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Evidence summaries

Minitympanometry in the Diagnosis of Acute Otitis Media in Children

Otitis media appears to be improbable if the tympanogram is normal, but the tympanogram may be abnormal in patients who do not have acute otitis media. Level of evidence: "B"

Puhakka 1 studied the usefulness of a small portable tympanometer compared to a clinic tympanometer, otomicroscopy, and if necessary, tympanocentesis in 277 children (mean age 5 years). A false positive result occurred in 7% and a false negative result in 3% (the tympanogram was normal although fluid was present in the middle ear).

van Balen and Melker 2 compared a portable tympanometer with clinic tympanometer and tympanocentesis in 142 children that had been referred for tympanostomy. The sensitivity of the portable device compared to the clinic tympanometer was 96% (95% CI 93 - 99%) and the specificity was 81% (95% CI 71 - 91%). Compared with tympanocentesis, the sensitivity of the portable tympanometer was 94% (95% CI 90 - 98%) but the specificity only 48% (95% CI 37 - 59%).

Koivunen et al 3 studied 162 children (age range 7 months to 8 years) who had been referred for tympanostomy or adenoidectomy. The sensitivity of a portable tympanometer was 79% and the specificity was 93% compared to tympanocentesis.

Shaikh et al 4 examined 783 children presenting for primary care. In addition, endoscopic still images of the tympanic membranes (TMs) were obtained. A sample of 135 of these images was sent for review to a group of independent otoscopists. Among both groups of observers, bulging of the TM differentiated best acute otitis from acute otitis with effusion (OME): 96% of ears and 93% of ear image evaluations assigned a diagnosis of acute otitis by the 2 groups were reported as showing bulging of the TM, compared with 0% and 3%, respectively, of ears and ear image evaluations assigned a diagnosis of OME. Opacification of the TM was the finding that best differentiated OME from no effusion.

Comment: The quality of evidence is upgraded by large magnitude of effect.

    References

    • Puhakka H. Pieni tympanometri parantaa lasten välikorvantulehdusten diagnostiikkaa avohoidossa. (in Finnish). 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]
    • Shaikh N, Hoberman A, Kaleida PH et al. Otoscopic signs of otitis media. Pediatr Infect Dis J 2011;30(10):822-6. [PubMed]

Primary/Secondary Keywords