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

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.