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At least 19 recordsLinked to original sources

PubMed2006

Video otoscopy: bringing otoscopy out of the "black box".

BACKGROUND: Several billion dollars are spent each year on otitis media, a diagnosis for which educational approaches and diagnostic skills are suboptimal. The Center for Disease Control has identified improvement in otoscopy skills as a key intervention to curb inappropriate antibiotic usage. Educators are looking for interventions to both improve and assess otoscopy skills. Video otoscopy (VO) uses endoscopic technology to project the image of the ear onto a monitor for all to see, offering unexplored educational opportunity. The objective of this study is to perform an evaluation of VO systems in medical education from a review of the literature and hands-on experience of available technology. METHODS: The evaluation will focus on the technical acceptability (user requirements), clinical appropriateness (validity, reliability, feasibility), operational effectiveness (training requirements and implementation), and equipment selection. RESULTS: The technical requirements in pediatric education exceed those available in some VO systems, specifically pneumatic capability, sophisticated cameras and optics, and pediatric-sized ear speculums. VO images are comparable to the conventional otoscopic and otomicroscopic examinations. VO is feasible in a primary care setting and can be integrated into resident and medical student education. The technology in VO systems is changing rapidly, necessitating comparison of systems before equipment is purchased. CONCLUSIONS: VO is technically acceptable, clinically appropriate and can be integrated into the otoscopic education of residents and medical students. VO provides an opportunity to bring the pediatric ear examination out of the "black box," potentially improving diagnostic skills, quality of care, and reducing antibiotic overuse.

Child↗

PubMed1993

Evaluation of the diagnostic value of pneumatic otoscopy in primary care using the results of tympanometry as a reference standard.

The aim of this study was to determine the value of pneumatic otoscopy in diagnosing otitis media with effusion in primary care. Pneumatic otoscopy was carried out for 111 children aged one to 16 years and the results obtained compared with those obtained from tympanometry. The children were those who had attended for a regular ear, nose and throat check up in the health centre of a school for the deaf during the period November 1989 to January 1990. Pneumatic otoscopy and tympanometry with the GSI 28 instrument (Grason-Stadler) were carried out by a trained ear, nose and throat nurse. All relevant features determined using otoscopy--the colour, position and mobility of the tympanum--and an overall assessment were recorded. The results of tympanometry were evaluated independently of the otoscopic findings. In the population examined the predictive values of positive and negative results of pneumatic otoscopy for diagnosing effusion were high; the sensitivity was low. Serious retraction of the eardrum and absence of mobility under positive pressure were the most predictive features but the colour of the tympanum did not show any relation to effusion. In the youngest age group (one to five years) 56% of the children had abnormal otoscopic findings in either one or both ears (odds ratio for this group versus remaining children 3.75; 95% confidence interval (CI) 1.75 to 15.2). The odds ratios of past and present history of upper respiratory tract infection with respect to abnormal results from otoscopy were 2.41 (95% CI 1.05 to 5.53) and 2.95 (95% CI 1.17 to 7.45), respectively. Pneumatic otoscopy carried out by an experienced health care worker is of high diagnostic value when compared with the results of tympanometry. Pneumatic otoscopy can improve the diagnostic capabilities of general practitioners and other primary care workers with regard to otitis media with effusion.

Acoustic Impedance Tests↗

PubMed1992

Tympanometry and otoscopy prior to myringotomy: issues in diagnosis of otitis media.

Tympanometry and pneumatic otoscopy were compared to findings at myringotomy in 86 children (163 ears). Seventy percent of the ears (115) had effusion, as revealed by myringotomy. Sensitivity and specificity for tympanometry were 90% and 86%, respectively. Sensitivity and specificity for pneumatic otoscopy were 93% and 58%, respectively. A chi-square was performed to compare the sensitivity and specificity to tympanometry to otoscopy, revealing tympanometry significantly better at determining non-effusion states. Additionally, a combined otoscopy and tympanometry sensitivity and specificity were calculated for those otoscopy and tympanometry determinations in agreement, revealing both sensitivity and specificity above 90%. A Fisher's exact probability test revealed no significant differences for the accuracy of tympanometry over otoscopy when the determinations of each were not in agreement. Implications of these results are discussed.

Acoustic Impedance Tests↗

PubMed1997

A protocol for otolaryngology-head and neck resident training in pneumatic otoscopy.

