Fluid In the Ear? New Imaging Technology Aims to Revolutionize Middle Ear Assessment

Amyn Amlani 0:09
Welcome to this Week in Hearing. My name is Amyn Amlani. I’m joined today by Jeff Hydar, Chief Commercial Officer of PhotoniCare, and Dr. Seth Pransky, a pediatric, a pediatric ENT physician. Together, we will be discussing how PhotoniCare is providing better and simple to use diagnostic technologies to clinicians. Welcome, gentlemen.

Jeff Hydar 0:33
Thanks for having us.

Amyn Amlani 0:35
My pleasure. So Jeff, you’re the Chief Commercial Officer. Can you tell us a little bit about yourself before we talk about your company?

Jeff Hydar 0:43
Yeah, absolutely. So my name is Jeff Hydar, Chief Commercial Officer at PhotoniCare. I have been in the medical device space for over 20 years and bringing new technologies to market, both in the imaging space as well as in soft tissue, implantables. Really love the idea of bringing something that’s new and novel to the market where people can improve the care they’re delivering or providers can improve their care, but also are making a difference, right? It’s not just a ‘me too’ product. I really enjoy bringing new true technologies that are novel to the marketplace.

Amyn Amlani 1:15
Great. And then we also have Dr. Seth Prensky again he’s a pediatric ENT. Would you tell us a little bit about yourself, sir.

Seth Pransky 1:23
Happy to. Good day everyone. My name is Seth Pranskey and I am a pediatric otolaryngologist. I’ve been in practice here in San Diego for 36 years. And for 20 of those years, I was the Chief of the Department of Pediatric ENT at the Rady Children’s Hospital. And my career has been both as a clinician and as an educator. We have had a fellowship program here in San Diego since 1990. And we train both residents and

of the ENT world and the pediatricians. And I also have been the director of the CME department for 17 years educating the primary care physicians and allied health personnel for 17 years. And so

it’s a pleasure to be able to be part of this discussion regarding what I see is an incredible advancement in the ability to correctly diagnose and manage ear problems.

Amyn Amlani 2:23
Wow. Well, we appreciate both of you gentlemen being here and talking about this. So Jeff, let’s start out by talking about PhotoniCare. Tell us a little bit about the company when it was founded, where you’re located and those kinds of things, please.

Jeff Hydar 2:37
So PhotoniCare came out of the University of Illinois, Urbana Champaign, Ryan Shelton, one of our co founders and co founders along with Steve Boppart were in a lab working on optics and optical coherence tomography (OCT). Ryan Nolan had joined them. And three of the, the gentlemen founded the company in 2015. Out of the need of really was was a parent need. Ryan Shelton’s child had been going to the doctor with repeated ear infections. And he just thought this is really

archaic, that we were diagnosing this a lot of guessing. And they developed the technology to be very objective, which is what OtoSight Middle Ear Scope is. And as I said, in 2015, we commercialized the company and really began to develop the product product received FDA clearance in beginning of 2020. And we’re really began to commercialize it then. And again, we’re co located between Champaign, Illinois, and Durham, North Carolina, Durham has a ton of knowledge base and a ton of talent in the world of optics and optical coherence tomography. And we’ve been commercializing that product since 2020.

Amyn Amlani 3:46
Wow. So you mentioned the OtoSight, middle ear scope. So can you tell us a little bit about that?

Jeff Hydar 3:55
jYeah, for sure. So, the OtoSight Middle Ear Scope is an imaging device that allows you to really assess what’s going on in the middle ear. A lot of times with kids come in with ear complaints or ear infections, you have a doctor using something’s essentially a magnifying glass and a headlight that was developed over 150 years ago, to look in the ear and kind of guess is there fluid is there not fluid – is this infected or not? And they’re really doing their best to do this in a subjective manner. What OtoSight does is it uses optical coherence tomography to look through the tympanic membrane into that middle ear cavity. And that middle your cavity is where the fluid is if there’s fluid present, so we’re actually able to identify the presence or absence of that fluid, the turbidity of that fluid and what’s nice is we can do that even when there’s earwax present in the ear. So we’re giving very objective data and a form factor that’s very similar to the common otoscope that you’re used to using just with a whole lot more specificity than you would have otherwise.

