← Product Code [PHZ](/submissions/AN/subpart-b%E2%80%94diagnostic-devices/PHZ) · K221614

# TytoCare Lung Sounds Analyzer (K221614)

_Tyto Care , Ltd. · PHZ · Feb 24, 2023 · Anesthesiology · SESE_

**Canonical URL:** https://fda.innolitics.com/submissions/AN/subpart-b%E2%80%94diagnostic-devices/PHZ/K221614

## Device Facts

- **Applicant:** Tyto Care , Ltd.
- **Product Code:** [PHZ](/submissions/AN/subpart-b%E2%80%94diagnostic-devices/PHZ.md)
- **Decision Date:** Feb 24, 2023
- **Decision:** SESE
- **Submission Type:** Traditional
- **Regulation:** 21 CFR 868.1900
- **Device Class:** Class 2
- **Review Panel:** Anesthesiology
- **Attributes:** AI/ML, Software as a Medical Device, Pediatric

## Intended Use

The TytoCare Lung Sounds Analyzer is an over-the-counter decision support software system used in the evaluation of lung sounds in adults and children (2 years and older). It automatically analyzes the acoustic signal of the lung as recorded by the FDA cleared compatible Tyto Stethoscope and identifies recordings where a specific abnormal lung sound suggestive of "Wheeze" is suspected. It is not intended to detect other abnormal or normal lung sounds. A licensed health care professional's advice is required to understand the meaning of the TytoCare Lung Sounds Analyzer result. Healthcare provider should consider the device result in conjunction with recording and other relevant patient data.

## Device Story

Web-based software system for clinical assessment of lung auscultation data. Inputs: audio files of lung sounds recorded by FDA-cleared Tyto Stethoscope. Processing: cloud-hosted algorithm analyzes recordings to detect presence of wheeze. Outputs: positive/negative wheeze detection result displayed via web interface. Used in clinical or home environments by clinicians or lay users. Output assists healthcare providers in clinical decision-making; requires professional interpretation. Benefits: provides automated decision support for identifying potential wheezing in patients.

## Clinical Evidence

Retrospective validation study using 371 recordings from 359 patients (age >2 years). Ground truth established by majority vote of three blinded pulmonologists. Sensitivity: 0.69 (95% CI: 0.57–0.78); Specificity: 0.92 (95% CI: 0.88–0.95). Clinical performance (AUC) compared to non-pulmonologist physicians: Device AUC 0.91 (0.86-0.94) vs. Reader AUC 0.83 (0.78-0.86), supporting non-inferiority (difference 0.09, 95% CI 0.04-0.13).

## Technological Characteristics

Cloud-hosted software system; processes audio input from Tyto Stethoscope. No physical sensors; relies on external hardware for data acquisition. Connectivity via IP network. Software lifecycle follows IEC 62304. Risk management per ISO 14971. Usability engineering per IEC 62366-1.

## Regulatory Identification

A diagnostic pulmonary-function interpretation calculator is a device that interprets pulmonary study data to determine clinical significance of pulmonary-function values.

## Predicate Devices

- wheezo WheezeRate Detector ([K202062](/device/K202062.md))

## Reference Devices

- Tyto Stethoscope ([K181612](/device/K181612.md))

## Submission Summary (Full Text)

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February 24, 2023

Tyto Care Ltd. Stella Perry RA&QA Director 14 Beni Gaon Street Netanya, 4250803 Israel

Re: K221614

Trade/Device Name: TytoCare Lung Sounds Analyzer Regulation Number: 21 CFR 868.1900 Regulation Name: Diagnostic Pulmonary-Function Interpretation Calculator Regulatory Class: Class II Product Code: PHZ Dated: January 26, 2023 Received: January 26, 2023

Dear Stella Perry:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's

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requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

### Rachana Visaria -S

Rachana Visaria, Ph.D. Assistant Director DHT1C: Division of Sleep Disordered Breathing, Respiratory and Anesthesia Devices OHT1: Office of Ophthalmic, Anesthesia, Respiratory, ENT and Dental Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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### Indications for Use

