Pediatric Otitis Media With Effusion Surgical Trends During COVID-19: A Time-Series Study.

OBJECTIVE: To evaluate the impact of the COVID-19 pandemic on pediatric surgery for otitis media with effusion (OME) in Japan, comparing the general population with high-risk groups (Down syndrome and cleft palate) to differentiate between environmental and anatomical drivers of surgical demand. METHODS: This retrospective cohort study used the Japanese Diagnosis Procedure Combination database (April 2013 to March 2023). Children < 18 years undergoing tympanostomy tube insertion or myringotomy were included. Interrupted time-series (ITS) analysis was employed to estimate immediate "level shifts" and pandemic-period "trend changes," effectively accounting for 10-year pre-existing secular trends to isolate the pandemic's impact. RESULTS: Among 22,748 surgical cases, no significant pre-pandemic trend (+0.05 surgeries/month) was observed, followed by a significant immediate level shift (-107.55 surgeries/month) and a non-significant slope change (0.95 surgeries/month). In contrast, immediate level shifts in the Down syndrome and cleft palate groups were not statistically significant, indicating relatively preserved surgical volume. Concomitant adenoidectomy and tonsillectomy decreased significantly from 38.8% to 29.7% and 23.2% to 16.9%, respectively (p < 0.001). CONCLUSIONS: While OME surgical volume for the general population plummeted, likely due to reduced community-acquired respiratory infections, it remained resilient in high-risk children. These findings suggest that while environmental factors drive OME in the general population, anatomical vulnerabilities necessitate consistent surgical intervention in high-risk groups even during a pandemic. This distinction provides a crucial framework for surgical prioritization in future public health crises.