Patent Publication Number: US-2023148851-A1

Title: Otoscope Providing Low Obstruction Electronic Display

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     This application is a continuation of U.S. application Ser. No. 15/856,865 filed Dec. 28, 2017, which is a continuation-in-part of U.S. application Ser. No. 14/749,945 filed Jun. 25, 2015, both of which are hereby incorporated by reference. 
    
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
     BACKGROUND OF THE INVENTION 
     The present invention relates to an otoscope for inspection of the ear and in particular to an otoscope employing an electronic camera insertable into the ear canal. 
     An otoscope is a medical device allowing a healthcare professional to inspect the ear canal and tympanic membrane (eardrum). A simple otoscope provides for a hollow funnel-shaped speculum whose small end is inserted into the ear canal. The purpose of the funnel shape of the speculum is to provide a visual path to the tympanic membrane and to assist in controlling depth of insertion of the speculum. Modern otoscopes include an internal source of illumination directed down the speculum axis from a contained battery-operated lamp and may provide a magnifying lens supported outside the ear and aligned with the axis of the speculum to provide an enlarged image of the ear structure being viewed. More recently, otoscopes have incorporated digital cameras with displays directly on the otoscope for viewing the camera image. An example of these otoscopes is found in U.S. Pat. No. 9,326,668 hereby incorporated by reference. 
     The use of an otoscope requires that the clinician attend carefully to the positioning of the otoscope throughout the examination. The clinician must both hold the otoscope and stabilize it against the patient&#39;s head with one hand, while the other hand manipulates the external ear to maximize “straightness” of the external auditory canal. Once the visual axis is properly aligned, a single user is able to view and assess the characteristics of the tympanic membrane. 
     The use of an otoscope, particularly with infants, requires that the healthcare professional pay constant attention to placement and positioning of the otoscope by observing the infant&#39;s outer ear and at times using one hand to both hold the otoscope and stabilize the otoscope against the infant&#39;s head while the other hand manipulates the external ear to maximize “straightness” of the external auditory canal. Desirably, the camera display for the otoscope is mounted on the otoscope itself to minimize the need for the healthcare professional to look away from the otoscope and patient to see the desired clinical information. Nevertheless, the necessary size of display needed to provide proper readability and resolution can often in such cases obstruct the healthcare professional&#39;s view of the patient during this positioning and bracing operation if the healthcare professional simultaneously wants to view the display. This can be a particular problem when the otoscope is rotated, for example, with a handle positioned laterally rather than vertically, for improved bracing or access to the patient. 
     SUMMARY OF THE INVENTION 
     The present inventors have recognized that because the region of interest of the image acquired by an otoscope is largely circular, by using a matching circular display that is directly aligned with the visual axis of the camera tip, the obstructive qualities of the display can be greatly minimized over a range of different otoscope orientations, thus improving the ability to simultaneously view the display and the patient&#39;s external ear. The net effect is to allow the clinician to have greater dexterity and maximize comfort during the otoscopic examination. 
     In different embodiments, the invention may also provide a disposable, clean, sheath (speculum) for an otoscope of a type having a tip-mounted camera and light source. Such tip-mounted cameras and light sources create substantial risk of blinding internal reflection when covered by a window. By providing a speculum with a window that may be pulled tightly against the light sources and camera, such intentionally blinding internal reflections are reduced or eliminated while providing a clean barrier between the otoscope and patient. 
     In different embodiments, the invention may provide a structure allowing the otoscope to be adapted to commonly available otoscope bases. This adaptation may employ a locking collar that overrides rheostat systems used for normal incandescent lamp otoscopes allowing the innovative otoscope of the present invention to be readily adapted to legacy examination rooms. 
     In different embodiments, the invention can provide an audio commands to the otoscope camera to obtain a “snapshot” eliminating the need for a manually operated button that could cause the healthcare professional to inadvertently reposition the otoscope while an image is being acquired. 
     Specifically, then, in one embodiment, the invention provides an otoscope having a housing adapted for support by a hand of a healthcare professional. An elongate probe element having a proximal end supported by the housing provides a distal end that may extend along an axis into the ear canal. The distal end of the elongate probe may support an electronic camera for viewing into the ear canal communicating with a circular electronic display displaying an otoscope image from the camera and spaced from the distal end of the elongate probe along the axis and centered along the axis. 
     It is thus a feature of at least one embodiment of the invention to provide the benefits of electronic display, including magnification, image stabilization, and brightness and contrast adjustment, while preserving the observing healthcare professional&#39;s ability to fully view the outer ear to assist in alignment and stabilization of the otoscope. A circular display maximizes the useful display area while minimizing the obstructive nature of the display particularly when the otoscope is used with the handle rotated from a vertical position. 
     The display may be circumscribed by a cone having an apex at the distal end of the probe and a conical angle of less than 45 degrees and/or may have a diameter that extends less than three inches from the axis at all angles about the axis. 
     It is thus a feature of at least one embodiment of the invention to optimize trade-off between display readability and minimizing display obstruction. 
     The processor may execute a stored program for displaying non-image data in a peripheral ring about the image. 
     It is thus a feature of at least one embodiment of the invention to permit the simultaneous display of image and non-image data on a single display to minimize the need for the healthcare professional to avert his or her eyes from the display and patient, while positioning the data in a location of the image having, a priori, less clinical significance. 
