title: Clinical characteristics of New York City children who received tympanostomy tubes in 2002.
abstract: 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.
authors.affiliation: Department of Health Policy, Mount Sinai School of Medicine, One Gustave L. Levy Pl, Box 1077, New York, NY 10029, USA. salomeh.keyhani@mountsinai.org
authors.forename: Salomeh
authors.initials: S
authors.lastname: Keyhani
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: Kleinman
authors.forename: Michael
authors.initials: M
authors.lastname: Rothschild
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Bernstein
authors.forename: Rebecca
authors.initials: R
authors.lastname: Anderson
authors.forename: Melissa
authors.initials: M
authors.lastname: Simon
authors.forename: Mark
authors.initials: M
authors.lastname: Chassin
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001299:Audiometry / Q000379:methods; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008876:Middle Ear Ventilation / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D009519:New York City / Q000453:epidemiology; D010034:Otitis Media with Effusion / Q000175:diagnosis* / Q000601:surgery*; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013997:Time Factors