194 - In-Office Tympanostomy Tube Placement Using the Hummingbird System: An Effective Alternative to Operating Room Insertion

Publication Number: 3186.194

Priyanka Sai, Creighton University School of Medicine, Phoenix, AZ, United States; Yu-Tzu Chang, Creighton University School of Medicine, Phoenix, AZ, United States; Nathan C. Page, Phoenix Children's Hospital, Phoenix, AZ, United States

Background: Otitis media is among the most common pediatric diagnoses, affecting up to 90% of children before school age and often leading to recurrent infections or effusions requiring standard tympanostomy tube placement. Tube selection depends on clinical factors and the anticipated duration of middle ear disease, with procedures typically performed under general anesthesia in the operating room (OR), as with Armstrong and Pope tubes. Although effective, anesthesia in young children has been associated with perioperative distress, parental anxiety, and potential long-term neurocognitive effects.
Recent advances in the Hummingbird Tympanostomy Tube System (HTTS) offers alternative in-office placement under topical anesthesia for appropriately selected children. Although the American Academy of Otolaryngology-Head and Neck Surgery supports in-office tympanostomy as a viable option, data comparing outcomes of in-office and OR tube placement remain limited.

Objective: To evaluate whether in-office use of the HTTS demonstrates comparable extrusion characteristics and efficacy to standard Armstrong and Pope tubes placed under general anesthesia in the OR among children under six years of age.

Design/Methods: We conducted a retrospective review of 200 children under 6 years who underwent in-office tympanostomy tube placement using the HTTS between December 2021 and September 2024. Outcomes were compared with 400 age-matched children who underwent OR placement using Pope or Armstrong tubes during the same period. Tube duration was determined from serial otolaryngology and audiology documentation. Kaplan-Meier (KM) survival analysis was performed to estimate tube duration, censoring patients without follow-up visits at their last recorded encounter.

Results: The predicted median survival time for Hummingbird tubes was 295 days (interquartile range [IQR] 178.5-518.5), compared with 264 days (IQR 172-410.5) for Pope tubes and 532 days (IQR 354.5-742) for Armstrong tubes (Figure 1). KM analysis demonstrated similar survival curves between Hummingbird and Pope tubes, both extruding earlier than Armstrong tubes (Figure 2).

Conclusion(s): In-office tympanostomy tube placement using the HTTS demonstrates comparable predicted median survival to traditional Pope tubes placed in the OR. While tube retention was shorter than with Armstrong tubes, extrusion patterns were similar between the in-office HTTS and OR-placed Pope tubes. These findings suggest that for appropriately selected patients, in-office tympanostomy using the HTTS offers outcomes comparable to OR-placed Pope tubes, providing a feasible anesthesia-sparing alternative.

Figure 1: Predicted Median Tympanostomy Tube Duration by Tube Type
Median tympanostomy tube durations with interquartile ranges summarize overall retention trends by tube type. Hummingbird and Pope tubes demonstrate comparable predicted durations, while Armstrong tubes show longer retention.

Figure 2: Kaplan-Meier Survival Analysis of Tympanostomy Tube Retention by Tube Type
Kaplan-Meier survival curves illustrate predicted tube retention over time for in-office Hummingbird tubes and operating room-placed Pope and Armstrong tubes. Hummingbird and Pope tubes demonstrate similar survival patterns, both with lower rates of median tube retention compared to Armstrong tubes.