Age as a Determinant to Select an Anesthesia Method for Tympanostomy Tube Insertion in a Pediatric Population

AbstractMyringotomy with tympanostomy tube placement and tonsillectomy (with or without adenoidectomy) are two of the most common procedures performed in the pediatric population. Indications for these surgical treatments are for correspondingly prevalent conditions affecting children, including middle ear and adenotonsillar disease, which are treated by many specialty groups spanning family physicians, pediatricians, emergency care physicians, and otolaryngologists. Despite the common nature of these diseases and respective indicated surgeries, their management has in the past had limited evidence-based guidelines. This article consolidates the most up-to-date evidence from the otolaryngology, pediatric, and infectious disease literature to guide the management with tympanostomy tube insertion and adenotonsillectomy in the pediatric population.

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Helping Children with Special Needs: Who Receives Tympanostomy Tubes?

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420987425 ◽

2021 ◽

pp. 000348942098742

Author(s):

David W. Wassef ◽

Nehal Dhaduk ◽

Savannah C. Roy ◽

Gregory L. Barinsky ◽

Evelyne Kalyoussef

Keyword(s):

Developmental Disorders ◽

Developmental Disorder ◽

Private Insurance ◽

Insurance Coverage ◽

Tube Placement ◽

Hospital Charges ◽

Tympanostomy Tube ◽

Tube Insertion ◽

Tympanostomy Tubes

Objectives: Tympanostomy tubes can prevent sequelae of otitis media that adversely affect long term hearing and language development in children. These negative outcomes compound the existing difficulties faced by children who are already diagnosed with developmental disorders. This study aims to characterize this subset of children with developmental disorders undergoing myringotomy and tympanostomy tube insertion. Methods: A retrospective review using the Kids’ Inpatient Database (KID) was conducted, with codes from International Classification of Diseases, Ninth Revision used to query data from the years 2003 to 2012 to determine a study group of children with a diagnosis of a developmental disorder undergoing myringotomy and tympanostomy insertion. This group was compared statistically to patients undergoing these procedures who did not have a diagnosed developmental disorder. Results: In total, 21 945 cases of patients with myringotomy with or without tympanostomy tube insertion were identified, of which 1200 (5.5%) had a diagnosis of a developmental disorder. Children with developmental disorders had a higher mean age (3.3 years vs 2.9 years, P = .002) and higher mean hospital charges ($43 704.77 vs $32 764.22, P = .003). This cohort also had higher proportions of black (17.6% vs 12.3%, P < .001) and Hispanic (23.9% vs 20.6%, P = .014) patients, and had lower rates of private insurance coverage (39.6% vs 49%, P < .001). Conclusion: The population of children with developmental disorders undergoing myringotomy or tympanostomy tube placement has a different demographic composition than the general population and faces distinct financial and insurance coverage burdens. Further study should be done to assess if these differences impact long term outcomes.

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Efficacy of antimicrobial prophylaxis and of tympanostomy tube insertion for prevention of recurrent acute otitis media: Results of a randomized clinical trial

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/0165-5876(93)90106-d ◽

1993 ◽

Vol 26 (3) ◽

pp. 271-272

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Otitis Media ◽

Antimicrobial Prophylaxis ◽

Acute Otitis Media ◽

Tympanostomy Tube ◽

Tube Insertion ◽

Recurrent Acute Otitis Media

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Adenoidectomy plus tympanostomy tube insertion versus adenoidectomy plus myringotomy in children with obstructive sleep apnoea syndrome

The Journal of Laryngology & Otology ◽

10.1017/s0022215110002549 ◽

2010 ◽

Vol 125 (3) ◽

pp. 274-278 ◽

Cited By ~ 5

Author(s):

I M Vlastos ◽

M Houlakis ◽

D Kandiloros ◽

L Manolopoulos ◽

E Ferekidis ◽

...

