Differential Diagnosis in Secretory Otitis Media: Different Techniques

Aim: To assess the efficacy of noninvasive techniques in the differential diagnosis of secretory otitis media (otitis media with effusion) in children.

Material and Methods: This study was an extensive review of the available literature, using the Medline data base.

Results: Pneumatic otoscopy appears to have the greatest validity, with a sensitivity of 94% and a specificity of 80%. Plain otoscopy shows an 87.5% sensitivity, but its specificity is limited to 61.1%. The validity of tympanometry is greatly influenced by the type of the tympanogram. Thus, a type-B tympanogram has a 91% sensitivity and a 79% specificity, while a type-A shows an extremely high sensitivity (99%), yet its specificity is very low (34%). When tympanometry is performed in infants younger than 7 months old, reliable results are taken using the 1 kHz frequency, rather than the usual 226 Hz frequency. Among the three tympanometric parameters, the curve gradient is considered to be more sensitive regarding the presence of fluid. Audiometry can be used adjuvantly for the diagnosis of otitis media with effusion. Otoacoustic emissions can be used only in the course of otitis media with effusion as they are again detectable after successful treatment. Acoustic otoscopy shows a 78% sensitivity and a 99.33% specificity when the curve angle is 75 degrees, but when the curve angle is 90 degrees, sensitivity rises to 97.33%, with a consequent reduction in specificity, down to 85.33%.

Conclusions: Among the noninvasive techniques, pneumatic otoscopy seems to be the gold standard for the diagnosis of otitis media with effusion. Tympanometry can be used as an alternative for the confirmation diagnosis. Its diagnostic accuracy can be improved with the addition of pure tone audiometry.