Can trained nurses exclude acute otitis media with tympanometry or acoustic reflectometry in symptomatic children?

Abstract

Objective Since acute otitis media (AOM) is the most prevalent bacterial infection in young children, the reliable exclusion of AOM by nurses might save physicians’ time for other duties. The study aim was to determine whether nurses without otoscopic experience can reliably use tympanometry or spectral gradient acoustic reflectometry (SG-AR) to exclude AOM.

Design Three nurses were trained, who performed examinations with tympanometry and SG-AR. Pneumatic otoscopy by the study physician served as the diagnostic standard.

Setting Study clinic at primary health care level.

Patients. 281 children 6–35 months of age.

Main outcome measures Predictive values (with 95% confidence interval) for tympanometry and SG-AR, and the clinical usefulness, i.e. the proportion of visits where nurses obtained the exclusive test result from both ears of the child.

Results At 459 visits, the negative predictive value of type A and C1 tympanograms (tympanometric peak pressure >–200 daPa) was 94% (91–97%). Based on type A and C1 tympanograms, the nurse could exclude AOM at 94/459 (20%) of visits. The negative predictive value of SG-AR level 1 result (>95°) was 94% (89–97%). Based on the SG-AR level 1 result, the nurse could exclude AOM at 36/459 (8%) of visits.

Conclusion Type A and C1 tympanograms and SG-AR level 1 results obtained by nurses are reliable test results in excluding AOM. However, the clinical usefulness of these test results is limited by their rarity. Type A and C1 tympanograms were obtained by nurses from both ears of the child only at one-fifth of the symptomatic visits.

Key Points

• Acute otitis media (AOM) is the most prevalent bacterial infection in young children. Nurses’ role in excluding AOM is unknown.

• Type A and C1 tympanograms (tympanometric peak pressure >–200 daPa) obtained by nurses are reliable test results in excluding AOM.

• With type A and C1 tympanograms, nurses could exclude AOM only at one-fifth of the symptomatic visits.

• The clinical usefulness of the exclusion of AOM performed by nurses seems to be limited.

KeyWords:

• Acute otitis media
• children
• exclusion
• Finland
• general practice
• spectral gradient acoustic reflectometry
• tympanometry

Acknowledgements

This work was supported by the Fellowship Award of the European Society for Paediatric Infectious Diseases to Dr Aino Ruohola and by grants from the Research Funds from Specified Government Transfers; the Foundation for Paediatric Research; Jenny and Antti Wihuri Foundation; the Maud Kuistila Memorial Foundation; University of Turku; the Turku University Foundation; the Finnish Medical Foundation; the Finnish Cultural Foundation, Varsinais-Suomi Regional Fund; the Turku University Hospital Research Foundation; the Paulo Foundation; the Outpatient Care Research Foundation; and the Finnish-Norwegian Medical Foundation.

The study protocol (http://www.clinicaltrials.gov, identifier NCT00299455) was approved by the Ethical Committee of the Hospital District of Southwest Finland.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.