The implementation of telemedicine disrupts medical care and provides great opportunities for low resource settings. However, expensive diagnostic equipment is hampering the adoption of telemedicine on a larger scale. Frugal innovations achieving cost reduction while maintaining functionality with a high-performance level might solve this issue. This study provides a review on frugal tele-otoscopy suitable for low- and middle-income countries. A systematic review was conducted on basis of the PRISMA 2020 flow diagram for new systematic reviews. The National Library of Medicine (NLM), the Web of Science Core Collection (WoS), Scopus (Scorpus) and the Cochrane Library (CochraneLibrary) were scanned for different terms including “tele-otoscopy” and “telemedicine”. After removing duplicates, the articles were scanned for Keywords like “cut-rate”, “low price”, “low resource”, “low- and middle-income countries” or “reverse innovation” using Rayyan. The remaining abstracts were screened, case reports as well as studies evaluating tele-otoscopy as study purpose and published after the year 2012 were included. None of the reviewed studies assessed a device meeting the criteria of a frugal innovation. Moreover, the term “frugal” does not seem to be established in the field of tele-otoscopy yet. However, versatile publications stated the potential of low cost tele-otoscopes for “at-home”, rural and low resource settings. Despite the great potential for “at-home”, rural and low resource settings, studies evaluating frugal otoscopy devices are lacking. This study provides the first systematic review on frugal tele-otoscopy. This study is part of Dr Buhr´s Masterthesis (MSc Digital Health St Andrews).