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Pediatric Otolaryngology

(011) Accuracy of Otitis Media Diagnosis According to Instrumentation and Training

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
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    Presenting Author(s)

  • Basil P. Alias, BS

    Medical Student
    Texas A&M University School of Engineering Medicine
    Houston, Texas, United States

  • Sindhura Sridhar, BS

    Medical Student
    Texas A&M University School of Engineering Medicine
    Austin, Texas, United States

  • Kajol J. Shah, BS

    Medical Student
    Texas A&M University School of Engineering Medicine
    Houston, Texas, United States

  • Alexandra N. Farhangui, BS, BA

    Medical Student
    Texas A&M University School of Engineering Medicine
    Houston, Texas, United States

    • Senior Author(s)

  • Jeffrey T. Vrabec, MD

    Attending physician
    Houston Methodist Hospital
    Houston, Texas, United States

Disclosure(s):
Basil P. Alias, BS: No relevant relationships to disclose.
Sindhura Sridhar, BS: No relevant relationships to disclose.
Kajol J. Shah, BS: No relevant relationships to disclose.
Alexandra N. Farhangui, BS, BA: No relevant relationships to disclose.
Jeffrey T. Vrabec, MD: No relevant relationships to disclose.


Introduction: Pneumatic otoscopy (PO), tympanometry, and binocular microscopy (BM) are instruments commonly used to diagnose otitis media with effusion (OME); however, due to different price points and training requirements, it is critical to determine which is most effective for diagnosis. This study aims to compare the accuracy of these diagnostic instruments and to analyze the impact of provider specialty on reported accuracy.

Methods: A meta-analysis of studies evaluating the diagnostic accuracy of PO, tympanometry, and BM in pediatric patients with suspected otitis media was performed. An initial record search from Pubmed, Embase, and Cochrane yielded 351 articles. Two reviewers evaluated the articles for inclusion of which 15 met the criteria. The random effects model of sensitivity, specificity, and diagnostic odds ratio (DOR) for each instrument was then compared. Additionally, the impact of provider specialty in diagnosing middle ear conditions using a PO was analyzed using a fixed effects model.

Results: Myringotomy was used as a standard for OME prevalence. PO had a sensitivity of 90.3% (95% CI: 77.3%-96.2%), specificity of 71.0% (95% CI: 55.6%-82.7%), and DOR of 21.97 (95% CI: 5.98 - 80.66). Tympanometry had a sensitivity of 85.9% (95% CI: 74.2-92.8%), specificity of 53.6% (95% CI: 18.9%-85.0%), and DOR of 8.44 (95% CI: 1.99-35.75). BM had a sensitivity of 94.4% (95% CI 66.5 - 99.3%), specificity of 81.4% (95% CI: 69.8 - 89.3%), and DOR of 39.4 (95% CI: 11.6- 134.1). Otolaryngologists had a diagnostic accuracy of 73.6% (95% CI 72.2-74.9%), followed by pediatricians at 51% (95% CI 50.6-51.4%), and other providers (GPs, NPs, Pediatric Residents) at 43.1% (95% CI 42.1- 44.2%). There is a statistically significant difference in accuracy by provider (p < 0.001).

Conclusions: BM provided superior results compared to other instruments. However, PO and tympanometry were able to detect the absence of normality with comparable sensitivity. The diagnostic accuracy of otolaryngologists for OME was greater compared to pediatricians and other providers.