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Advanced Otoscopy and AOM: A New Way to Combat Antibiotic Overprescription

It’s estimated that 80% of all children will develop acute otitis media (AOM) at least once. Of those children, between 80% and 90% will experience at least one episode of otitis media with effusion (OME) before they reach school age.1

For many years, physicians relied on reported symptoms to diagnose this common childhood condition—even when ear exams showed no inflammation. In the wake of antibiotic resistance and increased concerns about antibiotic overprescribing for children, the American Academy of Pediatrics (AAP) issued new guidelines in 2004 about the diagnosis and treatment of AOM. These guidelines stated that clinicians should only diagnose AOM in children who have:2

  • Moderate to severe bulging of the tympanic membrane (TM)
  • New onset of otorrhea not due to acute otitis externa
  • Mild bulging of the TM and recent (less than 48 hours) onset of ear pain or intense erythema of the TM

These updated guidelines called for pneumatic otoscopy and/or tympanometry to identify middle ear effusion (MEE), making the physical exam even more critical for diagnosing AOM in children. However, this new approach posed a challenge for clinicians: Getting a clear enough view of the middle ear to spot MEE.

Advanced otoscopes with wide view, higher magnification and digital imaging can and should play a role in more accurate diagnosis of MEE, but the benefits of advanced otoscopic technology go far beyond accurate diagnoses. It may also help physicians monitor for symptom variability, reduce errors associated with fatigue and increase their confidence. As a result, advanced optics, brighter LED illumination and digital imaging can make exams quicker and more convenient and may be key to curbing overprescription in children.

AOM Misdiagnosis

According to a study published in Family Practice comparing the diagnostic accuracy of physicians, there was “substantial discrepancy in diagnoses” of AOM. Since children are not reliable narrators of their symptoms, these discrepancies may come down to the lack of reliability in reported symptoms when relying on symptomatology alone.

The use of a pneumatic otoscope and tympanometry, however, reduced AOM diagnoses by more than 30%3— suggesting that the physical exam may be the missing link in accurately diagnosing pediatric AOM.

Plus, since many symptoms associated with AOM are highly variable, high-magnification optics and digital imaging may be powerful tools for identifying illness even when children are unaware of or unable to convey symptoms related to their condition. Wide-view optics mean more of the anatomy is in view at once and SureColorTM illumination provides a brighter image, which is important when examining young patients who move and squirm, especially when they’re not feeling well.

In fact, a study of 302 children with AOM found that 40% of these children never complained of or never had any symptoms of an earache, 31% did not have a fever, and half did not experience any sleep disturbances.4

Though symptoms like pain and fever should still play a role in the diagnosis of AOM in children, they are only part of the equation. Through the use of wide-view otoscopes coupled with digital imaging, physicians may have more confidence when detecting symptoms like MEE, and determine if a patient truly needs antibiotics.

Reducing Physician Fatigue with Improved Technology

Symptom variability aside, there are other factors that contribute to incorrect diagnosis and treatment of AOM in children. This includes physician fatigue and burnout, which according to a recent survey conducted by The Mayo Clinic is a growing issue facing physicians today. In the survey, a whopping 54.4% of physicians surveyed reported at least one symptom of burnout, compared to 45.5% just three years prior.5

This same research notes that excessive workloads and long working hours lead to physician fatigue, which can contribute to a rise in medical errors and a decrease in patient satisfaction.5 Technology that’s designed to make physical examinations faster and easier, however, can play a crucial role in reducing physician burnout and improving patient outcomes.

For example, advanced otoscopes, like the Welch Allyn® MacroView™ and Digital MacroView Otoscope, can provide a greater field of view and magnification. Additionally, SureColorTM LED lamps provide a brighter, easier-to-see view. The digital version also allows clinicians to capture images and document progression while conducting live exams with the parent. These features allow clinicians to diagnose patients faster, more easily and with greater comfort and confidence.


To accurately diagnose and treat AOM in children according to AAP guidelines, physicians need the tools and technology to help them diagnose patients faster and more easily. Advanced otoscopes do so by providing:

  • Greater field of view of the auditory canal and tympanic membrane
  • Greater magnification for closer inspection of the tympanic membrane
  • Greater clarity to allow for easier definition of landmarks

Enhancing the physical exam with technology can help physicians more accurately diagnose AOM. By balancing high tech and high touch as part of the physical examination, physicians can better solve for the challenge of antibiotic overprescription while improving patient outcomes and parent satisfaction.

Learn more about how technology can enhance diagnostic accuracy in the physical assessment by downloading our eBook: Your Guide to Performing the Modern-Day Physical Exam.


1. Otitis Media: Diagnosis and Treatment. American Family Physician. Retrieved April 26, 2019.
2. Lieberthal, A., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson, M., . . . Tunkel, D. E. (2013). The Diagnosis and Management of Acute Otitis Media. American Academy of Pediatrics, 131(3). Retrieved April 26, 2019.
3. Blomgren, K., & Pitkaranta, A. (2003). Is it possible to diagnose acute otitis media accurately in primary health care? Family Practice, 20(5). Retrieved April 26, 2019.
4. Pichichero, M. E., MD. (2000). Acute Otitis Media: Part I. Improving Diagnostic Accuracy. American Family Physician, 61(7). Retrieved April 26, 2019.
5. Shanafelt, T. D., MD, Hasan, O., MBBS, MPH, Dyrbye, L. N., MD, MHPE, Sinsky, C., MD, Satele, D., MS, Sloan, J., PhD, & West, C. P., MD, PhD. (2015). Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clinic Proceedings, 90(12), 1600-1613. Retrieved April 26, 2019.