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This common diagnostic tool got a 21st century makeover

It’s an essential tool in every general practitioner’s (GP) arsenal. It’s used all the time for routine exams and to diagnose common illnesses. It’s mounted on the wall in nearly every family clinic’s exam room.

And yet, the otoscope as we know it today hasn’t changed much since 1864.

This may be one of the reasons ear disease is notoriously difficult to diagnose. A study suggests GPs only have about 50% diagnostic accuracy―even for common ear diseases like acute and serous otitis media.

In these cases, GPs face a crossroads―risking a misdiagnosis or referring their patient specialist, a process that can take up to ten months in certain provinces.

This problem is exacerbated by the lack of otolaryngologists in rural, remote and underserved areas.


Turning challenge into opportunity

This is the issue Dr. Devon Livingstone, a newly practicing ENT specialist from Alberta, chose to tackle when he founded ENTiD (pronounced ‘E.N.T. - I.D.’) while finishing his masters in translational medicine from the University of California. 

“It started as a frustration that I had as a resident, doing research, and not seeing the direct clinical impact I wanted,” said Dr. Livingstone about why he pursued this masters, “So, I wanted to acquire a skill set that would allow me to have that impact, bringing that science into the clinic.”

The discipline’s motto, from bench to bedside, brings multiple disciplines together including engineers, clinicians and entrepreneurs to solve fundamental problems in health care delivery.
“I met professionals across different spaces―some in machine learning, others in programming. From there, we started to develop this product and thought―how can we leverage computer vision?”


How it works

ENTiD pairs a digital otoscope with a platform to help GPs better diagnose ear disease, decrease wait times and improve access to care. The platform is equipped with eReferral and artificial intelligence (AI) capabilities. 

The digital otoscope, which is the size of a pen, is connected to a device with the platform by USB―to either a computer, smartphone or tablet.

Armed with this solution, GPs can take high quality otoscopic images, store them on the platform, annotate the file with any pertinent information and share them with a specialist.

In addition to the countless patient benefits, this becomes a new revenue stream for both specialists and GPs, with Alberta Health Services paying $100 total per consult in the province.

What a doctor sees with a traditional otoscope (left), what a doctor sees with ENTiD (right)


The machine is learning

Presently, each condition is diagnosed by Dr. Livingstone and his team of specialists through the platform―while informing a neural network, which works like a brain, continually learning and refining its accuracy.

“We started by feeding the algorithm with a database of 1,366 otoscopic images,” said Dr. Livingstone, “and trained it to diagnose 14 conditions, even multiple conditions simultaneously.”

In initial pilot testing with 89 new images, the algorithm’s diagnostic capabilities were compared to 10 physicians. For nearly every diagnosis, ENTiD outperformed the physicians. 

Already, the algorithm’s diagnostic accuracy is 90%―exceeding the average performance of GPs and ENT residents alike.

Dr. Livingstone using ENTiD on a patient


Coming soon to a clinic near you

In its’ early stages of commercialization, ENTiD’s digital otoscope and eReferral platform are now being piloted in a few family practice clinics in Calgary.

Once their AI meets Health Canada requirements, the ENTiD platform will evolve―and GPs can rely on it as a diagnostic aid. The specialist’s role will evolve too, where instead they validate the algorithm’s suggestions.

Dr. Livingstone and his team have plans to expand beyond Alberta in 2020, both nationally and internationally in lower-resource communities. “Your average analog otoscope costs around $300,” he affirms, “and in remote communities setting up new clinics, for example, where budgets are lean―this is a barrier.”

To increase accessibility and adoption in these areas, Dr. Livingtone claims making ENTiD low-cost by design was essential. And, by nature of it being digital, access to an ENT specialist is only a message away.

What makes this truly transformative? Soon, physicians can have the support needed to get their patients the most accurate ear diagnosis possible, no matter where they live.


This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule.  Feel passionate about physician-led innovation? Please connect with us at