Dudkiewicz Dean, Bismuth Efrat Miryam, Tsur Nir, Gilony Dror, Hod Roy
Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petah- Tikva, 49100, Israel.
Department of Otolaryngology-Head and Neck Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Eur Arch Otorhinolaryngol. 2025 Feb;282(2):713-721. doi: 10.1007/s00405-024-08964-8. Epub 2024 Sep 6.
Tympanostomy tube insertion is a standard surgical procedure in children to address middle ear infections and effusion-related hearing and speech development issues. Perioperative treatments like ear drops containing antibiotics, steroids, and tube irrigation with saline aim to prevent complications, yet no universal gold standard treatment exists. Despite guidelines, practice preferences among ENT specialists vary, motivating this study to investigate perioperative management practices in Israel.
A survey was distributed among ENT surgeons, collecting data on their main workplace, sub-specialty, preoperative hearing test requirements, tube irrigation practices, tube selection criteria, and timing of tube removal. Distribution and association with main workplaces were examined.
The survey achieved a response rate of 27.33%. Most participants routinely required preoperative hearing tests, with a preference for conducting them within three months prior to surgery (62.2%). Tube irrigation during the procedure was less common among surgeons in the public system (p = 0.007). In response to the COVID-19 pandemic, the majority of respondents maintained their established practices (96.3%), while a small proportion (3.7%) adapted by replacing two in-person meetings with one virtual session. Variations in tube removal timing based on the main workplace were noted, with private practitioners opting for earlier removal (p = 0.002) and were less permissive in water deprivation practices (p = 0.053).
This study provides insights into the practices and preferences of ENT surgeons in tympanostomy tube insertion procedures in Israel. Adherence to standardized practices was observed, with variations influenced by the primary workplace. Despite the COVID-19 pandemic, minimal changes were made to established practices. Further research and consensus are necessary to optimize patient outcomes and develop tailored guidelines in this field.
鼓膜置管术是治疗儿童中耳感染及与积液相关的听力和言语发育问题的标准外科手术。围手术期治疗，如使用含抗生素、类固醇的滴耳液以及用生理盐水冲洗鼓膜置管，旨在预防并发症，但目前尚无通用的金标准治疗方法。尽管有相关指南，但耳鼻喉科专家的实践偏好各不相同，这促使本研究对以色列的围手术期管理实践进行调查。
向耳鼻喉科外科医生发放了一份调查问卷，收集他们的主要工作场所、亚专业、术前听力测试要求、鼓膜置管冲洗操作、置管选择标准以及拔管时间等数据。对数据分布及其与主要工作场所的关联进行了研究。
该调查的回复率为27.33%。大多数参与者常规要求进行术前听力测试，且倾向于在手术前三个月内进行（62.2%）。在公立系统的外科医生中，术中进行鼓膜置管冲洗的情况较少见（p = 0.007）。针对新冠疫情，大多数受访者维持其既定做法（96.3%），而一小部分（3.7%）进行了调整，将两次面对面会议改为一次虚拟会议。根据主要工作场所不同，拔管时间存在差异，私人执业医生选择更早拔管（p = 0.002），并且在限制水分摄入做法上更为严格（p = 0.053）。
本研究深入了解了以色列耳鼻喉科外科医生在鼓膜置管手术中的实践和偏好。观察到对标准化做法的遵循情况，且存在受主要工作场所影响的差异。尽管有新冠疫情，但既定做法的改变微乎其微。有必要进行进一步研究并达成共识，以优化患者治疗效果并制定该领域的针对性指南。
