Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Otoscopy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 91 records · Page 5Linked to original sources
PubMed2004

Comparison of performance by otolaryngologists, pediatricians, and general practioners on an otoendoscopic diagnostic video examination.

OBJECTIVE: To compare the performance of United States, South African, and Greek otolaryngologists, pediatricians, and general practitioners in recognizing the otoscopic examination findings of acute otitis media (AOM) and otitis media with effusion (OME) as presented in an otoendoscopic video evaluation test. DESIGN/SUBJECTS: Otolaryngologists, pediatricians, and general practitioners from the United States (n = 273, 2190, and 360 respectively), South Africa (n = 36, 36, and 206), and Greece (n = 58, 115, and 126) viewed nine different video-recorded otoscopic examinations, including pneumatic otoscopy of tympanic membranes. The ability to differentiate AOM, OME, and normal was ascertained. RESULTS: Overall, the average +/- standard deviation correct diagnosis on the otoscopic video exam by otolaryngologists was superior to pediatricians and general practitioners in all three countries: from the United States, it was 74 +/- 16% for otolaryngologists versus 51 +/- 11% for pediatricians (p < 0.000l) and 46+/-21% for general practitioners (p < 0.0001); from South Africa, it was 72 +/- 16% versus 53 +/- 21% (p = 0.16) and 47 +/- 19% (p = 0.002); and from Greece, it was 61 +/- 15% versus 36 +/- 12% (p < 0.003) and 39 +/- 10% (p = 0.009). CONCLUSIONS: A video-based otoscopy examination test may be a useful tool for evaluation of otoscopy-based diagnostic skills. Otolaryngologists performed significantly better than pediatricians in differentiating AOM, OME, and normal in such a test described here. However, all specialists who examine patients with AOM or OME may benefit from viewing video otoscopies to improve diagnostic accuracy.

Acute Disease↗
PubMed2003

Evidence assessment of the accuracy of methods of diagnosing middle ear effusion in children with otitis media with effusion.

OBJECTIVES: We report the findings of an evidence assessment on the accuracy of methods of diagnosing middle ear effusion in children with otitis media with effusion (OME). METHODS: We searched Medline (1966-January 2000), the Cochrane Library (through January 2000), and Embase (1980-January 2000) and identified additional articles from reference lists in proceedings, published articles, reports, and guidelines. Excluded were nonhuman studies; case reports; editorials; letters; reviews; practice guidelines; non-English-language publications; and studies on patients with immunodeficiencies, craniofacial anomalies (including cleft palate), primary mucosal disorders, or genetic conditions. From each eligible study, we calculated the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and prevalence of OME in the cohort. We determined the number of studies for each comparison of a diagnostic method and a reference standard listed within the scope of our assessment. For comparisons with 3 or more studies, we derived random effects estimates of sensitivity, specificity, and prevalence rate. Using the pooled estimates, we plotted the performance of each diagnostic test in terms of sensitivity and (1 - specificity) and identified the best performer among the tests included in the comparison. RESULTS: Among 8 diagnostic methods, pneumatic otoscopy had the best apparent performance with a sensitivity of 94% (95% confidence interval: 92%-96%) and a specificity of 80% (95% confidence interval: 75%-86%). However, examiner qualifications were reported inconsistently, and training was not specified. CONCLUSIONS: The finding that pneumatic otoscopy can do as well as or better than tympanometry and acoustic reflectometry has significant practical implications. For the typical clinician, pneumatic otoscopy should be easier to use than other diagnostic methods. The important question may be what degree of training will be needed for the clinician to be as effective with pneumatic otoscopy as were the examiners in the studies reviewed in this report.

Acoustic Impedance Tests↗
PubMed2002

Otitis media in children: use of diagnostic tools by family practice residents.

