Trends in otitis media surgery: a decrease in adenoidectomy.

OBJECTIVE: Large variability in adenoidectomies and tympanostomy tube insertions between Norway and Finland has been suggested, but not yet confirmed. Objective is to compare trends in paediatric adenoidectomies and tympanostomy tube insertions for Norway and Finland from 1999 to 2005. METHODS: National Finnish and Norwegian databases (STAKES and NPR) provided information on children between 0 and 7 years operated in the years 1999-2005. Surgical rates were viewed in the light of child density, age and gender, and compared bi-nationally. RESULTS: Adenoidectomies were more common in Finland throughout the study period. Adenoidectomies in both countries decreased markedly from 1999 to 2005. The Finnish adenoidectomy rates were reduced from 212 to 133 per 10,000 children, equivalent Norwegian figures were 84 and 44 per 10,000 children. Tympanostomy tube insertions increased from 97 to 147 per 10,000 children in Finland in the same study period. In Norway the rates were more stable, 119 and 123 per 10,000 in 1999 and 2005, respectively. Peak-age for otitis media surgery was the second year of life in Finland, sixth in Norway. Boys were more frequently operated on in both countries. CONCLUSION: Our study confirmed differences in the approach to otitis media surgery and revealed a decreasing trend in adenoidectomies in both countries. Similar data from other countries is needed to confirm the latter.

Tympanometry by nurses--can allocation of tasks be optimised?

OBJECTIVE: Acute otitis media and secretory otitis media are the most common pediatric infectious disease with a substantial impact on especially primary health care. If nurses could perform and interpret tympanometries, family practitioners workload could be reduced. We wanted to investigate the ability of nurses to perform tympanometry and evaluate the amount of training required. METHODS: Prospective study comparing results from tympanometry with results at myringotomy at a University Central Hospital was conducted. Nurses at the Paediatric Ear, Nose, and Throat Department performed tympanometry prior to myringotomy. Sensitivity and specificity of tympanometries versus myringotomy were calculated. Nurses' opinions about tympanometry and training required were evaluated. RESULTS: During a 1-year period, 199 children were enrolled in the study and 392 tympanograms were analyzed. Sensitivity of tympanograms to detect middle-ear fluid was 0.54, and specificity 0.82. Secretion occurred in 22.5% of children with type A curves and 45.3% of those with type C curves. Nurses evaluated their training in tympanometry as adequate. CONSCLUSIONS: A single training session in tympanometry is inadequate to qualify nurses to perform tympanometry independently. Thorough research and testing to evaluate the quality of such training is required to produce reliable tympanograms.

Otitis media surgery: large variability between Finland and Norway.

OBJECTIVE: Bi-national comparison of surgical treatment for paediatric otitis media. METHODS: Registry based cross-sectional study with complete data on surgery for otitis media in 2002; 21,811 Finnish and Norwegian children aged 0-16 years. RESULTS: Total rates for otitis media surgery were 82.5 and 146.5 per 10,000 children in Norway and Finland, respectively. Adenoidectomies were four times more frequently performed in Finland and rates for tympanostomy tube insertions differed 2-3-fold, Finland having the higher rate. The contrast in surgery rates was most striking in the age group 0-2 years. Further, the more sparsely populated regions had significantly higher overall surgery rates. CONCLUSION: The large variability in the incidence of otitis media surgery between two similar countries questions whether present guidelines ensure equal treatment in similarly affected children and pinpoints the difficulty in giving advice on age, time and type of surgery.

Paediatric otitis media surgery in Norway.

CONCLUSIONS: In Norway there are large, regional differences in the incidence of surgery and combinations of surgery for otitis media. OBJECTIVES: A descriptive study of complete national administrative data on frequency of surgery for otitis media in 2002. MATERIALS AND METHODS: This study analysed anonymous patient data from the Norwegian patient registry for 2002 and measured rates of tympanostomy tube insertions, myringotomy and the combinations of adenoidectomies and tympanostomy tubes and myringotomy, respectively. Surgical rates were assessed by region and variations within the country were evaluated. RESULTS: The peak age for surgical treatment of otitis media was 5 years. Tympanostomy tubes were inserted in more than half of the children treated and the analysis showed considerable regional variation in the rates and in choice of surgical treatment.

Finnish adenoidectomy and tympanostomy rates in children; national variation.

OBJECTIVES: To assess upper respiratory surgery rates in Finnish children and compare the rates of adenoidectomy and tympanostomy tubes in 2002 with the 1987 cohort. METHODS: Descriptive study of national upper respiratory surgery in Finland in 1987 and 2002; adenoidectomies, tympanostomy tubes and combination of these two. Surgical rates were viewed in the light of child density and number of primary care physicians and otorhinolaryngologists. RESULTS: Rates of adenoidectomy and tympanostomy tubes were highest in Western Finland and lowest in Eastern Finland (p<0.00001). Peak-age for adenoidectomy and tympanostomy tubes was in the second year of life. Surgery was most common in boys (p<0.00001). Both the numbers of otorhinolaryngologists and operations increased from 1987 to 2002; the largest surgery increase, 7.3%, was found in Western Finland. CONCLUSION: Large national differences in rates of paediatric adenoidectomy and tympanostomy tubes in Finland propose that national guidelines have not had an impact on the selection of children for surgery.