The effect and acceptability of tympanometry and pneumatic otoscopy in general practitioner diagnosis and management of XXXX .

@entity1 @entity2169 @entity2346 @entity2171
BACKGROUND: Tympanometry and pneumatic otoscopy are recommended for diagnosis of @entity2346 media, but are not frequently used by general practitioners (GPs). We examined how, after targeted short training, GP diagnosis and management of @entity2169 was changed by the addition of these techniques to non-pneumatic otoscopy. We further explored factors influencing the uptake of these techniques. METHODS: Between 2011 and 2012, we used a crossover experimental design to determine associations between tympanometry and pneumatic otoscopy and the GP diagnosis and management of @entity2169 in @entity1 aged 6  months to 6  years. GPs recorded a diagnosis and management plan after examining ears using non-pneumatic otoscopy, and another after using either tympanometry or pneumatic otoscopy. We compared diagnosis, prescription of oral antibiotics and planned GP follow-up at these two steps between the tympanometry and pneumatic otoscopy groups. We interviewed @entity1 about their views regarding these techniques and analysed these data thematically. RESULTS: Thirteen GPs recorded 694 ear examinations on 347 @entity1 : 347 examinations with non-pneumatic otoscopy; then 196 using tympanometry; and 151 using pneumatic otoscopy. Tympanometry was more likely to be associated with changes in diagnosis (   (2)   =   28.64, df 1, p   <   0.001) and planned GP follow-up (   (2)   =   9.24, df 1, p   <   0.01) than pneumatic otoscopy. Change in oral antibiotic prescription was no different between the two techniques. GPs preferred tympanometry to pneumatic otoscopy, but cost was a barrier to ongoing use. Pneumatic otoscopy was considered the more difficult skill. GPs were not convinced that the increased detection of @entity2171 afforded by tympanometry and pneumatic otoscopy resulted in benefit to general practice @entity1 . CONCLUSION: Tympanometry was more likely than pneumatic otoscopy to change GP diagnoses and follow-up plans of @entity2169 . Tympanometry may require less training than pneumatic otoscopy. GPs preferred tympanometry due to ease of use and interpretation; however, perceived high cost inhibited their intent to use it in the future. Training, cost and perceived lack of @entity1 benefit are barriers to the use of tympanometry and pneumatic otoscopy in general practice.
