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Infrared tympanic thermometry in the evaluation of pediatric acute otitis media
D F Brennan1, J L Falk, S G Rothrock
1Department of Emergency Medicine Orlando Regional Medical Center, FL 32806-2093, USA.
Insights
Infrared tympanic thermometry (ITT) is not a reliable tool for diagnosing acute otitis media (AOM) in children. This study found AOM has minimal impact on ITT readings, making it unhelpful for diagnosis.
Area of Science:
- Pediatrics
- Otolaryngology
- Diagnostic Accuracy
Background:
- The diagnostic utility of infrared tympanic thermometry (ITT) for acute otitis media (AOM) in children remains uncertain.
- Previous studies have yielded conflicting results regarding the reliability of ITT in pediatric populations.
Purpose of the Study:
- To evaluate the accuracy of ITT in diagnosing AOM in children.
- To determine the influence of AOM on ITT measurements.
Main Methods:
- A prospective observational study involving 520 children aged 6 months to 6 years presenting to an emergency department.
- Nurses recorded reference temperatures (oral/rectal) and bilateral ITT temperatures.
- Emergency physicians diagnosed AOM based on established clinical criteria, blinded to ITT results.
Main Results:
- In unilateral AOM cases, infected ears showed a statistically significant but clinically minor temperature difference compared to uninfected ears.
- No significant elevation in ITT temperatures was observed in children with AOM compared to those without AOM when compared to reference temperatures.
- The study possessed high statistical power to detect even small temperature differences.
Conclusions:
- Infrared tympanic thermometry is not a useful diagnostic tool for acute otitis media in children.
- Acute otitis media has a negligible direct effect on infrared tympanic temperature readings.
Objective:
The reliability of infrared tympanic thermometry (ITT) in children and the effect of acute otitis media (AOM) on ITT are unsettled. This study assessed the effect of AOM on ITT and the utility of ITT in the diagnosis of AOM.
Methods:
520 consecutive children, aged 6 months to 6 years, presenting to the ED of an urban teaching hospital were eligible for this prospective observational study. Nurses recorded oral or rectal reference temperatures (RefTs) and bilateral ITT temperatures upon presentation. Emergency physicians were blinded to the ITT temperatures. AOM was diagnosed according to published clinical criteria.
Results:
Among 520 patients, 108 had unilateral AOM and 78 had bilateral AOM. In patients with unilateral AOM, the infected ears were warmer (I = 100.4 +/- 1.8 degrees F) than the uninfected ears (U = 100.3 +/- 1.8 degrees F, p = 0.035). However, the disparity in TM temperatures in infected and uninfected ears with unilateral AOM (I - U = 0.2 +/- 0.9 degrees F) was similar to the difference between right and left ears in those without AOM (R - L = 0.1 +/- 0.8 degrees F, p = 0.60). Compared with patients without AOM, patients with AOM demonstrated no significant elevation of ITT temperatures over RefTs (I - RefT = -0.8 +/- 1.2 degrees F in AOM; ITT - RefT = -0.8 +/- 1.2 degrees F in non-AOM; p = 0.94). This study had >99% power to detect a 1.0 degrees F difference for all groups compared.
Conclusions:
Infrared tympanic temperature are not helpful in diagnosing AOM in children. AOM has little direct effect on ITT temperatures.