Tympanometry by nurses—Can allocation of tasks be optimised?

Blomgren, Karin; Haapkylä, Johanna; Pitkäranta, Anne

doi:10.1016/j.ijporl.2006.08.010

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…In this study, tympanometric and SG-AR success rates were affected by the children's age, the nurses’ experience, the tympanometer used, and whether examinations (ears) or visits were analysed. The tympanometric success rate was lower than in most of the previous studies [ 5 , 14 , 16 , 20 ]. On the other hand, the tympanometric success rate corresponds to some of the studies with children aged 6–35 months [ 9 , 10 ].…”

Section: Discussioncontrasting

confidence: 72%

Can nurses exclude middle-ear effusion without otoscopy in young asymptomatic children in primary care?

Laine

Tähtinen

Ruuskanen

et al. 2015

Scandinavian Journal of Primary Health Care

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Objective. Scandinavian guidelines recommend controlling middle-ear effusion (MEE) after acute otitis media. The study aim was to determine whether nurses without otoscopic experience can reliably exclude MEE with tympanometry or spectral gradient acoustic reflectometry (SG-AR) at asymptomatic visits. Design. Three nurses were taught to perform examinations with tympanometry and SG-AR. Pneumatic otoscopy by the study physician served as the diagnostic standard. Setting. Study clinic at primary health care level. Patients. A total of 156 children aged 6–35 months. Main outcome measures. Predictive values (with 95% confidence interval) for tympanometry and SG-AR, and the clinical usefulness, i.e. the proportion of visits where nurses obtained the exclusive test result from both ears of the child. Results. At 196 visits, the negative predictive value of type A and C1 tympanograms (tympanometric peak pressure > −200 daPa) was 95% (91–97%). Based on type A and C1 tympanograms, the nurse could exclude MEE at 81/196 (41%) of visits. The negative predictive value of SG-AR level 1 result was 86% (79–91%). Based on SG-AR level 1 results, the nurse could exclude MEE at 29/196 (15%) of visits. Conclusion. Tympanograms with tympanometric peak pressure > −200 daPa (types A and C1) obtained by nurses are reliable test results in excluding MEE. However, these test results were obtained at less than half of the asymptomatic visits and, thus, the usefulness of excluding MEE by nurses depends on the clinical setting.

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Section: Discussioncontrasting

confidence: 72%

Can nurses exclude middle-ear effusion without otoscopy in young asymptomatic children in primary care?

Laine

Tähtinen

Ruuskanen

et al. 2015

Scandinavian Journal of Primary Health Care

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“…The nurses’ success rates with tympanometry were lower than most of the previously reported success rates [ 11 , 16 , 20 ]. On the other hand, corresponding success rates have been reported in children of less than two years of age [ 8 ], who are the most difficult to examine [ 20 ].…”

Section: Discussioncontrasting

confidence: 63%

“…Blomgren et al. [ 16 ] concluded that, on the basis of a brief teaching session, nurses could not be taught to detect MEE with tympanometry in children undergoing tympanostomy tube placement. On the other hand, we have recently shown that nurses could reliably exclude MEE with type A and C1 tympanograms in asymptomatic children of 6–35 months of age [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Can trained nurses exclude acute otitis media with tympanometry or acoustic reflectometry in symptomatic children?

Laine

Tähtinen

Ruuskanen

et al. 2015

Scandinavian Journal of Primary Health Care

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Objective Since acute otitis media (AOM) is the most prevalent bacterial infection in young children, the reliable exclusion of AOM by nurses might save physicians’ time for other duties. The study aim was to determine whether nurses without otoscopic experience can reliably use tympanometry or spectral gradient acoustic reflectometry (SG-AR) to exclude AOM.Design Three nurses were trained, who performed examinations with tympanometry and SG-AR. Pneumatic otoscopy by the study physician served as the diagnostic standard.Setting Study clinic at primary health care level.Patients. 281 children 6–35 months of age.Main outcome measures Predictive values (with 95% confidence interval) for tympanometry and SG-AR, and the clinical usefulness, i.e. the proportion of visits where nurses obtained the exclusive test result from both ears of the child.Results At 459 visits, the negative predictive value of type A and C1 tympanograms (tympanometric peak pressure >–200 daPa) was 94% (91–97%). Based on type A and C1 tympanograms, the nurse could exclude AOM at 94/459 (20%) of visits. The negative predictive value of SG-AR level 1 result (>95°) was 94% (89–97%). Based on the SG-AR level 1 result, the nurse could exclude AOM at 36/459 (8%) of visits.Conclusion Type A and C1 tympanograms and SG-AR level 1 results obtained by nurses are reliable test results in excluding AOM. However, the clinical usefulness of these test results is limited by their rarity. Type A and C1 tympanograms were obtained by nurses from both ears of the child only at one-fifth of the symptomatic visits.Key PointsAcute otitis media (AOM) is the most prevalent bacterial infection in young children. Nurses’ role in excluding AOM is unknown.Type A and C1 tympanograms (tympanometric peak pressure >–200 daPa) obtained by nurses are reliable test results in excluding AOM.With type A and C1 tympanograms, nurses could exclude AOM only at one-fifth of the symptomatic visits.The clinical usefulness of the exclusion of AOM performed by nurses seems to be limited.

