Optical Coherence Tomography as an Emerging Technique for Identifying Pediatric Middle Ear Effusion

Acute otitis media (AOM) and otitis media with effusion (OME) rely on accurate characterization of middle ear effusion (MEE). Optical coherence tomography (OCT) is a potential modality for noninvasive analysis of MEE, thereby assisting with otitis media diagnosis. This study aims to compare the diagnostic performance of OCT with otoscopy and tympanometry in pediatric patients.

A prospective convenience sample of 164 pediatric patients aged 6 months to 12 years was recruited from two tertiary care pediatric otolaryngology clinics. During their visit, each child underwent otoscopy, tympanometry, and OCT evaluation. Scans were reviewed by both a fellowship-trained pediatric otolaryngologist and an individual with limited medical background. Pairwise comparisons between tests were performed to assess percent agreement, sensitivity, and specificity of OCT in the identification of MEE.

A total of 164 pediatric patients (328 ears) were enrolled, with 32% of ears classified as having a middle ear effusion by otoscopy, 24% by tympanometry, and 18% by OCT. Across all age groups, otoscopy and tympanometry agreed 81.2% of the time, otoscopy and OCT 77.7% of the time, and tympanometry and OCT 80.5% of the time. Cohen's Kappa showed moderate agreement between clinical and non-clinical OCT raters (κ = 0.41). Analysis revealed a sensitivity of 74% and specificity of 93% for OCT, comparable to existing methods.

Optical coherence tomography demonstrates promise as a valuable tool for MEE assessment in pediatric patients, with performance comparable to pneumatic otoscopy and tympanometry. These findings emphasize its potential for enhancing diagnostic accuracy and disease progression monitoring in clinical practice.