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Michael E. Pichichero, MD; Michael D. Poole, MD, PhD

Arch Pediatr Adolesc Med. 2001;155:1137-1142.

Background  The distinction between acute suppurative otitis media (AOM) and otitis media with effusion (OME) is important for antibiotic treatment decisions. Tympanocentesis may be useful in the diagnosis of AOM in selected patients.

Objectives  To assess physician accuracy in diagnosing AOM and OME from physical examination findings and technical competence in performing tympanocentesis.

Design and Subjects  Five hundred fourteen pediatricians and 188 otolaryngologists viewed 9 different videotaped pneumatic otoscopic examinations of tympanic membranes during a continuing medical education course. Diagnostic differentiation of AOM, OME, and a normal tympanic membrane was ascertained. An infant mannequin model was used to assess the technical proficiency of performing tympanocentesis on artificial tympanic membranes.

Results  Overall, the average correct diagnosis by pediatricians was 50% (range, 25%-73%) and by otolaryngologists was 73% (range, 48%-88%). Pediatricians and otolaryngologists correctly recognized the absence of normality 89% to 100% and 93% to 100% of the time, respectively, but overdiagnosed AOM in 7% to 53% (mean, 27%) and in 3% to 23% (mean, 10%) of examinations. Performance of tympanocentesis was optimally performed by 89% of otolaryngologists and by 83% of pediatricians.

Conclusions  The use of video-presented examinations to assess diagnostic ability suggests that AOM and OME may be misdiagnosed often. Interactive continuing medical education courses with simulation technology may enhance skills and improve diagnostic accuracy and treatment paradigms.

From the Departments of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, and the Elmwood Pediatric Group, Rochester, NY (Dr Pichichero); and the Department of Otolaryngology, University of Texas Medical School, Houston (Dr Poole). Drs Pichichero and Poole are co-chairs and principals in Outcomes Management Educational Workshops.

Corresponding author: Michael E. Pichichero, MD, University of Rochester Medical Center, 601 Elmwood Ave, Box 672, Rochester, NY 14642 (e-mail: michael_pichichero{at}urmc.rochester.edu).

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