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Intranasal Steroid Use for Otitis Media with Effusion: Ongoing Opportunities for Quality Improvement.

Authors
  • Wang, David E1
  • Lam, Derek J2
  • Bellmunt, Angela M3
  • Rosenfeld, Richard M4
  • Ikeda, Allison K5
  • Shin, Jennifer J1
  • 1 1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.
  • 2 2 Department of Otolaryngology, Oregon Health and Science University, Portland, Oregon, USA.
  • 3 3 Department of Otolaryngology, Hospital Universitari de la Vall d'Hebron, Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain. , (Spain)
  • 4 4 Department of Otolaryngology, SUNY Downstate Medical Center, New York, New York, USA.
  • 5 5 School of Medicine, Emory University, Atlanta, Georgia, USA. , (Georgia)
Type
Published Article
Journal
Otolaryngology
Publisher
SAGE Publications
Publication Date
Aug 01, 2017
Volume
157
Issue
2
Pages
289–296
Identifiers
DOI: 10.1177/0194599817703046
PMID: 28535109
Source
Medline
Keywords
License
Unknown

Abstract

Objectives Our objectives were (1) to assess patterns of intranasal steroid administration when otitis media with effusion (OME) has been diagnosed in children, (2) to investigate whether usage varies according to visit setting, and (3) to determine if practice gaps are such that quality improvement could be tracked. Study Design Cross-sectional analysis of an administrative database. Subjects and Methods National Ambulatory and Hospital Ambulatory Medical Care Surveys, 2005 to 2012; univariate, multivariate, and stratified analyses of intranasal steroid usage were performed. The primary outcome was intranasal steroid administration, and the primary predictor was a diagnosis of OME. The impact of location of service was also analyzed. Results Data representing 1,943,177,903 visits demonstrated that intranasal steroids were administered in 10.0% of visits in which OME was diagnosed, in comparison to 3.5% of visits in which OME was not diagnosed (univariate odds ratio, 3.07; 95% confidence interval [CI], 1.85-5.08; P < .001). After adjusting for age, sex, race/ethnicity, and other confounding conditions, multivariate analysis demonstrated that OME remained associated with an increase in intranasal steroid usage (odds ratio, 3.58; 95% CI, 1.60-8.01; P = .002). This practice pattern was more prevalent in the ambulatory office setting (risk difference 6.6%, P < .001) and less seen in a hospital-based office or emergency department. Conclusion Despite randomized controlled trials showing a lack of efficacy for isolated OME, nasal steroids continue to be used in treating children with OME in the United States. Related quality improvement opportunities to prevent usage of an ineffective treatment exist.

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