BackTable / ENT / Podcast / Episode #131
In-Office Ear Tubes in Children
with Dr. Jordan Schramm
In this episode of BackTable ENT, Dr. Jordan Schramm of Peak Pediatric ENT in Provo, Utah, chats with hosts Dr. Gopi Shah and Dr. Ashley Agan about in-office ear tubes for children.
BackTable, LLC (Producer). (2023, September 21). Ep. 131 – In-Office Ear Tubes in Children [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Jordan Schramm
Dr. Jordan Schramm is a pediatric otolaryngologist and head and neck surgeon with Peak ENT Associates in Salt Lake City, Utah.
Dr. Ashley Agan
Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.
Dr. Gopi Shah
Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.
First, Jordan describes the technology behind in-office tube placement. Jordan uses the Tula ® Tympanostomy system (available from Smith + Nephew) to insert ear tubes in-office. Tula offers an integrated tympanostomy solution that combines local anesthetic with tube insertion. With the Tula system, a gentle current numbs the tympanic membrane in 10-15 minutes, after which a pre-packaged delivery device allows the operator to insert a tube by simply placing the device on a patient’s eardrum and then clicking a button.
Next, the discussion shifts towards Jordan’s personal experience with the Tula system. Gopi, Ashley, and Jordan compare Tula tubes with conventional T-tubes. Jordan emphasizes that almost all children needing tubes are candidates, though normal ear anatomy and motivated parents make the procedure easier. Jordan then offers additional practical technical pearls about the Tula system.
Finally, Jordan shares how his experience with in-office ear tubes pushed the boundaries of in-office procedures. Given that ear tube placement in the OR requires general anesthesia, time off of work and facility fees are major challenges to traditional tympanostomy tube placement. For this reason, many of his families are excited to help their children hear better with an in-office procedure. He finishes with his tips for training clinic staff, working with insurance companies, and counseling families on the procedure.
Jordan’s Peak Pediatric ENT Profile:
Tula Tube System (for Physicians):
Article comparing outcomes of Tula tubes with conventional ear tubes (mentioned by Jordan):
Again, if you don't have the right parent selection from the get go, it's not going to go well.
These are parents that are, they want this done and they're willing to do this and they do not want to go to the OR. Even with the most difficult kids that I've done, I have yet to have a parent come back and say, “boy, that was traumatic. I would never do that again.” Save for maybe one of the older kids that was just really upset. That has been the surprising thing. The paradigm shift for me is it's amazing how much I'm able do now in the clinic that I just never thought I could because in training you don't do that.
In some ways it's allowed me to do some things in clinic that I would not have beforehand. Like there are times where I like when I do tubes in the OR, I tend to use silicone material. If I have a silicone collar button tube, I've been able to pull those out of the tympanic membrane in clinic in some of these kids, whereas I never would have attempted that before. It's all these same principles of, okay, preparing the family, make sure they're okay with it, make sure they know there might be some discomfort.
Let's see what we can do, what we can't do, and we balance the pros and cons of doing it here with a little bit of discomfort versus going to the OR with everything that the OR is.
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