COSM 2023 Sessions: A Review of Otolaryngology Topics

by Thomas R. Collins •

Editor’s note: In the April 2023 issue, we listed a variety of topics at the 2023 Combined Otolaryngology Spring Meetings (COSM) in Boston that had piqued the interest of ENTtoday’s physician editor Robin W. Lindsay, MD. This issue, we’ve taken a closer look and highlighted some of the topics chosen. —Amy E. Hamaker

Number of Tube Procedures Falls After Guidelines Issued

The 2013 Clinical Practice Guidelines (CPG) on tympanostomy tube procedures led to a drop in the number of procedures performed, according to a new analysis. The findings are an indication that the guidelines are more than just a publication in a journal; they have real-life effects on clinical care.

“We showed a 19% decrease in procedure rate following the publication of the CPG in 2013 in both military and civilian practices, suggesting that CPGs do impact clinical practice and decision-making,” said Jason Adams, MD, an otolaryngologist and researcher at Brooke Army Medical Center in San Antonio, Texas.

Tympanostomy tube insertion is the most common ambulatory procedure performed on U.S. children, with an annual healthcare cost of $1.8 billion, Dr. Adams said. “Nearly one in 10 children will have a set of ear tubes placed by the time they’re 17,” he added.

The 2013 CPG were meant to give clinicians evidence-based recommendations on patient selection for tube insertions, as well as surgical indications and management. Among other statements, the group recommended that the procedures shouldn’t be performed on children with a single episode of otitis media with effusion (OME) lasting for less than three months, that clinicians should offer bilateral insertion to children with bilateral OME lasting for three months or longer and documented hearing difficulties, that clinicians shouldn’t perform the procedures on children with acute otitis media (AOM) who don’t have middle ear effusion in either ear, and that clinicians should offer bilateral insertion to children with recurrent AOM who have unilateral or bilateral middle ear effusion (Otolaryngol Head Neck Surg. 2013 Jul;149:S1-35).

Researchers set out to capture all tympanostomy tube procedures done within the Department of Defense, looking at the CPT codes for insertions for children 17 years old or younger in the Tricare System, the healthcare program for uniformed service members, retirees, and their families.

We showed a 19% decrease in procedure rate following the publication of the Clinical Practice Guidelines in both military and civilian practices, suggesting that they do impact clinical practice and decision-making. —Jason Adams, MD