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.