Page, Nathan

ABSTRACT Objectives The purpose of this study is to compare the economics of in‐office tympanostomy tube placement using single use devices versus standard placement in the operating room (OR). Methods A retrospective chart review was completed for all pediatric patients who underwent in‐office tympanostomy tube placement (CPT 69433) along with insurance and date matched patients with placement in the OR (CPT 69436) between 12/1/21–3/1/24. Financial data were compared among the public vs. private insurance cohorts using the Wilcoxon rank‐sum test with a two‐sided significance level of 5%. Results One hundred and thirty‐six in‐office patients were identified, 102 private versus 34 public, and compared with 136 insurance and date matched OR patients. The average total payment for both privately insured patients, $647.14 in‐office versus $6873.45 in the OR, and publicly insured patients, $312.74 in‐office versus $2656.34 in the OR, was statistically significant. The average insurance payment for both privately insured patients, $301.58 in‐office versus $5445.73 in the OR, and publicly insured patients, $310.63 in‐office versus $2258.65 in the OR, was statistically significant. For the patient payment, public insurance usually has 0 copay and is therefore excluded. The patient payment of the private insurance cohort, $308.30 in‐office versus $670.61 in the OR, was not found to be statistically significant. Conclusion As expected, this study demonstrates significant reductions in overall cost with in‐office tympanostomy tube placement even with the added cost of single‐use devices compared to the standard placement in the OR, particularly for insurance companies, suggesting the potential benefit of providing reimbursement for these devices. Level of Evidence N/A.

Herein described is an eight-year-old female patient presenting with bilateral external ear canal duplication and a history of recurrent postauricular abscesses, otorrhea, and moderate left-sided conductive hearing loss. Previous incision and drainage of the postauricular abscesses yielded little long-term success. Medical history was otherwise unremarkable. Physical examination revealed a cystic mass in the right ear and postauricular fibrosis, likely a result of previous surgical interventions. An audiogram revealed asymmetric hearing function, with mild-to-moderate conductive hearing loss in the left ear contrasting normal hearing in the right ear, while tympanometry confirmed an intact right tympanic membrane but was precluded on the left due to purulent otorrhea. A head CT scan revealed postauricular soft tissue swelling and well-pneumatized mastoid air cells. Both ears were explored intraoperatively via postauricular incisions. Surgical excision included removal of a cyst, cartilaginous remnants, and fibrotic tissue. The patient was followed up to assess for postsurgical complications. The surgical site healed uneventfully; no new symptoms or recurrences of past symptoms of otorrhea, cyst formation, or abscesses had developed within the twelve weeks post-surgery. Although external ear canal duplications are rare, it is imperative that early, accurate diagnoses be made to ensure optimal patient outcomes.