Otoscopy in the diagnosis of otitis media with effusion: A study of observer agreement amoung otorhinolaryngologists

Abstract

Aim: To study otoscopy in terms of interobserver and intraobserver agreement, accuracy, sensitivity, specificity, positive and negative predictive value for the diagnosis of otitis media with effusion (OME) in children. 

Study Design: Cross-sectional study and agreement analysis. 

Methods: We presented otoscopy images to Otorhinolaryngology specialists and residents and they were instructed to identify the images that corresponded to cases of OME. The same test was repeated 1 month later, with the same images in a different order. We considered that the images were positive for OME whenever the respective tympanogram was type B. 

Results: Thirty-one otoscopy images and 1240 responses provided by 10 specialist doctors and 10 residents of Otorhinolaryngology were analyzed. Overall mean accuracy was 74.8%. Sensitivity of otoscopy in the diagnose of OME was 81.5% when performed by specialists doctors and 70.0% when performed by residents (p <0.05). Specificity was 69.4% and 76.1% in the group of specialists and residents physicians, respectively. Intraobserver agreement was moderate for both groups (κ = 0.41-0.6). The interobserver agreement was, in general, weak (κ <0.4). 

Conclusion: When performed by Otorhinolaryngology specialists, otoscopy can be a good screening test. However, given the overall low specificity and interobserver agreement, additional evaluation with other tests is necessary.