Children's Health

Pneumatic otoscopy may be less costly, easier to use, and just as accurate as other methods for diagnosing middle ear effusion in children

Pneumatic otoscopy can diagnose middle ear effusion (MEE) in children as well as or better than eight other diagnostic methods, concludes a study by the Southern California Evidence-based Practice Center-RAND, which is supported by the Agency for Healthcare Research and Quality (contract 290-97-0001). In MEE, a child's eustachian tube is usually blocked, and air cannot get into the middle ear, leading to an accumulation of fluid behind the eardrum (tympanic membrane).

Using a pneumatic otoscope, an instrument fitted with a light and magnifying lens, a clinician can look directly into the child's middle ear and view the transparency, position, and other qualities of the ear drum. A rubber bulb attached to the head of the otoscope can be squeezed to push air into the ear canal to view tympanic membrane mobility, which is impaired with MEE.

Glenn S. Takata, M.D., and his EPC colleagues assessed the research evidence from 1966 through January 2000 on the accuracy of eight methods for diagnosing MEE in children with otitis media with effusion (OME, ear infections involving fluid in the ear). Using pooled estimates for the studies, they plotted the performance of each diagnostic test in terms of sensitivity and specificity and identified the best performers among tests included in the comparison.

Among the eight diagnostic methods, including tympanometry and acoustic reflectometry, pneumatic otoscopy had the best apparent performance with a sensitivity of 94 percent and a specificity of 80 percent. For the typical clinician, pneumatic otoscopy should be easier to use than other diagnostic methods. The important question may be what degree of training will be needed for the clinicians to be as effective with pneumatic otoscopy as were the examiners in the studies reviewed. Although pneumatic otoscopy seemed to be more cost effective than other approaches for diagnosing OME, the researchers recommend that future studies include a cost-effectiveness analysis to permit more informed decisions on the best all around diagnostic method for OME.

See "Evidence assessment of the accuracy of methods of diagnosing middle ear effusion in children with otitis media with effusion," by Dr. Takata, Linda S. Chan, Ph.D., Tricia Morphew, M.S., and others, in the December 2003 Pediatrics 112(6), pp. 1379-1387.

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