficult to initially diagnose due to nasal edema and other factors.

Patients are often referred to an ear-nose-throat clinic after being assessed by an emergency department but a 2004 study by Karagama showed that about 80% of nasal trauma patients referred to ear-nose-throat (ENT) doctors did not show up or required no treatment.  This results in unnecessary costs and wait times.

In an effort to improve the efficiency of serving nasal bone injury patients, researchers in Ireland have studied the feasibility of using pictures taken with iPhones as a means of determining if patients need to see ENT doctors or not.  The study was carried out on 50 patients during a 3-month period in the summer of 2010. Patients at an ENT clinic were assessed, examined and filled out a questionnaire which included questions about pervious nasal fractures, symptoms and mechanism.

A 3mega-pixel iPhone camera was used to take antero-posterior and overhead photographs of the nose of each patient which was then sent securely to a senior team member, not in attendance at the clinic, for assessment. Image-based recommendations were compared with actual diagnosis at the clinic.

Results showed that 50% of the patients required and underwent nasal bone manipulation with the remainder not requiring any intervention. Correlation of the findings using images taken with actual management at the clinic showed “specificity of using a mobile phone camera was calculated at 88% and sensitivity at 100%.”  Researchers also stated that “the positive predictive value of the test was 89%, and the negative predictive value was 100%.” No patient requiring intervention was missed.


It was not clear from the study is why an iPhone was necessary for this intervention.  Given the low megapixel level of the iPhone camera and the availability of cameras with higher resolution and optical zoom – which may aid in assess nasal injuries –  research comparing the iPhone to other cameras would be useful.

The authors of the study themselves note that there are “medicolegal limitations” to this method of triaging nasal injuries. Nonetheless, their findings show that it is possible identify patients requiring nasal bone intervention using an iPhone and clinically using the methods of the study could potentially ease the pressure on outpatient clinics, resulting in reduced costs and waiting times for patients.

Authors: Taleb Barghouthi, Fergal Glynn, Richard-Benjamin Speaker & Michael Walsh 

Institutions: Department of Otolaryngology and Head and Neck Surgery Beaumont Hospital, Dublin, Ireland, United Kingdom

Original Abstract: Telemedicine & eHealth