A PROTOCOL FOR OTOLARYNGOLOGY - HEAD AND NECK RESIDENT TRAINING IN PNEUMATIC OTOSCOPY

Otitis media with effusion (OME) is one of the most frequent pediatric diagnoses and is also one of the most common indications for medical or surgical intervention in this age group. Pneumatic otoscopy is the standard for physical diagnosis of a middle ear effusion. We report on our experience with a validation program for otolaryngology-head and neck surgery residents in the use of pneumatic otoscopy to diagnose OM E. Four PGY 2 residents sequentially completed a 4 month clinical and didactic training program in pneumatic otoscopy. The trainee sequentia lly performs pneumatic otoscopy, otomicroscopy, and myringotomy on eac h patient scheduled for a myringotomy and tube placement the morning o f surgery. After each task the trainee is required to state if an effu sion is present or not, and the accuracy of the diagnosis is immediate ly reinforced at the time of myringotomy. The trainee's sensitivity an d specificity in diagnosing OME is then calculated for the first and s econd half of the study period. The trainee is validated in pneumatic otoscopy if the sensitivity is > 80% and > 70% respectively, and the t rainee is validated in otomicroscopy if the sensitivity and specificit y is > 90% and > 80% respectively. Four residents completed the protoc ol, and a total of 275 ears were examined. Four residents were validat ed in pneumatic otoscopy, and three residents were validated in otomic roscopy. We conclude that this protocol allows for accurate documentat ion of the resident's skill progression and enhances resident educatio n. (C) 1997 Elsevier Science Ireland Ltd.