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Antibiotic use and parental home otoscopy.
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[Otoscopy and tympanometry in the diagnosis of secretory otitis media]
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Pneumatic otoscopy and tympanometry.
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[Possibilities for using rhinoscopy and otoscopy in forensic autopsy].
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[Otitis media in the neonatal period: tympanometric diagnosis in relation to otoscopy].
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[Otoscopy: its requirements and limitations].
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[Otoscopy with Siegle's pneumatic speculum].
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[Tympanometric findings in relation to otoscopy and audiometric findings].
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A clinical trial of antihistamine, decongestant, or placebo in antibiotic-treated acute otitis media followed with pneumatic otoscopy and impedance tympanometry.
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Telescopic otoscopy and photography of the tympanic membrane.
High resolution wide field photographs of the external canal, tympanic membrane, and middle ear can now be readily taken using a Hopkin's Lens Fiberoptic Tele-otoscope with a high intensity flash generator and light source. The equipment required and the technique used are described and sample photographs presented. The old adage that one picture is worth a thousand words holds true for illustrating tympanic membrane and middle ear pathology. The pictures taken have proved to be extremely valuable in following the course of disease within an ear. When ears are examined for photographic purposes the examiner tends to look at the ears in greater detail and develops an appreciation of the subtle departures from normal which occur.
[Otoscopy and acoustic impedance in newborn infants in the first 5 days of life].
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Multipurpose rubber tubing for use in tympanocentesis and pneumatic otoscopy.
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Resolution of middle ear effusion in newborns.
OBJECTIVES: To determine the natural history of middle ear effusion (MEE) in newborns and compare the results of pneumatic otoscopy with tympanometry and acoustic reflex measurements in the evaluation of the middle ear of neonates. DESIGN: A descriptive natural history study with comparison of three evaluation methods for MEE. SETTING: County hospital nursery and pediatric clinic. PARTICIPANTS: Sixty-eight full-term, healthy neonates were studied on day 1 of life; 65 on day 2; and 24 on day 3. Thirty-eight infants returned at 2 weeks of age, and from this group, 23 returned at 2 months of age. INTERVENTIONS: Two independent observers performed otoscopy. An audiologist performed tympanometry and ipsilateral acoustic reflex measurements. Infants were evaluated daily from birth by all three methods for up to 3 days. MAIN OUTCOME MEASURE: The time to resolution of MEE as determined by three methods. RESULTS: In the first 3 hours of life, all babies examined had MEE diagnosed in both ears. By the third day, MEE apparently had resolved in 73% of ears by otoscopy, 88% by acoustic reflex measurements, and 92% by tympanometry. At 2 weeks, MEE was present by otoscopy in 13% (10/75 of ears). These were primarily newly acquired MEEs. Interobserver agreement by otoscopy as determined by kappa scores was moderate on days 1 and 3, poor on day 2, and excellent at 2 weeks and 2 months. CONCLUSIONS: Middle ear effusion diagnosed by otoscopy apparently resolves in 72 hours in most neonates. Interobserver agreement of otoscopists was excellent after babies were discharged from the nursery, suggesting that pneumatic otoscopy can be used to diagnose MEE in neonates this age. Most MEEs that are diagnosed 2 weeks and 2 months after birth are new and asymptomatic.
A comparison assessment of videotelescopy for diagnosis of pediatric otitis media with effusion.
OBJECTIVES: A correct diagnosis of pediatric otitis media with effusion (OME) is imperative for instituting an appropriate treatment. The aim of this study was to compare the diagnostic efficacies of videotelescopy, pneumatic otoscopy, and tympanometry for detecting the presence or absence of pediatric OME, and thereby, to recommend a standardized procedure for assessing possible OME in the outpatient setting of a referral center. STUDY DESIGN: Prospective study. METHODS: Between November 1999 and May 2002, 104 children were enrolled in this comparison study of diagnostic methods for OME. Based on a presumptive diagnosis of OME or atelectasis of the eardrum, patients under 12 years of age were admitted to the ward for ventilation-tube insertion. In the 2 days prior to surgery, videotelescopy, pneumatic otoscopy, and tympanometry were performed. Myringotomies were subsequently conducted under general anesthesia to confirm the presence or absence of OME. Type B tympanograms were accepted as positive results for ears with effusion. RESULTS: : Of the 201 ears assessed in the study, middle-ear effusion was detected in 179, while the remaining 22 ears were found to be dry on myringotomy. It was demonstrated that videotelescopy had the highest sensitivity (97.8%), specificity (100%), and accuracy (98.0%), reflecting significantly better results than those for pneumatic otoscopy and tympanometry. CONCLUSIONS: In our study, videotelescopy seemed to be better than pneumatic otoscopy and tympanometry for diagnosis of pediatric OME. It may be has the potential to become the standard diagnostic and teaching procedure for pediatric OME in the outpatient setting of a referral center, and for validation of pneumatic otoscopy.
