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Temporal Trends in and Patient Characteristics Associated with Surgery for Otitis Media
Kavita Dedhia1, Mitchell Maltenfort2, Jenna Briddell3
1The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
Insights
This study found that while overall rates of tympanostomy tube insertion (TTI) for otitis media (OM) remained stable, specific patient factors like sensorineural hearing loss and chronic adenoiditis significantly increased the likelihood of surgery. Older age and sleep disorders were also linked to higher rates of TTI with adenoidectomy (TTI-A).
Area of Science:
- Pediatric Otolaryngology
- Epidemiology of Ear Infections
- Surgical Intervention Trends
Background:
- Otitis media (OM) is a common childhood condition requiring medical or surgical management.
- Tympanostomy tube insertion (TTI) is a primary surgical intervention for recurrent or persistent OM.
- Understanding trends and patient factors influencing OM surgery is crucial for healthcare planning.
Purpose of the Study:
- To analyze temporal trends in otitis media surgery rates.
- To identify specific patient characteristics associated with tympanostomy tube insertion (TTI) and TTI with adenoidectomy (TTI-A).
Main Methods:
- Retrospective cohort study utilizing electronic health records from seven pediatric networks (2009-2022).
- Included children under 6 months at cohort entry with OM history, followed longitudinally.
- Analyzed rates of TTI and TTI-A and associated patient demographics and conditions.
Main Results:
- Overall TTI rate was 5.3% in the cohort, rising to ~20% for children with OM.
- TTI rates showed seasonal variation with a dip in 2020; TTI-A rates were stable.
- Key predictors for TTI included sensorineural hearing loss, chronic adenoiditis, and cleft palate.
- Older age (4-8 years), chronic adenoiditis, and sleep disorders strongly predicted TTI-A.
Conclusions:
- Surgical rates for OM remained largely stable, excluding pandemic-related fluctuations.
- Sensorineural hearing loss is a major risk factor for TTI, while older age is key for TTI-A.
- Identifying high-risk patients can inform surgical decision-making and resource allocation.
Objectives:
To evaluate temporal trends and identify patient characteristics associated with otitis media (OM) surgery.
Methods:
A retrospective cohort study performed using electronic health record data from seven large pediatric medical networks from January 1, 2009, to December 31, 2022. Children <6 months old cohort entrance time and OM history were included and followed longitudinally.
Results:
The database included 1,448,390 children entering at age <6 months of which 5.3% underwent tympanostomy tube insertion (TTI). Inclusion criteria was met by 454,924 children. Age at first OM was 1.6 years (standard deviation [SD]: 1.1), with mean follow-up of 6.3 years (SD 3.7), and 249,818 (54.9%) were male. Among children with OM 64,950 (14.3%) underwent only TTI, and 13,188 (2.9%) had TTI with adenoidectomy (TTI-A). Over time, TTI only rates exhibited seasonal fluctuations with a drop in 2020, TTI-A rates were flat. The following patient characteristics greatly increased TTI: sensorineural hearing loss (adjusted hazard ratio, aHR 4.0, [95% confidence interval, CI] 3.9-4.1), chronic adenoiditis (aHR 3.4 [95% CI 3.0-3.5]), and cleft palate (aHR 1.9 [95% CI 1.8-2.0]). Children 4-8 years old (aHR >11.7 [95% CI 10.6-16.4]), history of chronic adenoiditis (aHR 6.4 [95% CI 5.4-7.7]), or sleep disorders (aHR 4.9 [95% CI 4.7-5.2]) greatly increased TTI-A odds.
Conclusions:
Overall TTI rate was 5.3%, which increased to approximately 20% in children with OM. Aside from the COVID-19 pandemic, surgical rates have been stable. Though multiple characteristics increase the risk of TTI, sensorineural hearing loss for TTI only, and older age in the TTI-A subset carried the highest risk.
Level Of Evidence:
3 Laryngoscope, 135:1821-1829, 2025.
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