(1038) Implementation of a Protocol for Manual Myringotomy Tube Insertion Performed In-Office

Introduction: Bilateral Tympanostomy Tube Insertion (BTI) is a common procedure done in the pediatric population. Improving access to this procedure as well as reduction of cost and potential risks from general anesthesia has led to the development of one step in office tube insertion devices that may also incur significant cost. We aimed to develop a protocol for manual ear tube insertion, without device, in the clinic setting of our tertiary care pediatric hospital.

Methods: A prospective study was done analyzing patients 7-16 months seen between April 2023 and January 2024 for recurrent acute otitis media or chronic otitis media with effusion. Upon meeting criteria, parents were offered the in-office procedure, and consent was obtained. Topical anesthetic was used with standard BTI procedure. Ear drops and Tylenol were administered. Satisfaction surveys were issued at follow up. Questions included (1) presence of ear drainage following the procedure, (2) use of ototopical drops in the postop period (3) OTC pain medication administration in the postop period and (4) parent satisfaction with the procedure. Additionally, cost of the office visit with procedure was compared to traditional tube insertion under general anesthesia.

Results: In total, 32 in office ear tubes and 26 surveys were completed to date. Reasons for noncompletion included no show to postop visit or postop visit had not yet occurred. Of surveys completed 50% reported ear drainage, 92% reported use of ear drops, 58% reported Tylenol or Motrin use after the initial dose, and 96% reported satisfaction with the in-office procedure. Reported dissatisfaction was due to perceived fear of medical appointments after the procedure. The total cost for traditional BTI with anesthesia was estimated at $3,000, the office tube insertion cost approximately $415.

Conclusions: Based on the results of this analysis, it is feasible to safely perform manual in-office ear tube insertion in younger pediatric patients. Office ear tube insertion significantly reduces expense compared to the traditional procedure with anesthesia. Families were overall satisfied with the in-office procedure.