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Primary care physicians can successfully use tympanometry to diagnose children's middle ear infections

Tympanometry is recommended when the diagnosis of acute otitis media (middle ear infection with effusion) is uncertain. A tympanometer measures the mobility and impedance of the tympanic membrane and ossicles of the middle ear and provides an objective assessment of middle ear status. For some children, it correlates with hearing loss.

Primary care physicians (PCPs), who have been trained in using hand-held tympanometers and interpreting tympanograms (graphic representations of middle ear activity), interpret tympanograms as accurately as experts, according to a study supported by the Agency for Healthcare Research and Quality (HS07035). Thus, PCPs can accurately interpret tympanograms to diagnose children's middle ear infections during daily practice, concludes principal investigator Jack Froom, M.D., of the State University of New York—Stony Brook.

The researchers determined the level of agreement between experts and PCPs in practice-based research networks in The Netherlands, United Kingdom, United States, and Canada, for interpretation of tympanograms of children aged 6 to 180 months. One comparison used 6,358 individual ear tracings, and a second used 3,179 office visits by children as the unit of analysis.

Results showed that the distribution of expert interpretation of all tympanograms was 51.3 percent normal, 42 percent abnormal, and 6.8 percent uninterpretable. For visits, 37.8 percent were normal, 55.6 percent abnormal, and 6.6 percent could not be classified. There was a high degree of agreement in the interpretation of tympanograms between experts and PCPs across networks, age groups of children, and types of visits.

The authors conclude that interpretations of tympanograms by PCPs can be used with confidence, and that primary care physicians can provide high quality data for research purposes.

For details, see "Tympanometry interpretation by primary care physicians," by Larry A. Green, M.D., Larry Culpepper, M.D., M.P.H., Ruut A. De Melker, M.D., and others, in the October 2000 Journal of Family Practice 49(10), pp. 932-936.

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