Optimizing effectiveness of laser tympanic membrane fenestration in chronic otitis media with effusion. Clinical and technical considerations.
OBJECTIVE
To describe the patient, disease and clinical characteristics that optimize the effectiveness of laser tympanic membrane fenestration (LTMF) to treat chronic otitis media with effusion (OME).


METHODS
Four pediatric otolaryngology tertiary referral centers. IRB approved; participation by informed consent.


METHODS
An observational clinical effectiveness trial was conducted in 164 ears (94 children), who had chronic OME. All patients were candidates for insertion of pressure equalization tubes (PETs) but agreed to undergo LTMF instead. Clinical and audiologic follow-up are reported at 90 days after LTMF.


METHODS
Clinical effectiveness was defined as an effusion free middle ear at otoscopy with A or C1 tympanogram and normal hearing.


RESULTS
At 90 days, 66% of the 95 evaluable ears were effusion free, all with normal hearing. Children younger than 4 years (P<0.04), who had shorter durations of effusion (P<0.009), and who experienced longer duration of fenestration patency (FP) (P<0.009) correlated to improved outcomes.


CONCLUSIONS
The use of LTMF to create 2--3 weeks of middle ear ventilation in patients with chronic OME (middle ear effusion (MEE) for 3 months or greater) is effective in 66% of 95 (58%) of ears evaluable at 90 days follow-up. This study provides basic information needed to optimize the use of LTMF today and enhance research efforts in the future.
Department of Otolaryngology, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, and The Children's Hospital of Buffalo/Kaleida Health, 219 Bryant Street, Buffalo, NY 14222, USA. lbrodsky@kaleidahealth.org
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L
Brodsky
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S
Cook
E
E
Deutsch
P
P
Brookhouser
C
C
Bower
M
M
Waner
J
J
Reilly
D
D
Chait
C
C
Poje
S
S
Shaha
D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006320:Hearing Tests; D006801:Humans; D007223:Infant; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008876:Middle Ear Ventilation / Q000379:methods*; D010034:Otitis Media with Effusion / Q000175:diagnosis / Q000601:surgery*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000601:surgery*