     The non-image data may include an arcuate bar display whose angular extent indicates data. 
     It is thus a feature of the invention to provide an intuitive compact graphic that works well in the periphery of the circular display. 
     The circular electronic display may provide a touchscreen for sensing touches on a surface of the circular electronic display wherein the arcuate bar display represents a video sequence of images taken from the electronic camera and wherein a touch along the arcuate bar display selects an image from the video sequence for display. 
     It is thus a feature of at least one embodiment of the invention to provide an extremely compact method of indexing through a video sequence allowing the healthcare professional to capture the best image therefrom, for example, when imaging an agitated or juvenile patient. 
     The display may indicate a left or right ear being imaged as linked to the image. 
     It is thus a feature of at least one embodiment of the invention to ensure recorded images clearly indicate which ear was being imaged in the image record. 
     The otoscope may further include an electronic inclinometer for changing the orientation of at least one of the displayed non-image data and recorded image data according to a deduced gravitational vector. 
     It is thus a feature of at least one embodiment of the invention to maximize the readability of non-image data during use of the otoscope and to maximize the interpretability of image data reviewed at a later time by clearly indicating the orientation of that data. 
     The housing may provide a display portion holding the electronic display and elongate probe, and a handle portion extending away from the axis to be held by a healthcare professional, and the display portion may be mechanically and electrically releasably attachable to the handle portion by means of a twist lock coupling. 
     It is thus a feature of at least one embodiment of the invention to integrate smoothly with existing examination room equipment intended for conventional otoscopes having a twist lock connector. 
     The handle portion may provide a rheostat controlling electrical power delivered to the display portion and the handle portion may provide a collar fitting over the rheostat to prevent movement thereof. 
     It is thus a feature of at least one embodiment of the invention to disable the rheostat found on conventional otoscopes to prevent an inadvertent reduction in electrical power during use of the otoscope. 
     The collar portion may include a rheostat engagement surface turning the rheostat to a full power position with rotation of a twist lock coupling for engagement. 
     It is thus a feature of at least one embodiment of the invention to promote a full power position of the rheostat when the otoscope is assembled to a pre-existing legacy handle. 
     The invention may also provide for a speculum for an otoscope having an in-ear camera providing a replaceable tubular sheath sized to fit within in the ear canal and to receive the elongate probe element therein, the distal end of the tubular sheath providing a transparent window covering permitting imaging therethrough and a proximal end of the tubular sheath providing a connection to the housing creating a spring biasing of the window against the distal end of the probe element. 
     It is thus a feature of at least one embodiment of the invention to permit a protective covering of the camera from cross-contamination with the patient using a window layer without creating image degradation caused by the close proximity of an intense light source and the camera in the narrow tip of the probe. 
     In one embodiment, the distal end of the tubular sleeve maybe covered by an elastic cot and the proximal end of the tubular sheath may stretch the elastic cot over the electronic camera to provide a transparent covering of the camera allowing imaging therethrough. 
     It is thus a feature of at least one embodiment of the invention to provide a close abutment of the window against the camera and light sources (to minimize internal reflections and maximize image quality) while providing an easily fabricated low-aberration window formed in part by the stretching process. 
     The invention may in addition or alternatively provide a speculum having a tubular sheath sized to fit within in the ear canal to receive an elongate otoscope probe element therein wherein a distal end of the tubular sleeve provides a tool extending axially beyond the distal end of the probe element for engaging objects within the ear within the field of view of the camera. In this manner, ear wax and foreign bodies may be removed safely under direct visualization. 
     It is thus a feature of at least one embodiment of the invention to provide a disposable scraper tool integrated into the disposable speculum and positioned proximate to the camera for improved positioning and manipulation. 
     The tool element may be malleable to be formed into a curve after manufacture with respect to the axis and to retain that curvature. 
     It is thus a feature of at least one embodiment of the invention to provide an extremely versatile tool that can be modified by the healthcare professional as needed for a particular situation and that better nests for efficient shipping. 
     The tool element may provide a scoop communicating with a channel connectable to a vacuum source. 
     It is thus a feature of at least one embodiment of the invention to provide a suction tool closely located to the camera for accurate control of that suction tool. 
     The otoscope may provide a processor operating in a first mode to provide a dynamic image on the display indicating the view from the electronic camera and in the second mode, triggered by a user&#39;s voice received by the microphone, to capture a static image on the display indicating the view from the electronic camera at the time of the voice command. 
     It is thus a feature of at least one embodiment of the invention to allow capture of an image without disrupting the orientation of the otoscope as may occur during the activation of a physical button or touchscreen by the user&#39;s hand. 
