Assessing diagnostic accuracy and tympanocentesis skills in the management of otitis media.
BACKGROUND
The distinction between acute suppurative otitis media (AOM) and otitis media with effusion (OME) is important for antibiotic treatment decisions. Tympanocentesis may be useful in the diagnosis of AOM in selected patients.


OBJECTIVE
To assess physician accuracy in diagnosing AOM and OME from physical examination findings and technical competence in performing tympanocentesis.


METHODS
Five hundred fourteen pediatricians and 188 otolaryngologists viewed 9 different videotaped pneumatic otoscopic examinations of tympanic membranes during a continuing medical education course. Diagnostic differentiation of AOM, OME, and a normal tympanic membrane was ascertained. An infant mannequin model was used to assess the technical proficiency of performing tympanocentesis on artificial tympanic membranes.


RESULTS
Overall, the average correct diagnosis by pediatricians was 50% (range, 25%-73%) and by otolaryngologists was 73% (range, 48%-88%). Pediatricians and otolaryngologists correctly recognized the absence of normality 89% to 100% and 93% to 100% of the time, respectively, but overdiagnosed AOM in 7% to 53% (mean, 27%) and in 3% to 23% (mean, 10%) of examinations. Performance of tympanocentesis was optimally performed by 89% of otolaryngologists and by 83% of pediatricians.


CONCLUSIONS
The use of video-presented examinations to assess diagnostic ability suggests that AOM and OME may be misdiagnosed often. Interactive continuing medical education courses with simulation technology may enhance skills and improve diagnostic accuracy and treatment paradigms.
Pichichero
M E
ME
Department of Microbiology, University of Rochester School of Medicine and Dentistry, NY 14642, USA. michael_pichichero@urmc.rochester.edu
Poole
M D
MD
D002983:Clinical Competence; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control; D004502:Education, Medical, Continuing; D004521:Educational Measurement / Q000379:methods; D006801:Humans; D007223:Infant; D008348:Manikins; D010034:Otitis Media with Effusion / Q000175:diagnosis*; D010035:Otitis Media, Suppurative / Q000175:diagnosis*; D010036:Otolaryngology / Q000193:education / Q000592:standards; D019720:Otoscopes; D019152:Paracentesis / Q000592:standards*; D010372:Pediatrics / Q000193:education / Q000592:standards; D010808:Physical Examination; D013663:Teaching / Q000379:methods; D014432:Tympanic Membrane / Q000601:surgery*; D014481:United States; D014743:Videotape Recording