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Pediatr Ann 2019 Sep;48(9):e343-e348

For pediatric practitioners, acute otitis media (AOM) and group A streptococcal pharyngitis are two of the most common infections seen in ambulatory practices. The purpose of this article is to review these conditions with the focus of highlighting evidence-based guidelines. AOM in children is a visual diagnosis and not one that can be made on history alone. Read More

Biomed Opt Express 2018 Feb 3;9(2):397-409. Epub 2018 Jan 3.

Department of Bioengineering, University of Illinois at Urbana-Champaign, 1304 W. Springfield Avenue, Urbana, IL 61801, USA.

Pneumatic otoscopy to assess the mobility of the tympanic membrane (TM) is a highly recommended diagnostic method of otitis media (OM), a widespread middle ear infection characterized by the fluid accumulation in the middle ear. Nonetheless, limited depth perception and subjective interpretation of small TM displacements have challenged the appropriate and efficient examination of TM dynamics experienced during OM. In this paper, a pneumatic otoscope integrated with low coherence interferometry (LCI) was adapted with a controlled pressure-generating system to record the pneumatic response of the TM and to estimate middle ear pressure (MEP). Read More

Int J Pediatr Otorhinolaryngol 2018 Mar 8;106:59-63. Epub 2018 Jan 8.

Connecticut Children's Medical Center, Division of Otolaryngology, 282 Washington Street, 2nd Floor, Hartford, CT 06106, United States. Electronic address:

Objectives: Tele-otoscopy has been validated for tympanostomy surveillance and remote diagnosis when images are recorded by trained professionals. The CellScope iPhone Otoscope is a device that may be used for tele-otoscopy and it enables parents to record their children's ear examinations and send the films for remote physician diagnosis. This study aims to determine the ability to diagnose, and the reliability of the diagnosis when utilizing video exams obtained by a parent versus video exams obtained by an otolaryngologist. Read More

Minerva Pediatr 2016 Dec 19;68(6):470-477. Epub 2016 May 19.

Department of Otolaryngology, Head and Neck Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA -

Accurate diagnosis of otitis media is important to prevent suffering and complications when infection is present, and unnecessary antibiotic use when infection is absent. The usual signs and symptoms of acute otitis media are unreliable guides in infants and young children. Similarly, middle ear effusions may present with little discomfort in older children. Read More

Indian J Otolaryngol Head Neck Surg 2013 Dec 21;65(Suppl 3):660-1. Epub 2012 Feb 21.

ENT Department, Penteli Children Hospital, 43 Agoracritou Street, 10440 Athens, Greece.

Pneumatic otoscopes do not support video assisted clinical examination, as they are not equipped with built-in cameras, so diagnosis is based on real-time direct observation rather than on video studying. On the other hand, classic rigid endoscopes usually provide otologists with a clear view of the tympanic membrane and its mobility, allowing subsequent video recording. Unfortunately, rigid endoscopes cannot be used for pneumatic otoscopy, unless they are properly fitted for such use. Read More

Laryngorhinootologie 2009 Apr 6;88(4):226-8. Epub 2009 Apr 6.

The simple technique of Siegle's otoscope has unfortunately passed out of date. Ever since, tympanometry gives a general view over pressure conditions in the middle ear in a fast way. Only with pneumatic otoscopy, the examiner gets more detailed information if the tympanic membrane is sclerotic or retracted. Read More

Int J Pediatr Otorhinolaryngol 2006 Nov 9;70(11):1875-83. Epub 2006 Aug 9.

Department of Pediatrics, Uniformed Services University of the Health Sciences (USUHS), San Antonio Military Pediatric Center, 2200 Bergquist Dr. STE1, Lackland AFB, San Antonio, TX 78236, United States.

Background: Several billion dollars are spent each year on otitis media, a diagnosis for which educational approaches and diagnostic skills are suboptimal. The Center for Disease Control has identified improvement in otoscopy skills as a key intervention to curb inappropriate antibiotic usage. Educators are looking for interventions to both improve and assess otoscopy skills. Read More

Laryngoscope 2002 Apr;112(4):669-75

Department of Otorhinolaryngology, Kuopio University Hospital, Finland.

Objective: Ventilation tubes in the treatment of otitis media in young children remain controversial. Despite abundant research, few prospective long-term follow-up studies have included even a minority of patients under 1 year old. We investigated long-term otological and audiological outcomes in children with recurrent acute otitis media and otitis media with effusion, who were treated early with ventilation tubes. Read More

Arch Pediatr 2002 Jun;9(6):644-5

Hôpital Saint-Michel, 33, rue Olivier-de-Serres, 75015 Paris, France.

