Pressure Equalization Tube Insertion Research Articles

Emergence characteristics of sevoflurane compared to halothane in pediatric patients undergoing bilateral pressure equalization tube insertion

Study Objective: To compare the emergence characteristics of sevoflurane with halothane in pediatric patients having bilateral myringotomy and pressure equalization tube insertion using a highly standardized and common anesthetic technique. Design: Prospective, randomized, double-blind study. Setting: University hospital. Patients: 43 ASA physical status I and II healthy pediatric outpatients scheduled for initial ear tube placement by one surgeon. Interventions: Patients were randomized to receive either halothane or sevoflurane as their sole anesthetic drug for ear tube insertion. All patients as well as the research nurse grading emergence agitation were blinded to group assignment. No premedication was administered, and all patients received a standard dose of rectal acetaminophen for postoperative pain control. Measurement and Main Results: The primary outcome was the percentage of patients with emergence agitation, defined as thrashing behavior requiring physical restraint for greater than three minutes. Time to discharge from the postanesthesia care unit (PACU) and from the hospital were also compared. Sevoflurane patients had a greater incidence of emergence delirium: 57% versus 27% [95% CI (1.7%–58.1%) p = 0.047]. Time to discharge from the PACU and the hospital were longer for patients who received sevoflurane: 62 versus 50 min [95% CI (1.4–23.6) p = 0.02] and 102 versus 79 mins [95% CI (9.6–37.1) p = 0.003]. Conclusion: In our institution there is a trend toward greater emergence agitation in ear tube placement patients given sevoflurane versus halothane anesthesia. Further, (with our discharge criteria) patients are actually discharged from the PACU and the hospital faster when given halothane as a sole anesthetic when compared to sevoflurane.

Office-based laser assisted tympanic membrane fenestration in adults and children: pilot data to support an alternative to traditional approaches to otitis media

Objectives: To determine the role of intermediate duration (∼3 weeks) middle ear ventilation using office-based laser assisted tympanic membrane fenestration in resolving an episode of otitis media with effusion in adults and children who otherwise would have been treated with insertion of pressure equalization tubes. Methods: A retrospective chart review of 92 patients (162 ears) was conducted to identify the utility and technical challenges associated with laser assisted tympanic membrane fenestration in an office setting. Clinical characteristics reviewed included: age, gender, duration of effusion, season performed, and hearing and health status of middle ear upon healing of the fenestration. Results: 69% of all patients were effusion free upon closure of the fenestration; 68% of those <3 years; 70% of those 3–7 years; and 70% of those 25–80 years. Some episodes recurred and at final follow-up 64% had normal middle ear structure and function (range of follow-up =1–18 months, mean 2.5 months, median 2.0). Shorter duration of effusion pre-fenestration was more often associated with return to normal middle ear structure and function ( P<0.01). Season performed, number of previous episodes of otitis media and pre-treatment tympanometry were not predictive of result. No significant complications were observed. Conclusions: The use of office-based laser assisted tympanic membrane fenestration is a reasonably safe and effective procedure for the treatment of otitis media in most adults and children. As a minimally invasive otologic procedure, laser assisted tympanic membrane fenestration has great potential to decrease the rates of both antibiotic usage and insertion of ear tubes.

Office-based insertion of pressure equalization tubes: the role of laser-assisted tympanic membrane fenestration.

