title: Disease severity in patients referred to pediatric otolaryngologists with a diagnosis of otitis media.
abstract: OBJECTIVE
  This study evaluated disease severity of children referred to a pediatric otolaryngology practice with a diagnosis of otitis media (OM) before and after tympanostomy tube (TT) placement.
  
  
  METHODS
  A retrospective review was conducted of patients referred to a pediatric otolaryngology practice from January 2000 to April 2004, with the chief complaint of middle ear effusion (MEE) and/or OM. Patients who underwent TT placement had pre- and post-operative hearing levels (HL) and bilaterality of disease analyzed.
  
  
  RESULTS
  A total of 286 patients who underwent TT placement were included. Recurrent OM (ROM) was the most common diagnosis (42.6%), followed by OM with effusion (OME) plus ROM (ROM + OME) (31.7%) and then OME (25.7%) alone. The mean improvement in the pure tone average (PTA) hearing level was 14.8 dB in patients with OME, 9.5 dB in patients with ROM + OME and 6.3 dB in patients with ROM alone. The hearing improvements in OME and ROM + OME were statistically larger than the ROM group (P < or =0.0004). Hearing levels at 500, 1000, 2000 Hz and PTA showed statistically significant improvements in HL after tube placement in each group (P < 0.0001). Of the patients presenting with OME or ROM + OME, 70% had pre-operative findings demonstrating bilateral MEE.
  
  
  CONCLUSIONS
  Most children referred for consideration of surgical management of OM have a diagnosis of ROM, or ROM in conjunction with OME, with only a small percentage having the diagnosis of OME alone. In addition, the majority of children have bilateral disease, suggesting a more severely affected patient population treated by the pediatric otolaryngologist. The results also demonstrate a significant improvement in hearing after the placement of TT. However, the long-term impact of this hearing improvement on a child's development is not known and an additional prospective study of children in this population group is warranted.
authors.affiliation: Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Poetker
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Ubell
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Kerschner
mesh_terms: D000158:Acoustic Impedance Tests; D001301:Audiometry, Pure-Tone; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006314:Hearing Loss, Conductive / Q000150:complications / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008876:Middle Ear Ventilation / Q000379:methods*; D010034:Otitis Media with Effusion / Q000150:complications* / Q000601:surgery*; D010036:Otolaryngology; D038781:Otoscopy; D012008:Recurrence; D012017:Referral and Consultation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome