This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (12)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Takata, G. S.
Right arrow Articles by Shekelle, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Takata, G. S.
Right arrow Articles by Shekelle, P.
Related Collections
Right arrow Infectious Disease & Immunity
PEDIATRICS Vol. 112 No. 6 December 2003, pp. 1379-1387

REVIEW ARTICLE

Evidence Assessment of the Accuracy of Methods of Diagnosing Middle Ear Effusion in Children With Otitis Media With Effusion

Glenn S. Takata, MD*,§, Linda S. Chan, PhD{ddagger},§, Tricia Morphew, MS§, Rita Mangione-Smith, MD||, Sally C. Morton, PhD,# and Paul Shekelle, MD, PhD,**

* Division of General Pediatrics, Childrens Hospital Los Angeles, Los Angeles, California
{ddagger} Division of Biostatistics and Outcomes Assessment, Los Angeles County+University of Southern California Medical Center, Los Angeles, California
§ Center for Pediatric Health Outcomes Research, Department of Pediatrics, University of Southern California, Los Angeles, California
|| Department of Pediatrics, University of California, Los Angeles, Los Angeles, California
Southern California Evidence-Based Practice Center, Rand, Santa Monica, California
# Statistics Group, Rand, Santa Monica, California
** Health Services Research and Development Service, Greater Los Angeles Veterans Affair Healthcare System, Los Angeles, California

Objectives. We report the findings of an evidence assessment on the accuracy of methods of diagnosing middle ear effusion in children with otitis media with effusion (OME).

Methods. We searched Medline (1966–January 2000), the Cochrane Library (through January 2000), and Embase (1980–January 2000) and identified additional articles from reference lists in proceedings, published articles, reports, and guidelines. Excluded were nonhuman studies; case reports; editorials; letters; reviews; practice guidelines; non–English-language publications; and studies on patients with immunodeficiencies, craniofacial anomalies (including cleft palate), primary mucosal disorders, or genetic conditions. From each eligible study, we calculated the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and prevalence of OME in the cohort. We determined the number of studies for each comparison of a diagnostic method and a reference standard listed within the scope of our assessment. For comparisons with 3 or more studies, we derived random effects estimates of sensitivity, specificity, and prevalence rate. Using the pooled estimates, we plotted the performance of each diagnostic test in terms of sensitivity and (1 – specificity) and identified the best performer among the tests included in the comparison.

Results. Among 8 diagnostic methods, pneumatic otoscopy had the best apparent performance with a sensitivity of 94% (95% confidence interval: 92%–96%) and a specificity of 80% (95% confidence interval: 75%–86%). However, examiner qualifications were reported inconsistently, and training was not specified.

Conclusions. The finding that pneumatic otoscopy can do as well as or better than tympanometry and acoustic reflectometry has significant practical implications. For the typical clinician, pneumatic otoscopy should be easier to use than other diagnostic methods. The important question may be what degree of training will be needed for the clinician to be as effective with pneumatic otoscopy as were the examiners in the studies reviewed in this report.

Key Words: diagnostic methods • otitis media with effusion

Abbreviations: OME, otitis media with effusion • AHCPR, Agency for Health Care Policy and Research • CI, confidence interval

Received for publication Nov 18, 2002; Accepted Apr 28, 2003.




This article has been cited by other articles:


Home page
 Arch Pediatr Adolesc MedHome page
J. Chianese, A. Hoberman, J. L. Paradise, D. K. Colborn, D. Kearney, H. E. Rockette, and M. Kurs-Lasky
Spectral Gradient Acoustic Reflectometry Compared With Tympanometry in Diagnosing Middle Ear Effusion in Children Aged 6 to 24 Months
Arch Pediatr Adolesc Med, September 1, 2007; 161(9): 884 - 888.
[Abstract] [Full Text] [PDF]

Home page
 Fam PractHome page
R. A. Damoiseaux, M. M Rovers, F. A. Van Balen, A. W Hoes, and R. A de Melker
Long-term prognosis of acute otitis media in infancy: determinants of recurrent acute otitis media and persistent middle ear effusion
Fam. Pract., February 1, 2006; 23(1): 40 - 45.
[Abstract] [Full Text] [PDF]

Home page
 Evid. Based Nurs.Home page
Other articles noted: 06 Feb 2004 to 16 Apr 2004
Evid. Based Nurs., July 1, 2004; 7(3): e3 - e3.
[Full Text] [PDF]