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Acute Otitis Media and Associated Complications in United States Emergency Departments

Ren, Yin; Sethi, Rosh K. V.; Stankovic, Konstantina M.

doi: 10.1097/MAO.0000000000001929

Objective: Complications due to acute otitis media (AOM), while rare, are associated with significant morbidity and are not well characterized from an epidemiological perspective. We analyze the pattern of presentation and emergency department (ED) utilization in patients with AOM and associated complications.

Study Design: Retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 to 2011.

Setting: Emergency Department.

Patients: Patients who presented with a primary diagnosis of AOM or acute mastoiditis.

Intervention: Diagnostic.

Main Outcome Measures: NEDS was queried for patient encounters with a diagnosis of AOM or acute mastoiditis based on ICD-9 codes. Complications of severe infection, including petrositis, Gradenigo's syndrome, facial paresis, labyrinthitis, meningitis, intracranial abscess, venous sinus thrombosis, and cerebrospinal fluid leak, were assessed. Weighted estimates for demographics, types of complications, socioeconomic status, and trends over time were extracted.

Results: A weighted total of 5,811,127 ED visits were identified. The majority of patients were less than 18 years old (79.9%) with an average age of 10.1 years. Most were discharged (99.4%). There were 15,243 (0.26%) patients who presented with a complication. The most common complications were acute mastoiditis (0.16%), labyrinthitis (0.06%), and facial paresis (0.03%). Compared with patients with uncomplicated AOM, patients with complicated AOM were older (37 vs. 10-yr old), insured by Medicare (18% vs. 2.1%), and more likely to be admitted (43.6% vs. 0.4%) (p < 0.0001, for all comparisons).

Conclusions: ED visits related to AOM or mastoiditis are common and complications are rare. An in-depth analysis on a national level is useful for assessing healthcare utilization trends.

Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts

Address correspondence and reprint requests to Yin Ren, M.D., Ph.D., Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA 02114; E-mail:

Y.R. and R.K.V.S. have equal contributions.

The study was supported by NIDCD grant R01DC015824 (K.M.S.) and Nancy Sayles Day Foundation (K.M.S.).

The authors have indicated they have no financial relationships relevant to this article to disclose.

This article was presented as an oral presentation at the 151st Annual Spring Meeting of the American Otologic Society, National Harbor, MD, April 21, 2018.

The authors disclose no conflicts of interest.

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