Comparison of tympanocentesis, CO₂ laser tympanostomy and grommet insertion in the treatment for secretory otitis media in children

Abstract

Objective:To compare adenoidectomy combined tympanocentesis, CO₂ laser tympanostomy and grommet insertion in the treatment for secretory otitis media (SOM) in children, and to provide basis for selection of surgical treatments. Method: Four hundred and twenty-six ears in 244 children with adenoid hypertrophy and SOM were divided into 3 groups which were: group A, 80 cases (142 ears) were treated with adenoidectomy combined with tympanocentesis; group B, 86 cases (145 ears) were treated with adenoidectomy combined with CO₂ laser tympanostomy; group C, 78 cases (139 ears) were treated with adenoidectomy combined with grommet insertion. Endotoscopy, tympanometry and PTA (or ABR) were conducted. Based on the characters of the middle ear effusion in operation, each ear were divided into two groups: Serous group and Mucus group. All patients conducted PTA (or ABR) 6 months after surgery and they were followed up until 1 year after surgery. The efficacy and postoperative complications and recurrence rate were compared among 3 groups, the prognosis of both serous group and mucus group were analyzed. Result:The effective rate of 3 groups at 6 months postoperative were 89.44%, 90.34% and 96.40% respectively, which showed no statistical difference among 3 groups and statistical difference between group C and group A, B was found. No statistical difference was found among 3 groups in serous group. The effective rate of group C was higher than that of group A and group B, with statistical difference. The rate of postoperative complications (permanent tympanic membrane perforation, middle ear infection postoperative, tympanic tube blockage or detachment, etc.) during 1 year postoperative in 3 groups were: 16.20%, 13.10%, 33.81%, respectively. The recurrence rates were: 11.02%, 12.98%, 3.73%, respectively, and the reoperation rate in all 3 groups were 0. Conclusion:In the treatment for SOM in children with adenoid hypertrophy, adenoidectomy combined with tympanocentesis or combined with CO₂ laser tympanostomy showed a similar effects, which was slightly lower than adenoidectomy combined with gromment insertion. Considering the complications postoperative and recurrence rates of different operations, tympanocentesis or CO₂ laser tympanostomy is recommended to be conducted as routine, and grommet insertion is recommended to be conducted when mucus-like middle ear effusion is found during surgery.