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.
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