Factors affecting clinic attendance for children referred with middle ear conditions.

BACKGROUND: Middle ear disease is common in children and, if untreated, can lead to long term complications. This study investigated whether ethnic or socioeconomic inequities existed among children referred to a tertiary regional paediatric ORL service. METHODS: All middle ear pathology related referrals to Starship Children's Hospital ORL service during 2018 and 2019 were reviewed. Online clinical records were accessed to collect demographic data and appointment outcomes. The relationships between ethnicity, socioeconomic status, age at referral and clinic attendance were analysed. RESULTS: A total of 1530 children were referred and 214 (14.0%) of these did not attend their scheduled appointments. Compared with the age of referral for European children, Maori children were referred on average 1.1 years older while Pasifika children were referred 2.4 years older. Compared to European children, Maori children were 4.3 times more likely to miss an appointment while Pasifika were 7.2 times more likely. Socioeconomic status had no significant effect on either age of referral or clinic attendance. CONCLUSIONS: Maori and Pasifika children with middle ear disease are referred later and are more likely to miss outpatient clinic appointments. Pasifika children are affected more than Maori.

Clinical characteristics of obstructive sleep apnea versus infectious adenotonsillar hyperplasia in children.

INTRODUCTION: Children who undergo adenotonsillectomy have a range of symptoms. Some present with infective symptoms, others with obstructive symptoms, and many with a combination of both. The most common surgical indication has changed over the past several decades from infective symptoms to obstructive symptoms. However, there are few data available to differentiate these groups of children in terms of their clinical characteristics. This study aimed to determine the clinical characteristics of children with obstructive sleep apnea versus infectious adenotonsillar hyperplasia. METHODS: Data were obtained from the medical records of two district health boards in Auckland, New Zealand. Extraction of clinical information was performed following the identification of all patients under the age of 16 years undergoing adenotonsillectomy between December 2015 and December 2017. RESULTS: A total of 1538 children were included in this study. There were 112 (7.3%) with recurrent tonsillitis (RT) symptoms only, 624 (40.6%) with RT and sleep-disordered breathing symptoms (SDB), and 802 (52.1%) with symptoms suggestive of obstructive sleep apnea (OSA). Children with OSA were more likely to be male (p < 0.001), younger (p < 0.001), and have lower body mass indexes at time of surgery (p < 0.001). There was no difference between groups in the number of antibiotic courses prescribed in the year before surgery (p = 0.7). There was no significant difference in tonsil or adenoid grade between groups (p = 0.2). Children with OSA were more likely to have a diagnosis of asthma (p < 0.001) and allergic rhinitis (p < 0.001), but less likely than those with RT to have a diagnosis of eczema (p < 0.001). Children with OSA were more likely to have otitis media with effusion requiring ventilation tube insertion (p < 0.001) and a documented history of speech delay (p < 0.001). Thirty-day readmission rates were higher in the OSA (8.5%) and SDB/RT (9.3%) groups when compared to those with RT (1.8%) (p = 0.03). CONCLUSION: Children with OSA have different perioperative characteristics than those with recurrent tonsillitis, including increased risk of postoperative bleeding and need for post op readmission. Therefore, management strategy may vary according to the indications for tonsillectomy and adenoidectomy.

Surgical treatment of otitis media with effusion in Maori children.

BACKGROUND: This study aimed to compare the incidence and outcomes of Maori and non-Maori children with otitis media with effusion who underwent myringotomy plus ventilation tube insertion (MVTI). METHODS: De-identified extraction of Auckland District Health Board (ADHB) morbidity records belonging to all children who underwent an MVTI procedure between January 1996 and June 2016 at Starship Children's Hospital was performed. Demographic, procedural and outcome data were analysed. RESULTS: A total of 11 941 children aged less than 10 years underwent at least one MVTI procedure in the Auckland region from January 1996 to June 2016. Of those, 2387 (20%) were Maori and 9554 (80%) were non-Maori. There was no difference in gender, age, length of stay, 30-day readmissions or complications between Maori and non-Maori at index or subsequent surgeries. Maori were not more likely than non-Maori to require subsequent MVTI (P = 0.13). There was no difference between Maori and non-Maori rates of having MVTI alone (P = 0.11) or MVTI with adenoidectomy ± tonsillectomy (P = 0.61). CONCLUSIONS: Some epidemiological evidence suggests that Maori have a higher incidence of middle ear disease in the community. However, this study indicates that there is no difference in the post-operative course between Maori and non-Maori children.