A novel approach to myringotomy simulation.

OBJECTIVE: In the wake of the 2019 coronavirus disease pandemic, elective cases and opportunities for clinical application have decreased, and the need for useful simulation models has become more apparent for developing surgical skills. A novel myringotomy with ventilatory tube insertion simulation model was created. METHODS: Residents across all levels at our institution participated in the simulation. Participants were evaluated in terms of: time of procedure, microscope positioning, cerumen removal, identification of middle ear effusion type, canal wall trauma, tympanic membrane damage and tube placement. RESULTS: Eleven residents participated. Scores ranged from 14 to 34, out of a maximum of 40. The average score among junior and senior residents was 24 and 31, respectively. The simulation was felt to be representative of the operating theatre experience. CONCLUSION: This study demonstrates a low-cost simulation model that captures several important, nuanced aspects of myringotomy with tube insertion, often overlooked in previously reported simulations.

Tympanostomy tubes in the age of quarantine.

OBJECTIVES: After state-mandated COVID-19 quarantine measures were lifted in 2020, pediatric otolaryngologists noticed that many children who were previously scheduled for tympanostomy tube (TT) placement for indications of acute otitis media (AOM) or chronic middle ear effusions (OME) no longer required surgery. This study aims to describe the effect of home-quarantine on pediatric patients with recurrent AOM and OME to increase our understanding of these conditions. METHODS: This was a retrospective review of pediatric patients that were originally scheduled for TT for recurrent AOM and/or OME, but had their procedure cancelled due to COVID-19. The chi-square test was used to compare the proportion of patients who no longer met indications for surgery stratified by original indication. Data was also collected for TT volume in the months before and after the start of the pandemic. RESULTS: Of 59 patients originally scheduled for TT, 31.0% of the 42 patients who returned for follow-up still met indications for a procedure after a period of home-quarantine. Of these, 76.9% had persistent OME, 61.5% had recurrent AOM, and 69.2% had persistent conductive hearing loss. After elective surgery resumed, there was a substantial decrease in the number of TT procedures performed compared to pre-pandemic data. CONCLUSION: After a period of quarantine, many patients previously scheduled for TT experienced resolution of their AOM or OME. Despite a nationwide recovery in outpatient surgical volume across otolaryngology practices, TT volumes remain low one year after the start of the pandemic, suggesting that continued COVID-19 precautionary measures are contributing to this lingering effect.

Recurrent acute otitis media: a survey of current management in England.

OBJECTIVE: Recurrent acute otitis media is common in children. The preferred treatment measures for recurrent acute otitis media have a mixed evidence base. This study sought to assess baseline practice across ENT departments in England. METHODS: A national telephone survey of healthcare staff was conducted. Every ENT centre in England was contacted. A telephone script was used to ask about antibiotic and grommet use and duration in recurrent acute otitis media cases. RESULTS: Ninety-six centres (74 per cent) provided complete information. Recurrent acute otitis media treatment across England by ENT departments varied. The antibiotic first- and second-line prophylaxis offered varies, with trimethoprim used in 33 centres and 29 centres not offering any antibiotics. The timing or choice about when to use grommets also varies, but 87 centres (91 per cent) offer grommet surgery at one stage. CONCLUSION: The treatments received by children in England for recurrent acute otitis media vary by centre; collaborative research in this area is advised.

Considerations in Management of Acute Otitis Media in the COVID-19 Era.

OBJECTIVES: To present the otologic findings of a patient with COVID-19 and complicated acute otitis media, evaluate for the presence of SARS-CoV-2 in middle ear fluid, and assess whether suctioning of middle ear fluid may be aerosol- generating. METHODS: The case of a man with SARS-CoV-2 infection and complicated acute otitis media with facial paralysis is presented to illustrate unique clinical decisions made in context of the COVID-19 pandemic. A cadaveric temporal bone was used to simulate droplet spread during suctioning of fluorescein-labelled middle ear fluid and visualized with a blue-light filter. RESULTS: A 23-year-old male who presented with complicated acute otitis media with facial paralysis was found to have an acute infection with SARS-CoV-2, with positive viral PCR of nasopharyngeal swab, and a negative PCR of the middle ear fluid. He was placed on isolation precautions and treated with myringotomy, topical and systemic antibiotics, and antivirals. Consistent with observations during endonasal suctioning, suctioning of middle ear fluid was not found to be aerosol or droplet generating. CONCLUSION: The case of a patient with active COVID-19 presenting with complicated acute otitis media in whom middle ear fluid was sampled to evaluate the etiology of the infection and the potential middle ear predilection of SARS-CoV-2 is described. This study has implications for the clinical management of patients with both known and unknown SARS-CoV-2 infection who present with ear disease. While middle ear suctioning may not be aerosol-generating, the risk of coughing or prolonged close contact requires heightened precautions during otologic procedures in patients with suspected or confirmed COVID-19.