In January 2021, the pediatric otolaryngologists at Nemours Children’s Hospital in Orlando, Fla., performed just 18 bilateral myringotomies and tube placements.
Explore This IssueMay 2021
Before the COVID-19 pandemic, the team was regularly doing an average of 150 such surgeries each month. That number, of course, dropped to nearly zero last March, when state governments issued stay-at-home orders and elective surgeries were canceled. Nationwide, adult and pediatric otolaryngology clinic volumes decreased by about 30%; some practices reported decreases of almost 50%.
In recent months, volume has rebounded somewhat as states have relaxed COVID-19-related restrictions and vaccinations have decreased public concerns regarding disease transmission. However, appointments and surgical volumes have yet to return to pre-pandemic numbers. The pediatric otolaryngologists at Nemours Children’s Hospital performed 52 bilateral myringotomies and tube placements in February 2021—a nearly three-fold increase over the month previous. But in March, they performed only 53, or about one-third of the division’s usual volume.
Their experience isn’t isolated. According to Eric Gantwerker, MD, MMSc (MedEd), pediatric otolaryngologist at Cohen Children’s Medical Center at Northwell Health/Hofstra in Hempstead, N.Y., adult-oriented otolaryngology clinic and surgical volumes have rebounded to about 90% of their usual numbers. Pediatric cases, however, seem stalled at about 75% percent of pre-pandemic volume.
What do these decreased numbers mean for pediatric otolaryngologists and the families and communities they serve? Which pandemic-necessitated shifts in care delivery will persist? And how should pediatric laryngologists prepare for post-pandemic practice?
ENT Today asked physicians around the country to share their thoughts on the future of pediatric otolaryngology. Here are their predictions:
Healthcare Systems/Physician Practices Will Scramble to Make Up Lost Revenue
For decades, pediatric tympanostomy tube placements, tonsillectomies, and adenoidectomies have been the mainstay of otolaryngology practices. These relatively easy-to-perform, typically uncomplicated procedures can usually be completed in minutes—and net substantial income for hospitals, surgery centers, and physician practices. The nationwide pause on elective surgeries deeply affected the bottom line of hospitals, healthcare systems, and physicians.
“Because our U.S. healthcare system is a fee-for-service model, the decrease in pediatric ENT volume had a significant negative impact on children’s hospitals and practices, as well as community general otolaryngologists,” said Julie Wei, MD, division chief of otolaryngology at Nemours Children’s Hospital. “The financial impact isn’t just surgeon-related procedural fees, but anesthesia and facility fees, as well as all other associated procedural costs and revenues, such as audiology services.”
Of course, tympanostomy tube placements—and other common pediatric surgeries—had been trending downward even before the pandemic in response to clinical evidence showing that surgery isn’t necessary to manage many cases of recurrent otitis media and strep throat.
“Globally, over the last five years or so, while still a significant portion of our practice, we weren’t seeing as many kids coming in for ear tubes and tonsillectomies as we did around 15 years ago,” said Karen Zur, MD, chief of the division of otolaryngology at Children’s Hospital in Philadelphia (CHOP).
The sudden cessation of elective surgeries in early 2020 certainly accounts for much of the dramatic decline in surgical volumes from 2019 to the present. Physicians expect that numbers haven’t fully bounced back because many children remain home from school and daycare, and mask wearing, social distancing, and increased attention to hygiene have reduced children’s exposure to bacteria and viruses. Decreased exposure to germs means fewer cases of otitis media and strep throat, which may be one reason why tube placement and tonsillectomy numbers remain down nationwide.
Additionally, many parents and guardians who would once have brought their children in as soon as they noted fever or discomfort didn’t do so in 2020, as they were concerned about possible COVID-19 exposure in healthcare settings. Some of these adults learned that waiting two or three days may make the problem go away, Dr. Gantwerker said, noting that the so-called “worried well” typically accounted for a large majority of patients seen in urgent cares and pediatricians’ offices, and that some of these patients ended up being referred for ear tube placement or other procedures.