چکیده (انگلیسی):

Background:Tympanometry and pneumatic otoscopy are recommended for diagnosis of otitis media, but are not
frequently used by general practitioners (GPs). We examined how, after targeted short training, GP diagnosis and
management of childhood ear disease was changed by the addition of these techniques to non-pneumatic otoscopy.
We further explored factors influencing the uptake of these techniques.
Methods:Between 2011 and 2012, we used a crossover experimental design to determine associations between
tympanometry and pneumatic otoscopy and the GP diagnosis and management of ear disease in children aged
6 months to 6 years. GPs recorded a diagnosis and management plan after examining ears using non-pneumatic
otoscopy, and another after using either tympanometry or pneumatic otoscopy. We compared diagnosis, prescription
of oral antibiotics and planned GP follow-up at these twosteps between the tympanometry and pneumatic otoscopy
groups. We interviewed participants about their views regarding these techniques and analysed these data thematically.
Results:Thirteen GPs recorded 694 ear examinations on 347 children: 347 examinations with non-pneumatic otoscopy;
then 196 using tympanometry; and 151 using pneumatic otoscopy. Tympanometry was more likely to be associated
with changes in diagnosis (χ
2
= 28.64, df 1, p < 0.001) and planned GP follow-up (χ
2
= 9.24, df 1, p < 0.01) than
pneumatic otoscopy. Change in oral antibiotic prescription was no different between the two techniques. GPs
preferred tympanometry to pneumatic otoscopy, but cost was a barrier to ongoing use. Pneumatic otoscopy was
considered the more difficult skill. GPs were not convinced that the increased detection of middle ear effusion
afforded by tympanometry and pneumatic otoscopy resulted in benefit to general practice patients.
Conclusion:Tympanometry was more likely than pneumatic otoscopy to change GP diagnoses and follow-up plans of
childhood ear disease. Tympanometry may require less training than pneumatic otoscopy. GPs preferred tympanometry
due to ease of use and interpretation; however, perceived high cost inhibited their intent to use it in the future. Training,
cost and perceived lack of patient benefit are barriers to the use of tympanometry and pneumatic otoscopy in general
practice.