Otoscopy alone has low sensitivity and specificity for acute otitis media (AOM). Otomicroscopy and pneumatic methods are superior to otoscopy. However, these methods require clinical skills. The use of different diagnostic methods for AOM differs between countries and has not been evaluated in Sweden since new guidelines were introduced in 2010. This study aimed to describe the extent of which diagnostic methods and written advice were used for AOM in children 1 to 12 years old. In this cross-sectional study all general practitioners (GPs) and specialist trainees in primary care (STs) at 27 primary health care centres in Sweden were asked to complete a self-administrated questionnaire including diagnostic approach and the management of AOM; 75% (111/148) responded to the questionnaire. Outcome Measures: GPs versus STs and their gender, the use of otoscopy, pneumatic otoscopy, otomicroscopy, tympanometry and written advice. Logistic regressions were used to evaluate the association between GPs versus STs and their gender and the use of diagnostic methods and written advice. To diagnose AOM, 98% of the GPs and STs often or always used otoscopy, in addition to this 17% often or always used otomicroscopy, 18% pneumatic otoscopy and 11% tympanometry. Written advice to parents was provided often or always by 19% of the GPs and STs. The GPs used otomicroscopy more often than STs, adjusted OR 4.9 (95% CI 1.5–17; p = 0.011). For the other diagnostic methods, no differences were found. Female GPs and STs provided written advice more often than male GPs and STs, OR 5.2 (95% CI, 1.6–17; p = 0.0061), adjusted for GP versus ST. Otoscopy was by far the most commonly used method for the diagnosis of AOM. Female GPs and STs provided written advice more frequently than did their male colleagues. GPs used the significantly better method otomicroscopy more often than STs, therefore, it is important to emphasise teaching of practical skills in otomicroscopy in the specialist training programme for general practice. A correct diagnosis is important for avoiding potentially harmful antibiotic treatments, antimicrobial resistance and possible delay of other diagnoses.

中文翻译：

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1至12岁儿童急性中耳炎的诊断方法：初级保健中的横断面研究

单独的耳镜对急性中耳炎（AOM）的敏感性和特异性较低。耳镜和气动方法优于耳镜。但是，这些方法需要临床技能。自2010年引入新指南以来，各国对AOM的不同诊断方法的使用有所不同，瑞典尚未对此进行评估。该研究旨在描述1至12岁儿童使用AOM的诊断方法和书面建议的程度老的。在这项横断面研究中，要求瑞典27个初级卫生保健中心的所有全科医生（GPs）和初级卫生保健（ST）专业受训者填写一份自我管理的问卷，包括诊断方法和AOM的管理；75％（111/148）回答了问卷。成果指标：全科医生与性工作者及其性别，使用耳镜，气动耳镜，耳镜，鼓室图和书面建议。Logistic回归用于评估GP与ST和性别之间的关联以及诊断方法和书面建议的使用。为诊断AOM，除了经常或经常使用耳镜检查的17％，气动耳镜检查的18％和鼓室压检查的11％之外，98％的GP和ST经常或经常使用耳镜。19％的全科医生和性服务人员经常或始终向父母提供书面建议。GP使用耳镜检查的频率高于ST，校正后的OR值为4.9（95％CI 1.5-17； p = 0.011）。对于其他诊断方法，未发现差异。女性全科医生和性工作者比男性全科医生和性工作者提供书面建议的频率更高，OR 5.2（95％CI，1.6–17； p = 0.0061），针对全科医生和性工作者进行了调整。迄今为止，耳镜检查是诊断AOM的最常用方法。女性全科医生和性工作者比男性同事更频繁地提供书面建议。GPs使用耳镜的方法明显优于ST，因此，在一般实践的专业培训计划中强调耳镜的实践技能的教学很重要。正确的诊断对于避免潜在的有害抗生素治疗，抗菌素耐药性和其他诊断可能的延误很重要。重要的是，应在一般实践的专业培训计划中强调耳镜的实践技能的教学。正确的诊断对于避免潜在的有害抗生素治疗，抗菌素耐药性和其他诊断可能的延误很重要。重要的是，应在一般实践的专业培训计划中强调耳镜的实践技能的教学。正确的诊断对于避免潜在的有害抗生素治疗，抗菌素耐药性和其他诊断可能的延误很重要。