Innovation
Introduction
Otitis media with effusion is the commonest disease of childhood. The associated hearing loss can affect language, education and socialisation. Ventilation tubes (VTs) normalise hearing but the waiting list in many hospitals is long. Awake outpatient VTs could be a quicker solution for selected children. We present our experience of setting up this service.
Method
(1) Permission from the clinical governance committee for new interventional procedure, (2) business case for funding of new equipment, (3) compare options for topical anaesthesia (EMLA, co-phenylcaine, phenol) and means of application, (4) trial the rapid VT insertion device (Solo +, Karl Storz Ltd) on suitably-consented children undergoing VT insertion under GA to familiarise with technique, and compare microscope vs endoscope, (5) finalise protocol, (6) Clinics: pre Solo with 7 slots and Solo with 6 slots, (7) disseminate referral criteria
Results
The final protocol comprises: microscope, topical phenol applied with orange top fine bacteriology swab and VT insertion with the Solo+ device. Referral criteria are: neurotypical children aged 10-16 with uni/bilateral OME or recurrent AOM, no ear wax, normal canals and nil significant TM retractions. Attempted VT insertion in 9 children (4 boys, 5 girls, age 10 to 16 years, median 13 years). Successful attempts in 8 cases. One case refused. All children and families very happy with the procedure.
Discussion
We continue to refine our process as we gain experience, and we may reduce our minimum age criterion in due course. For selected children, awake VT insertion is an excellent option.