title: Re-evaluation of CO₂ laser myringotomy for managing children with persistent acute otitis media.
abstract: BACKGROUND
  This study aimed to re-evaluate the utility of CO(2) laser myringotomy in children with persistent acute otitis media (PAOM).
  
  
  METHODS
  From September 2002 to April 2008, 40 children with PAOM received CO(2) laser myringotomy. PAOM was defined as continuing symptoms and signs after systemic antibiotic treatment. Before laser myringotomy, the eardrums were checked under videotelescopy, pure tone audiometry or behavior audiometry and tympanometry. Middle ear effusions were collected using our own designed bottle culture device after laser myringotomy. The patients were followed up at outpatient clinics for 3 months. Cultured middle ear pathogens, healing time of the eardrums, hospital course (for admitted patients), and the development of middle ear effusions were recorded.
  
  
  RESULTS
  Forty children with 53 ears with PAOM were enrolled. Eight patients (20%) had bilateral disease and underwent bilateral laser myringotomy. The overall culture rate was 28.3%, and Streptococcus pneumoniae was the most common pathogen. Eight patients (20%) were admitted for intravenous antibiotics. The average eardrum healing time was 22 days in those with positive cultures, and 16.4 days in those with negative cultures (p=0.125). All eardrums healed in 1 month. The resolution rate was 62.5% at 1 month. Patients with bilateral PAOM were prone to have positive middle ear culture (5/8) compared with those with unilateral PAOM (8/32) (p=0.086).
  
  
  CONCLUSIONS
  CO(2) laser myringotomy is an applicable means of treating PAOM. S pneumoniae is the most common pathogen in PAOM. CO(2) laser myringotomy allows for the drainage and culture sampling of middle ear effusion, relieving the need of taking prolonged medication.
authors.affiliation: Department of Otolaryngology and Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Yen-Ling
authors.initials: YL
authors.lastname: Kuo
authors.forename: Mao-Che
authors.initials: MC
authors.lastname: Wang
authors.forename: Chia-Huei
authors.initials: CH
authors.lastname: Chu
authors.forename: An-Suey
authors.initials: AS
authors.lastname: Shiao
mesh_terms: D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D053685:Laser Therapy / Q000379:methods*; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D010033:Otitis Media / Q000382:microbiology / Q000601:surgery*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D014432:Tympanic Membrane / Q000601:surgery*