Duration of patency of laser-assisted tympanic membrane fenestration.
BACKGROUND
Laser-assisted tympanic membrane fenestration (LTMF) provides intermediate-duration middle ear ventilation, which benefits selected children with acute otitis media (AOM) and otitis media with effusion (OME).


OBJECTIVE
To evaluate clinical and technical factors that may affect duration of LTMF patency.


METHODS
Prospective clinical cohort effectiveness trial.


METHODS
Four tertiary care children's hospitals.


METHODS
Volunteer sample of 251 children (430 ears) followed up at 1, 2, 3, 4, 8, and 12 weeks; time to fenestration closure was evaluable in 201 ears, and assessment of cure at study conclusion was evaluable in 128 ears.


METHODS
Laser-assisted tympanic membrane fenestration for prospectively defined AOM or OME. The surgeon determined spot size, wattage, and concurrent adenoidectomy based on clinical judgment.


METHODS
Cure of AOM/OME with effusion at 90 days and duration of LTMF patency relative to spot size (1.8-2.8 mm), fenestration location on tympanic membrane, power (7-22 W), concurrent adenoidectomy, age, diagnosis (AOM vs OME), type of effusion, and preoperative tympanogram characteristics. Results are based on the number of ears that could be evaluated at each data collection interval.


RESULTS
Fenestrations remained patent for 2 to 4 weeks (mean = 2.52, median = 2.0, SD = 1.4, n = 201); 97.4% were closed at 6-week follow-up. Spot sizes of 2.4 and 2.6 mm had a higher rate of patency than 2.0-mm spot size at 3 weeks following LTMF. Cure at 90 days was related to duration of patency for all patients combined and for patients treated for AOM and OME, but not for those undergoing adjunctive adenoidectomy. Cure at 90 days was related to larger spot size for all patients combined and those treated for AOM. Other investigated factors did not achieve statistical significance.


CONCLUSIONS
Spot size of 2.4 mm or greater results in improved duration of LTMF patency, persisting for up to 3 weeks after LTMF, especially for treatment of AOM. Increased duration of LTMF patency correlates with greater incidence of cure of middle ear effusion at 90 days. Additional investigation is indicated to determine optimum spot size and optimum duration of patency for disease- severity-adjusted populations.
Deutsch
Ellen S
ES
Department of Surgery, Division of Pediatric Otolaryngology, Alfred I. duPont Hospital for Children, Wilmington, Del, USA. edeutsch@nemours.org
Cook
Steven P
SP
Shaha
Steve
S
Brodsky
Linda
L
Reilly
James S
JS
D000208:Acute Disease; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008876:Middle Ear Ventilation / Q000379:methods*; D010033:Otitis Media / Q000175:diagnosis / Q000601:surgery*; D010034:Otitis Media with Effusion / Q000175:diagnosis / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000601:surgery*