In-Office Tympanostomy Tube Placement in Awake Pediatric Patients: A Meta-analysis of Proportions.

Abstract

To evaluate the feasibility, effectiveness, and safety of in-office tympanostomy tube placement (TTP) performed in awake pediatric patients without general anesthesia. We searched PubMed, Embase, Web of Science, and the Cochrane Library from inception through March 20, 2025. We screened the abstracts of potentially eligible studies and subsequently assessed the full-text reports of those deemed relevant in detail. The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Study quality and risk of bias were assessed using the ROBINS-I tool for non-randomized studies and the AXIS tool for the single cross-sectional study. Meta-analyses of proportions were conducted in R using the meta package. Eleven studies met inclusion criteria. Office-based TTP demonstrated a high pooled procedural success rate of 97% (95% CI, 0.89-0.99; P < .01; I² = 86.4%). Pain levels were low, with a mean Face, Legs, Activity, Cry, and Consolability (FLACC) score of 1.26 (95% CI, 1.10-1.45; I² = 0%), consistent with mild discomfort. Parental satisfaction was uniformly high at 95% (95% CI, 0.92-0.97; I² = 0%). Adverse events were infrequent, generally mild, and comparable in severity to those reported for operating-room tympanostomy under general anesthesia. Office-based TTP in awake pediatric patients appears to be a safe, effective, and well-tolerated alternative to operative tympanostomy under general anesthesia, offering high success rates, minimal discomfort, and strong caregiver acceptance while reducing anesthesia exposure and healthcare costs.