title: Ear oximetry: a noninvasive method for detection of patent foramen ovale: a study comparing dye dilution method and oximetry with contrast transesophageal echocardiography.
abstract: OBJECTIVE
  Patent foramen ovale (PFO) may play an important role as a risk factor for ischemic stroke and some other neurological conditions. There is a need for low-cost and noninvasive methods for the detection of PFO. This study evaluates the accuracy of two simple bedside tests, the dye dilution method and ear oximetry, in the detection of PFO.
  
  
  METHODS
  Dye dilution curves and ear oximetry recordings with a noninvasive ear densitometer were obtained from consecutive cryptogenic stroke patients referred for contrast transesophageal echocardiography (TEE). All test results were blindly assessed for the presence of PFO. Sensitivity and specificity were calculated with TEE used as a reference method. kappa statistics were used to measure interrater agreement.
  
  
  RESULTS
  Dye dilution curves were obtained from 67 patients. Dye dilution correctly diagnosed 35 of the 46 patients who had PFO in TEE and all the 21 patients without PFO. Thus, the sensitivity (95% CI) of the dye dilution method was 76% (61% to 87%) and its specificity 100% (84% to 100%). Ear oximetry was done on 83 patients. Oximetry correctly diagnosed 45 of the 53 patients who had PFO in TEE and all of the 30 patients without PFO. Thus, the sensitivity of ear oximetry was 85% (72% to 93%) and its specificity 100% (88% to 100%). The interrater agreement was excellent (kappa value 0.94 for dye dilution and 0.90 for oximetry).
  
  
  CONCLUSIONS
  Dye dilution and oximetry are both sensitive and specific methods for the detection of PFO. Oximetry has the following primary advantages over the currently available diagnostic methods: it is noninvasive, safe, and inexpensive and causes no discomfort for the patient. We suggest that oximetry could be used as a first-line screening method for PFO in patients with cryptogenic stroke. Ear oximetry also has potential use in epidemiological studies.
authors.affiliation: Department of Neurology, Oulu (Finland) University Hospital. vesa.karttunen@oulu.fi
authors.forename: V
authors.initials: V
authors.lastname: Karttunen
authors.forename: M
authors.initials: M
authors.lastname: Ventilä
authors.forename: M
authors.initials: M
authors.lastname: Ikäheimo
authors.forename: M
authors.initials: M
authors.lastname: Niemelä
authors.forename: M
authors.initials: M
authors.lastname: Hillbom
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000150:complications; D003287:Contrast Media; D004395:Dye Dilution Technique / Q000191:economics; D004423:Ear; D017548:Echocardiography, Transesophageal; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010092:Oximetry / Q000191:economics / Q000379:methods*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media