Opioid stewardship and perioperative management of pediatric tympanoplasty

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Minimally Invasive Surgery

Background:

• Tympanoplasty is a common surgical procedure to repair eardrum perforations.
• Microscope-assisted and endoscope-assisted techniques are utilized for tympanoplasty.
• Comparative data on pediatric outcomes, particularly pain management and admission course, are valuable.

Purpose of the Study:

• To compare the intraoperative management, admission course, pain management, and graft success of microscope- and endoscope-assisted tympanoplasty in pediatric patients.
• To evaluate the effectiveness and safety of endoscopic versus microscopic approaches in children undergoing tympanoplasty.

Main Methods:

• Retrospective chart review of 321 pediatric patients (≤18 years) who underwent ambulatory tympanoplasty between January 2018 and December 2020.
• Data collected included intraoperative factors, surgical approach, complications, and perforation closure success rates.
• Multivariate analysis was performed to compare the two surgical approaches.

Main Results:

• Endoscopic tympanoplasty (17.4%) and microscopic tympanoplasty (82.6%) showed similar rates of intraoperative complications, postoperative complications, audiological improvement, and perforation closure.
• Patients undergoing endoscopic tympanoplasty were significantly less likely to require postoperative opioids (3.96 times) and had shorter hospital admissions.
• Graft type (autograft) did not influence opioid requirements.

Conclusions:

• Both endoscopic and microscopic tympanoplasty are viable surgical options for pediatric patients.
• Endoscopic tympanoplasty demonstrates a reduced need for postoperative opioids and shorter admissions compared to the microscopic approach, with comparable graft success.
• The minimally invasive endoscopic approach offers a less painful perioperative experience for children and supports appropriate opioid stewardship.