title: Antihistamine Use for Otitis Media with Effusion: Ongoing Opportunities for Quality Improvement.
abstract: OBJECTIVE
  The otitis media with effusion (OME) clinical practice guideline endorsed by the American Academy of Otolaryngology-Head and Neck Surgery Foundation, the American Academy of Pediatrics, and the American Academy of Family Physicians recommends against using antihistamines. Avoiding antihistamines was previously endorsed as a performance measure by the National Quality Foundation, but data regarding current practice patterns are lacking. Thus, our objectives were to evaluate (1) antihistamine usage in association with OME, (2) whether practice varies according to visit setting, and (3) if usage patterns are such that a future change would be measurable.
  
  
  METHODS
  Cross-sectional analysis.
  
  
  METHODS
  Ambulatory visits in the United States.
  
  
  METHODS
  National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Surveys, 2005-2010; univariate, multivariate, and stratified analyses of antihistamine usage were performed.
  
  
  RESULTS
  A total of 133,968 observations representing 1.49 × 10(9) pediatric visits met inclusion criteria. Antihistamines were used in 9.5% of OME visits, as opposed to 5.5% of visits without OME (univariate odds ratio, 1.83; 95% confidence interval, 1.02-3.29; P = .042). Multivariate analysis confirmed that OME was associated with a significant increase in nonsedating antihistamine usage (odds ratio, 3.53; 95% confidence interval, 1.62-7.71; P = .002), when adjusted for age, sex, race/ethnicity, allergic conditions and nasal inflammatory diagnoses.
  
  
  CONCLUSIONS
  Oral antihistamines are significantly more likely to be administered when OME is diagnosed. Although antihistamine use for OME is proportionally low, the high prevalence of OME creates an opportunity for quality improvement. Future changes in clinician behavior in response to an updated guideline or related performance metric could be monitored.
authors.affiliation: Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Prince
authors.affiliation: Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Rosenfeld
authors.affiliation: Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA jennifer_shin@meei.harvard.edu.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Shin
mesh_terms: D000284:Administration, Oral; D002648:Child; D003430:Cross-Sectional Studies; D005064:Eustachian Tube; D005260:Female; D006633:Histamine Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D016015:Logistic Models; D008297:Male; D010034:Otitis Media with Effusion / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D012044:Regression Analysis; D065631:Rhinitis, Allergic / Q000150:complications
chemical_list: D006633:Histamine Antagonists
keywords: antihistamines; otitis media with effusion; performance metric; practice patterns; quality improvement