Protocol implementation for in-office manual tympanostomy tube insertion

Bilateral myringotomy/tympanostomy tube insertion (BTI) can decrease the frequency, severity, and quality of life burden of acute otitis media and chronic otitis media with effusion for pediatric patients and their caregivers. Implementing a practice protocol for in-office BTI (IO-BTI) can benefit patients by eliminating the risks associated with general anesthesia, pre-procedure fasting, and post-anesthetic effects such as emergence delirium. However, adaptation of IO-BTI has largely relied on proprietary devices that may limit cost savings and access to care. The goal of this study was to develop a protocol for manual IO-BTI without single use device to yield the aforementioned benefits, as well as lower health care costs to families and improve access to and timeliness of care. Described is a protocol for manual IO-BTI in an ambulatory clinic setting. The caregivers of 178 pediatric patients who underwent IO-BTI between 04/01/2023-07/31/2024 were administered a binary satisfaction survey. Surgical outcomes such as post-operative pain, early tympanostomy tube extrusion, and tympanostomy tube plugging were examined via retrospective chart review. The cost of BTI with general anesthesia in the operating room (OR) setting, device manual IO-BTI, and IO-BTI with single use devices were also examined. Survey responses demonstrated a 99 % post-procedure satisfaction rate among patient caregivers. There were low frequencies of post-operative pain (0.7 %), premature tympanostomy tube extrusion (0.8 %), and plugging of tympanostomy tubes (1.5 %). Gross cost analysis of device manual IO-BTI compared to IO-BTI with single use devices and BTI with general anesthesia in the OR revealed a 1.5x and 6x cost increase, respectively. The presented study demonstrates that manual IO-BTI is safe, feasible, cost effective, and yields high caregiver satisfaction and positive surgical outcomes for pediatric patients.