Factors associated with tympanostomy tube insertion among preschool-aged children in the United States

Kogan, Michael D.; Overpeck, Mary D.; Hoffman, Howard J.; Casselbrant, Margaretha L.

doi:10.2105/ajph.90.2.245

Cited by 101 publications

(34 citation statements)

References 51 publications

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“…Among them, 2221 had tympanostomy tube insertion before the age of 8 or 9 years for a cumulative incidence of 0.393%. Compared to other reports, one study showed the tympanostomy tube insertion rate in United states was 6.8% before the age of 3 and another study revealed middle ear surgical procedure was 9% in Norway [41], [42]. The rate of tube re-insertion is about 20% to 50% [8]–[10], [43].…”

Section: Discussionmentioning

confidence: 84%

The Protective Effect of Adenoidectomy on Pediatric Tympanostomy Tube Re-Insertions: A Population-Based Birth Cohort Study

Wang

Chu

et al. 2014

PLoS ONE

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ObjectivesAdenoidectomy in conjunction with tympanostomy tube insertion for treating pediatric otitis media with effusion and recurrent acute otitis media has been debated for decades. Practice differed surgeon from surgeon. This study used population-based data to determine the protective effect of adenoidectomy in preventing tympanostomy tube re-insertion and tried to provide more evidence based information for surgeons when they do decision making.Study DesignRetrospective birth cohort study.MethodsThis study used the National Health Insurance Research Database for the period 2000–2009 in Taiwan. The tube reinsertion rate and time to tube re-insertion among children who received tympanostomy tubes with or without adenoidectomy were compared. Age stratification analysis was also done to explore the effects of age.ResultsAdenoidectomy showed protective effects on preventing tube re-insertion compared to tympanostomy tubes alone in children who needed tubes for the first time (tube re-insertion rate 9% versus 5.1%, p = 0.002 and longer time to re-insertions, p = 0.01), especially those aged over 4 years when they had their first tube surgery. After controlling the effect of age, adenoidectomy reduced the rate of re-insertion by 40% compared to tympanostomy tubes alone (aHR: 0.60; 95% CI: 0.41–0.89). However, the protective effect of conjunction adenoidectomy was not obvious among children with a second tympanostomy tube insertion. Children who needed their first tube surgery at the age 2–4 years were most prone to have tube re-insertions, followed by the age group of 4–6 years.ConclusionsAdenoidectomy has protective effect in preventing tympanostomy tube re-insertions compared to tympanostomy tubes alone, especially for children older than 4 years old and who needed tubes for the first time. Nonetheless, clinicians should still weigh the pros and cons of the procedure for their pediatric patients.

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Section: Discussionmentioning

confidence: 84%

The Protective Effect of Adenoidectomy on Pediatric Tympanostomy Tube Re-Insertions: A Population-Based Birth Cohort Study

Wang

Chu

et al. 2014

PLoS ONE

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“…Insurance status, maternal education, daycare attendance, breastfeeding, and exposure to secondhand smoke have been associated with OM and, in some cases, specifically to OME 21,24 . Although we found significant associations between SES and indications for TT, we did not find significant associations for race/ethnicity, the presence of siblings at home, daycare attendance, or secondhand smoke exposure.…”

Section: 4 Discussionmentioning

confidence: 99%

Do race/ethnicity or socioeconomic status affect why we place ear tubes in children?

Nieman

Tunkel

Boss

2016

International Journal of Pediatric Otorhinolaryngology

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Introduction Despite recent concerns about potential overuse of tympanostomy tube (TT) placement to treat otitis media in children, utilization of this common procedure in the U.S. has been shown to be relatively less common among minority children. It is not known if the indications for TT differ by child race/ethnicity and/or socioeconomic status (SES). Our objective is to analyze the association of patient- and neighborhood-level demographics and SES with clinical indications for TT. Methods We conducted a retrospective chart review of children who underwent TT at single urban academic tertiary pediatric care center in a 6-month period (8/2013-3/2014). Children with congenital anomalies or syndromic diagnoses were excluded (50/137 children, 36.5%). Children were grouped by primary TT indication, recurrent acute otitis media (RAOM) or chronic otitis media with effusion (OME). Group characteristics were compared using t-tests and chi-square analyses, and logistic regression was performed to assess the association between demographics and TT indication. Results 87 children were included in this analysis (mean age=2.8 years,1-6 years). The most common indication for TT was RAOM (53%), and these children had a mean of 6 AOM episodes/year. Indications for TT varied significantly by the patient's neighborhood SES (median neighborhood income $70,969.09-RAOM vs $58, 844.95-OME, p-value=0.009) Those undergoing TT for RAOM were less likely to live in a high-poverty neighborhood (OR=0.36,p-value=0.02), whereas children who underwent TT for OME were more likely to live in a high-poverty neighborhood. There was no significant difference in indication by race/ethnicity or insurance type. Conclusions In this population, TT indications differed by SES. Among children receiving tubes, those from high poverty areas were more likely than those from low poverty neighborhoods to receive tubes for the indication of OME as opposed to RAOM. This finding suggests that concerns for appropriate use of TT in the setting of RAOM may be specific to a more affluent population. Future prospective patient-centered research will evaluate cultural and economic influences for families pursuing TT placement, as well as factors considered by physicians who make surgical recommendations.

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“…54 One out of 15 children, or 6.8% of the population, had tympanostomy tubes placed before the age of 3 years. 55 The health care costs of tympanostomy tubes are enormous, at an estimated cost of $2200 per patient 56 for a total of nearly $1.5 billion annually in the United States.…”

Section: Recurrent Aom and Tympanostomy Tubesmentioning

confidence: 99%

Contemporary Concepts in Management of Acute Otitis Media in Children

Rettig

Tunkel

2014

Otolaryngologic Clinics of North America

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Factors associated with tympanostomy tube insertion among preschool-aged children in the United States

Cited by 101 publications

References 51 publications

The Protective Effect of Adenoidectomy on Pediatric Tympanostomy Tube Re-Insertions: A Population-Based Birth Cohort Study

The Protective Effect of Adenoidectomy on Pediatric Tympanostomy Tube Re-Insertions: A Population-Based Birth Cohort Study

Do race/ethnicity or socioeconomic status affect why we place ear tubes in children?

Contemporary Concepts in Management of Acute Otitis Media in Children

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