Amyn Amlani 4:54
Okay, alright, so as I’m as I was looking at your website here, doing my

for this webinar, this webcast, and you talk about a 90.6% accuracy compared to a 50% accuracy with a traditional otoscope. So you’ve got some clinical evidence here. Can you talk a little bit about that for us?

Jeff Hydar 5:15
Of course, yeah. So there’s data published in 2001, by Pichichero et al out of Rochester, New York that showed that clinicians were accurate 50% of the time when diagnosing an ear infection. And this was done by showing the images and then they hadn’t made a clinical diagnosis based on the patient history and other material while other evolved. We followed that study up using the technology within OtoSight to look at similar images, showing them in a surface image of the eardrum along with an middle ear scan. And those combined, they showed about a 90.6% accuracy rate. And then this was against all comers. So we range from fellowship trained pediatric ENTs, to hospital administration, and they all work very, very equal and how they assess and diagnose if there’s fluid or not in the ear. Now, the benefit of this is this technology can be used by anybody, right? It could be the MA in the office could be the nurse, it could be the provider, but it was very objective, there was no art that had to be learned and how to use the technology and be able to correctly diagnose the presence or absence of fluid. And and or the turbitity of that fluid.

Amyn Amlani 6:26
Interesting. So I’m wondering, so to Dr. Pransky here. So you had mentioned that you train fellows and you’ve got residents that are coming in. And traditionally we’ve used an otoscope to look in the middle ear. Can you talk a little bit about how well that particular instrument, the otoscope has allowed you to look at middle ear and how this new product could potentially change the way that health care is being delivered in in people who have middle ear issues.

Seth Pransky 6:55
I think it’s important to understand that ENT is a tech heavy specialty. And we have seen magnificent changes in our ability to manage, diagnose and treat a variety of diseases that involve the head and neck.

And there was an interesting interaction that I had with the PhotoniCare co founders when walking through the academy meeting one year, I saw them began a dialogue was interested in what they were offering. And as I learned more about it saw the OtoSight as a sea change in the ability to appropriately and accurately diagnose what’s going on in the middle ear. For me as a clinician, I’ve spent a lot of time having to discuss with patients, what they may have been told which may not have been accurate in terms of their ear problems. Of course, as an otolaryngologist, I have technology, I have a microscope, I have the ability to have binocular vision I have all the things that we need within our specialty, which does not is not available to the vast majority of those that are looking at the ear. So an otoscope is small.

The light may vary depending on whether the battery’s running down or not. And it is, quite frankly, challenging, especially when dealing with wax that might be in the way with a struggling 18 month old who is irritable or crying or doesn’t like something going into the year. And consequently, what Mike Pichichero showed back in 2001 is that diagnostic accuracy is limited with an otoscope. And I saw the oversight as a sea change in the ability to visualize the tympanic membrane to record it, to be able to review it to show parents what’s going on and to assess the middle ear for the presence or absence of fluid, which quite frankly, can be rather challenging, and takes years and years of clinical acumen to really get right. So this has been an amazing development for routine standard care. Ear infections are the most common cause for going to the pediatrician after going for vaccinations and standard things like rashes and routine pediatric care. It’s an enormous number of patients that go there being diagnosed correctly or sometimes not correctly with an ear infection and being placed on antibiotics needed, maybe sometimes not needed.

Amyn Amlani 9:34
That’s very telling of the clinical efficiencies that new technologies are starting to bring in as Jeff pointed out, and you brought up the point here

that it’s using this on an 18 month old But can this also technology also we use on adults or is it primarily only for children?

Seth Pransky 9:51
Of course this is a wonderful tool for all patients. The the what you get with the instrument is

improvement. Furthermore, all patients, parents, patients themselves, adults, love to see what’s going on in their body. We know that in the ENT world, because we use scopes all the time, we’re passing scopes will look at different parts of the anatomy. And patients are more than just curious. They’re fascinated by what they’re what’s going on. And now they can understand with a little bit greater clarity, why a particular type of intervention has been recommended, be it do nothing or, or intervene with antibiotics or a recommended surgery. So of course, this is excellent for children, for adolescents for adults, for literally for everyone. And and it all marketplaces, I mean, it can be done in an emergency department in an urgent care in the primary cares office, the audiologist will benefit from this as well. Patients are curious, they want to see they’re used to it from the technology that we have in all other fields to be able to see and then be able to make a more informed decision.

