Tympanic thermometry and minor ear surgery

Accuracy of infrared tympanic thermometry used in the diagnosis of Fever in children: a systematic review and meta-analysis

BACKGROUND

Accurate determination and detection of fever is essential in the appropriate treatment of pediatric population. It is widely known that improper definitions of fever can cause grave and dangerous consequences in medical procedures. Infrared tympanic thermometry seems a relatively new and popular alternative for traditional measurement in the diagnosis of pediatric fever. However, its accuracy in the diagnosis of fever remains a major concern.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Medline, Ovid, Elsevier, Google Scholar, and Cochrane library.

STUDY SELECTION

Cross-sectional, prospective design.

DATA EXTRACTION

Two investigators independently assessed selected studies and extracted data. Disagreements were resolved by discussion with other reviewers.

RESULTS

A total of 25 articles were included in our meta-analysis. The summary estimates revealed that the pooled sensitivity was 0.70 (95% confidence interval [CI] = 0.68-0.72), pooled specificity was 0.86 (95% CI = 0.85-0.88), and pooled diagnostic odds ratio was 47.3 (95% CI = 29.76-75.18), for the diagnosis of fever using infrared tympanic thermometry. Additionally, the area under the summary receiver operating characteristic curve was 0.94, and Q* value was 0.87.

CONCLUSION

A total of 25 articles that encompassing 31 studies were analyzed. Based on our meta-analysis, accuracy of infrared tympanic thermometry in diagnosing fever is high. We can cautiously make conclusion that infrared tympanic thermometry should be widely used as fever of thermometer.

La mesure de la température en pratique pédiatrique quotidienne

The use of rectal mercury thermometer has long been the standard method for measurement of body temperature. The restriction of mercury use since 1996 has led to development of other devices. The liquid crystal strip thermometer held against the forehead has a low sensitivity. The single-use chemical thermometer measures oral temperature. Its accuracy must be evaluated. Infrared ear thermometers are routinely used because it is convenient and fast to use. However, numerous studies have shown that it does not show sufficient correlation with rectal temperature, leading to the risk to miss cases of true fever. Rectal temperature remains the gold standard in case of fever. Rectal temperature measurement with an electronic device is well correlated with the glass mercury standard. Galistan thermometer accuracy must be evaluated because of sterilization of the whole device, which is not the case for the electronic thermometer. A pediatric study is necessary to evaluate the performance of this device in comparison with the electronic thermometer.

Effect of the status after ear surgery and ear pathology on the results of infrared tympanic thermometry

Most publications that deal with infrared tympanic thermometry (ITT) have performed a comparison between the established temperature measurements and ITT. However, to date an understanding of the influence of pathological ear findings on ITT test results is incomplete. Therefore, in the present study ITT was performed in healthy adults (n =21), adult patients with monaural central perforation (n =31) or strong scar formations (n =24) of the tympanic membrane and 18 adult patients after monaural canal wall down surgery. Right and left ear and oral temperature were measured three times by one investigator in a room with a constant temperature of 20-22 degrees C. Between every measurement there was a free time interval of 2 min. In healthy adults (36.50 degrees C vs. 36.51 degrees C) patients with monaural central perforation of the tympanic membrane (36.41 degrees C vs. 36.34 degrees C) and with monaural strong scar formations in the tympanic membrane (36.39 degrees C vs. 36.45 degrees C), no significant difference between the right and left ear could be proved. In contrast to this, a significantly higher temperature in the surgically treated ear compared to the healthy side (36.97 degrees C vs. 36.31 degrees C; P <0.001) occurred in patients with a status of after monaural canal wall down surgery. In summary, it could be demonstrated that, in contrast to minor ear surgery, major ear surgery such as canal wall down has a significant influence on the results of ITT. If a patient's history gives reference to previous ear surgery, an otoscopic examination is necessary in order to exclude the presence of an after-canal-wall-down surgery status and thus to avoid false ITT test results.

