الفهرس 
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Abstract
Summary
Otitis media with effusion (OME) is defined as a collection of fluid in the middle ear without signs or symptoms of acute ear infection. It is a common childhood disorder. It can lead to significant complications and affect children’s education and quality of life. It is considering a leading cause of antibiotic prescription in primary healthcare.
OME has numerous causes. The primary causes include viral upper respiratory tract infection, recurrent acute otitis media and chronic dysfunction of the eustachian tube. Symptoms commonly involve hearing loss or aural fullness .The majority of cases is self-limiting. If there is no improvement in 1 - 3 months of medical treatment, surgical myringotomy is indicated.
Tympanometry and pneumatic otoscopy are recommended for diagnosis of otitis media with effusion. Pneumatic otoscopy is an examination that allows detection of the mobility of tympanic membrane (TM) in response to pressure changes. Immobility of TM indicates effusion in the middle ear. One of the earliest usages of tympanometry was to estimate the middle ear pressure and, indirectly, to measure the eustachian tube functions. Clinical guidelines of OME management recommend tympanometry 226-Hz for diagnosis of OME.
Myringotomy is the gold standard for detection of otitis media with effusion. Myringotomy confirmed the presence/ absence of MEE that detected by pneumatic otoscopy and tympanometry.
In this meta-analysis, 6 articles were included with a total number of participants (475) patients and all were published between 1990 and 2005. The results of the pneumatic otoscopy and tympanometry were compared with the myringotomy findings.
The research studies were documented the sensitivity of pneumatic otoscopy to be between (87% and 93%) and the specificity to be between (58% and 91.4%). While the sensitivity of Type A and Type B tympanograms were documented to be between (80.2% and 90%) and the specificity of Type A and Type B tympanograms to be between (71% to 98.8%). This indicates no statistically difference between studies.
The studies included used different thresholds to define positive and negative test results. If there is a threshold effect, the best summary of study results is an ROC curve. There are two methods of fitting the ROC curve: symmetrical and asymmetrical curves around the (Sen=Spe) line, depending on whether DOR is or is not constant. The Diagnostic odds ratio (DOR) is calculated depending on likelihood ratio positive (LR+) and likelihood ratio negative (LR-) after determining the sensitivity and specificity of pneumatic otoscopy and tympanometry.
The Moses-Littenberg b parameter is not statistically significant (p-value = 0.2819) denoting constant diagnostic odds ratio (DOR) across included studied, so symmetric summary receiver-operating characteristic (SROC) curve is plotted. The SROC for pneumatic otoscopy shows excellent diagnostic value with an area under the ROC curve (AUC) of 0.9325 (SE = 0.0145).
The Moses-Littenberg b parameter is statistically significant (p-value = 0.0253) denoting non constant diagnostic odds ratio (DOR) across included studies, so asymmetric summary receiver-operating characteristic (SROC) curve is plotted. The SROC for tympanometry shows excellent diagnostic value with an area under the ROC curve (AUC) of 0.9136 (SE = 0.0162).
Pneumatic otoscopy is considering a successful predictor of fluid presence; consistent with previous research studies that supporting the usefulness of pneumatic otoscopy as a diagnostic tool. The use of 226-Hz tympanometry was also found to be a good predictor of presence or absence of effusion in the middle ear