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

Figures & data

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

Table 1. Successful tympanometric examinations (n = 670) performed by the nurses.

	Pneumatic otoscopic diagnosis by the physician
Tympanometric result^1 of the nurse (n, %)	Healthy middle ear (n = 291)	Otitis media with effusion (n = 213)	Acute otitis media (n = 166)	Total (n = 670)
A	159 (89%)	11 (6%)	9 (5%)	179
C1	71 (65%)	32 (29%)	7 (6%)	110
C2	46 (46%)	42 (42%)	12 (12%)	100
Cs	0 (0%)	5 (83%)	1 (17%)	6
B	15 (5%)	123 (45%)	137 (50%)	275

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

Table 2. Predictive values (with respective 95% confidence intervals [CI]) for the diagnostic test results with tympanometry (n = 670) and spectral gradient acoustic reflectometry (SG-AR) (n = 782) obtained by the nurses¹.

	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^2	90% (85–94%)	54% (50–58%)	39% (35–44%)	94% (91–97%)
SG-AR level 2–5 (≤95°) vs. level 1 (> 95°) results	95% (91–98%)	26% (22–30%)	32% (28–36%)	94% (89–97%)

Notes: Pneumatic otoscopy by the study physician served as the diagnostic standard; acute otitis media (AOM) was contrasted with non-AOM (i.e. healthy middle ear or otitis media with effusion).

2 Classification of tympanograms. Type A (tympanometric peak pressure greater than –100 daPa); type C1 (pressure between –100 and –199 daPa); type C2 (pressure –200 daPa or less); type Cs (width >300 daPa or static acoustic admittance <0.2 mmho); and type B (flat).

Table 3. Successful spectral gradient acoustic reflectometry (SG-AR) examinations (n = 782) performed by the nurses.

	Pneumatic otoscopic diagnosis by the physician
SG-AR result of the nurse (n, %)	Healthy middle ear (n = 329)	Otitis media with effusion (n = 244)	Acute otitis media (n = 209)	Total (n = 782)
Level 1 (>95°)	117 (74%)	32 (20%)	10 (6%)	159
Level 2 (70–95°)	129 (53%)	83 (34%)	33 (13%)	245
Level 3 (60–69°)	43 (40%)	34 (31%)	32 (29%)	109
Level 4 (49–59°)	34 (31%)	36 (33%)	40 (36%)	110
Level 5 (<49°)	6 (4%)	59 (37%)	94 (59%)	159

Figure 2. Exclusion of acute otitis media (AOM) based on tympanometry performed by the nurses at symptomatic visits (n = 459). Type A and C1 tympanograms from both ears of the child were regarded as the exclusive test result for AOM.

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