{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T17:27:58Z","timestamp":1775755678585,"version":"3.50.1"},"reference-count":23,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,7,25]],"date-time":"2017-07-25T00:00:00Z","timestamp":1500940800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Otitis media (OM) is the most common reason children receive general anesthesia, with bilateral tympanostomy tube (TT) insertion the second most common surgery in children. Prior research suggests overuse of TT. As part of a project designed to improve appropriateness of OM referrals, we evaluated appropriateness of TT insertion in a patient cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients younger than 9 years with initial otolaryngology (ORL) visits in academic and private office settings for OM from January 1, 2012, to August 31, 2013, were identified through claims database. A detailed retrospective chart review of patients undergoing TT insertion was performed to determine appropriateness of TT insertion per the 2013 American Academy of Otolaryngology\u2014Head and Neck Surgery Foundation (AAO\u2010HNSF) guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 120 patients undergoing TT insertion were randomly chosen for detailed chart review; 32 patients were excluded. Sixty\u2010six (75%) of 88 patients available for analysis met AAO\u2010HNSF guidelines for TT. Recurrent acute OM with middle ear effusion was the most common indication (56%). Other indications included chronic OME and TT in at\u2010risk patients with speech, learning, or behavioral delays. Of the 22 patients undergoing TT insertion not meeting AAO\u2010HNSF guidelines, 11(50%) had abnormal exams, but were 1 to 2\u00a0infections short of meeting guidelines; 7 (33%) had normal exams but met criteria for number of infections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Contrary to prior publications, 75% of patients undergoing TT insertion had an appropriate indication per AAO\u2010HNSF guidelines. In only 5% was TT insertion a substantial departure from guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Implications for Practice<\/jats:title><jats:p>The study outcomes suggest appropriate clinical decision making, improved guideline adherence, and better guideline applicability from the previously published 1994 and 2004 guidelines.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599817721454","type":"journal-article","created":{"date-parts":[[2017,7,25]],"date-time":"2017-07-25T08:00:35Z","timestamp":1500969635000},"page":"1041-1047","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Appropriateness of Tympanostomy Tubes in the Boston Metropolitan Area: Are the AAO\u2010HNSF Guidelines Being Met?"],"prefix":"10.1002","volume":"157","author":[{"given":"Amy L.","family":"Hughes","sequence":"first","affiliation":[{"name":"Department of Otolaryngology and Communication Enhancement Boston Children\u2019s Hospital Boston Massachusetts USA"},{"name":"Department of Otology and Laryngology Harvard Medical School Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Roberson","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Communication Enhancement Boston Children\u2019s Hospital Boston Massachusetts USA"},{"name":"Department of Otology and Laryngology Harvard Medical School Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cassandra","family":"Bannos","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Communication Enhancement Boston Children\u2019s Hospital Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily K.","family":"Trudell","sequence":"additional","affiliation":[{"name":"Pediatric Physicians\u2019 Organization at Children\u2019s Brookline Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louis","family":"Vernacchio","sequence":"additional","affiliation":[{"name":"Pediatric Physicians\u2019 Organization at Children\u2019s Brookline Massachusetts USA"},{"name":"Division of General Pediatrics Boston Children\u2019s Hospital Boston Massachusetts USA"},{"name":"Department of Pediatrics Harvard Medical School Boston Massachusetts 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