- Design
- Interrupted time-series analysis of a national database
- Population
- 22,748 paediatric tympanostomy or myringotomy operations in Japan, 2013 to 2023
- Primary outcome
- Monthly surgical volume before and during COVID-19
- Effect
- Immediate drop of 107.55 operations/month overall; no significant drop in Down syndrome or cleft palate
This Japanese national database study used interrupted time-series analysis of 22,748 paediatric tympanostomy tube or myringotomy operations from 2013 to 2023.
There was no pre-pandemic trend, then an immediate drop of about 108 operations a month when COVID-19 arrived. In children with Down syndrome or cleft palate, the drop was not significant. Concomitant adenoidectomy fell from 38.8% to 29.7% and tonsillectomy from 23.2% to 16.9%.
The interpretation offered is that fewer respiratory infections during distancing reduced otitis media with effusion in typical children, while children with anatomical risk continued to need surgery. That supports watchful waiting for most children and prompt management for those with craniofacial risk. It is an ecological inference, and reduced access to surgery may explain part of the fall.
- Offer watchful waiting for otitis media with effusion in otherwise well children, as infection exposure drives much of it.
- Refer children with Down syndrome or cleft palate and persistent effusion without the same delay.
- Check hearing in children with craniofacial conditions regularly, as effusion persists regardless of season.
- Reserve adenoidectomy for clear indications alongside grommets.
Why it matters
The pandemic acted as a natural experiment separating infective from anatomical causes of glue ear.
Don't overread it
Ecological data; the fall may partly reflect reduced surgical access, not only less disease.
The statistics, in plain English
An interrupted time series compares the trend before and after an event. A level shift of −107.55 operations a month is an immediate step down; the slope change afterwards was not significant.
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