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Published on: October 13, 2017
Diode laser myringotomy for chronic otitis media with effusion in adults
Diego Zanetti1, Michela Piccioni, Nader Nassif
1Otorhinolaryngologic Department, University of Brescia, Italy. diego_zanetti@iol.it
Objective:
To analyze the closure time of diode laser-assisted myringotomies, the incidence of complications, and the hearing results in comparison with the "cold" procedure in adults with otitis media with effusion (OME).
Study Design:
Prospective case-control study.
Setting:
Tertiary referral center, university hospital.
Patients:
Twenty-eight adult patients (39 ears), 13 men and 15 women, age 13 to 76 years (mean, 51.9). Inclusion criteria included 3 months (or more) history of OME resistant to medical therapy. Twenty-two control patients (34 ears) underwent cold myringotomies with knife and ventilation tubes (VT).
Intervention:
Diode laser myringotomy performed in an office setting under local anesthesia with topical EMLA ointment.
Main Outcome Measures:
Timing of closure of the myringotomy, hearing results, incidence of complications, recurrence of OME.
Results:
No intra- or postoperative pain nor complications were observed. Otomicroscopic daily monitoring documented the healing patterns of the tympanostomies, which remained patent for 7 to 25 days (average, 15.6 +/- 4.8 days). Immediate improvement of hearing was achieved in every patient. Recurrence of OME was observed in 36 ears (92.3%) within 1 month from healing. In the control group with VTs, healing of the eardrum was observed between 126 and 301 days (average, 183.2 +/- 44.8 days), and recurrence of OME was observed in 8 ears (23.5%) (p < 0.001). One month after healing, the air-bone gap was retained within 10 dB in 10.3% (4/39) of the diode laser group and in 50% (17/34) of the standard procedure group (p=0.0001).
Conclusions:
Diode laser myringotomy is a straightforward, painless procedure simplified by the thin fiberoptic cables available. Functional benefit is comparable to conventional tympanostomies plus VTs, but the duration of patency is too short to achieve long-term clearance of the effusion in "glue" ears of adult patients. Selected indications could be acute or recurrent otitis media or the prevention of barotraumas in tubal dysfunction.
