Comparison of performance by otolaryngologists, pediatricians, and general practioners on an otoendoscopic diagnostic video examination

https://doi.org/10.1016/j.ijporl.2004.10.013Get rights and content

Summary

Objective:

To compare the performance of United States, South African, and Greek otolaryngologists, pediatricians, and general practitioners in recognizing the otoscopic examination findings of acute otitis media (AOM) and otitis media with effusion (OME) as presented in an otoendoscopic video evaluation test.

Design/subjects

: Otolaryngologists, pediatricians, and general practitioners from the United States (n = 273, 2190, and 360 respectively), South Africa (n = 36, 36, and 206), and Greece (n = 58, 115, and 126) viewed nine different video-recorded otoscopic examinations, including pneumatic otoscopy of tympanic membranes. The ability to differentiate AOM, OME, and normal was ascertained.

Results

: Overall, the average ± standard deviation correct diagnosis on the otoscopic video exam by otolaryngologists was superior to pediatricians and general practitioners in all three countries: from the United States, it was 74 ± 16% for otolaryngologists versus 51 ± 11% for pediatricians (p < 0.000l) and 46 ± 21% for general practitioners (p < 0.0001); from South Africa, it was 72 ± 16% versus 53 ± 21% (p = 0.16) and 47 ± 19% (p = 0.002); and from Greece, it was 61 ± 15% versus 36 ± 12% (p < 0.003) and 39 ± 10% (p = 0.009).

Conclusions:

A video-based otoscopy examination test may be a useful tool for evaluation of otoscopy-based diagnostic skills. Otolaryngologists performed significantly better than pediatricians in differentiating AOM, OME, and normal in such a test described here. However, all specialists who examine patients with AOM or OME may benefit from viewing video otoscopies to improve diagnostic accuracy.

Introduction

Otitis media with effusion (OME) and acute otitis media (AOM) are disease entities in the otitis media (OM) continuum. There is often a transition between OME and AOM and the two conditions at times may be indistinguishable from each other diagnostically. Nevertheless, a first step in treatment decisions regarding OM must rely on accurate diagnosis to distinguish AOM, OME, and a retracted TM without middle ear effusion from normal [1], [2], [3], [4]. For both AOM and OME, a middle ear effusion is present and tympanic membrane (TM) mobility may be diminished with pneumatic otoscopy examination. If patients with AOM have a TM under positive (full or bulging) pressure bacterial pathogens are isolated >90% of the time [5]. Patients with OME typically have a TM under negative pressure (retracted) or no pressure (neutral position). Although systemic and ear-specific symptoms of acute onset (24–48 h) were noted as one of three key features by the AHRQ evidence report on AOM [6] they are neither sensitive nor specific in predicting AOM [7], [8], leaving the visual examination by experienced otoscopists as the most important element in making the diagnosis. In 2001, we described the accuracy of US pediatricians in distinguishing AOM and OME based on otoendoscopic video-recorded examinations [9] and since then more than 2000 pediatricians and 360 general practitioners in the US have taken the test. The same continuing medical education (CME)-accredited course included participation by 273 otolaryngologists from the US and we recently had the opportunity to give the course to otolaryngologists, pediatricians, and general practitioners from South Africa and Greece. The comparative performance on the otoscopic video test are described for the three specialist groups in this report.

Section snippets

Methods

CME accredited workshops were conducted in the US, South Africa, and Greece as previously described [9]. Participants self-selected attendance voluntarily in response to an invitation sent by the workshop organization. Mostly, community-based practitioners attended although about 20% were academic based. The courses were conducted in English with simultaneous translation to Afrikaans in South Africa and Greek in Greece. As part of this course, participants were shown video footage obtained with

Results

Two hundred and seventy-three otolaryngologists, 2190 pediatricians, and 360 general practitioners from the US; 36, 36, and 206 from South Africa; and 58, 115, and 126 from Greece, respectively, comprise the study population. The years of practice experience among otolaryngologists from the US was 18% for 0–3 years, 46% for 4–10 years, and 36% for >10 years, respectively. For otolaryngologists from South Africa, the distribution was 4%, 42%, and 54%, respectively; and from Greece was 24%, 49%,

Discussion

Otolaryngologists, pediatricians, and general practitioners perform otoscopic examinations every day in practice as part of routine care. Their skills and accuracy are infrequently if ever assessed in any formal way after leaving training. Differentiation of AOM from OME has become more critical in an era of rising antibiotic resistance among AOM bacterial pathogens. To test practicing otolaryngologist's, pediatrician's, and general practioner's diagnostic accuracy and to evaluate otoendoscopic

Acknowledgements

The authors are co-chairmen of Outcomes Management Education Workshops (OMEW), the organization that facilitates the workshops described in this paper and their academic institutions co-sponsor the CME accreditation of the program. Dr. Poole has no financial relationship with OMEW. Dr. Pichichero is the principal of OMEW, a for-profit medical education company; he donates net revenues to the University of Rochester Medical Center supporting education and research.

References (21)

  • A.B. Silva et al.

    A protocol for otolaryngology-head and neck resident training in pneumatic otoscopy

    Int. J. Pediatr. Otorhinolaryngol.

    (1997)
  • S.F. Dowell et al.

    Otitis media: principles of judicious use of antimicrobial agents

    Pediatrics

    (1998)
  • L.H. Carlson et al.

    Diagnosis

  • M.E. Pichichero

    Acute otitis mediaPart I. Improving diagnosic accuracy

    Am. Fam. Physician

    (2000)
  • W. Stool et al.

    Otitis Media with Effusion in Young Children: Clinical Practice Guideline

    (1994)
  • C. Halsted et al.

    Otitis media: clinical observations, microbiology, and evaluation of therapy

    Am. J. Dis. Child.

    (1968)
  • Agency for Health Care Policy (AHCPR), Final evidence report: management ofotitis media, US Department of Health and...
  • T. Heikkinen et al.

    Signs and symptoms predicting acute otitis media

    Arch. Pediatr. Adolesc. Med.

    (1995)
  • M. Niemela et al.

    Lack of specific symptomology in children with acute otitis media

    Pediatr. Infect. Dis. J.

    (1994)
  • M.E. Pichichero et al.

    Assessing diagnostic accuracy and tympanocentesis skills in the management ofotitis media

    Arch. Pediatr. Adolesc. Med.

    (2001)
There are more references available in the full text version of this article.

Cited by (82)

  • Artificial intelligence and tele-otoscopy: A window into the future of pediatric otology

    2022, International Journal of Pediatric Otorhinolaryngology
    Citation Excerpt :

    Furthermore, otologic pathologies including AOM are frequently misdiagnosed by primary care physicians. In one study, the accuracy of diagnosing AOM and AOM with effusion was 51% for pediatricians and 44% for general practitioners, as compared to 74% for otolaryngologists [15]. This suggests that many patients are misdiagnosed for otherwise treatable pathologies.

View all citing articles on Scopus
View full text