BACKGROUND AND OBJECTIVES: Although otitis media is a common problem in primary care, little is known about the use of diagnostic tools such as pneumatic otoscopy, tympanometry, acoustic reflectometry, or tympanocentesis by family physicians in training. METHODS: This was a self-reported observational study of family practice residents' use of otitis media diagnostic tools. Twenty-three family practice programs in Texas and Oklahoma were surveyed during November and December 2000. Residents were asked about their use of diagnostic tools, and, if tools were not used, they were asked the reason for not using them. Residents were also asked about the criteria they used to diagnose otitis media, and their responses were compared to criteria recommended by national guideline panels. RESULTS: The response rate was 61% (n = 316). The percentage of residents using pneumatic otoscopy was 66%, tympanometry 29%, acoustic reflectometry 2%, and tympanocentesis 0%. The most common reasons cited for not using tools were lack of training or unavailability of equipment. Fifty-five percent of family practice residents do not report pneumatic otoscopy for diagnosing otitis media and thus did not use recommended criteria. Faculty training of residents in the use of diagnostic tools was associated with a higher rate of using these tools. DISCUSSION: Few residents believed that diagnostic tools had no value in the diagnosis of otitis media, but lack of training or equipment problems were reported as contributing to their not using these tools. Half of family practice residents may be inadequately diagnosing middle ear problems since they did not report that pneumatic otoscopy was necessary for diagnosing otitis media. Because training was associated with higher rates of using appropriate diagnostic tools, family medicine faculty can play a significant role in improving the residents' diagnostic skills.

Acoustic Impedance Tests↗
PubMed2000

Otoscopic findings in relation to tympanometry during infancy.

To determine the value of different otoscopic findings in diagnosing otitis media with effusion, 3,780 otological examinations of 250 infants at ages 0-2 years were compared with tympanometric findings. Otoscopy was performed by an experienced otologist and research-audiologist prior to tympanometry. The following success rates for these procedures were found: otoscopy, 85-91%, tympanometry, 74-94%, either otoscopy or tympanometry, 89-99%. "Glue" was noted as the most frequent abnormal otoscopic feature, i.e., depending on age, 6-32%. Fluid line/ bubbles, bulging/hyperaemia or otorrhoea were rarely (0-5%) observed and contributed little to the diagnosis of otitis media with effusion. No structural changes of the tympanic membrane were observed. Analysis of tympanometric data revealed that the prevalence of tympanogram types B (21-44%), C1 (0.5-16%) and C2 (0-8%) was age-dependent. Comparison of otoscopic and tympanometric findings indicated sufficient diagnostic agreement (Cohen's kappa between 0.41 and 0.74) at age 6-24 months. In conclusion, otoscopy appears to be a valid instrument for diagnosing otitis media with effusion, at least from 6 to 24 months of age. In addition, the results of our study suggest that tuba-dysfunction and otitis media with effusion are age-dependent disorders during infancy, without structural effects on the tympanic membrane.

Acoustic Impedance Tests↗
PubMed1983

Pass/fail criteria in screening for otitis media in children with learning disorders.

A group of 75 children with language/learning disorders were screened for middle ear problems using serial tympanometry and otoscopy. Using a fail criterion of -200 mm H2O for tympanometry, 68% of the ears identified as pathological by otoscopy were identified by two serial tympanometry screens. The concurrence of otoscopy and serial tympanometry indicated a failure rate of 18% of the ears tested. It is concluded that for children in special populations, such as those with language/learning disorders, who may need careful monitoring for identification of middle ear problems, a combination of otoscopy and a single test of tympanometry may improve the reliability of screening programs.

Acoustic Impedance Tests↗
PubMed1995

[From otoscope to ophthalmoscope and back. The interwoven history of their invention and introduction into medical practice. Pictures from the history of otorhinolaryngology, illustrated by instruments from the collection of the Ingolstadt German Medical History Museum].