510(k) Number (if known) K221614

#### Device Name

TytoCare Lung Sounds Analyzer

#### Indications for Use (Describe)

The TytoCare Lung Sounds Analyzer is an over-the-counter decision support software system used in the evaluation of lung sounds in adults and children (2 years and older). It automatically analyzes the acoustic signal of the lung as recorded by the FDA cleared compatible Tyto Stethoscope and identifies recordings where a specific abnormal lung sound suggestive of "Wheeze" is suspected. It is not intended to detect other abnormal or normal lung sounds. A licensed health care professional's advice is required to understand the meaning of the TytoCare Lung Sounds Analyzer result. Healthcare provider should consider the device result in conjunction with recording and other relevant patient data.

| Type of Use (Select one or both, as applicable) |
|-------------------------------------------------|
|-------------------------------------------------|

Prescription Use (Part 21 CFR 801 Subpart D)

> Over-The-Counter Use (21 CFR 801 Subpart C)

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### 510(k) Summary

| Submitter Name<br>and Address:           | Tyto Care Ltd.<br>14 Beni Gaon Street<br>Netanya, Israel, 4250803                                                                                                                            |
|------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Contact Person:                          | Stella Raizelman Perry<br>RA & QA Director<br>Email: stellar@tytocare.com<br>Phone Number: +972 72-2210750<br>Fax Number: +972 72-2210752                                                    |
| Establishment<br>Registration<br>Number: | 3012678246                                                                                                                                                                                   |
| Date Prepared:                           | February 24, 2023                                                                                                                                                                            |
| Device Trade<br>Name(s):                 | TytoCare Lung Sounds Analyzer                                                                                                                                                                |
| Device Common<br>Name:                   | TytoCare Lung Sounds Analyzer                                                                                                                                                                |
| Classification:                          | Name: Diagnostic pulmonary-function interpretation<br>calculator<br>Product code: PHZ<br>Secondary product code: DQD<br>Regulation No: 21 CFR 868.1900<br>Class: II<br>Panel: Anesthesiology |

### Predicate Device(s):

Device name wheezo WheezeRate Detector (by Respiri Limited) 510(k) No. K202062

Date of Clearance March 11, 2021

#### Reference Device(s):

| Device name      | 510(k) No. | Date of Clearance |
|------------------|------------|-------------------|
| Tyto Stethoscope | K181612    | December 17, 2018 |

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#### Intended use / indication for use statement

The TytoCare Lung Sounds Analyzer is an over-the-counter decision support software system used in the evaluation of lung sounds in adults and children (2 years and older). It automatically analyzes the acoustic signal of the lung as recorded by the FDA cleared compatible Tyto Stethoscope and identifies recordings where a specific abnormal lung sound suggestive of "Wheeze" is suspected. It is not intended to detect other abnormal or normal lung sounds. A licensed health care professional's advice is required to understand the meaning of the TytoCare Lung Sounds Analyzer result. Healthcare provider should consider the device result in conjunction with recording and other relevant patient data.

#### Device description

The TytoCare Lung Sounds Analyzer is a web-based software system designed to aid in the clinical assessment of lungs auscultation sound data by analyzing recorded lung sounds to determine whether a Wheeze is detected within the recorded sound data.

The TytoCare Lung Sounds Analyzer Software is intended to process recordings from the FDA-cleared compatible Tyto Stethoscope (Tyto Stethoscope, K181612). The acquisition of the acoustic data (recordings) is carried out by a professional user in a clinical environment or by a lay- user in a non-medical environment, in compliance with the labeling of the Tyto Stethoscope.

The system is composed of the following sub-systems:

- 1. The TytoCare Lung Sounds Analyzer Application Server (APS) communicates with the TytoCare Lung Sounds Analyzer Algorithm Server (ALS) and implements an application programming interface (API) for communication with the telehealth server.
- 2. The TytoCare Lung Sounds Analyzer Algorithm Server (ALS) receives an audio file as input and returns an analysis result of positive or negative regarding whether a wheeze was detected as output.
- 3. The TytoCare Lung Sounds Analyzer Web Server (WBS) provides a graphic indication whether a wheeze is detected in the recording. It can be utilized both in patient and clinician side.

All the software subsystems (servers and storage) are hosted in the cloud and communicate through IP network.

