title: Can nurses exclude middle-ear effusion without otoscopy in young asymptomatic children in primary care?
abstract: OBJECTIVE
  Scandinavian guidelines recommend controlling middle-ear effusion (MEE) after acute otitis media. The study aim was to determine whether nurses without otoscopic experience can reliably exclude MEE with tympanometry or spectral gradient acoustic reflectometry (SG-AR) at asymptomatic visits.
  
  
  METHODS
  Three nurses were taught to perform examinations with tympanometry and SG-AR. Pneumatic otoscopy by the study physician served as the diagnostic standard.
  
  
  METHODS
  Study clinic at primary health care level.
  
  
  METHODS
  A total of 156 children aged 6-35 months.
  
  
  METHODS
  Predictive values (with 95% confidence interval) for tympanometry and SG-AR, and the clinical usefulness, i.e. the proportion of visits where nurses obtained the exclusive test result from both ears of the child.
  
  
  RESULTS
  At 196 visits, the negative predictive value of type A and C1 tympanograms (tympanometric peak pressure > -200 daPa) was 95% (91-97%). Based on type A and C1 tympanograms, the nurse could exclude MEE at 81/196 (41%) of visits. The negative predictive value of SG-AR level 1 result was 86% (79-91%). Based on SG-AR level 1 results, the nurse could exclude MEE at 29/196 (15%) of visits.
  
  
  CONCLUSIONS
  Tympanograms with tympanometric peak pressure > -200 daPa (types A and C1) obtained by nurses are reliable test results in excluding MEE. However, these test results were obtained at less than half of the asymptomatic visits and, thus, the usefulness of excluding MEE by nurses depends on the clinical setting.
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Turku University Hospital , Turku , Finland.
authors.forename: Miia K
authors.initials: MK
authors.lastname: Laine
authors.forename: Paula A
authors.initials: PA
authors.lastname: Tähtinen
authors.forename: Olli
authors.initials: O
authors.lastname: Ruuskanen
authors.forename: Eliisa
authors.initials: E
authors.lastname: Löyttyniemi
authors.forename: Aino
authors.initials: A
authors.lastname: Ruohola
mesh_terms: D000158:Acoustic Impedance Tests; D002675:Child, Preschool; D004423:Ear / Q000473:pathology; D005260:Female; D006320:Hearing Tests / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D009726:Nurses; D010033:Otitis Media / Q000150:complications*; D010034:Otitis Media with Effusion / Q000175:diagnosis* / Q000209:etiology; D038781:Otoscopy; D011320:Primary Health Care; D012537:Scandinavian and Nordic Countries
keywords: Children; Finland; exclusion; general practice; middle ear effusion; routine control; spectral gradient acoustic reflectometry; tympanometry
references.citation: Arch Otolaryngol. 1970 Oct;92(4):311-24
references.pmid: 5455571
references.citation: Arch Otolaryngol. 1979 Aug;105(8):461-6
references.pmid: 464883
references.citation: J Pediatr. 1984 Jun;104(6):832-8
references.pmid: 6539374
references.citation: J Pediatr. 1997 Sep;131(3):419-22
references.pmid: 9329419
references.citation: Pediatr Infect Dis J. 1998 Jun;17(6):552-5; discussion 580
references.pmid: 9655559
references.citation: Int J Pediatr Otorhinolaryngol. 1999 Aug 20;49(3):207-13
references.pmid: 10519700
references.citation: Scand J Prim Health Care. 2006 Jun;24(2):88-92
references.pmid: 16690556
references.citation: Pediatrics. 2006 Jul;118(1):1-13
references.pmid: 16818543
references.citation: J Fam Pract. 2006 Nov;55(11):946-52
references.pmid: 17090353
references.citation: Int J Pediatr Otorhinolaryngol. 2007 Jan;71(1):7-10
references.pmid: 16973222
references.citation: Arch Pediatr Adolesc Med. 2007 Sep;161(9):884-8
references.pmid: 17768289
references.citation: N Engl J Med. 2011 Jan 13;364(2):116-26
references.pmid: 21226577
references.citation: Pediatr Infect Dis J. 2012 Oct;31(10):1003-6
references.pmid: 22592519
references.citation: Pediatr Infect Dis J. 2012 Oct;31(10):1007-11
references.pmid: 22592520
references.citation: Fam Pract. 2012 Dec;29(6):726-32
references.pmid: 22850248
references.citation: Otolaryngol Head Neck Surg. 2013 Jul;149(1 Suppl):S1-35
references.pmid: 23818543
references.citation: Int J Pediatr Otorhinolaryngol. 2014 Jan;78(1):124-7
references.pmid: 24315212
references.citation: Pediatr Infect Dis J. 2014 Aug;33(8):e183-6
references.pmid: 24717962