Acute Otitis Media: A simple conditions well treated via TeleHealth versus ambulatory clinics or ER
Posted May 27 2011 3:31am
A minor acute illness that affects thousands each year and contributes to huge health care dollars being spent rather unnecessarily. $489 Million spent on Acute Otitis Media? What? None that presented to ambulatory care centers required admission. 3% visiting emergency department were admitted? What??? Malignant Otitis Media where surrounding soft tissue around the ear canal is inflamed and concerns about an aggressive spreading cellulitis are certainly red flags for considering an admission for this condition. However, one wonders if there are industry and administrative pressures to "admit" when these relatively ubiquitous and easily treated conditions report to the emergency department.
Another example of an industry run amuck with over-the-top defensive practice costing hundreds of health care dollars diverted unnecessarily away from where it should be spent. AOE is such as simple and straightforward diagnosis to make, an average clinician can make the diagnosis with 96% certainty with just a good history alone. No need for fancy tests or examination, having the patient "tell" you it hurts to depress the tragus or yank of the helix of the ear is "proof enough" to make a diagnosis with a recent history of "water in the ear", swimming, and wearing ear plugs in humid environments. Another near perfect example of how telemedicine can drastically reduce the health care cost of a simple condition. No need to spend more than $55 on a diagnosis and treatment. No real cause to spend $200 or more for this condition to be assessed.
Swimmer's Ear Triggered 2.4 Million Treatment Visits
By: ALICIA AULT, Family Practice News Digital Network
Swimmer’s ear caused an estimated 2.4 million trips to physician offices and emergency departments in 2007 and cost nearly $500 million to treat, the Centers for Disease Control and Prevention reported May 19.
The condition, also known as acute otitis externa (AOE), is easy to prevent, however – a fact the CDC is highlighting in advance of the nation’s swimming pools opening around Memorial Day weekend.
"Most people think of swimmer’s ear as a mild condition that quickly goes away, but this common infection is responsible for millions of illnesses and substantial medical costs each year," Dr. Michael Beach, associate director for healthy water at the CDC, said in a statement. "By taking simple steps before and after swimming or coming in contact with water, people can greatly reduce their risk of this painful infection," he said.
A study in the agency’s Morbidity and Mortality Weekly Report is the first to look at the national costs associated with swimmer’s ear, a common condition in which pathogens proliferate in a moist environment in the ear canal ( MMWR 2011;60:605-9 ).
The condition occurs most often in people who are exposed frequently to water, through bathing or swimming, and also in residents of warm and humid climates. Swimmer’s ear is characterized by pain, tenderness, redness, and swelling of the external ear canal. Most cases can be treated easily with topical antimicrobials, according to a statement from the CDC.
Not surprisingly, the study showed that AOE cases peak during the summer months. A total of 44% of cases occurred during June, July, and August, noted Dr. Emily W. Piercefield of the CDC’s Division of Applied Sciences, and her colleagues.
The data showed that children aged 5-9 years accounted for the highest frequency of physician visits for AOE, at 18.6 visits/1,000 people. Children aged 10-14 years accounted for 15.8/1,000. Interestingly, adults age 20 years and older accounted for 53% of AOE-related physician visits.
Southerners had the highest frequency of visits, at 9.1/1,000. AOE cases were least frequent in the West, at 4.3/1,000. There was no difference in frequency between urban and rural residents.
The estimated annual tally for direct health-care costs was $489 million. The average cost per case was $200 for those patients who did not require hospitalization. None of the ambulatory care patients required admission, but almost 3% of those who visited an emergency department for swimmer’s ear were hospitalized.
Health care providers spent an estimated 597,761 hours annually treating swimmer’s ear in the ambulatory-care setting, according to the study authors.
Among the prevention measures suggested by the CDC:
• Use ear plugs or bathing caps to reduce exposure of the ears to water.
• Dry the ears after swimming.
• Keep foreign objects – which could break the skin and create an avenue for infection – out of the ear.
The agency also cautioned against removing ear wax, which protects from infection. And it recommended that pool and water park operators maintain proper pH and chlorine levels to retard growth of Pseudomonas aeruginosa and Staphylococcus species, which are responsible for AOE infections.
The CDC has two websites for more information on swimmer’s ear and healthy swimming. [editor's note: A reasonable and cost effective means for evaluation and treatment is via telemedicine, a premier group experienced in telehealth is AtroGene Telehealth Consultations ]