Which children are being operated on for recurrent acute otitis media?

OBJECTIVE

To examine at the population level which children were operated on for recurrent acute otitis media episodes, how ill they were, and what factors affected the operation rate.

DESIGN

A retrospective birth cohort with an approximate 2-year follow-up. Infection data were gathered from medical records, and background information was gathered from questionnaires.

SETTING

Primary health care centers, hospitals, and private practices in 10 randomly selected local government districts in the two northernmost provinces of Finland.

SUBJECTS

A random sample of 2512 children from the cohort.

OUTCOME MEASURES

Adenoidectomy and/or tympanostomy tube insertion.

RESULTS

Only one of 10 of those with actual recurrent disease (> or = 4 episodes) had been operated on, and three of every five children operated on, in fact, had rather few episodes. The operation rate among those children with only a few episodes was increased by factors such as consulting an ear, nose, and throat specialist (risk ratio [RR], 13.0; 95% confidence interval [CI], 7.6 to 22.2); parental exaggeration of the episodes (RR, 6.7; 95% CI, 3.8 to 11.9); having the first episode under 6 months of age (RR, 4.5; 95% CI, 2.5 to 7.9); recurrent respiratory tract infections (RR, 3.3; 95% CI, 1.9 to 5.7); male sex (RR, 2.6; 95% CI, 1.4 to 4.6); urban domicile (RR, 2.4; 95% CI, 1.1 to 4.9); and day care (RR, 2.1; 95% CI, 1.1 to 3.8). The decision to operate was more or less a random phenomenon among those children with numerous episodes.

CONCLUSIONS

Physicians at the primary care level should be familiar with these pitfalls concerning patient selection so that the operations are targeted at those children who are most seriously ill.