Friedrich Hofmann, medical officer in Burgsteinfurt, Westphalia, Germany, in 1841 described a concave mirror with a central aperture in it as the ideal instrument that allowed reflecting and focussing light into the external auditory canal and simultaneously inspecting the tympanic membrane without obstructing either the light or the view. He recommended his device also for the inspection of other concealed regions of the body. His invention was referred to by Martell Frank in his textbook of otology in 1845, but otherwise attracted no attention. Hermann Helmholtz, physiologist in Königsberg, East Prussia, devised his ophthalmoscope in 1850-51 in order to study the phenomenon of glowing eyes. With this instrument he was the first to see the retina of a living human. As means of illumination he used small panes of glass similar to cover-glasses which were introduced into the common visual axis of the observer and the subject at such an angle that light from a lamp was reflected into the subject's eye while the observer inspected the subject's retina through the glass and an appropriate lens. He recommended this type of illumination also for otoscopy. His invention was at once acclaimed throughout the world and opened completely new opportunities in ophthalmology. The slanting panes of glass, however, were not the ideal solution for illumination. It was only one year later that Ruete in Göttingen replaced them with a concave mirror with a central aperture, and there is every indication that Frank's report on Hofmann's mirror had suggested this technique to him. During the following two years quite a number of other modifications of the ophthalmoscope were constructed, all of them using the concave mirror with a central aperture, which soon became synonymous with the ophthalmoscope as such. Von Tröltsch, otologist and ophthalmologist in Würzburg, presented a concave mirror with a central aperture for otoscopy in Paris in 1855-56. His instrument was obviously derived from the already well known ophthalmoscope by adapting the diameter and focal distance to this special application. His primary concern was to use daylight instead of artificial light for otoscopy. Von Tröltsch did not know Hofmann's publication, but later did not hesitate to acknowledge Hofmann's priority. It was von Tröltsch who popularized the concave reflector with a central aperture as the instrument of choice in otoscopy, and subsequently also for rhinoscopy and laryngoscopy. Further modifications were devised to have the hands free for operations. Thus the reflector was fixed to the forehead by strap and buckle or a vulcanite band, or it was provided with a handle that was to be held between the teeth, or it was attached to a spectacle frame. The details of this interwoven history are related and highlighted by numerous quotations and historical illustrations.

Ear↗
PubMed1996

Examining the ear: clinical teaching.

Although otolaryngology represents up to 20% of the workload of general practitioners, the time allocated in the undergraduate medical curriculum to clinical teaching of ENT disorders is disproportionately small. Many GPs have indicated a desire for further training in ENT, particularly in small groups. This study was carried out on a group of 27 GPs who wished to revise their diagnostic skills in otoscopy by attending a 2-hour teaching session on basic examination of the ear and the recognition and management of common otological conditions. The GPs skill in otoscopy before and after the course was assessed subjectively by means of a self-administered questionnaire and scored objectively by ENT surgeons. Aspects of otoscopy chosen for assessment were technique of examination of the external ear, choosing correct speculum size, techniques of holding the otoscope and pinna, tympanic membrane description and diagnostic ability. An improvement between the objective pre- and post-workshop scores was found for assessment of the external ear, choice of speculum size, description of the tympanic membrane and diagnostic ability. No significant differences in the pre- and post-workshop scores was found for the techniques of holding the otoscope or holding the pinna. The majority of the GPs found the workshop beneficial. Postgraduate teaching of specialist diagnostic skills such as otoscopy to GPs is useful. An improvement in such skills should enable the GPs to manage ENT problems more confidently and refer patients appropriately to the ENT outpatients.

Clinical Competence↗
PubMedDate not supplied

Design factors in the characterization and identification of otitis media and certain related conditions.

