Is it possible to diagnose acute otitis media accurately in primary health care?

BACKGROUND: Acute otitis media causes human suffering and enormous costs to society. Symptoms of acute otitis media overlap those of the common cold, and diagnostic methods confirming the diagnosis are used only occasionally. Uncertainty in diagnostics may lead either to overdiagnosis and unnecessary treatment or to underdiagnosis and an increase in complications.

OBJECTIVE: Our aim was to evaluate the inter-rater agreement in diagnosis of acute otitis media for children in primary health care.

METHODS: The GP on duty and the otorhinolaryngology resident at a primary health care clinic examined the same 50 children with caregiver-suspected acute otitis media. The otorhinolaryngologist photographed the tympanic membranes. Afterwards, two experienced clinicians evaluated the photographs with and without tympanograms. Diagnostic rates and diagnostic methods between clinicians were compared.

RESULTS: The otorhinolaryngologist diagnosed acute otitis media in 44% and the GP in 64%. The GP based the diagnoses on symptoms and on the colour of the tympanic membrane, whereas the otorhinolaryngologist paid more attention to the movement and position of the tympanic membrane.

CONCLUSION: The use of a pneumatic otoscope and tympanometry reduces the number of acute otitis media diagnoses by >30%, suggesting that acute otitis media may be misdiagnosed often. Between clinicians, there was a substantial discrepancy in diagnoses of acute otitis media.