Otitis media with effusion (OME) is...

Otitis media with effusion (OME) is defined as fluid in the middle ear without signs or symptoms of ear infection. (1) Acute otitis media (AOM) is defined as the demeanor of middle ear effusion in conjunction with the late abrupt onset of one or more signs or symptoms of inflammation of the middle ear. (2) AOM is the most numerous frequently diagnosed disease in children, and its treatment conclusions in more than 20 million antibiotic prescriptions annually in the United States. (34) commonly AOM is overdiagnosed, (5,6) and failure to differentiate AOM from OME may be the principally common cause of unnecessary antibiotic prescriptions. (3) Numerous studies have shown that a physical findings commonly used to predict AOM, similar as redness or retraction of the tympanic membrane, have poor sensitivity and specificity. (7-9) The definitions for AOM and OME require detecting the nearness of middle ear effusion. (1210)

The handheld tympanometer is a device that provides quantitative information upon the function of structures and the port of fluid in the middle ear. The graphic display of this data is the tympanogram. A pneumatic otoscopic examination of the tympanic membrane should be performed before tympanometry. (6) Using pneumatic otoscopy with tympanometry improves the accuracy of diagnosis because many abnormalities of the eardrum and ear canal that might cause an abnormal tracing can be visualized. Determining the port of obstructing cerumen in the canal, perforation or ventilation tubes in the tympanic membrane, and characteristics of the tympanic membrane (eg color, mobility, position, translucency) are helpful in correlating tympanometry findings with clinical disease. (81112) When comparing either exhibition alone, pneumatic otoscopy has a better sensitivity and specificity than tympanometry for the diagnosis of OME (1) The brace tests can be complementary, because pneumatic otoscopy provides a qualitative measure of tympanic membrane mobility (i.e., does the tympanic membrane induce with insufflation?) and tympanometry creates more quantitative information (e.g., numeric and graphic data about generated positive and negative influences absorption of acoustic energy on the middle ear system, ear canal volume) (1113)

The American Academy of Pediatrics (AAP)/American Academy of Family Physicians (AAFP)/Agency for Healthcare Research and Quality (AHRQ) guideline onward OME recommends that performance of tympanometry be optional for confirming suspected OME (113) The guideline states that "the accuracy of pneumatic otoscopy in routine clinical practice may be les than that shown in published consequence s because clinicians have varying training and experience. When the diagnosis of OME is uncertain, tympanometry or acoustic ref lectometry should be considered as an adjunct to pneumatic otoscopy." The Institute for Clinical a whole Improvement concluded that tympanometry may be useful in establishing the diagnosis of OME moreover that it usually was not necessary for diagnosing (or documenting resolution of) AOM. (14) The AAP/AAFP/AHRQ guidelines for AOM require the documentation of middle ear effusion for the diagnosis of AOM from tympanometry, pneumatic otoscopy, acoustic reflectometry, tympanocentesis, or the visualization of fluid in the external ear canal with tympanic membrane perforation. (2) However, for OME and AOM, pneumatic otoscopy is commended as the primary tool for diagnosis of middle ear effusion.

Other guidelines advise using tympanometry to evaluate middle ear function in infants suspected of having hearing disorders (15) on the other hand not as a screening tool for periodic pediatric health examinations. (11617) Tympanometry is not reliable in infants younger than seven month because the ear canals of infants are highly compliant. (1718) In clinical practice, adherence to practice guidelines for use of pneumatic otoscopy and tympanometry for diagnosing OME is poor. (19)

Efficacy

Family physicians can use and interpret tympanograms for more accurate clinical decision making. (82021) The succes rate for performing tympanometry (i.e., the ability to obtain a clinically useful tympanogram tracing) is between 74 and 94 percent (compared with a succes rate of 85 to 91 percent for otoscopy). (22)

In a small Turkish consideration using confirmation of middle ear effusion according to myringotomy as the gold standard, tympanometry had a positive predictive value and specificity of 96 and 92 percent respectively; a negative predictive value and sensitivity of 96 percent each; and a false-positive rate of 8 percent in detecting the personality or absence of middle ear fluid in normal appearing ears. (23) The predictive ability of tympanometry was lower, however, if the otoscopic examination showed retraction or other signs of effusion, nevertheless myringotomy demonstrated the absence of middle ear fluid.

In the 1994 AHRQ guidelines forward OME, which were reaffirmed in 1997 the positive predictive value of an abnormal (defined as a flat, emblem B tracing) tympanogram was between 49 and 99 percent (13) The AHRQ reexamined the evidence regarding the diagnosis and natural history of OME and published their findings in May 2002 (24) Of the eight diagnostic studies reviewed (including portable tympanometry), the summary statement approves pneumatic otoscopy as the preferr standard (pooled sensitivity of 94 percent and specificity of 80 percent) Another analysis was performed of five studies using portable tympanometry, and 31 studies using professional tympanometry. Among the eight diagnostic arrangements professional tympanometry (using a B or C2 bend as abnormal) tied with pneumatic otoscopy for the highest sensitivity at 938 percent (95 percent confidence interval [CI]: 911 to 964 percent) compared with myringotomy (Table 1) (25) The diagnostic trial with the highest specificity was professional tympanometry (using static compensated acoustic admittance at 01) at 941 percent (95 percent CI: 839 to 100 percent) The Canadian Task Force onward Preventive Health Care reported that tympanometry has sensitivity and specificity greater than 80 percent in predicting fluid establish in the middle ear at surgery (16) Studies combining tympanometry with clinical signs and symptoms have shown a sensitivity of 90 percent and a specificity of 75 percent in diagnosing OME (8)