Karma P H, Penttilä M A, Sipilä M M, Kataja M J
Department of Clinical Sciences, University of Tampere, Finland.
Int J Pediatr Otorhinolaryngol. 1989 Feb;17(1):37-49. doi: 10.1016/0165-5876(89)90292-9.
To determine the value of different pneumotoscopic findings in diagnosing the middle ear effusion (MEE) of acute (AOM) and non-acute otitis media, 11,804 ear-related visits of 2,911 unselected children at ages 0.5-2.5 years were analysed. About half of these were examined by an otolaryngologist in one, and half by a pediatrician in another, urban area. Myringotomy was always performed when MEE was suspected, and it confirmed the presence of MEE in 85% (otolaryngologist) and 82% (pediatrician) of altogether 5,462 acute and in 69% (both doctors) of 1,092 non-acute cases suspected. Redness of the tympanic membrane (TM) was found in only 18% and 27% of the visits with AOM, and it predicted MEE with only 60% and 51% probability, if seen in acute visits. Cloudiness of the TM was noticed in 81% and 67% of the visits with AOM; its specificity and the other calculated variables were good in regard to the diagnosing of MEE, especially in acute cases in both groups. Distinctly impaired mobility of the TM was of about the same diagnostic value, but its position reliably indicated MEE only when bulging. In AOM the colour or mobility of the TM was normal very rarely, but the position was normal in a third of the cases. Thus, although there were differences in the incidences of different otoscopic findings in the two study groups, the diagnostic value of certain pneumatic otoscopic findings, especially cloudiness and distinct hypomobility of the TM, seemed to be good in both groups.
为确定不同的鼓膜镜检查结果在诊断急性中耳炎（AOM）和非急性中耳炎的中耳积液（MEE）中的价值，对2911名年龄在0.5 - 2.5岁的未经过筛选的儿童的11804次耳部相关就诊情况进行了分析。其中约一半儿童在一个市区由耳鼻喉科医生检查，另一半在另一个市区由儿科医生检查。当怀疑有中耳积液时均进行鼓膜切开术，在总共5462例急性病例中，85%（耳鼻喉科医生）和82%（儿科医生）的病例经鼓膜切开术证实存在中耳积液，在1092例疑似非急性病例中，69%（两位医生检查结果）的病例存在中耳积液。在急性中耳炎就诊病例中，仅18%和27%发现鼓膜（TM）发红，在急性就诊中若发现鼓膜发红，其预测中耳积液的概率仅为60%和51%。在急性中耳炎就诊病例中，81%和67%观察到鼓膜浑浊；其特异性及其他计算变量在诊断中耳积液方面表现良好，尤其是在两组的急性病例中。鼓膜活动明显受限具有大致相同的诊断价值，但其位置仅在鼓膜膨出时才能可靠地提示中耳积液。在急性中耳炎中，鼓膜的颜色或活动很少正常，但三分之一的病例鼓膜位置正常。因此，尽管两个研究组不同耳镜检查结果的发生率存在差异，但某些鼓膜气镜检查结果，尤其是鼓膜浑浊和明显活动度降低，在两组中似乎都具有良好的诊断价值。