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“…It has been argued that nurses do not have the skills or sufficient training to conduct tympanometry. 100 Most of this research has been conducted in secondary care, where tympanometry diagnosis has been compared directly with the best relative standard of myringotomy ('relative' because of substantial dry tap rates at myringotomy), giving a direct measure of specificity and sensitivity for detecting middle ear effusions. 101 In the secondary care environment, multiple rigorous measures of bilateral OME causing persistent hearing loss are required as part of the AM process prior to undertaking grommet surgery, a requirement of the NICE guidelines.…”

Section: Primary Care Management Of Glue Earmentioning

confidence: 99%

An open randomised study of autoinflation in 4- to 11-year-old school children with otitis media with effusion in primary care

Williamson

Vennik

Harnden

et al. 2015

Health Technol Assess

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BackgroundOtitis media with effusion (OME) is a very common problem in primary care, but one that lacks an evidence-based non-surgical treatment.ObjectiveTo determine the clinical effectiveness of nasal balloon autoinflation for the treatment of OME in children.DesignA pragmatic, two-arm, open randomised controlled trial.SettingForty-three general practices from 17 UK primary care trusts recruited between January 2012 and February 2013.ParticipantsSchool children aged 4–11 years with a history of OME symptoms or related concerns in the previous 3 months, and a type B tympanogram, diagnostic of a middle ear effusion, in one or both ears.InterventionThree hundred and twenty children were randomised, 160 to each group, using independent web-based computer-generated randomisation (with minimisation based on age, sex and baseline severity of OME) to either nasal balloon autoinflation performed three times per day for 1–3 months plus usual care, or usual care alone.Main outcome measuresThe proportion of children demonstrating clearance of middle ear fluid in at least one ear (with normal tympanograms) at 1 and 3 months, assessed blind to treatment. An ear-related measure of quality of life (QoL) [a 14-point questionnaire on the impact of OME (OMQ-14)], weekly diary recorded symptoms, compliance and adverse events were all secondary outcomes.ResultsAt 1 month, the proportion of children with normal tympanograms was 47.3% (62/131) in those allocated to autoinflation and 35.6% (47/132) in those receiving usual care [adjusted relative risk (RR) 1.36, 95% confidence interval (CI) 0.99 to 1.88]. At 3 months, the proportions were 49.6% (62/125) and 38.3% (46/120), respectively (adjusted RR 1.37, 95% CI 1.03 to 1.83; number needed to treat = 9). The change in OMQ-14 also favoured the intervention arm (adjusted global score difference –0.42;p = 0.001). Reported compliance was good: 89% in the first month and 80% in months 2 and 3. Adverse events included otalgia in 4% of treated children compared with 1% in the control group. Minor nosebleeds (14% vs. 15%) and respiratory tract infections (18% vs. 13%) were noted.ConclusionWe found the use of autoinflation in young children with OME to be feasible in primary care and effective in both clearing effusions and improving child and parent ear-related QoL and symptoms. This method has scope to be used more widely. Further research is needed for very young children, and to inform prudent use in different health settings.Trial registrationCurrent Controlled Trials ISRCTN55208702.FundingThis project was funded by the National institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment, Vol. 19, No. 72. See the NIHR Journals Library website for further project information.

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Tympanometry by nurses—Can allocation of tasks be optimised?

Cited by 4 publications

References 18 publications

Can nurses exclude middle-ear effusion without otoscopy in young asymptomatic children in primary care?

Can nurses exclude middle-ear effusion without otoscopy in young asymptomatic children in primary care?

Can trained nurses exclude acute otitis media with tympanometry or acoustic reflectometry in symptomatic children?

An open randomised study of autoinflation in 4- to 11-year-old school children with otitis media with effusion in primary care

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