How to improve the accuracy of diagnosing otitis media with effusion in a pediatric population.
OBJECTIVE
To determine the accuracy of pneumatic otoscopy, a tympanogram and otomicroscopy for diagnosing otitis media with effusion (OME) in a pediatric population.


METHODS
Prospective blinded clinical and IRB-approved study at a secondary referral hospital. SUBJECTIVE AND METHODS: Eighty-one children (155 ears) were recruited for this study, who were referred to my secondary referral hospital after OME was diagnosed at other primary clinics. The examiner was blinded for the findings of the diagnostic tools. Myringotomy under local anesthesia was used as the diagnostic reference standard. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the three diagnostic tools were calculated.


RESULTS
Otomicroscopy was the most sensitive and specific tool among the three diagnostic tools. Otomicroscopy showed the best agreement with myringotomy (kappa=0.784).


CONCLUSIONS
Otomicroscopy can make a more accurate diagnosis even for children who are seen at an outpatient clinic. The much higher specificity of otomicroscopy makes it the best confirmative test and its much higher positive predictive value can prevent a late diagnosis of OME, which can result in severe sequelae.
Lee
Dong-Hee
DH
Department of Otolaryngology-Head and Neck Surgery, Uijeongbu St Mary's Hospital, The Catholic University of Korea, College of Medicine, #65-1 Geumo-Dong, Uijeongbu City, Gyeonggi-Do, Seoul 480-717, Republic of Korea.
D000158:Acoustic Impedance Tests; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008876:Middle Ear Ventilation / Q000295:instrumentation; D010034:Otitis Media with Effusion / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D011237:Predictive Value of Tests; D011446:Prospective Studies