Because the state of our knowledge of many aspects of the etiology and pathogenesis of otitis media and related conditions is deficient, precise characterizations of certain aspects of the disease may not be possible. In fact although most studies in the past have failed to define the specific disease state to be investigated, the specific type of otitis media or related condition to be studied must be as clearly defined as is clinically possible in order for any prospective study of otitis media to be valid. The state of the art of the presently available methods to identify these conditions also poses certain limitations; at present, there are five methods to identify otitis media and related conditions: history, audiometry, tympanocentesis/myringotomy, otoscopy (including otomicroscopy), and impedance measurements (tympanometry and assessment of the middle earl muscle reflex), and they all have inherent elements of unreliability. Historical information obtained from parents or the child is usually unreliable; a positive history may aid in defining the problem, but a negative otologic history does not rule out the presence of otitis media since it is frequently asymptomatic. Audiometry has been shown to be a poor method of identifying otitis media. Although tympanocentesis or myringotomy is the most reliable way to identify otitis media with effusion (OME), it is invasive, frequently requires an anesthetic, and is usually a confounding variable. In an effort to establish the diagnostic value of otoscopy, tympanometry, and the presence or absence of the middle ear muscle reflex in identifying OME, the diagnostic findings by these three methods, were compared with the findings at myringotomy in 239 children (425 ears). The study showed that even experienced clinicians had some difficulty in identifying those ears with effusion (sensitivity) and had even greater difficulty in making a diagnosis of those ears without an effusion (specificity). Tympanometry employing patterns that have been validated with myringotomy findings was found to be as accurate as expert otoscopy. On the other hand, the presence or absence of the middle ear muscle reflex was found not to be a useful method of diagnosing the presence of OME due to its extremely low specificity. An algorithm derived from the combination of the three methods had highest sensitivity and specificity. From this study, the following recommendations regarding the identification of OME are suggested. All investigators who employ otoscopy should be validated by comparing their assessments either with the findings at myringotomy or with a previously validated otoscopist. Interobserver realiability of all otoscopists should be established prior to and maintained during clinical studies of OME. Only electroacoustic impedance instruments in which the tympanometric patterns have been validated should be used. Tympanometry employing validated tympanometric patterns has a high degree of sensitivity and specificity, and as such can provide an objective method to identify OME...

Acoustic Impedance Tests↗
PubMed1998

[Clinical symptomatology and diagnosis of otitis and its complications].

Clinical presentation of children having an otitis media includes earache and fever. Both signs are not found in 20% of cases, while 20% of children with otitis have gastrointestinal disorders. Systematic clinical otoscopy should be performed in each child, because of the lack of value of symptoms for predicting otitis media in children. Clinical otoscopy shows first a red tympanic membrane, then a bulging eardrum, followed by an abscess of the middle ear. Otoscopy interpretation can be difficult in cases of chronic otitis media surinfection or in neonates. Otoscopy can be hard to perform: technical improvements exist, but they cannot be used in the everyday practice at home. The current complication of otitis media are facial palsy (5/1,000) and meningitis (1/1,000) leading to sequellae (deafness).

Acute Disease↗
PubMed1992

Assessment of the otoscopic skills of general practitioners and medical students: is there room for improvement?

Ear, nose and throat problems are common in general practice, yet undergraduate and postgraduate teaching in the subject is variable and often sparse. The assumption that direct experience in otoscopy in practice will compensate for inadequate previous tuition was tested by assessing a group of 53 general practitioners and 59 medical students. Confidence in otoscopy was assessed using a visual analogue scale and skill was assessed by clinical examination of four ears. Otoscopy was divided into identifying the tympanic membrane, distinguishing a normal from an abnormal membrane and identifying specific features of the membrane. The medical students and general practitioners were comparable in both confidence and skill for all parameters except skill in identification of specific features of the tympanic membrane, in which the students' ability was greater (Student's t-test, P < 0.01). In both groups the percentage of false negative observations was reassuringly low--for students the mean was 3.0%; and for general practitioners 4.3%. There is room for improvement in general practitioner's training in otoscopy. Supervised tuition is essential and cannot be compensated for by unsupervised experience. More involvement with ear, nose and throat problems in vocational training or attendance at continuing education courses is suggested.

Clinical Competence↗
PubMed1997

Effects of tympanic membrane abnormalities on auditory function.

This article discusses how several diagnostic tools used by audiologists inter-relate to anatomical abnormalities viewed by video otoscopy. Background of common middle ear pathology is reviewed, with emphasis on new research findings regarding pathophysiology. A review of video otoscopy, multifrequency tympanometry, and otoreflectance is provided. Case studies illustrate the integrated use of these diagnostic tools. Audiologic results are integrated with video otoscopy through case study analysis and interpretation. Understanding of the complexity of the physiologic and behavioral measurements is enhanced with the ability to closely inspect tympanic membrane pathology through video otoscopy. Multifrequency tympanometry, otoreflectance, and otoacoustic emissions (OAEs) allow us to more easily detect pathologic conditions such as cholesteatoma and chronic (silent) otitis media with effusion (OME).

