C. McMurtry

Objective Tympanostomy tube insertion (TTI) is typically accomplished under general anesthesia (GA) in the operating room. We aimed to compare pain between GA and local anesthesia (LA) in surgically naïve children undergoing TTI. Secondary objectives examined patient's quality of life (QoL) and parent's satisfaction. Study Design Prospective single‐center study. Setting Tertiary pediatric academic center. Methods Consecutive children who underwent TTI under GA were compared to patients under LA. Pain standardized observational pain scales (Face, Legs, Activity, Cry, Consolability Scale [FLACC], Children's hospital of Eastern Ontario Pain Scale [CHEOPS]) were completed pre‐procedure, during the first tympanostomy and second tympanostomy, and post‐procedure, as well as 1 week postoperatively. General health‐related QoL (PedsQL) and QoL specific to otitis media (OM‐6) were measured before insertion and 1 month postoperatively. Parental satisfaction was also evaluated using a qualitative scale. Results LA group had statistically significant higher pain levels at the beginning (7.3 vs. 0), during the first tympanostomy (7.8 vs. 0), during the second tympanostomy (7.7 vs. 0), and at end of the procedure (6.9 vs. 0) with the FLACC scale (all p < 0.01). Results were similar with the CHEOPS scale. No pain was noted 1 week after surgery in either group. Both groups had similar improvement in their QoL ( p > 0.05). Minor complication occurred at a similar rate ( p > 0.05). Parents were equally satisfied with their choice of anesthesia in both groups when initially questioned after the procedure ( p > 0.05). Conclusions Children experienced significantly less pain under GA than LA. If LA is to be used, pain and distress‐reducing strategies are critical. Shared decision‐making with families is essential. Level of Evidence 3 Laryngoscope , 134:2422–2429, 2024

Existing research has identified evidence-based strategies for mitigating fear and pain during needle procedures; yet, families often experience limited access to health professionals who deliver these interventions. Children may benefit from learning about such strategies in a developmentally appropriate and accessible format such as a picture book. This review aimed to summarize content related to needle procedures represented in picture books for 5- to 8-year-old children. Key terms were searched on Amazon, and the website was used to screen for relevant eligibility criteria. Three levels of screening and exclusions resulted in a final sample of 48 books. Quantitative content analysis was used to apply a coding scheme developed based on relevant Clinical Practice Guidelines and systematic reviews. Cohen’s Kappa indicated strong reliability, and frequencies were calculated to summarize the content. The books were published between 1981 and 2022. All 48 books included at least one evidence-based coping strategy. Distressing aspects such as scary visuals were often included (27.1%), as well as specific expressions of fear (52.1%) and pain (16.7%). Overall, this study paves the way for researchers interested in evaluating the effectiveness of picture books on children’s knowledge and self-efficacy, as well as creating interventions for coping.