Diode laser myringotomy for chronic otitis media with effusion in adults.
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).


METHODS
Prospective case-control study.


METHODS
Tertiary referral center, university hospital.


METHODS
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).


METHODS
Diode laser myringotomy performed in an office setting under local anesthesia with topical EMLA ointment.


METHODS
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.
Zanetti
Diego
D
Otorhinolaryngologic Department, University of Brescia, Italy. diego_zanetti@iol.it
Piccioni
Michela
M
Nassif
Nader
N
Campovecchi
Chiara
C
Redaelli de Zinis
Luca O
LO
D000158:Acoustic Impedance Tests; D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold / Q000502:physiology; D001844:Bone Conduction; D016022:Case-Control Studies; D002908:Chronic Disease; D004867:Equipment Design; D005260:Female; D005336:Fiber Optic Technology / Q000295:instrumentation; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D009225:Myringoplasty / Q000295:instrumentation*; D010034:Otitis Media with Effusion / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D013673:Technology Assessment, Biomedical; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation / Q000503:physiopathology / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology