Two‐Year Outcomes After Pediatric In‐Office Tympanostomy Using Lidocaine/Epinephrine Iontophoresis and an Automated Tube Delivery System

Waldman, Erik H.; Ingram, Amy; Vidrine, D. Macy; Gould, Andrew; Zeiders, Jacob W.; Ow, Randall A.; Thompson, Christopher; Moss, Jonathan R.; Mehta, Ritvik P.; McClay, John E.; Brenski, Amy; Gavin, J.B.; Ansley, John; Yen, David M.; Chadha, Neil K; Murray, Michael T.; Kozak, Frederick K.; York, Christopher; Brown, David M.; Grunstein, Eli; Sprecher, Robert C.; Sherman, Denise A.; Schoem, Scott R.; Puchalski, Robert; Hills, Susannah; Harfe, Dan; England, Laura; Syms, Charles A.; Lustig, Lawrence R.

doi:10.1002/ohn.336

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…One study have showed that there was no difference between tube extrusion, tympanic membrane perforation, and tube occlusion under GA or LA. 35…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Tympanostomy Tubes Under Local Anesthesia Versus General Anesthesia for Children

Fournier,

Caron,

McMurtry

et al. 2023

The Laryngoscope

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ObjectiveTympanostomy tube insertion (TTI) is typically accomplished under general anesthesia (GA) in the operating room. We aimed to compare pain between GA and local anesthesia (LA) in surgically naïve children undergoing TTI. Secondary objectives examined patient's quality of life (QoL) and parent's satisfaction.Study DesignProspective single‐center study.SettingTertiary pediatric academic center.MethodsConsecutive children who underwent TTI under GA were compared to patients under LA. Pain standardized observational pain scales (Face, Legs, Activity, Cry, Consolability Scale [FLACC], Children's hospital of Eastern Ontario Pain Scale [CHEOPS]) were completed pre‐procedure, during the first tympanostomy and second tympanostomy, and post‐procedure, as well as 1 week postoperatively. General health‐related QoL (PedsQL) and QoL specific to otitis media (OM‐6) were measured before insertion and 1 month postoperatively. Parental satisfaction was also evaluated using a qualitative scale.ResultsLA group had statistically significant higher pain levels at the beginning (7.3 vs. 0), during the first tympanostomy (7.8 vs. 0), during the second tympanostomy (7.7 vs. 0), and at end of the procedure (6.9 vs. 0) with the FLACC scale (all p < 0.01). Results were similar with the CHEOPS scale. No pain was noted 1 week after surgery in either group. Both groups had similar improvement in their QoL (p > 0.05). Minor complication occurred at a similar rate (p > 0.05). Parents were equally satisfied with their choice of anesthesia in both groups when initially questioned after the procedure (p > 0.05).ConclusionsChildren experienced significantly less pain under GA than LA. If LA is to be used, pain and distress‐reducing strategies are critical. Shared decision‐making with families is essential.Level of EvidenceLevel 3 Laryngoscope, 2023

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“…One study have showed that there was no difference between tube extrusion, tympanic membrane perforation, and tube occlusion under GA or LA. 35…”

Section: Discussionmentioning

confidence: 99%

“…Long‐term follow‐up regarding children's fear of doctors and/or medical staff will also be evaluated. One study have showed that there was no difference between tube extrusion, tympanic membrane perforation, and tube occlusion under GA or LA 35 …”

Section: Discussionmentioning

confidence: 99%

Comparison of Tympanostomy Tubes Under Local Anesthesia Versus General Anesthesia for Children

Fournier,

Caron,

McMurtry

et al. 2023

The Laryngoscope

View full text Add to dashboard Cite

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Tympanostomy Tubes Under Local Versus General Anesthesia for Children: A Prospective Long‐Term Study

