Use of Concentrated Light to Determine Middle Ear Effusion: The Laser Otoscope

Abstract

Objectives: (1) Appreciate the current diagnostic limitations and significant misinterpretation rate (nearly 50%) of acute otitis media (AOM) and otitis media with effusion (OME) by general practitioners and pediatricians using the conventional otoscope. (2) Recognize the optical properties of middle ear effusion (MEE) and this innovation’s ability to improve diagnosis using a concentrated (laser) light. Methods: Laser otoscopes were developed and designed with class IIIa lasers. The laser propagates with the incandescent light to illuminate on the tympanic membrane (TM). An institutional review board–approved prospective pilot study was completed at a tertiary care hospital. Study patients were 1 to 18 years and undergoing ear tube placement. The laser otoscope was used on each ear for assessment of MEE prior to myringotomy. The simple objective presence or nonpresence of a glow of the laser on the TM surface was recorded. Presence of a glow signified MEE due to the dispersion quality of light through liquid versus air. True presence of MEE was then determined with myringotomy. Results: Fifty ears (25 patients) were enrolled. Assessing only for a simple objective glow without any further interpretation of the middle ear contents yielded an 89.4% accuracy for determining MEE. Conclusions: The laser otoscope is a novel, simple, and potentially extremely useful tool for assisting in otoscopic determination of fluid in the middle ear. Particularly among primary care givers, MEE assessment may be able to be increased from nearly 50% to nearly 90%, by simply assessing for a laser glow or no-glow on the TM surface.