Table 5.

Participant views on the use of tympanometry and pneumatic otoscopy

Acceptability to patients	Both of them were easy to do. I think most of the patients like especially the tympanogram … it was very easy to show a parent, “Here’s the little graph, it’s flat, it needs to have a peak, its peak is supposed to be in the box. Come back in a couple of weeks, we’ll do it again and we’ll make sure that the peak’s in the box”. And parents responded really well to that, it was something they could see, it was a change that could be measured. (GP 9)
	The kids tend to not quite like that [pneumatic otoscopy] as well, it caused more discomfort so why do I want to keep causing discomfort to every kid. (GP 5)
Ease of use of tympanometry and pneumatic otoscopy	I found the pneumatoscope harder than the tympanogram … Sometimes I could see the drum moving beautifully, sometimes it just wouldn’t move, and yet I didn’t know whether that was technique or pathology…Whereas, the tympanogram tells you if you’ve achieved a seal, and so you’re more confident in your technique. (GP 12)
	The technical side of using the tympanometer is not that tricky … but it is also about interpreting the results. Sometimes it is not quite clear cut. (GP 5)
	People that have got very little training at all could use it [tympanometry] quite professionally because it’s really easy. It basically does everything for you, and you know, you know which one to press for the next step and so and so. (GP 10)
GPs attitudes to whether detecting effusions is essential in diagnosis of AOM	Not acute otitis media, I guess a lot of it’s clinical, in the story, and then the drum looking red. (GP 12, discussing whether pneumatic otoscopy or tympanometry are needed for diagnosis of AOM)
	[Tympanometry or pneumatic otoscopy] has to be part of the examination. Just looking at the eardrum is not enough to diagnose it unless they come with a terribly red eardrum … but I myself don’t think that this enough. It is just a guess. (GP 7)
	I didn’t find them helpful [for diagnosis of AOM)….I mean if it’s really acute, you know, it’s like staring me in the face. (GP 2)
Diagnosis of OME increased	If I hadn’t done the tympanogram I might have just said, “See you later”, you know? It’s hard to appreciate middle ear pathology, I think, just from looking. (GP 12)
	I thought it (tympanometry) changed my management. Follow ups. Otherwise I would have told them that it looks alright. Because if it is flat, I ask them to come back and then get it checked again so, it is a lot of more follow up. (GP 7)
	There’s no good cone of light, and there’s this retraction, but the Tymp was perfect. Which means it’s better not to depend on your eyes.(GP 4)
Barriers to increasing use of tympanometry and pneumatic otoscopy in general practice	[The tympanometer] is too expensive, so I don’t, I just don’t think I will buy that one, the cost is the issue for that one - and not much rebate. (GP 3)
	When we invest extra time to actually do additional tests you want to gain something beneficial for the patient management. It [pneumatic otoscopy] didn’t feel like it is worth the additional, time investment to do that because even when there is an outcome most of the time I am not quite sure whether it is reliable or not. (GP 5)
	It [tympanometry] actually didn’t change my management … If ENT specialists use that it may change their management but with me, no I didn’t change my management … Your clinical judgment is the most important in my view, so what you can see through your eye with opthalmoscope is the one which is more, is sufficient and the presentation, duration of the symptoms, history and examination. (GP 13)
	I am not too sure that all the ear drums need to be referred … How accessible is it to send them to hearing test, how often do you send them for a hearing test? When you send to the ENT, look at the cost issue and the waiting time issue and the impact on the family. (GP 7)
	I suppose there needs to be evidence that widespread use would improve outcomes if all they [pneumatic otoscopy and tympanometry] do is pick up stuff that the natural course of it is resolution. (GP 2)