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Ear, Nose and Throat Surgery Among Young Australian Children

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Ear, Nose and Throat Surgery Among Young Australian Children Ear, nose and throat surgery among young Australian children Marilyn I Rob A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy School of Public Health and Community Medicine Faculty of Law University of New South Wales March 2005 1 TABLE OF CONTENTS LIST OF FIGURES........................................................................................... 7 LIST OF TABLES ............................................................................................ 9 ABSTRACT.................................................................................................... 13 ACKNOWLEDGEMENTS.............................................................................. 14 CHAPTER 1 RESEARCH BACKGROUND AND AIMS ........................... 15 INTRODUCTION .................................................................................................... 16 RESEARCH BACKGROUND AND SCOPE........................................................ 23 MYRINGOTOMY ................................................................................................... 23 What is myringotomy? ........................................................................................... 23 Why is myringotomy performed?........................................................................... 23 Prevalence and incidence of acute otitis media and OME ..................................... 30 Natural history of acute otitis media and OME...................................................... 34 Management of acute otitis media and OME ......................................................... 35 Debate regarding management options .................................................................. 39 Incidence of myringotomy and population prevalence .......................................... 51 Risk factors for myringotomy ................................................................................ 54 TONSILLECTOMY AND ADENOIDECTOMY................................................. 57 What is tonsillectomy? ........................................................................................... 57 Why is tonsillectomy performed?........................................................................... 57 Prevalence and incidence of tonsillitis and OSAS ................................................. 58 Natural history of tonsillitis and OSAS.................................................................. 59 Management of tonsillitis and tonsillar hypertrophy.............................................. 59 What is adenoidectomy?......................................................................................... 63 Why is adenoidectomy performed?........................................................................ 64 Management of adenoid hypertrophy and infection............................................... 64 Incidence of tonsillectomy and adenoidectomy and population prevalence .......... 65 Variation in rates of tonsillectomy and adenoidectomy ......................................... 68 Debate regarding tonsillectomy and adenoidectomy.............................................. 70 NEED FOR CLINICAL PRACTICE GUIDELINES........................................... 75 What are clinical practice guidelines?.................................................................... 78 What is the aim of CPGs? ...................................................................................... 79 What factors influence the acceptability of CPGs?................................................ 81 How effective are CPGs? ....................................................................................... 88 Potential effectiveness of NSW guidelines for paediatric ENT surgery ................ 90 1 CONCLUSION......................................................................................................... 95 CHAPTER 2 EPIDEMIOLOGY OF ENT SURGERY IN NSW: INTRODUCTION & METHODS ..................................................................... 99 INTRODUCTION .................................................................................................. 100 METHODS.............................................................................................................. 103 Definition of terms ............................................................................................... 103 Data source ........................................................................................................... 103 Record selection ................................................................................................... 105 Statistical analysis ................................................................................................ 107 Advantages of the ISC data .................................................................................. 116 Limitations of the data.......................................................................................... 117 CHAPTER 3 EPIDEMIOLOGY OF ENT SURGERY IN NSW: RESULTS & DISCUSSION ............................................................................................ 118 RESULTS................................................................................................................ 119 The contribution of ENT surgery to hospital utilisation....................................... 119 Type of hospital and insurance status................................................................... 120 Incidence of ENT procedures, 1981-1998/99 ...................................................... 120 International comparison ...................................................................................... 121 Lifetime risk of ENT surgery ............................................................................... 126 Trends in surgery rates ......................................................................................... 128 Trends in age- and gender-specific procedure rates ............................................. 130 Changes in age profiles, 1988/89-1998/99........................................................... 139 Changes in prevalence of surgery among children aged 0-4 years ...................... 141 Procedure combinations over time ....................................................................... 143 Geographical variation ......................................................................................... 145 Management of acute otitis media by general practitioners, 1990/91 and 1998/99 .............................................................................................................................. 147 DISCUSSION.......................................................................................................... 149 Burden of paediatric ENT surgery on the health system...................................... 149 Epidemiology of ENT surgery ............................................................................. 149 Trends in ENT surgery ......................................................................................... 149 International comparison ...................................................................................... 150 Predisposing factors for surgery........................................................................... 151 More surgery among young males ....................................................................... 152 Increased surgery for the very young ................................................................... 152 Possible explanations for increasing rates among young children....................... 153 CONCLUSION ....................................................................................................... 157 2 CHAPTER 4 EFFECT OF GUIDELINES ON RATES OF ENT SURGERY.. ............................................................................................ 159 INTRODUCTION .................................................................................................. 160 METHODS.............................................................................................................. 161 Study design ......................................................................................................... 161 Data source ........................................................................................................... 161 Statistical analysis ................................................................................................ 161 RESULTS................................................................................................................ 164 Effect of guidelines on rates of surgery................................................................ 164 Recorded diagnosis compared with guideline recommendations......................... 167 DISCUSSION.......................................................................................................... 171 CHAPTER 5 UTILISATION OF HEALTH SERVICES BY A COHORT OF NSW CHILDREN: INTRODUCTION & METHODS..................................... 175 INTRODUCTION .................................................................................................. 176 METHODS.............................................................................................................. 180 Data source ........................................................................................................... 180 Selection of subjects ............................................................................................
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