Diagnostic accuracy of the video otoscope in tympanic membrane perforation

OBJECTIVE: The video otoscope has already proven to be useful for the diagnosis of several pathologies, so the objective of this study was to evaluate the diagnostic accuracy of the video otoscope in cases of tympanic membrane perforation. METHODS: This is a diagnostic accuracy study performed at the hearing health division of a tertiary-level referral hospital. Patients older than 8 years of age who had any symptom that could be related to perforation (otalgia, otorrhea, tinnitus, and/or hypoacusis) were invited to participate in the study. Participants were evaluated by three different diagnostic methods (otomicroscope, conventional otoscope, and video otoscope) performed by three different evaluators in a blind fashion. The microscope was considered the reference standard. RESULTS: 176 patients were evaluated, totaling 352 tympanic membranes. Twenty-seven tympanic membrane perforations were diagnosed by the microscope, a prevalence of 7.7%. The video otoscope showed a sensitivity of 85.2% (95% CI 81.5%‒88.9%), specificity of 98.1% (95% CI 96.7%‒99.5%) and accuracy of 97.1% (95% CI 95.4 %–98.8 %). The conventional otoscope showed a sensitivity of 96.3% (95% CI 94.3–98.3), specificity of 98.8% (95% CI 97.7–99.9) and accuracy of 98.6% (95% CI 97.4–99.8). The Kappa value between the microscope and the video otoscope was 0.8 and between the microscope and the conventional otoscope was 0.9. Regarding the participants' perception, 53.4% (p < 0.001) considered the video otoscope as the best method for understanding the tympanic membrane condition presented by them. CONCLUSIONS: The video otoscope showed relevant sensitivity and specificity for clinical practice in the diagnosis of tympanic membrane perforation. Moreover, this is an equipment that can facilitate the patient's understanding of the otologic pathology presented by him/her. In this regard, this method may be important for better patient compliance, requiring further studies to evaluate this hypothesis. LEVEL OF EVIDENCE: Is this diagnostic or monitoring test accurate? (Diagnosis)—Level 2 (Individual cross-sectional studies with consistently applied reference standard and blinding).