Acoustic Impedance Tests↗
PubMed2004

Preschool hearing screening: pass/refer rates for children enrolled in a head start program in eastern North Carolina.

This 4-year project investigated the pass/refer rates of preschool children in a hearing screening program. Three- and 4-year-old children who attended Head Start centers in rural, traditionally medically underserved, eastern North Carolina participated (n = 1,462). Screening procedures and pass/refer criteria were based on the Guidelines for Audiologic Screening (American Speech-Language-Hearing Association [ASHA], Panel on Audiologic Assessment, 1997). Only 54% (n = 787) of children passed the initial screening (i.e., passed all three of the screening components, which included pure-tone audiometry, tympanometry, and otoscopy), and an additional 22% (n = 323) passed the rescreening, for an overall pass rate of 76%. The initial pass rate was 90%, 71%, and 71% for otoscopy, tympanometry, and pure-tone audiometry, respectively. After the initial screening, 675 children were referred (i.e., 83%, 2%, and 15% for audiologic rescreening, medical evaluation, or both, respectively). About 71% (n = 478) received the recommended evaluation. Follow-up assessment compliance after the rescreening was poor. Slightly more than 10% of children were evaluated. The hearing status of 267 (i.e., 18.3%) children was never determined. Six (i.e., 0.5%) of the 1,195 children who completed the audiologic screening and/or received diagnostic audiologic assessment were confirmed to have hearing loss. Methodological factors that may have contributed to this high refer rate include the use of all screening techniques (pure tones, tympanometry, and otoscopy), procedural considerations in testing protocol and pass/refer criteria, and the demographic characteristics of the children screened.

Acoustic Impedance Tests↗
PubMed2003

Evaluation of audiologic impairment in critically ill patients: results of a screening protocol.

OBJECTIVE: To assess hearing impairment in adults admitted to a university surgical intensive care unit in order to identify patients at risk for impaired receptive communication. DESIGN: Prospective, clinical, observational study within the continuing quality improvement program. SETTING: Ten-bed adult surgical intensive care unit at a university hospital. PATIENTS: Patients were 442 adult patients admitted to the surgical intensive care unit for trauma, a critical illness, or postoperative monitoring. INTERVENTIONS: As part of a continuing quality improvement protocol, adults admitted to the surgical intensive care unit were screened for hearing loss. Screening included otoscopy, tympanometry, and distortion product otoacoustic emissions as near the time of admission as was possible. Testing was available only on weekdays. MEASUREMENTS AND MAIN RESULTS: Audiologic testing was performed on day 1.7 +/- 3.0 and took 9.3 mins (range, 5-17 min). The women studied (n = 177, 56.2 +/- 18.2 yrs) were significantly older than the men (n = 265, 51.2 +/- 17.8 yrs, p <.0001). We found that 71.4% of patients had normal otoscopy. Only 42.5% of patients passed tympanometry. True failures accounted for 37.3% of patients and technical failures for 20.2%. Distortion product otoacoustic emission (DPOAE) testing was performed on 97.4% of ears. Only 36.2% of patients passed; 58.4% of ears failed, suggesting clinically significant auditory impairment. DPOAE results correlated with age. The pass rate was approximately 60% for patients <40 yrs of age but declined steadily by decade to <7% in patients >80 yrs. The mean age of passed DPOAE (44.2 +/- 16.2 yrs) was significantly younger than patients who failed DPOAE (60.0 +/- 16.6 yrs, p <.0001). CONCLUSIONS: Adult patients admitted to the surgical intensive care unit for trauma, postoperative monitoring, or critical illness are at significant risk of impaired auditory reception. Almost two thirds of patients studied failed the screening protocol. Risk of failure increases with age and male gender. Screening with otoscopy, tympanometry, and DPOAE is an efficient and sensitive way to identify patients at risk for impaired auditory acuity.

