Feedback with Education versus Digital Otoscopy for Acute Otitis Media Diagnosis and Treatment

To determine whether feedback with education and digital otoscopy could potentially address a lack of knowledge regarding acute otitis media (AOM) diagnostic criteria and difficulty visualizing the tympanic membrane, thereby resulting in more judicious use of antibiotics for AOM.

This randomized controlled trial included 40 primary care pediatricians, each of whom had an AOM treatment rate, defined as the proportion of encounters with an AOM diagnosis and antibiotic treatment divided by all encounters with a respiratory condition, above the network mean. Subjects were randomized into 1 of 4 arms: feedback with education, digital otoscopy, both, or control. A difference-in-differences analysis was used to assess the change in the intervention arms relative to the control arm.

Both the feedback/education and combined arms of the study demonstrated a significant change in the AOM treatment rate from baseline relative to the control arm (-12.8% [95% CI: -20.9 to 4.7] and -9.7% [-16.5 to 2.9], respectively), yet digital otoscopy alone did not yield a significant change in the outcome (-7.3% [-16.8 to 2.3]). Clinicians using digital otoscopy reported improved visualization of the tympanic membrane, and 70% preferred a digital otoscope over a traditional otoscope.

Antibiotic use for AOM can be modified with performance feedback and education. Although there appears to be no added effect of digital otoscopy alone in this trial, clinicians using digital otoscopy preferred it over traditional otoscopy, and this technology holds promise for further development in AOM-related antibiotic stewardship.

https://clinicaltrials.gov/study/NCT06731660.