Differentiating Acute Otitis Media (AOM) from Otitis Media with Effusion (OME) Using Autofluorescence of NADPH in Neutrophils; Otoscopes as a Method to Assess Changes in the Medical Field

Tulsian, Esha, School of Engineering and Applied Science, University of Virginia
Guilford, William, EN-Biomed Engr Dept, University of Virginia
Seabrook, Bryn, EN-Engineering and Society, University of Virginia

The two reports presented in this portfolio are connected by their interest to understand and reduce medical misdiagnosis rates. Within this portfolio, there is a technical report and a science and technology in society (STS) research paper united by analyses of a common medical device used to visually diagnose ear pathologies called the otoscope. The approaches these reports take differ, allowing a more holistic view of the problem. The technical report describes a new design in otoscopes to decrease the medical misdiagnosis rates of ear pathologies and the consequential effects those diagnoses cause. The STS research paper discusses the social and medical impact the design of the otoscope has had since it was first invented.
Approximately 80 to 90% of children will be diagnosed with otitis media (OM) - also known as an ear infection - before reaching school age (Harmes et al., 2013). This Capstone project is focusing on two specific types of otitis media. Acute otitis media (AOM) is an accumulation of middle ear fluid (MEF) due to viral or bacterial pathogens and causes recruitment of neutrophils - a type of white blood cell (Schilder et al., 2016). Otitis media with effusion (OME) is a mechanical malfunction of the eustachian tubes. Currently, there is a 50% misdiagnosis rate of OM type among pediatricians (Pichichero & Poole, 2001). This rate is of concern because the standards of care are different; AOM can be resolved with antibiotics, while OME is nonbacterial and may require surgical drainage of MEF (Schilder et al., 2016). Therefore, the goal of this project is to develop a diagnostic method capable of measuring neutrophil autofluorescence levels with a degree of sensitivity that enables differentiation between the concentrations found in healthy, AOM, and OME MEF. The ability to non-invasively detect infection in MEF would greatly improve diagnostic standards of care.
Otoscopes are a common diagnostic tool found in all physician offices to diagnose ear disorders. Its earliest iterations have been around since the 1600s and have been continuously evolving since its invention. In addition to design changes, impacts on society and medical diagnostic processes have occurred as a result. Due to these changes, the STS research paper is answering the question “how has the evolution of the otoscope shaped the diagnostic process of middle ear pathologies since its invention?” Using Thomas Hughes’ theory of technological momentum as a tool for analysis, two broad time periods - 1600s to 1900s and 1900s to present - are used to relate the changes in medical education and doctor-patient interactions to otoscopic designs. Through the 1600s to 1900s, otoscope technology was newly introduced, so technology impacted society more. Then, through the 1900s to present, society has dominated the changes in the design of the otoscope. Discourse analysis is used to collect traditional and non-traditional sources to support these claims. This research will aid the biological field, specifically the medical education as it will be able to better assess how technology and society impact diagnostic processes for ear pathologies. A better understanding of this relationship will enable better medical interactions and, ultimately, better physician and patient satisfaction.
Typically, context of medical devices is overlooked, and the focus is solely on user-input and current issues. However, it is important to understand the societal and medical impacts of the otoscope to develop better future iterations. Analyzing only one of the approaches would diminish the holistic review of the issues discussed and give biased results of the problem. Each iteration of the otoscope has improved diagnostic processes and changed the interaction between society and technology. Now, based on the analysis of the STS research paper, the designs are tackling accessibility of the device and improving medical education. The paper highlights considerations engineers should make when defining goals of their design and user needs. These considerations will be taken into account for the Capstone project and future innovations to allow for an improved design. Studying both approaches demonstrates the importance of medical context and will better predict the impacts of the device when the iteration is introduced to society.

Harmes, K. M., Blackwood, R. A., Burrows, H. L., Cooke, J. M., Harrison, R. V., & Passamani, P. P. (2013). Otitis media: Diagnosis and treatment. American Family Physician, 88(7), 435–440.
Pichichero, M. E., & Poole, M. D. (2001). Assessing Diagnostic Accuracy and Tympanocentesis Skills in the Management of Otitis Media. Archives of Pediatrics & Adolescent Medicine, 155(10), 1137–1142. https://doi.org/10.1001/archpedi.155.10.1137
Schilder, A. G. M., Chonmaitree, T., Cripps, A. W., Rosenfeld, R. M., Casselbrant, M. L., Haggard, M. P., & Venekamp, R. P. (2016). Otitis media. Nature Reviews Disease Primers, 2(1), Article 1. https://doi.org/10.1038/nrdp.2016.63

BS (Bachelor of Science)
Otitis Media, Differential Diagnosis, Autofluorescence, Otoscopes, Technological Momentum

School of Engineering and Applied Science
Bachelor of Science in Biomedical Engineering
Technical Advisor: William Guilford
STS Advisor: Bryn Seabrook
Technical Team Members: Caroline Anderson, Layth Popp, Dreyden Wedertz

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