Surgical undertreatment of glaucoma in black beneficiaries of medicare.

OBJECTIVE: To identify whether there was surgical undertreatment of glaucoma in black beneficiaries of Medicare from 1991 to 1994. METHODS: We performed a retrospective cohort analysis on all argon laser trabeculoplasty or trabeculectomy surgery claims to the Health Care Financing Administration between 1991 and 1994. There were 191 287 Medicare patients who were black or white, at least 65 years of age, and resided in the United States at the time of their glaucoma surgery. Age- and sex-adjusted rates were obtained and compared with surgery rates expected based on disease prevalence. RESULTS: The age-sex-adjusted rate ratio of glaucoma surgical procedures for blacks to whites was 2.14. Assuming that treatments should be done in proportion to age-race prevalence, blacks undergo glaucoma surgery at approximately 47% below the expected rate. CONCLUSIONS: Blacks underwent argon laser trabeculoplasties and trabeculectomies at half the rate of whites from 1991 to 1994. Although in 1993 and 1994 there was a slight trend toward higher surgery rates in blacks, the magnitude of this improvement was small compared with estimated differences in the surgery rates between blacks and whites.

Pediatric tympanoplasty. A 10-year experience.

OBJECTIVES: To determine if the age of the child is a factor in healing after tympanoplasty and to find other factors that affect the outcome in these patients. DESIGN: Case series by retrospective otological chart review. SETTING: A group private practice otology and neuro-otology referral center. PATIENTS AND OTHER PARTICIPANTS: A consecutive sample of all patients younger than 20 years who had tympanoplasty performed at the House Ear Clinic between January 1, 1983, and January 1, 1993. The 318 patients, who had had 381 ears operated on, were separated into four age groups: younger than 7 years, 7 to 8 years, 9 to 12 years, and 13 to 19 years. The 268 patients who had follow-up examinations for 6 months or longer after tympanoplasty are grouped in the same age categories for outcomes analysis. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Preoperative and postoperative audiometric data and otologic examination at the final follow-up examination. Results are reported for hearing, healing, and "success," which combines hearing and healing and is defined as an intact graft with a postoperative air-bone gap of less than 25 dB. RESULTS: The operation resulted in an intact graft in 92.5% of ears and a postoperative air-bone gap less than 25 dB in 84% of ears. Success was achieved in 81% of ears. No difference in outcome was observed among the four age groups. Success was negatively affected by mastoidectomy, previous tympanoplasty, and use of total ossicular replacement prosthesis ossiculoplasty; perhaps by the number of previous myringotomy and tubes; but not by age, status of the contralateral ear, middle ear discharge, or fellow as primary surgeon. CONCLUSION: Tympanoplasty can be safely and effectively performed in children.