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Cotton-Fitton Lecturer Examines Present, Future of Otitis Media

Joseph E. Kerschner, MD

Joseph E. Kerschner, MD

It’s been 15 short years since Joseph E. Kerschner, MD, finished his training, but a lot has changed since then.

Some of those changes in the area of otitis media, and a few still to come, were the subject of his Cotton-Fitton Endowed Lecture in Pediatric Otolaryngology, “Otitis Media: This is Not What I Learned in Residency.”

On the final day of the AAO-HNSF 2013 Annual Meeting & OTO EXPOSM, Dr. Kerschner spoke about the changes he’s seen in the treatment of the disease he’s focused on throughout his career.

“One of the gifts of being able to give that kind of talk is you have a few moments to reflect over some of the things that have changed and some of the impacts those aspects have had,” he said. “When I finished my training, the Eustachian tube was still the center of the universe. It was what we talked about with our parents and family members. It’s what we talked about at conferences and it’s what was found in textbooks.”

Otitis media also was considered during that time to be a pretty boring topic outside of the really “big” complications, and there was little funding at the National Institutes of Health for otitis media research that examined cellular and molecular causes into the disease.

Dr. Kerschner, now dean, executive vice president, and professor of otolaryngology and communication sciences at the Medical College of Wisconsin, said otitis media is one of the most expensive diseases treated by otolaryngologists today. There’s also still much to learn about the clinical manifestations of the disease.

Dr. Kerschner also told those in attendance that their practices and the management of otitis media in general would be influenced more by science, guidelines, and policy in the future. True value-based healthcare, he added, should include assessment related to quality of life and unintended consequences, and otolaryngologists must be involved in the knowledge creation around the disease, which along with that of other diseases, will take a more sophisticated approach.

Today, tympanostomy tubes are the norm in the treatment of otitis media. However, there’s no telling how often they’ll be used in the future.

“You have two pretty highly managed areas in northern Europe as well as in the U.K. and they’re on opposite polar spectrums about how frequently they put in tympanostomy tubes,” he said.

The Netherlands, for example, has one of the highest incidents of tympanostomy tubes per 100,000 patients. There, tympanostomy tubes are seen as more of a solution than antibiotics. In the United Kingdom, however, a lower incidence of tympanostomy tube use exists.

As the future of otitis media treatment comes into view, Dr. Kerschner suggested that attendees stay on top of all unfolding developments.

“I would just encourage us all to be mindful of policies and guidelines and white papers,” he said. “They’re going to be increasingly important. It’s going to be sort of science verses opinion and that’s why we need more science.

“One of the things the Academy is doing very well is they’re being proactive from a guidelines perspective and they’re trying to bring in the best science that can happen.”