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Inicio Acta Otorrinolaringológica Española Value of simple otoscopy in diagnosing otitis media with effusion in children
Información de la revista
Vol. 74. Núm. 3.
Páginas 175-181 (mayo - junio 2023)
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Vol. 74. Núm. 3.
Páginas 175-181 (mayo - junio 2023)
Original article
Value of simple otoscopy in diagnosing otitis media with effusion in children
Cátia Azevedoa,
Autor para correspondencia
catiacazevedo17@gmail.com

Corresponding author.
, João Firmino Machadob,c,d, António Fontes Limaa, Fernando Milhazes Mara, Sérgio Vilarinhoa, Luís Diasa
a Hospital de Braga, Braga, Portugal
b EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
c Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
d Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Table 1. Sensitivity, Specificity, PPV, and NPV of otoscopy in the diagnosis of otitis media with effusion, when performed by specialists and residents in each medical specialty.
Table 2. Interobserver and Intraobserver agreement within each specialty.
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Abstract
Aims

To explore the value of otoscopy in diagnosing OME when performed by otorhinolaryngology, pediatrics, and primary care physicians; to evaluate the interobserver and intraobserver agreement of interpretation of otoscopy images.

Material and methods

A cross-sectional study using an anonymous mailed survey was used. We presented pre-recorded otoscopy images of pediatric patients to otorhinolaryngology, pediatrics, and primary care physicians (ten volunteer specialists and residents from each medical specialty). All participants had to answer “yes” or “no” if they considered that the image corresponded or not to an OME case, respectively. We considered that the images were positive for OME whenever the respective tympanogram was type B.

Results

Thirty-one otoscopy images and 1860 responses provided by sixty physicians were analyzed. The accuracy of otoscopy in diagnosing OME was highest in the Otolaryngologists group (mean 74.8%), with the worst rate observed in the primary care residents group (mean 51.3%). Overall sensitivity, specificity, and positive predictive value of otoscopy for diagnosing OME were significantly higher when performed by otorhinolaryngologists (75.8%, 72.8%, 66.8%, respectively). Fleiss' kappa showed that interobserver agreement was globally weak within each group of specialties, with overall better interobserver agreement observed among otorhinolaryngologists (κ = 0.30; 95% CI 0.27–0.32).

Conclusion

According to our data, simple otoscopy as a single diagnostic method in pediatric OME is insufficient, even for otorhinolaryngologists. Current recommendations must be followed to improve diagnostic accuracy.

Keywords:
Simple otoscopy
Otitis media with effusion
Sensitivity
Specificity
Observer agreement

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