Pneumatic video-otoscopy teaching improves the diagnostic accuracy of otitis media with effusion: results of a randomized controlled trial.

BACKGROUND: the diagnostic accuracy of otitis media with effusion (OME) has been shown to be poor among medical students, residents, and practicing physicians. OBJECTIVE: to determine if the use of pneumatic video-otoendoscopic examination (VOE) improves the diagnostic accuracy of OME among residents. METHODS: pediatric residents were randomized into a "pneumatic" examination group (intervention) and a "still" examination group (control). The control group viewed a set of 25 still VOE images of the tympanic membranes of both normal and OME ears. The intervention group viewed the same still images but with the addition of pneumatic VOE assessments. Each resident documented each of his or her diagnoses as normal or OME. The accuracy of assessment for both the static and the pneumatic methods was compared. RESULTS: twenty-nine pediatric residents participated in this study: 15 in the intervention group and 14 in the control group. The overall diagnostic accuracy was 91% for the intervention group versus 78% for the control group (p  =  .0003). CONCLUSION: pneumatic video-otoscopy teaching improves the diagnostic accuracy of OME among residents.

Linking laryngopharyngeal reflux to otitis media with effusion: pepsinogen study of adenoid tissue and middle ear fluid.

HYPOTHESIS/OBJECTIVES: Laryngopharyngeal reflux (LPR) was recently implicated in the etiology of otitis media with effusion (OME). To study the hypothesis that gastric juice reaches the middle ear through the nasopharynx and eustachian tube, we evaluated the presence of pepsinogen in the adenoid tissues of children with otitis media with effusion (OME) and compared them with the tissues of a control group of children without OME. METHODS: In the study group, middle ear effusions (MEEs) and adenoidal tissue biopsies were obtained from patients undergoing simultaneous tympanostomy tube placement and adenoidectomy. In the control group, adenoid specimens were taken during adenoidectomy (+/- tonsillectomy) from children with no history of OME. The adenoid tissues were analyzed immunohistochemically to confirm the presence of pepsinogen. Normal gastric tissue was used as a positive control and lymphatic tissue as a negative control. Total pepsinogen levels of MEE were measured with enzyme-linked immunosorbent assay. RESULTS: Adenoid tissue of the OME group (n = 25) demonstrated significantly higher pepsinogen immunoreactivity when compared with the adenoid tissue of the control group (n = 29), specifically in staining of both the epithelia (p < .0001) and the subepithelia, (p < .001). The presence of pepsinogen was detected in 84% of MEEs from the OME group, at concentrations 1.86 to 12.5 times higher than that of serum. Pepsinogen messenger ribonucleic acid was not demonstrated in any of the adenoid tissues of the OME group. CONCLUSION: LPR plays an important role in the pathogenesis of OME as gastric reflux reaches the middle ear through the nasopharynx and eustachian tube to cause OME.