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LETTER TO THE EDITOR |
David Ashe, MD
Robert Ruben, MD
Richard Propp, MD
Immediate Past Co-Chair
New York State Otitis Project
To the Editor.—
The June 2005 Pediatrics articles on acute otitis media1,2 were commendable and timely. However, if physicians are to appropriately use "watchful waiting" for acute otitis media, they will need to be much better versed in evaluating the tympanic membrane. Visualization of the tympanic membrane and assessment of mobility are the standard of care for the diagnosis of middle-ear disease. Accurate diagnosis of tympanic pathology is the cornerstone for physicians to judiciously decide between the observation option and antibiotics.
For the past 8 years, the New York State Otitis Project, sponsored by the New York State Department of Health, has been actively dealing with issues related to diagnostic accuracy, evidence-based judicious use of antibiotics, and parental and professional perceptions and education. The work of the Capital Region Otitis Project in Albany, New York, and later the New York Region Otitis Project, led to the development of the New York State Observation Option Toolkit (available at: www.health.state.ny.us/nysdoh/antibiotic/antibiotic.htm).3,4 This toolkit was adapted into the new American Academy of Pediatrics national guidelines published in 2004.5
As a result of our work (including review of the literature; surveys of practitioners and parents; relevant evidence-based conferences; preconference and postconference evaluations; and Web-site surveillance), we have come to an urgent conclusion: our future doctors need to be better educated about otitis media. This diagnosis is one of the most prevalent problems that practitioners face in practice. Accurate diagnosis by visualizing the tympanic membrane and assessing its mobility determines proper management, including watchful waiting and the observation option. Yet, our medical students and residents leave their training programs inadequately prepared to correctly diagnose and manage this important and ubiquitous health care issue.
Precious little time in pediatric residency training programs is spent lecturing about otitis media; it is often buried within other more generalized topics.6 Despite the fact that tympanic membrane mobility is a criterion for accurate diagnosis,7 residents in pediatrics and family medicine have failed to mention the importance of pneumatic otoscopy when assessing for otitis media; lack of training or equipment problems were reported as contributing to their not using this tool.8 Other assessment methods that help make the diagnosis, such as tympanometry and acoustic reflectometry, are also available but not routinely taught.9
A large, discreet, and accurate body of scientific and clinical information exists today that is very specific regarding definitions, diagnosis (including the proper use of equipment and interpretation of results), treatment, and outcomes and needs to be transmitted to our trainees.
The New York State Otitis Project strongly recommends that otitis media be addressed in an expanded and detailed manner within medical school curricula and in residency training programs that are concerned with primary care. Specifically, our profession needs to:
We can no longer afford to neglect our teaching responsibilities toward our future doctors on this widespread clinical problem that has such vast public health implications.
REFERENCES
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