Me. Pichichero et Md. Poole, Assessing diagnostic accuracy and tympanocentesis skills in the managementof otitis media, ARCH PED AD, 155(10), 2001, pp. 1137-1142
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.