Antihistamine Use for Otitis Media with Effusion: Ongoing Opportunities for Quality Improvement

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The otitis media with effusion (OME) clinical practice guideline endorsed by the American Academy of Otolaryngology—Head and Neck Surgery Foundation, the American Academy of Pediatrics, and the American Academy of Family Physicians recommends against using antihistamines. Avoiding antihistamines was previously endorsed as a performance measure by the National Quality Foundation, but data regarding current practice patterns are lacking. Thus, our objectives were to evaluate (1) antihistamine usage in association with OME, (2) whether practice varies according to visit setting, and (3) if usage patterns are such that a future change would be measurable.

Study Design

Cross-sectional analysis.


Ambulatory visits in the United States.

Subjects and Methods

National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Surveys, 2005-2010; univariate, multivariate, and stratified analyses of antihistamine usage were performed.


A total of 133,968 observations representing 1.49 × 109 pediatric visits met inclusion criteria. Antihistamines were used in 9.5% of OME visits, as opposed to 5.5% of visits without OME (univariate odds ratio, 1.83; 95% confidence interval, 1.02-3.29; P = .042). Multivariate analysis confirmed that OME was associated with a significant increase in nonsedating antihistamine usage (odds ratio, 3.53; 95% confidence interval, 1.62-7.71; P = .002), when adjusted for age, sex, race/ethnicity, allergic conditions and nasal inflammatory diagnoses.


Oral antihistamines are significantly more likely to be administered when OME is diagnosed. Although antihistamine use for OME is proportionally low, the high prevalence of OME creates an opportunity for quality improvement. Future changes in clinician behavior in response to an updated guideline or related performance metric could be monitored.

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