#### Substantial Equivalence to Predicate Devices

The following table compares the TytoCare Lung Sounds Analyzer to the predicate

and reference device devices:

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|                                        | Device                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       | Predicate                                                                                                                                                                                                    | Reference device                                                                                                                                                                                                                                                                                                                                                                                       | Summary                                                                                                                                                                                                                                                                                                                                |
|----------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Device Name                            | TytoCare Lungs Sounds<br>Analyzer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            | wheezo WheezeRate<br>Detector                                                                                                                                                                                | Tyto Stethoscope (OTC)                                                                                                                                                                                                                                                                                                                                                                                 | NA                                                                                                                                                                                                                                                                                                                                     |
| Device<br>Manufacturer                 | Tyto Care Ltd.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               | Respiri Limited                                                                                                                                                                                              | Tyto Care Ltd.                                                                                                                                                                                                                                                                                                                                                                                         | NA                                                                                                                                                                                                                                                                                                                                     |
| 510(k) Number                          | K221614                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      | K202062                                                                                                                                                                                                      | K181612                                                                                                                                                                                                                                                                                                                                                                                                | NA                                                                                                                                                                                                                                                                                                                                     |
| Device Class                           | Class II                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     | Class II                                                                                                                                                                                                     | Class II                                                                                                                                                                                                                                                                                                                                                                                               | Same                                                                                                                                                                                                                                                                                                                                   |
| Review Panel                           | Anesthesiology                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               | Anesthesiology                                                                                                                                                                                               | Cardiovascular                                                                                                                                                                                                                                                                                                                                                                                         | Same                                                                                                                                                                                                                                                                                                                                   |
| Product code                           | PHZ<br>DQD                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   | PHZ                                                                                                                                                                                                          | DQD                                                                                                                                                                                                                                                                                                                                                                                                    | Same                                                                                                                                                                                                                                                                                                                                   |
| Regulation number                      | 21 CFR 868.1900                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              | 21 CFR 868.1900                                                                                                                                                                                              | 21 CFR 870.1875                                                                                                                                                                                                                                                                                                                                                                                        | Same                                                                                                                                                                                                                                                                                                                                   |
| Classification Name                    | Diagnostic pulmonary-<br>function interpretation<br>calculator                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               | Diagnostic pulmonary-<br>function interpretation<br>calculator                                                                                                                                               | Stethoscope                                                                                                                                                                                                                                                                                                                                                                                            | Same                                                                                                                                                                                                                                                                                                                                   |
| Intended use and<br>indication for use | The TytoCare Lung Sounds<br>Analyzer is an over-the-<br>counter decision support<br>software system used in the<br>evaluation of lung sounds in<br>adults and children (2 years<br>and older). It automatically<br>analyzes the acoustic signal                                                                                                                                                                                                                                                                                                              | Wheezo is intended to<br>detect and record<br>abnormal breath sounds<br>(continuous adventitious<br>breath sounds/CABS) at<br>the windpipe (trachea),<br>reported as WheezeRate<br>in adults and children (2 | The Tyto Stethoscope is an<br>electronic stethoscope that<br>enables transmission of<br>auscultation sound data,<br>whereby a clinician at one<br>location on an IP network<br>can listen to the auscultation<br>sounds of a patient on site or                                                                                                                                                        | Same<br>Both the predicate device and the<br>subject device have the same<br>intended use and indication for<br>use in that both are intended to<br>detect specific and abnormal<br>breath sounds in the same                                                                                                                          |
|                                        | Device                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       | Predicate                                                                                                                                                                                                    | Reference device                                                                                                                                                                                                                                                                                                                                                                                       | Summary                                                                                                                                                                                                                                                                                                                                |
|                                        | of the lung as recorded by<br>the FDA cleared compatible<br>Tyto Stethoscope and<br>identifies recordings where<br>a specific abnormal lung<br>sound suggestive of<br>"Wheeze", is suspected. It<br>is not intended to detect<br>other abnormal or normal<br>lung sounds. A licensed<br>health care professional's<br>advice is required to<br>understand the meaning of<br>the TytoCare Lung Sounds<br>Analyzer result. Healthcare<br>provider should consider<br>the device result in<br>conjunction with recording<br>and other relevant patient<br>data. | years and older). A<br>licensed health care<br>professional's advice is<br>required to understand the<br>meaning and importance<br>of the wheezo readings.                                                   | at a different location on the<br>IP network with the signal<br>carried on an IP connection<br>between the two locations.<br>The Tyto Stethoscope is<br>intended to be used by<br>professional users in a<br>clinical environment or by<br>lay users in a nonclinical<br>environment. The device is<br>for medical diagnostics<br>purposes only. The device is<br>not intended for self-<br>diagnosis. | intended patient population (adult<br>and pediatric) by the same user<br>[Health Care Professional (HCP)]<br>when self-administered by patient<br>and/or the HCPs.<br>Both devices are only intended to<br>be interpreted by HCP and HCP<br>advice is required for the patient<br>to understand their result. Both<br>are labeled OTC. |
| Type of use                            | Over-The-Counter Use                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         | Over-The-Counter Use                                                                                                                                                                                         | Over-The-Counter Use                                                                                                                                                                                                                                                                                                                                                                                   | Same                                                                                                                                                                                                                                                                                                                                   |
| Intended users                         | Intended to be used by<br>professional users and lay<br>users.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               | Intended to be used by lay<br>users                                                                                                                                                                          | Intended to be used by<br>professional users and lay<br>users                                                                                                                                                                                                                                                                                                                                          | Similar, the TytoCare Lung<br>Sounds Analyzer is intended for<br>clinicians and lay users.                                                                                                                                                                                                                                             |

