The Effect of Patient Volume and Experience on Management of Menière's Disease.

Hypothesis: Treatment modalities administered by Otolaryngologists vary based on patient volume and years of experience.

Objective: It was our goal to evaluate the current trends in treatment modalities administered by Otolaryngologists based on patient volume and years of experience.

Methods: An electronic questionnaire was distributed to all General Otolaryngologists and fellowship-trained Neurotologist members of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). Respondents were separated into groups by patients per year (<10, 10-29, 30-49, 50-99, or >100 patients) and years in practice (0-5, 6-10, 11-15, 16-20, or >20 yrs).

Results: Eight hundred and sixty members replied for a response rate of 14.5% for generalists and 35% for neurotologists. Patient volume was found to have a positive association with perceived benefit of lifestyle and diet modification, and use of intratympanic steroids, intratympanic gentamycin, oral steroids, benzodiazepines, acetazolamide, endolymphatic sac procedures, vestibular nerve section, and surgical labyrinthectomy. Only endolymphatic sac procedures were found to have a significant positive association with a physician's length in practice. The only negative association was between intratympanic steroids and a physician's length in practice.

Conclusion: Physicians who see more MD patients annually are more likely to use these treatment modalities: diet and lifestyle modification, intratympanic steroids, intratympanic gentamycin, surgical labyrinthectomy, vestibular nerve section, acetazolamide, alprazolam, lorazepam, dexamethasone, and prednisone. Physicians with a longer length of time in practice are more likely to use only endolymphatic sac procedures, and they are less likely to use intratympanic steroids.