Pneumatic otoscopy is based upon the reaction of the tympanic membrane after sending a small air volume. A normal mobility means that air is present in the middle ear. Instead absent or reduced mobility means that effusion is present. Read More

Arch Pediatr Adolesc Med 2001 Oct;155(10):1137-42

Department of Microbiology, University of Rochester School of Medicine and Dentistry, NY 14642, USA.

Background: The distinction between acute suppurative otitis media (AOM) and otitis media with effusion (OME) is important for antibiotic treatment decisions. Tympanocentesis may be useful in the diagnosis of AOM in selected patients.

Objectives: To assess physician accuracy in diagnosing AOM and OME from physical examination findings and technical competence in performing tympanocentesis. Read More

Clin Allergy Immunol 2000 ;15:247-62

University of Pittsburgh School of Medicine, Pennsylvania, USA.

Accurate diagnosis of OM is important but often difficult. To enhance the likelihood of accurate diagnosis, pneumatic otoscopy is the preferred method of examination generally available to clinicians. Findings by pneumatic otoscopy should be coupled with the presence or absence of symptoms and signs to delineate a diagnosis of AOM or OME. Read More

Arch Fam Med 1998 Mar-Apr;7(2):174-6

Department of Family Medicine, University of Texas Medical Branch, Galveston 77555-1123, USA.

Previous reports of telemedicine consultations have demonstrated that the technology is effective but inefficient. Little attention has been directed to the use of telemedicine in a primary care practice, especially the use of the medical peripheral devices. We used a functioning primary care practice as a telemedicine test bed, providing unselected patients in the study group. Read More

Br J Audiol 1993 Dec;27(6):409-14

ENT Department, P. and A. Kyriakou Children's Hospital, Athens, Greece.

Accurate detection of middle-ear effusion in children is not only useful but also necessary for diagnosis, management and follow-up of otitis media. A relatively new device, the Acoustic Otoscope (model 101, ENT Medical Devices) has been introduced for detecting middle-ear fluid in children. We tested 158 ears and the diagnosis was confirmed by acoustic admittance, acoustic reflex and pneumatic otoscopy. Read More

J R Coll Gen Pract 1988 Apr;38(309):149-52

Children aged six months to 10 years in one practice who were diagnosed with acute otitis media were examined one, three, six and 12 months after diagnosis by a general practitioner and an otolaryngologist on the same day using pneumatic otoscopy. Tympanometry and pure tone audimetry were also carried out. Tympanograms were combined with the specialist's otoscopy findings to determine whether effusion was present. Read More

Otolaryngol Head Neck Surg 1987 Feb;96(2):119-24

Division of Otorhinolaryngology, University of Texas Health Science Center, San Antonio 78284.

Pneumatic otoscopy has long been espoused as an easily and rapidly used, inexpensive method for routine evaluation of the tympanic membrane and middle ear. This widely used technique, however, has not been explored in a quantitative manner. Therefore, we measured the differential pressure and frequency of the pressure pulse used by a group of experienced otoscopists during routine pneumatic otoscopic examination. Read More

South Med J 1982 Mar;75(3):335-8

The pneumatic otoscope is indispensable in evaluating pressure within the middle ear of infants and children by measuring the tympanic membrane mobility. If the eardrum moves normally in response to positive and negative pressure, then a significant ear effusion, suppurative or nonsuppurative, is highly unlikely. Tympanic membrane color, luster, translucence, and light reflex should therefore be correlated with mobility before any decisions regarding therapy are made. Read More

Int J Pediatr Otorhinolaryngol 1980 Sep;2(3):261-3

JAMA 1979 Dec;242(24):2664-5

Ann Otol Rhinol Laryngol 1976 Mar-Apr;85(2 Suppl 25 Pt 2):229-33

A new quantitative diagnostic otoscope presently under development supplements the conventional otoscopic examination with a quantitative pneumatic system and objective measurements derived from tympanometry. The instrument provides information to assist in the diagnosis of the presence of middle ear effusion (MEE), the middle ear pressure and tympanic membrane status during the visual examination. Uncertainty introduced by subjective judgement involved with traditional pneumatic otoscopy is eliminated enabling a more rapid and accurate diagnosis. Read More