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|                                                           | Device                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        | Predicate                                                                                                                                                                                                                                                                                                                                                                                                      | Reference device                                                                                                                                                                                                                                                                                                                                                                                                        | Summary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          |
|-----------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Intended patient population                               | Intended for patients of 2 years and older                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    | Intended for patients of 2 years and older                                                                                                                                                                                                                                                                                                                                                                     | Intended for patients of all ages                                                                                                                                                                                                                                                                                                                                                                                       | Same                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             |
| Intended environment                                      | Non-clinical (home) and clinical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              | Non-clinical (home)                                                                                                                                                                                                                                                                                                                                                                                            | Non-clinical (home) and clinical                                                                                                                                                                                                                                                                                                                                                                                        | Similar.<br>the TytoCare Lung Sounds Analyzer is intended for both home and clinical environment                                                                                                                                                                                                                                                                                                                                                                                                                                                                 |
| Form                                                      | Stand-alone software system                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   | Hardware and Software, hand-held stand-alone device used with smartphone                                                                                                                                                                                                                                                                                                                                       | Hardware and Software, hand-held stand-alone device used with smartphone                                                                                                                                                                                                                                                                                                                                                | Different.<br>The acquisition of lung sounds of both devices is conducted by FDA cleared device, therefore there is no new question of effectiveness.                                                                                                                                                                                                                                                                                                                                                                                                            |
|                                                           | Device                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        | Predicate                                                                                                                                                                                                                                                                                                                                                                                                      | Reference device                                                                                                                                                                                                                                                                                                                                                                                                        | Summary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          |
| Device composition                                        | The following modules<br>compose the TytoCare<br>Lung Sounds Analyzer:<br>• The TytoCare Lung<br>Sounds Analyzer<br>Application Server (APS)<br>• The TytoCare Lung<br>Sounds Analyzer<br>Algorithm Server (ALS)<br>• The TytoCare Lung<br>Sounds Analyzer Web<br>Server (WBS) provides a<br>graphic indication<br>whether a wheeze is<br>detected in the recording<br>It can be utilized both in<br>patient and clinician side.                                                                                                                                                                                                                                                                              | The wheezo WheezeRate<br>Detector consists of:<br>• Wheezo Sensing<br>Device<br>• Wheezo App<br>• Cloud server                                                                                                                                                                                                                                                                                                 | Hardware:<br>• A stethoscope Chest<br>Piece:<br>o Stethoscope Adaptor<br>o TytoCare Device<br>Software:<br>• TytoCare Device<br>Application<br>[runs on TytoCare Device]<br>• TytoCare<br>Application<br>[runs on the mobile<br>device]<br>• Clinician<br>Application<br>[runs on the clinician<br>platform]<br>• Server software<br>[runs on the Tyto Server]                                                          | Different<br>The TytoCare Lung Sounds<br>Analyzer is a Stand-alone<br>software system used with<br>compatible Tyto Stethoscope to<br>record lung sounds. The Wheezo<br>is Hardware and Software, hand-<br>held device used with smartphone.<br>Both devices acquire lung sounds<br>and provide indication on the<br>presence of wheeze to the user.<br>The difference doesn't raise new<br>questions of safety or<br>effectiveness.                                                                                                                              |
| Input                                                     | Lung sounds recorded by<br>compatible Tyto<br>Stethoscope                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     | Lung sounds recorded by<br>the wheezo device                                                                                                                                                                                                                                                                                                                                                                   | Lung sounds recorded by<br>the Tyto Stethoscope                                                                                                                                                                                                                                                                                                                                                                         | Different<br>Both devices acquire lung sounds<br>with device cleared by the FDA<br>for that purpose                                                                                                                                                                                                                                                                                                                                                                                                                                                              |
