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Evidence summaries

Tympanometry in the Diagnosis of Acute Otitis

It appears that tympanogram may be abnormal without acute otitis, but if tympanogram is normal acute otitis is unlikely. Level of evidence: "B"

Puhakka 1 studied the usefulness of a small portable tympanometer in the diagnosis of otitis by comparing it with a normal-size tympanometer, otomicroscope and, if necessary, tympanocentesis in 277 children (altogether 553 ears, the mean age of children was approximately 5 years). A false-positive result (tympanogram abnormal, but no middle ear effusion) was obtained in 7% of the children and a false-negative result (tympanogram normal with middle ear effusion present) in 3% of the children.

In a study by van Balen and de Melker 2 a portable tympanometer was compared with a normal tympanometer and with tympanocentesis in children (n = 142) referred for insertion of ventilation tubes. Compared with a normal-size tympanometer, the sensitivity of the portable device was 96% (95% CI 93 to 99) and specificity 81% (95% CI 71 to 91). Compared with tympanocentesis findings the sensitivity of the portable device was 94% (95% CI 90 to 98) but specificity only 48% (95% CI 37 to 59).

A study by Koivunen et al 3 included 162 children (age range 7 months to 8 years) who had been referred for the insertion of ventilation tubes or for adenoidectomy. Compared with tympanocentesis findings the sensitivity of the portable tympanometer was 79% and specificity 93% in children who cooperated well.

In a study by Helenius et al 4 515 children aged 6-35 months at primary care were followed at symptomatic and asymptomatic visits. At symptomatic visits, different peaked tympanograms were associated with a healthy middle ear as follows: type A in 78%, type C1 in 62%, type C2 in 54% and type Cs in 18% of examinations. In contrast, any peaked tympanogram was related to healthy middle ear in 67% of examinations. Flat (type B) tympanogram was related to otitis media with effusion in 44% and to acute otitis media in 56% of examinations, respectively. At asymptomatic visits, the peaked tympanograms together were associated with a healthy middle ear in 87% of otoscopic examinations. Flat tympanogram indicated otitis media with effusion as well in 87% of examinations.

    References

    • Puhakka H. Pieni tympanometri parantaa lasten välikorvantulehdusten diagnostiikkaa avohoidossa, Suom Lääkäril 1991;46:2708-11.
    • van Balen FA, de Melker RA. Validation of a portable tympanometer for use in primary care. Int J Pediatr Otorhinolaryngol 1994 Jun;29(3):219-25. [PubMed]
    • Koivunen P, Alho OP, Uhari M, Niemelä M, Luotonen J. Minitympanometry in detecting middle ear fluid. J Pediatr 1997 Sep;131(3):419-22. [PubMed]
    • Helenius KK, Laine MK, Tähtinen PA et al. Tympanometry in discrimination of otoscopic diagnoses in young ambulatory children. Pediatr Infect Dis J 2012;31(10):1003-6. [PubMed]

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