Keyhani Salomeh, Kleinman Lawrence C, Rothschild Michael, Bernstein Joseph M, Anderson Rebecca, Simon Melissa, Chassin Mark
Department of Health Policy, Mount Sinai School of Medicine, One Gustave L. Levy Pl, Box 1077, New York, NY 10029, USA.
Pediatrics. 2008 Jan;121(1):e24-33. doi: 10.1542/peds.2007-0623.
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.
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.
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.
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.
在美国，鼓膜置管术是儿童最常需要全身麻醉的手术。我们报告了2002年纽约市一组接受鼓膜置管术儿童的临床特征。
这项回顾性队列研究纳入了2002年在纽约市地区5家医院中任何一家接受置管术的所有1046名儿童。我们分析了所有682名（65%）儿童的临床数据，我们能够从医院、儿科医生和耳鼻喉科医生的病历这3个来源提取前一年的数据。
平均年龄为3.8岁，57%为男性，74%有私人保险。超过25%的儿童曾接受过置管术。手术的既定原因是60.4%的儿童为中耳积液，20.7%为复发性急性中耳炎，10.6%为咽鼓管功能障碍。复发性急性中耳炎儿童前一年平均发作3.1±0.2次（中位数：3.0次）；中耳积液儿童手术时积液平均持续29±1.7天（中位数：16天）。25%的儿童手术时双侧积液持续时间超过42天。尽管有关于中耳积液的临床实践指南建议，对于其他方面健康的儿童，在双侧积液至少3至4个月大之前暂不进行鼓膜置管术，但50%的儿童在手术前一年累计积液未达3个月就接受了手术。
接受鼓膜置管术的儿童临床特征差异很大。许多中耳积液儿童的积液持续时间比手术前通常建议的要短。在治疗这种常见疾病时，治疗选择有限，差异程度表明按照临床实践指南管理常见做法既重要又困难。
