Published online December 31, 2007
PEDIATRICS Vol. 121 No. 1 January 2008, pp. e24-e33 (doi:10.1542/peds.2007-0623)
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ARTICLE

Clinical Characteristics of New York City Children Who Received Tympanostomy Tubes in 2002

Salomeh Keyhani, MD, MPHa,b, Lawrence C. Kleinman, MD, MPHa, Michael Rothschild, MDc, Joseph M. Bernstein, MDd, Rebecca Anderson, MPHa, Melissa Simon, BSe and Mark Chassin, MD, MPP, MPHa

a Departments of Health Policy
c Otolaryngology and Pediatrics, Mount Sinai School of Medicine, New York, New York
b James J. Peters VA Medical Center, Bronx, New York
d Departments of Otolaryngology and Pediatrics, New York University School of Medicine, New York, New York
e University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

OBJECTIVE. Tympanostomy tube insertion is the most common procedure that requires general anesthesia for children in the United States. We report on the clinical characteristics of a cohort of New York City children who received tympanostomy tubes in 2002.

METHODS. This retrospective cohort study included all 1046 children who received tubes in 2002 in any of 5 New York City area hospitals. We analyzed clinical data for all 682 (65%) children for whom we were able to abstract data for the preceding year from all of 3 sources: hospital, pediatrician, and otolaryngologist medical charts.

RESULTS. Mean age was 3.8 years, 57% were male, and 74% had private insurance. More than 25% of children had received tubes previously. The stated reason for surgery was otitis media with effusion for 60.4% of children, recurrent acute otitis media for 20.7%, and eustachian tube dysfunction for 10.6%. Children with recurrent acute otitis media averaged 3.1 ± 0.2 episodes (median: 3.0) in the previous year; those with otitis media with effusion averaged effusions that were 29 ± 1.7 days long (median: 16 days) at surgery. Twenty-five percent of children had bilateral effusions of >42 days’ duration at surgery. Despite a clinical practice guideline for otitis media with effusion that recommends withholding tympanostomy tubes for otherwise healthy children until a bilateral effusion is at least 3 to 4 months old, 50% of children had surgery without having had 3 months of effusion cumulatively during the year before surgery.

CONCLUSIONS. The clinical characteristics of children who received tympanostomy tubes varied widely. Many children with otitis media with effusion had shorter durations of effusions than are generally recommended before surgery. The extent of variation in treating this familiar condition with limited treatment options suggests both the importance and the difficulty of managing common practice in accordance with clinical practice guidelines.

Key Words: tympanostomy tubes • epidemiology • physician's practice pattern • use

Abbreviations: RAOM—recurrent acute otitis media • OME—otitis media with effusion • AOM—acute otitis media • PCP—primary care provider • ETD—eustachian tube dysfunction • IQR—interquartile range • CV—coefficient of variation

Accepted May 24, 2007.