Amyn Amlani 11:26
And I’m glad that you talked about the fact that you know, there’s different medical entry points in which this technology is going to be used. So Jeff, can you talk a little bit about how this is potentially being used in hearing care, versus for example, the medical setting a pediatric office, or an ENTs office?

Yeah, so I’m going to open the door, but I would like Dr. Pransky, really put the exclamation point on the statement. So, you know, a lot of times, you know, kids aren’t very communicative, or able to convey what their hearing losses because they don’t know what hearing loss is. What’s really nice about this is when you’re looking at this, you’re not gonna get a baseline for that patient of what their eardrum looks like, or what that is. But I think, Dr. Pransky’s we’ve had this conversation before, you know, when your kid has repeated fluid present, and you do a hearing test, and they have a decibel hearing loss, right? Talk about how you had that with some of your patients, if you don’t mind?

Well, I think if we just back up a little bit and talk about the fact that when you’re dealing with an ear, and either an ear infection or hearing impairment, the assessment has to be comprehensive. So you get the physicians look at the ear and the patient goes to the audiologist, for evaluation of what they’re hearing level is. And that in turn is a complex set of tasks to identify is there or is there not a hearing impairment. So you have the hearing test, and you have tympanogram, so it can pentagram done by both primary care physicians and certainly by audiologist is an adjunct tool to help determine if there is or is not fluid in the ear, or what the status of the tympanic membrane may be.

Unknown Speaker 13:12
But it’s exactly that it’s, it’s a, in some cases, a confirmatory evaluation, it is not a diagnostic evaluation that cannot tell you whether the fluid is infected or not, it cannot tell you if the are a significant retraction area or a mass behind the ear versus fluid. Whereas with the OtoSight, you get a chance to really see the eardrum and assess what’s going on behind the eardrum. So in that case, it’s it is a far more diagnostic tool, taking a lot of the guesswork out of the recommended management. And again, you can show the parent or the individual what’s going on and maybe explained why they have a hearing loss.

Amyn Amlani 13:58
Yeah, so it sounds like this particular instrument is a great differentiator in the marketplace. Jeff, can you talk a little bit about that?

Jeff Hydar 14:05
Yeah, so I my mind right away goes to the whole continuum of care from the entry point of a patient into the care system to ending up you know, at someone like Dr. Pransky’s office or any other sub specialist, so you know, one thing we have what they got broken bone, for example, we have a common language, we take an X ray and X ray goes in the EMR. And no matter who looks at that you have a pretty good idea that there’s a broken bone there is visual proof of that with an ear infection. We hear this very consistently that you know, you can back up to the entry point of the care system that pediatrician never trust the urgent care provider. The the ENT doesn’t trust the pediatrician. No one knows that anybody is doing the job properly. Well with this with OtoSight, you get that scan it goes into the medical record. And everybody is asked to that can clearly see the presence

or absence of the fluid in the ear, they can see what the eardrum looks like they can get that from anywhere. So when the urgent care provider says you have an ear infection, or you don’t have an infection, we’re not going to prescribe antibiotics, I want you to see your pediatrician tomorrow, and the pediatrician shows up and sees the converse. They can look at that and say, Okay, well, the disease is progressing the disease is in decline, or if it’s carrying it from the pediatrician to the ENT, you know, the guidelines call for three year infections in a six month period or four in 12 months. Well, some of those are subjective. And if you’re a parent taking your kid to a primary care office, you may not see the same provider twice in a row. So now you have what is your infection worth versus with somebody else? Again, we talked about objective proof. There’s no more opinion. There’s no more, ‘I don’t think so’ ‘I do think so’. It’s very clear, so that when they show up, or suspected tube placement, or, you know, further evaluation at a ENT office at an ENT office, that’s very clear, there’s no argument there’s no opinion. And having launched other technologies in the plastic surgery space that provided similar objective proof, the quality of care increase for everybody. Everyone’s worried about referral patterns, and I don’t want to upset my pediatrician. This takes that argument away. It either was or it wasn’t. So, you know, even the audiologist when they make their assessment, utilizing, say, for example, Otosight instead of a tympanometer. It’s very objective. There’s no ‘How good was the exam?’ How good was the technician who did the exam, it’s very clear, objective. And the proof was there in the images you see, in the medical record

