Surgical management of uncomplicated otitis media in a pediatric Medicaid population

The objective of this study was to document the frequency and timing of oti tis media-related visits, audiological consultations, and surgical interven tions following a new episode of otitis media. A retrospective descriptive study was performed on a Medicaid administrative database that follows indi vidual patients over time. The study included 14,453 children enrolled in M edicaid during 1991 and 1992 who were 30 months of age or younger and had a "new" episode of otitis media. Among 14,321 patients with an uncomplicated episode of otitis media, there were 10,443 with additional otitis media vi sits. Audiological testing was performed in 1,134 (10.9%). The testing occu rred within 2 months of the onset of otitis media in 52.2% of the children and within 3 months in 66.6%. Physicians referred 400 children (3.8%) to an otolaryngologist; 299 (75%) underwent 1 or more surgical procedures. These surgical interventions included placement of ventilating tubes in 296 chil dren, adenoidectomy in 34 children (all of whom also had placement of venti lating tubes), mastoidectomy in 2 children, and tympanoplasty in 1 child. T he proportion of children who underwent surgical placement of ventilating t ubes who had prior audiological testing was 174 of 296 (58.8%). The overall surgical rate for ventilating tubes was 2.9%. Among children who underwent surgery, the procedure occurred within 2 months of the onset of otitis med ia in 21.4% of children. Attempts to rationalize the management of otitis m edia in early childhood must deal with the difficulties in distinguishing a mong the otitis media conditions. The findings of this study suggest a need to know whether insertions of ventilating tubes within 3 months after a ne w episode of otitis media are related to unresponsive or recurrent infectio ns.