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, especiall y as unjustified prescription of antibiotics has become a major proble m in clinical praxis. Objectives. Our aim was to evaluate the predicti ve value of different otological findings in diagnostics and treatment of acute otitis media among Gps and ear specialists and to investigat e if the diagnosis could be improved by the use of an ear microscope i nstead of an otoscope. Furthermore, we aimed to test the value of foll owing an algorithm, Methods. Thirty-one patients with otalgia at the E mergency Department at the Karolinska Hospital in Stockholm were exami ned by both a GP and an ear specialist. The GP used an otoscope, where as the ear specialist first used an otoscope and then an ear microscop e. The doctors registered their findings and their proposal for treatm ent in questionnaires. The ability among participating ear specialists to give a correct diagnosis was confirmed by the use of 12 video-tape d selected cases of aural diseases. An algorithm for diagnostics, base d on medical facts, was formulated and tested. Results. In general, th e concordance between ear specialists and GPs was satisfactory with re gard to establishing the diagnosis acute otitis media. The diagnostics were not improved by use of an ear microscope. The algorithm identifi ed most patients with acute otitis media. Conclusion. The results indi cate that the following of a simple algorithm may simplify the decisio n-making and lead to a correct diagnosis of acute otitis media.