     These particular objects and advantages may apply to only some embodiments falling within the claims and thus do not define the scope of the invention. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG.  1    is a perspective view of an otoscope constructed according to the present invention providing a housing presenting on a front side an electronic display and on a rear side having a camera on a probe element extending away from the electronic display for insertion into the ear canal and covered by a disposable speculum; 
         FIG.  2    is an elevational cross-section through the probe element and the disposable speculum showing a mechanism for retracting the probe element and camera when the speculum is removed and extending the probe element and camera when the speculum is in place; 
         FIG.  3    is a detailed fragmentary view of  FIG.  2    with the camera element fully extended showing radial and axial illumination of the ear canal such as creates a diffuse lighting for better resolving the ear structure; 
         FIG.  4    is a side elevational view of the speculum installed on the probe element showing flexibility of the combined assembly; 
         FIG.  5    is a detailed cross-section of the distal end of  FIG.  4    showing radial teeth on the speculum for assisting in the removal of foreign material from the ear canal and showing a lens protector incorporated into the disposable speculum; 
         FIG.  6    is a simplified block diagram of the electronics of the otoscope of  FIG.  1   ; 
         FIG.  7    is a figure similar to  FIG.  2    showing an alternative otoscope design providing a circular display and improved visualization of the outer ear when the healthcare professional is viewing the display and further showing a releasable power handle; 
         FIG.  8    is a side elevational fragmentary view of the embodiment of  FIG.  7    showing a replaceable clean speculum being partially installed on the otoscope and having an elastomeric window material at a distal end of the speculum; 
         FIG.  9    is a side elevational cross-section in a vertical plane of the distal end of the clean speculum of  FIG.  8    showing a stretching of the elastomeric material to provide a tight spring-biased window against the distal end of the probe; 
         FIG.  10    is a side elevational cross-section through the distal end of the probe showing a positioning of a camera and peripheral fiber optic light sources segregated so as to minimize internal reflections when coupled with a spring-biased front window of the replaceable speculum; a 
         FIG.  11    is a perspective view of an alternative speculum having an axially extending scraper; 
         FIG.  12    is a side elevational perspective along a vertical plane of the distal end of the speculum of  FIG.  11    showing a laminated soft metal element providing a malleable and reshapeable scraper; 
         FIG.  13    is an exploded diagram showing an alternative speculum having a vacuum scoop for communicating with a corresponding port on the otoscope; 
         FIG.  14    is a cross-sectional view along a vertical plane through the speculum and assembled otoscope of  FIG.  13   ; 
         FIG.  15    is a perspective view of an alternative design of the speculum providing an inflatable collar for the removal of obstructions from the ear canal; 
         FIG.  16    is a cross-section along a vertical plane through the speculum and otoscope of  FIG.  15    showing internal air passages for inflation of the collar; 
         FIG.  17    is a figure similar to that of  FIG.  7    showing the addition of a valve pump button and valve release button and a pump mode button allowing for generation of small amounts of stored pressurized air or relative vacuum within the housing of the otoscope; 
         FIG.  18    is a schematic diagram of the pump system of  FIG.  17    showing a system to provide for a reservoir of high or low-pressure air releasable after generation; 
         FIG.  19    is a partial cross-section through the housing of  FIG.  1    showing engagement of the releasable handle to a display portion using a collar extending over the upper end of the handle for preventing inadvertent operation of a rheostat of the handle and providing an activation of the rheostat when the collar is installed; 
         FIG.  20    is a rear elevational view of the otoscope of  FIG.  1    showing the addition of non-image data to the image displayed on the display and a separable adapter for implementing the collar arrangement of  FIG.  19   ; 
         FIG.  21    is embodiment showing a spring-loaded collar that extends outward to protect the probe when the speculum is removed; and 
         FIG.  22    is a partial cross-sectional view of the probe element of  FIG.  7    allowing snap-in replaceability of the probe element in the event of damage and possible mitigation of damage through a snap-out of the probe element. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
     First Embodiments 
     Referring now to  FIG.  1   , an otoscope  10  of the present invention may provide a housing  12  having a head portion  14  and a detachable grip portion  16 . The grip portion  16  is sized to be grasped by the hand of a healthcare professional in the manner of a conventional otoscope with the grip portion  16  extending generally upward from the healthcare professional&#39;s hand to the head portion  14 . 
     A front surface of the head portion  14  may provide for an electronic touchscreen display  18 , for example, being a backlit three-color liquid crystal display (LCD) of a type known in the art having a touch surface and decoder. An elongate probe assembly  20  may extend from a rear face of the head portion  14  in a direction away from the display  18  along an axis  22  normal to the surface of the display  18 . The probe assembly  20  may include a generally conical speculum  24  constructed at least in part of the transparent thermoplastic material to provide for light conducting properties as will be described below. 
     As is generally understood, the outer ear  33  of a human patient includes the pinna  37  providing a sound collecting structure. The pinna  37  surrounds an ear canal  36  leading to and terminating at the tympanic membrane or eardrum  38 . A length of the ear canal  36  in an average adult human is approximately 2.5 centimeters and the ear canal  36  has an average diameter of approximately 0.7 centimeters. 
     Referring now also to  FIG.  2   , the speculum  24  may taper inward as one moves away from the head portion  14  to a distally located distal tip  26 . The speculum  24  provides a central bore which holds an extendable cylindrical probe  28  having on its distal tip a front facing electronic camera  30  for acquiring multi-pixel, three-color images in a field of view directed along the axis  22 . Electronic camera  30  may, for example, be a self-contained charge coupled device (CCD) camera such as is commercially available providing, for example, a measurement area of 1.4 mm diagonal and 62,500 pixels. 
     A proximal end of the cylindrical probe  28  is supported by a spring-loaded slider  32  that may move along the axis  22  with respect to structure of the housing  12  generally constrained for translational motion only. A helical compression spring  34  may extend between an inwardly extending flange  39  of the housing  12  and a rearward radially outwardly extending flange  41  on the slider  32  to bias the slider  32  in a retraction direction withdrawing the camera  30  within a protective sleeve  35 . The sleeve  35  is fixed with respect to the housing  12  and surrounds the camera  30  for protection when the camera  30  is fully retracted. 