Otitis media with effusion (OME) is one of the most frequent pediatric diagnoses and is also one of the most common indications for medical or surgical intervention in this age group. Pneumatic otoscopy is the standard for physical diagnosis of a middle ear effusion. We report on our experience with a validation program for otolaryngology-head and neck surgery residents in the use of pneumatic otoscopy to diagnose OME. Four PGY 2 residents sequentially completed a 4 month clinical and didactic training program in pneumatic otoscopy. The trainee sequentially performs pneumatic otoscopy, otomicroscopy, and myringotomy on each patient scheduled for a myringotomy and tube placement the morning of surgery. After each task the trainee is required to state if an effusion is present or not, and the accuracy of the diagnosis is immediately reinforced at the time of myringotomy. The trainee's sensitivity and specificity in diagnosing OME is then calculated for the first and second half of the study period. The trainee is validated in pneumatic otoscopy if the sensitivity is > 80% and > 70% respectively, and the trainee is validated in otomicroscopy if the sensitivity and specificity is > 90% and > 80% respectively. Four residents completed the protocol, and a total of 275 ears were examined. Four residents were validated in pneumatic otoscopy, and three residents were validated in otomicroscopy. We conclude that this protocol allows for accurate documentation of the resident's skill progression and enhances resident education.

Adolescent↗

PubMed1989

Acoustic otoscopy in the diagnosis of otitis media.

Acoustic otoscopy detects middle ear pathology by measuring the ability of the tympanic membrane to reflect sound. Fluid or thickening of the tympanic membrane increases sound reflection. We conducted a study to compare acoustic otoscopy with pneumatic otoscopy in identifying middle ear pathology in 80 children (160 ears) presenting to the emergency department with ear or upper respiratory complaints. We then evaluated the use of acoustic otoscopy in 34 adults (68 ears) with and without ear complaints. Using a reflectivity of 5 or more units to signify acute pathology in children, the sensitivity was 82%, and the specificity was 100%. Using a reflectivity of 6 or more units to indicate acute suppurative pathology in adults, the sensitivity was 83%, and the specificity was 95%. We found acoustic otoscopy to be objective, practical, and reproducible. We conclude that acoustic otoscopy is a valuable adjunct in the diagnosis of otitis media in children and adults.

Acoustic Stimulation↗

PubMed1990

Pneumatic otoscopy and tympanometry in the detection of middle ear effusion.

A prospective study was designed to assess the relative merits of pneumatic otoscopy and tympanometry in predicting the presence of a middle ear effusion, and to determine if both tests in conjunction provided any significant advantage. In 121 patients (222 ears) pneumatic otoscopy with a Seigles speculum and tympanometry were performed prior to myringotomy. An immobile tympanic membrane on otoscopy, or a Jerger type B curve on tympanometry were considered indicative of a middle ear effusion. There was no significant difference (P greater than 0.05) between the predictive value of pneumatic otoscopy (88%) and tympanometry (89%). When pneumatic otoscopy and tympanometry were used in conjunction, the predictive accuracy did not increase significantly. Pneumatic otoscopy and tympanometry are simple and reliable methods of predicting the presence or absence of a middle ear effusion. Their use together did not increase diagnostic accuracy.

Acoustic Impedance Tests↗

PubMed1983

Otoscopy compared with tympanometry.

A study comparing otoscopy with tympanometry was carried out in 1702 ears in seven- and ten-year-old children. Pneumatic otoscopy in 917 ears showed an 88 per cent agreement with tympanometry. The agreement was better in ears considered normal by the otoscopist than in ears that were considered abnormal. Furthermore, the accuracy of otoscopy was better in the older children than in the younger ones. A procedure employing simple otoscopy in 785 ears gave an 83 per cent agreement, but in about 15 per cent of these ears the examiner felt unable to base his evaluation on certainty. It was found that a middle-ear pressure of -100 mm. H2O correlated with recognizable pathology when pneumatic otoscopy was performed.

Acoustic Impedance Tests↗

PubMed1994

Identification of middle ear effusion by aural acoustic admittance and otoscopy.