Neonatal middle ear effusion predicts chronic otitis media with effusion.
HYPOTHESIS AND AIMS: The specific aims of the research are to determine whether newborn ears with persistent middle ear effusion at age 30 to 48 hours are more likely to develop chronic otitis media with effusion over the first year of life when compared with ears without persistent middle ear effusion. The hypothesis is that neonates with middle ear effusion persisting to 30 to 48 hours are more likely to develop chronic otitis media with effusion. STUDY DESIGN: Prospective, case-control design. Loupe-magnified pneumatic otoscopy performed at the time of newborn hearing screening determined presence or absence of effusion. Infants enrolled in the study returned for outpatient examinations. SETTING: University medical center well-baby nursery and out-patient audiology clinic. SUBJECTS: From 454 neonates, 14 experimental subjects with neonatal middle ear effusions and 15 control subjects free of neonatal effusion were recruited for the study and followed-up for 1 year. INTERVENTIONS: Outpatient study tests included transient-evoked otoacoustic emissions, tympanometry, pneumatic otoscopy, and visual reinforcement audiometry (starting at age 6 months), at 3, 6, 9, and 12 months of age. Experimental (neonatal effusion) infants were followed-up starting at age 1 month. Infants found at any follow-up examination to have effusion on otoscopy were followed-up and tested 1 month later. MAIN OUTCOME MEASURES: Chronic otitis media with effusion defined as hypomobile or immobile tympanic membrane on pneumatic otoscopy in one or both ears for three consecutive monthly examinations. Hearing loss defined as greater than 25-dB hearing loss visual reinforcement audiometry thresholds. RESULTS: Eight experimental infants (58%) and three control infants (20%) developed chronic otitis media with effusion (p < 0.04). The average number of effusions was 1.27 for control and 4.14 for experimental infants (average number of effusions for each group at 3-, 6-, 9-, and 12-month visits). Warbled tone and speech visual reinforcement audiometry thresholds averaged 3 dB worse in the experimental group, but these differences were not statistically significant. For the control group, mean visual reinforcement audiometry thresholds never exceeded 25 dB hearing loss. For the experimental group, mean visual reinforcement audiometry thresholds exceeded 25 dB hearing loss at 1,000, 2,000, and 4,000 Hz at 9 months. CONCLUSIONS: A majority of infants with persistent neonatal middle ear effusion found by pneumatic otoscopy at 30 to 48 hours will develop chronic otitis media with effusion during the first year of life. However, chronic otitis media with effusion is common in all infants (20% of controls), a time during which infants are examined and tested frequently.
Diagnostic methods for otitis media with effusion in children.
BACKGROUND: Correct diagnosis of otitis media with effusion (OME) in children is imperative for instituting appropriate treatment. This study aims to establish the diagnostic value of pneumatic otoscopy, tympanometry, acoustic reflectometry and videotelescopy by comparing them with myringotomy findings. METHODS: Between November 1999 and July 2001, we conducted a prospective study on diagnosis of OME in children. The children studied were candidates for ventilation tube insertions or other ENT surgeries. All tests, including acoustic reflectometry, tympanometry, pneumatic otoscopy and videotelescopy, were performed two days before surgery. Myringotomy or tympanocentesis was then performed to confirm the presence or absence of OME. A type B tympanogram was accepted as a predictor of effusion. The curve angle of acoustic reflectometry with cut-point of 69 degrees (< or = 69 degrees) was also used to predict the presence of OME. RESULTS: Eighty-nine children (58 males and 31 females), ranging in age from 1 to 13 years, participated in the study. Of 172 ears assessed in the study, middle ear effusion was detected in 124; the remaining 47 ears were found to be dry at myringotomy or tympanocentesis. Videotelescopy gave the highest sensitivity, specificity and accuracy, followed by pneumatic otoscopy, tympanometry and acoustic reflectometry. CONCLUSIONS: Videotelescopy seems to have the potential to become the standard for diagnosis of OME in children and for validation of pneumatic otoscopy. When videotelescopy is not available, tympanometry could be an instrumental adjunct to pneumatic otoscopy. Although acoustic reflectometry gave the worst results, it is still useful for assessing and screening OME in children because of the ease and speed of its operation irrespective of crying, cerumen, an air seal in the ear, or lack of cooperation from the young children.