In-Office Tympanostomy Tube Placement in Children Using Iontophoresis and Automated Tube Delivery.

OBJECTIVES/HYPOTHESIS: Evaluate technical success, tolerability, and safety of lidocaine iontophoresis and tympanostomy tube placement for children in an office setting. STUDY DESIGN: Prospective individual cohort study. METHODS: This prospective multicenter study evaluated in-office tube placement in children ages 6 months through 12 years of age. Anesthesia was achieved via lidocaine/epinephrine iontophoresis. Tube placement was conducted using an integrated and automated myringotomy and tube delivery system. Anxiolytics, sedation, and papoose board were not used. Technical success and safety were evaluated. Patients 5 to 12 years old self-reported tube placement pain using the Faces Pain Scale-Revised (FPS-R) instrument, which ranges from 0 (no pain) to 10 (very much pain). RESULTS: Children were enrolled into three cohorts with 68, 47, and 222 children in the Operating Room (OR) Lead-In, Office Lead-In, and Pivotal cohorts, respectively. In the Pivotal cohort, there were 120 and 102 children in the <5 and 5- to 12-year-old age groups, respectively, with a mean age of 2.3 and 7.6 years, respectively. Bilateral tube placement was indicated for 94.2% of children <5 and 88.2% of children 5 to 12 years old. Tubes were successfully placed in all indicated ears in 85.8% (103/120) of children <5 and 89.2% (91/102) of children 5 to 12 years old. Mean FPS-R score was 3.30 (standard deviation [SD] = 3.39) for tube placement and 1.69 (SD = 2.43) at 5 minutes postprocedure. There were no serious adverse events. Nonserious adverse events occurred at rates similar to standard tympanostomy procedures. CONCLUSIONS: In-office tube placement in selected patients can be successfully achieved without requiring sedatives, anxiolytics, or papoose restraints via lidocaine iontophoresis local anesthesia and an automated myringotomy and tube delivery system. LEVEL OF EVIDENCE: 2b Laryngoscope, 130:S1-S9, 2020.

N-Acetylcysteine as an adjunct for refractory ear infections.

OBJECTIVE: To analyze the efficacy of Ciprodex otic augmented with N-acetylcysteine (NAC) against difficult ear infections. SUBJECTS: Subjects were selected with at least 1 month of continuous otorrhea despite at least 3 distinct medical or surgical treatments. INTERVENTIONS: Subjects received Ciprodex otic augmented with 0.5 or 2% NAC using standard dosing schemes. MAIN OUTCOME MEASURES: Serial audiometry and cessation of otorrhea by both history and binocular microscopy. RESULTS: Seven subjects were included with an average of 18.4 months of continuous otorrhea despite aggressive therapy. Cessation of otorrhea was achieved in 6 of 7 subjects generally within 4 weeks of treatment. One of these 6 subjects remains on chronic suppressive therapy. The remaining subject failed because of persistent noncompliance. No subjects demonstrated ototoxicity via pretreatment and posttreatment audiometry. CONCLUSION: Ciprodex otic augmented with NAC seems to have considerable efficacy against otherwise refractory ear infections. This technique may prove to be a simple and powerful option for the treatment of difficult ear infections.