Using tympanometry to detect glue ear in general practice.

Topical intranasal corticosteroids in 4-11 year old children with persistent bilateral otitis media with effusion in primary care: double blind randomised placebo controlled trial

“…[8][9][10] Active monitoring of such children may be done in primary or secondary care, although questions have been asked as to whether general practitioners have the techniques for active monitoring or whether use of tympanometry in this setting would lead to over-referral. 11 During such periods anticipating natural resolution, temporising medical management is often given, including off-licence use of topical intranasal corticosteroids. The reasons for use of topical steroids include preliminary evidence of effectiveness and lack of proven effectiveness of other commonly given treatments such as antibiotics, decongestants, and antihistamines, which are associated with several potential harms and disadvantages, 8 some of which are major ones such as antibiotic resistance.…”

A double-blind randomised placebo-controlled trial of topical intranasal corticosteroids in 4- to 11-year-old children with persistent bilateral otitis media with effusion in primary care

“…Relatively few practices (probably less than 5%) have audiometers and/or tympanometers on their premises to aid more accurate diagnosis and improve the PPV of referral (by excluding non-cases), 31 although it has been speculated that indiscriminate use of tympanometry in primary care could lead to over referral. 32 Selection of appropriate children for referral and treatment remains a clinical priority but simple markers of severity and persistence such as season, day care, frequency of episodes (infection load) and maternal smoking could be better established and used in this setting. 13,[33][34][35][36] Referral for early surgical intervention to prevent disability developing has been part of the underlying philosophy of treatment, but current interpretation of the existing evidence is challenging this because of the clinical heterogeneity in surgical trials in Cochrane with potential for differential treatment effects.…”

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

“…[22][23][24][25] Although the history alone has moderate specificity, it is not particularly sensitive for how a child is likely to function, for example in a noisy learning environment. 26,27 OME has been described as a chronic 'invisible' illness that can be relapsing and frustrating for both the parent and child.…”