Pediatric Otitis Media With Effusion Surgical Trends During COVID-19: A Time-Series Study

To evaluate the impact of the COVID-19 pandemic on pediatric surgery for otitis media with effusion (OME) in Japan, comparing the general population with high-risk groups (Down syndrome and cleft palate) to differentiate between environmental and anatomical drivers of surgical demand.

This retrospective cohort study used the Japanese Diagnosis Procedure Combination database (April 2013 to March 2023). Children < 18 years undergoing tympanostomy tube insertion or myringotomy were included. Interrupted time-series (ITS) analysis was employed to estimate immediate "level shifts" and pandemic-period "trend changes," effectively accounting for 10-year pre-existing secular trends to isolate the pandemic's impact.

Among 22,748 surgical cases, no significant pre-pandemic trend (+0.05 surgeries/month) was observed, followed by a significant immediate level shift (-107.55 surgeries/month) and a non-significant slope change (0.95 surgeries/month). In contrast, immediate level shifts in the Down syndrome and cleft palate groups were not statistically significant, indicating relatively preserved surgical volume. Concomitant adenoidectomy and tonsillectomy decreased significantly from 38.8% to 29.7% and 23.2% to 16.9%, respectively (p < 0.001).

While OME surgical volume for the general population plummeted, likely due to reduced community-acquired respiratory infections, it remained resilient in high-risk children. These findings suggest that while environmental factors drive OME in the general population, anatomical vulnerabilities necessitate consistent surgical intervention in high-risk groups even during a pandemic. This distinction provides a crucial framework for surgical prioritization in future public health crises.