     A proximal end of the conical speculum  24  may provide for a collar  40  having internal threads that can engage outwardly extending pins  42  of the slider  32 . Clockwise rotation of the collar  40  (looking toward the proximal end) pulls the pins  42  forward toward the distal tip  26  of the speculum  24  while pulling the speculum  24  onto the housing  12 . Forward motion of the pins  42  moves the slider  32  forward against the force of the spring  34  extending the camera  30  to a position proximate to the distal tip  26 . Thus, the fragile camera  30  is exposed only when the protective speculum  24  is in place. A detent feature on the housing  12  (not shown) may lock the collar  40  against dislodgment or, alternatively, friction provided by the force between the internal threads and the pins  42  may serve the same purpose. 
     Referring now also to  FIG.  3   , all or part of the speculum  24  may be constructed of a transparent material so that light emitting diodes  44  mounted on the structure of the housing  12  may project light  52  into a proximal portion of the conical speculum  24 . From there, the light  52  may be conducted by internal reflection in the manner of a light pipe to the distal tip  26  of the conical speculum  24 . The light emitting diodes  44 , as attached to structure of the housing  12 , will be retained when the conical speculum  24  is removed and may be oriented to face a feature on the conical speculum  24  that promotes coupling of light  52  from the LEDs  44  into the conical speculum  24 , for example, an optical flat perpendicular to the direction of light propagation. In alternate embodiments, the light emitting diodes  44  may couple to fiber optics within the speculum  24 . 
     In one embodiment, the LEDs  44  may provide for a combination of red, green, and blue elements so that the hue of the project light  52  from the LED  44  may be controlled, for example, to accentuate certain ear structure. At the distal tip  26  a portion of light  52   a  exits in a direction parallel to the axis  22 ; however, some light  52   b  in a distal region  46  of the speculum  24 , before distal tip  26 , may be coupled by a diffusing roughness  48  on the outer surface of the speculum  24  out of the speculum  24  to provide light  52   b  emanating along a radial direction from the speculum  24  to strike the walls of the ear canal  36 . This light  52   b,  through reflection and scattering between the outer surface of the speculum  24  and the walls of the ear canal  36  and through internal conductance to the tissue of the ear canal  36 , provides diffuse multi-angle illumination of the ear structure in the ear canal providing improved viewing of that structure through more uniform illumination and illumination arriving at multiple angles. The region  46  may be, in one embodiment, five millimeters in length along the axis  22  and as much as one and a half centimeters in some embodiments. 
     Referring now to  FIG.  4   , the diameter  31  of the distal tip  26 , measured in a plane perpendicular to the axis  22 , may be less than two millimeters and the diameter  31  of the speculum  24  in the distal region  46 , extending from the distal tip  26  along the axis  22  by at least five millimeters and in one embodiment one centimeter, may be less than five millimeters and in some embodiments less than three millimeters to be substantially smaller than the ear canal  36 . It is intended that the speculum  24  that surrounds the camera  30  be sized to allow imaging of the eardrum  38  past minor obstructions, such as normally present earwax, and to allow passage within the ear canal  36  by medical instruments such as a curette for removing obstructing bodies such as earwax while probe assembly  20  is in place for imaging, that is, to permit instruments to extend to the side and pass the end of the distal tip  26 . 
     Referring still to  FIG.  4   , as noted above, the present invention provides a distal tip  26  that is more flexible than a typical otoscope speculum. Generally, the flexibility of the distal tip  26  is intended to improve the comfort to the patient and reduce risk of damage to structure of the outer ear  33  caused by a small diameter probe. When the head portion  14  is stabilized, a perpendicular force  68  applied to the distal end of the distal tip  26  of 100 grams will cause a deflection  69  of no less than one millimeter. In contrast, a similar force applied to the end of the atypical speculum will provide a corresponding deflection at the end of the speculum of much less than one millimeter. It will be appreciated that this flexibility may be provided by constructing the cylindrical probe  28  and conical speculum  24  from a flexible material or by mounting the cylindrical probe  28  and conical speculum  24  to the housing  12  through a flexible or compliant mount that allows a tipping of these elements in response to applied lateral force, or by a coating of the cylindrical conical sheath by elastomeric material, or by a combination of these approaches. 
     Referring now to  FIG.  5   , the distal tip  26  of the speculum  24  may be closed by an optically transparent, low distortion window  50  allowing images to be detected therethrough while protecting the camera  30  from contamination while also providing a clean shield between the camera  30  and patient. An outer surface of the speculum  24  proximate to the distal tip  26  may include rearwardly canted bristles or teeth  53  that may serve the purpose of assisting in the removal of debris and material from the ear canal  36  using the speculum  24  itself. These teeth  53  may be formed simultaneously with the material of the speculum  24  to be optically clear and therefore to pass illumination. Alternatively, the teeth  53  may be overmolded of a flexible elastomeric material such as silicone rubber thereby serving also to reduce the pressure between the distal tip  26  and the ear canal  36  by a cushioning operation. 
     The cylindrical probe  28  may be constructed of a relatively flexible material such as a silicone or polyvinyl chloride material and may be tubular to provide a passage for electrical conductors  54  communicating pixel image data from the camera  30 . 
