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Chinnadurai S, Meyer C, Roby B, Redmann A, Meyer A, Tibesar R, Jakubowski L, Lander TA, Finch M, Jayawardena ADL. Reduction of Antibiotic-Associated Conditions After Tympanostomy Tube Placement in Children. Laryngoscope 2024. [PMID: 39172004 DOI: 10.1002/lary.31717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/17/2024] [Accepted: 08/02/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVE Tympanostomy tube placement has been shown to decrease systemic antibiotics usage in patients with recurrent acute otitis media. Systemic antibiotics in children are associated with an increase in antibiotic-associated conditions (asthma, allergic rhinitis, food allergy, atopic dermatitis, celiac disease, overweight/obesity, attention-deficit hyperactivity disorder [ADHD], autism, learning disability, and Clostridium difficile colonization) later in life. The objective of this study is to estimate whether tympanostomy tube placement is associated with a reduction in antibiotic-associated conditions in children with recurrent acute otitis media (RAOM). METHODS A retrospective cohort review of electronic medical records from 1991 to 2011 at a large pediatric hospital system was performed identifying 27,584 patients under 18 years old with RAOM, defined by 3 or more episodes of AOM. Antibiotic-associated conditions were defined using ICD-9 and ICD-10 codes. RESULTS The enrollment population was largely composed of White patients (28.9%), Black patients (30.1%), and Hispanic/Latino patients (16.4%). The number of systemic antibiotics prescribed per encounter was significantly lower in children who pursued tympanostomy tubes (0.14 antibiotics per encounter) versus those who did not (0.23 antibiotics per encounter) (p < 0.001). Patients with RAOM who received tympanostomy tubes were less likely to have diagnoses of overweight/obesity (OR. 0.62 [0.55, 0.68]; p < 0.001), asthma (OR 0.8 [0.74, 0.87]; p < 0.001), allergic rhinitis (OR 0.72 [0.65, 0.81]; p < 0.001), and atopic dermatitis (0.78 [0.71, 0.86]; p < 0.001). CONCLUSIONS AND RELEVANCE Tympanostomy tube placement is associated with less systemic antibiotic administration and a decreased incidence of overweight/obesity, asthma, allergic rhinitis, and atopic dermatitis in children diagnosed with RAOM. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Sivakumar Chinnadurai
- ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, USA
- Otolaryngology Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cassandra Meyer
- ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, USA
- Research Institute, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - Brianne Roby
- ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, USA
- Otolaryngology Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew Redmann
- ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, USA
- Otolaryngology Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Abby Meyer
- ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, USA
- Otolaryngology Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robert Tibesar
- ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, USA
- Otolaryngology Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Luke Jakubowski
- ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, USA
- Otolaryngology Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Timothy A Lander
- ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, USA
- Otolaryngology Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael Finch
- Research Institute, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - Asitha D L Jayawardena
- ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, USA
- Otolaryngology Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Pershad AR, Knox EC, Shah RK, Zalzal HG. Disparities in the prevalence and management of otitis media: A systematic review. Int J Pediatr Otorhinolaryngol 2024; 176:111786. [PMID: 37984128 DOI: 10.1016/j.ijporl.2023.111786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Alisha R Pershad
- School of Medicine and Health Sciences, The George Washington University, Washington, D.C, USA.
