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This one is about: Ear Tubes as an Office Procedure
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EAR TUBES AS AN OFFICE PROCEDURE
by Kat Huck
I wondered about my doctor's decision to insert myringotomy tubes in my son's ears as an office procedure, rather than as an outpatient hospital procedure, which is far more common. For a long time I was feeling like we have a quack for an ENT because no one else here has heard much about tubes being done this way. I did ask the nurse about it in July (about why in-office vs. hospital). She told us as long as they feel the patient can tolerate it under local, they prefer to do it that way.
This ENT we have is maybe in his 60's and I'm assuming he does a lot of tube procedures. When we went to see the PS a few weeks ago, there was another family there (2yr old son was CA) who also saw Dr. W. She said they did tubes the same way; and that Dr. W also did tubes for her 10 year old daughter, too. That was comforting to hear!
Many parents would feel that if the procedure isn't too scary or dangerous for a child to have done under a local anesthesia, they would much prefer that than a general anesthesia.
We feel the same way too. I believe the discomfort & fear is no greater than what some children/adults have to face going to the dentist.
To tell you a little more about how it was done in our case:
The drug prescribed for him was: Demoral, Phenegran & Thorazine (14mgs a piece for this 28 lb. boy!). They call it their "DPT Cocktail". A while back, the side affects of thorazine was questioned here on the list...so this time, I asked the pharmacist about it. From what I understand, the thorazine given here is in a small amount and is not known to cause severe reactions in otherwise healthy children.
The demoral is for the pain; Phenegran is to alleviate nausea and the thorazine helps to calm them.
Well, to start the procedure, we administered the drug about an hour prior to our appointment. Upon going into the office, they use a "papoose board" to strap down the child. [There is a photo of it in the Gallery - http://www.widesmiles2.org/gallery ] -- Look under Amber's picture of her getting the stitches out. It looks like a surfboard with huge canvas flaps that adhere together with velcro to "strap" the child in.
Our son was quite "loopy" by now; but not unconscious. He didn't resist being strapped in but I could tell that he totally didn't like it! (Don't all kids hate being restrained?)
The nurse then proceeded to put in some ear drops. Next she used this electrode instrument -- iosynthesizer? (I don't really know the name of this thing) ?? to numb his ears. She told us that the most discomfort experienced here is that it itches like crazy. She told us that she actually had to have someone do it ON her to illustrate to an older patient that it really wasn't painful, but just itchy. The instrument itself looked like just a thin wire, that she inserted into his ear canal and held it there for a few minutes on each side.
When she was done, the ENT came in and spent all of 5 minutes or so placing the tube. (He first suctioned out the solution, then inserted the tubes). Voila. End of procedure. We unstrapped our angel, took him off the examining table, gave him a little drink and then went home.
If anything, that is why parents who are faced with having this surgery done in the OR might not understand why they are called back to the recovery room within minutes of having handed over their child. It really is a very quick procedure, and there's no need to worry when you are called back so soon.
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