Keyword(s):

Otitis Media ◽

Obstructive Sleep Apnoea ◽

Otitis Media With Effusion ◽

Sleep Apnoea ◽

Obstructive Sleep Apnoea Syndrome ◽

Tympanostomy Tube ◽

Tube Insertion ◽

Sleep Apnoea Syndrome ◽

Obstructive Sleep

AbstractObjective:To determine whether tympanostomy tube insertion has benefit, compared with simple myringotomy, in children with otitis media with effusion who receive concurrent adenoidectomy as treatment for obstructive sleep apnoea syndrome caused by adenoid hypertrophy.Methods:Fifty-two children older than three years with obstructive sleep apnoea syndrome were randomly assigned to receive either adenoidectomy plus tympanostomy tube insertion (group one, n = 25) or adenoidectomy plus myringotomy (group two, n = 27). Pre- and post-operative health-related quality of life was assessed using the otitis media-6 (OM-6) tool, and audiological outcomes were recorded six and 12 months post-operatively.Results:Group one showed better quality of life scores six months post-operatively (score difference −0.38, confidence interval −0.65 to −0.10) but not 12 months post-operatively (score difference −0.23, confidence interval −0.76 to 0.11), compared with pre-operative values. Audiological outcomes did not differ significantly at either time point, compared with pre-operative values.Conclusion:Tympanostomy tube insertion confers a short term benefit, compared with simple myringotomy, in children older than three years with otitis media with effusion who receive concurrent adenoidectomy as treatment for obstructive sleep apnoea syndrome. Further studies are necessary to identify which of these children will receive long-lasting benefit from tympanostomy tube insertion.

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A Surgical Simulator for Tympanostomy Tube Insertion Incorporating Capacitive Sensing Technology to Track Instrument Placement

Otolaryngology ◽

10.1177/0194599820901684 ◽

2020 ◽

Vol 162 (3) ◽

pp. 343-345

Author(s):

Vilija J. Vaitaitis ◽

Michael E. Dunham ◽

Yong-Chan Kwon ◽

Wyatt C. Mayer ◽

Adele K. Evans ◽

...

Keyword(s):

External Auditory Canal ◽

Computer Aided Design ◽

Capacitive Sensor ◽

Physical Models ◽

Tympanostomy Tube ◽

Tympanic Cavity ◽

Tube Insertion ◽

3 Dimensional ◽

Sensing Technology ◽

Aided Design

We describe a device engineered for realistic simulation of myringotomy and tympanostomy tube insertion that tracks instrument placement and objectively measures operator proficiency. A 3-dimensional computer model of the external ear and cartilaginous external auditory canal was created from a normal maxillofacial computed tomography scan, and models for the bony external auditory canal and tympanic cavity were created with computer-aided design software. Physical models were 3-dimensionally printed from the computer reconstructions. The external auditory canal and tympanic cavity surfaces were coated with conductive material and wired to a capacitive sensor interface. A programmable microcontroller with custom embedded software completed the system. Construct validation was completed by comparing the run times and total sensor contact times of otolaryngology faculty and residents.

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Tympanostomy Tubes for Otitis Media: Quality-of-Life Improvement for Children and Parents

Ear Nose & Throat Journal ◽

10.1177/014556130508400712 ◽

2005 ◽

Vol 84 (7) ◽

pp. 418-424 ◽

Cited By ~ 14

Author(s):

Stanley Mui ◽

Barry M. Rasgon ◽

Raymond L. Hilsinger ◽

Brent Lewis ◽

Gretchen Lactao

Keyword(s):

Quality Of Life ◽

Otitis Media ◽

Chart Review ◽

Telephone Survey ◽

Tympanostomy Tube ◽

Tube Insertion ◽

Health Maintenance ◽

Cost Effective Treatment ◽

Tympanostomy Tubes

We measured quality of life issues for both children and their parents on the premise that parental quality of life should be an aspect of cost-effectiveness in otitis media treatment. The patients were less than 18 years of age and had had myringotomy with tube insertion at the head and neck surgery department of a large health maintenance organization. Quality of life for patients, parents, and caregivers was evaluated by telephone survey of parents or caregivers and by retrospective chart review of the number of pre- and postoperative healthcare visits and antibiotic usage. Chart review showed a significant postoperative reduction in the number of clinic visits and in use of antibiotic drugs after insertion of tympanostomy tubes. Improved postoperative hearing was noted, and tympanostomy tube insertion was shown to be safe. The chart-review cost analysis showed that tympanostomy tube insertion is a cost-effective treatment for otitis media in children, and the telephone survey results showed that it improves quality of life for children and their parents or other caregivers.

