Tympanostomy Tube Placement vs Medical Management for Recurrent Acute Otitis Media in TRICARE-Insured Children

Objective: To compare number of infections and health care utilization in children insured by TRICARE with recurrent acute otitis media (RAOM) managed surgically with tympanostomy tube (TT) placement compared with those managed medically. Study Design: Retrospective matched cohort study. Setting: TRICARE claims database from 2006 to 2010. Subjects and Methods: We matched TRICARE beneficiaries ≤5 years of age diagnosed with RAOM who underwent TT placement with those managed medically using 1:1 coarsened-exact matching on age, sex, race, sponsor rank, and region. We used multivariable negative binomial regression to compare number of infections and health care utilization at 1 and 2 years. Outcomes were adjusted for rate of infection before treatment for RAOM, season of either TT placement or establishment of candidacy for TT placement, and comorbidities. Results: Among 6659 pairs identified at 1-year follow-up, the TT group had fewer infections (1.96 vs 2.18, P <.001) and oral antibiotic prescriptions (1.52 vs 1.67, P <.001) but more visits to primary care physicians (4.36 vs 4.06, P <.0001) and otolaryngologists (1.21 vs 0.44, P <.0001) compared with the medically managed group. At 2-year follow-up, the benefits of TT placement were no longer seen. Conclusion: TT placement for RAOM is associated with fewer infections and oral antibiotic prescriptions in the first year after surgery but more doctor visits. Benefits of TT placement do not appear to extend through the second year. Future research should investigate costs associated with TT placement vs medical management, as well as real-time health care utilization with impact on patient symptoms and quality of life.