Otitis media, tympanostomy tube placement, and use of antibiotics

Arason, Vilhjalmur A.; Sigurdsson, Jóhann Á.; Kristinsson, Karl G.; Getz, Linn; Guðmundsson, Sigurður

doi:10.1080/02813430510031298

Cited by 16 publications

(12 citation statements)

References 24 publications

(19 reference statements)

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“…In Iceland [7] and USA [100] correlations have been shown between physicians’ practices and knowledge or attitudes about OM. But what is cause and what is effect here?…”

Section: Public Information Campaignsmentioning

confidence: 99%

Poor adherence to antibiotic prescribing guidelines in acute otitis media—obstacles, implications, and possible solutions

Haggard

2010

Eur J Pediatr

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Many countries now have guidelines on the clinical management of acute otitis media. In almost all, the public health goal of containing acquired resistance in bacteria through reduced antibiotic prescribing is the main aim and basis for recommendations. Despite some partial short-term successes, clinical activity databases and opinion surveys suggest that such restrictive guidelines are not followed closely, so this aim is not achieved. Radical new solutions are needed to tackle irrationalities in healthcare systems which set the short-term physician–patient relationship against long-term public health. Resolving this opposition will require comprehensive policy appraisal and co-ordinated actions at many levels, not just dissemination of evidence and promotion of guidelines. The inappropriate clinical rationales that underpin non-compliance with guidelines can be questioned by evidence, but also need specific developments promoting alternative solutions, within a framework of whole-system thinking. Promising developments would be (a) physician training modules on age-appropriate analgesia and on detection plus referral of rare complications like mastoiditis, and (b) vaccination against the most common and serious bacterial pathogens.

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“…In Iceland [7] and USA [100] correlations have been shown between physicians’ practices and knowledge or attitudes about OM. But what is cause and what is effect here?…”

Section: Public Information Campaignsmentioning

confidence: 99%

Poor adherence to antibiotic prescribing guidelines in acute otitis media—obstacles, implications, and possible solutions

Haggard

2010

Eur J Pediatr

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“…Our study confirms the previously reported high incidence rate and prevalence of TTP in Iceland, compared to other countries. The prevalence of children one to six years of age who underwent one or more TTP in Iceland was 29% in 1998 (18) and 34% in 2003 (19). Our data show that 31% of children in the latest birth-cohort with full five years of follow-up had undergone TTP.…”

Section: Discussionmentioning

confidence: 69%

“…Study demographics are summarised in Table 1. The median age of the children at the time of their first TTP was 17 months (IQR [13][14][15][16][17][18][19][20][21][22][23][24]. Of the children who underwent the procedure, 10 248 (71%) had only one TTP procedure, 2902 (20%) had two, and 1201 (8%) had three or more.…”

Section: Demographicsmentioning

confidence: 99%

Increase in tympanostomy tube placements despite pneumococcal vaccination, a population‐based study

et al. 2019

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Aim The aim was to estimate the impact of the 10‐valent pneumococcal vaccine (PHiD‐CV) on tympanostomy tube placements (TTP) in children under five years of age in Iceland. Methods This population‐based observational cohort study followed 11 consecutive birth‐cohorts 2005–2015 from birth until their fifth birthday. Population registries were merged using national identification numbers. The risk of TTP was compared between birth‐cohorts adjusted for the number of previous otitis media diagnoses and antimicrobial prescriptions. A Cox regression model was applied and the hazard ratio (HR) of TTP was estimated between each birth‐cohort and the last vaccine non‐eligible birth‐cohort. The vaccine impact of PHiD‐CV10 on TTP was estimated as 1‐HR ×100%. Results In total, 51 247 children were followed for 210 724 person‐years, of which 14 351 underwent 20 373 procedures. The estimated vaccine impact on TTP was −6% (95% CI −16% to 2.7%). Children in the vaccine‐eligible cohorts had fewer previous otitis media diagnoses and had been prescribed fewer antimicrobials prior to the procedure than children in the vaccine non‐eligible cohorts. Conclusion Despite high uptake of PHiD‐CV10, tympanostomy procedures increased in Iceland during the study period. Vaccine‐eligible children had milder disease prior to the procedure. The reason underlying these findings are speculative.

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“…The incidence of VT in Denmark is the highest compared to available data from other developed countries [10–15,26] (S1 Fig) and with a continuing increase over the study period (Fig 2). …”

Section: Discussionmentioning

confidence: 84%

“…The rate of VT insertions varies greatly across developed countries, and does not directly reflect socioeconomic affluence [10–16]. The incidence is under 10/1000 in United Kingdom, Canada and United States but over 30/1000 in Iceland and Denmark, S1 Fig.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Determinants of Ventilation Tubes in Denmark

et al. 2016

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Background and objectivesMany children are treated for recurrent acute otitis media and middle ear effusion with ventilation tubes (VT). The objectives are to describe the incidence of VT in Denmark during 1997–2011 from national register data, furthermore, to analyze the determinants for VT in the Copenhagen Prospective Studies on Asthma in Childhood2010 (COPSAC2010) birth cohort.MethodsThe incidence of VT in all children under 16 years from 1997–2011 were calculated in the Danish national registries. Determinants of VT were studied in the COPSAC2010 birth cohort of 700 children.ResultsNationwide the prevalence of VT was 24% in children aged 0 to 3 three years, with a significant increase over the study period. For all children 0–15 years, the incidence of VT was 35/1,000. In the VT population, 57% was male and 43% females. In the COPSAC2010 birth cohort, the prevalence of VT during the first 3 years of life was 29%. Determinants of VT were: maternal history of middle ear disease; aHR 2.07, 95% CI [1.45–2.96] and siblings history of middle ear disease; aHR 3.02, [2.11–4.32]. Paternal history of middle ear disease, presence of older siblings in the home and diagnosis of persistent wheeze were significant in the univariate analysis but the association did not persist after adjustment.ConclusionThe incidence of VT is still increasing in the youngest age group in Denmark, demonstrating the highest incidence recorded in the world. Family history of middle ear disease and older siblings are the main determinants for VT.

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Otitis media, tympanostomy tube placement, and use of antibiotics

Cited by 16 publications

References 24 publications

Poor adherence to antibiotic prescribing guidelines in acute otitis media—obstacles, implications, and possible solutions

Poor adherence to antibiotic prescribing guidelines in acute otitis media—obstacles, implications, and possible solutions

Increase in tympanostomy tube placements despite pneumococcal vaccination, a population‐based study

Incidence and Determinants of Ventilation Tubes in Denmark

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