     Referring now to  FIG.  6   , the otoscope  10  may incorporate an electronic controller  102  such as a microcontroller being in essence an electronic computer and I/O circuitry. The controller  102  will provide a processor  104  communicating with a memory  106  permitting non-transient storage of a program  108 . Generally, the program  108  will provide for the receipt of signals from the camera  30  for presentation on display  18  of images from the camera  30  and will provide for transmission of such images to affiliated equipment, for example, a PACS device. Program  108  may perform normal image processing, for example, exposure control, contrast adjustment, color balance, motion stabilization, image rotation and the like. The program  108  through the controller  102  may also control the illumination of the LEDs  66  as part of the exposure control process. In addition, the memory  106  may hold a barcode decoder program  111  allowing the otoscope  10  to also be used for reading data from barcodes  117 , for example, to identify a particular image to a particular patient&#39;s file and transmit that barcode data with images in a protocol for linking the two. 
     The controller  102  may also communicate either through a wireless transceiver  112  or an electrical connector  114  with other devices, for example, to permit the transmission of image data and barcode data to a remote electronic medical record server. 
     A power button  113  may communicate with the controller  102  to put electronic circuitry into a low power sleep state, disabling the display  18 , camera  30 , and LEDs  66 . 
     The program  108  in a standby mode may cycle through different colors on the LEDs  44  or display particular colors (e.g., pink) to improve the attractiveness of the otoscope  10  for pediatric patients who may be fearful of medical equipment. The otoscope circuitry described above may be powered by a battery  109  contained in a grip that may be removably connected to the housing  12  by electrical and mechanical connector  115 . Alternatively, the electrical and mechanical connector  115  may allow attachment of the otoscope  10  to a handle unit attached to a wall transformer or the like generally understood in the art such as are used in many examination rooms. 
     A sleeve detector switch  120  may also be provided to detect whether speculum  24  is in place before activating the otoscope  10  to prevent use of the otoscope  10  without a protective speculum  24 . 
     The controller  102  may also communicate with a microphone  105 , for example, exposed through a microphone grate  110  shown in  FIG.  7   . In this respect, the controller  102  may provide for simple speech recognition properties, for example, allowing the healthcare professional to take a snapshot using the otoscope  10 , for example, by saying a keyword such as “snapshot”. An example speech recognition core suitable for use with the present invention is the Texas instrument C 5535  or C 5534  devices commercially available from Texas instruments Corporation. 
     A MEMS type inclinometer  107 , for example, in the form of a three-axis accelerometer or accelerometer/gyroscope or similar device, may be used to detect the rotational orientation of the housing  12  about the axis  22  which will be used to provide rotational correction of the image as will be discussed below. 
     As will be discussed in greater detail below, the controller  102  may receive data from the camera  30  and provide for image processing such as contrast and brightness adjustment, image stabilization and magnification and may display the image together with salient other non-image data based on battery charge, video sequence, etc. on the touch screen display  18  while communicating with the various components discussed above using a stored program. The camera  30  may obtain a regular sequence of images in a video stream to be stored in the memory  106  or may store or mark selected snapshot images under control of the user as will be discussed below. 
     It will be appreciated that the speculums  24  are constructed to be relatively low-cost and therefore disposable, for example, such as may be manufactured by injection molding, and in this regard a variety of different sleeve types may be provided, for example, having different teeth designs for different purposes including other medical inspection of the nose or the like. 
     Second Embodiments 
     Referring now to  FIG.  7   , the display  18  may be circular in outline having a diameter of approximately 1.5 inches and less than two inches and desirably less than 2.5 inches. The display  18  may be centered on the axis  22  having a viewable face perpendicular to that axis  22  so that the display  18  is subtended by a right circular cone  133  having its apex at the distal end of the cylindrical probe  28  and its base perpendicular to the axis  22 . This subtending cone  133  may have a vertex angle  23  of less than 60 degrees and ideally less than 45 degrees to provide an improved ability by the healthcare professional to visualize the outer ear  33  (shown in  FIG.  1   ) around the display  18  and the housing  12 . 
     The grip portion  16  may include a downwardly extending grip collar  124  connecting the head portion  14  with a removable power handle  126  that may fit within the collar  124  and lock to the housing  12  with a quarter turn of the power handle  126 . In this regard, the power handle may have an upwardly extending electrical and mechanical connector  128  received by a corresponding connector within the collar  124 . Surrounding the connector  128  is a rheostat operator  130  whose rotation changes the voltage delivered by the handle  126  to the remainder of the head portion  14 . A lock button  132  may protrude upward from an edge of the rheostat operator  130  to be depressed before the rheostat operator  130  may be rotated from an off position to increase the power to the connector  128  from zero voltage to an operating voltage. The handle  126  may provide for internal rechargeable batteries or may be connected by a cable extending from the bottom of the handle  126  (not shown) connecting the handle  126  to a wall transformer or the like. 
     Referring now also to  FIG.  8   , a removable speculum  24  may fit over the probe  28 , the latter attached to the head portion  14  of the housing  12 , by a quarter turn twist lock engagement between a cylindrical mounting boss  134  on the housing  12  and the tubular speculum collar  136 . As is understood in the art, such a quarter turn collar  136  allows slidable installation of the speculum  24  over the probe  28  and into engagement with the mounting boss  134 , the former having a radially inwardly extending tooth received within a corresponding outer peripheral helical groove  137  around the outside of the cylindrical boss  134 . This helical groove  137  spirals away from the distal end of the probe  28  for approximately 90 degrees and then returns a short distance in the opposite direction to provide a detent stop point. A locking is provided because of a spring biasing tending to push the locking collar  136  away from the housing  12  either from interference between the speculum  24  and the housing  12  or the probe  28  and the speculum  24  as will be discussed below. 
