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Scientific Oral Presentation

Otology/Neurotology

In-office versus Operating Room Pediatric Tympanostomy Tube Insertion: A Systematic Review of Methods and Outcomes

Monday, October 19, 2026
8:42 AM - 8:48 AM PT
Location: 511AC

    Presenting Author(s)

  • George Ashji, BS

    Medical Student
    Home
    Fairfield, NJ, United States

    • Co-Author(s)

  • IC

    Isabella Caiola, n/a

    Undergraduate Student
    University of Rochester, United States

    • Senior Author(s)

  • BM

    Brian Manzi, MD

    Assistant Professor of Pediatric Otolaryngology
    Rutgers New Jersey Medical School, United States

  • YY

    Yu-Lan Mary Ying, MD

    Professor
    Rutgers New Jersey Medical School
    Millburn, NJ, United States

Disclosure(s):
George Ashji, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Tympanostomy tube insertion (TTI) in pediatric patients has traditionally been done under general anesthesia in the operating room (OR), with multiple in-office alternatives becoming increasingly used recently. A systematic review comparing the methods for pediatric TTI was conducted.

Methods: PubMed, Embase, and Web of Science were queried for articles (on 01/02/2026) evaluating outcomes of TTI in pediatric patients ( < 18 years old). Study selection was reported according to PRISMA guidelines. Full texts were reviewed to confirm that the setting (OR and/or In-Office) was specified and no other major procedures were performed. Qualitatively evaluated outcomes included early tube extrusion, post-tube otorrhea, and patient/family satisfaction.

Results: Initial screening of 347 titles/abstracts narrowed to 54 full-text articles, of which 19 met inclusion criteria (accounting for 2,644 patients). In studies that reported TTI success rates, in-office success rates ranged from 87.4–100% (8 studies), while OR was 96.6–100% (2 studies). In two studies that directly compared otorrhea rates between OR and in-office, there was no significant difference in rates of otorrhea. Time-to-tube extrusion findings were inconsistent; one study reported a shorter tube life for in-office procedures beyond 1 year, whereas two others observed a similar direction without statistical significance. One study showed that physician training level (resident vs. attending) could also impact outcomes. In-office placement had >90% caregiver satisfaction (6 studies), with one study reporting lower post-op scores on qualitative pain assessments compared to OR TTI.

Conclusions: Pediatric in-office TTI demonstrates high procedural success, with complication rates generally comparable to OR insertion. Also, it provided high caregiver satisfaction, offering a viable alternative that avoids general anesthesia and the operative experience for families. However, limitations arising from heterogeneity in techniques and outcome reporting highlight the need for standardized procedures and outcomes.