Value of simple otoscopy in diagnosing otitis media with effusion in children

Aims To explore the value of otoscopy in diagnosing OME when performed by otorhinolaryngology, pediatrics, and primary care physicians; to evaluate the interobserver and intraobserver agreement of interpretation of otoscopy images. Material and methods A cross-sectional study using an anonymous mailed survey was used. We presented pre-recorded otoscopy images of pediatric patients to otorhinolaryngology, pediatrics, and primary care physicians (ten volunteer specialists and residents from each medical specialty). All participants had to answer “yes” or “no” if they considered that the image corresponded or not to an OME case, respectively. We considered that the images were positive for OME whenever the respective tympanogram was type B. Results Thirty-one otoscopy images and 1860 responses provided by sixty physicians were analyzed. The accuracy of otoscopy in diagnosing OME was highest in the Otolaryngologists group (mean 74.8%), with the worst rate observed in the primary care residents group (mean 51.3%). Overall sensitivity, specificity, and positive predictive value of otoscopy for diagnosing OME were significantly higher when performed by otorhinolaryngologists (75.8%, 72.8%, 66.8%, respectively). Fleiss' kappa showed that interobserver agreement was globally weak within each group of specialties, with overall better interobserver agreement observed among otorhinolaryngologists (κ = 0.30; 95% CI 0.27–0.32). Conclusion According to our data, simple otoscopy as a single diagnostic method in pediatric OME is insufficient, even for otorhinolaryngologists. Current recommendations must be followed to improve diagnostic accuracy. (AU)

Value of simple otoscopy in diagnosing otitis media with effusion in children.

AIMS: To explore the value of otoscopy in diagnosing OME when performed by otorhinolaryngology, pediatrics, and primary care physicians; to evaluate the interobserver and intraobserver agreement of interpretation of otoscopy images. MATERIAL AND METHODS: A cross-sectional study using an anonymous mailed survey was used. We presented pre-recorded otoscopy images of pediatric patients to otorhinolaryngology, pediatrics, and primary care physicians (ten volunteer specialists and residents from each medical specialty). All participants had to answer "yes" or "no" if they considered that the image corresponded or not to an OME case, respectively. We considered that the images were positive for OME whenever the respective tympanogram was type B. RESULTS: Thirty-one otoscopy images and 1860 responses provided by sixty physicians were analyzed. The accuracy of otoscopy in diagnosing OME was highest in the Otolaryngologists group (mean 74.8%), with the worst rate observed in the primary care residents group (mean 51.3%). Overall sensitivity, specificity, and positive predictive value of otoscopy for diagnosing OME were significantly higher when performed by otorhinolaryngologists (75.8%, 72.8%, 66.8%, respectively). Fleiss' kappa showed that interobserver agreement was globally weak within each group of specialties, with overall better interobserver agreement observed among otorhinolaryngologists (κ = 0.30; 95% CI 0.27-0.32). CONCLUSION: According to our data, simple otoscopy as a single diagnostic method in pediatric OME is insufficient, even for otorhinolaryngologists. Current recommendations must be followed to improve diagnostic accuracy.

Nasal septum deviation and Eustachian tube function: A prospective case-control study based on tympanometry, tubomanometry, and ETDQ-7.

INTRODUCTION: The influence of isolated nasal septum deviation (NSD) in the Eustachian Tube (ET) function is still undetermined. OBJECTIVE: compare ET function between patients with severe NSD and patients with adequate nasal patency in terms of symptomology and objective exams and assess the impact of septoplasty in ET function in patients with severe NSD. METHODS AND METHODOLOGY: a prospective study was conducted. In the first phase of the study, two opportunistic samples were selected: 35 patients with severe NSD for group A and 35 patients with adequate nasal patency for group B. Both groups were evaluated through Nasal obstruction Subjective Questionnaire (NOSE) and ET dysfunction questionnaire 7 (ETDQ7) -, and through two objective exams to assess ET function - tympanometry, and tubomanometry (TMM); results were compared between group A and B. In the second phase of the study, the patients from group A underwent septoplasty and were re-evaluated through ETDQ7, tympanometry and TMM; results were compared before and after surgery. RESULTS: we found a statistically significant difference between patients with NSD and patients with adequate nasal patency in NOSE and ETDQ7 (higher scores in the latter), and TMM (worse results in patients with NSD); the difference in tympanometry was not statistically significant. The side of the NSD did not correlate with the side of the dysfunction. After septoplasty, patients from group A had statistically significant lower scores in ETDQ7 and a lower proportion of patients with findings compatible with ET dysfunction using TMM. CONCLUSION: according to our results, severe NSD alone is a cause of ET dysfunction; septal surgery might improve ET function in these patients.

Desviación del septo nasal y función de la trompa de Eustaquio: estudio prospectivo de control de casos basado en timpanometría, tubomanometría y ETDQ-7 / Nasal septum deviation and Eustachian tube function: A prospective case-control study based on tympanometry, tubomanometry, and ETDQ-7

Introduction: The influence of isolated nasal septum deviation (NSD) in the Eustachian Tube (ET) function is still undetermined. Objective: compare ET function between patients with severe NSD and patients with adequate nasal patency in terms of symptomology and objective exams and assess the impact of septoplasty in ET function in patients with severe NSD. Methods and methodology: a prospective study was conducted. In the first phase of the study, two opportunistic samples were selected: 35 patients with severe NSD for group A and 35 patients with adequate nasal patency for group B. Both groups were evaluated through Nasal obstruction Subjective Questionnaire (NOSE) and ET dysfunction questionnaire 7 (ETDQ7) –, and through two objective exams to assess ET function – tympanometry, and tubomanometry (TMM); results were compared between group A and B. In the second phase of the study, the patients from group A underwent septoplasty and were re-evaluated through ETDQ7, tympanometry and TMM; results were compared before and after surgery. Results: we found a statistically significant difference between patients with NSD and patients with adequate nasal patency in NOSE and ETDQ7 (higher scores in the latter), and TMM (worse results in patients with NSD); the difference in tympanometry was not statistically significant. The side of the NSD did not correlate with the side of the dysfunction. After septoplasty, patients from group A had statistically significant lower scores in ETDQ7 and a lower proportion of patients with findings compatible with ET dysfunction using TMM. Conclusion: according to our results, severe NSD alone is a cause of ET dysfunction; septal surgery might improve ET function in these patients. (AU)

Introducción: Aún sigue sin determinarse la influencia aislada de la desviación del septo nasal (DSN) en la función de la trompa de Eustaquio (TE). Objetivo: Comparar la función de la TE entre los pacientes con DSN grave y los pacientes con patencia nasal adecuada, en términos de sintomatología y exámenes objetivos, y evaluar el impacto de la septoplastia en la función de la TE en pacientes con DSN grave. Métodos y metodología: Se realizó un estudio prospectivo seleccionándose 2 muestras oportunistas en la primera fase del mismo: 35 pacientes con DSN grave en el grupo A, y 35 pacientes con patencia nasal adecuada en el grupo B. Se evaluó a ambos grupos utilizando los cuestionarios Nasal Obstruction Subjective Questionnaire (NOSE) y disfunción de TE (ETDQ7), así como mediante 2 exámenes objetivos, para evaluar la función de la TE: timpanometría y tubomanometría (TMM), comparándose los resultados entre los grupos A y B. En la segunda fase del estudio, los pacientes del grupo A fueron sometidos a septoplastia y reevaluados mediante ETDQ7, timpanometría y TMM, comparándose los resultados de antes y después de la cirugía. Resultados: Encontramos una diferencia estadísticamente significativa en NOSE y ETDQ7 entre los pacientes con DSN y los pacientes con patencia nasal adecuada (con puntuaciones superiores en este último), y TMM (con peores resultados en los pacientes con DSN), no siendo estadísticamente significativa la diferencia en la timpanometría. El lado de DNS no se correlacionó con el lado de la disfunción. Tras la septoplastia, los pacientes del grupo A reflejaron puntuaciones menores en ETDQ7 con significación estadística, y existió una menor proporción de pacientes con hallazgos compatibles con la disfunción de la TE utilizando TMM. Conclusión: Con arreglo a nuestros resultados, la DNS en solitario es una causa de disfunción de la TE, pudiendo mejorar la septoplastia la función de la TE en estos pacientes. (AU)