     Generally, the body of the speculum  24  may be in the form of a hollow trumpet tapering downward toward the distal tip  26 , for example, constructed of a rigid thermoplastic integrally molded to the collar  136 . This rigid material allows the speculum  24  to easily slide over the probe  28  without the resistance that might be expected for example if this material were an elastomer. A transparent elastomeric material  138  may be overmolded to the speculum  24  to hermetically seal that the distal tip  26  of the probe  28  against contamination from the environment of the ear and vice versa. 
     Referring now to  FIG.  9   , the length of the speculum  24  is set so that when the locking collar  136  is fully installed on the cylindrical boss  134 , the distal end of the probe  28  presses outward on the elastomeric material  138  stretching it and thinning it to improve its transparency and reduce optical aberration therethrough by means of the naturally evening property of the stretching of elastomeric material. During the stretching process, the elastomeric material  138  remains adhered to the end of the speculum  24  preserving a clean isolation between the ear and the probe  28 . Elasticity of the elastomeric material  138  provides the spring biasing promoting engagement of the lock between the collar  136  and boss  134  and also pulls the elastomeric material  138  into a window  140  closely abutting against the end of the probe  28  to reduce internal reflections. 
     Referring momentarily to  FIG.  10   , the outer wall of the probe  28  may be formed by an outer tube  143  holding a second coaxial tube  142 . Within the second coaxial tube  142  is the camera  30  oriented to look along axis  22 . The second coaxial tube  142  serves to block light transmitted by optical fibers  144  from passing laterally to the camera  30 , the optical fiber&#39;s  144  position preferably aligned with axis  22  between tube  142  and the outer tube  143  of the probe  28 . Both the optical fibers  144  and the camera  30  may be embedded in an optically transparent epoxy material  139  and have rearward conductors  141  for camera electrical signals. The window  140  of elastomeric material  138  is pulled tight against the ends of these tubes  143  and  142  eliminating the gap that would permit internal reflection off of the inner surface of the window  140  from the optical fibers  144  to the camera  30  such as would blind the camera  30  if the window  140  were spaced loosely away from the end of the tubes  142  and  143 . A similar effect may be obtained without the inner tube  142  by placing the optical fibers or the camera  30  directly at the edges of the tube  143  so that there is no gap in which an optical internal reflection can occur. In this case, the optical fibers  144  may communicate with LEDs  44  being either a set of colored LEDs or one or more high-intensity white LEDs. 
     In an alternate embodiment (not shown), the window  140  may be constructed of a rigid material, for example, using a thermoforming process or injection molding process to form the speculum  24  and window  140  either separately or as assembled components, so that the window  140  is nevertheless pulled closely against the end of the tube  142  to prevent light reflection between the bright light source and the camera  30  through the presence of the window  140 . By managing intense internal reflection, the invention allows a complete covering of the probe to reduce cross-contamination. 
     Referring now to  FIGS.  11  and  12   , in an alternative embodiment, the speculum  24  may have at its distal tip  26  a scraper  146  extending parallel to the axis  22  from a side wall of the of the speculum  24  at a periphery around the circular orifice in the speculum  24  exposing the distal end of the probe  28 . The scraper  146 , for example, may extend from the end of the probe  28  by ⅛ to ½ inch in a preferred embodiment. The scraper  146  may, for example, be pre-curved toward or away from the axis  22  or in a preferred embodiment may be parallel to the axis  22  for general use and for improved shipping in which the speculums  24  are nested. In this latter case, the scraper  146  may include a ductile metal layer  148  alone or laminated to a flexible thermoplastic layer  150  allowing a curvature to be formed in the scraper  146  by the healthcare professional for particular application by a simple bending process of the scraper  146  where the ductile metal layer  148  retains that curvature after bending. Generally, curvature is possible within a field of view  153  of the camera  30  within the probe  28  (about 50 degrees) permitting use of the scraper  146  to be visualized during use. 
     Referring now to  FIGS.  13  and  14   , in an alternative embodiment, the speculum  24  may have at its distal tip  26 , a scoop  152  extending, like the scraper  146  of  FIG.  11   , parallel to the axis  22  from the side wall of the speculum  24  at a periphery around the circular opening in the speculum  24  exposing the distal end of the probe  28 . The scoop  152  may be positioned to the side of the distal end of the probe  28  to extend beyond the distal end of the probe  28  and face inward over the front of the probe  28 . The scoop  152  may communicate via an internal channel  154  within the speculum  24  that may connect to air ports  156  in the front face of the boss  134 , the ports  156  leading to a source of vacuum via conduit  160 , allowing the speculum  24  to be used to aspirate debris and the like through the scoop  152 . In this case, the collar  136  may support on its inner face an O-ring  162  providing a seal against the front face of the boss  134  to prevent leakage of air through the proximal end of the sheath and its interface with the boss  134 . As will be discussed below the source of vacuum connected the conduit  160  may be either an external vacuum line connected to the housing  12  or an internal vacuum pump system as will be discussed. 
