Infrared transtympanic temperature measurement and otitis media with effusion

Comparison of bilateral eardrum temperatures measured using an infrared tympanic thermometer before and after surgery in patients with chronic otitis media

This study aimed to investigate the effect of chronic otitis media (COM) and COM surgery on infrared tympanic thermometer measurements. We retrospectively reviewed the medical records of 192 patients (192 surgery cases) who underwent surgery for COM and whose bilateral tympanic membrane temperature was measured with an infrared tympanic thermometer the day before surgery and at 2, 3, 4, and 6 months after surgery. Patients underwent surgery for COM in 1 ear, the other eardrum was intact. Patients who underwent tympanoplasty, simple mastoidectomy, and canal wall up mastoidectomy, surgeries performed to preserve the ear canal, were included in group A, and patients who underwent canal wall down mastoidectomy, a surgery to remove the ear canal, were included in group B. There were 115 and 77 patients in groups A and B, respectively. The mean temperature on the side with COM measured the day before surgery was 37.09°C ± 0.325°C and the mean temperature on the opposite normal side was 37.03°C ± 0.330°C (P = .000). In group A, the eardrum temperature on the surgical and contralateral side was not statistically different after surgery (P = .439). The temperature difference between both sides of the eardrums (dTemp) changed from 0.056°C before surgery to 0.014°C after surgery (P = .008). However, in group B, which canal wall down mastoidectomy was performed, the eardrum temperature of the surgical side was higher than that on the other side (P = .001). The dTemp increased up to 0.15°C after surgery (P = .000). The temperature of the eardrum was slightly increased by COM. The COM surgeries, which preserve the ear canal, brought the temperature of the eardrum close to that of the normal eardrum, and the surgery to remove the ear canal raised the temperature of the eardrum.

Perioperative hypothermia during hip fracture surgery: An observational study

RATIONALE

Elderly patients are at high risk of accidental perioperative hypothermia. The primary objective of this study was to measure the changes in body temperature and the incidence of hypothermia in elderly patients undergoing hip fracture surgery.

METHODS

We conducted a prospective observational study on all adult patients undergoing surgery for fractured neck of femur between December 2013 and July 2014. We monitored their temperatures in different perioperative areas at multiple time points and also noted the warming methods used.

RESULTS

Eighty-seven patients were included in this study. A significant drop in body temperature (0.7°C, 95% CI: 0.6-0.9, P < 0.001) occurred from their arrival at the operating theatre until their arrival at the recovery room. A significant drop of 0.2°C (95% CI: 0.1-0.4, P < 0.001) was observed at the holding bay area. One third of the patients were noted to be hypothermic when they arrived at the recovery room.

CONCLUSION

These results indicate that despite the use of active warming methods for most patients, significant hypothermia is still an issue amongst elderly patients undergoing hip fracture surgery. Further improvement is necessary to prevent hypothermia in this high-risk group of patients.

Variation in Normal Ear Temperature

BACKGROUND

Variation in baseline ear temperature, taken in the unadjusted mode, has yet to be established in different age groups. Because normal body temperatures show large variations, the same may be expected for increased temperatures in fever. The aims were to study variations in normothermic body temperatures measured with an ear thermometer and to determine differences between actual and perceived body temperature during a febrile episode (referred to as difftemp) in apparently healthy children and adults.

METHODS

Ear temperature was measured once in 2,006 individuals (61.7% females): 683 children aged 2 and 4 years, 492 adolescents aged 10-18 years, 685 adults aged 19-65 years and 146 elderly aged 66-89 years. Difftemp was estimated as the difference between the individual's ear body temperature, measured in the present study, and the respondent's reported temperature when feverish.

RESULTS

Mean ear temperature was 36.4 ± 0.6°C overall and in the child and adult groups. In adolescents, it was 36.5 ± 0.5°C, and in elderly, 36.1 ± 0.5°C. Temperature in men was 36.3 ± 0.6°C, and in women, 36.5 ± 0.5°C. Difftemp was 1.1 ± 0.7°C in adolescents, 1.5 ± 0.7°C in children and adults, and 1.6 ± 0.7°C in those >65 years.

CONCLUSIONS

Ear body temperature is lower than traditionally reported and differs with age and sex. An individual difftemp of 1.0-1.5°C along with malaise might indicate fever.

Comparison of Axillary and Tympanic Temperature Measurements in Children Diagnosed with Acute Otitis Media

Background. Acute otitis media [AOM] may affect the accuracy of tympanic temperature measurements. We aimed to compare tympanic temperature measurements in patients with AOM against control groups, as well as compare the tympanic temperatures with axillary thermometry. Methods. This is a prospective, observational study. Patients from pediatric outpatient and emergency clinics who were diagnosed as single-sided AOM were included consecutively in the study. Normal ears of patients and children having the same age and gender who were not diagnosed as AOM were also studied as controls. Results. In patients with AOM, infected ears had higher temperatures than normal ears with a mean of 0.48 ± 0.01°C. There was no significant difference between the right and left tympanic temperatures in control group. Compared with axillary temperature, the sensitivity of tympanic temperature in the infected ear was 91.7% and the specificity was 74.8%. Conclusion. Comparisons of axillary and tympanic temperatures in children with AOM during the active infection concluded higher tympanic temperatures in infected ears. We suggest that the higher tympanic temperatures, approximately 0.5°C in our study, in infected ears may aid in diagnosis of patients with fever without a source in pediatric clinics.

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.