Seth Pransky 16:42
if I can expand on that, as an otolaryngologist were referred patients for the idea of abnormalities, and the indications for tube or multiple for tympanostomy tubes or multiple. And so what Jeff was just referring to was the baseline indications for placement of tubes for recurrent ear infections. There’s also placement of tubes for persistent middle ear fluid. And the truth is that for many, many, many years, there’s been this problem of believability, that patient comes into the office. They’ve been told by their primary care provider, that they’ve just had their fifth ear infection in six months and are on yet another course of antibiotics. And as she goes through the evaluation and evaluate the ear, the ears are looking normal. Well, this is problematic for many, many years. And several years ago, our academies, the American Academy of Otolaryngology and our mother organization, American Society of pediatric otolaryngology, came out with a guideline saying, in order for the otolaryngologist to be comfortable placing tubes for recurrent otitis media for ear infections, they should see an abnormal eardrum. And that’s this concept of believability. It’s not meant to be a pejorative comment about primary care providers, it’s meant to be a comment about the challenges of really making an accurate diagnosis in a squirming kid with an otoscope. And so this removes that aspect of things to be able to say, well, here it is, it’s the same thing as if we’re going to place an ear tube for persistent middle ear fluid, we want to see an audiogram, which is as objective as one could get in terms of assessment of the hearing. If the audiogram is normal, maybe we don’t need to place in your tube quite yet. Maybe we need to wait and watch a little bit longer. And I think that the the OtoSight provides that extra sense of of objectivity. And if you will believe ability that allows the otolaryngologist to more comfortably say to the parent, I think the time has come to move to the next step in management.

Amyn Amlani 18:56
Yeah, in as you’re saying is I think about my children, right? One of them, one of them struggled with, with ear infections as a child a little bit of a language delay, you know, if I would this tool was available at that time, we could have potentially correlated their performance on the on the OtoSight device, with their abilities to acquire language development, because as the fluid dissipates, then you would see an improvement in their language abilities. And so, you know, from a, I think, from a parental standpoint, you could almost and even from a clinician standpoint, you can go in and say Hey, Mom, look, these things are changing. They’re changing for the better. So you should now see an improvement in your child’s behavior or your child’s language development or whatever the case may be. Am I correct?

Seth Pransky 19:44
I think Indeed you are. I think that we have seen so many technological advancements throughout the the medical world and of course in the non medical world with iPhones and and the newest and the best and it’s been a long

Time in coming in for the ear examination world to catch up in terms of this technological advancement to be far more accurate, to be able to show the parents to be able to discuss the situation and to and to move forward. There, as you know, there have been issues with the use of antibiotics for the last 30 years in terms of overuse, misuse, and concerns with developing resistance, versus the incredible benefits of antibiotics when you’re treating an acute ear infection. And so, this makes it much easier to have a conversation with the parents, when you can show them that this is an ear infection. And you can compare it to what is not an ear infection. And so either the four using an antibiotic or the not using an antibiotic is far more easily discussed, when you have an objective view of the tympanic membrane and looking at what’s going on in the middle ear.

