Effect of Insurance Type on Postoperative Tympanostomy Tube Follow-up

Objective Bilateral myringotomy with tube insertion (BMT) is a common procedure performed in children. Appropriate follow-up is necessary to ensure management of postoperative sequalae. The objectives are to investigate (1) the relationship between insurance type and postoperative follow-up attendance and (2) the effect of follow-up on need for further care after BMT. Study Design Retrospective cohort study. Setting The study included patients <3 years of age undergoing BMT for recurrent acute otitis media at a tertiary care children’s hospital within a single year and followed for 3 years. Patients were excluded if they had received a prior BMT; underwent a concurrent otolaryngologic procedure; or had a syndromic diagnosis, craniofacial abnormality, or any significant cardiac or respiratory comorbidity. Methods Number of follow-up appointments, demographics, socioeconomic status, and postoperative outcomes were analyzed. Results A total of 734 patients were included with mean (SD) age of 1.4 years (0.50). The majority of patients had private insurance (520/734, 70.8%). Patients with public insurance attended fewer postoperative appointments (1.5 vs 1.8, P < .001) and had a higher incidence of BMT-related emergency department (ED) visits (10.3% vs 3.8%, P = .001). There was no significance found when different insurance providers were compared. An adjusted multivariate regression analysis showed that patients with private insurance were more likely to attend postoperative appointments (odds ratio, 3.52 [95% CI, 2.12-5.82]; P < .001) and less likely to have a BMT-related ED visit (odds ratio, 0.42 [95% CI, 0.20-0.89]; P = .024). Conclusion Insurance type is related to outcomes after the treatment of recurrent acute otitis media with BMT. Future studies that survey individuals will help identify barriers that contribute to patient absence at follow-ups and need for subsequent ED visits.

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Comparative study of once-weekly azithromycin and once-daily amoxicillin treatments in prevention of recurrent acute otitis media in children.

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.40.12.2732 ◽

1996 ◽

Vol 40 (12) ◽

pp. 2732-2736 ◽

Cited By ~ 15

Author(s):

P Marchisio ◽

N Principi ◽

E Sala ◽

L Lanzoni ◽

S Sorella ◽

...

Keyword(s):

Otitis Media ◽

Randomized Study ◽

Acute Otitis Media ◽

Occurrence Rate ◽

Once Daily ◽

Recurrent Acute Otitis Media ◽

Periodic Administration ◽

Resistant Strains ◽

Selection Of

Continuous chemoprophylaxis is effective in the prevention of new episodes of acute otitis media (AOM) in otitis-prone children, but compliance can be a problem and thus efficacy can be decreased. Intermittent chemoprophylaxis has so far shown conflicting results. Azithromycin, which has a peculiar pharmacokinetics, resulting, even after a single dose, in persistently elevated concentrations in respiratory tissues, could permit a periodic administration with higher compliance. We compared a 6-month course of once-weekly azithromycin (5 or 10 mg/kg of body weight) with that of once-daily amoxicillin (20 mg/kg) in a single-blind, randomized study of prophylaxis for recurrent AOM in 159 children aged 6 months to 5 years with at least three episodes of AOM in the preceding 6 months. In the amoxicillin group, 23 (31.1%) of 74 children developed 29 episodes of AOM, while in the 10-mg/kg azithromycin group, 11 (14.9%) of 74 children experienced 15 episodes. The 5-mg/kg/week azithromycin trial was prematurely interrupted after nine cases, due to the high occurrence rate of AOM (55.5%). During the 6-month prophylaxis period, the proportion of children with middle ear effusion declined similarly in both groups. No substantial modification of the nasopharyngeal flora was noted at the end of prophylaxis in both antimicrobial groups. In the 6-month-postprophylaxis follow-up period, about 40% of children in both groups again developed AOM. Azithromycin at 10 mg/kg once weekly can be regarded as a valid alternative to once-daily low-dose amoxicillin for the prophylaxis of AOM. Although in the present study no microbiological drawback was noted, accurate selection of children eligible for prophylaxis is mandatory to avoid the risk of emergence of resistant strains.

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Sequelae of recurrent acute otitis media. Ten-year follow-up of a prospectively studied cohort of children

Acta Paediatrica ◽

10.1111/j.1651-2227.1997.tb14848.x ◽

1997 ◽

Vol 86 (11) ◽

pp. 1208-1213 ◽

Cited By ~ 10

Author(s):

M. Ryding ◽

K. Konradsson ◽

O. Kalm ◽

K. Prellner

Keyword(s):

Otitis Media ◽

Acute Otitis Media ◽

Recurrent Acute Otitis Media

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Language development in children with recurrent acute otitis media during the first three years of life. follow-up study from birth to seven years of age

The Journal of Laryngology & Otology ◽

10.1017/s0022215100123291 ◽

1993 ◽

Vol 107 (5) ◽

pp. 407-412 ◽

Cited By ~ 23

Author(s):

Göran Harsten ◽

Ulrika Nettelbladt ◽

Lucyna Schalén ◽

Olof Kalm ◽

Karin Prellner

Keyword(s):

Language Development ◽

Otitis Media ◽

Early Onset ◽

Acute Otitis Media ◽

Study Groups ◽

Healthy Children ◽

Follow Up Study ◽

Recurrent Acute Otitis Media ◽

Linguistic Analyses

From a cohort of 113 children, followed prospectively from birth during the first three years of life regarding different aspects of acute otitis media (AOM), two study groups were selected for the present investigation: 13 children with recurrent AOM (rAOM, i.e. at least six episodes of AOM during a 12–month period), and 29 children without any AOM episode. The purpose of this study was to analyse the possible effects of early onset rAOM on language development as assessed at four and seven years of age at phoniatric and linguistic examinations performed blindly. There were no differences between the two groups on any of the linguistic analyses performed, although the rAOM group manifested a somewhat better performance on auditory discrimination tests at four years of age. The results of the present study show that rAOM during the first three years of life, in otherwise healthy children, does not cause a detectable delay of language development at four and seven years of age.

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