Optical coherence tomography for middle ear effusion diagnosis in children

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Created On: 08/04/2026

Accurate detection of middle ear effusion (MEE) is fundamental for diagnosing acute otitis media (AOM) and otitis media with effusion (OME) in kids.

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Key take away

Optical coherence tomography demonstrates high specificity and comparable diagnostic accuracy to otoscopy and tympanometry for detecting middle ear effusion in pediatric patients.

Background

Accurate detection of middle ear effusion (MEE) is fundamental for diagnosing acute otitis media (AOM) and otitis media with effusion (OME) in kids. Optical coherence tomography (OCT) has evolved as a valuable noninvasive imaging technique for evaluating MEE. This study compared the diagnostic accuracy of OCT with standard methods, including otoscopy and tympanometry, in pediatric patients.

Method

In this prospective study, 164 children (aged 6 months to 12 years) were enrolled from two tertiary pediatric otolaryngology clinics. Each kid underwent otoscopic examination, tympanometry, and OCT imaging during their visit. OCT scans were independently evaluated by both a non-clinical reviewer and fellowship-trained pediatric otolaryngologist. Diagnostic performance was assessed using agreement rates, sensitivity, and specificity for MEE detection.

Result

A total of 328 ears were analyzed. MEE was identified in 32% of cases via otoscopy, 24% through tympanometry, and 18% using OCT. Agreement rates were high across modalities: 81.2% between otoscopy and tympanometry, 77.7% between otoscopy and OCT, and 80.5% between tympanometry and OCT. Inter-rater reliability for OCT interpretation illustrated moderate agreement (Cohen’s κ = 0.41). OCT depicted a sensitivity of 74% and a specificity of 93%, indicating diagnostic performance comparable to conventional techniques.

Conclusion

OCT exhibited strong potential as a reliable, noninvasive diagnostic tool for assessing MEE in children. With accuracy comparable to pneumatic otoscopy and tympanometry, OCT may enhance early diagnosis, improve clinical decision-making, and support ongoing monitoring of pediatric ear infections.