Use of Acoustic Reflectometry for Home Monitoring of Otitis Media in a High-Risk Pediatric Population

Introduction Frequent visits to rule out acute otitis media or to verify resolution of middle ear fluid accumulation occupy a substantial number of pediatric office appointments and emergency department visits, many of which are unnecessary. Clinical studies and experience have shown that acute otitis media is difficult to diagnose by symptoms alone and is frequently overdiagnosed by parents of fussy children. To society, the cost of otitis media is huge in terms of medical costs and time lost from work for parents. An accurate, easy home method for detecting accumulation of fluid in the middle ear could substantially reduce these costs. Several traditional, in-clinic methods already exist for documenting accumulation of fluid in the middle ear. These methods include pneumatic otoscopy, tympanometry, and tympanocentesis. Each of these methods has distinct drawbacks, including the need for special training, cooperation of the patient, and presence of an airtight seal in the ear canal. Reliability of each method often depends on the skill and technique of the examiner, and results can be difficult to reproduce. None of these methods can be used at home by parents. A more recent technology using Abstract Objective: To evaluate use of a home ear-monitoring device to reduce medical utilization and unnecessary office visits for otitis media in young children who have frequent ear problems. Study Design: Prospective study of pediatric patients aged between six months and four years who had two or more office visits for any ear complaint in the previous six months. Subjects were randomized to a study group (n = 237) or a control group (n = 256). Parents of both groups were given general information on ear infections and middle ear fluid and were instructed to follow their usual procedure for scheduling a medical appointment if they were concerned about the child’s ears. Each child in the study group received the EarCheck Middle Ear Monitor and detailed instructions for its use at home. The medical charts of both groups were reviewed after one year, and the physician office and emergency department (ED) visits for ear-related concerns were counted. At the end of the study, parents of children in the study group received patient satisfaction questionnaires by mail. Main Outcome Measures: 1) Number of physician office and ED visits made by children in the study and control groups for ear-related problems during the study period; 2) Self-reported parental satisfaction with the health plan’s efforts to reduce unnecessary physician office visits for pediatric ear-related problems. Results: Paired t tests indicated no statistically significant difference between the control and study groups in total number of visits for ear-related problems. Mean number of total ear-related visits during the study period was 3.5 for the control group and was 3.4 for the study group; standard deviation was 0.25 for each group. These results were obtained whether the purpose of the medical visit was to rule out suspected ear infection or to conduct follow-up examination after treating an episode of otitis. Patient satisfaction questionnaires were returned by 127 parents of children in the study group and showed generally high satisfaction with the EarCheck Middle Ear Monitor: 70.4% of these respondents stated that they were either satisfied or very satisfied with the product, and 75.6% of respondents stated that they would recommend the product to other parents. Conclusions: Use of a home ear-monitoring device did not decrease the number of medical office visits for ear concerns among a high-risk pediatric population. However, the product was well received by parents of this population, and parents expressed high satisfaction with the purpose of the study.