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Otolaryngologists' perceptions of the indications for tympanostomy tube insertion in children.
CMAJ 2000; 162(9):1285-8CMAJ

Abstract

BACKGROUND

Bilateral myringotomy with insertion of tympanostomy tubes is the most common operation that children in Canada undergo. Area variations in surgical rates for this procedure have raised questions about indications used to decide about surgery. The objective of this study was to describe the factors that influence otolaryngologists to recommend tympanostomy tube insertion in children with otitis media and their level of agreement about indications for surgery.

METHODS

A survey was sent to all 227 otolaryngologists in Ontario in the fall of 1996. The influence of 17 clinical and social factors on recommendations to insert tympanostomy tubes were assessed. Case vignettes were used to determine the effect of multiple factors in decisions about the need for surgical management.

RESULTS

Surveys were returned by 138 (68.3%) of the 202 eligible otolaryngologists. There was agreement (more than 90% of respondents) about 6 indications for surgery: persistent effusion, a lack of improvement after 3 months of antibiotic therapy, a history of persistent effusion for 3 or more months per episode of otitis media, more than 7 episodes of otitis media in 6 months, a bilateral conductive hearing loss of 20 dB or more and a persistently abnormal tympanic membrane. Some respondents were more likely to recommend tube insertion if there were parental concerns about hearing problems or the frequency or severity of episodes of otitis media. Otolaryngologists agreed about the role of tympanostomy tubes in 1 of 4 case vignettes but disagreed about whether adenoidectomy should also be performed in that instance. Most viewed tympanostomy tube insertion as beneficial, with few adverse effects.

INTERPRETATION

There is a lack of consensus among practising otolaryngologists in Ontario as to which children with recurrent otitis media or persistent effusion should undergo bilateral myringotomy with tympanostomy tube insertion. These findings suggest the need to revisit clinical guidelines for this procedure.

Authors+Show Affiliations

Department of Family and Community Medicine, University of Toronto, Ont. wmcisaac@mtsinai.on.ca

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10813009

Citation

McIsaac, W J., et al. "Otolaryngologists' Perceptions of the Indications for Tympanostomy Tube Insertion in Children." CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, vol. 162, no. 9, 2000, pp. 1285-8.
McIsaac WJ, Coyte PC, Croxford R, et al. Otolaryngologists' perceptions of the indications for tympanostomy tube insertion in children. CMAJ. 2000;162(9):1285-8.
McIsaac, W. J., Coyte, P. C., Croxford, R., Asche, C. V., Friedberg, J., & Feldman, W. (2000). Otolaryngologists' perceptions of the indications for tympanostomy tube insertion in children. CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, 162(9), pp. 1285-8.
McIsaac WJ, et al. Otolaryngologists' Perceptions of the Indications for Tympanostomy Tube Insertion in Children. CMAJ. 2000 May 2;162(9):1285-8. PubMed PMID: 10813009.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Otolaryngologists' perceptions of the indications for tympanostomy tube insertion in children. AU - McIsaac,W J, AU - Coyte,P C, AU - Croxford,R, AU - Asche,C V, AU - Friedberg,J, AU - Feldman,W, PY - 2000/5/17/pubmed PY - 2000/6/3/medline PY - 2000/5/17/entrez SP - 1285 EP - 8 JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne JO - CMAJ VL - 162 IS - 9 N2 - BACKGROUND: Bilateral myringotomy with insertion of tympanostomy tubes is the most common operation that children in Canada undergo. Area variations in surgical rates for this procedure have raised questions about indications used to decide about surgery. The objective of this study was to describe the factors that influence otolaryngologists to recommend tympanostomy tube insertion in children with otitis media and their level of agreement about indications for surgery. METHODS: A survey was sent to all 227 otolaryngologists in Ontario in the fall of 1996. The influence of 17 clinical and social factors on recommendations to insert tympanostomy tubes were assessed. Case vignettes were used to determine the effect of multiple factors in decisions about the need for surgical management. RESULTS: Surveys were returned by 138 (68.3%) of the 202 eligible otolaryngologists. There was agreement (more than 90% of respondents) about 6 indications for surgery: persistent effusion, a lack of improvement after 3 months of antibiotic therapy, a history of persistent effusion for 3 or more months per episode of otitis media, more than 7 episodes of otitis media in 6 months, a bilateral conductive hearing loss of 20 dB or more and a persistently abnormal tympanic membrane. Some respondents were more likely to recommend tube insertion if there were parental concerns about hearing problems or the frequency or severity of episodes of otitis media. Otolaryngologists agreed about the role of tympanostomy tubes in 1 of 4 case vignettes but disagreed about whether adenoidectomy should also be performed in that instance. Most viewed tympanostomy tube insertion as beneficial, with few adverse effects. INTERPRETATION: There is a lack of consensus among practising otolaryngologists in Ontario as to which children with recurrent otitis media or persistent effusion should undergo bilateral myringotomy with tympanostomy tube insertion. These findings suggest the need to revisit clinical guidelines for this procedure. SN - 0820-3946 UR - https://www.unboundmedicine.com/medline/citation/10813009/Otolaryngologists'_perceptions_of_the_indications_for_tympanostomy_tube_insertion_in_children_ L2 - http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=10813009 DB - PRIME DP - Unbound Medicine ER -