A comparison between video otoscopy and standard tympanometry findings in adults living with human immunodeficiency virus (HIV) in South Africa

Abstract

BackgroundLiterature suggests that there is a correlation between video otoscopy and standard tympanometry findings. However, there is limited evidence on whether these two measures are comparable in the identification of middle ear pathologies in adults living with human immunodeficiency virus (HIV).ObjectiveThis study aimed to determine the correlation between video otoscopy and standard tympanometry with 226 Hz probe tone in the identification of middle ear pathologies in adults living with HIV in Limpopo, South Africa.MethodA prospective, non-experimental, comparative design was employed on HIV-positive adults aged 18 years and older. All participants underwent basic audiological assessment including case history interviews, video otoscopy, tympanometry with a 226 Hz probe tone and pure tone audiometry. Two ear, nose and throat (ENT) specialists independently analysed video otoscopic images and provided their reports to the researcher, and these were compared to the tympanometry results. The IBM SPSS v.24 was used for data analysis, including the use of Cohen’s kappa to determine the agreement between the two procedures. Pearson’s correlation coefficient was used to determine the strength of the correlation between tympanometry and video otoscopy.ResultsA total of 87 adults (N = 161 ears) took part in the study. Middle ear pathology was observed in 8% (n = 13) of the sample when tympanometry was used, and this increased to 10.6% (n = 17) when video otoscopy was utilised. Kappa statistics found a good agreement (k = 0.7) between the diagnoses made by two ENTs. However, there was poor agreement (k = 0.2) between the diagnoses by video otoscopy and tympanometry. Pearson’s correlation coefficient indicated weak correlation between video otoscopy and tympanometry (r = 0.195).ConclusionFindings from this study suggest that video otoscopy may be more accurate in the identification of middle ear pathologies in adults living with HIV when compared to tympanometry. These findings have training implications in the use of video otoscopy to ensure accuracy and reliability. Clinical implications of current findings include the use of both video otoscopy and tympanometry in a complementary manner for more sensitive identification of middle ear pathologies in this population. Lastly, tele-audiologic implications of the use of video otoscopy to increase access in resource-constrained contexts are raised.

Diagnostic accuracy of non‐specialist versus specialist health workers in diagnosing hearing loss and ear disease in Malawi

“…In a study by Sebothoma et al . (2018), agreement in diagnoses between two ENTs was high . Pinchichero reported that within cadres, the diagnoses were highly consistent, however, data were not provided on level of agreement .…”

Middle ear Pathologies in Adults Living with Human Immunodeficiency Virus: A Systematic Review

“…1,10 Despite these advancements, occurrence of middle ear pathologies seems to persist in individuals living with HIV. 11,12 Disorders of the auditory and vestibular system, including otitis media, are often associated with HIV/AIDS 13,14…”

“…There has been increasing evidence that suggests that HIV increases the risk of middle ear pathologies by causing the CD4 cell count to decline in the body and thus incapacitating the immune system, 15 allowing the viruses and bacteria to enter the middle ear system causing middle ear disorders. 16 Several studies have reported that otitis media with effusion (OME), serous otitis media (SOM), retracted tympanic membrane (TM) and perforated TM occur in adults with HIV, 12,16-18 and this has an influence in patients’ quality of lives.…”

A systematic review of remote otological assessment using video-otoscopy over the past 10 years: reliability and applications

“…The accuracy of assessment may be improved using adjuvant tests such as pure-tone audiometry and tympanography; however, this requires the use of additional equipment and training for facilitators. None of the included studies looked specifically at the use of adjuvant investigations and whether this improved diagnostic concordance; however, Sebothoma et al [ 9 ] suggested that remote assessment of video-otoscopy plus tympanometry, is superior in identifying middle ear effusions compared to tympanometry alone. It could be suggested that the ability of remote assessment to answer the binary question of whether an examination is ‘normal’ or ‘abnormal’ is more important that its ability to distinguish between specific pathologies, as this is likely to be the trigger for further assessment by an otolaryngology specialist.…”