Laser eustachian tuboplasty: two-year results.
OBJECTIVE
Laser eustachian tuboplasty (LETP) combined with appropriate medical management will eliminate the chronic presence of middle ear effusions in selected patients.


METHODS
The study population consisted of 13 adults with otitis media with effusion (OME). Patients underwent slow-motion video endoscopy to identify the location and extent of surgical resection. A diode or argon laser was used to vaporize areas of hypertrophic mucosa and submucosa along the cartilaginous eustachian tube. Patients were evaluated at 6, 12, and 24 months. Successful outcome was defined as absence of OME. Patients with evidence of reflux disease or allergic rhinitis were treated with medical therapy before surgery and throughout the follow-up period as indicated.


RESULTS
LETP combined with medical management eliminated OME in 36% (4 of 11) of patients at 6 months, 40% (4 of 10) at 1 year, and 38% (3 of 8) at 2 years. Failure of LETP correlated with presence of laryngopharyngeal reflux (P = .01) or allergic disease (P = .05) for the results at 1 year but not at 2 years.


CONCLUSIONS
LETP combined with appropriate medical management may be an effective treatment in select patients with chronic persistent eustachian tube dysfunction. A controlled trial with a larger number of subjects will be necessary to determine the efficacy of LETP and identify those factors predictive of successful outcome.
Poe
Dennis S
DS
Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA. dennis.poe@childrens.harvard.edu
Grimmer
J Fredrik
JF
Metson
Ralph
R
D000328:Adult; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D005064:Eustachian Tube / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000188:drug therapy; D006309:Hearing / Q000502:physiology; D006801:Humans; D006984:Hypertrophy; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery; D009853:Omeprazole / Q000627:therapeutic use; D010034:Otitis Media with Effusion / Q000188:drug therapy / Q000601:surgery*; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D012130:Respiratory Hypersensitivity / Q000188:drug therapy; D012220:Rhinitis / Q000188:drug therapy; D016896:Treatment Outcome; D020535:Video-Assisted Surgery
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D009853:Omeprazole