The accuracy of otomicroscopy for the diagnosis of paediatric middle ear effusions

Objective: To determine the diagnostic accuracy of otomicroscopy performed by otolaryngology specialists for the diagnosis of paediatric middle ear effusions. Methods: Prospective study of consecutive children receiving tympanostomy tubes between December 2004 and February 2005 within the Department of Otolaryngology-Head & Neck Surgery, Manukau Surgery Centre, Middlemore Hospital, New Zealand. Eighty-six children were included in the study. Intraoperative otomicroscopic examination of the ears was performed under general anaesthesia by two otolaryngology specialists. The presence or absence of middle ear effusion was predicted prior to myringotomy. Intraoperative myringotomy findings were used as the diagnostic reference standard. Results: The prevalence of middle ear effusions was 52.6% (71/135 ears). Otomicroscopy had a sensitivity 94.4% (95% CI: 85.5-98.2), and specificity 93.8% (95% CI: 84.0-98.0). The positive predictive and negative predictive values of otomicroscopy for the identification of middle ear effusions were 94.4% (95% CI: 85.5-98.2), and 93.8% (95% CI: 84.0-98.0) respectively. The overall accuracy of otomicroscopy was 94.1%. There was an excellent level of agreement between otomicroscopy and myringotomy findings (kappa = 0.88, 95% CI: 0.80-0.96). Conclusions: Otomicroscopy performed by the specialist otolaryngologist is an accurate tool for the diagnosis of middle ear effusions. Otomicroscopy performed on the anaesthetised child achieves greater diagnostic accuracy than tympanometry and pneumatic otoscopy. (C) 2009 Elsevier Ireland Ltd. All rights reserved.