The ability of aural acoustic immittance measures and validated pneumatic otoscopy to identify middle ear effusion (MEE) was determined for a group of children with chronic or recurrent otitis media. The measures were made immediately prior to surgery for placement of tympanostomy tubes, with the validating diagnosis of MEE made by the surgeons. Aural acoustic admittance measures were made by a certified and licensed clinical audiologist using an instrument that meets current standards and otoscopic examinations were made by a nurse practitioner validated for use of otoscopy in the identification of MEE. Logistic regression analyses were done to determine the ability of admittance variables, otoscopy, and their combination to discriminate between ears with and ears without MEE. Of the individual admittance variables, tympanometric width had the best performance. Otoscopy alone had good sensitivity but only fair specificity. Combining acoustic admittance data with the otoscopist's findings did not improve sensitivity greatly, but improved the specificity relative to that of the otoscopist. The criterion tympanometric width > 150 daPa or Ytm < 0.2, a criterion commonly used based on interim norms published in an appendix of ASHA guidelines for screening, had good sensitivity but very poor specificity in the group of children scheduled for surgery. Also, a comparison was made for tympanometric width measures from the children undergoing surgery with those from a group of children more representative of the general population. Three distributions were found; one for ears with MEE, one for ears with no MEE of children scheduled for otologic surgery and one for ears with no MEE from the group of children from the general population. The data illustrate the importance of the population characteristics on the test measure used and have implications for choosing test criteria. In addition, group estimates of performance of acoustic admittance variables were approximately the same when otoscopy was used as the gold standard for identification of MEE as when findings at surgery were used. However, when comparing the two diagnostic methods on a case-by-case basis, it was determined that the otoscopist's diagnosis disagreed with the diagnosis of the surgeons in over 21% of the ears.

Acoustic Impedance Tests↗

PubMed1987

Telescopic video-otoscopy using a compact home video color camera.

Our method of telescopic video-otoscopy using a telescope (Hopkins) and a compact home video camera is presented. Telescopic video-otoscopy is a most effective method of demonstrating and documenting the anatomy and pathology of the tympanic membrane, ear canal, and mastoid cavity. It is of considerable value for teaching, patient counseling, and making a permanent record. It obtains instantaneously a video print-out either in black-and-white or in color of video images of telescopic otoscopy. A simple and economical method of telescopic pneumatic otoscopy (pneumatic teleotoscopy) is also described. Telescopic video otoscopy combined with the use of a video printer is a useful addition to the clinical practice of otology.

Data Display↗

PubMedDate not supplied

[Otoscopy and tympanometry in the diagnosis of secretory otitis media]

OBJECTIVE: To study the sensitivity and specificity of otoscopy and tympanometry in the diagnosis of secretory otitis media. METHODS: A prospective study was performed in 98 children (196 ears) with indication of myringotomy with placement of tympanostomy tube because of the diagnosis of secretory otitis media. All these patients had conductive hearing loss and/or delay of speech and/or low school performance. To evaluate the diagnostic power of the tests, both otoscopy and tympanometry were performed. Myringotomy was established as the gold-standard. The statistical analysis was done using the chi-square test, being significant a p<0.05.RESULTS: The mean age of the patients was 6.02 years (sd: 2.93 years). The otoscopy presented sensitivity of 87.5% and specificity of 61.1% and the tympanometry presented sensitivity of 93.75% and specificity of 72.2%. CONCLUSIONS: There was no statistically significant difference in sensitivity between otoscopy and tympanometry for the diagnosis of secretory otitis media, however, tympanometry was significantly more specific than otoscopy (p< 0.01).

Journal Article↗

PubMed2005

The use of tympanometry and pneumatic otoscopy for predicting middle ear disease.

PURPOSE: Otitis media is the most common condition diagnosed by pediatricians and is estimated to affect approximately 70% of the pediatric population. The goal of this study was to evaluate the effectiveness of otoscopy and multifrequency tympanometry (MFT) for diagnosis of otitis media in children. METHOD: Twenty-one children, age 1 to 10 years, who were seeking medical treatment for suspected middle ear disease were selected to participate. Data were collected prior to myringotomy to determine the sensitivity and specificity rates of the following otologic and audiologic measures: (a) pneumatic otoscopy, (b) conventional tympanometry, and (c) MFT. For this study, the "gold standard," myringotomy, was used along with pneumatic otoscopy to determine the effectiveness, sensitivity, and specificity of conventional 226-Hz tympanometry, 678-Hz tympanometry, and 1000-Hz tympanometry to predict middle ear disease. RESULTS: The diagnoses provided with pneumatic otoscopy and tympanometry were both similar, agreeing in diagnosis 80%-100% of the time. The diagnoses from 678-Hz and 1000-Hz tympanometry were nearly equal and proved to detect abnormality at a higher rate. CONCLUSIONS: MFT is recommended on a routine basis with children having a history of otitis media, or else abnormal or notched 226-Hz tympanograms. Further research with a larger sample size will illuminate the possible predictive potential of MFT in otitis media.