Jeff Hydar 21:00
Just Just a brief story on that. So I have a daughter who is, you know, had recurrent ear infections from 12 years old on and she just kept getting these things and were like, the real Are they not? And they would look in the ear. And ultimately, it just became dogma, like, Oh, she has another ear infection, they almost didn’t even look in the ear. They just gave her another round of antibiotics. Well, you know, now at 20 years old, I started to work with with PhotoniCare. And we, you know, came home at Thanksgiving two years ago, year and a half ago. And we looked in the air and there was no fluid, but yet she had just been diagnosed for her, you know what it was about her 12th round of antibiotics, lo and behold, no fluid, she goes back to the ENT and said, Well, maybe it’s something else. And she end up having some some nerve damage from cheerleading of kids landing on her. So here’s a kid for eight years that received multiple rounds of antibiotics. And again, through that time, right, you’re going to different primary care providers, you’re going to urgent care at the university. Nobody is consistent in the care, but had that objective view and done early on. And it’s a no fluid, no fluid, now referred to physical therapy, and all these rounds of antibiotics. And to this point, I mean, for the most part resistance to the most common antibiotics that are on the market.

Seth Pransky 22:15
You know, there’s to to expand upon this. One of the incredible advantages of this tool is beyond parents, and beyond the physician practitioner, but in terms of education of our trainees, because it’s hard to learn what is right and wrong in the middle ear, it’s hard to differentiate infection from fluid, it’s hard to know at what point in the whole process you’re coming in. Is it midway in in the whole process of infection? Is it resolving? Is it just starting, and this provides the ability to take our trainees, our pediatricians, our our general practitioners, the urgent care doctors in the emergency room physicians, and to be given them to give them the training that they need to make the right diagnosis. In the ENT world, we have all encountered the patient’s being urgently added on for yet another ear infection for which they have yet another course of antibiotics. The prescription is still in the parents pocket. But they were just seeing 12 hours ago with an obvious ear infection, and you look at the ear and it’s completely normal. And that’s problematic. It leads to a lot of misdiagnosis and a lot of mistreatment and the ability to have this instrument and even within an urgent care setting or in an emergency department to make a recording and to discuss it immediately with your colleagues if you’re not sure is yet another way of making sure that the patient’s getting the appropriate care that they need.

Amyn Amlani 23:53
Yeah, it what’s going through my mind as you’re speaking Dr. Pransky and I really appreciate your comment is some of my colleagues might be saying, Well, do you have this OtoSight device? Is it replacing the tympanometer? Or should they work cohesively together? Can you elaborate on that a little bit?

Seth Pransky 24:10
Yes. So you have to understand exactly what it tympanometry what tympanometry does. It’s not a diagnostic tool. It can’t tell you what the diagnosis is. It’s a wonderful tool as an adjuvant or complementary to the evaluation. But what it does is it provides a pressure wave and it tells you whether the eardrum is in a particular position, or whether it’s not moving appropriately, or perhaps volume is such that there’s a hole in the eardrum, but it doesn’t give you a diagnosis. And consequently, when you have something in which you can look at it and objectively say it meets the criteria of x, y or z then that will pretty much obviate the need for tympanometry not completely eliminate it, there will be times when tympanometry will be useful. But as a routine test that needs to be done well, when you get to look at the ear, and you have it recorded, and you can memorialize it in the medical record and use it to compare for the future, it’s, it provides something beyond tympanometry. Remember that audiometric evaluations are complex and involve a lot of different tools to assess the entire hearing status. tympanometry is one of those. And that’s not not the be all and end all of assessing the ear.

Amyn Amlani 25:34
Yeah, and I appreciate you sharing that comment. Because again, I you know, a lot of my peers might be thinking it’s replacing one or taking in it really appreciate that comment. Jeff, I’m gonna come back to two questions really quick about the product, and then we’ll move on to, to reimbursement and revenue. The two questions are training, does the person that’s using this need to be trained? And if so, do you all provide that?

Jeff Hydar 26:00
So yes, and yes, we find that a lot of times, I mean, doctor Pransky can speak to this more directly. But there’s very little education done in medical school on how to properly conduct an otoscopy exam, we spend a lot of time just going through the ear anatomy, understanding why you approached the ear, the way you do with the OtoSight, middle ear scope, training, in all actuality, takes, you know, to get someone proficient using the device, getting them trained in about a 10 to 15 minute timeframe, which is support electronically through a learning management system, but also on site. And then it really takes about 10 to 15 exams for a user to get to that just normal muscle memory, they’re used to using with an otoscope. It’s not that much, radically different. But it is from a point of view is that we’re depth dependent. So you have to insert the device a certain depth to be able to get the proper reading within the middle ear space that exists as far as the ability to use it and learning very, very simple just takes time. And again, the challenge is you’re breaking a muscle, breaking a muscle memory or a habit that you’re used to using and just approaching it slightly differently.

