ASPO011 - Pro vs Con: Office Tympanostomy Tube Placement in Young Children
Friday, April 29, 2022
3:30 PM – 4:25 PM CT
Location: Landmark C
Franklin Rimell, MD , Richard M. Rosenfeld, MD, MPH, MD, Shelagh Cofer, MD , Noel Jabbour, MD ,
Southwest Florida Children's Hospital, Fort Myers, FL, SUNY Downstate Health Sciences, Brooklyn, NY, Mayo Clinic, Rochester, MN, Children's Hospital of Pittsburgh, Pittsburgh, PA
Children's Hospital of Southwest Florida Fort Myers, Florida
This mini-seminar will discuss the rationale and various techniques that are used for pediatric tympanostomy tube (TT) placement in the office. We will discuss advantages and disadvantages of office base TT placement versus the approach under general anesthesia (GA). We will debate various techniques from standard surgical instruments used in the office to those using an assist device. We will debate reimbursement and the economics of pediatric office TT versus procedures done with GA. Also, the approaches to local anesthesia or other methods for pain and movement control during the office TT procedure will also be presented. The shift to an office-based approach for pediatric TT placement was recently endorsed in a position statement by the AAO-HNS. The Position Statement concluded, "although insertion of tympanostomy tubes in children is generally accomplished in the operating room under GA, insertion in the clinic in appropriately selected patients using shared decision making between clinicians and families can be appropriate". TT procedures under GA carry an inherent risk to children from acute anesthetic complications (including laryngospasm or emergence delirium). Additionally, there may be potential long-term adverse neurodevelopmental effects when young children who receive repeated TT receive multiple exposures of GA as noted in recent studies. Otitis media and subsequent TT placement also involves a socioeconomic burden for parents with multiple outpatient visits. Ideally, once the patient sees the otolaryngologist, it would be most efficient for all parties to perform TT at that initial otolaryngology visit if criteria for TT are met. We will also discuss best practices for managing the child in the office as well as the parents during the procedure and the approaches panel members have found to be most successful. We will present data and studies that were used and resulted in FDA clearance for the various techniques. This includes videotaped analysis on pediatric tolerance of the office procedure. We will also discuss the pros and cons of various anesthetic options for in-office TT placement. We will debate whether office TT placement is a more cost effective process to TT placement then the traditional approach under general anesthesia. We will also debate the potential of office-based TT placement to reduce the role and over use of antibiotics in the management of recurrent acute otitis media. Adults are part of shared decision making and given options for themselves in various otolaryngologic procedures as our field evolves to minimally invasive office-based procedures. They are given a choice of GA in the operating room or local anesthesia in the office and our field of otolaryngology is changing like all other surgical specialties with that trend. Should that same approach of shared decision making and options be applied to children and their parents with regard to TT placement ?