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A Preliminary Study

Christopher M. Discolo, MD; Michael C. Byrd, MD; Teresa Bates, BA; Dov Hazony, PhD; Jan Lewandowski, PhD; Peter J. Koltai, MD

Arch Otolaryngol Head Neck Surg. 2004;130:1407-1410.

Objective  To assess the ability to detect and characterize middle ear effusion in children using A-mode ultrasonography.

Design  Prospective nonblinded comparison study.

Setting  Tertiary children’s hospital.

Patients  Forty children (74 ears) scheduled to undergo bilateral myringotomy with pressure equalization tube placement.

Interventions  Before myringotomy, ultrasound examination of the tympanic membrane and middle ear space was performed on each ear. Afterward, myringotomy was performed and the type of effusion (serous, mucoid, or purulent) was recorded. Pressure equalization tubes were then placed.

Main Outcome Measure  Comparison of ultrasound findings with the visual assessment of the type of middle ear effusion present.

Results  Of the 74 ears tested, 45 (61%) had effusion on direct inspection. The effusion was purulent in 8 ears (18%), serous in 9 ears (20%), and mucoid in 28 ears (62%). Ultrasound identified the presence or absence of effusion in 71 cases (96%) (P = .04). Ultrasound distinguished between serous and mucoid effusion with 100% accuracy (P = .04). The probe did not distinguish between mucoid and purulent effusion.

Conclusions  Ultrasonography is an accurate method of diagnosing middle ear effusion in children. Moreover, it can distinguish thin from mucoid fluid. Further refinements in probe design may further improve the sensitivity of fluid detection and allow differentiation of sterile vs infectious effusion.

Author Affiliations: Section of Pediatric Otolaryngology, Head and Neck Institute, The Cleveland Clinic Foundation (Drs Discolo, Byrd, and Koltai), Biomec Inc (Ms Bates and Dr Lewandowski), and Department of Electrical Engineering and Computer Science, Case Western Reserve University (Dr Hazony), Cleveland, Ohio. Dr Koltai is now with the Division of Pediatric Otolaryngology, Stanford University, Stanford, Calif.

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