[Otologic determining factors on infra-red tympanic thermometry in children]

OBJECTIVE

To evaluate the influence of different otoscopic findings on body thermometry in children using an infra-red tympanic thermometer.

PATIENTS AND METHODS

Body temperature was measured on healthy right and left ear canals with Thermoscan systems. Moreover, it was determined on children with altered otoscopy, companng to normal contralateral ear. To assess its diagnostic fiability, accuracy ratios were calculated in different temperatures.

RESULTS

Temperature measured bilaterally did not offer differences, and intra/interassay variation ratios were always less than 0.34%. Acute otitis externa increased tympanic thermometry a mean of 0.36 degrees C (p < 0.001), and cerumen and previously radical surgery decreased a mean of 0.62 and 0.53 degrees C, respectively (p < 0.001).

CONCLUSIONS

The conditions mentioned before modify body thermometry if measured by infra-red tympanic thermometer. So, this system must be avoided in these circumstances. Otitis media, fluid in middle ear, tympanic perforation and ventilation tubes did not modify thermometric results.

Infrared tympanic thermometer can accurately measure the body temperature in children in an emergency room setting

OBJECTIVE

The objective in this study was to compare the accuracy of the tympanic membrane infrared thermometer with the other conventional temperature measurement options.

METHODS

One hundred and ten randomly selected pediatric patients who admitted to our emergency room were included in the study. Each child underwent simultaneous temperature measurement via rectum, axilla, and external auditory canal. The rectal and axillary measurements were performed using conventional mercury in glass thermometers. The aural measurement was performed using the non-contact infrared thermometer (Braun ThermoScan IRT 1020, Germany).

RESULTS

On aural measurement, the results of both ears as well as the first, second and third measurements were similar (P<0.01). The mean results of the axillary, rectal and tympanic temperature measurements were 37.46+/-1, 38.18+/-1, and 38.01+/-1.1, respectively. The mean axillary temperature was 0.72 degrees C lower than the mean rectal temperature, and 0.55 degrees C lower than the tympanic temperature. The difference between the mean tympanic and rectal temperatures was 0.17 degrees C. The results of measurements via rectum, axilla and ear were similar (P<0.01).

CONCLUSION

In conclusion, it is apparent that each of the temperature measurement options has some advantages and disadvantages. An optimal thermometer should have the following features; accurate temperature measurement; ease of application in a short while; safety and absence of potential risks; and tolerability by the patient. Since the aural infrared thermometer meets these criteria, its use in the routine clinical practice appears to be advantageous rather than or complementary to the conventional methods.

Comparison of axillary and infrared tympanic membrane thermometry in a pediatric oncology outpatient setting

The purpose of this study was to determine whether infrared tympanic membrane thermometry can replace mercury-in-glass temperatures as an assessment tool for detecting fevers earlier and more reliably in a pediatric oncology outpatient setting. A total of 313 patient visits had infrared tympanic temperatures (obtained by using the LighTouch LTX Pedi-Q thermometer (Exergen; Watertown, MA) and axillary temperatures taken simultaneously (obtained by using mercury-in-glass thermometers). Those patients with a normal axillary temperature and an elevated tympanic measurement of 38 degrees C or higher had a follow-up axillary temperature conducted that evening to determine whether an elevated tympanic temperature predicted on coming fever or infection. The mean tympanic temperature was 37.5 degrees C and the mean axillary temperature was 36.8 degrees C, a difference of 0.7 degree C (P = .0001). Sixty-two (20%) patients had discrepant temperatures with a febrile tympanic and normal axillary measurement. Three (5%) of these patients were febrile at their follow-up axillary reading. Tympanic thermometry resulted in a significantly higher temperature reading than the axillary method. Elevated tympanic temperatures were not predictive of oncoming fever or infection. Fevers were not missed when using the tympanic method. To prevent unnecessary medical intervention, it is recommended that mercury-in-glass thermometers verify elevated tympanic temperatures.