Characteristics of Acute Otitis Media in Primary Care Are Associated with Tympanostomy Tube Outcomes

Objective: To identify characteristics of acute otitis media (AOM) at primary care presentation associated with TT placement and outcomes.

Methods: A retrospective cohort study of pediatric patients (birth-12 years old) with AOM at an academic primary care pediatric practice and affiliated tertiary referral free-standing Children's hospital from August 1, 2017 to December 31, 2019 was performed. The outcomes measured were TT placement, postoperative otorrhea, need for additional tube placement, and other complications (i.e., perforation and/or granulation).

Results: The 3189 patients were included, 484 of whom were referred to otolaryngology. Multivariate logistic regression analysis revealed that a greater number of AOM episodes diagnosed at primary care was associated with tube placement (OR = 1.21; 95% CI, 1.04-1.41,  = .02). Of the 336 patients who received tubes, older age at first AOM diagnosis was associated with postoperative otorrhea (OR = 1.02; 95% CI, 1.01-1.03;  = .001) and additional tube placement (OR = 1.03; 95% CI, 1.02-1.04;  < .001). Older age was also associated with other complications (OR = 1.02; 95% CI, 1.01-1.03;  = .001) by univariate analysis. Additionally, postoperative otorrhea was more common among patients who first received an AOM diagnosis at primary care in the spring (OR = 2.69; 95% CI, 1.37-5.29;  = .004), summer (OR = 2.88; 95% CI, 1.46-5.69;  = .002), and fall (OR = 2.18; 95% CI, 1.20-3.96;  = .01) seasons.

Conclusions: Clinical data from pediatric primary care visits found older age at first AOM diagnosis and having a first AOM diagnosis outside of winter to be associated with a more complicated eventual disease course.

Level Of Evidence: 3-cohort study.