AAP guideline recommends using pneumatic otoscopy
as a primary method for diagnosing OME and tympanometry can be used to confirm the diagnosis".
(8) Another study in 2012, conducted by Rosenkranz, et al, of 23 general practitioners found that a multimodal, interactive workshop can significantly increase the confidence of general practitioners for diagnosis of otitis media with effusion and also for using pneumatic otoscopy
On examination, she was found to have a normal left TM (figure, A) and a vascular mass behind the right TM inferiorly (figure, B) that was compressible on pneumatic otoscopy
. She denied a history of recurrent ear infections or prior ear surgeries.
These examiners almost always use pneumatic otoscopy
(a tool that pushes air in and out of the ear canal to more accurately test for ear disease) or an otomicroscope (allowing for three dimensional ear exams).
, which can reveal decreased or absent movement of the tympanic membrane (the result of fluid behind the membrane), is the primary diagnostic method recommended by the guideline.
Many clinicians have not been trained on using pneumatic otoscopy
, or even if trained, they fend it inconvenient and/or problematic to use because it requires a seal of the speculum against the external auditory canal; this makes children cry.
The guidelines also emphasize pneumatic otoscopy
to ensure the presence of a middle-ear effusion, calling the pneumatic otoscope the "standard tool" for diagnosing otitis media.
The standard recommendation, according to the literature (1) on COME, is the use of pneumatic otoscopy
as the primary diagnostic method, with tympanometry reserved as a confirmatory test.
Accurate diagnosis of AOM can only be made after confirmation of positive physical findings with pneumatic otoscopy
. Pneumatic otoscopy
permits the examiner to evaluate the appearance and mobility of the tympanic membrane (TM).
Children suffering from OME as diagnosed by impedance audiometry (Tympanometry), Pure tone audiogram and pneumatic otoscopy
. PTA air-bone gap should be at least 25db.
Some patients may have findings of a red mass that blanches with pneumatic otoscopy
, called Browns sign.
Despite that, "relatively few physicians consistently use pneumatic otoscopy
, and they may be resistant to changing their practice," Dr.