The Best Site for Pediatric TT Placement: OR or Office?

For those who do qualify, “think about all the steps they can skip” when compared with a child who is scheduled for OR tympanostomy tube placement, Dr. Cofer noted. “First, the patient sees their pediatrician and gets a referral to an ENT practice,” she said. “Then they often have to wait weeks or even months for an appointment, followed by an evaluation. If they’re deemed a candidate for tubes, and the OR is the chosen site of care, they must schedule that procedure for a later date, requiring yet another day off work for the parent. Meanwhile, the child continues to suffer from chronic ear infections, hearing loss, or other potential complications. Eventually, they undergo surgery in the OR and return for yet another follow-up.”

With the Hummingbird in-office system, in contrast, “everything is streamlined,” Dr. Cofer said. “After a referral, the patient has a single ENT visit. I conduct the consultation, and within 15 minutes, we place the tubes. After about 30 minutes, you’re basically done and on your way.”

As for the issue of cost, Dr. Cofer agreed that reimbursement can be a complicated issue to navigate. Although “somewhat shielded” from the intricacies of insurer contracting, she said a lot of work was done at Mayo to negotiate coverage for both the device and the longer time spent with younger patients treated with Hummingbird. Part of those discussions led to more favorable reimbursement, she said—so much so that her team has a dedicated Hummingbird clinic, where for a half day each week, they perform the in-office procedure on patients deemed to be good candidates.

Therein lies another benefit Dr. Cofer cited for Hummingbird. “I am a tertiary pediatric ENT specialist, which means I have a lot of complex cases to get through each week,” she said. “Hummingbird is so fast that it frees up my time to treat those more difficult patients, who often do need to be managed in the OR.”

Next Steps

Assuming other institutions have success meeting the reimbursement challenges for the automated devices, what else needs to happen for them to gain more traction? “Well, I have to say that I’m not sure this is ever going to be the standard of care,” Dr. Page said. “There’s far too much inertia with the current very safe methodology for doing tubes in the OR, even given the general anesthesia risks.”

Dr. Cofer agreed. “Any qualified ENT surgeon can walk into an OR, put in ear tubes for an anesthetized patient, and walk out in five minutes,” she said. “But is that really the best strategy for the patient, or does this just work out better for the surgeon? I’m just not sure practitioner convenience is the right criteria for these patients.”

Dr. Waldman offered this final consideration when doing this site-of-care calculus. “Remember, tympanostomy tube placement is an elective procedure,” he stressed. “So, of course it makes sense why families of younger patients may want to avoid the OR. But if we opt for placing tubes in the office, we must be ready to manage expectations and choose our patients wisely.”  

David Bronstein is a freelance medical writer based in New Jersey.

Disclosures: Dr. Cofer reported that she has participated in research trials funded by Preceptis Medical. Dr. Waldman has participated in research trials funded by Tusker Medical, a subsidiary of Smith+Nephew. Dr. Rosenfeld reported that he’s a consultant to Karl Storz for in-office tympanostomy tube procedures.