New technology allowing ENTs to place tubing in patients' ears at the office instead of the operating room is just one of the trends advancing otolaryngology, says Nicole Aaronson, MD, pediatric otolaryngologist at Wilmington, Del.-based Alfred I. duPont Hospital. She told Becker's ASC Review what she thinks are the biggest trends in ENT technology today.
Note: Response has been edited for style and length.
Dr. Nicole Aaronson: There are three major trends in technology and devices that are used in ENT.
First, there are new technologies being developed both to improve patient care and education.
Second, existing technologies are repurposed to help manage new problems or new populations.
Third, new technologies are used to find solutions to problems that are more cost-effective or more convenient than the current solutions.
New technologies in ENT include new hearing-assistive devices both implanted and external. Other technologies like 3D printing have been used for tissue engineering and implantable prosthesis as well as to create preoperative models to allow customized surgical planning. This technology can also be used for trainee education as a way to practice before operating on live patients and reduce the number of cadavers needed.
With respect to extending use of existing technologies to new populations, there are several examples. Cochlear implants are no longer a new technology. However, indications for cochlear implants have expanded in terms of acceptable patient age, level of hearing loss, and single-sided deafness.
Similarly, the hypoglossal nerve stimulator was first introduced in the adult population. Through research trials, it has been introduced to pediatric patients with trisomy 21 who meet a set of criteria. As this technology is used more widely, it is likely that indications will expand within the pediatric population to groups other than just those with trisomy 21.
In addition to extending the indications for a device by finding new populations to treat, a device can also be used to treat new problems other than the ones for which it was originally intended. For example, steroid-eluting stents are frequently used in adult sinus surgery to help maintain patency and reduce post-operative scarring. Steroid-eluting stents are now being studied to see if they can have similar effects in patients undergoing choanal atresia repair and laryngotracheal reconstruction.
Sometimes, there are problems in ENT that already have solutions, but new technologies provide a solution that is either more efficient, more cost effective or has significant benefits for the patient. For example, bilateral myringotomy with tubes is typically performed in the operating room via mask anesthesia for the vast majority of pediatric patients. However, device systems do exist that allow for placement of PE tubes in office on children who are appropriate candidates. These systems can theoretically decrease cost by decreasing an operating room visit and improve convenience for the family by avoiding a separate second visit. Similarly, telemedicine can be used as a way to improve family convenience and satisfaction. While at-home telemedicine does have some limitations of utility in pediatric otolaryngology, medical assistant-assisted telemedicine can be beneficial. The family can drive to a clinic location closer to home where an MA can perform an exam using a video otoscope so that the physician can see the exam while being at a physically disparate location.