In-Office Tympanostomy Tube Placement in Children Using Iontophoresis and Automated Tube Delivery

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Anesthesiology

Background:

• Tympanostomy tube placement is a common pediatric procedure.
• Traditional methods often require sedation or general anesthesia.
• Office-based procedures aim to improve efficiency and reduce costs.

Purpose of the Study:

• To evaluate the technical success, tolerability, and safety of in-office tympanostomy tube placement in children.
• To assess the efficacy of lidocaine iontophoresis for local anesthesia.
• To determine if sedation or restraints are necessary for this procedure.

Main Methods:

• A prospective multicenter study involving children aged 6 months to 12 years.
• Lidocaine/epinephrine iontophoresis was used for anesthesia.
• An automated myringotomy and tube delivery system was employed.
• Anxiolytics, sedation, and papoose boards were intentionally omitted.
• Pain was assessed using the Faces Pain Scale-Revised (FPS-R) in older children.

Main Results:

• Successful tube placement was achieved in 85.8% of children under 5 and 89.2% of children aged 5-12.
• Mean pain scores were 3.30 during placement and 1.69 five minutes post-procedure.
• No serious adverse events were reported.
• Nonserious adverse event rates were comparable to standard procedures.

Conclusions:

• In-office tympanostomy tube placement is technically successful and safe for selected pediatric patients.
• Lidocaine iontophoresis provides adequate local anesthesia, eliminating the need for sedatives or restraints.
• This approach offers a viable alternative for outpatient tympanostomy tube procedures.