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Abstrait

Promoting diagnostic accuracy in general practitioner management of otitis media in children: findings from a multimodal, interactive workshop on tympanometry and pneumatic otoscopy

Sara Rosenkranz, Penelope Abbott, Jennifer Reath, Hasantha Gunasekera, Wendy Hu

Aim Previous research has shown that general practitioners (GPs) rarely use pneumatic otoscopy or tympanometry as recommended by best practice guidelines for diagnosing otitis media. The purpose of this study was to determine whether a multimodal, interactive training workshop on the techniques of pneumatic otoscopy and tympanometry would improve the confidence of GPs for the diagnosis of otitis media with effusion (OME) and acute otitis media (AOM), and for using pneumatic otoscopy and tympanometry. Additionally, we sought to determine whether this training could change GPs’ intentions for using pneumatic otoscopy and tympanometry in their practices. Methods Twenty-three GPs participated in a three-hour training workshop led by an ear, nose and throat (ENT) surgeon, a paediatrician and an audiologist. Prior to and following the workshop, GPs completed questionnaires indicating their previous use and beliefs about the usefulness of pneumatic otoscopy and tympanometry, confidence for diagnosing AOM and OME, confidence for using pneumatic otoscopy and tympanometry, and intention to use pneumatic otoscopy and tympanometry in the future. ResultsThere were no differences (P > 0.05) from pre- to post-workshop in GP confidence for diagnosing AOM. There were increases in GP confidence for diagnosis ofOME(pre: 4.5_0.9, post: 4.9_0.4, P 0.01) and confidence for using pneumatic otoscopy (pre: 3.6 _ 1.6, post: 4.8 _ 1.0, P 0.01) and tympanometry (pre: 3.3 _ 1.5, post: 5.0 _ 0.7, P 0.01), but no change (P > 0.05) in intention to use pneumatic otoscopy or tympanometry in their practices in the future. ConclusionThese results suggest that a multimodal, interactive workshop can significantly increase the confidence of GPs for diagnosis of OME and also for using pneumatic otoscopy and tympanometry. It is likely, however, that GPs will need follow-up and further practice with these techniques to implement them in their practices.