D Cohen1, Y Shechter, M Slatkine, N Gatt, R Perez. 1. Department of Otolaryngology/Head and Neck Surgery, Shaare Zedek Medical Center, PO Box 3235, Jerusalem, Israel 91031.
Abstract
OBJECTIVE: To study the qualities of laser myringotomy (LM) as a treatment for middle ear ventilation problems. DESIGN: Prospective study and follow-up of consecutive cases of adults, children, and infants. Patients were observed for up to 2 years. SETTING: Children underwent LM, with or without adenoidectomy, under general anesthesia in the operating room. Adults and infants underwent LM under topical anesthesia, as an outpatient procedure. PATIENTS: All consecutive patients with either secretory otitis media (SOM) (adults and children) or acute otitis media (AOM) (infants) who agreed to participate were included without selection. INTERVENTION: Myringotomy was performed using new laser equipment, enabling a 0.1-second ablation with changeable diameter. OUTCOME MEASURES: Close follow-up, with microscopic examination of all ears. Findings were noted on the medical charts. RESULTS: Among all age groups, 136 ears were followed up. Perforation lasted a mean 22 days in adults, 17 days in children, and 11 days in infants. Patient age was found to be a significant determining factor for duration of perforation (P =.002). Laser myringotomy in the anterior and inferior areas lasted longer than posterior LM (P<.001). In patients with SOM, during the time the LM was patent, all ears were ventilated. In children, 38% of SOM cases resolved after a single LM treatment. All infants with AOM recovered promptly without antibiotic treatment. CONCLUSIONS: Laser myringotomy is a convenient, quick procedure that can be performed in the medical office with the use of topical anesthesia and is suitable for patients with AOM or for those who need short-term ventilation for SOM. It was found to be a safe alternative to ventilation tubes in these patients. In AOM, it was used instead of antibiotics and gave prompt relief from symptoms and cure of the AOM.
OBJECTIVE: To study the qualities of laser myringotomy (LM) as a treatment for middle ear ventilation problems. DESIGN: Prospective study and follow-up of consecutive cases of adults, children, and infants. Patients were observed for up to 2 years. SETTING:Children underwent LM, with or without adenoidectomy, under general anesthesia in the operating room. Adults and infants underwent LM under topical anesthesia, as an outpatient procedure. PATIENTS: All consecutive patients with either secretory otitis media (SOM) (adults and children) or acute otitis media (AOM) (infants) who agreed to participate were included without selection. INTERVENTION: Myringotomy was performed using new laser equipment, enabling a 0.1-second ablation with changeable diameter. OUTCOME MEASURES: Close follow-up, with microscopic examination of all ears. Findings were noted on the medical charts. RESULTS: Among all age groups, 136 ears were followed up. Perforation lasted a mean 22 days in adults, 17 days in children, and 11 days in infants. Patient age was found to be a significant determining factor for duration of perforation (P =.002). Laser myringotomy in the anterior and inferior areas lasted longer than posterior LM (P<.001). In patients with SOM, during the time the LM was patent, all ears were ventilated. In children, 38% of SOM cases resolved after a single LM treatment. All infants with AOM recovered promptly without antibiotic treatment. CONCLUSIONS: Laser myringotomy is a convenient, quick procedure that can be performed in the medical office with the use of topical anesthesia and is suitable for patients with AOM or for those who need short-term ventilation for SOM. It was found to be a safe alternative to ventilation tubes in these patients. In AOM, it was used instead of antibiotics and gave prompt relief from symptoms and cure of the AOM.