Changing patterns of otitis media in the Waikato region during the COVID-19 pandemic
Andre Becker 1 , Ha Nguyen
2 * , Michael Becker 3 , Andrew Wood 4 5 , Ross Lawrenson 2 4
1 Otago Medical School, The University of Otago, Wellington, New Zealand.
2 Medical Research Centre, School of Health, University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand.
3 Ōtorohanga Medical, 13 Kakamutu Road, Ōtorohanga, New Zealand.
4 Te Whatu Ora, Health New Zealand (Waikato).
5 Department of Surgery, FMHS, University of Auckland, New Zealand.
Journal of Primary Health Care 15(3) 224-229 https://doi.org/10.1071/HC23026
Published: 8 June 2023
Abstract
Acute otitis media (AOM) is a common condition of children encountered in general practice. A proportion of children develop otitis media with effusion (OME), which may require tympanostomy and ventilation tube insertion.
The aim of the study was to compare the incidence of AOM in Māori and New Zealand (NZ) European children in general practice and the referral practices to secondary care for tympanostomy and ventilation tube insertion.
The study was conducted in two parts: (1) an analysis of the incidence of AOM and OME in a rural Waikato general practice (Ōtorohanga) with a high Māori population over a 2-year period; and (2) an analysis of all referrals to the otorhinolaryngology (ORL) department at Waikato District Health Board and tympanostomy and ventilation tube insertion by this service over the same period.
The incidence of AOM was similar in Māori compared with NZ European children. The incidence declined significantly between 2019 and 2020 and 50% of children with AOM were treated with antibiotics. Referral rates to the ORL department were greater for Māori compared with NZ European children as were tympanostomy and ventilation tube insertion rates.
Although AOM is common, OME was rarely diagnosed. The clinical guidelines regarding antibiotic use for common conditions are not being readily adopted and further research is needed into this matter. The COVID-19 pandemic had a substantial effect on demand both in general practice and in the hospital sector. This may have been due to a reduction in the incidence of AOM or due to system changes caused by the pandemic.
Keywords: antibiotics, COVID-19 pandemic, general practice, grommet surgery, incidence, Māori, otitis media with effusion, tympanostomy.
References
1 Gribben B, Salkeld L, Hoare S, et al. The incidence of acute otitis media in New Zealand children under five years of age in the primary care setting. J Prim Health Care 2012; 4(3): 205-12.
| Crossref | Google Scholar |
2 BPACNZ. Otitis media: a common childhood illness. 2022. Available at https://bpac.org.nz/2022/otitis-media.aspx
3 Hoberman A, Paradise JL, Rockette HE, et al. Treatment of acute otitis media in children under 2 years of age. N Engl J Med 2011; 364(2): 105-15.
| Crossref | Google Scholar |
4 Johnston J, McLaren H, Mahadevan M, et al. Surgical treatment of otitis media with effusion in Maori children. ANZ J Surg 2018; 88(11): 1141-4.
| Crossref | Google Scholar |
5 Dickinson LJ, Nimmo M, Morton RP, et al. ‘Asymptomatic’ South Auckland preschool children have significant hearing loss and middle ear disease. Int J Pediatr Otorhinolaryngol 2018; 114: 106-10.
| Crossref | Google Scholar |
6 Paterson JE, Carter S, Wallace J, et al. Pacific Islands families study: the prevalence of chronic middle ear disease in 2-year-old Pacific children living in New Zealand. Int J Pediatr Otorhinolaryngol 2006; 70(10): 1771-8.
| Crossref | Google Scholar |
7 McCallum J, Craig L, Whittaker I, et al. Ethnic differences in acute hospitalisations for otitis media and elective hospitalisations for ventilation tubes in New Zealand children aged 0–14 years. N Z Med J 2015; 128(1416): 10-20.
| Google Scholar |
8 Browning GG, Rovers MM, Williamson I, et al. Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev [10] 2010; CD001801.
| Crossref | Google Scholar |
9 Rosenfeld RM, Schwartz SR, Pynnonen MA, et al. Clinical practice guideline: tympanostomy tubes in children. Otolaryngol Head Neck Surg 2013; 149(1_suppl): S1-35.
| Crossref | Google Scholar |
10 Foley KA, Maile EJ, Bottle A, et al. Impact of COVID-19 on primary care contacts with children and young people in England: longitudinal trends study 2015–2020. Br J Gen Pract 2022; 72(720): e464-71.
| Crossref | Google Scholar |
11 Heikkinen T, Chonmaitree T. Importance of respiratory viruses in acute otitis media. Clin Microbiol Rev 2003; 16(2): 230-41.
| Crossref | Google Scholar |
12 Trenholme A, Webb R, Lawrence S, et al. COVID-19 and infant hospitalizations for seasonal respiratory virus infections, New Zealand, 2020. Emerg Infect Dis 2021; 27(2): 641-3.
| Crossref | Google Scholar |
13 Kuitunen I, Artama M, Mäkelä L, et al. Effect of social distancing due to the COVID-19 pandemic on the incidence of viral respiratory tract infections in children in Finland during early 2020. Pediatr Infect Dis J 2020; 39(12): e423-7.
| Crossref | Google Scholar |
14 Aldè M, Di Berardino F, Marchisio P, et al. Effects of COVID-19 lockdown on otitis media with effusion in children: future therapeutic implications. Otolaryngol Head Neck Surg 2021; 165(5): 710-5.
| Crossref | Google Scholar |
15 Kaur R, Schulz S, Fuji N, et al. COVID-19 pandemic impact on respiratory infectious diseases in primary care practice in children. Front Pediatr 2021; 9: 722483.
| Crossref | Google Scholar |
16 Health Quality and Safety Commission New Zealand. Community use of antibiotics. 2021. Available at https://www.hqsc.govt.nz/our-data/atlas-of-healthcare-variation/community-use-of-antibiotics/
17 Ryan J, Giles M. Management of acute otitis media by New Zealand general practitioners. N Z Med J 2002; 115(1148): 67-9.
| Google Scholar |
