Six Sigma tympanostomy tube insertion: achieving the highest safety levels during residency training

Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
Glenn Isaacson

Abstract

To evaluate a protocol designed to avoid complications during tympanostomy tube insertion by residents. Ten-year consecutive cases series by a single surgeon supervising residents. Tertiary children's hospital. Children 6 weeks to 21 years. Residents followed a defined protocol for tube insertion. A resident operated until the tube was placed or he/she committed one major or two minor errors. Incidence of 1) major complications: profound sensorineural hearing loss (SNHL), injury to major vascular structures, or disruption of the ossicular chain; and 2) minor complications: tube loss into the middle ear, tympanic membrane tears, or tube occlusion by blood clot. There were no major complications in 10,000 tube insertions. Two children had unilateral profound SNHL; both were found to have Mondini malformations. Five tubes were recovered from the middle ear. Eight tympanic membrane tears healed with gelatin patches. Three tubes were occluded by blood clots. By following a defined protocol, major complications of a common operation can be reduced to the five-sigma level and minor complications minimized.

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Citations

Feb 15, 2011·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Luca BertolacciniAlberto Terzi
Jun 30, 2012·BMC Medicine·Renée M van der LeeuwMaas Jan Heineman
Dec 5, 2015·Acta Odontologica Scandinavica·Elmira Pakbaznejad EsmaeiliJanna Waltimo-Sirén
Jun 30, 2012·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·Glenn Isaacson
Jun 20, 2020·Ear, Nose, & Throat Journal·Glenn Isaacson
Jul 3, 2021·International Journal of Pediatric Otorhinolaryngology·Glenn Isaacson, Brian Reilly
Feb 27, 2013·Pediatrics·Allan S LieberthalDavid E Tunkel
Jun 1, 2017·Pediatrics·Dale W SteeleThomas A Trikalinos

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