Acoustic Impedance Tests↗

PubMed1992

Paediatric otoscopy--clinical and histological correlation.

Otoscopy is a subjective clinical method. Its subjectively has led physicians to verify its accuracy through correlations with findings of otomicroscopy, pneumatic otoscopy, tympanometry, and myringotomy. In the very young population, however, the interpretation of otoscopic findings become more difficult. To improve the interpretation of normal otoscopy in young children, an otoscopic-histological correlation was attempted in children up to nine years of age. Twenty-one temporal bones from 15 children aged from two days to nine years who had no evidence of otological disease or congenital anomalies were examined under light microscopy; the thickness of the pars flaccida, posterior superior quadrant, and umbo were measured. Twenty-five eardrums of 15 healthy children without past or present history of otological disease were examined using otoscopy; a photograph of each eardrum was obtained. Our study demonstrates that structural changes in the tympanic membrane during these years of childhood have a good correlation with otoscopic findings. Understanding normal histological changes in the paediatric eardrum may improve our interpretation of otoscopic findings.

Aging↗

PubMedDate not supplied

Pneumatic otoscopy: a review of the literature.

Pneumatic otoscopy is a universally recommended method of diagnosing otitis media by detecting the presence of a middle ear effusion and hypomobility of the tympanic membrane. This review presents a synthesis of the existing research on the value of pneumatic otoscopy as a diagnostic tool. A literature search from 1987 to 1997 produced 11 applicable research articles. In five studies, which compared pneumatoscopy with myringotomy, the mean sensitivity score was 89% and the mean specificity score was 80%. In the only study of clinical use of pneumatic otoscopy, 21% of respondents always used it, while 42% never used it as part of their routine examinations. Education level of the examiner had no affect on the value of pneumatoscopic findings. Pneumatic otoscopy is an important diagnostic tool available to all health care providers, but replication of these studies is essential to support these results. Furthermore, research is needed to quantify its actual application on the clinical level.

Child↗

PubMed1995

Is otoscopy reliable? A structured teaching method to improve otoscopic accuracy in trainees.

Otoscopy is an important skill for primary care physicians and otologists. Until now, training has been by repeated exposure to patients with ear disease. Structured instruction in how to assess an ear has not previously been reported. Not-diseased ears and those with varying types of chronic (suppurative) otitis media were chosen to be photographed as this is an important condition to be able to diagnose and in which pneumatic otoscopy has no role. Two sets of 30 slides of equal difficulty were shown to 10 trainees, one before and one after structured teaching. The overall error rate fell from 44 to 21% (P < 0.001). Most importantly, the error rate in assessing ear activity fell from 35 to 17% (P < 0.05). In conclusion, a structured approach to otoscopy has been shown to improve the diagnostic ability of trainess tested with photographs of ears with chronic otitis media. Such a teaching approach is likely to be equally beneficial to other otological conditions and to live otoscopy.

Diagnostic Errors↗

PubMed2003

How helpful is pneumatic otoscopy in improving diagnostic accuracy?

