The otoscope: an update on assessment skills.
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Clinical Competence↗
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Improving visualization of intrameatal warts: use of the otoscope.
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Condylomata Acuminata↗
Tympanometric and otoscopic evaluations of a school-age deaf population: a longitudinal study.
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Audiometry↗
Improving visualization of intrameatal warts: use of the otoscope.
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Condylomata Acuminata↗
[A comparison of tympanometric with audiometric and otoscopic findings (author's transl)].
An analysis is reported of the assessment of 233 ears by otoscopy from which the tympanic membrane appearances were classed into five groups, audiometry, tympanometry and in 57 cases middle-ear-puncture. Although observer errors must be acknowledged the findings were that the type B tympanogram does not conform to a specific pathology and may occur with different degrees of conductive hearing loss. Furthermore in the diagnosis of middle ear effusion the tympanogram does not supercede careful otoscopy and pure tone audiometry.
Acoustic Impedance Tests↗
Effective photography in otolaryngology-head and neck surgery: endoscopic photography of the middle ear.
A side- or oblique-viewing needle otoscope was used for the endoscopic examination of the middle ear. The needle otoscope consists of a Selfoc glass rod lens for observation and a bundle of glass fibers for illumination. Prisms attached at the tip of the lens and the glass fiber bundle facilitate the examination of 90 degrees lateral and 60 degrees oblique regions. Through an existing perforation of the tympanic membrane, the tip of the instrument is introduced into the middle ear cavity without anesthesia, using a self-illuminating otoscope. The needle otoscope can also be introduced into the middle ear cavity after myringotomy or during ear surgery. The instrument is extremely helpful in locating lesions and diagnosing middle ear diseases. The image can be photographed by connecting the needle otoscope to a special camera, which is equipped with an automatic exposure and a self-winding system. A high-power light source is essential for taking photographs. Photographs taken on 16-mm film are presented.
Child↗
Effects of exam procedures on transient evoked otoacoustic emissions (TEOAEs) in neonates.
Debris in the ear canal and ear canal collapse in newborns have been shown to interfere with recording transient evoked otoacoustic emissions (TEOAEs). The purpose of this study was to prospectively evaluate the effects of two simple ear canal cleaning procedures on the TEOAE responses of normal newborns. Three hundred and sixteen ears were studied with an initial TEOAE followed randomly by either an otoscopic exam and refit procedure or a probe refit procedure. At the time of each procedure, any superficial debris attached to the otoscope or probe were removed before the second TEOAE was repeated with identical procedures. The study sample consisted of two equal groups of ears (otoscopic exam and refit). Each group initially had equal proportions of ears with no emission, a weak emission, or a robust emission. In the otoscopic group, 12 of 51 (24%) weak emissions converted to robust emissions, 10 of 53 (19%) no emissions converted to robust emissions, and 15 of 53 (28%) no emissions improved to weak emissions. In the refit group, 20 of 50 (40%) weak emissions converted to robust emissions, 13 of 57 (23%) no emissions converted to weak emissions, and 9 of 57 (16%) no emissions improved to weak emissions. Both the otoscopic viewing procedure and the refit procedure were effective in improving the TEOAE response.
Acoustic Stimulation↗
Use of acoustic reflectometry in the detection of middle ear effusion.
The purpose of the present investigation was to compare the performance of the acoustic otoscope/DPU-411 printer and acoustic immittance with otoscopic examinations by a physician for the detection of middle ear effusion (MEE). Three hundred and two patients (11 months to 69 years) were evaluated with the acoustic otoscope, acoustic immittance, and otoscopic examinations. The patients were divided into two age groups for data analysis: 1 to 12 years (children) and 13 to 69 years (adults). Reflectivity and angle data were evaluated at different cut-off points and receiver operating characteristics (ROC) curves were determined. The variables were analyzed in different combinations for each study group. Sensitivity and specificity were poorest for the acoustic otoscope in children. Furthermore, acoustic immittance data compared more favorably with otoscopy than did the acoustic otoscope for all ages.
