Evidence based approach and quality control in management of otitis media with effusion and recurrent acute otitis media

Abstract

Learning Objectives: In Sweden approximately 10 000 children per year have surgery with tube insertion. The Swedish National Register for Tube Treatment includes children with otitis media with effusion (OME) or recurrent acute otitis media (rAOM). Clinics participate on a voluntary basis. The first version (1997-2008) of the register collected about 40000 cases. Data showed that a majority (75%) of the registered cases had tubes inserted due to OME. More boys (52%) than girls (42%) were included, supposedly mirroring the clinical situation. In 2008 the Swedish Council on Health Technology Assessment (SBU) initiated a systematic review on tube treatment in rAOM and OME. Based on this report national guidelines for tube treatment were drawn up, and the register was revised and later rebooted in 2013. The treatment guidelines include recommendations for hearing tests before and after tube insertion in cases of OME. Pre-per-and postoperative questionnaires are submitted by the participating clinics and there is also a postoperative questionnaire answered by the parents (6 months postoperatively). Data extracted from the new registry on hearing results and patients satisfaction are now being reviewed. At present the new register contains about 7000 cases. Resent analysis indicate that the rate of preoperative hearing tests is to low according to treatment guidelines. The gender difference with a majority of cases being male remains. The group of children with rAOM is younger than the OME-group. There is room for improvement concerning pre-and post-operative hearing tests, improved collections rates for the parent's questionnaires and the total rate of clinics participating in the register. A consultant group works on solutions for improvement, together with Centre of Registers Västra Götaland, which is the national hub for all the ENT-registers. Methods for using the register in clinical research are being developed, in order to answer relevant clinical questions.