Tympanometry for diagnosis and treatment of otitis media in general practice.

Objective. The aim of this study was to evaluate the role of tympanometry for diagnosis, treatment and follow-up of otitis media in general practice. Methods. The results from otoscopy performed by 40 physicians in general practice in Vejle County, Denmark were combined with the clinical condition and this was recorded as the preliminary decision about diagnosis, treatment and follow-up. Subsequently, tympanometry was performed in 3176 children aged between 1 month and 16 years; a total of 6352 tympanometries. With this added knowledge, a final decision about diagnosis, treatment and follow-up was recorded. The practitioners were trained in performing tympanometry including the interpretation of the results. Simultaneously, they were involved in the establishment of guidelines for diagnosis, treatment and follow-up of otitis media in general practice. The main outcome measures were changes between preliminary and final decisions about diagnoses, treatments and follow-up regimens. Results. Tympanometry was performed successfully in 87.7% of the children, and in 26.4% changes in diagnoses were found. However, tympanometry did not influence the distributions of the main outcome measures in the sample as a whole. Uncomplicated cases were checked in general practice and referrals to specialists were not increased. Conclusion. Tympanometry can be performed successfully in general practice after appropriate instruction. In 26.4% of children, the diagnoses were changed, which may result in more appropriate treatment and follow-up. Tympanometry is a clinically relevant supplement to the examination of a child in general practice.