Day-case pediatric middle ear surgery: From myringoplasty to bilateral cochlear implantation

Should pediatric tympanomastoidectomy and cochlear implantation routinely Be performed as outpatient surgery?

“…None of the patients who underwent same‐day discharge later required admission in any of these studies . Rowlands et al found no significant difference in complication rate between those discharged on the day of surgery, or those who were admitted .…”

“…Powell et al prospectively examined 52 pediatric patients undergoing otologic surgery ranging from myringoplasty to mastoidectomy for chronic ear disease to cochlear implantation . All patients were discharged on the same day as surgery after ensuring adequate oral intake and pain control . Hasan et al retrospectively reviewed the records of 144 children undergoing 152 consecutive tympanomastoid surgeries .…”

“…The most common reason cited for overnight observation was postoperative nausea and vomiting (PONV) . Three studies cited an incidence of PONV ranging from 14% to 23%, whereas a fourth study found an incidence of 77% . Prophylaxis using a serotonin 5‐HT3 receptor antagonist (dolasetron) was not found to have a significant effect on PONV or the length of hospital stay .…”

“…Other reasons cited for admission included pain, poor oral intake, and fever with cough . Although Powell et al found no association between length of anesthetic and time required prior to discharge, Hasan et al found that patients undergoing more complex procedures were significantly more likely to require overnight observation . Several studies cited the importance of performing planned same‐day procedures earlier in the day to allow enough time for recovery before finalizing discharge plans …”

Day Care Ear Surgery: Our Experience of 4 Years

“…Whereas in a study by Rowlands et al [7], the unplanned admission rate for surgery, excluding mastoid surgery, was 6.7% and they opined that procedures such as myringoplasty, ossiculoplasty, bilateral pinnaplasty, meatoplasty and tympanotomy with excision of cholesteatoma, were eminently suitable for day surgery. In a prospective study of 52 consecutive children undergoing tympanomastoid surgery by Powell, Rowlands [8], all patients were discharged on day of surgery despite of minor post operative problems including pain, bleeding, nausea vomiting.…”