     Referring now to  FIGS.  15  and  16   , in yet a further alternative embodiment, the speculum  24  may have at its distal tip  26  a small toroidal balloon  164  coaxial about axis  22  that may be inflated and deflated to extend radially from the speculum  24  or to collapse against the speculum  24 . This inflation and deflation may be through a channel  154  in the speculum  24  leading to a port  156 . In this case the conduit  160  provides a source of pressurized air or release of pressurized air for the inflation and deflation operation. The balloon  164  may be constructed of the elastomeric material  138  also used for the window  140  formed at the same time during a dipping process. In this respect, the balloon  164  may be inflated once the speculum  24  is in place for the removal of debris or earwax from the ear, for example, as taught in US patent  6 , 152 , 940  hereby incorporated by reference, albeit with the modification that the toroidal shape of the balloon  164  permits continued visualization through the window  140  unlike that of the cited reference. The conduit  160  may be provided with an external source of pressurized gas or may operate from an internal pressure reservoir as will be described below. 
     Features of these embodiments may be combined, for example, adding a clear window to either of the embodiments of  FIGS.  11  and  13   , 
     Referring now to  FIGS.  17  and  18   , the housing  12  may be modified to provide for a pump button  166 , a release button  168 , and a valve direction knob  170  that allow an internal reservoir  172  within the housing  12  to be pressurized or evacuated using a pump  176  actuated by pump button  166 . Once the reservoir  172  is charged, the vacuum or pressure may be released by valve button  168  controlling a valve  178  communicating through the speculum  24  with either the scoop  152  or balloon  164  discussed above. An input check valve  180  on the inlet side of the pump  76  and an output check valve  182  on the outlet side of the pump  176  may be simultaneously rotated in two different directions to provide either that the pump  176  evacuates the reservoir  172  or pressure rises in the reservoir  172 . By pre-pumping the reservoir  172 , a vacuum or pressure may be easily applied by the healthcare professional with little disruption of the housing  12  during use of the otoscope  10 . 
     Referring now to  FIGS.  7  and  19   , the collar  124  of the head portion  14  of the housing  12  may fit over the handle  126  and in particular over the rheostat operator  130  and rheostat operator button  132  to prevent inadvertent movement of these components during use of the otoscope  10 . During installation of the collar  124  over the end of the handle  126 , an internal collar ledge  184  extending radially inward over the rheostat operator  130  and having an elastomeric gripping material  186  on its lower surface may engage with the upper surface of the rheostat operator  130  and the rheostat operator button  132  to press the button  132  downward to release the rheostat operator for motion. A twisting of the handle  188  to engage connector  128  with mating connector  190  held in the head portion  14  will then rotate the rheostat operator  130  with respect to the handle  126  to turn the rheostat to its highest voltage position and retain it there during use of the otoscope  10 . 
     Connector  128  and connector  190  may work with standard otoscope handles  126  using a connector system, for example, taught by U.S. Pat. Nos. 3,071,747, 1,516,133, and 2,469,857 hereby incorporated by reference. As noted, interconnection of the connectors  190  and  128  provides both mechanical connection between the handle  126  and the housing  12  and electrical connection with wiring terminals  192  of connector  190 , the latter providing power to the system shown, for example, in  FIG.  6    as battery  109  where connectors  190  and  128  provide connector system  115 . 
     Referring now to  FIG.  20   , the collar  124 , ledge  184 , elastomeric gripping material  186 , and connector  190  may alternatively be placed in a releasable adapter  194  that may be releasably attached to the remainder of the head portion  14  so that the adapter  194  may be pre-installed on the handle  126  and a separate arbitrary connector system used to mechanically and electrically join the adapter  194  with the remainder of the head portion  14  and grip portion  16 . 
     Referring still to  FIG.  20   , the circular display  18 , for example, may be a touchscreen LCD or organic LED display such as minimizes obstruction of vision by the healthcare professional viewing the display  18  displaying a field of interest such as may depict a clinical image  200  of an eardrum and portions of the ear canal. A peripheral region of the display  18  may provide for non-image data of an arcuate bar display  202 , for example, providing an arcuate band extending by varying angles about the center of the display  18  to indicate a magnitude and/or range of a variety of different quantities. In one embodiment, the arcuate length of the bar display  202  may represent a length of the video sequence of images acquired by the camera  30 . Moving one&#39;s finger  204  around the arc of the bar display  202  allows selection of a particular still image from that video sequence for viewing in the manner of a video scrubbing operation. The bar display  202  may also indicate by its length a variety of different quantities, for example, battery charge. Alternatively, the arcuate length of the bar display  202  may indicate a range of battery charge states (0 to 100 percent), and a marker arrow  205  moving about the periphery may indicate a battery charge within that range. Generally, the invention contemplates that this peripheral region may be used for display purposes without interfering with the display clinical image  200 . 
     A center region of the circular display  18  may also provide a touch sensitivity, for example, to allow a touch to trigger the taking of a snapshot of the given video when video recording is not enabled. A touch to the right of the display  18  may display non-image data of a right-side marker  206  indicating on the display  18  (and recorded in the stored images) that a particular story image is an image of the right ear. A corresponding a touch on the left side of the display  18  may provide a similar (but not shown) left marker. By placing this data around a periphery of the display  18 , less important areas of clinical image  200  are covered while permitting simultaneous viewing of important areas of the clinical image  200  together with non-image data without the healthcare physician averting his or her eyes. 
