title: Should obtaining a preoperative audiogram before tympanostomy tube placement be used as a quality metric? A survey of pediatric otolaryngologists.
abstract: BACKGROUND
  Obtaining a preoperative audiogram prior to tympanostomy tube placement is recommended by the American Academy of Otolaryngology-Head and Neck Surgery clinical practice guideline (CPG): Tympanostomy tubes in Children, and this process measure is also used as a quality metric by payers. However, whether audiograms should be mandated in cases of tube placement for both chronic otitis media with effusion (COME) and recurrent acute otitis media (RAOM) is controversial. The objective of this study is to determine reports of practice patterns of pediatric otolaryngologists regarding obtaining audiograms before and after tympanostomy tube placement and opinions regarding utility of CPGs and use of this process measure as a quality metric.
  
  
  METHODS
  A 16-question cross-sectional survey of American Society of Pediatric Otolaryngology (ASPO) members was conducted. Per ASPO policy, no repeated requests or other enhanced response techniques were permitted. Independent t-tests for proportions were used to compare responses.
  
  
  RESULTS
  127 pediatric otolaryngologists completed the survey (response rate 26.9%). Nearly 70% of respondents reported being in practice for >10 years. 74% of respondents reported obtaining preoperative audiograms "always" or "most of the time" for COME, vs. 56.7% for RAOM (p < 0.0001). 76% agreed that obtaining a preoperative audiogram was representative of high quality for COME, vs. 52% for RAOM (p < 0.0001). 12% of respondents "completely agreed" that compliance with all aspects of CPGs represented high quality, while 68.8% responded that they somewhat agreed.
  
  
  CONCLUSIONS
  There is no consensus among pediatric otolaryngologists regarding the necessity of a preoperative audiogram in tympanostomy tube placement, especially for RAOM. Further evidence demonstrating the benefit of preoperative audiogram obtainment should be developed prior to inclusion as a guideline recommendation and as a quality metric.
authors: Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA; Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, Harvard Medical School, Boston, MA, USA. Electronic address: nraol@partners.org.
authors: Nikhila
authors: N
authors: Raol
authors: Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.
authors: Christopher J
authors: CJ
authors: Hartnick
authors: Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA.
authors: Joel S
authors: JS
authors: Weissman
mesh_terms: D000208:Acute Disease; D001299:Audiometry / Q000379:methods*; D002908:Chronic Disease; D000066491:Clinical Decision-Making; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008876:Middle Ear Ventilation / Q000379:methods*; D010033:Otitis Media / Q000601:surgery; D010034:Otitis Media with Effusion / Q000601:surgery*; D000072220:Otolaryngologists; D010036:Otolaryngology; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D012008:Recurrence; D011795:Surveys and Questionnaires
keywords: Audiograms; Quality metrics; Tympanostomy tube