Department of Otolaryngology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA.
Ann Otol Rhinol Laryngol. 2022 Jan;131(1):101-107. doi: 10.1177/00034894211008063. Epub 2021 Apr 23.
Our objectives were to assess attitudes regarding office-based insertion of tympanostomy tubes without general anesthesia, to identify barriers that would discourage in-office procedures, and to highlight opportunities that would potentially facilitate this approach in the future.
Cross-sectional survey administered to members of the American Society of Pediatric Otolaryngology (ASPO) from March to April 2020 using the Research Electronic Data Capture (Redcap), internet-based data capture platform. The brief, 10-item survey required 3 minutes to complete and used a 5-point Likert scale for primary questions.
Respondents included 172 fellowship trained, pediatric otolaryngologists with 14 median years of clinical practice and 25 median tympanostomy tube insertions per month (75% >40 per month). Although tubes, in any setting, were most often inserted in children under age 2 years (95% "often" or "very often") and in those aged 3 to 5 years (93%), the likelihoods of doing this in-office for these age groups were only 8% and 6% respectively. For children aged 6 to 12 years, likelihood of in-office insertion was only 15%. Frequent barriers noted were safety concerns, emotional trauma, physical pain, and inability to suction. Opportunities to facilitate this approach include improved topical anesthesia, availability of conscious sedation, conclusive research on adverse effects of general anesthesia, and availability of an automated tube insertion device.
Office-based insertion of tympanostomy tubes in children without general anesthesia is performed by a small minority of respondents, but there are discernible barriers and opportunities to promote future uptake. Our results should facilitate ongoing discussion and innovation to better accommodate the preferences of families whose children are candidates for tympanostomy tubes.
我们的目的是评估不全身麻醉行门诊鼓膜置管术的态度，确定阻碍门诊手术的因素，并强调未来可能促进这种方法的机会。
2020 年 3 月至 4 月，采用 Research Electronic Data Capture（Redcap）互联网数据采集平台，向美国儿科学耳鼻喉科学会（ASPO）成员发放横断面调查。简短的 10 项调查需要 3 分钟完成，主要问题采用 5 分制李克特量表。
共纳入 172 名接受过 fellowship培训的儿科耳鼻喉科医生，中位临床实践年限为 14 年，每月中位鼓膜置管数为 25 例（75%>40 例/月）。虽然在任何环境下，最常为 2 岁以下（95%“经常”或“非常经常”）和 3 至 5 岁（93%）的儿童插入管，但这两个年龄段在门诊进行置管的可能性分别仅为 8%和 6%。对于 6 至 12 岁的儿童，门诊置管的可能性仅为 15%。经常提到的障碍包括安全问题、情绪创伤、身体疼痛和无法抽吸。促进这种方法的机会包括改善局部麻醉、清醒镇静的可用性、全麻不良影响的结论性研究以及自动化管插入装置的可用性。
少数受访者在不全身麻醉的情况下在儿童中进行门诊鼓膜置管，但存在明显的障碍和机会来促进未来的应用。我们的研究结果应有助于进一步讨论和创新，以更好地满足那些患儿候选鼓膜置管的家庭的偏好。