Nasal septum deviation and Eustachian tube function: A prospective case-control study based on tympanometry, tubomanometry, and ETDQ-7.

INTRODUCTION: The influence of isolated nasal septum deviation (NSD) in the Eustachian Tube (ET) function is still undetermined. OBJECTIVE: compare ET function between patients with severe NSD and patients with adequate nasal patency in terms of symptomology and objective exams and assess the impact of septoplasty in ET function in patients with severe NSD. METHODS AND METHODOLOGY: a prospective study was conducted. In the first phase of the study, two opportunistic samples were selected: 35 patients with severe NSD for group A and 35 patients with adequate nasal patency for group B. Both groups were evaluated through Nasal obstruction Subjective Questionnaire (NOSE) and ET dysfunction questionnaire 7 (ETDQ7) -, and through two objective exams to assess ET function - tympanometry, and tubomanometry (TMM); results were compared between group A and B. In the second phase of the study, the patients from group A underwent septoplasty and were re-evaluated through ETDQ7, tympanometry and TMM; results were compared before and after surgery. RESULTS: we found a statistically significant difference between patients with NSD and patients with adequate nasal patency in NOSE and ETDQ7 (higher scores in the latter), and TMM (worse results in patients with NSD); the difference in tympanometry was not statistically significant. The side of the NSD did not correlate with the side of the dysfunction. After septoplasty, patients from group A had statistically significant lower scores in ETDQ7 and a lower proportion of patients with findings compatible with ET dysfunction using TMM. CONCLUSION: according to our results, severe NSD alone is a cause of ET dysfunction; septal surgery might improve ET function in these patients.

Is pediatric cholesteatoma more aggressive in children than in adults? A comparative study using the EAONO/JOS classification.

INTRODUCTION: chronic otitis media with cholesteatoma (COMC) is a serious condition that may cause severe complications. According to the literature, in pediatric patients this entity can have a more aggressive behavior, leading to higher rates of morbidity. Consensus regarding the definition of aggressive and extensive cholesteatoma was lacking until recently. European Academy of Otology and Neurotology/Japan Otologic Society (EAONO/JOS) proposed a classification and staging system which was highly accepted by a group of otology experts. OBJECTIVE: to compare cholesteatoma characteristics between pediatric and adult patients using the EAONO/JOS stating system. MATERIAL AND METHODS: a retrospective analysis of the patients who underwent surgery for cholesteatoma treatment in a tertiary hospital was performed using EAONO/JOS classification. Congenital cholesteatoma, revision surgery, and follow-up losses were excluded. The patients were further divided into two cohorts: a pediatric group (<16 years old) and an adult group (>16 years old). The results were compared between them. RESULTS: 134 patients fulfilled the inclusion criteria, 27 were pediatric, and 107 adult patients. We found a significant difference in supratubal recess, with higher rates of extension to this location in the pediatric group. Also in the pediatric cohort, COMC was accompanied by malleus erosion in a higher frequency, with a significant difference from adults; it also presented in higher stages of the disease according to EAONO/JOS classification. We found no differences in hearing gain post-operatively. Moreover, we found that age younger than 16 years was an independent risk factor for relapse with time. DISCUSSION AND CONCLUSIONS: according to our data, cholesteatoma in pediatric age has a more aggressive and extensive nature than in adults, and age younger than 16-years-old is an independent risk factor for relapse.