| | - Emily C Knox
- School of Medicine and Health Sciences, The George Washington University, Washington, D.C, USA
| | - Rahul K Shah
- Division of Otolaryngology-Head and Neck Surgery, Children's National Medical Center, Washington, D.C, USA
| | - Habib G Zalzal
- Division of Otolaryngology-Head and Neck Surgery, Children's National Medical Center, Washington, D.C, USA
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Kacin AJ, Jabbour N, Ford MD, Losee JE, Shaffer AD. The limits of pandemic precautions: Tympanostomy tube placement in children with cleft palate during COVID-19. Am J Otolaryngol 2022; 43:103279. [PMID: 34800861 PMCID: PMC8580857 DOI: 10.1016/j.amjoto.2021.103279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/07/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Coronavirus Disease-2019 (COVID-19) mitigation measures have led to a sustained reduction in tympanostomy tube (TT) placement in the general population. The present aim was to determine if TT placement has also decreased in children at risk for chronic otitis media with effusion (COME), such as those with cleft palate (CP). MATERIALS AND METHODS A cohort study with medical record review was performed including consecutive children, ages 0-17 years, undergoing primary palatoplasty at a tertiary children's hospital February 2019-January 2020 (pre-COVID) or May 2020-April 2021 (COVID). Revision palatoplasty (n = 29) was excluded. Patient characteristics and middle ear status pre-operatively and at palatoplasty were compared between groups using logistic regression or Wilcoxon rank-sum. RESULTS The pre-COVID and COVID cohorts included 73 and 87 patients, respectively. Seventy (44%) were female and median age at palatoplasty was 13.5 months for CP ± cleft lip (CP ± L) and 5.5 years for submucous cleft palate (SMCP). In patients with CP ± L, TT were placed or in place and patent at palatoplasty in 28/38 (74%) pre-COVID and 37/50 (74%) during COVID (P = 0.97). In patients with SMCP, these proportions were 5/35 (14%) and 6/37 (16%), respectively (P = 0.82). Examining only patients <2 years of age also revealed no difference in TT placement pre-COVID versus COVID (P = 0.99). Finally, the prevalence and type of effusion during COVID was similar to pre-COVID. CONCLUSIONS Reduced infectious exposure has not decreased TT placement or effusion at palatoplasty. Future work could focus on non-infectious immunologic factors underlying the maintenance of COME in these children.
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Affiliation(s)
- Alexa J. Kacin
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Noel Jabbour
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Department of Otolaryngology, Division of Pediatric Otolaryngology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew D. Ford
- Department of Communication Disorders, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph E. Losee
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Department of Plastic Surgery, Division of Pediatric Plastic Surgery, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Amber D. Shaffer
- Department of Otolaryngology, Division of Pediatric Otolaryngology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA,Corresponding author at: Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 7th Floor, Faculty Pavilion, Pittsburgh, PA 15224, USA
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Patel TA, McCoy JL, Belsky MA, Sim ES, Konanur A, Yan A, Jabbour N, Padia R. Effect of Insurance Type on Postoperative Tympanostomy Tube Follow-up. Otolaryngol Head Neck Surg 2021; 166:1078-1084. [PMID: 34962848 DOI: 10.1177/01945998211067504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Bilateral myringotomy with tube insertion (BMT) is a common procedure performed in children. Appropriate follow-up is necessary to ensure management of postoperative sequalae. The objectives are to investigate (1) the relationship between insurance type and postoperative follow-up attendance and (2) the effect of follow-up on need for further care after BMT. STUDY DESIGN Retrospective cohort study. SETTING The study included patients <3 years of age undergoing BMT for recurrent acute otitis media at a tertiary care children's hospital within a single year and followed for 3 years. Patients were excluded if they had received a prior BMT; underwent a concurrent otolaryngologic procedure; or had a syndromic diagnosis, craniofacial abnormality, or any significant cardiac or respiratory comorbidity. METHODS Number of follow-up appointments, demographics, socioeconomic status, and postoperative outcomes were analyzed. RESULTS A total of 734 patients were included with mean (SD) age of 1.4 years (0.50). The majority of patients had private insurance (520/734, 70.8%). Patients with public insurance attended fewer postoperative appointments (1.5 vs 1.8, P < .001) and had a higher incidence of BMT-related emergency department (ED) visits (10.3% vs 3.8%, P = .001). There was no significance found when different insurance providers were compared. An adjusted multivariate regression analysis showed that patients with private insurance were more likely to attend postoperative appointments (odds ratio, 3.52 [95% CI, 2.12-5.82]; P < .001) and less likely to have a BMT-related ED visit (odds ratio, 0.42 [95% CI, 0.20-0.89]; P = .024). CONCLUSION Insurance type is related to outcomes after the treatment of recurrent acute otitis media with BMT. Future studies that survey individuals will help identify barriers that contribute to patient absence at follow-ups and need for subsequent ED visits.
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Affiliation(s)
- Terral A Patel
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jennifer L McCoy
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael A Belsky
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Edward S Sim
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anisha Konanur
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Annie Yan
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Noel Jabbour
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Reema Padia
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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