|                                                           | Device                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        | Predicate                                                                                                                                                                                                                                                                                                                                                                                                      | Reference device                                                                                                                                                                                                                                                                                                                                                                                                        | Summary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          |
|                                                           |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |                                                                                                                                                                                                                                                                                                                                                                                                                |                                                                                                                                                                                                                                                                                                                                                                                                                         | The difference doesn't raise new<br>questions of safety or<br>effectiveness                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      |
| Device technology<br>and operating<br>principle           | The recordings are created<br>by the compatible Tyto<br>Stethoscope (K181612) and<br>are sent by the third-party<br>point of care app to the<br>clinician app through the<br>telehealth server.<br>The telehealth server sends<br>the set of the lung sound<br>recordings to the TytoCare<br>Lung Sounds Analyzer web<br>server using its dedicated<br>API.<br>The telehealth server<br>subsequently sends the link<br>to results and the relevant<br>UI web view to the point of<br>care app and clinician app.<br>The algorithm runs<br>automatically and returns a<br>response for each audio file<br>with the indication of<br>wheezes to the telehealth<br>server, which sends a<br>response to both the | User places sensor on<br>their neck for 30 seconds<br>to perform a passive<br>manoeuvre. The device<br>records, analyses the lung<br>sounds and quantifies the<br>presence of wheezing.<br>The wheezo transfers a<br>user's breath sound data to<br>the App using a Smart<br>Device. The sound data is<br>analyzed in the algorithm,<br>which is integrated inside<br>the App and runs on the<br>Smart Device. | User place the Tyto<br>Stethoscope's adaptor in full<br>contact with the patient's<br>body, data is recorded and<br>transmitted from the chest<br>piece (i.e., the The TytoCare<br>device mounted with<br>adaptor) to the user end unit<br>(i.e., a mobile device such<br>as smartphone), via Wi-Fi,<br>and then over the internet to<br>the clinician end unit (i.e., a<br>clinician platform such as<br>PC or laptop. | Same.<br>Both devices acquire lung<br>sounds with device cleared by the<br>FDA for that purpose, analyze the<br>lung sounds and provide<br>indication on the presence of<br>wheeze.                                                                                                                                                                                                                                                                                                                                                                              |
|                                                           | Device                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        | Predicate                                                                                                                                                                                                                                                                                                                                                                                                      | Reference device                                                                                                                                                                                                                                                                                                                                                                                                        | Summary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          |
|                                                           | clinician side and the<br>patient side.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |                                                                                                                                                                                                                                                                                                                                                                                                                |                                                                                                                                                                                                                                                                                                                                                                                                                         |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  |
| Sensor type and<br>technology                             | NA, software only                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             | Microphone sensor (made<br>of silicon) acquires, filters<br>and digitizes the breath<br>sounds.                                                                                                                                                                                                                                                                                                                | Embedded acoustic<br>piezoelectric contact sensor<br>captures analog auscultation<br>sound data, amplifies it,<br>filters, digitizes and store it.                                                                                                                                                                                                                                                                      | Different but the difference<br>doesn't raise new questions of<br>safety or effectiveness. The<br>subject device is intended to be<br>used with compatible Tyto<br>Stethoscope (reference device) to<br>record lung sounds.<br>The predicate and the reference<br>devices both use a handheld piece<br>with embedded sensor in the chest<br>piece to acquire lung sounds. The<br>safety and performance of the<br>reference device sensor's type and<br>technology has been established<br>previously for acquiring lung<br>sounds by means of FDA<br>clearance. |
| Sensor location                                           | NA, software only                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             | Trachea                                                                                                                                                                                                                                                                                                                                                                                                        | Top part of the chest and the<br>top part of patient's back<br>(Left Upper Lobe, Left<br>Lower Lobe, Right Upper<br>Lobe, Right Lower Lobe).                                                                                                                                                                                                                                                                            | Different but the difference<br>doesn't raise new questions of<br>safety or effectiveness. The<br>subject device is intended to be<br>used with compatible Tyto<br>Stethoscope (reference device) to<br>record lung sounds.<br>The safety and performance of the<br>reference device sensor's location<br>for acquiring lung sounds has<br>been established before by means<br>of FDA clearance.                                                                                                                                                                 |
