Lack of association of race/ethnicity and otitis media in the first 2 years of life

Reduction of Antibiotic-Associated Conditions After Tympanostomy Tube Placement in Children

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.

Race, otitis media, and antibiotic selection

BACKGROUND AND OBJECTIVE

Previous research suggests that physicians may be less likely to diagnose otitis media (OM) and to prescribe broad-spectrum antibiotics for black versus nonblack children. Our objective was to determine whether race is associated with differences in OM diagnosis and antibiotic prescribing nationally.

METHODS

We examined OM visit rates during 2008 to 2010 for children ≤14 years old using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. We compared OM visits between black and nonblack children, as percentages of all outpatient visits and visit rates per 1000. We compared antibiotic prescribing by race as the percentage of OM visits receiving narrow-spectrum (eg, amoxicillin) versus broader-spectrum antibiotics. We used multivariable logistic regression to examine whether race was independently associated with antibiotic selection for OM.

RESULTS

The percentage of all visits resulting in OM diagnosis was 30% lower in black children compared with others (7% vs 10%, P = .004). However, OM visits per 1000 population were not different between black and nonblack children (253 vs 321, P = .12). When diagnosed with OM during visits in which antibiotics were prescribed, black children were less likely to receive broad-spectrum antibiotics than nonblack children (42% vs 52%, P = .01). In multivariable analysis, black race was negatively associated with broad-spectrum antibiotic prescribing (adjusted odds ratio 0.59; 95% confidence interval, 0.40-0.86).

CONCLUSIONS

Differences in treatment choice for black children with OM may indicate race-based differences in physician practice patterns and parental preferences for children with OM.

Racial/ethnic and socioeconomic disparities in the prevalence and treatment of otitis media in children in the United States

OBJECTIVES

Although racial/ethnic and socioeconomic disparities in child health are prevalent, little is known about them within common pediatric otolaryngic problems. Otitis media (OM) is a frequent diagnosis in children, and tympanostomy tube placement is the most common surgical treatment for OM. We sought to identify current knowledge regarding racial/ethnic and socioeconomic disparities in children with OM or tympanostomy tube placement.

METHODS

Qualitative systematic review of MEDLINE database for U.S.-based articles reporting on racial/ethnic or socioeconomic disparities in diagnosis or surgical treatment of OM over the last 30 years.

RESULTS

Of 428 abstracts identified, 15 met inclusion criteria. Articles addressed OM prevalence (12 of 15), risk factors (9 of 15), and tympanostomy tube insertion (4 of 15). Minority racial/ethnic groups studied were Black (11 of 15), Hispanic (6 of 15), American Indian/Alaska Native (2 of 15), and Asian (1 of 15). Predominant findings showed: 1) the most common identified risk factor for OM is socioeconomic status; 2) considerable variability exists concerning racial/ethnic disparities in disease prevalence; and 3) White children are more likely to undergo tympanostomy tube insertion compared to Black or Hispanic children.

CONCLUSIONS

Racial/ethnic and socioeconomic disparities exist for the prevalence and treatment of children with OM. Socioeconomic deprivation increases the risk of OM in children. Despite the frequency of tympanostomy tube insertion in children in the United States, few studies have addressed inequalities in access or utilization of surgical therapy. Given the changing healthcare climate and the social and economic impact of OM in children, further investigation of racial/ethnic and socioeconomic disparities targeting access to surgical treatment of OM should take precedence in health services research.

Clinical and demographic risk factors associated with chronic suppurative otitis media

BACKGROUND

The incidence of chronic suppurative otitis media (CSOM) is high worldwide but increasing occurrence of complications appear peculiar to West Africa. However, knowledge of associated risk factors is sparse, we report the sociodemographic risk factors of CSOM with the aim of control of the disease and complications; and possible preventive strategies.

METHOD

This is a survey of children with CSOM in five sites spread in two suburban cities in two states in Nigeria. Questionnaire was administered on the informants followed by examination of the children.

RESULT

Of the 189 children, 114 (60%) had developed ear suppuration before 6 months of age, the number of attacks within the previous 18 months ranged between 2-12 with average of 7. Sociodemographic risk factors included low socioeconomic class in 153 (81%), 136 (72%) live in congested houses with more than 10 people and 79 (42%) belonged to families with more than 5 children. Indoor-cooking and infant daycare attendance were 117 (62%) while supine bottlefeeding was 115 (61%) and 34 (18%) of subjects had smoking father. The clinical risk factors were upper respiratory tract infection (URI) 85 (45%), allergy 53 (28%), adenoid 54 (28%) and malnutrition 65 (34%). The univariate analysis revealed that low social class (OR=7.33, CI=4.18-12.83, P=0.0001), malnutrition (OR=3.57, CI=1.88-6.76, P=0.00001), bottlefeeding (OR=2.93, CI=1.63-5.28, P=0.0001), indoor-cooking (OR=1.35, CI=0.88-2.10, P=0.161) and high number of people in a household (OR=0.59, CI=0.34-0.98, P=0.04) are significant in development of OM; while multivariate logistic regression analysis showed malnutrition (OR=3.48, CI=1.633-7.425, P=0.001), low social status (OR=7.74, CI=4.15-14.43, P=0.0001) and indoor-cooking (OR=2.34, CI=1.18-4.66, P=0.014), second table. Parental smoking, daycare attendance, allergy, adenoiditis/adenoidal hypertrophy and upper respiratory tract infection were not found significant.

CONCLUSION

Low socioeconomic class, malnutrition, congestion from high number of children in the household and bottlefeeding constitute significant risk factor. The early onset of disease (<6 months) may suggest a prenatal predisposition. We need further research for the understanding of the biologic effect of these factors while this remains a database for prevention and control of disease.