Acute Otitis Media and Associated Complications in United States Emergency Departments

Abstract

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.

Figure 1

Temporal trends in the volume of visits with a diagnosis of either otitis media or mastoiditis in hospital-based emergency departments in the United States (2009 through 2011).

Figure 2

Temporal trends in the volume of visits with a diagnosis of acute otitis media and associated complications in hospital-based emergency departments in the United States (2009 through 2011).

Figure 3

Weighted estimates of incidence of complications associated with acute otitis media in visits to hospital-based emergency departments stratified by census-defined regions (2009 through 2011).