|                                                           |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |                                                                                                                                                                                                                                                                                                                                                                                                                |                                                                                                                                                                                                                                                                                                                                                                                                                         |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  |
| Signal length                                             | The length of the signal is dictated by the recording process of the compatible Stethoscope. The subject device processes the recordings in segments of up to 12 seconds while signals shorter than 6 seconds will not be processed.                                                                                                                                                                                                                                                                                                                                                                                                                                                                          | 30 seconds                                                                                                                                                                                                                                                                                                                                                                                                     | Variable                                                                                                                                                                                                                                                                                                                                                                                                                | Different but the difference doesn't raise new questions of safety or effectiveness. The safety and performance of the different signal length that is used in the process of lung sound acquisition by numerous FDA cleared electronic stethoscopes including the reference device as well as Diagnostic Pulmonary-Function Interpretation Calculators including the predicate device was established. Thus, the impact of different signal length on performance does not raise a new question of safety or performance.                                       |
| Data transfer and storage                                 | The telehealth server sends the list of the recordings (identified by a unique identifier and time stamp) to the TytoCare Lung Sound Analyzer web server using its dedicated API. The server executes the TytoCare Lung Sounds Analyzer which runs the algorithm and provides the results. Then the TytoCare Lung Sound Analyzer web                                                                                                                                                                                                                                                                                                                                                                          | Every recording is automatically uploaded to the cloud. However, if an Internet connection is not available, up to 20 most recent recordings will be stored locally on the smartphone.                                                                                                                                                                                                                         | The stethoscope recordings are transferred to the server using the software of the Tyto Stethoscope. However, if an Internet connection is not available, most recent recordings will be stored locally on the Tyto Stethoscope.                                                                                                                                                                                        | Different medical device data system but the difference doesn't raise new questions of safety or effectiveness.                                                                                                                                                                                                                                                                                                                                                                                                                                                  |
|                                                           | Device                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        | Predicate                                                                                                                                                                                                                                                                                                                                                                                                      | Reference device                                                                                                                                                                                                                                                                                                                                                                                                        | Summary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          |
|                                                           | server initiates the web user<br>interface.<br>All the software subsystems<br>(server and storage) are<br>hosted in the cloud and<br>communicate through IP<br>network.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |                                                                                                                                                                                                                                                                                                                                                                                                                |                                                                                                                                                                                                                                                                                                                                                                                                                         |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  |
| Output                                                    | • Positive (wheeze<br>suspected),<br>• Negative (Wheeze not<br>suspected),<br>• The TytoCare lungs<br>sounds analyzer was not<br>able to analyze the<br>recording                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             | Detection and<br>quantification of wheeze<br>presence, expressed as<br>"wheeze rate".                                                                                                                                                                                                                                                                                                                          | NA                                                                                                                                                                                                                                                                                                                                                                                                                      | Different but no new questions of<br>safety and effectiveness as both<br>the device and the predicate use<br>software algorithm to detect<br>abnormal breath sound (wheeze)<br>in lung recordings.                                                                                                                                                                                                                                                                                                                                                               |
| Accuracy                                                  | Non-inferior to clinical<br>readers                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           | Non-inferior to clinical<br>readers…

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**Source:** [https://fda.innolitics.com/submissions/AN/subpart-b%E2%80%94diagnostic-devices/PHZ/K221614](https://fda.innolitics.com/submissions/AN/subpart-b%E2%80%94diagnostic-devices/PHZ/K221614)

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