Otitis media with effusion: Accuracy of tympanometry in detecting fluid in the middle ears of children at myringotomies.

Khurshid Anwar

doi:10.12669/pjms.322.9009

Abstract

Objective:(1) The diagnostic accuracy of tympanometry in detecting fluid in the middle ear space in children with otitis media with effusion by comparing its findings with those of myringotomies. (2) Identify the age group most commonly affected by OME.Methods:This prospective study was conducted at the Department of ENT& Head and Neck Surgery, Postgraduate Medical Institute Hayatabad Medical complex, Peshawar from July 1, 2012 to April 30, 2015. Patients with suspicion of OME underwent tympanometry and later myringotomies. Using Jerger’s classification, Type B tympanogram with normal canal volume was considered as conclusive evidence of fluid in the middle ear space. Its findings were compared with those of the respective myringotomies. From the data collected, the accuracy, sensitivity, specificity, positive predictive value and negative predictive values were calculated.Results:A total 117 ears of 63 patients were operated. The age range was 3 to 12 years. The commonest age group (58.7%) affected by OME was 6-8 years. Type B tympanogram with flat curve and normal canal volume was obtained in 71.4% of the ears. Comparison with myringotomy findings showed TP 85, TN 13, FP 5 and FN 14. The diagnostic value of tympanometry was; Sensitivity 85.85%, Specificity 72.22%, PPV 94.44%, NPV 48.14% and Accuracy of 83.76%. P value calculated using chi square test showed that there was significant difference between tympanometry and myringotomy findings in OME (p < 0.05).Conclusions:OME is common in age group 6-8 years. Tympanogram Type B with normal canal volume is fairly sensitive in diagnosing this condition. However for occurrence of false positive results, final decision regarding management should be made on clinical findings and other supportive audiological tests.

Highlights

Otitis media with effusion (OME) is defined as fluid in the middle ear and, sometimes, the mastoid air cell system without signs or symptoms of ear Correspondence: September 18, 2015 January 27, 2016 January 31, 2016 infection.[1]
Using Jerger’s classification, Type B tympanogram with normal canal volume was considered as conclusive evidence of fluid in the middle ear space
Type B tympanogram with flat curve and normal canal volume was obtained in 71.4% of the ears

Summary

Introduction

Otitis media with effusion (OME) is defined as fluid in the middle ear and, sometimes, the mastoid air cell system without signs or symptoms of ear Correspondence: September 18, 2015 January 27, 2016 January 31, 2016 infection.[1]. Children with Eustachian tube dysfunction, adenoid hyperplasia, nasal allergy, cleft palate, Down syndrome and other craniofacial anomalies are at high risk for developing OME.[7] Recently GERD has been implicated in OME in young children.[8] rare, OME occurs in adults. This usually occurs following upper respiratory infection, severe nasal allergies and rapid air pressure changes during flight or scuba diving. The incidence of prolonged OME in adults can occur but is rare and is much less common than in children.[9]

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