Acoustic Impedance Tests↗
Adequate illumination for otoscopy. Variations due to power source, bulb, and head and speculum design.
To determine the working condition of otoscopes used in our community to diagnose middle-ear disease in children, we examined 221 otoscopes located in a hospital clinic, four emergency rooms, and the private offices of 96 physicians. The light output of each unit was measured in "as is" condition and then remeasured after a new lamp and, when possible, a new battery had been placed in the unit. A light output of 100 foot-candles or more was judged optimal for clinical otoscopy. Replacement of the bulb was significantly more likely than replacement of the battery to restore adequate light output to those units with initially poor performance (80% vs 26%). Almost one third of physicians reported changing otoscope bulbs less often than every two years, and several did not know how to replace the bulb. Almost half of the 93 rechargeable nickel-cadmium batteries inspected were outdated, but even these "expired" batteries provided adequate power when fully charged. Office otoscopes should be maintained properly to ensure optimal performance.
Evaluation Studies as Topic↗
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↗
Aspects of diagnosis of acute otitis media.
BACKGROUND: Acute otitis media is a common disease, particularly among children. The importance of a correct diagnosis is crucial, especially as unjustified prescription of antibiotics has become a major problem in clinical praxis. OBJECTIVES: Our aim was to evaluate the predictive value of different otological findings in diagnostics and treatment of acute otitis media among GPs and ear specialists and to investigate if the diagnosis could be improved by the use of an ear microscope instead of an otoscope. Furthermore, we aimed to test the value of following an algorithm, METHODS: Thirty-one patients with otalgia at the Emergency Department at the Karolinska Hospital in Stockholm were examined by both a GP and an ear specialist. The GP used an otoscope, whereas the ear specialist first used an otoscope and then an ear microscope. The doctors registered their findings and their proposal for treatment in questionnaires. The ability among participating ear specialists to give a correct diagnosis was confirmed by the use of 12 video-taped selected cases of aural diseases. An algorithm for diagnostics, based on medical facts, was formulated and tested. RESULTS: In general, the concordance between ear specialists and GPs was satisfactory with regard to establishing the diagnosis acute otitis media. The diagnostics were not improved by use of an ear microscope. The algorithm identified most patients with acute otitis media. Conclusion. The results indicate that the following of a simple algorithm may simplify the CONCLUSION: and lead to a correct diagnosis of acute otitis media.
Acute Disease↗
Accuracy of the Bing and Rinne tuning fork tests.
Fifty children seen in an ENT clinic received the Bing and Rinne tuning fork tests, otoscopic examination, and puretone audiometry to determine the accuracy of the tuning fork tests in predicting otoscopic abnormality or conductive hearing loss. Neither tuning fork test showed high accuracy. The Bing test overidentified by yielding negative results (conductive loss) for many ears with normal hearing or sensorineural loss. It correctly identified conductive loss or otoscopic abnormality only slightly better than chance57% to 66% of the time. The Rinne test identified with high accuracy those ears with a 40 dB or greater air-bone gap. For air-bone gaps of 10-35 dB, only 27% of the ears gave negative results, meaning correct identification. However, when a negative Rinne occurred, the result was in error only 2% of the time.
Adolescent↗
Effect of middle-ear dysfunction and disease on hearing and language in high-risks infants.
The effect of middle-ear dysfunction and disease on hearing and language development at one year of age was evaluated for 143 high-risk infants. These infants were categorized as normal or abnormal based on otologic history, otoscopic examinations, and on tympanometric examinations. Language was significantly related to gestational age, being delayed by approximately the amount of prematurity. Language scores were therefore adjusted for gestational age. Speech-detection threshold was not related to gestational age, and was used as the measure of hearing. Hearing levels were negatively correlated with adjusted language quotients. Infants with abnormal otologic histories reported were not different from infants with normal histories in either hearing or language development. Infants with bilateral otoscopic abnormalities had significantly higher speech-detection thresholds, but did not differ in language development from those with bilaterally normal otoscopy. Infants who were abnormal bilaterally by tympanometric examination had significantly higher speech-detection thresholds as well as significantly delayed language development. A significant effect on both hearing and language was found among those infants bilaterally abnormal by tympanometry for whom evidence of middle-ear disease was not visualized by otoscopic examination. Implications of these findings are discussed.
