(0969) Trends in Surgery for Chronic Ear Disease Among Medicare Patients

Introduction: Chronic otitis media has a variety of presentations, and thus, a variety of different surgical treatments that include tympanoplasty, atticotomy, ossicular chain reconstruction (OCR) and mastoidectomy (either canal wall up or canal wall down procedures). The performed procedure depends on the presentation of the disease and surgeon preference.

Methods: The annual procedure data for tympanoplasty, antrostomy, mastoidotomy and mastoidectomy (CPT codes 69631, 69632, 69633, 69635, 69636, 69637, 69641, 69642, 69643, 69644, 69645 and 69646) were obtained from the Part B National Summary Data File from the Centers from Medicare and Medicaid Services. Descriptive statistics were used to analyze the number of procedures per year and to calculate the yearly variation.

Results: During this 21-year period there were 176,650 procedures performed among Medicare patients, the most common of them being 69631, representing 41.5% of the procedures, followed by 69643 with 10.31%, and 69641, with 10.04%. The average number of procedures performed per year was 8,030. The year with the most procedures performed was 2004 with 8,608, and the year with the least procedures was 2020 with 6,191. The average change per year in the number of procedures performed was -0.45%. The year with the biggest change in the number of procedures performed was 2020, with a 23.01% decrease in procedures performed relative to those of year 2019. Procedures 69631, 69637, 69643, 69644, 69645 and 69646 had an average increase, while procedures 69632, 69633, 69635, 69636, 69641 and 69642 had an average decrease.

Conclusions: The biggest factor influencing the number of surgeries for chronic ear disease was the COVID-19 pandemic, making 2020 the year with the least procedures performed, and the year with the biggest decrease respective to the previous year. 69631 remains the procedure more commonly performed since it involves only a tympanoplasty without mastoidectomy and without OCR. Procedures involving tympanoplasty and OCR but no mastoidectomy. This could be due to a more aggressive approach towards cholesteatoma.