To begin this episode, Dr. Schramm describes the technology behind in-office tube placement. He uses the Tula ® Tympanostomy system (available from Smith + Nephew) to insert ear tubes in-office. Tula offers an integrated tympanostomy solution that combines local anesthetic with tube insertion. With the Tula system, a gentle current numbs the tympanic membrane in 10-15 minutes, after which a pre-packaged delivery device allows the operator to insert a tube by simply placing the device on a patient’s eardrum and then clicking a button.

Next, the discussion shifts towards Dr. Schramm’s personal experience with the Tula system. The physicians compare Tula tubes with conventional T-tubes. Dr. Schramm emphasizes that almost all children needing tubes are candidates, though normal ear anatomy and motivated parents make the procedure easier. He also offers additional practical technical pearls about the Tula system.

Dr. Schramm then shares how his experience with in-office ear tubes pushed the boundaries of in-office procedures. Given that ear tube placement in the OR requires general anesthesia, time off work and facility fees are major challenges to traditional tympanostomy tube placement. For this reason, many of his families are excited to help their children hear better with an in-office procedure. To conclude this episode, Dr. Schramm shares his tips for training clinic staff, working with insurance companies, and counseling families on the procedure.