## Adjustment & Fixation  
Regarding the efficiency of the new video otoscope, we were asked two questions: the first on the complete visualization of the tympanic membrane and the second on the visualization of the entire external auditory canal, obtaining average answers of 3.18 (SD \(\pm\) 1.62) and 3.77 (SD \(\pm\) 1.19), with a mode of 5 in both questions. Overall, on the effectiveness of the new device, we found an average response of 3.48 (SD \(\pm\) 1.44) with a mode of five (maximum value). Satisfaction with the new device was assessed through two questions: the first, How satisfied are you with using the video otoscope?, and the second, which focused on the comfort and ergonomics of the equipment, entitled Does the equipment seem ergonomic and comfortable for long-term use in your clinical practice? The answers to these questions had a mean of 3.18 (SD \(\pm\) 0.98) and 2.45 (SD \(\pm\) 1.21), with a mode of 3 and 2, respectively. An overview analysis of satisfaction on the part of the Health professionals who took part in this pre-test of the new device shows that the average response was 2.88 (SD \(\pm\) 1.14),  
Figure 7: Results of the questionnaire to health professionals regarding adjustment and fixation of the video otoscope. with a mode of 2. Open-ended questions and suggestions for improvement were put forward, which essentially focused on attaching the equipment to the patient's head, with the possibility of the professional pulling the EEC, and on the ergonomics of the device with a view to greater comfort, which is in line with the responses obtained in the questionnaire. The results of the questionnaire addressed to patients (N = 10, 1 of the questionnaires was not considered since the patient did not answer all the questions) revealed that their level of satisfaction with the use of the video otoscope is 4.1 (SD \(\pm\) 0.64) on the Likert scale, with a mode of responses equal to 4 (Figure 8). Compared to conventional otoscopy, the patients' opinion points to a good degree of satisfaction with this new device, with an average of 3.7 (SD \(\pm\) 1.42) and a mode of 5. When asked about the ergonomics and comfort of the device, the participants' answers point to an average of 3.1 (SD \(\pm\) 1.29) on the Likert scale, with a mode of answers equal to 3. Facing the question, \"Would you recommend this device to a family member or friend?\", the majority of participants (80%) said yes. In the open-ended questions, participants mentioned improving the fit of the head support for greater comfort. At this stage of development, it is possible to observe that this prototype version is already at a stage where it is producing results with some consistency. However, given the results obtained in the pre-test, the prototype's next iteration should consider improving patient comfort and improving the device's fastening system. The optimization proposals presented as results of the usability tests will increase the developed device's effectiveness, comfort, and adaptability. Improvements to be taken into account for the next iteration include the following: (i) changing geometry to unobstructed manual retraction, (ii) reducing camera diameter, (iii) increasing insertion angle flexibility, (iv) button integration for image capture, and (v) simplifying the harness attachment system. Implementing these optimization proposals is crucial for the otoscope to respond to clinical needs in a more robust way, facilitating the work of speech therapists and increasing patients' well-being. However, the work does not end with the improvement proposals presented. It is essential to continue the development process to ensure the video otoscope meets the clinical needs in an effective and safe manner, applying the suggested changes and carrying  
Figure 8: Results of the questionnaire to patients regarding their level of satisfaction with the use of the video otoscope. out new validation tests.