Hemlin C, Hassler E, Hultcrantz M, Papatziamos G, Krakau I
Department of Oto-Rhino-Laryngology and Head & Neck Surgery, Karolinska Hospital, Stockholm, Sweden.
Fam Pract. 1998 Apr;15(2):133-7. doi: 10.1093/fampra/15.2.133.
Acute otitis media is a common disease, particularly among children. The importance of a correct diagnosis is crucial, especially as unjustified prescription of antibiotics has become a major problem in clinical praxis.
Our aim was to evaluate the predictive value of different otological findings in diagnostics and treatment of acute otitis media among GPs and ear specialists and to investigate if the diagnosis could be improved by the use of an ear microscope instead of an otoscope. Furthermore, we aimed to test the value of following an algorithm,
Thirty-one patients with otalgia at the Emergency Department at the Karolinska Hospital in Stockholm were examined by both a GP and an ear specialist. The GP used an otoscope, whereas the ear specialist first used an otoscope and then an ear microscope. The doctors registered their findings and their proposal for treatment in questionnaires. The ability among participating ear specialists to give a correct diagnosis was confirmed by the use of 12 video-taped selected cases of aural diseases. An algorithm for diagnostics, based on medical facts, was formulated and tested.
In general, the concordance between ear specialists and GPs was satisfactory with regard to establishing the diagnosis acute otitis media. The diagnostics were not improved by use of an ear microscope. The algorithm identified most patients with acute otitis media. Conclusion. The results indicate that the following of a simple algorithm may simplify the
and lead to a correct diagnosis of acute otitis media.
急性中耳炎是一种常见疾病，在儿童中尤为常见。正确诊断至关重要，特别是因为不合理使用抗生素已成为临床实践中的一个主要问题。
我们的目的是评估不同耳科检查结果在全科医生（GP）和耳科专家对急性中耳炎的诊断和治疗中的预测价值，并研究使用耳显微镜而非耳镜是否能改善诊断。此外，我们旨在测试遵循一种算法的价值。
斯德哥尔摩卡罗林斯卡医院急诊科的31名耳痛患者由一名全科医生和一名耳科专家进行检查。全科医生使用耳镜，而耳科专家首先使用耳镜，然后使用耳显微镜。医生们在问卷中记录他们的检查结果和治疗建议。通过使用12个选定的耳部疾病录像病例，确认了参与的耳科专家做出正确诊断的能力。制定并测试了一种基于医学事实的诊断算法。
总体而言，在诊断急性中耳炎方面，耳科专家和全科医生之间的一致性令人满意。使用耳显微镜并未改善诊断。该算法识别出了大多数急性中耳炎患者。结论。结果表明，遵循一种简单的算法可能会简化诊断，并得出急性中耳炎的正确诊断。