Acoustic Impedance Tests↗
PubMed2004

Clinical diagnostic accuracy of otitis media with effusion in children, and significance of myringotomy: diagnostic or therapeutic?

The specific aims of this prospective survey were to determine the accuracy of traditional diagnostic tools, such as pneumatic otoscopy, otomicroscopy, and tympanometry, and evaluate the usefulness of myringotomy as a diagnostic method; also to determine the significance of myringotomy in treating otitis media with effusion (OME). The status of middle ear of 51 children (85 ears) from November 2002 to February 2003 was examined using pneumatic otoscopy, otomicroscopy, and tympanometry, and the presence/absence of middle ear effusion was confirmed by myringotomy. The otomicroscopy was the most sensitive and specific one among three diagnostic tools. But, it had some false positive cases. This study failed to show the therapeutic efficacy of myringotomy. Otomicroscopy seems to have the potential to become the standard for diagnosis of OME and for validation of pneumatic otoscopy in children. However, when otoscopic, otomicroscopic findings and tympanogram of suspected ear show poor correlation, myringotomy can be used to confirm the presence of OME, as the diagnostic modality. As the therapeutic modality, we think that it is proper to limit indications of myringotomy to some selected cases.

Child↗
PubMed2004

Aural irrigation using the OtoClear Safe Irrigation System in children.

OBJECTIVE: To evaluate the safety and efficacy of the OtoClear Safe Irrigation System for removing cerumen from the external auditory canal in children. METHODS: Eligible subjects were 6 months-17 years of age with cerumen obstructing > or = 50% of the tympanic membrane (TM) from view (by otoscopy). Pneumatic otoscopy, tympanometry, and audiometry were performed followed by cleansing of the affected ear canal(s) with the OtoClear Safe Irrigation System and warm tap water. Otoscopy was performed after each wash of the canal. A curette or small alligator forceps was used to remove remaining cerumen if necessary. Tympanometry and audiometry were repeated after all procedures were completed. Telephone contact was made 1 week later regarding symptoms of acute otitis externa or any other problems. RESULTS: Eighteen children (28 ears) ages 1-10/12 to 11-2/12 years were entered. Four had previously had tympanostomy tubes. At entry, there was no visible TM in 19 ears, 5-10% visible TM in 5 ears, 20% in 1 ear, and 30-40% of the TM in 3 ears. The number of washes needed per ear was: 1 wash--16 ears, 2 washes--8 ears, 3 washes--1 ear, 4 washes--2 ears; washing was stopped in 1 ear because of pain. After irrigation, a curette or forceps was used in 6 ears. Following the procedures, > or = 95% of the TM was visible in 24 ears, and > or = 80% was visible in all ears. Six ears (4 children) with flat tympanograms at entry became normal after irrigation. On audiometry, a conductive loss in 2 ears at entry resolved after irrigation. The mean change in pure tone average (PTA) was -2.9 dB. Three subjects were noted to have hearing losses >5 dB at some frequencies which on review by audiologists were deemed non-significant. No perforations of the TM occurred. There were no reports of otitis externa or any other adverse events occurring after leaving the clinic. CONCLUSION: We found the OtoClear Safe Irrigation System to be safe and effective in our small sample of children. It was well tolerated in most and provided a non-traumatic method for the removal of obstructing cerumen.

Acoustic Impedance Tests↗
PubMed2002

Otitis media in children: seasonal changes and socioeconomic level.