BACKGROUND: Pneumatic otoscopy is believed to be helpful in optimally assessing the presence or absence of middle ear effusion (MEE). Although expert clinicians teach the importance of this diagnostic skill to trainees, evidence exists that many pediatric providers do not typically perform pneumatic otoscopy. OBJECTIVE: To determine if the otoscopic accuracy within a group of clinicians improves with the pneumatic assessment when compared with the static assessment using videotaped otoendoscopic examinations (VOEs). METHODS: Residents and faculty from 2 pediatric training programs served as subjects. All viewed a set of 50 video otoscopic examinations of tympanic membranes (TMs) from a validated VOE developed previously for training purposes. The video displays each TM in a static presentation and then in a pneumatic (mobile) presentation, followed by a final static presentation. Each subject first viewed the initial static presentation of each TM and responded "yes/no" to the presence of MEE, and then viewed the pneumatic presentation of the same TM and again responded "yes/no" to the presence of MEE. We compared the accuracy of assessment for both the static and the pneumatic tests. RESULTS: Thirty-four pediatric residents and 6 clinical faculty participated. Accuracy (percent of total test items correct) on the pneumatic test was uniformly greater than accuracy on the static test. The mean absolute improvement in the accuracy from the static test (61%) to the pneumatic test (76%) was 15% (95% confidence interval [CI] = 12%-18%). The mean relative improvement in accuracy from the static test to the pneumatic test was 26% (95% CI = 19%-32%). Higher accuracy on the VOE was associated with greater absolute (r = 0.57) and greater relative (r = 0.47) improvement. The mean relative improvement in sensitivity and specificity from static viewing to pneumatic viewing was 24% (95% CI = 15%-33%) and 42% (95% CI = 27%-58%), respectively. CONCLUSIONS: Using a video otoendoscopic test, we found that accurate identification of both the presence and the absence of MEE improved after pneumatic assessment of TM mobility. Providers who were more accurate at otoscopy, defined by higher video total test scores, benefited more from the pneumatic component than providers with lower scores.

Acoustic Impedance Tests↗

PubMed1998

Virtual otoscopy.

Imaging techniques assist the surgeon in diagnosis of disease, surgical planning, and providing image guidance during surgery. Endoscopy has the drawback of being a minimally invasive procedure and limiting visualization to the inner surface of the lumen. Ultrasound, CT, and MR imaging show volumes of tissue beyond the lumen wall; however, their planar, two-dimensional representations require mental reconstruction of anatomic structures, which often proves difficult with the small, complex structures within the temporal bone. To improve three-dimensional visualization of the inner ear, we successfully completed a virtual model that can be displayed as a contiguous, three-dimensional luminal view, known as virtual otoscopy, which emulates traditional endoscopy. A concomitant global view and a view of the related CT slice adds a distinct advantage in the presentation and study of this complex organ. Advances in computer and software technology may overcome the time and cost factors that, at present, limit widespread use of virtual otoscopy. Overall, virtual otoscopy stands as a promising new visualization technique for elucidation of the middle ear, inner ear, and temporal bone structures.

Computer Simulation↗

PubMed1992

Is undergraduate otoscopy teaching adequate?--An audit of clinical teaching.

Otoscopy is an important skill for the general practitioner, yet skill in the technique is rarely assessed formally at undergraduate level. This study aimed to assess the effect of teaching on the acquisition of otoscopic skill. Thirty-five medical students were assessed prospectively during their ENT attachments. Seventeen students were randomized to the standard course and 18 attended an additional seminar on otoscopy. Students' confidence was assessed for various aspects of otoscopy using a visual analogue scale, and clinical skill was assessed in examining four patients. Assessments took place at the beginning and end of the course. Students gained in their confidence and skill for all parameters, although the clinical ability to distinguish normal from abnormal tympanic membranes changed little from baseline levels. Extra teaching produced better gains in confidence (P less than 0.05) and skill (P less than 0.01) in identifying specific features of the tympanic membrane and eliminated errors of the 'false negative' variety. A minimal investment in teaching effort produces appreciable gains in students' otoscopic skills. This has implication for the planning of undergraduate ENT courses and vocational training for general practice.

Clinical Competence↗

PubMed1983

Prediction of serous versus purulent otitis media by otoscopy and tympanometry in an animal model.

Non-invasive methods for distinguishing different types of otitis media would have clinical value in predicting otologic morbidity. Two such methods, otoscopy and tympanometry, were used in two experimental models of otitis media to determine whether there are unique otoscopic and tympanometric characteristics of serous and purulent otitis media. A flat (type B or B+) tympanogram and yellow tympanic membrane each had a high likelihood of predicting middle ear effusion in these models, and the best prediction was obtained using both parameters simultaneously. A yellow tympanic membrane color predicted purulent otitis media in one model but did not distinguish purulent from serous ears in the other model. In one model, serous otitis media was frequently associated with a type C (negative pressure) tympanogram. Tympanometry provided a valuable adjunct to otoscopy in detecting effusion and in distinguishing serous and purulent disease. These observations may apply to otitis media in humans, although the variable etiologies of otitis media in humans may confound the ability of otoscopy and tympanometry to distinguish middle ear effusion types.

Acoustic Impedance Tests↗