Two-Year Outcomes After Pediatric In-Office Tympanostomy Using Lidocaine/Epinephrine Iontophoresis and an Automated Tube Delivery System.

Autor: Waldman EH; Yale New Haven Children's Hospital, New Haven, Connecticut, USA., Ingram A; Advanced ENT & Allergy, Louisville, Kentucky, USA., Vidrine DM; South Carolina ENT Allergy & Sleep Medicine (SCENT), Columbia, South Carolina, USA., Gould AR; Advanced ENT & Allergy, Louisville, Kentucky, USA., Zeiders JW; South Florida Pediatric Otolaryngology, Fort Lauderdale, Florida, USA., Ow RA; Sacramento Ear, Nose and Throat, Roseville, California, USA., Thompson CR; Ear Nose and Throat Specialists of Abilene, Abilene, Texas, USA., Moss JR; Charlotte Eye Ear Nose & Throat Associates (CEENTA), Matthews, North Carolina, USA., Mehta R; California Head and Neck Specialists, Carlsbad, California, USA., McClay JE; Cook Children's Physician Network, Frisco, Texas, USA., Brenski A; Cook Children's Physician Network, Frisco, Texas, USA., Gavin J; Albany ENT and Allergy, Albany, New York, USA., Ansley J; Carolina Ear Nose & Throat Clinic, Orangeburg, South Carolina, USA., Yen DM; Specialty Physician Associates, Bethlehem, Pennsylvania, USA., Chadha NK; British Columbia Children's Hospital, Vancouver, British Columbia, Canada., Murray MT; Camino Ear, Nose & Throat Clinic, San Jose, California, USA., Kozak FK; British Columbia Children's Hospital, Vancouver, British Columbia, Canada., York C; ENT Clinics of San Antonio, San Antonio, Texas, USA., Brown DM; Specialty Physician Associates, Bethlehem, Pennsylvania, USA., Grunstein E; Columbia University Irving Medical Center, New York City, New York, USA., Sprecher RC; Nemours Children's Health, Jacksonville, Jacksonville, Florida, USA., Sherman DA; Nemours Children's Health, Jacksonville, Jacksonville, Florida, USA., Schoem SR; Connecticut Children's Medical Center, Hartford, Connecticut, USA., Puchalski R; South Carolina ENT Allergy & Sleep Medicine (SCENT), Columbia, South Carolina, USA., Hills S; Columbia University Irving Medical Center, New York City, New York, USA., Harfe D; Smith+Nephew Inc., Menlo Park, California, USA., England LJ; Smith+Nephew Inc., Menlo Park, California, USA., Syms CA; Ear Medical Group, San Antonio, Texas, USA., Lustig LR; Columbia University Irving Medical Center, New York City, New York, USA.
Jazyk: angličtina
Zdroj: Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery [Otolaryngol Head Neck Surg] 2023 Sep; Vol. 169 (3), pp. 701-709. Date of Electronic Publication: 2023 Apr 01.
DOI: 10.1002/ohn.336
Abstrakt: Objective: Evaluate 2-year outcomes after lidocaine/epinephrine iontophoresis and tympanostomy using an automated tube delivery system for pediatric tube placement in-office.
Study Design: Prospective, single-arm.
Setting: Eighteen otolaryngology practices.
Methods: Children age 6 months to 12 years indicated for tympanostomy were enrolled between October 2017 and February 2019. Local anesthesia of the tympanic membrane was achieved via lidocaine/epinephrine iontophoresis and tympanostomy was completed using an automated tube delivery system (the Tula® System). An additional Lead-In cohort of patients underwent tube placement in the operating room (OR) under general anesthesia using only the tube delivery system. Patients were followed for 2 years or until tube extrusion, whichever occurred first. Otoscopy and tympanometry were performed at 3 weeks, and 6, 12, 18, and 24 months. Tube retention, patency, and safety were evaluated.
Results: Tubes were placed in-office for 269 patients (449 ears) and in the OR for 68 patients (131 ears) (mean age, 4.5 years). The median and mean times to tube extrusion for the combined OR and In-Office cohorts were 15.82 (95% confidence interval [CI]: 15.41-19.05) and 16.79 (95% CI: 16.16-17.42) months, respectively. Sequelae included ongoing perforation for 1.9% of ears (11/580) and medial tube displacement for 0.2% (1/580) observed at 18 months. Over a mean follow-up of 14.3 months, 30.3% (176/580) of ears had otorrhea and 14.3% (83/580) had occluded tubes.
Conclusion: In-office pediatric tympanostomy using lidocaine/epinephrine iontophoresis and automated tube delivery results in tube retention within the ranges described for similar grommet-type tubes and complication rates consistent with traditional tube placement in the OR.
(© 2023 The Authors. Otolaryngology-Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology-Head and Neck Surgery Foundation.)
Databáze: MEDLINE
Externí odkaz: