Silva A B, Hotaling A J
Loyola University Chicago Medical Center, Department of Otolaryngology, Maywood, IL 60153, USA.
Int J Pediatr Otorhinolaryngol. 1997 Jun 20;40(2-3):125-31. doi: 10.1016/s0165-5876(97)00033-5.
Otitis media with effusion (OME) is one of the most frequent pediatric diagnoses and is also one of the most common indications for medical or surgical intervention in this age group. Pneumatic otoscopy is the standard for physical diagnosis of a middle ear effusion. We report on our experience with a validation program for otolaryngology-head and neck surgery residents in the use of pneumatic otoscopy to diagnose OME. Four PGY 2 residents sequentially completed a 4 month clinical and didactic training program in pneumatic otoscopy. The trainee sequentially performs pneumatic otoscopy, otomicroscopy, and myringotomy on each patient scheduled for a myringotomy and tube placement the morning of surgery. After each task the trainee is required to state if an effusion is present or not, and the accuracy of the diagnosis is immediately reinforced at the time of myringotomy. The trainee's sensitivity and specificity in diagnosing OME is then calculated for the first and second half of the study period. The trainee is validated in pneumatic otoscopy if the sensitivity is > 80% and > 70% respectively, and the trainee is validated in otomicroscopy if the sensitivity and specificity is > 90% and > 80% respectively. Four residents completed the protocol, and a total of 275 ears were examined. Four residents were validated in pneumatic otoscopy, and three residents were validated in otomicroscopy. We conclude that this protocol allows for accurate documentation of the resident's skill progression and enhances resident education.
分泌性中耳炎（OME）是儿科最常见的诊断之一，也是该年龄组进行药物或手术干预最常见的指征之一。鼓气耳镜检查是中耳积液体格诊断的标准方法。我们报告了一项针对耳鼻咽喉头颈外科住院医师使用鼓气耳镜诊断OME的验证计划的经验。4名二年级住院医师依次完成了为期4个月的鼓气耳镜临床和理论培训计划。在手术当天上午，对每例计划行鼓膜切开置管术的患者，受训者依次进行鼓气耳镜检查、耳显微镜检查和鼓膜切开术。每项操作后，要求受训者说明是否存在积液，并且在鼓膜切开术时立即强化诊断的准确性。然后计算受训者在研究期前半段和后半段诊断OME的敏感性和特异性。如果敏感性分别>80%和>70%，则受训者在鼓气耳镜检查方面得到验证；如果敏感性和特异性分别>90%和>80%，则受训者在耳显微镜检查方面得到验证。4名住院医师完成了该方案，共检查了275只耳朵。4名住院医师在鼓气耳镜检查方面得到验证，3名住院医师在耳显微镜检查方面得到验证。我们得出结论，该方案能够准确记录住院医师的技能进展情况，并加强住院医师教育。
