Legros J-M, Hitoto H, Garnier F, Dagorne C, Parot-Schinkel E, Fanello S
Département universitaire de santé publique-CHU Angers, 49933 Cedex 9, France.
Int J Pediatr Otorhinolaryngol. 2008 Jan;72(1):23-30. doi: 10.1016/j.ijporl.2007.09.010. Epub 2007 Oct 31.
Assess the quality of the diagnosis of acute otitis media (AOM) given by general practitioners (GPs) on a daily basis and compare it with the diagnosis of ear, nose and throat specialist (ENTS) which is considered as the gold standard.
Every GP had to include six children aged 1-4 years for whom he suspected or diagnosed that they were suffering from AOM. Parents had to accept to see the ENTS participating in the survey within 48 h.
Twenty-four GPs took part in the survey and included at least one child, which amounts to a final 57% acceptability rate. Two hundred and eight eardrums were included in the survey. 21.9% of assumptions or diagnosis's of AOM (30/137) were declared null by the ENTS. GPs diagnose AOM without any doubt only in 54% of all cases. The diagnosis and the assumption of AOM were respectively confirmed in 83.8% of all cases and 71.4% by the ENTS. The combination of redness and bulge, and isolated redness accounted for respectively 44.3% and 26.2% of the main otoscopical factors reminiscent of the AOM according to GPs. In the case of redness and bulge, the diagnosis was confirmed in 83% of all cases by the ENTS as opposed to 75% regarding the isolated redness. An AOM was suspected in 57.1% of the eardrums barely or not visible or without any sign of infection and not confirmed in 25% of all cases.
The global over diagnosis is 21.9% and 25% when the otoscopy is hindered by the presence of cerumen or when the eardrums are only inflammatory. Even though the over diagnosis is inferior to the one mentioned in published writings, post-graduate teaching on the various cerumen removal techniques and the use of pneumatic otoscopy could contribute to improving the quality of diagnosing AOM.
评估全科医生（GP）日常对急性中耳炎（AOM）的诊断质量，并将其与被视为金标准的耳鼻喉科专家（ENT）的诊断进行比较。
每位全科医生必须纳入6名1 - 4岁疑似或被诊断患有急性中耳炎的儿童。家长必须同意在48小时内带孩子去看参与调查的耳鼻喉科专家。
24名全科医生参与了调查，至少纳入了一名儿童，最终接受率为57%。调查共纳入208只鼓膜。耳鼻喉科专家判定21.9%的急性中耳炎假设或诊断（30/137）不成立。全科医生在所有病例中仅54%能明确诊断急性中耳炎。耳鼻喉科专家分别在83.8%的所有病例中确认了急性中耳炎的诊断，在71.4%的病例中确认了急性中耳炎的假设。根据全科医生的判断，发红和鼓膜膨出以及单纯发红分别占提示急性中耳炎的主要耳镜检查因素的44.3%和26.2%。在发红和鼓膜膨出的情况下，耳鼻喉科专家在所有病例的83%中确认了诊断，而单纯发红的情况为75%。在57.1%几乎不可见或无感染迹象的鼓膜中怀疑有急性中耳炎，其中25%的所有病例未得到确认。
当耳镜检查因耵聍存在而受阻或鼓膜仅为炎症时，总体过度诊断率分别为21.9%和25%。尽管过度诊断低于已发表文献中提及的水平，但关于各种耵聍清除技术和鼓气耳镜使用的研究生教学可能有助于提高急性中耳炎的诊断质量。