To describe the role of the hand-held otoscope combined with a flashscanner CO2 laser, OtoLAM (ESC/Sharplan, Yokneam, Israel), for pressure equalization tube (PET) insertion in an office setting. Prospective, multisite, clinical cohort trial (Institutional Review Board approved; informed consent) in the setting of pediatric otolaryngology outpatient departments at four tertiary care children's hospitals. Selected for the study were 54 patients (96 ears), ages 6 months to 23 years, who met standard indications for PET insertion using cold-knife myringotomy and tube insertion under general anesthesia. PETs were indicated for recurrent otitis media, chronic otitis media with effusion, and eustachian tube dysfunction-all unresponsive to medical therapy. Topical anesthesia was achieved with iontophoresis (n = 1) or topical anesthesia: 8% tetracaine on an Otowick (Xomed Surgical Products, Jacksonville, FL, catalogue No. 400141) against the tympanic membrane for 45 to 180 minutes (n = 53). Laser-assisted tympanic membrane fenestration was performed with the OtoLAM set at single pulse, 2.0- to 2.6-mm spot size, and between 3 and 18 W. Insertion of grommets was accomplished using the otomicroscope and an "alligator" microforceps. Restraints with papoose were used in 79% of children with a mean age of 34.4 months (SD = 60.9 mo). Clinical, parent/patient, and physician satisfaction and comparative cost impact outcomes are described. All ears but three (3%) underwent successful placement of a PET. Pain was described as "absent" in 39%, "present but tolerable" in 30%, and "severe" in 30% of children at the time of procedure; 5 minutes after the procedure pain was described as "absent" in 75%, "present but tolerable" in 22%, and "severe" in 3%. Tube plugging (3 of 74 available ears; 4%) or persistent otorrhea (1 of 74 ears; 1.4%) occurred infrequently at the 1-month follow-up. Before PET insertion, hearing loss was noted in 66% of cases (mild, 38%; moderate, 22%; and severe, 6%). Mild hearing loss was noted in only 8% and moderate hearing loss in 2% of 47 (50%) of the ears at the 3-month follow-up. Ninety-two percent of parents were highly satisfied with the procedure in preference to PETs in the operating room under general anesthesia, and 97% preferred OtoLAM with PET insertion, rather than further courses of antibiotics; only one parent would rather have had the PET insertion under general anesthesia. Cost savings to health care organizations, particularly payers, and to parents are substantial (32%-48%) and warrant attention. Cost to the physician is manageable only if an appropriate approach to the third party payers results in a substantial increase in reimbursements. The data indicate excellent clinical effectiveness, reduced risk, and high parent and physician satisfaction. Strong incentives for physicians to use this technique are in all stakeholders' best interests. These incentives need to evolve as soon as possible for the more widespread acceptance of OtoLAM with PET insertion in an office setting for appropriately selected patients.

Recovery Characteristics of Sevoflurane and Halothane in Preschool-Aged Children Undergoing Bilateral Myringotomy and Pressure Equalization Tube Insertion

DAVIS, PETER J.; GREENBERG, JAMES A.; GENDELMAN, MARLA; FERTAL, KATHLEEN Author Information

Recovery Characteristics of Sevoflurane and Halothane in Preschool-Aged Children Undergoing Bilateral Myringotomy and Pressure Equalization Tube Insertion

Recovery Characteristics of Sevoflurane and Halothane in Preschool-Aged Children Undergoing Bilateral Myringotomy and Pressure Equalization Tube Insertion

A preliminary report on the use of auditory brain-stem response audiometry and the timing of tympanotomy with pressure equalization tube insertion in cleft palate neonates.

To the Editor .—Twenty-seven newborns with cleft lip and/or palate were tested between 1984 and 1987 using auditory brain-stem response (ABR) audiometry. Nineteen (70% ) of these 27 neonates with cleft palate and/or cleft lip failed the ABR screening test at 40-dB hearing level (HL). Sixteen percent of all neonates at risk for hearing loss failed this same test. A protocol is being established at the University of Miami (Fla) using ABR in neonates with cleft palate to help identify hearing loss, to confirm middle ear effusion (MEE) as diagnosed by otologic examination performed in the newborn nursery, and to use early pressure equalization tube placement to restore hearing very early in the life of the neonate with cleft palate. History .—In 1958, Skolnik 1 reported only a 6% incidence of pathologic findings in the middle ear of children younger than 1 year of age with cleft palates. In 1969, however,

772 ACOUSTIC OTOSCOPY (A.O.) COMPARED WITH TYM PANOMETRY AND MYRINGOTOMY IN THE DIAGNOSIS OF MIDDLE EAR EFFUSION IN CHILDREN AND INFANTS

216 outpatients had 346 middle ear aspirates for either acute otitis media (#66) or insertion of pressure equalization tubes (#150). A.O. was available immediately prior to aspiration in 346 ears and both tympanometry and A.O. were available in 162 ears. The sensitivity of the A.O. was 85% with a specificity of 64% in the 346 ears aspirated. The sensitivity of tympanometry was 90% and specificity was 67% in the 162 ears for which both measurements were made. These sensitivities and specificities are not significantly different, but the specificities are better than the prediction of an experienced pediatrician using pneumatic otoscopy on the same patients.