     An accelerometer or inclinometer  107 , discussed with respect to  FIG.  16   , may be used to deduce the orientation of the handle element at 18 or 18′, for example, to rotate displayed non-image data such as the arcuate bar display  202  or the side marker  206  to maintain a standard orientation with respect to gravity and the user for these elements as displayed during use of the otoscope  10 . During normal use, the displayed clinical image  200  always maintains the same orientation as the image structure in the ear; however, the recorded image may be adjusted upon storage by using the orientation derived from the inclinometer  107  to rotate that image so that it displays in the same orientation as if the otoscope  10  were held with a normal position of the grip portion  16  (directed generally downward). In this way, images viewed by an individual who is unaware of the actual orientation of the otoscope  10  during the image acquisition provide a standard orientation eliminating confusion. Thus, use of the inclinometer  107  to rotate the images before storage allows more flexibility in obtaining images without concern about their recorded orientation being confusing. Alternatively, the inclinometer  107  may be used to place an arrow marker (non-image data) in the image indicating the up direction. 
     Referring now to  FIG.  21   , in one embodiment, a protective tubular sheath  210  may extend from the housing  12  around the probe  28  when the speculum  24  is removed or changed. This sheath  210  may pass around the outside of the boss  134  to be received within an internal pocket  212  within the housing. The sheath  210  may be biased outward toward the extended position as urged by a helical compression spring  214  captured in the pocket  212 . The extension of the sheath  210  when the speculum  24  is removed prevents damage to the probe  28 , for example, if the otoscope  10  were to be dropped. Contact between collar  136  and the distal end of the sheath  210  when the speculum  24  is attached presses the sheath  210  back into the housing  12  and out of the way. 
     Referring now to  FIG.  22   , space between the inside surface of the speculum  24  (not shown in  FIG.  21   ) and the probe  28  may contain one or more conforming ribs  216  or similar over-molded plastic supports having a generally trumpet shaped profile. These ribs  216  provide additional support and protection to the probe  28  and eliminate a visual impression that the probe  28  is a needle such as may be distressing to pediatric patients. The ribs  216  may be integrally molded with the boss  134  for extra strength. The boss  134  may be detachable from the structure of the housing  12 , for example, providing a plug end  218  on the boss  134  releasably retained, for example, by snap elements  220  in a socket  222  affixed to the housing  12 . The socket  222  may support an electrical connector  224  mating with a similar connector  226  supported by the plug end  218 . Socket  222  may also support one or more high-powered LEDs  227  to be aligned with the fiber optics  144  when the plug end  218  is inserted into the socket  222 . In this way, the probe  28  may be readily replaced if damaged or different styles or lengths of probes  28  can be installed. The amount of force necessary to remove the plug end  218  from the socket  222  may be set to allow these components to separate if the otoscope  10  is dropped minimizing damage. In one embodiment, the inclinometer  107  may be accelerometer-based and detect freefall of the otoscope  10  (by a near zero measured acceleration) and employ an electronic actuator (not shown) to release this connection further minimizing damage. 
     The boss  134  may also include the LEDs to simplify its replacement by requiring only electrical connections to the rest of the otoscope. The boss  134  may have its own threaded attachment or may be held in place by a threaded collar or the like. 
     Certain terminology is used herein for purposes of reference only, and thus is not intended to be limiting. For example, terms such as “upper”, “lower”, “above”, and “below” refer to directions in the drawings to which reference is made. Terms such as “front”, “back”, “rear”, “bottom” and “side”, describe the orientation of portions of the component within a consistent but arbitrary frame of reference which is made clear by reference to the text and the associated drawings describing the component under discussion. Such terminology may include the words specifically mentioned above, derivatives thereof, and words of similar import. Similarly, the terms “first”, “second” and other such numerical terms referring to structures do not imply a sequence or order unless clearly indicated by the context. 
     When introducing elements or features of the present disclosure and the exemplary embodiments, the articles “a”, “an”, “the” and “said” are intended to mean that there are one or more of such elements or features. The terms “comprising”, “including” and “having” are intended to be inclusive and mean that there may be additional elements or features other than those specifically noted. It is further to be understood that the method steps, processes, and operations described herein are not to be construed as necessarily requiring their performance in the particular order discussed or illustrated, unless specifically identified as an order of performance. It is also to be understood that additional or alternative steps may be employed. 
     References to “a controller” and “a processor” can be understood to include one or more microprocessors that can communicate in a stand-alone and/or a distributed environment(s), and can thus be configured to communicate via wired or wireless communications with other processors, where such one or more processor can be configured to operate on one or more processor-controlled devices that can be similar or different devices. Furthermore, references to memory, unless otherwise specified, can include one or more processor-readable and accessible memory elements and/or components that can be internal to the processor-controlled device, external to the processor-controlled device, and can be accessed via a wired or wireless network. 
     “Diameter” as used herein should not be understood to require a cylindrical or circular element but to simply describe a diameter of a circumscribing cylinder closely conforming to the element. 
     It is specifically intended that the present invention not be limited to the embodiments and illustrations contained herein and the claims should be understood to include modified forms of those embodiments including portions of the embodiments and combinations of elements of different embodiments as come within the scope of the following claims. All of the publications described herein, including patents and non-patent publications are hereby incorporated herein by reference in their entireties.