ArticleBMJ (Clinical research ed.)2008
Overuse of tympanostomy tubes in New York metropolitan area: evidence from five hospital cohort.
Article in BMJ (Clinical research ed.), 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 47 citations in OpenAlex.
- Latest research hot spots of tympanostomy tube: A bibliometric analysis and visualized review.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2026Review
- Approaching Social Determinants of Health in Otolaryngology - Head Neck Surgery: Linking Needs to Resources to Promote Health Equity.ORL-head and neck nursing : official journal of the Society of Otorhinolaryngology and Head-Neck Nurses · 2025Article
- Association Between Social Disadvantage and Otitis Media Treatment in US Children With Commercial Insurance.JAMA otolaryngology-- head & neck surgery · 2022Article
- Factors influencing surgeon decision-making by measuring waiting time for pediatric ventilation tube insertions.Journal of the Chinese Medical Association : JCMA · 2022Article
- Niche- and Gender-Dependent Immune Reactions in Relation to the Microbiota Profile in Pediatric Patients with Otitis Media with Effusion.Infection and immunity · 2020Article
- Direct Analysis of Pathogenic Structures Affixed to the Tympanic Membrane during Chronic Otitis Media.Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2018Article
- Noninvasive in vivo optical coherence tomography tracking of chronic otitis media in pediatric subjects after surgical intervention.Journal of biomedical optics · 2017Article
- Nonadherence to Guideline Recommendations for Tympanostomy Tube Insertion in Children Based on Mega-database Claims Analysis.Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2017Article
- Variation in Utilization and Need for Tympanostomy Tubes across England and New England.The Journal of pediatrics · 2016Article
- Do race/ethnicity or socioeconomic status affect why we place ear tubes in children?International journal of pediatric otorhinolaryngology · 2016Article
- Association of pneumococcal conjugate vaccination with rates of ventilation tube insertion in Denmark: population-based register study.BMJ open · 2015Article
- Impact of pneumococcal conjugate vaccine on pediatric tympanostomy tube insertion in partial immunized population.TheScientificWorldJournal · 2015Article
- Contemporary concepts in management of acute otitis media in children.Otolaryngologic clinics of North America · 2014Review
- The protective effect of adenoidectomy on pediatric tympanostomy tube re-insertions: a population-based birth cohort study.PloS one · 2014Article
- Pediatric health care quality measures: considerations for pharmacotherapy.Paediatric drugs · 2013Article
- Article
- Trends in the overuse of ambulatory health care services in the United States.JAMA internal medicine · 2013Article
- The underuse of overuse research.Health services research · 2008Article
- Assessment of the association between atopic conditions and tympanostomy tube placement in children.Allergy and asthma proceedingsArticle
- Racial and Ethnic Differences in Receipt of Pressure Equalization Tubes Among US Children, 2014.Academic pediatricsArticle
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesTo compare tympanostomy tube insertion for children with otitis media in 2002 with the recommendations of two sets of expert guidelines.
designRetrospective cohort study.
settingNew York metropolitan area practices associated with five diverse hospitals.
participants682 of 1046 children who received tympanostomy tubes in the five hospitals for whom charts from the hospital, primary care physician, and otolaryngologist could be accessed.
resultsThe mean age was 3.8 years. On average, children with acute otitis media had fewer than four infections in the year before surgery. Children with otitis media with effusion had less than 30 consecutive days of effusion at the time of surgery. Concordance with recommendations was very low: 30.3% (n=207) of all tympanostomies were concordant with the explicit criteria developed for this study and 7.5% (n=13) with the 1994 guideline from the American Academy of Pediatrics, American Academy of Family Medicine, and American Academy of Otolaryngology-Head and Neck Surgery. Children who had previously had tympanostomy tube surgery, who were having a concomitant procedure, or who had "at risk conditions" were more likely to be discordant.
conclusionsA significant majority of tympanostomy tube insertions in the largest and most populous metropolitan area in the United States were inappropriate according to the explicit criteria and not recommended according to both guidelines. Regardless of whether current practice represents a substantial overuse of surgery or the guidelines are overly restrictive, the persistent discrepancy between guidelines and practice cannot be good for children or for people interested in improving their health care.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.