Use of Phenol as a Local Anaesthetic for Adult Grommet Insertion in Resource-Limited Settings: A Preliminary Report

Modified Intravenous Cannula Ventilation Tubes for Otic Barotrauma Prevention

Objectives: Middle ear barotrauma is a common complication of hyperbaric oxygen therapy (HBOT). Tympanostomy tube placement prevents barotrauma by facilitating middle ear equalization. We describe variations on techniques published by Mooney et al and Zhang et al for placing modified peripheral intravenous cannula (PIVC) ventilation tubes, which can be performed at the bedside under topical anesthesia. We aim to evaluate the safety and efficacy of this technique when performed to prevent otic barotrauma in patients undergoing HBOT. Methods: We performed an analytical observational study at a tertiary metropolitan Australian hospital with a state-wide adult hyperbaric service between 2018 and 2022. Patients were identified via unit audits. Patient, HBOT, and procedural factors were analyzed against complications using Fisher's exact test with Bonferroni correction and simple logistic regression. Results: Over 4 years, 112 patients (220 ears) underwent modified PIVC ventilation tube insertion. Mean age was 58.6 years (95% CI: 55.7-61.6, SD: 15.9). Thirty-eight patients (33.9%) were female, 74 (66.1%) were male. Thirty-four ears (15.5%) had preexisting barotrauma at the time of tympanostomy tube insertion. Patients underwent a mean of 11.5 dives (95% CI: 9.0-14.0, SD: 13.4), with ventilation tubes being required for a mean of 15.0 days (95% CI: 9.0-14.0, SD: 24.0) to complete HBOT. Fourteen ventilation tubes (6.4%) developed blockage during HBOT, and 12 (5.5%) prematurely extruded. Sixteen ears (7.3%) required reinsertion of ventilation tubes. Nine ears (4.1%) suffered barotrauma despite ventilation tube insertion. Conclusions: Otic barotrauma prophylaxis is paramount for safety during HBOT. We describe a safe, effective, and convenient technique for barotrauma prevention using modified PIVCs.

Efficacy and Safety of Endoscopic Tympanic Membrane Catheterization Plus Ofloxacin Ear Drops in the Treatment of Secretory Otitis Media in Infants and Toddlers

Objective

To investigate the efficacy and safety of endoscopic tympanic membrane catheterization and ofloxacin ear drops in the treatment of secretory otitis media in infants and toddlers.

Methods

A total of 80 children suffering from secretory otitis media who underwent treatment in our hospital from July 2018 to April 2020 were divided into the control group (n = 40) and experimental group (n = 40) by randomization. The control group was treated with endoscopic tympanic membrane catheterization alone, while the experimental group was treated with ofloxacin ear drops based on the same treatment as the control group. The treatment effect, air conduction hearing level, clearance rate of pathogenic bacteria secreted by the ear canal, recurrence rate, and adverse reactions were compared between the two groups.

Results

The treatment in the experimental group led to a significantly better outcome than that in the control group (P < 0.05). After treatment, a substantially improved air conduction hearing level in the experimental group was observed (P < 0.001). A chi-square test showed a significantly higher clearance rate of pathogenic bacteria secreted from the ear canal of the children in the experimental group compared to that of the control group (P < 0.05). The treatment in the experimental group resulted in a lower recurrence rate and adverse reaction rate as compared to the control group (P < 0.05).

Conclusion

Concurrent endoscopic tympanic membrane catheterization and ofloxacin ear drops showed excellent efficacy in the treatment of secretory otitis media in infants and toddlers. The therapy offers promising solutions for the improvement of hearing level, increase of clearance rate of pathogenic bacteria secreted from the ear canal, and decrease of disease recurrence and adverse reactions during treatment.