Amyn Amlani 27:16
Yeah. In the second question that I have for you, Jeff, you talked about the the data as did Dr. Pransky, but the data is somehow stored? Is it stored on a cloud? Is it stored on a local computer? Because it has to somehow access, you have to be able to access it in your EMR. Can you talk a little bit about that?

Jeff Hydar 27:33
Yeah, so our device stores the data on the device and then can be transferred to your internal or on premises server for manipulation into the EMR, we don’t directly integrate to the EMR, I think is anybody within the world of the medical device industry knows, if you connected with one hospital, you’ve connected with one hospital, it’s a challenging and expensive prospect. So we find that through Wi Fi, getting it off the device into the network for users, it works out very, very well. And again, it saves on the device as well. So you can go back, either through your servers or through the device itself and historical data.

Amyn Amlani 28:12
Very cool. I appreciate you sharing that. So last last section here, and that is practice revenue. People want to know how is this going to benefit their bottom line? Can you both talk to us a little bit about that?

Jeff Hydar 28:27
Yeah, so I’ll take it from a reimbursement perspective. And, you know, coming from the past, wound care industry, I’m always cautious to say that the terms of profit or revenue around making money on a device, but the reality is our device is reimbursed, you got a reimbursement code that can be applied for you either unilaterally or bilaterally. For reimbursement purposes, we see a very robust reimbursement rate with that, we are a category three code. So that means that the user kind of dictates what they want to have for reimbursement, there’s not a set code at this point. And then, as far as revenue outside of reimbursement, which is again, a very positive situation for us, you know, when when a provider can uniquely offer this technology, it really is a differentiator in a practice. Now, you know, we, through our marketing have approached, you know, through through, you know, reaching out to parents and saying, you know, if your provider had this, would you choose this one versus not? And very clearly, having advanced technology is something that parents want for their children. Every mom wants to do the best they can for their child. This allows them to do that. And, you know, I know for myself, if I can go to an office that is treating stomach upset stomach issues with Coca Cola versus one that saying, Hey, here’s a diagnostic we know what the problem is. This is how it’s being documented. This is how to treat it. I want to go to the ones a little bit more advanced. And we find that to be the case here as well. So really differentiating as a higher tech practice. Again, frontline care doesn’t get a whole lot of advancement. There’s not a lot of money being spent by in by industry to advance what’s going on in the pediatricians office or the family practice office or the primary care office. So while a new and differentiated technology, you know, that’s really important. Again, that’s the entry point for parents into an entire health care system. So once they’re in your primary care network, of course, you’re going to get the whole IDN supported with that. Dr. Pransky, do you want to add anything to that?