Hearing Disorders↗
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↗
Neonatal hearing screening with otoscopy, auditory brain stem response, and otoacoustic emissions.
A study was performed to investigate the relationship between external and middle ear factors and hearing screening results by auditory brain stem response (ABR) and transient evoked otoacoustic emissions (EOAEs). The ears of 200 well newborns aged 5 hours to 48 hours underwent screening by ABR and EOAEs, followed by otoscopic examination. The pass rates for ABR and EOAE screening were 88.5% and 79%, respectively. On otoscopic examination, 13% (53 of 400) ears had occluding vernix obscuring the view of the tympanic membrane. Cleaning of vernix was attempted in ears that failed ABR or EOAE screening. Seventeen ears that failed ABR were cleaned, and 12 (71%) of them passed repeat ABR. Thirty-three ears that failed EOAE screening were cleaned, and 22 (67%) of them passed repeat emissions testing. Cleaning vernix increased the pass rates for ABR and EOAE screening to 91.5% and 84%, respectively. Decreased tympanic membrane mobility was found in 9% of ears that could be evaluated otoscopically. Increased failure rates for both ABR and EOAE screening were found in infant ears with decreased tympanic membrane mobility, but significance testing could not be performed because of inadequate sample size. Prevalence of occluding external canal vernix and middle ear effusion as a function of increasing infant age were studied. Implications for newborn hearing screening are discussed.
Body Fluids↗
Middle-ear cholesteatoma in children--an Indian perspective.
A study of the clinical presentation of acquired aural cholesteatoma in 51 Indian children is presented. An attempt has been made to assess the impact of this chronic ear disease in terms of the morbidity it incurs upon the paediatric population. The preponderance of bilateral presentation in cholesteatomatous otitis media (24.5 per cent) and the associated sensorineural or mixed hearing loss (in 25.4 per cent of the ears) is emphasized, to reflect the alarming audiological disability in the afflicted child. An attempt has been made to correlate the otoscopic profile with the extent of disease, osteitic damage and co-existing complications. It was noted that, in Indian children, mesotympanic choleasteatoma was more often associated with large defects of the pars tensa (viz. marginal, subtotal and total perforations--54.4 per cent) than with postero-superior retraction pockets (37.2 per cent) or purely attic defects (7.8 per cent). Further analysis revealed this common otoscopic presentation to be a more active process, occurring in predominantly cellular mastoids and associated with extensive disease. Based on this study, a more aggressive canal down tympanomastoid approach is advocated for children presenting with this otoscopic profile.
Adolescent↗
Tympanometric evaluation of middle ear barotrauma during recreational scuba diving.
We report the first prospective evaluation of middle ear barotrauma in experienced recreational scuba divers. In this pilot study, tympanometric and otoscopic evaluations were performed daily on two experienced scuba divers engaged in multi-day repetitive diving. Middle ear pressures decreased in proportion to diving frequency, demonstrating eustachian tube dysfunction which promptly reversed upon cessation of diving Otoscopic evidence of traumatic injury to the middle ear occurred in proportion to diving frequency, and also readily reversed upon cessation of diving. Tympanic membrane compliance remained normal, often despite pronounced otoscopic abnormalities. Otologic symptoms and impairment of acuity were not observed. Tympanometry appears to be a valuable modality for the verification of middle ear hemorrhage or tympanic membrane rupture. This preliminary data should assist investigators in planning more comprehensive studies of middle ear barotrauma, including clinical trials of treatment and prophylactic interventions for this common condition.
Acoustic Impedance Tests↗