Transtympanic Middle Ear Ventilation in Otitis Media with Effusion (OME) after Myringotomy with a CO 2 Laserotoscope

• Published in: Medical laser application 2002, Vol.17 (3), p.214-222
• Main Authors: Sedlmaier, Benedikt, Jivanjee, Antonio, Jovanovic, Sergije
• Format: Article
• Language: English
• Subjects: CO 2 lasermyringotomy; laserotoscope; otitis media with effusion; transtympanic ventilation
• ISSN: 1615-1615; 1878-3228
• DOI: 10.1078/1615-1615-00064

The aim was to investigate the transtympanic ventilation time, the healing course of the tympanic membrane, the early and late complications and the recurrence rate of otitis media with effusion within six months after CO 2 laser myringotomy with the CO 2 laser otoscope Otoscan™. In this study, myringotomy was performed with the CO 2 laser otoscope Otoscan™ in a patient population comprising 81 children (159 ears) with a history of otitis media with effusion (OME) associated with adenoidal and sometimes tonsillar hyperplasia. The procedure on the tympanic membrane was accordingly combined with an adenoidectomy, a CO 2 laser tonsillotomy or a tonsillectomy and therefore performed under insufflation anesthesia. In all ears, approximately 2 mm circular perforations were created in the lower anterior quadrants with a power of 12–15 W, a pulse duration of 180 ms and a scanned area of 2.2 mm in diameter. None of the children showed postoperative impairment of cochleovestibular function such as sensoneural hearing loss or nystagmus. Otomicroscopic and videoendoscopic monitoring documented the closure time and healing pattern of tympanic membrane perforations. The mean closure time was found to be 16.35 days with a minimum of 8 and a maximum of 34 days. As a rule, an onion-skin-like membrane of keratinized material was seen in the former myringotomy perforations at the time of closure. At the follow-up six months later, the condition of the tympanic membrane of 129ears could be checked by otomicroscopy and videoendoscopy and the hearing ability by audiometry. The CO 2 laser myringotomy sites appeared normal and irritation-free. Two of the tympanic membranes examined (1.6%) showed atrophic scar formation, and one (0.8%) had a perforation with a diameter of 0.3 mm. The perforation was seen closed in a control otoscopy 15 months postoperatively. OME recurred in 26.3% (n = 10) of the ears seen intraoperatively with mucous secretion (n = 38) and in 13.5% (n = 5) of the ears with serous secretion (n = 37) (p < 0.05). The most important principle in treating OME is ventilation of the tympanic cavity. CO 2 laser myringotomy achieves this via a self-healing perforation whose diameter roughly determines the duration of transtympanic ventilation. Laser myringotomy competes with ventilation tube insertion in the treatment of OME. It may be a useful alternative in the surgical management of secretory otitis media.