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Am Fam Physician. 2004;69(7):1773

Pneumatic otoscopy has been considered an important tool in the accurate diagnosis of ear infections, including acute infections and those with effusion. Tympanic membrane mobility allows the examiner to determine the amount of middle ear effusion, the degree of negative or positive pressure alteration, and sclerosis and other changes on the tympanic membrane. Many physicians who treat children do not perform otoscopy. However, the benefits of pneumatic otoscopy do not appear to have been studied. Jones and Kaleida conducted a study to determine whether pneumatic otoscopy improved the accuracy of diagnosing middle ear effusion.

Participants from two pediatric residencies viewed a videotaped otoendoscopic examination using static and pneumatic tests. The video included otoscopic examinations of 50 tympanic membranes, using static images followed by a motion sequence in which the ear was exposed to positive and negative pressures. The video previously had been validated to distinguish experts from novices and was shown to correlate well with direct otoscopic findings.

Forty clinicians—34 pediatric residents and six clinical faculty—participated in the video examinations. The accuracy of all participants' pneumatic tests was greater than that of their static tests. The mean total score, sensitivity, and specificity of the tests were significantly higher after pneumatic otoscopy than after static assessment. The mean absolute improvement from static to pneumatic performance was 15 percent in total score, 12 percent in sensitivity, and 18 percent in specificity. The mean relative improvement was 26 percent in total score, 24 percent in sensitivity, and 42 percent in specificity. A higher degree of accuracy was associated with greater absolute and relative improvement.

The authors conclude that pneumatic assessment appears to improve accurate diagnosis of middle ear effusion or its absence. Clinicians with better visual assessment skills showed the greatest improvement using otoscopy.

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