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

OBJECTIVE: To evaluate the feasibility, effectiveness, and safety of in-office tympanostomy tube placement (TTP) performed in awake pediatric patients without general anesthesia. DATA SOURCES: We searched PubMed, Embase, Web of Science, and the Cochrane Library from inception through March 20, 2025. REVIEW METHODS: 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. RESULTS: 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. CONCLUSION: 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.