Factors affecting clinic attendance for children referred with middle ear conditions.

BACKGROUND: Middle ear disease is common in children and, if untreated, can lead to long term complications. This study investigated whether ethnic or socioeconomic inequities existed among children referred to a tertiary regional paediatric ORL service. METHODS: All middle ear pathology related referrals to Starship Children's Hospital ORL service during 2018 and 2019 were reviewed. Online clinical records were accessed to collect demographic data and appointment outcomes. The relationships between ethnicity, socioeconomic status, age at referral and clinic attendance were analysed. RESULTS: A total of 1530 children were referred and 214 (14.0%) of these did not attend their scheduled appointments. Compared with the age of referral for European children, Maori children were referred on average 1.1 years older while Pasifika children were referred 2.4 years older. Compared to European children, Maori children were 4.3 times more likely to miss an appointment while Pasifika were 7.2 times more likely. Socioeconomic status had no significant effect on either age of referral or clinic attendance. CONCLUSIONS: Maori and Pasifika children with middle ear disease are referred later and are more likely to miss outpatient clinic appointments. Pasifika children are affected more than Maori.

Is Hospitalization Necessary after Ear Surgery? A National Survey and Retrospective Review of Postoperative Events.

Objective First, to survey our national otolaryngology colleagues on their postoperative care habits (hospitalization vs day surgery) after elective middle ear surgery. Second, to evaluate the necessity of hospitalization and safety of day surgery after these procedures. Methods A national survey regarding postoperative habits after elective middle ear surgery was launched. Then, the cases of all patients having undergone these surgical procedures at our center between 2010 and 2016 were reviewed. They were divided into 2 groups: hospitalization and day surgery. Postoperative events during hospitalization and rate of consultation/readmission for day surgery were recorded. Results Heterogeneity in postoperative habits for most elective otologic surgery exists among otolaryngologists. For tympanoplasty, however, day surgery was uniformly favored. At our institution, 88.6% of hospitalization patients had no complications during their stay. Complications noted for others were nausea (7.2%), bleeding (3.1%), hematoma (0.5%), and sensorineural hearing loss (0.5%). In the day surgery group, 3.0% consulted within 48 hours following their procedure, and the readmission rate was 1.3%. Nausea was the only cause for readmission, and stapes surgery accounted for 100% of readmissions. Discussion Most elective middle ear surgery can be safely performed as day care. Hospitalization does not provide care that could not have been provided at home in the majority of cases. Overnight hospital stay may be considered for stapes surgery. Implications for Practice Day surgery for elective middle ear surgery is sufficient for most cases. Transferring these cases to day care should lower costs to our health care system and increase bed availability.