Related Experiment Videos
Selecting persistent glue ear for referral in general practice: a risk factor approach
Insights
Identifying risk factors for persistent glue ear (otitis media with effusion) can improve referral appropriateness. Key predictors include seasonal referral, maternal smoking, upper airway symptoms, and family history.
Area of Science:
- Pediatric Otolaryngology
- Epidemiology
- Public Health
Background:
- Glue ear (otitis media with effusion) is a leading cause for pediatric surgical intervention.
- Appropriate referrals to Ear, Nose, and Throat (ENT) services are crucial for timely and effective management.
- Understanding predictors of persistent glue ear can optimize the referral process.
Purpose of the Study:
- To identify risk factors for persistent glue ear.
- To determine the predictive value of these factors for children referred to ENT services.
- To enhance the appropriateness of general practitioner referrals for glue ear.
Main Methods:
- A nested case-control study was conducted across 16 UK ENT departments.
- Diagnostic information, including audiometry and tympanometry, was collected for 548 children.
- Parental reports on risk factors were gathered to classify children with or without persistent glue ear.
Main Results:
- Four significant predictors of persistent glue ear were identified after adjusting for referral time and age.
- These include referral between July-December (OR=1.73), maternal smoking (≥10 cigarettes/day, OR=1.7), multiple upper airway symptoms (OR=2.2), and siblings with a history of glue ear (OR=1.6).
- The odds of persistent glue ear were significantly increased by these factors.
Conclusions:
- A combination of specific risk factors substantially increases the likelihood of persistent glue ear.
- Children referred during July-December, with multiple upper airway symptoms, a sibling history of glue ear, and maternal smoking, face over tenfold the odds of persistent glue ear.
- These findings can aid in refining referral criteria and managing pediatric otitis media with effusion.
Background:
Glue ear (otitis media with effusion) is the most common reason for surgical intervention in children.
Aim:
To determine the yield and predictive value of a set of risk factors that predict persistence of glue ear over the interval from general practice referral to ear, nose and throat (ENT) consultation to ensure the appropriateness of referrals.
Design Of Study:
Nested case control study
Setting:
Sixteen ENT departments in the UK.
Method:
With the aid of audiometry and tympanometry, diagnostic information was collected on 548 children from 16 ENT departments after referral by their general practitioner (GP), as a lead-in to a clinical trial, the Trial of Alternative Regimens in Glue Ear Treatment (TARGET). Using cases and controls, children were classified as either having or not having persistent glue ear. Parental reports on an extensive list of risk factors were also collected.
Results:
After adjustment for time waiting to be seen from GP referral and age at referral, four main significant factors emerged for persistence of glue ear. These were: referral between July and December (OR [odds ratio] = 1. 73, 95% CI = 1.15 to 2.6); having a mother who smokes ten or more cigarettes per day (OR = 1.7, 95% CI = 1.1 to 2.8); multiple upper airway symptoms (OR = 2.2, 95% CI = 1.5 to 3.2; and siblings with a history of glue ear (OR = 1.6 for one sibling versus none).
Conclusion:
For a child who is referred between July and December; who has two or more upper airway symptoms, who has a sibling who has had glue ear, and who has a mother who smokes ten or more cigarettes per day, the odds of having persistent glue ear are over ten times that of a child without adverse values on these factors.