Assessment of body temperature measurement options

Assessment of body temperature is important for decisions in nursing care, medical diagnosis, treatment and the need of laboratory tests. The definition of normal body temperature as 37°C was established in the middle of the 19th century. Since then the technical design and the accuracy of thermometers has been much improved. Knowledge of physical influence on the individual body temperature, such as thermoregulation and hormones, are still not taken into consideration in body temperature assessment. It is time for a change; the unadjusted mode should be used, without adjusting to another site and the same site of measurement should be used as far as possible. Peripheral sites, such as the axillary and the forehead site, are not recommended as an assessment of core body temperature in adults. Frail elderly individuals might have a low normal body temperature and therefore be at risk of being assessed as non-febrile. As the ear site is close to the hypothalamus and quickly responds to changes in the set point temperature, it is a preferable and recommendable site for measurement of body temperature.

Regional neonatal brain absolute thermometry by 1H MRS

Therapeutic hypothermia is standard care for infants with moderate to severe encephalopathy. (1) H MRS thermometry (MRSt) measures regional brain absolute temperature using the temperature-dependent water chemical shift. This study evaluates the clinical feasibility of MRSt in human neonates, and correlates white matter (WM) and thalamus (Thal) MRSt with conventional rectal temperature (Trectal ) measurement. Fifty-six infants born at term underwent perinatal MRSt for suspected hypoxic-ischaemic brain injury and 33 infants born preterm had MRSt at a term-equivalent age; 56 of the 89 had Trectal measured after MRSt of either a Thal or posterior WM voxel, or both. MRSt used point-resolved spectroscopy (no water suppression; TR = 1370 ms; TE = 288 ms; 1.5 × 1.5 × 1.5 cm(3) Thal and 1.1 × 1.3 × 1.4 cm(3) WM voxels). Time domain data were phase and frequency corrected before summation and motion-corrupted data were excluded from further analysis using simple criteria [preprocessing + quality assurance (QA)]. Two published water temperature-dependence calibrations [both using cerebral creatine (Cr), choline (Cho) and N-acetylaspartate (Naa) as independent reference peaks] were compared. The temperature measurements derived from Cr, Cho and Naa were combined to give a single amplitude-weighted combination temperature (TAWC ). WM and Thal TAWC correlated linearly with Trectal (Thal slope, 0.82 ± 0.04, R(2) = 0.85, p < 0.05; WM slope, 0.95 ± 0.04, R(2) = 0.78, p < 0.05). Preprocessing + QA improved the correlation between WM TAWC and Trectal (R(2) increased from 0.27 to 0.78, p < 0.001). Both calibration datasets showed specific inconsistencies between the temperatures calculated using Cr, Cho and Naa reference peaks when applied to this neonatal dataset. Neonatal MRSt is clinically feasible. Preprocessing + QA improved MRSt reliability in WM. The consideration of MRSt calibration internal biases is necessary before combining MRSt temperatures from multiple reference peaks to obtain TAWC.

[Circadian variability at oral, tympanic and axillary temperature in hospitalized adults]

The aim of this study was to measure the circadian variability of patients' temperature in the eardrum, oral, and armpit positions considering the measurement angle. The study was carried out at the State University of Campinas' Clinics Hospital (HC Unicamp), a school hospital in the city of Campinas, State of São Paulo. Temperatures were taken in the Cardiology, Adult General Clinic and Gastric infirmaries every two hours in two consecutive days, from the time patients woke up until 10 PM. The results show a significant difference, p-value = 0.0001, between the morning and afternoon periods compared to the evening period. The Tukey test has also showed a difference. It was observed that the measurement in the eardrum position resulted in higher temperatures compared to the other positions, thus confirming data in the international literature. The circadian variability eardrum temperature was similar to the measurements of the oral temperature during the patients' awaked period.

Is tympanic membrane thermometry the best method for recording temperature in children?

Tympanic membrane thermometry has become increasingly popular for measuring temperature in children. The aim of this review is to ascertain the most appropriate, research-based thermometry method for use with children in acute healthcare settings. The following are considered: Concerns regarding the accuracy of the tympanic membrane thermometer. Whether comparison of the tympanic membrane thermometer with temperature measurement at other body sites is appropriate. How choice of thermometer may be influenced by children's and nurses' preferences, technique, the age of the child, ear size and children with otitis media, perforated eardrums, cerumen (ear wax), ear pain or grommets in-situ. Children's preferences and rectal thermometry in relation to children's rights, which have not been reviewed so far.

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.

Can There Be a Standard for Temperature Measurement in the Pediatric Intensive Care Unit?

Temperature measurement is a commonly used assessment parameter when caring for the critically ill child. Interpreting the temperature measurement mode and what constitutes clinically significant thermal instability are poorly defined. Thus, decisions made regarding patient management based on temperature measurement can be challenging for caregivers. Infants and children have unique physioanatomic considerations that impact maintaining thermoregulation. Numerous routes for taking temperature measurements are described including the oral, axillary, tympanic (aural), rectal, skin, urinary bladder, pulmonary artery, esophageal, nasopharyngeal, supralingual (pacifier), and temporal-artery. Numerous studies on temperature measurement have been conducted on children of various ages using a variety of thermometers and routes in both the inpatient and outpatient setting. Although there are limited studies reported on the critically ill child, research data pertinent to the critically ill child from subjects in the neonatal intensive care unit, pediatric intensive care unit, operating room, and inpatient units are summarized.

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.