National Institute for Clinical Excellence guidelines on the surgical management of otitis media with effusion: Are they being followed and have they changed practice?

Daniel, Matija; Kamani, Tawakir; El-Shunnar, Suliman; Jaberoo, Marie-Claire; Harrison, Anthony; Yalamanchili, Seema; Harrison, Laura; Cho, Waisum; Fergie, N.; Bayston, Roger; Birchall, John P.

doi:10.1016/j.ijporl.2012.09.029

Cited by 26 publications

(31 citation statements)

References 21 publications

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“…20,21 While OME spontaneously resolves for most children, a proportion suffer from a persistent effusion that may cause hearing loss and, in some children, affect educational performance, language development, and/or behavior. 1,32 Tympanostomy tubes for OME have been shown to reduced OME and improve hearing, but longer-term benefits have been harder to detect, 14,22–24 particularly with regard to improved language and cognitive development. 14,21 Therefore, even guidelines-based assessments of over and under use may overestimate the benefit from tympanostomy tubes.…”

Section: Discussionmentioning

confidence: 99%

“…14,21 Therefore, even guidelines-based assessments of over and under use may overestimate the benefit from tympanostomy tubes. 7,8,12,22,24 …”

Section: Discussionmentioning

confidence: 99%

“…In the same guidelines, it is recommended that “Clinicians may perform tympanostomy tube insertion in children with unilateral or bilateral OME for 3 months or longer (chronic OME) AND symptoms that are likely attributable to OME that include, but are not limited to, balance (vestibular) problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life.” The two other current guidelines also suggest consideration of tube placement for at-risk children. 1,17 In England, the majority of insertions were recommended on the basis of “exceptional circumstances.” 22 …”

Section: Discussionmentioning

confidence: 99%

“…7 In England, a recent multi-center study found that only 32% of ear tubes were in concordance with the NICE criteria. 22 In England, epidemiological modeling indicates that about 31,000 children would have benefited from the procedure (25dB threshold), but only about 16,600 operations were undertaken. If the previous clinical audit study is accurate, 22 two thirds of those 16,600 were not consistent with guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…22 In England, epidemiological modeling indicates that about 31,000 children would have benefited from the procedure (25dB threshold), but only about 16,600 operations were undertaken. If the previous clinical audit study is accurate, 22 two thirds of those 16,600 were not consistent with guidelines. In NNE, using the U.S. 20dB threshold, about 8,000 children would have benefited from the procedure, but applying the findings of the New York State appropriateness study, 7 less than 1,000 of the operations would have been consistent with guidelines.…”

Section: Discussionmentioning

confidence: 99%

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Variation in Utilization and Need for Tympanostomy Tubes across England and New England

Parker

Schang

Wasserman

et al. 2016

The Journal of Pediatrics

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Objectives To assess rates of tube insertions for otitis media with effusion (OME) with estimates of need. Study Design This cross-sectional analysis used all-payer claims to calculate rates of tube insertions for insured children age 2 to 8 years (2007–2010) across pediatric surgical areas (PSA) for Northern New England (NNE; Maine, Vermont, and New Hampshire) and the English National Health Service Primary Care Trusts (PCT). These rates were compared to expected rates estimated using a Monte Carlo simulation model that integrates clinical guidelines and published probabilities of the incidence and course of OME. Results Observed rates of tympanostomy tubes varied >30-fold across English PCTs (N=150) and >3-fold across NNE PSAs (N=30). At a 25 dB hearing threshold the overall difference in observed to expected tympanostomy tubes provided was −3.41 per 1,000 children in England and −0.01 per 1,000 children in NNE. Observed incidence of insertion was less than expected in all but eight PCTs while higher than expected in half of the PSAs. Using a 20 dB hearing threshold, there were fewer tube insertions than expected in all but 2 England and 7 NNE areas. There was an inverse relationship between estimated need and observed tube insertion rates. Conclusions Regional variations in observed tympanostomy tube insertion rates are unlikely to be due to differences in need and suggest overall underuse in England and both over and underuse in NNE.

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Section: Discussionmentioning

confidence: 99%

“…14,21 Therefore, even guidelines-based assessments of over and under use may overestimate the benefit from tympanostomy tubes. 7,8,12,22,24 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Variation in Utilization and Need for Tympanostomy Tubes across England and New England

Parker

Schang

Wasserman

et al. 2016

The Journal of Pediatrics

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Parental decision making in pediatric otoplasty: The role of shared decision making in parental decisional conflict and decisional regret

et al. 2016

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Decision aid prototype for treatment of pediatric sleep disordered breathing: A randomized pilot study

2018

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Objectives 1) To examine the feasibility and usability of a decision aid prototype (DA) for pediatric obstructive sleep apnea (OSA). 2) to estimate parameters for a future randomized controlled trial. Study Design Multicenter randomized pilot trial. Methods Ninety‐nine parents of children ( < 6 years of age) undergoing consultation for adenotonsillectomy for sleep‐disordered breathing were prospectively enrolled. Families were randomly assigned to receive the DA or to follow standard care procedures. All consultations were video‐recorded and coded with the observing patient involvement in decision making (OPTION) instrument. Following the consultation, parents completed the Decisional Conflict Scale (DCS) and Shared Decision‐Making Questionnaire (SDM‐Q‐9), whereas otolaryngologists completed the physician version (SDM‐Q‐Doc). A subset of parents and surgeons were interviewed to assess the usability of the DA. Results: Overall, a significantly negative correlation between DCS and SDM‐Q‐9 was observed (P < 0.001). Interviews showed that parents found the DA helpful but wanted more time to read and contemplate the information. Both parents and surgeons indicated that instructions on how to use the DA would be beneficial. For parents receiving the DA, the mean total OPTION score was 13.83 out of 40 (standard deviation 5.24), compared to 11.95 (standard deviation 5.21) in those not receiving the DA (P = 0.11). There were no significant differences in the decisional conflict or shared decision making when using the DA. Conclusion: The DA was feasible but used differently among surgeons. The need to improve SDM techniques was suggested by both surgeons and parents. Future studies training otolaryngologists on effective SDM techniques and how to appropriately utilize decision aids may improve SDM for pediatric OSA. Level of Evidence 1b Laryngoscope, 129:229–234, 2019

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National Institute for Clinical Excellence guidelines on the surgical management of otitis media with effusion: Are they being followed and have they changed practice?

Cited by 26 publications

References 21 publications

Variation in Utilization and Need for Tympanostomy Tubes across England and New England

Variation in Utilization and Need for Tympanostomy Tubes across England and New England

Parental decision making in pediatric otoplasty: The role of shared decision making in parental decisional conflict and decisional regret

Decision aid prototype for treatment of pediatric sleep disordered breathing: A randomized pilot study

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