Date of Award


Document Type


Degree Name

Doctor of Nursing Practice (DNP)

School Name

Donna and Allan Lansing School of Nursing and Health Sciences



Major Advisor

Heather Owens

Second Advisor

Chris Webb



Background: The use of Tympanometry to diagnosis Otitis Media with Effusion (OME) in adults is not routine practice in primary care, although it is supported by evidence and clinical practice guidelines. The misdiagnosis of OME frequently leads to inappropriate antibiotic prescribing, contributing to the rise in drug resistant infections.

Purpose: This evidence-based practice, quality improvement project sought to determine if the use of tympanometry by Family Nurse Practitioners (FNPs), to assess adults visiting primary care clinics, improved the accuracy of otitis media diagnoses and decreased unnecessary antibiotic therapy. The project also evaluated whether experience using the tympanometer was correlated with decreased changes in FNP diagnoses after the review of tympanometer tracings.

Methods: A single tympanometer was provided to four FNPs in two primary care clinics. Tympanometry was performed on patients presenting with ear or hearing complaints, without otorrhea, recent ear surgery, or recent trauma to the ear. FNPs performed routine otoscopy exams and made a diagnosis while tympanometry naïve (prior to reviewing tympanometry tracings), and then reviewed tympanometry tracings and either maintained the original diagnosis or changed their diagnosis.

Results: A total of 42 patients were seen during the project timeframe and FNPs changed their diagnoses in 45.2% of cases (n =19) after reviewing tymponometry tracings. Most changes in diagnoses resulted in a shift from abnormal to normal (63.2%), potentially preventing the inappropriate prescribing of antibiotics. In addition, FNPs reported a review of tympanometry tracings informed their clinical decision making 69% of the time. Experience using the tympanometer was not significantly correlated with a decrease in changed diagnoses.

Discussion: While the number of cases was lower than expected, this project supports the use of tympanometers in primary care settings to diagnosis OME in adults.

Available for download on Tuesday, July 23, 2024