title: The feasibility of office-based laser-assisted tympanic membrane fenestration with tympanostomy tube insertion: the duPont Hospital experience.
abstract: OBJECTIVE
  To determine the feasibility of inserting tympanostomy tubes in children using office-based laser-assisted tympanic membrane fenestration.
  
  
  METHODS
  Study consisted of a retrospective review of the charts of all children who underwent office-based laser-assisted tympanic membrane fenestration with tympanostomy tube insertion from July 1, 1998 to August 31, 2000. Tetracaine eardrops were used for topical anesthesia. Fenestration was achieved with the OtoLAM flashscanner laser (ESC Sharplan, Yokneam, Israel).
  
  
  RESULTS
  Of the 127 patients (185 ears) who underwent laser-assisted tympanic membrane fenestration, 61 ears underwent tympanostomy tube insertion. Ten ears were treated for otitis media with effusion, 43 for recurrent acute otitis media, and eight for acute otitis media not responding to antibiotics. Fifteen ears had purulent effusion, five had a serous effusion, and 23 had mucoid middle ear fluid. Eighteen ears had no middle ear fluid. At the first follow-up visit, all tested ears had hearing of 20 dB or better. Two children had tubes that were blocked. Blockage occurred in ears that required more than one laser firing to penetrate the tympanic membrane. Otorrhea was present in 13 ears (21%). Otorrhea occurred exclusively in ears with purulent or mucoid middle ear fluid.
  
  
  CONCLUSIONS
  Office-based laser-assisted tympanic membrane fenestration with tympanostomy tube insertion is a safe and effective alternative to tube placement in the operating room. The outcome compares favorably with previously published data.
authors.affiliation: Department of Otolaryngology, Thomas Jefferson University Hospital, 111 S. 11th Street, Philadelphia, PA 19134, USA.
authors.forename: Oren
authors.initials: O
authors.lastname: Friedman
authors.forename: Ellen S
authors.initials: ES
authors.lastname: Deutsch
authors.forename: James S
authors.initials: JS
authors.lastname: Reilly
authors.forename: Steven P
authors.initials: SP
authors.lastname: Cook
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003691:Delaware; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008876:Middle Ear Ventilation / Q000295:instrumentation* / Q000379:methods; D009819:Office Visits; D010034:Otitis Media with Effusion / Q000175:diagnosis / Q000601:surgery*; D010035:Otitis Media, Suppurative / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome