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Aspects of diagnosis of acute otitis media
C Hemlin1, E Hassler, M Hultcrantz
1Department of Oto-Rhino-Laryngology and Head & Neck Surgery, Karolinska Hospital, Stockholm, Sweden.
Insights
A diagnostic algorithm improved acute otitis media diagnosis in primary care and specialist settings. Using an ear microscope did not enhance diagnostic accuracy for acute otitis media.
Area of Science:
- Otolaryngology
- Primary Care Medicine
Background:
- Acute otitis media (AOM) is a prevalent childhood illness.
- Accurate AOM diagnosis is critical to prevent unnecessary antibiotic prescriptions.
Purpose of the Study:
- Evaluate diagnostic findings for AOM among general practitioners (GPs) and ear specialists.
- Assess if ear microscopy improves AOM diagnosis compared to otoscopy.
- Test the efficacy of a diagnostic algorithm for AOM.
Main Methods:
- 31 patients with otalgia were examined by GPs and ear specialists.
- GPs used otoscopes; specialists used otoscopes and microscopes.
- A diagnostic algorithm was formulated and tested.
Main Results:
- Good concordance between GPs and specialists for AOM diagnosis.
- Ear microscopy did not improve diagnostic accuracy.
- The algorithm successfully identified most AOM cases.
Conclusions:
- A simple diagnostic algorithm can simplify and improve AOM diagnosis.
- Algorithm-guided diagnosis may reduce unnecessary antibiotic use.
Background:
Acute otitis media is a common disease, particularly among children. The importance of a correct diagnosis is crucial, especially as unjustified prescription of antibiotics has become a major problem in clinical praxis.
Objectives:
Our aim was to evaluate the predictive value of different otological findings in diagnostics and treatment of acute otitis media among GPs and ear specialists and to investigate if the diagnosis could be improved by the use of an ear microscope instead of an otoscope. Furthermore, we aimed to test the value of following an algorithm,
Methods:
Thirty-one patients with otalgia at the Emergency Department at the Karolinska Hospital in Stockholm were examined by both a GP and an ear specialist. The GP used an otoscope, whereas the ear specialist first used an otoscope and then an ear microscope. The doctors registered their findings and their proposal for treatment in questionnaires. The ability among participating ear specialists to give a correct diagnosis was confirmed by the use of 12 video-taped selected cases of aural diseases. An algorithm for diagnostics, based on medical facts, was formulated and tested.
Results:
In general, the concordance between ear specialists and GPs was satisfactory with regard to establishing the diagnosis acute otitis media. The diagnostics were not improved by use of an ear microscope. The algorithm identified most patients with acute otitis media. Conclusion. The results indicate that the following of a simple algorithm may simplify the
Conclusion:
and lead to a correct diagnosis of acute otitis media.