Seth Pransky 30:29
Just make a few comments. First one, on a little bit of the more global level. Years ago, when lecturing to the primary care physicians, I would indicate that the otitis marketplace was a $15 billion marketplace in terms of office visits, in terms of cost of medications, the use of antibiotics, miss time from work, and all the aspects of taking care of an ear infection. And when you have proper diagnosis, the ultimate result is reduced costs. Either you’re treating a problem appropriately, and avoiding problems that come with a treatment, such as giving an antibiotic and having an adverse reaction, or you’re treating the problem and getting it taken care of appropriately, more rapidly. And in the end, proper diagnosis leads to reduce costs on the healthcare system in general. Secondly, in terms of just the day to day, environment of families, parents going to their primary care physician, where travels quickly, parents talk to each other mommy groups are all over the place. And as soon as one parent goes in, and sees what happens and says, I saw my childs eardrum, and now I understand why she didn’t sleep last night, it was horrible. You could see one ear was okay. The other ear was bulging and red and inflamed. Now I understand. And that word travels very, very quickly. And for the competitive marketplace, within patient care. The idea of being up to date at having the best technology, having a comfort zone with your pediatrician mean, parents admire, they love their pediatricians. And they want to know that they’re getting the best care possible. And the best diagnostic decision making. And this the OtoSight, as I’ve mentioned, is just so much better than working with a handheld otoscope. Regarding the the learning of the use of the tool, there is nothing within the field of medicine that doesn’t require from the medical school one up just as in basketball, or football, multiple reps, you got to do it, you got to do it again and again and again. And you get better as you do it again and again. And again. So of course there’s the learning curve. But fortunately, it’s a it’s not a steep learning curve, you are used to putting something in the ear, albeit an otoscope. And this is an alternate form of it. And you’re using the same approach when you’re using a different technology. And it doesn’t take long to get better and better at it. Of course, there’s steps along the way. But the gains are so much more to be able to take this finding and discuss it with your colleagues or to take it to a meeting and show this picture of year. And what happened by virtue of what you saw. That aspect of training and education is so far superior to Well, I looked in the ear, and this is what I saw. And no one really knows what you saw. It’s just what you’re describing. So learning how to use the tool is like anything else, a stethoscope or any other device, you’ve got to listen to the heart about 10,000 times before you can figure out what that murmur is. Well, looking at an eardrum requires a similar sort of training. But this requires provides immediate feedback and the ability to sit there and talk to your students about what it is they just saw.

Amyn Amlani 34:15
Yeah, I’m glad. I’m glad you shared that because that’s I think that’s important for our viewership to to understand that and thank you both. Last question. So, Jeff, is I’m looking at your website, if your product is only available in the United States at this point in time. So can you talk a little bit about any future developments without giving away the secret sauce of PhotoniCare?

Yeah, so we’re definitely globalizing the product as well. We’re working with some folks in Japan, distribution group in Japan, they’re going through our process there as well some other countries. So yes, we continue to work towards globalization. As far as the product itself, we continue to iterate as you would with any technology. Whether it be portability, size function, the technology itself is in eyecare right now. And as we grow PhotoniCare, we’ll begin to see it, I’m sorry, is in ear care right now. But we have other tissue sites that we can use this technology with as well, whether it be Dental, or cardiac, or dermal or other. So other places that we can go with technology as well, right now are very focused on the frontline care market with OtoSight Middle Ear Scope. And we know we’re going to deliver excellence there. Once that’s done, we’ll go to the next site.

Yeah, gentlemen, as we wrap up any final comments for viewership?

I’ll go first. And Dr. Pransky, you can close it out. But I would just say thank you very much for the opportunity to talk a little about oversight to talk about optical coherence tomography outside of the eye, in this case in the ear, and we’re very thankful to be able to make you aware of it. I think one thing that I would say in closing is everyone’s used to the common technologies they’re used to using and it’s easy to just say, I’m going to use my otoscope or whatever it is. But just like when we started out with no phone, and then we had a flip phone, and then we had a Blackberry. Now we got to an Apple, and now you know whatever your smartphone of choice is. Medicine needs to continue to iterate and get better and introduce technology. And the more we do that the more objective data we get, and the better quality of care we can deliver as a whole again, from our my part as being part of industry. But Dr. Pransky as a provider I think can offer better care as well. Do you want to anything that Dr. Pransky

Seth Pransky 36:33
I think it’s like most things in medicine. It’s the next step. We’ve we’ve had this otoscope technology for X number of years, and it’s been begging to be improved. And we’re finally there, we’ve got the next step. And the bumps along the way have been ironed out as with any technology difference between an iPhone 5 and an iPhone 13, things get better and better. And like driving a Tesla, the software enhancements can be made. And it’s just the the concept of, quote, prove it to me as the otolaryngologist or prove it to me as the parent has now been changed to let me show you why I’m doing what I’m doing. So from my perspective, this has been a long time in coming and I’m delighted to be able to share my experience and expertise with this and and will anticipate that this will take off like wildfire in the all of the medical community involved with hearing with ears and with medical management.

Amyn Amlani 37:50
Well, gentlemen, we really appreciate you all sharing your insights, your product, your services, and how this can benefit the community. And we look forward to catching up with you guys down the road here a little bit. So again, thank you for coming on and we’ll be in touch soon.