Bellavance,

Khoury,

Fournier

et al. 2024

The Laryngoscope

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ObjectivesTympanostomy tube insertion (TTI) under local anesthesia (LA) is gaining popularity but literature comparing long‐term outcomes for children undergoing TTI under LA versus general anesthesia (GA) is limited. This study compares the long‐term quality of life (QoL) between LA and GA in children undergoing TTI. Secondary objectives included long‐term behavioral changes, parental satisfaction, tube durability, and postoperative complications.MethodsWe prospectively followed children aged under 6 who underwent TTI, under LA or GA, 2 years prior. We assessed QoL using validated scales (OM6, PedsQL), analyzed behavioral changes and parental satisfaction through qualitative scales, and retrieved data on tube durability and non‐immediate complications.ResultsA total of 84 children (LA = 42; GA = 42) had complete data and a minimum of 1 year of follow‐up. Demographic data were similar, except for younger patients in the LA group (1.4 vs. 1.9 years, p = 0.02). LA group exhibited increased fear of health care professionals following TTI (LA: Likert scale 2.1/5, GA: 1.5/5, p = 0.04). Tube retention rate was shorter in the LA group (at 15 months: GA:72%, LA:50%, p = 0.039). Two years post‐TTI, there were no differences regarding QoL (OM‐6 score; LA: 15.2/100, GA: 21.4/100, p = 0.18, and PedsQL score; LA: 84.3/100, GA: 83.8/100, p = 0.90), parental satisfaction with anesthesia (GA: 4.5/5, LA: 4.6/5, p = 0.56), and postoperative complications (GA: 3/42, LA: 7/42, p = 0.18).ConclusionsTTI under LA in children is associated with an increased fear of health care professionals and shorter functionality of tympanostomy tubes as compared to GA. No difference was observed in long‐term QoL, parental satisfaction, and complications rate.Level of EvidenceLevel 3 Laryngoscope, 2024

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Use of Topical Phenol in Awake Young Children for Tympanostomy Tube Placement

Rimell,

Cofer,

Truitt

et al. 2023

Ear Nose Throat J

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Importance: Phenol kits cleared by the Food and Drug Administration (FDA) are indicated as a topical anesthetic for the tympanic membrane (TM) in adults. However, there is no existing literature that reports outcomes to support the safety and use of phenol on the TM of awake children. Objective: Determine if topical phenol is safe and at low risk for complications and therefore be used effectively in awake children to facilitate office otologic procedures as in adults. Design, Setting, and Participants: Children under 21 years of age whose parents agreed to participate in an awake office setting for tympanostomy tube (TT) placement. All children had TT placement after phenol placement on the TM prior to insertion. Main Outcomes and Measures: TM perforation or other signs of TM complications through a minimum of 6-month clinical follow-up, along with assessment of the tolerability of the procedure by the child. Results: A total of 228 children with an age range of 6 months to 15.9 years and 435 TMs completed TT placement using phenol as a local anesthetic while awake in the office. There were no complications reported in the 204 children at the first follow-up visit post TM placement within 3 to 10 weeks. Of the 93 children followed up at least 6 months, there were no TM complications reported. Conclusions: This is the first study to report the outcomes on the use of phenol in an office setting in children. In this large experience, phenol appears to be tolerable and safe for use in young children in the office and is a potential safe choice of topical anesthesia for surgeons if they choose to perform office procedures such as myringotomies or TT placement on children.

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Two‐Year Outcomes After Pediatric In‐Office Tympanostomy Using Lidocaine/Epinephrine Iontophoresis and an Automated Tube Delivery System

Cited by 3 publications

References 33 publications

Comparison of Tympanostomy Tubes Under Local Anesthesia Versus General Anesthesia for Children

Comparison of Tympanostomy Tubes Under Local Anesthesia Versus General Anesthesia for Children

Tympanostomy Tubes Under Local Versus General Anesthesia for Children: A Prospective Long‐Term Study

Use of Topical Phenol in Awake Young Children for Tympanostomy Tube Placement

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