| Summary: | 博士 === 國立陽明大學 === 公共衛生研究所 === 103 === Part 1 The Protective Effect of Adenoidectomy on Pediatric Tympanostomy Tube Re-insertions: A Population-Based Birth Cohort Study
Objectives: Adenoidectomy in conjunction with tympanostomy tube insertion for treating pediatric otitis media with effusion and recurrent acute otitis media has been debated for decades. Practice differed surgeon from surgeon. This study used population-based data to determine the protective effect of adenoidectomy in preventing tympanostomy tube re-insertion and tried to provide more evidence based information for surgeons when they do decision making.
Study Design: Retrospective birth cohort study
Methods: This study used the National Health Insurance Research Database for the period 2000-2009 in Taiwan. The tube reinsertion rate and time to tube re-insertion among children who received tympanostomy tubes with or without adenoidectomy were compared. Age stratification analysis was also done to explore the effects of age.
Results: Adenoidectomy showed protective effects on preventing tube re-insertion compared to tympanostomy tubes alone in children who needed tubes for the first time (tube re-insertion rate 9% versus 5.1%, p=0.002 and longer time to re-insertions, p=0.01), especially those aged over 4 years when they had their first tube surgery. After controlling the effect of age, adenoidectomy reduced the rate of re-insertion by 40% compared to tympanostomy tubes alone (aHR: 0.60; 95% CI: 0.41-0.89). However, the protective effect of conjunction adenoidectomy was not obvious among children with a second tympanostomy tube insertion. Children who needed their first tube surgery at the age 2-4 years were most prone to have tube re-insertions, followed by the age group of 4-6 years.
Conclusions: Adenoidectomy has protective effect in preventing tympanostomy tube re-insertions compared to tympanostomy tubes alone, especially for children older than 4 years old and who needed tubes for the first time. Nonetheless, clinicians should still weigh the pros and cons of the procedure for their pediatric patients.
Part 2 Impact of Seven-Valent Pneumococcal Conjugate Vaccine on Pediatric Tympanostomy Tube Insertions in A Partial Immunized Population: A Population Based Study
Objectives: The seven-valent pneumococcal conjugate vaccine has been effective in preventing invasive pneumococcal disease in children and has indirect effects on unvaccinated individuals in different age groups. The vaccine also decreases the incidence of otitis media and tympanostomy tube procedures in children. However the indirect effect of the vaccine on tube insertions has seldom been mentioned. The vaccine was released in Taiwan in 2005. We examined the impact of the vaccine on tube insertions in a partially immunized pediatric population.
Study Design: Retrospective ecological study
Methods: This study used the Taiwan National Health Insurance Research Database for the period 2000-2009. Every child under 17 years of age who had received tubes during this 10-year period was identified and analyzed. The tube insertion rates in different age groups, before and after the year 2005, and the risk to receive tubes in different birth cohort were compared.
Results: The tube insertion rate of children under 2 years of age decreased significantly after 2005 in period effect analysis and increased in children 2 to 9 years of age throughout the study period. However, the decreasing trend of tube insertion rate seemed to be begun in 2003. The risk of tube insertion was lower in 2004-2005 and 2006-2007 birth cohorts than that of 2002-2003 birth cohort.
Conclusions: The seven-valent pneumococcal conjugate vaccine may reduce the risk of tube insertion for children of later birth cohorts in comparison with 2002-2003 birth cohort. This effect may be due to the direct effect or both direct and indirect effect of the vaccine. There was no obvious indirect effect of the vaccine on tube insertions in children older than 2 years of age.
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