Pediatricians and the pneumatic otoscope: are we playing it by ear?

The amount of positive pressure delivered during pneumatic otoscopy was recorded in 53 healthy pediatric patients. The pressures generated ranged from 338 to 1134 mm H2O. The mean pressure introduced was 748 mm H2O with the bulb and 502 mm H2O through the mouthpiece. The mean intraobserver variation in pressure delivered to each patient was 199 and 125 mm H2O with these two methods of insufflation, respectively. These data document the wide variation in pressures generated with the pneumatic otoscope and suggest that the feasibility of modifying this instrument into a standardized, objective pneumatic system should be explored.