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
Children suffering from OME as diagnosed by impedance audiometry (Tympanometry), Pure tone audiogram and pneumatic otoscopy
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).
Tympanometry and acoustic reflectometry may also be used to make the diagnosis, especially when the presence of MEE is difficult to determine using pneumatic otoscopy
The problem is that you really need to use pneumatic otoscopy
in some cases to determine if the TM is retracted (no acute infection) or bulging (acute infection, or AOM).
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.
permits the examiner to evaluate the appearance and mobility of the tympanic membrane (TM).
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.
The American Academy of Pediatrics the American Academy of Family Practice recently published a guideline on diagnosing AOM and have finally got it correct: the only accurate way to diagnose AOM (confirmed by tympanocentesis) is when the tympanic membrane is bulging, opaque, and (if using pneumatic otoscopy
, which should be standard) the TM should be non-mobile or only slightly mobile to positive pressure.