title: Parental role in the diagnostics of otitis media: can layman parents use spectral gradient acoustic reflectometry reliably?
abstract: OBJECTIVE
  Spectral gradient acoustic reflectometry (SG-AR) can be used to detect middle ear effusion (MEE). Since both families and primary health care systems carry the burden of otitis media, our aim was to determine whether layman parents could be taught to use the SG-AR reliably.
  
  
  METHODS
  We enrolled 359 children (age 6-35 months) whose parents were willing to use SG-AR at home. The parents were asked to perform bilateral SG-AR daily on their child. In this study, we included children who had undergone successful parental home SG-AR examination performed on the same day that a physician had also performed successful SG-AR examination and pneumatic otoscopy at the study clinic. We compared the parental and study physician SG-AR examination results to the study physicians' pneumatic otoscopy, which served as the diagnostic standard.
  
  
  RESULTS
  We analyzed 571 successful parental home SG-AR examinations performed on the same day that a study physician had performed a successful SG-AR examination and pneumatic otoscopy at the study clinic. None of the evaluated SG-AR level combinations resulted in both high sensitivity and specificity. For symptomatic visits, the negative predictive value of a parental SG-AR level 1 to detect MEE was 64%. For parental SG-AR levels 4-5, the positive predictive value to detect MEE was 88%. However, for asymptomatic visits, the negative predictive value of a parental SG-AR level 1 to detect MEE was 83%.
  
  
  CONCLUSIONS
  This study showed that layman parents are able to use the SG-AR technically successfully. In symptomatic children, parentally obtained SG-AR level 1 examination is not adequate to exclude MEE. However, parentally obtained SG-AR levels 4-5 do indicate the presence of MEE. At the same time, in asymptomatic children, parentally obtained SG-AR level 1 examination seems to indicate a healthy middle ear. From the perspective of primary care, the implementation of parental SG-AR examinations in the diagnostic chain of otitis media would be intriguing. This study showed that the possibilities lie in the follow up of the resolution of MEE after an episode of OM in asymptomatic children. However, it seems that currently, the SG-AR technique is an obstacle for wider clinical implementation.
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; City of Turku Welfare Division, Primary Healthcare Services, Turku, Finland. Electronic address: nora.erkkola-anttinen@turku.fi.
authors.forename: Nora
authors.initials: N
authors.lastname: Erkkola-Anttinen
authors.affiliation: Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland.
authors.forename: Miia K
authors.initials: MK
authors.lastname: Laine
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland.
authors.forename: Paula A
authors.initials: PA
authors.lastname: Tähtinen
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland.
authors.forename: Aino
authors.initials: A
authors.lastname: Ruohola
mesh_terms: D000158:Acoustic Impedance Tests / Q000379:methods*; D002675:Child, Preschool; D004432:Ear, Middle; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010034:Otitis Media with Effusion / Q000175:diagnosis*; D038781:Otoscopy; D010290:Parents; D011237:Predictive Value of Tests; D012648:Self Care
keywords: Middle ear effusion; Otitis media; Otoscopic diagnosis; Parental; Primary care; Spectral gradient acoustic reflectometry