Can nurses exclude middle-ear effusion without otoscopy in young asymptomatic children in primary care?

Figures & data

Figure 1. Flow chart of the included children, visits, and tympanometric and spectral gradient acoustic reflectometry (SG-AR) examinations.

Table I. Successful tympanometric examinations (n = 272) performed by the nurses.

Tympanometric result^a of the study nurse (n, %)	Pneumatic otoscopic diagnosis by the study physician		Total (n = 272)
	Healthy middle ear (n = 210)	Middle ear effusion (n = 62)
A	136 (94%)	8 (6%)	144
C1	47 (96%)	2 (4%)	49
C2	9 (53%)	8 (47%)	17
Cs	0 (0%)	2 (100%)	2
B	18 (30%)	42 (70%)	60

Notes: ^aTympanogram types: Type A (tympanometric peak pressure greater than −100 daPa); type C1 (the pressure between −100 and −199 daPa); type C2 (the pressure −200 daPa or less); type Cs (width > 300 daPa or static acoustic admittance < 0.2 mmho); and type B (flat).

Table II. Exclusion of middle-ear effusion (MEE) by nurses.^a

	Sensitivity (95% CI)	Specificity (95% CI)	Positive predictive value (95% CI)	Negative predictive value (95% CI)
Type C2, Cs, and B vs. type A and C1 tympanograms^b	84% (73–91%)	87% (82–91%)	66% (55–75%)	95% (91–97%)
SG-AR level 2–5 (≤ 95°) vs. level 1 (> 95°) results	79% (69–86%)	45% (38–51%)	33% (27–40%)	86% (79–91%)

Notes: ^aTest characteristics (with respective 95% confidence intervals [CI]) for the diagnostic test results with tympanometry (n = 272) and spectral gradient acoustic reflectometry (SG-AR; n = 332). MEE was contrasted with a healthy middle ear. The diagnostic standard was pneumatic otoscopy by the study physician. ^bTympanogram types: Type A (tympanometric peak pressure greater than −100 daPa); type C1 (the pressure between −100 and −199 daPa); type C2 (the pressure −200 daPa or less); type Cs (width > 300 daPa or static acoustic admittance < 0.2 mmho); and type B (flat).

Table III. Successful spectral gradient acoustic reflectometry (SG-AR) examinations (n = 332) performed by the nurses.

SG-AR result of the study nurse (n, %)	Pneumatic otoscopic diagnosis by the study physician		Total (n = 332)
	Healthy middle ear (n = 247)	Otitis media with effusion (n = 85)
Level 1 (> 95˚)	110 (86%)	18 (14%)	128
Level 2 (70–95˚)	96 (81%)	23 (19%)	119
Level 3 (60–69˚)^a	25 (63%)	15 (38%)	40
Level 4 (49–59˚)	13 (54%)	11 (46%)	24
Level 5 (< 49˚)	3 (14%)	18 (86%)	21

Note: ^aPercentages do not total 100% because of rounding

Figure 2. Flow chart of the clinical usefulness of excluding middle-ear effusion (MEE) based on tympanometry performed by the nurses at asymptomatic visits (n = 196). Type A and C1 tympanograms from both ears of the child were regarded as the exclusive test result for MEE. Notes: ^aTympanogram types: Type A (tympanometric peak pressure greater than −100 daPa); type C1 (the pressure between −100 and −199 daPa); type C2 (the pressure −200 daPa or less); type Cs (width > 300 daPa or static acoustic admittance < 0.2 mmho); and type B (flat).