Tympanostomy Tube Innovation: Advances in Device Material, Design, and Office-Based Technology

Abstract

Objectives: With tympanostomy tube insertion remaining the most common procedure performed in children to date, growing interests in minimizing both procedural costs and anesthetic exposure in the pediatric population have inspired innovation with respect to tympanostomy tubes. As such, we aim to discuss the current state of tympanostomy tube innovation including insertion devices, tube material, and design. Methods: Computerized literature review. Results: (1) Numerous single-use devices consisting of a myringotomy knife and preloaded tympanostomy tube offer potential advantages of decreasing or eliminating operating room time and may be performed under moderate instead of a general anesthetic. (2) Innovation with respect to tympanostomy tube material and design may offer enhanced ototopical drug delivery, decreased rates of tube occlusion, and/or the ability to dissolve “on-command” with application of a novel ototopical material. (3) These technologies currently remain in various phases of preclinical and clinical testing. Conclusions: While clinical testing for a number of new technologies is preliminary and ongoing, tympanostomy tube-related innovations hold exciting promise to supplement or potentially replace the present-day armamentarium of tympanostomy tube design and insertion moving forward.

Efficacy of Ventilation Tube Insertion with Palatal Repair for Otitis Media in Cleft Palate: Meta-Analysis and Trial Sequential Analysis

“…On the other hand, reasonable selection of the ventilation tube also plays a key role to prevent post-VTI otorrhea. Biocompatibility and surface composition are two important components to be considered for tube insertion [16]. Metal ventilation tubes, including gold tubes and titanium tubes, have been proven less biocompatible when compared to plastic tubes, including silicone or fluoroplastic tubes, and were not suitable for long-term use [17,18].…”

“…However, whether VTI can truly help patients with cleft palate remains controversial [10,15]. Though there is much development in the design and material of ventilation tubes, including biocompatible tubes and substance-coated tubes, which provides diversified choice of tubes according to clinical requirement [16][17][18], VTI itself still cause various complications, including secondary infection or tube-related problems (e.g., tube displacement or prolonged indwelling) and the best timing of VTI is unclear [10,19]; clinicians may choose to perform VTI concurrently with palatal repair surgery or to postpone VTI until OME develops [10,15]. Different policies for VTI are adopted across different countries, and it remains inconclusive whether VTI is effective for the management of OME in patients with cleft palate.…”

Otolaryngologists’ Attitudes toward In-Office Pediatric Tympanostomy Tube Placement without General Anesthesia

“…8-10 Additionally, there is growing interest both among otolaryngologists and medical industry to develop an automated insertion device, some of which also deal with topical anesthesia and experience management. 3-7,14,15 Whelan and Maguire’s 7 recent publication reviews the most current technologies and future directions. The survey results did indicate interest in such a device but also a desire for additional outcome information regarding tube properties prior to their adoption.…”

“…Several manufacturers are developing automated devices to facilitate rapid and efficient tube insertion in the office setting, leading to increased awareness by clinicians and parents as a potential means to avoid general anesthesia. 3-7 All devices share the common features of a preloaded, proprietary tube that is rapidly deployed upon pressing a button, or rolling a knob, after the device tip penetrates the tympanic membrane. Additional device-specific details are beyond the scope of this discussion and can be found on the manufacturers’ websites.…”

Design of medical tympanostomy conduits with selective fluid transport properties

“…Whereas selective fluid transport is frequently achieved by optimizing the conduit size, fluid interface chemistry, or through active gating (15)(16)(17)(18), we hypothesized that the lumen shape can be tailored to discriminate between even chemically similar liquids. In particular, a design featuring a curved profile would enable us to better engineer a specific capillary resistance along the tube that blocks the entry of environmental water but simultaneously allows passive delivery of ear drops while also facilitating the exit of effusion fluid (19). Here, through synergistic tailoring of materials and geometries, we demonstrated such rationally designed TTs that solve the above fluid discrimination challenges in one subcapillary-length-scale device and prevent the adhesion of pathogenic bacteria, cells, and blood yet at a smaller scale than current SoC-TT(s).…”