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