OBJECTIVE: Our objective was to determine the frequency of otitis media (OM) in relation to socioeconomic and seasonal factors in a city in southern Brazil. METHODS: A prospective, longitudinal study was carried out with a 3-4-year-old cohort of children randomly selected in schools serving populations of higher socioeconomic status (AB; monthly family income >10 minimum wages, US$ 1000) or lower socioeconomic status (CD; monthly family income < or = 3 minimum wages, US$ 300). The children were assessed in the fall, winter, and spring of 1997 using otoscopy and tympanometry. RESULTS: Among 156 children who finished the study, 53.8% belonged to socioeconomic group CD. Otoscopy suggested chronic suppurative otitis media (OM) (tympanic membrane perforation or otorrhea) in <6% of children in the CD group, with no seasonal variation. Alterations suggesting secretory otitis media (SOM) were significantly more frequent in the CD group (P< or = 0.001), with a peak in the winter. The prevalence of SOM on otoscopy was: fall (20.9% AB; 38.1% CD); winter (28.6% AB; 81% CD), and spring (23% AB; 49.3% CD). The incidence of SOM in the winter according to tympanometry was 18.4% (group AB) and 72.9% (group CD). Among children with a normal tympanogram in the fall, 44.7% presented a type B tympanogram (presence of middle ear effusion) in the winter. Only 17.6% still presented a type B tympanogram in the spring. From the ears with type B tympanogram in the fall, 80% had the same result in the winter, and 60.9%, in the spring. A sharp seasonal SOM peak was observed in the CD group in the winter. CONCLUSION: Children in the lower socioeconomic group have a peak incidence of serous otitis media (OM) in the winter. Presence of type B tympanogram in the fall and belonging to socioeconomic group CD are indicators of poor prognosis in terms of the spontaneous resolution of SOM.

Acoustic Impedance Tests↗
PubMed1998

Middle ear disease in cystic fibrosis.

A prospective cross-sectional study was done to investigate the involvement of middle ear disease in cystic fibrosis. Eighty-eight patients with cystic fibrosis, aged 1-28 years, were examined during the winter period 1995-1996 at regular follow-up visits to detect history and prevalence of inflammatory and infectious middle ear disease by questionnaire, otoscopy and tympanometry. One third of the patients had a history of otitis media, but only in 9% did this occur more than once. Hearing problems were recorded in 8%, but this was severe in only one case. Otoscopy showed 141 normal tympanic membranes, 17 times retraction, 15 times otitis media with effusion, once an acute otitis media in both ears. Only one patient had a grommet in one ear. More than 70% of the tympanograms were normal. A flat curve, type B according to Jerger's classification, was found in 11 ears. The youngest age group had a higher prevalence of abnormal findings on otoscopy and tympanometry, while patients who had undergone paranasal sinus surgery had less frequently abnormal findings. In conclusion, no evidence that cystic fibrosis is associated with increased prevalence of middle ear disease has been found in this prospective cross-sectional study.

Acoustic Impedance Tests↗
PubMed1996

Efficacy of ceftibuten compared with amoxicillin for otitis media with effusion in infants and children.

OBJECTIVES: This trial compared the efficacy of ceftibuten with that of amoxicillin in resolving otitis media with effusion. METHODS: Two hundred ten children with otitis media with effusion were randomly assigned to receive either ceftibuten (9 mg/kg/day in one daily dose) or amoxicillin (40 mg/kg/day divided into 3 daily doses) for 14 days. Outcome was assessed at 2 and 4 weeks in all subjects; those without middle ear effusion at the 4-week visit were examined at 8, 12 and 16 weeks. Middle ear status was determined by pneumatic otoscopy and by an algorithm combining pneumatic otoscopy with tympanometry. RESULTS: The percentages of subjects who were effusion-free in the ceftibuten and amoxicillin groups at 2 weeks by otoscopy were 29.8 and 27.2%, respectively (P = 0.59), and by the algorithm, 23.4 and 20.4%, respectively (P = 0.47). In children who were effusion-free at 2 weeks, recurrence of effusion by 16 weeks was noted in approximately 60% of the ceftibuten group and 67% of the amoxicillin group. No medication side effects were reported by 88% of subjects in the ceftibuten group and by 93% of subjects in the amoxicillin group. We found no significant differences between the ceftibuten and amoxicillin groups with respect to resolution of middle ear effusion, rate of recurrence or side effects. CONCLUSIONS: Amoxicillin remains the drug of first choice for treatment of otitis media with effusion when treatment is deemed advisable, but ceftibuten may be an alternative drug in selected situations.

Amoxicillin↗