Assessing diagnostic accuracy and tympanocentesis skills in the managementof otitis media

Background: The distinction between acute suppurative otitis media (AOM) an d otitis media with effusion (OME) is important for antibiotic treatment de cisions. Tympanocentesis may be useful in the diagnosis of AOM in selected patients. Objectives: To assess physician accuracy in diagnosing AOM and OME from phy sical examination findings and technical competence in performing tympanoce ntesis. Design and Subjects: Five hundred fourteen pediatricians and 188 otolaryngo logists viewed 9 different videotaped pneumatic otoscopic examinations of t ympanic membranes during a continuing medical education course. Diagnostic differentiation of AOM, OME, and a normal tympanic membrane was ascertained . An infant mannequin model was used to assess the technical proficiency of performing tympanocentesis on artificial tympanic membranes. Results: Overall, the average correct diagnosis by pediatricians was 50% (r ange, 25%-73%) and by otolaryngologists was 73% (range, 48%-88%). Pediatric ians and otolaryngologists correctly recognized the absence of normality 89 % to 100% and 93% to 100% of the time, respectively, but overdiagnosed AOM in 7% to 53% (mean, 27%) and in 3% to 23% (mean, 10%) of examinations. Perf ormance of tympanocentesis was optimally performed by 89% of otolaryngologi sts and by 83% of pediatricians. Conclusions: The use of video-presented examinations to assess diagnostic a bility suggests that AOM and OME may be misdiagnosed often. Interactive con tinuing medical education courses with simulation technology may enhance sk ills and improve diagnostic accuracy and treatment paradigms.