Overuse of tympanostomy tubes in New York metropolitan area: evidence from five hospital cohort

Abstract

Objectives To compare tympanostomy tube insertion for children with otitis media in 2002 with the recommendations of two sets of expert guidelines. Design Retrospective cohort study. Setting New York metropolitan area practices associated with five diverse hospitals. Participants 682 of 1046 children who received tympanostomy tubes in the five hospitals for whom charts from the hospital, primary care physician, and otolaryngologist could be accessed. Results The mean age was 3.8 years. On average, children with acute otitis media had fewer than four infections in the year before surgery. Children with otitis media with effusion had less than 30 consecutive days of effusion at the time of surgery. Concordance with recommendations was very low: 30.3% (n=207) of all tympanostomies were concordant with the explicit criteria developed for this study and 7.5% (n=13) with the

Inequalities in ventilation tube insertion procedures between Aboriginal and non-Aboriginal children in New South Wales, Australia: a data linkage study

“…There is no published evaluation of this in Australia; however, a significant discrepancy between the insertion of ventilation tubes and clinical guidelines was reported among New York metropolitan hospitals in the USA 43. The most common discrepancy between guidelines and practice was the premature insertion of ventilation tubes 43.…”

“…There is no published evaluation of this in Australia; however, a significant discrepancy between the insertion of ventilation tubes and clinical guidelines was reported among New York metropolitan hospitals in the USA 43. The most common discrepancy between guidelines and practice was the premature insertion of ventilation tubes 43. However, even among the most advantaged children in our cohort, the proportion who had a ventilation tube inserted by 8 years of age (6%; data not shown) was lower than that in studies from the USA34 and Europe 44 45.…”

Contemporary Concepts in Management of Acute Otitis Media in Children

“…Possible overuse of tympanostomy tubes has been identified, particularly for children with MEEs of short duration and for children with infrequent or poorly documented episodes of AOM. 58 These issues have been addressed by a national “overuse” summit that included tympanostomy tube placement as 1 of the 5 potentially overused treatments, 59 as well as by the recent publication of a multidisciplinary clinical practice guideline on the use of tympanostomy tubes in children. 1 …”

30 years of change in the world, science and medicine

“…It may seem professionally or internationally impolite to talk about these financial differences, but it is actually dishonest to fail to bring out the differences in healthcare as a background to the clinical samples seen in research studies, to which the economic differences lead, and to possible consequences for effectiveness. In some areas of ORL there is a level of over-intervention [14] with much lower/wider criteria than recommended in clinical guidelines.…”