Tympanostomy Tube Placement and Auditory Brainstem Response Test Under Sedation

Auditory brainstem response testing is typically done under sedation in the pediatric sedation unit but often requires tympanostomy tube placement, typically done under general anesthesia in the operating room (OR), to be performed first to obtain accurate results. This is the first report on the feasibility of performing tympanostomy tube placement in combination with auditory brainstem response testing under sedation provided by pediatric critical care medicine and hospitalist physicians outside the OR. A retrospective review was performed of cases at two children's hospitals in the United States, between July 2021 and February 2024. A total of 28 cases of tympanostomy tube placement in conjunction with auditory brainstem response testing under sedation provided by pediatric critical care medicine and hospitalist physicians outside the OR were identified. All the sedative regimens utilized propofol. All procedures were successful, but 6 patients experienced adverse events, with 5 patients experiencing only minor respiratory adverse events. One patient experienced laryngospasm, requiring unplanned intubation and Pediatric Intensive Care Unit admission. Lower direct facility costs and wait times were noted in a convenience sample of cases under sedation outside the OR compared to cases under general anesthesia in the OR.