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Otoacoustic emissions: assessment of hearing after tympanostomy tube insertion

Clinical Otolaryngology ◽

10.1111/j.1365-2273.1996.tb01097.x ◽

1996 ◽

Vol 21 (6) ◽

pp. 492-494 ◽

Cited By ~ 8

Author(s):

H. DAYA ◽

A. E. HINTON ◽

P. RADOMSKIEJ ◽

P. HUCHZERMEYER

Keyword(s):

Otoacoustic Emissions ◽

Tympanostomy Tube ◽

Tube Insertion

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Preventing Otitis Media

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894941030s506 ◽

1994 ◽

Vol 103 (5_suppl) ◽

pp. 20-23 ◽

Cited By ~ 15

Author(s):

G. Scott Giebink

Keyword(s):

Otitis Media ◽

Otitis Media With Effusion ◽

Antimicrobial Prophylaxis ◽

Acute Otitis Media ◽

Tympanostomy Tube ◽

Tube Insertion ◽

Protein Conjugate ◽

Recurrent Acute Otitis Media ◽

Prevalent Disease ◽

The Common

Recurrent acute otitis media (AOM) is an extremely prevalent disease in young children. Epidemiologic associations suggest that primary prevention or reduction of AOM frequency may be achieved with breast-feeding during infancy, elimination of household tobacco smoking, and use of small rather than large day-care arrangements for infants and toddlers. Secondary antimicrobial prophylaxis with amoxicillin or sulfisoxazole reduces the frequency of recurrent AOM by about 50%, but it does not appear to reduce the duration of otitis media with effusion (OME). Tympanostomy tube insertion is not as effective as amoxicillin in reducing AOM frequency in children without OME. Adenoidectomy appears to be warranted for children who develop recurrent AOM after extrusion of tubes. Vaccines against the common bacteria and viruses causing AOM hold the greatest promise of preventing AOM and blocking the sequence of pathologic events leading to chronic OME and middle ear sequelae. The greatest progress has been made recently with pneumococcal protein conjugate vaccines, and clinical testing is in progress.

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The relationship between repeat tympanostomy tube insertion and adenoidectomy

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2011.06.023 ◽

2011 ◽

Vol 75 (10) ◽

pp. 1247-1251 ◽

Cited By ~ 10

Author(s):

David M. Gleinser ◽

Hilda H. Kriel ◽

Shraddha Mukerji

Keyword(s):

Tympanostomy Tube ◽

Tube Insertion ◽

The Relationship

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Management of recurrent acute otitis media in children: systematic review of the effect of different interventions on otitis media recurrence, recurrence frequency and total recurrence time

The Journal of Laryngology & Otology ◽

10.1017/s0022215112001338 ◽

2012 ◽

Vol 126 (9) ◽

pp. 874-885 ◽

Cited By ~ 11

Author(s):

K H Cheong ◽

S S M Hussain

Keyword(s):

Systematic Review ◽

Otitis Media ◽

Acute Otitis Media ◽

Prophylactic Antibiotics ◽

Recurrence Time ◽

Tympanostomy Tube ◽

Tube Insertion ◽

Hand Search ◽

Randomised Controlled ◽

Recurrence Frequency

AbstractObjective:To conduct a systematic review comparing the effect of three interventions (prophylactic antibiotics, tympanostomy tube insertion and adenoidectomy) on otitis media recurrence, recurrence frequency and total recurrence time.Methods:Literature on recurrent otitis media was identified using the PubMed and Scopus search engines for the period January 1990 to March 2011. A hand search of the reference lists of relevant articles and textbooks was conducted to identify additional studies. Randomised, controlled trials with a minimum of 40 children and follow up of at least 12 months were included.Results:Eighteen publications were identified. Each was assessed using preset inclusion criteria; seven publications met these criteria.Conclusion:Prophylactic antibiotics are effective in reducing otitis media recurrence, recurrence frequency and total recurrence time. Tympanostomy tube insertion failed to reduce the prevalence of otitis media recurrence, but reduced the recurrence frequency and total recurrence time. Adenoidectomy reduced otitis media recurrence; results on otitis media recurrence frequency differed but on average there was a reduction; however, the two studies with relevant data on total recurrence time had contradictory results.

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