Objective:
Laryngeal endoscopy is essential for voice assessment but remains inaccessible in many low- and middle-income countries due to high equipment costs and limited specialist availability. Early mHealth applications in laryngoscopy have emerged but still rely on expensive or impractical components. The aim of this study was to evaluate the feasibility of using low-cost, commercially available smartphone-compatible endoscopes as accessible alternatives for laryngeal imaging and pathology detection in resource-limited settings.

Methods:
A feasibility study was conducted in South Africa to determine whether affordable smartphone-compatible endoscopes could be used for laryngeal imaging. Borescopes were identified online and compared with conventional laryngoscopes for usability and smartphone integration. Three devices were tested on an airway mannequin by speech-language pathologists for ergonomics, image quality, and safety, and were rated using the System Usability Scale (SUS). Scores ≥68 were considered above average. The two best-performing devices were subsequently trialed in three human participants by an otolaryngologist using the same criteria. The highest-scoring device was identified as a potential low-cost alternative, and a literature review determined the biocompatibility and disinfection properties of the selected scope.

Results:
Eight smartphone-compatible borescopes (<$340) were initially identified; four were excluded for poor comparability with conventional laryngoscopes and one for unreliable smartphone connectivity. The remaining three models, which were single-lens, dual-lens, and screen-based respectively, integrated well with Android and iOS systems. Mannequin testing showed that the single- and dual-lens models achieved high SUS scores (95% and 97.5%). The screen-based model scored only 30% and was excluded. During human trials, both the single- and dual-lens devices demonstrated acceptable ergonomics and safety (SUS 50 and 62.5, respectively), but only the dual-lens model produced sufficiently clear laryngeal images for continued evaluation. The final device appeared biocompatible and suitable for high-level disinfection with hydrogen peroxide.

Discussion and conclusions:
Findings suggest that low-cost, smartphone-compatible endoscopes can feasibly capture laryngeal images in controlled settings. The dual-lens model provided the best balance of image quality, ergonomics, and usability, though refinements, such as a 3D-printed stabilizing sleeve, may enhance clinical performance. Further validation by otolaryngologists should determine whether short video recordings obtained from this device can reliably support detection of normal and abnormal laryngeal structures.