Researchers have found a significant lack of consensus among surgeons in Ontario on when to operate on children with ear infections - the most common surgery among Canadian children - according to a study in the May 2 issue of the Canadian Medical Association Journal.
Led by Dr. Warren McIsaac, associate professor of family and community medicine at the University of Toronto and family physician at Mount Sinai Hospital, researchers surveyed ear, nose and throat specialists in Ontario to determine which factors they rely on when deciding when to operate. "The insertion of tiny tubes in the ear drums, a very simple procedure, has replaced tonsillectomies as the most frequent surgery among Canadian children but the rates of surgery vary drastically across the province," says McIsaac. "We wanted to find out which factors were influencing surgeons to perform this operation and determine their level of agreement on these factors."
Of the 17 clinical and social factors assessed in the survey, surgeons agreed on the importance of six. When all factors were combined in hypothetical scenarios of children with recurrent or prolonged ear infections, surgeons agreed about the role of tubal insertion in only one out of four cases.
"Parents who are told their child needs surgery have no assurances that a different surgeon would also agree," says McIsaac. "Part of the problem may be that previous studies did not address all of the factors that surgeons have to consider and so they are having to rely on their own opinions, which vary from surgeon to surgeon. Our findings suggest the medical community needs to revisit the whole issue of surgery in children with ear infections."
The study's other authors are Dr. Peter Coyte, a health economist at U of T; Dr. William Feldman, professor emeritus of pediatrics at U of T and Dr. Jacob Friedberg, associate professor of otolaryngology at U of T and staff otolaryngologist at the Hospital for Sick Children. This study was funded by the Medical Research Council of Canada.
Contact: Steven de Sousa
University of Toronto Public Affairs