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Oral Steroid Usage for Otitis Media with Effusion, Eustachian Tube Dysfunction, and Tympanic Membrane Retraction.
Otolaryngol Head Neck Surg. 2016 07; 155(1):139-46.OH

Abstract

OBJECTIVES

Avoiding oral steroids for otitis media with effusion (OME) is endorsed as a performance measure by the National Quality Foundation, but data regarding current gaps and practice patterns are lacking. Our objectives were to evaluate oral steroid use for OME and the related diagnoses of eustachian tube dysfunction (ETD) and tympanic membrane retraction (TMR), to assess variations by visit setting, and to identify opportunities for measurable performance improvement.

STUDY DESIGN

Cross-sectional analysis of a national database.

SETTING

Ambulatory visits in the United States.

SUBJECTS

Children and adults in the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey (2005-2010).

METHODS

Data were coded for patient demographic information, potential confounders (eg, concurrent conditions managed by oral steroids), and diagnosis of OME, ETD, or TMR (OME/ETD/TMR). The latter 2 diagnoses were included to meet minimum numbers for reliability of weighted estimates, but OME constituted the majority of cases. Multivariate regression was used to determine the variables associated with oral steroid use.

RESULTS

Among 590,772 observations representing 7,191,711,480 visits for OME/ETD/TMR, 3.2% resulted in a new prescription for oral steroid medication (2.3% for children, 7.0% for adults). Adults were more likely to receive steroids (odds ratio = 3.50, P < .001) than those with other diagnoses, but a similar association was not found for children. Patients seen by an otolaryngologist or in the emergency department were less likely to receive steroids than those seen in other settings.

CONCLUSIONS

OME/ETD/TMR is infrequently treated with oral steroids, particularly in children. Opportunities for performance improvement are limited.

Authors+Show Affiliations

Ear Nose Throat Department, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.Department of Otolaryngology, Washington University in St Louis, St Louis, Missouri, USA.Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA.Pomona Pediatrics, Pomona, New York, USA.Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA jennifer_shin@meei.harvard.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27026728

Citation

Bellmunt, Angela M., et al. "Oral Steroid Usage for Otitis Media With Effusion, Eustachian Tube Dysfunction, and Tympanic Membrane Retraction." Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, vol. 155, no. 1, 2016, pp. 139-46.
Bellmunt AM, Vila PM, Chen JX, et al. Oral Steroid Usage for Otitis Media with Effusion, Eustachian Tube Dysfunction, and Tympanic Membrane Retraction. Otolaryngol Head Neck Surg. 2016;155(1):139-46.
Bellmunt, A. M., Vila, P. M., Chen, J. X., Rosenfeld, R. M., Hackell, J. M., & Shin, J. J. (2016). Oral Steroid Usage for Otitis Media with Effusion, Eustachian Tube Dysfunction, and Tympanic Membrane Retraction. Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 155(1), 139-46. https://doi.org/10.1177/0194599816637845
Bellmunt AM, et al. Oral Steroid Usage for Otitis Media With Effusion, Eustachian Tube Dysfunction, and Tympanic Membrane Retraction. Otolaryngol Head Neck Surg. 2016;155(1):139-46. PubMed PMID: 27026728.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Oral Steroid Usage for Otitis Media with Effusion, Eustachian Tube Dysfunction, and Tympanic Membrane Retraction. AU - Bellmunt,Angela M, AU - Vila,Peter M, AU - Chen,Jenny X, AU - Rosenfeld,Richard M, AU - Hackell,Jesse M, AU - Shin,Jennifer J, Y1 - 2016/03/29/ PY - 2015/10/18/received PY - 2016/02/17/accepted PY - 2016/3/31/entrez PY - 2016/3/31/pubmed PY - 2017/7/18/medline KW - otitis media with effusion KW - performance metric KW - practice patterns KW - quality improvement KW - steroids SP - 139 EP - 46 JF - Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery JO - Otolaryngol Head Neck Surg VL - 155 IS - 1 N2 - OBJECTIVES: Avoiding oral steroids for otitis media with effusion (OME) is endorsed as a performance measure by the National Quality Foundation, but data regarding current gaps and practice patterns are lacking. Our objectives were to evaluate oral steroid use for OME and the related diagnoses of eustachian tube dysfunction (ETD) and tympanic membrane retraction (TMR), to assess variations by visit setting, and to identify opportunities for measurable performance improvement. STUDY DESIGN: Cross-sectional analysis of a national database. SETTING: Ambulatory visits in the United States. SUBJECTS: Children and adults in the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey (2005-2010). METHODS: Data were coded for patient demographic information, potential confounders (eg, concurrent conditions managed by oral steroids), and diagnosis of OME, ETD, or TMR (OME/ETD/TMR). The latter 2 diagnoses were included to meet minimum numbers for reliability of weighted estimates, but OME constituted the majority of cases. Multivariate regression was used to determine the variables associated with oral steroid use. RESULTS: Among 590,772 observations representing 7,191,711,480 visits for OME/ETD/TMR, 3.2% resulted in a new prescription for oral steroid medication (2.3% for children, 7.0% for adults). Adults were more likely to receive steroids (odds ratio = 3.50, P < .001) than those with other diagnoses, but a similar association was not found for children. Patients seen by an otolaryngologist or in the emergency department were less likely to receive steroids than those seen in other settings. CONCLUSIONS: OME/ETD/TMR is infrequently treated with oral steroids, particularly in children. Opportunities for performance improvement are limited. SN - 1097-6817 UR - https://www.unboundmedicine.com/medline/citation/27026728/Oral_Steroid_Usage_for_Otitis_Media_with_Effusion_Eustachian_Tube_Dysfunction_and_Tympanic_Membrane_Retraction_ DB - PRIME DP - Unbound Medicine ER -