J Korean Soc Emerg Med.  2004 Aug;15(4):222-226.

Clinical Value of a Video Otoscope in Diagnosis of Acute Otitis Media

Affiliations
  • 1Department of Emergency Medicine, Pundang Jesaeng Hospital, Seongnam, Korea. rocky66@dmc.or.kr

Abstract

PURPOSE
Acute otitis media(AOM) has variable clinical symptoms and is diagnosed with injection, bulging, and decreased mobility of tympanic membrane. There are many misdiagnoses because children who are suspected of having acute otitis media are uncooperative during diagnosis with an otoscope. An inaccurate diagnosis of acute otitis media when using an otoscope results in wasted of medical resourses and increased tolerance to antibiotics. Therefore, this study was conducted to evaluate the usefulness of a video otoscope as a tool of diagnosis of acute otitis media.
METHODS
Among 416 patients who visited Pundang Jesaeng Hospital Emergency Medical Center with a complaint of otalgia from 1 October 2002 to 30 September 2003, we studied 51 patients who were followed up at the otorhinolaryngology depatment. Emergency Medicine residents recorded the findings for tympanic membrane by using an otoscope and by using a video otoscope. we used kappastatistics to carry out a prospective study in which the accuracy of diagnosis of AOM was analyzed by comparison with the confirmed diagnosis by an otolaryngologic specialist.
RESULTS
In this study, the number of males was 24 (47%) and that of females was 27 (53%). Of the 51 Patients, 22 (43%) presented with rhinorrhea, 15 (29%) with cough, 11 (22%) with sputum, 10 (20%) with fever, 8 (16%) with a sore throat, 7 (14%) with otorrhea, 4 (8%) with hearing difficulty, 3 (6%) with irritability, 3 (6%) with tinnitus, 3 (6%) with vomiting and 2 (4%) with dizziness. A comparison of the diagnostic accuracy of AOM between otolaryngologic specialist and residents in emergency department, when was undertaken by using kappa statistics, and a diagnostic agreement of 65% (kappa=0.28) for the otoscope, and 76 %( kappa=0.45) for the video otoscope. The diagnostic sensitivity of acute otitis media by video otoscope was 75%, and specificity was 82%.
CONCLUSION
When the tympanic membrane of the patient suspected of a having AOM is examined in an emergency medical center, video otoscopy should be a useful diagnostic tool for AOM owing to its high diagnostic accuracy.

Keyword

Otitis media; Otoscope

MeSH Terms

Anti-Bacterial Agents
Child
Cough
Diagnosis*
Diagnostic Errors
Dizziness
Earache
Emergencies
Emergency Medicine
Emergency Service, Hospital
Female
Fever
Hearing
Humans
Male
Otitis Media*
Otitis*
Otolaryngology
Otoscopes*
Otoscopy
Pharyngitis
Prospective Studies
Sensitivity and Specificity
Specialization
Sputum
Tinnitus
Tympanic Membrane
Vomiting
Anti-Bacterial Agents
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