Hummingbird In-office Tympanostomy Tube Placement: Protocol Implementation and Outcomes

Introduction: Office-based tympanostomy tube placement using the Hummingbird system offers an alternative to operating room placement under general anesthesia, but no standardized protocol exists for room setup, instrumentation, or workflow. This study aimed to develop a reproducible, safe, and efficient in-office protocol.

Methods: A retrospective case series was conducted at a tertiary hospital including 76 children aged < 1–12 years during 2024 and 2025. Patients were selected based on otitis media history and tympanic membrane findings. The protocol included pre-procedure counseling, efficient room layout, standardized equipment, designated staff roles, and caregiver involvement. Tympanostomy tubes were placed using the Hummingbird device under topical or local anesthesia. Outcomes were procedural success, tolerance, workflow efficiency, and complications.

Results: All 76 procedures were completed in-office without conversion to the OR. Of the 70 patients seen for follow-up, at least one mild, expected postoperative event occurred in 54% of patients (drainage 36%, bleeding 10%, transient otitis media 7%, ear-pulling 4%), with 46% experiencing no events. Local anesthesia regimens were well-tolerated. Room turnover was efficient, and staff proficiency was consistent. One patient had PET extrusion within 9–12 months; one required subsequent tube placement with adenoidectomy.

Conclusions: Standardized in-office Hummingbird tympanostomy tube placement was safe, reproducible, and efficient in this pediatric cohort. Protocol-driven setup and staff roles support workflow consistency, predictability, patient and caregiver satisfaction, and procedural success.