Recognition of paediatric otopathology by General Practitioners

Abstract

Objective: General Practitioners (GPs) are required to diagnose a number of common ear pathologies on a regular basis. In particular, otitis media with effusion (OME) can be well managed in primary care if a reliable diagnosis can be made. We set out to assess the confidence and ability of GPs to diagnose otopathology, as well as the access that they had to tympanometry and pneumatic otoscopy to assist in making their diagnoses.

Methods: Twenty GPs were shown a series of forty slides, half with OME and half with normal tympanic membranes; they were then asked to state whether each image represented an ear with OME or not. The same GPs were then shown 20 slides, half of which were ears with a common pathology and half were normal; the participants were asked to state whether the slide was of a normal ear or make a diagnosis of the pathology. Access to equipment and previous training were assessed via a short questionnaire.

Results: The median score for the correct diagnosis of OME was 53% (range 30-67.5%), only slightly higher than chance. The participants correctly identified that an ear was abnormal for a mean of 80% of the time (range 65-95%), but were only able to make a correct diagnosis of the pathology for a mean of 41% of the ears (range 20-80%). No participant had access to pneumatic otoscopy or tympanometry in their practices.

Conclusions: GPs have difficulty in correctly diagnosing OME from otoscopy alone, but are able to determine the presence of other otopathology. They were less able to diagnose specific abnormalities.