Accuracy of Video Otoscopy in Predicting the Presence of Middle Ear Effusion in Children Compared to Tympanometry: A Diagnostic Study

Abstract

Importance: Middle ear effusion (MEE) is the primary cause of conductive hearing impairment among children, predominantly occurring up to the age of two years. The gold standard for detecting MEE is tympanometry (Grayson-Stadler, Eden Prairie, Minnesota). This study explores a less costly alternative, the video otoscope (Inventis S.R.L, Padova, Italy).

Objective: The primary objective is to compare video otoscopy with tympanometry in terms of its ability to diagnose MEE. The secondary objective is to explore the prevalence of MEE in special populations.

Methods: We conducted a retrospective diagnostic study that included patients aged 0-18 years who visited the pediatric otolaryngology clinic for suspected MEE over a two-year period. Clinical presentation, otoscopy findings, and tympanometry results were reviewed. The data were analyzed using IBM SPSS Statistics for Windows, Version 24 (Released 2016; IBM Corp., Armonk, New York). The significance of the results was assessed using the chi-squared test.

Results: We included 337 patients with a mean age of 5.1 years (standard deviation = 2.68); 967 tympanometry tests were available for comparison with the corresponding ears. Validity tests showed that the sensitivity of video otoscopy was 79.5%, the specificity was 56.9%, the positive predictive value was 89.6%, and the negative predictive value was 37.4%. The overall accuracy was 75.5%. These results were statistically significant.

Conclusion: Video otoscopy was capable of diagnosing MEE in children 89.6% of the time. However, tympanometry is still needed in specific conditions, such as narrow ear canals, dull tympanic membranes, and clear tympanic membranes in patients with decreased hearing, a history of ear infections, or speech delay.