Paediatric ear, nose, and throat surgery: incidence patterns and parental experiences

Abstract

Background: Surgery on the ears, nose, and throat (ENT) is amongst the most frequently performed on children driven by the propensity of children to contract infectious diseases as their immature immune systems develop. Previously epidemiological reports presented incidence of surgical intervention in age-bands, typically in 5-year age groups, which when reporting on paediatric conditions, can obscure the reporting of those children most likely to undergo surgery. Reports also suggested that the geographical distribution of the children who undergo surgery may follow specific patterns reflecting socio-economic status or geographical locale. The purpose of the thesis was to gain a clear and in-depth understanding of the incidence of tonsillectomy, adenoidectomy, and myringotomy within South Australia; to investigate how these incidences compared to other states and territories within Australia, and to identify and understand the factors that underpin and influence these incidences. Method: In order to address the aims of the thesis, a mixed methods approach was adopted. Three retrospective cross-sectional quantitative studies were conducted to 1) describe the epidemiology of the procedures within the South Australian paediatric population; 2) describe and compare the epidemiology of the procedures across the Australian paediatric population; and 3) to describe and compare the geographical distribution of the surgical incidences across the South Australia. A prospective cross-sectional qualitative study was conducted that utilised semi-structured interviews with parents/caregivers of children undergoing ENT surgical intervention to understand their experiences, perspectives, and expectations. Results: This thesis has shown that South Australian children have a higher than expected incidence of these ENT surgical procedures as compared to other Australian states and territories. There are definitive disparities across Australia in the frequency and age at which children undergo the procedures, with the state in which a child lives clearly associated with the likelihood of undergoing the surgery. Specifically, within South Australia, the children who most often underwent tonsillectomy, adenoidectomy, and myringotomy with/without tympanostomy tube insertion were very young, more commonly were boys, and with private health insurance. Disruptions to the financial security and wellbeing of the child’s household - through school and childcare absences, parental work absences, cost of repeat doctors’ visits and medications, and the household’s overall quality of life - were identified as key factors influencing the decision of parents and caregivers to proceed with surgery. Conclusion: Clearly, there are geographical disparities in the ENT surgical incidences in South Australia and these are influenced by the child’s age, gender and state in which they lived, with South Australian children undergoing these surgical interventions at a somewhat earlier age than the other states and territories examined in this thesis. These variations are most likely underpinned by difficulties in the affordability of healthcare and the financial pressures linked to lower socioeconomic status. This was further reinforced by the experiences described by parents and caregivers of children undergoing the surgeries; with financial security and disruptions to the family’s quality of life being key factors driving surgical intervention. These broader implications of childhood illness should be considered when planning improvements in the access to appropriate health services, and may have important implications for reducing the burden on the Australian healthcare system.